Subarachnoid hemorrhage (SAH) or bleeding in the brain as a result of ruptured aneurysm is a
devastating type of stroke. Many patients who undergo emergent neurosurgery to repair the
aneurysm and remove the bleeding suffer from complications in their subsequent hospital stay,
the most frequent and morbid of which is delayed cerebral ischemia (DCI) or small strokes
resulting from impaired blood flow to certain vital brain centers. This occurs because of
changes to the brain's blood vessels that occur after the bleed. The arteries can become
narrow (spasm) or small clots can form within the vasculature that disrupts normal blood
flow. Patients are left with profound neurologic deficits from these secondary complications.
Anesthesiologists, neurosurgeons, and intensivists are in need of a way to protect the brain
during this vulnerable period following aneurysm repair. One drug that may provide such
protection is ketamine, a compound frequently used in operating rooms and intensive care
units to provide anesthesia and analgesia. Ketamine works by blocking glutamate receptor ion
channels that play a pivotal role in promoting brain cell death during strokes by flooding
the brain with too much calcium and dangerous chemicals. This project is designed to test the
efficacy of ketamine in protecting the brain following aneurysm repair by using a controlled
infusion of the drug in the intensive care unit (ICU) when patients return from their
operation.