Open Heart Surgery Clinical Trial
Official title:
Neuroprotection During Open Heart Surgery Propofol Versus Ketofol
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
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the skull base is reached then withdrawn about 1 to 2 mm.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
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