Ketamine vs. Propofol in Cardiac Surgery A Clinical Look at Neurocognitive Outcomes

Introduction:

Neurocognitive complications remain a persistent challenge following cardiac surgery, despite advances in cardiopulmonary bypass (CPB) and anesthetic techniques. This study evaluates whether ketaminea known NMDA receptor antagonist offers neuroprotective benefits when compared to propofol in patients undergoing coronary artery bypass grafting.

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Neuroprotective Potential of Ketamine What Was Investigated

Researchers conducted a randomized, double-blind trial involving 50 patients aged between 58 and 76 years undergoing elective coronary artery bypass surgery. The study aimed to assess preoperative and postoperative cognitive performance using the Mini-Mental State Examination (MMSE):

• Group 1: Received ketamine in combination with propofol
• Group 2: Received propofol alone

All patients were monitored for hemodynamic stability and MMSE scores before and three days after surgery.

Read the full study at https://doi.org/10.29328/journal.ijcar.1001007

Key Findings in Simple Terms

• No significant difference was observed between the two groups in MMSE score changes.
• Hemodynamic stability was comparable, with minor differences in perioperative blood pressure and pulse rates.
• Both anesthetics maintained sinus rhythm and intraoperative safety.
• Propofol’s known anti-inflammatory and microemboli-reducing effects may have overshadowed ketamine’s potential benefits.

A detailed analysis can be found in our main journal article.

Clinical Significance and External Insights

While ketamine is pharmacologically suited for neuroprotection through NMDA receptor antagonism, its role in cardiac surgery remains uncertain.

The American Society of Anesthesiologists (ASA) highlights that neurocognitive disorders post-surgery can arise from multiple etiologies, including embolic events and inflammation. This reinforces the need to evaluate anesthetic agents not only by efficacy but also by their systemic interactions and context of use.

Additionally, the Heart and Stroke Foundation emphasizes continuous innovation in cerebral protection strategies during major surgeries to enhance patient outcomes.

Implications for Anesthesia Practice

This study adds to the body of evidence suggesting that propofol remains a reliable agent during cardiac surgery, potentially offering neuroprotective benefits due to:

• Microemboli reduction
• Direct anti-inflammatory action
• Stable anesthetic profiles under CPB conditions

While ketamine’s theoretical advantages are recognized, further controlled trials are necessary to isolate its effects independently of propofol.

To explore related research in anesthetic practices and neuroprotection, check out the Cardiac Anesthesia category.

You can also browse the General Anesthesia section for additional resources and articles.

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