Aim: Ketamine and midazolam are two anaesthetics frequently used in anesthesia for day surgeries and induction of general anesthesia. In recent years, several reports have emerged reporting their toxicity following anesthesia use. On the other hand, both are being investigated as possible cytoprotective agents after brain injury. Simultaneously, the role of astrocytes has been shown to be crucial in preserving brain homeostasis and function. The viability of astrocytes directly affects the function of the entire central nervous system. The objective of this study is to examine and compare, in vitro, the effect of both anaesthetics on the viability of astrocytes placed in simulated physiological or pathological conditions.
Methods: Primary cell cultures of rat cortical astrocytes were used as the basis for the experimental model. The cells were divided into two groups: one group was damaged with simulated brain ischemia before treatment, and the other group was not. Both cell groups were then exposed for 24 hours to increasing concentrations of ketamine and midazolam, including clinically observed plasma concentrations during anesthesia. To assess the viability of previously undamaged astrocytes, flow cytometric analysis was used to measure apoptosis and necroptosis as two types of regulated cell death. The viability of the ischemically damaged cell group was determined by measuring mitochondrial membrane potential with flow cytometry and cell metabolic activity with AlamarBlue® test, using a microplate reader.
Results: Therapeutic concentrations of ketamine and midazolam did not affect the viability or induce cell death in previously undamaged astrocytes. A decrease in cell viability was observed only at concentrations 100-times higher due to apoptosis in ketamine and 400-times higher due to necrosis in midazolam. Ketamine stabilized the mitochondrial membrane potential of ischemically damaged astrocytes and increased their metabolic activity at therapeutic concentrations (0,05 mM). However, such a protective effect on ischemically damaged astrocytes was not observed with midazolam at therapeutic concentrations.
Conclusions: Ketamine and midazolam do not show toxicity and do not decrease astrocyte viability in simulated physiological conditions in vitro. In pathological conditions, such as brain ischemia, therapeutic concentrations of ketamine, but not midazolam, increase astrocyte viability in vitro and indicate a protective effect towards ischemically damaged astrocytes.
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