Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass.
OBJECTIVE
To determine if ketamine attenuates postoperative delirium concomitant with an anti-inflammatory effect in patients undergoing cardiac surgery using cardiopulmonary bypass.


METHODS
A prospective randomized study.


METHODS
A Veterans Affairs medical center.


METHODS
Cardiac surgical patients.


METHODS
Patients at least 55 years of age randomly received placebo (0.9% saline, n = 29) or an intravenous bolus of ketamine (0.5 mg/kg intravenously, n = 29) during anesthetic induction in the presence of fentanyl and etomidate.


RESULTS
Delirium was assessed by using the Intensive Care Delirium Screening Checklist before and after surgery. Serum C-reactive protein concentrations were determined before and 1 day after surgery. The incidence of postoperative delirium was lower (p = 0.01, Fisher exact test) in patients receiving ketamine (3%) compared with placebo (31%). Postoperative C-reactive protein concentration was also lower (p < 0.05) in the ketamine-treated patients compared with the placebo-treated patients. The odds of developing postoperative delirium were greater for patients receiving placebo compared with ketamine treatment (odds ratio = 12.6; 95% confidence interval, 1.5-107.5; logistic regression).


CONCLUSIONS
After cardiac surgery using cardiopulmonary bypass, ketamine attenuates postoperative delirium concomitant with an anti-inflammatory effect.
Hudetz
Judith A
JA
Department of Anesthesiology, Medical College of Wisconsin and Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI, USA. judith.hudetz@va.gov
Patterson
Kathleen M
KM
Iqbal
Zafar
Z
Gandhi
Sweeta D
SD
Byrne
Alison J
AJ
Hudetz
Anthony G
AG
Warltier
David C
DC
Pagel
Paul S
PS
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003693:Delirium / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D018836:Inflammation Mediators / Q000627:therapeutic use; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013997:Time Factors
D018836:Inflammation Mediators; D007649:Ketamine