Assessment of recovery, dreaming, hemodynamics, and satisfaction in postcardiac surgery patients receiving supplementary propofol sedation with S(+)-ketamine.
BACKGROUND
S(+)-ketamine is an analgesic and sedative drug with dissociative attributes. When it is used without sedatives, nightmares have been described. The aim of this study was to assess the effects of postoperative analgosedation with propofol and S(+)-ketamine when compared to standard propofol analgosedation in terms of recovery, dreaming, hemodynamics, and patient satisfaction.


METHODS
Forty-eight patients were sedated with propofol (1-3 mg/kg/h) after coronary artery bypass grafting and allocated randomly on admission to the intensive care unit to receive either S(+)ketamine (2 mg mg/kg/h; group A) or 0.9% saline as a placebo (group B) in a double-blind fashion. If necessary, boli of 3.75 mg piritramide (an opioid) were given in both groups.


RESULTS
Patients receiving S(+)-ketamine had significantly higher satisfaction for pain management (Visual Analog Scale [VAS] = group A: median 10 [range 9-10]; group B: median 9 [range 6-10]) despite their lower piritramide consumption. Patients receiving S(+)ketamine showed significantly faster eye opening (82+/-51 vs 156+/-110 min) but dreamed significantly more often (at 2 h, 67% in group A vs 29% in group B; at 24 h, 43% in group A vs 10% in group B), whereas no significant differences were detected in the incidence of nightmares at 2 h, 14% in group A vs 10% in group B; at 24 h, 5% in group A vs 5% in group B.


CONCLUSIONS
Patients receiving S(+)-ketamine showed higher satisfaction for pain management and dreamed more often, but they did not have more nightmares.
Piper
S N
SN
Department of Anesthesiology and Intensive Care Medicine, Hospital of Frankenthal, Frankenthal, Germany. swen.n.piper@t-online.de
Beschmann
R
R
Mengistu
A
A
Kalenka
A
A
Maleck
W H
WH
Boldt
J
J
Röhm
K D
KD
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000762:Anesthesia Recovery Period; D000778:Anesthetics, Dissociative; D006348:Cardiac Surgical Procedures; D001026:Coronary Artery Bypass; D004325:Dreams / Q000187:drug effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects; D017060:Patient Satisfaction; D010892:Pirinitramide / Q000627:therapeutic use; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D015742:Propofol
D000701:Analgesics, Opioid; D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D010892:Pirinitramide; D007649:Ketamine; D015742:Propofol