Neuroprotection During Open Heart Surgery

Brief Summary

Millions of individuals with coronary artery, or valvular heart disease have been given a new chance at life by heart surgery, but the potential for neurological injury is a great risk .Neural complications - including neurocognitive dysfunction and ischemic complications are complications of cardiac surgery that can restrict the improved quality of life.

Propofol is one of the most popular agents used for induction of anesthesia. propofol reduces cerebral blood flow but maintains coupling with cerebral metabolic rate for oxygen and decreases intracranial pressure, allowing optimal intraoperative conditions.

Ketamine is a non-competitive antagonist of NMDA receptors that has well documented neuroprotective effects against ischemic brain injury and glutamate-induced brain injury. ketamine has neuroprotective effects against oxygen-glucose deprivation injury

Intervention / Treatment

  • Drug: Ketofol (propofol to ketamine ratio 1:1)
  • Drug: propofol

Condition or Disease

  • Open Heart Surgery

Phase

Study Design

Study type: Interventional
Status: Completed
Study results: No Results Available
Age: 30 Years to 70 Years   (Adult, Older Adult)
Enrollment: 50 ()
Funded by: Other

Masking

Clinical Trial Dates

Start date: Jul 01, 2016
Primary Completion: Jun 30, 2017
Completion Date: Jun 30, 2017
Study First Posted: Jul 24, 2020
Results First Posted: Aug 31, 2020
Last Updated: Jul 24, 2020

Sponsors / Collaborators

Lead Sponsor: N/A
Responsible Party: N/A

The aim of the study is to evaluate neuroprotective effect of mixture of propofol and ketamine (ketofol) as compared to propofol after open heart surgery.

Induction;

  • Pre-oxygenation with100% O2 for 3 min.
  • Morphine 0.1-0.15 mg/kg
  • Fentanyl, dose 3-5 mcg/kg.
  • hypnotic agent differs for each group:
  • Propofol group: Propofol, dose 0.5-2 mg/kg.
  • Ketofol group: Ketofol,( dose 0.25-1 mg/kg propofol plus 0.25-1 mg/kg ketamine diluted in normal saline with maintained 1:1 ratio between propofol and ketamine. )

Catheterization:

  1. Central venous catheter: A suitable central venous catheter will be inserted into Right subclavian vein under complete aseptic technique using seldinger technique.
  2. Jugular bulb catheterization: Patients is placed in supine position with mild neck extension. The head is placed in neutral position with mild tilt to the opposite side of insertion. Under complete aseptic conditions, the anatomical landmarks for the right internal jugular vein will be identified (at the level of cricoid cartilage, medial to the sternomastoid muscle and lateral to a palpable internal carotid artery). The internal jugular vein will be then cannulated by retrograde insertion of a catheter for sampling of the jugular venous bulb blood. Catheter will be advanced till resistance of the skull base is reached then withdrawn about 1 to 2 mm.

Position of the catheter will be confirmed by antero-posterior and lateral neck C-arm x-ray to verify the correct placement of the catheter tip in the will be sutured to the skin and dressed with sterile gauze

Eligibility Criteria

Sex: All
Minimum Age: 30
Maximum Age: 70

More Details

NCT Number: NCT04486690
Other IDs: (MS/16.05.63)
Study URL: https://ClinicalTrials.gov/show/NCT04486690
Last updated: Jan 27, 2021