Ketamine and the coagulation response during and after cardiopulmonary bypass

The inflammatory response and the coagulation-fibrinolytic cascades are closely interconnected. Vascular injury following cardiopulmonary bypass (CPB) may result in uncontrolled platelet activation, thrombin generation, and disseminated intravascular coagulation. Many of the anesthetic agents posses immunomodulatory effects. The clinical implications of such effects in the context of CPB remain unknown. Ketamine attenuates IL-6 response and production of the superoxide anion by neutrophils after CPB, and reduces coronary uptake of neutrophils following myocardial ishemia and reperfusion. We studied the effect of small-dose ketamine on the coagulation response (antithrombin III, fibrinogen, D-dimers, platelets) during and after CPB.