Ketamine Attenuates Delirium After Cardiac Surgery With Cardiopulmonary Bypass

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• 作者：Judith A. Hudetz ; Kathleen M. Patterson ; Zafar Iqbal ; Sweeta D. G ; hi ; Alison J. Byrne ; Anthony G. Hudetz ; David C. Warltier ; Paul S. Pagel
• 关键词：ketamine ; delirium ; cognitive dysfunction ; cardiac surgery ; cardiopulmonary bypass
• 刊名：Journal of Cardiothoracic and Vascular Anesthesia
• 出版年：2009
• 出版时间：October 2009
• 年：2009
• 卷：23
• 期：5
• 页码：651-657
• 全文大小：1896 K

文摘

Objective

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

Design

A prospective randomized study.

Setting

A Veterans Affairs medical center.

Participants

Cardiac surgical patients.

Interventions

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.

Measurements and Main 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.