[Vascular effects of ketamine during anesthesia with diazepam and fentanyl]

Twenty-six adults undergoing elective cardiac surgery were anaesthetized with diazepam and fentanyl (induction with 200 micrograms.kg-1 and 30 micrograms.kg-1 respectively, maintenance with incremental doses). Normothermic constant perfusion output cardiopulmonary bypass was carried out with a membrane oxygenator, haemodilution with Ringer's lactate solution, and cardioplegia with St. Thomas's Hospital solution. The patients were randomly assigned to two groups. They were given either 2 mg.kg-1 of ketamine (group 1) or placebo (5 ml of normal saline) (group 2) via the venous line of the oxygenator. The non pulsatile flow was then kept at a steady rate of 2.41 x min-1.m-2, and no other infusion or treatment was started during the study period (ten minutes). The mean arterial pressure and blood reservoir level were measured every min during this period. The systemic vascular resistances did not change significantly in either group, but remained 27% lower in the ketamine group than in the placebo group (p less than 0.01). The blood reservoir level was 37% higher in the ketamine group (p less than 0.01), suggesting a decreased venous capacitance. It is therefore concluded that ketamine leads to venous constriction, and probably arterial dilation, during fentanyl-diazepam anaesthesia and normothermic cardiopulmonary bypass. The venous effects of ketamine could explain why it is usually well tolerated in hypovolaemic states.