Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

Abstract

Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review.

Keywords

• Cardiac surgery; Coronary artery bypass grafting; European system for cardiac operative risk evaluation; Risk factor
• After drop; Extravascular lung water; Fluid balance
• Anesthesia; pregnancy; pulmonary hypertension
• Cardiac surgery; heart disease; mortality; postoperative complications; risk stratification in cardiac surgery
• Cardiac anesthesia; Etomidate; Propofol
• CPB
• Cardiac computerized tomographic angiography; Congenital heart disease; General anesthesia
• Image quality; Induced apnea
• Extracorporeal membrane oxygenation; simulation; training
• Mitral valve prolapse; NeoChord delivery system; three-dimensional transesophageal echocardiography
• Congenital heart defect; Transesophageal echocardiogram; Tei index
• Cardiac surgery; dissociative anesthesia; intensive care; ketamine