Erica D. Wittwer, M.D., Ph.D.

The purpose of this study is to evaluate stellate ganglion blockade with local anesthetic intraoperatively to reduce the development of postoperative atrial fibrillation.

Atrial fibrillation is an important postoperative complication following cardiac surgery despite many attempts to reduce the incidence. Temporary stellate ganglion blockade reduces ventricular arrythmias in various circumstances with animal and early human data also showing an effect on the development of atrial fibrillation. The duration of arrythmia control outlasts the expected duration of local anesthetic effect by a significant duration.  Stellate ganglion blockade has potential for great impact reducing the burden of POAF including large cost savings, reduction in hospital length of stay, and improvement in quality of life via reduction of large degree of morbidity. If effective, this could revolutionize cardiac surgery care.

The purpose of this study is to investigate cardiac surgical procedures requiring cardiopulmonary bypass (CPB). Ketamine has been demonstrated to have an anti-inflammatory effect as shown by reductions in Interleukin 6 (IL-6) levels.  Postoperative dysfunctions in which inflammation has been implicated may be reduced by this anti-inflammatory effect.  Use of inotropic and vasopressor support, hemodynamic variables, incidence of renal dysfunction, and effect on biomarkers of renal function in the early postoperative period. Specifically, we will test the hypothesis that ketamine provides anti-inflammatory effects in this population of patients undergoing surgery requiring CPB and that the incidence of renal dysfunction will be decreased.

The purpose of the study is to determine the feasibility of administration of high dose intravenous ascorbic acid in the operative and post-operative environments as well as sample size for a prospective, randomized, placebo controlled study.

Ketamine is a commonly used anesthetic medication which is used for induction of anesthesia as well as as an analgesic. It has been shown to have anti-inflammatory properties which may decrease post-operative complications following cardiac surgery with cardiopulmonary bypass that are thought to associated with inflammation. Some studies have shown that ketamine does decrease these complications when compared with anesthetics that are not commonly used in our cardiac anesthesiology practice. Propofol is another commonly used anesthetic medication which is used for induction of anesthesia. Ketamine has not been compared with propofol for potential to reduce post-operative complications associated with the inflammatory process. This study aims to see if ketamine will reduce the incidence of cognitive dysfunction, delirium, and renal dysfunction in comparison with propofol. In addition, the hemodynamic impact of ketamine compared with propofol will be investigated.