PMID: 9163280Mar 1, 1997Paper

Ketamine racemate and S-(+)-ketamine. Cerebrovascular effects and neuroprotection following focal ischemia

Der Anaesthesist
C WernerE Kochs

Abstract

The phencyclidine derivative ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist with the thalamo-neocortical projection system as the primary site of action. Racemic ketamine consists of the enantiomers S(+)-ketamine and R(-)-ketamine. Racemic ketamine has never been considered an adequate anaesthetic agent in neurosurgical patients since it produces regionally specific stimulation of cerebral metabolism (CMRO2) and increases cerebral blood flow (CBF) and intracranial pressure (ICP). However, recent experiments suggest that both tracemic ketamine and S(+)-ketamine may reduce infarct size in animal models of incomplete cerebral ischaemia and brain injury. This experimental protective effect appears to be related to decreases in Ca++ influx and maintenance of brain tissue magnesium levels due to NMDA and quisqualate receptor blockade by ketamine. Studies in dogs have shown that racemic ketamine (2.0 mg/kg) increases CBF in the presence of the cerebral vasodilator N2O. In contrast, studies in rats without background anaesthesia showed increases in CBF after racemic ketamine (100 mg/kg i.p.). This suggests that the cerebrovascular effects of racemic ketamine are related to the pre-existing cerebrovascular...Continue Reading

Citations

Jan 1, 2016·Journal of Cerebral Blood Flow and Metabolism : Official Journal of the International Society of Cerebral Blood Flow and Metabolism·Afnan AtallahValérie Grange-Messent
Jan 27, 2004·Medicinski pregled·Dragana Radovanović, Miroslava Pjević
Nov 4, 2005·Journal of Neurosurgery·Charles L RosenTodd Crocco
Oct 3, 2006·Current Opinion in Anaesthesiology·D K Menon, A C Summors
Oct 5, 2006·Current Opinion in Anaesthesiology·P Hans, V Bonhomme
Oct 15, 2005·Stroke; a Journal of Cerebral Circulation·Tatsushi KamiyaWilliam A Pulsinelli
Aug 2, 2008·Expert Review of Neurotherapeutics·Simon NagelAlastair M Buchan
Nov 7, 1998·Anesthesia and Analgesia·R Kohrs, M E Durieux
Feb 24, 2007·Wiener klinische Wochenschrift·Lucia LenartovaUNKNOWN Austrian Severe TBI Study Investigators

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