Subanesthetic doses of ketamine infusion for neuroprotection in the postoperative period of pediatric cardiac surgery: a prospective randomized study

BACKGROUND: Children with congenital heart disease are at high risk of cerebral injury in the postoperative period owning to age-related anatomical and physiological characteristics and a wide range of cardiac surgery–related factors detrimental to the brain. With its neuroprotective properties, ketamine may reduce these risks. However, its optimal dosing and effectiveness in pediatric patients require further investigation.

AIM: This study aimed to evaluate the effect of subanesthetic doses of ketamine on the brain in pediatric patients during the postoperative period after cardiac surgery with cardiopulmonary bypass.

METHODS: A prospective randomized study included 91 patients (aged 1–60 months). Patients were divided into a control group and three intervention groups receiving ketamine at 0.1, 0.2, or 0.3 mg/(kg · h), respectively, for 16 hours after surgery. Serum biomarkers of brain injury (S-100β, NSE, GFAP, occludin, and claudin-1), postoperative delirium (assessed using the CAPD scale), and adverse effects were evaluated.

RESULTS: No differences in intraoperative or postoperative parameters were observed between groups. At 16 hours after surgery, S-100β and NSE levels were significantly lower in intervention groups 2 and 3. CAPD scores were also statistically lower in all ketamine infusion groups.

CONCLUSION: In pediatric patients undergoing cardiac surgery, ketamine infusion at doses of 0.2–0.3 mg/(kg · h) resulted in lower levels of brain injury biomarkers S-100β and NSE, as well as reduced severity of postoperative delirium. The optimal ketamine dose requires further clarification in future studies.