Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0917798 (cerebral ischemia)
 17,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This experiment evaluated the potential for ketamine HCl, a non-competitive glutamate antagonist, to minimize injury resulting from temporary focal cerebral ischemia. Male spontaneously hypertensive rats were randomly assigned to receive either ketamine (n = 13) or halothane anesthesia (n = 12) during 2 h of reversible middle cerebral artery occlusion (MCAO). Ketamine was administered as a 50 mg/kg i.v. loading dose followed by a continuous 1.25 mg/kg/min i.v. infusion beginning 25 min prior to ischemia and continued until 30 min after reperfusion. An additional group of rats (ketamine-shams, n = 8) underwent craniectomy and ketamine administration (as above) but the middle cerebral artery was not ligated. Physiologic values were similar between groups with the exception of plasma glucose which was elevated in the halothane-MCAO group. After 4 days recovery, rats in all groups were neurologically evaluated. There were no differences between the two groups undergoing MCAO for neurologic grading or open field behavior, although both groups performed worse than did ketamine-shams (P less than 0.05). In contrast, motor performance revealed more severe deficits in the ketamine-MCAO rats vs either the halothane-MCAO or ketamine-sham groups (P less than 0.05). Cerebral infarct volume was then planimetrically measured after triphenyl tetrazolium chloride (TTC) staining of fresh brain sections. Mean +/- S.D. infarct volume was not different between the halothane-MCAO (134 +/- 51 mm3) and ketamine-MCAO (131 +/- 64 mm3) groups. Seven of 8 sham rats were free of TTC demarcated injury and in the remaining rat injury was minimal.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Effects of ketamine on outcome from temporary middle cerebral artery occlusion in the spontaneously hypertensive rat. 177 49

Metabolic changes in the ischemic brains of cats were investigated in vivo with high energy phosphate compounds as parameters by using a topical magnetic resonance (TMR) spectrometer. The experimental focal cerebral ischemia was made in four cats by modifying the method of O'Brien and Waltz. The stem of left middle cerebral artery was exposed and set the occlusive device 5-7 days before the in vivo measurement. 31P-NMR spectrum was taken under general anesthesia with Ketamine HCI and with decreased blood flow. The following points must be considered in obtaining 31P-TMR spectrum in a cat brain: Firstly, as much muscle as possible must be removed from the detective area because it contains phosphate compounds. Our experiment showed that bone and blood had little or no effect on the 31P-TMR spectrum. Secondly, although same procedure was repeated, it was difficult to obtain constant ischemic lesion; in site and size. The detective area in setting was not changed in the particular area. However there was a possibility of the detective area also including various non-ischemic regions. Thirdly, 31P-TMR spectrum had several peaks in a cat brain; which were sugar phosphate, inorganic phosphate, phosphodiesters, phosphocreatine, gamma-, alpha-, beta-ATP in the pre-occlusive conditions. These peaks did not appear in clear volume separation with one another. We drew the perpendicular line from through between two neighbour peaks to the horizontal base line and artificially divided two peaks. The area of each peak did not represent correctly the density of each component. Fourthly, unnecessary components were rationalistically excluded from the 'raw' spectrum.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Research on experimental cerebral infarction in cats with in vivo TMR (topical magnetic resonance) approach]. 646 7

The administration of an intravenous anaesthetic agent before experimental cerebral ischaemia in animals improves the functional and histological outcome. Cerebral ischaemia may be global or focal, complete or incomplete. Intravenous anaesthetic agents reduce the cerebral metabolic demand for oxygen (CMRO2) and abolish electrophysiological activity. This reflects a discontinuation of the functional neuronal activity with maintenance of its basic metabolic activity. The oxygen spared by the decrease in consumption, while reducing the functional activity, might be used by the neurons to sustain longer periods of ischaemia. This protective effect is also observed after pretreatment with either lidocaine or volatile agents, but their potentially deleterious vasodilating effect must be considered. Ketamine has recently been shown to antagonize NMDA receptors. The protective effect of barbiturates was experimentally demonstrated more than 30 years ago. They are still used as a reference. They reduce CMRO2, optimise the ratio between oxygen consumption and oxygen delivery and thus reduce cerebral blood flow and cerebral blood volume, as a result of the decrease of the metabolic demand. This might explain why a protective effect is seen in case of global or focal hypoxia with increased intracranial pressure, while no protection is documented in case of global cerebral ischaemia, such as after cardiac arrest, where EEG is immediately flat and ICP low. However, at doses required to obtain a protective effect, barbiturates induce deleterious side effects such as severe arterial hypotension, which limits their use. Cerebrovascular and cardiac surgery or surgery of the carotids are characterised by potentially ischaemic episodes which can be predicted.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Cerebral protection: contribution of intravenous anesthetic agents]. 767 77

Ketamine is said to increase intracranial pressure (ICP), cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) and hence to be unsuitable for neuroanaesthesia. This may require reconsideration in the light of the neuroprotective properties mediated by the interaction of ketamine with the N-methyl-D-aspartate receptor (NMDA). Meta-analysis of published experimental rodent studies yields contradictory conclusions. Ketamine does not provide neuroprotection against hypoxic hypoxaemia or focal cerebral ischaemia. During complete forebrain ischaemia of 10 min duration, ketamine offers some degree of protection only if administered before (i.e. prophylactically) and after (i.e. therapeutically) a transient ischaemic episode. In experimental head injury, ketamine may be protective if administered therapeutically within 2 h after the trauma. In the case of incomplete forebrain ischaemia, ketamine provides neuroprotection if administered both before and during ischaemia. Clinical or primate studies are not available; extrapolation of results derived from rodent studies requires caution and has limitations. With respect to the pharmacodynamic action providing neuroprotection, NMDA-receptor antagonism may be just one of several mechanisms; others include scavenging of free radicals, a central sympatholytic effect and augmentation of dopamine metabolism in the caudate. The suitability of ketamine for neuroanaesthesia, which must also take account of its effects on ICP, CBF and CMRO2, is--for the time being--questionable.
 ...
PMID:[Cerebral neuroprotection and ketamine]. 784 Apr 13

Male Sprague Dawley rats were anesthetised with Xylazine and Ketamine intraperitoneally. After a lateral craniotomy the cerebral inferior vein was ligated and a very small clip (Biemer clip) was placed on the MCA near its origin for 1 hour. This procedure induced a focal infarction in 100% of the rats. After removal of the clip the lumen of the MCA was patent. The study was divided in 3 randomized groups (control group n = 15; Nimodipine group n = 11, treatment 30 micrograms/hour/kg body-weight; Mannitol group n = 15, treatment 5.4 ml/hour/kg body-weight). Besides heart-rate, ECG and blood pressure we measured the extracellular potassium and calcium concentration with ion-selective microelectrodes; the ICBF was estimated by laser-doppler-flowmeter. The MCA was clipped for 1 hour. After 1 hour of reperfusion the brain was fixated and the volume of infarction was measured by serial slices. Nimodipine or Mannitol treatment started 5 min before clipping the MCA. In rats with Nimodipine treatment the extracellular calcium starts at a significantly higher level (2.3 +/- 0.5 mmol/l) and the decrease during ischemia remains above a level of 1.2 +/- 0.2 mmol/l. The increase in potassium during ischemia and Nimodipine (calculated in change of concentration/time [dc/dt]) is significantly slower than in the control group. In contrast to the post-ischemic hyper- and hypoperfusion in the control group the reperfusion in the Mannitol group is nearly normal. In the control group the infarction volume is 20% of the brain, in the Nimodipine group 15% and in the Mannitol group only 11%. The calcium antagonist Nimodipine and the free-radical scavenger Mannitol therefore promise to be a way to treat or prevent temporary focal cerebral ischemia.
 ...
PMID:The effect of mannitol and nimodipine treatment in a rat model of temporary focal ischemia. 838 44

There are still divergent opinions regarding the pharmacodynamic effects of ketamine on the brain. In this study, the cerebral blood flow (CBF), cerebral metabolic rate for oxygen (CMRO2) and electroencephalographic (EEG) activity were sequentially assessed over 80 min in 17 normoventilated pigs following rapid i.v. infusions of anaesthetic (10.0 mg.kg-1; n = 7) or subanaesthetic (2.0 mg.kg-1; n = 7) doses of ketamine or of its major metabolite norketamine (10.0 mg.kg-1; n = 3). The animals were continuously anaesthetized with fentanyl, nitrous oxide and pancuronium. CBF was determined by the intra-arterial 133Xe technique. Ketamine (10.0 mg.kg-1) induced an instant, gradually reverting decrease in CBF, amounting to -26% (P < 0.01) at 1 min and -13% (P < 0.05) at 10 min, a delayed increase in CMRO2 by 42% (P < 0.01) at 10 min and a sustained rise in low- and intermediate-frequency EEG voltage by 87% at 1 and 97% at 10 min (P < 0.0001). It is concluded that metabolically formed norketamine does not contribute to these effects. Considering the dissociation of CBF from CMRO2 found 10-20 min after ketamine (10.0 mg.kg-1) administration, it is suggested that ketamine should be used with caution for anaesthesia in patients with suspected cerebral ischaemia in order not to increase the vulnerability of brain tissue to hypoxic injury. Ketamine (2.0 mg.kg-1) had no significant effects on CBF, CMRO2 or EEG. It therefore seems that up to one fifth of the minimal anaesthetic i.v. dose can be used safely for analgesia, provided that normocapnaemia is preserved.
 ...
PMID:Cerebral pharmacodynamics of anaesthetic and subanaesthetic doses of ketamine in the normoventilated pig. 844 13

The goal of therapy in patients with severe head injury is to avoid secondary brain damage. Analgesia and sedation are an essential part of the therapy, and several drugs are in current use. However, few controlled clinical trials have been performed so far, and none of these drugs has proved to be superior. Although in the past the therapy has been focused on controlling elevated intracranial pressure (ICP), many authors emphasize the role of cerebral ischaemia in the prognosis of patients. Therefore, cerebral perfusion pressure (CPP) i.e. the difference between ICP and mean arterial pressure (CPP = MAP-ICP), seems to be more important than ICP alone. Analgesics and sedatives reduce the cerebral metabolic rate (CMR), and the consequent decrease in cerebral oxygen uptake might prevent ischaemic damage in regions with low perfusion. Moreover, a decrease in CMR is often associated with a decrease of cerebral blood flow (CBF) in regions with normal perfusion and, as a result, ICP is also reduced. Basically, the cerebral effects (on ICP, CMR, and CBF) and the haemodynamic effects with respect to maintenance of a sufficient CPP are most important in the selection of drugs for analgosedation. In addition, the effects on general intensive care management must be considered (pulmonary function, immunreactivity bowel motility). The purpose of this paper is to describe drugs commonly used for analgosedation in severe head injury. Barbiturates bring about the most pronounced decrease of CMR and ICP. In the past these drugs were used routinely in high doses ("barbiturate coma"). However, no improvement in outcome was demonstrable, and vitally dangerous side effects, such as infection, pulmonary dysfunction, arterial hypotension, and renal failure often occurred. High-dose barbiturate therapy is therefore only indicated in exceptional cases, such as refractory increase in ICP with preserved CO2 response of cerebral vessels. The effect is dependent on CMR at the start of this therapy. Benzodiazepines are frequently used in patients with head injury. They cause only a moderate decrease of CMR and ICP. In general, side effects are negligible. However, a possible decrease of MAP by reduced central sympathetic drive has to be taken into account. Opioids are also frequently used in patients with head trauma. The observed cerebral effects are inconsistent. Some authors have described increases in ICP, CBF, and CMR, but in most studies no influence on these values, or a decrease, has been observed. In any case, cautious titration of these drugs and cerebral monitoring are therefore desirable. As with benzodiazepines, a decrease in MAP due to central effects is possible. In addition, opioids inhibit bowel motility. Ketamine is generally used because of its favourable circulatory effects, bronchodilatation and absence of inhibition of bowel motility. In patients with increased ICP, however, it is often considered contraindicated, since it can be associated with cerebral vasodilation and ICP increase. Other studies did not confirm an increase of ICP when controlled ventilation and additional sedation were applied. More recent studies have demonstrated the role of neuroexcitatory NMDA-receptors in ischaemic and traumatic brain damage. Since ketamine exerts an antagonistic effect on N-methyl-D-aspartate receptors (NMDA) and studies in animals have demonstrated a protective effect of ketamine against ischaemic and traumatic brain damage, controlled clinical studies in patients with head injury are desirable. Propofol results in a profound decrease of CMR and a significant decrease of ICP, but often also in haemodynamic depression. Few results obtained during long-term administration are available, but it seems to be beneficial. More clinical studies are warranted. Gamma-hydroxybutyrate (GHB) is a physiological substance, which has only sporadically been investigated for sedation in patients with head trauma. The few available studies show beneficial res
 ...
PMID:[Analgesia and sedation in patients with head-brain trauma]. 859 67

Thus far, a sufficiently effective cerebroprotective substances has not been discovered. Glutamate overproduction plays a key role in ischemic brain lesion. Ketamine is assigned to the group of commonly used clinical anesthetics, being also familiar as NMDA antagonist. Sodium fluoride-induced cerebral ischemia in mice is used as a model of circulatory ischemic lesion. As shown by the experimental data, simultaneous administration of NaF + ketamine has no effect whatsoever on the survivorship of animals, as compared to that in the control group treated with NaF alone. Beforehand treatment of mice with 150 mg/kg ketamine brings about considerable prolongation of the survival term (15 per cent of the animals survive for more than 2 hours). The inference is reached that ketamine is endowed with cerebroprotective activity largely attributable to glutamate antagonism at the level of ischemia involved neurons.
 ...
PMID:[The use of ketamine in an experimental model of generalized cerebral ischemia]. 997 25

The effect of the AMPA antagonist NBQX (10 microM), NMDA antagonist ketamine (100 microM) and 5-HT1A agonist 8-OH-DPAT (1, 10 and 100 microM) on the properties of a KCl-induced spreading depression (SD) was studied in parietal cortical slices of adult rats. Whereas NBQX did not significantly affect the SD, ketamine significantly (p < 0.01) reduced the amplitude of the first SD peak (12.8 +/- 4.6 mV) and blocked the second SD peak when compared with the controls (19.8 +/- 5.2 mV and 25 +/- 5 mV, respectively). Ketamine also decreased the SD duration at half maximal amplitude from 34.9 +/- 12.4 s to 22.2 +/- 12 s (p < 0.05). 8-OH-DPAT attenuated the duration of the SD from 42 +/- 15.6 s to 21.2 +/- 10.6 s (p < 0.05, 100 microM). These data indicate that not only NMDA receptor blockade, but also activation of the 5-HT1A receptor attenuates the SD and may be beneficial in the reduction of ischemic injury following focal cerebral ischemia.
 ...
PMID:Effects of ionotropic glutamate receptor blockade and 5-HT1A receptor activation on spreading depression in rat neocortical slices. 1057 86

Ketamine (2-o-chlorophenenyl-2-methylaminocyclohexanone hydrochloride) is a dissociative general anaesthetic with neuroprotective properties. Since ketamine is optically active, we compared the neuroprotective efficacy of the (+)- or (-)-enantiomers in global cerebral ischaemia. Rat corticostriatal slices superfused with, or incubated in, artificial CSF at 34 degrees C were subjected to a brief ischaemic insult. Dopamine efflux was measured using fast cyclic voltammetry. Tissue metabolism was determined with 2,3,5-triphenyltetrazolium chloride staining, a marker of mitochondrial enzyme activity. In control slices, ischaemia caused rapid striatal dopamine release (to 122 microM over 18 s) after an initial delay of 149s. Racemic ketamine (100 micromol/l) significantly delayed (by 24%, P<0.05), slowed (by 63%, P<0.01) and reduced (by 27%, P<0.05) ischaemia-induced dopamine release. Ischaemia (10 min) also caused significant decreases in striatal (25%, P<0.01) and cortical (31%, P<0.001) metabolic activity, manifested as a drop in mean TTC staining intensity. Racemic ketamine and its (+)- and (-)-enantiomers (each 100 microM) attenuated the loss of metabolic activity in the striatum. However, in the cortex, only (+)-ketamine (100 microM) was significantly neuroprotective. We conclude that neuroprotection by ketamine in cerebral ischaemia is both region- and isomer-dependent.
 ...
PMID:Comparison of ketamine stereoisomers on tissue metabolic activity in an in vitro model of global cerebral ischaemia. 1122 16


1 2 Next >>