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Preoperative ketamine administration for prevention of postoperative neurocognitive disorders after major orthopedic surgery in elderly patients: A multicenter randomized blinded placebo-controlled trial.
- Source :
-
Anaesthesia, critical care & pain medicine [Anaesth Crit Care Pain Med] 2024 Aug; Vol. 43 (4), pp. 101387. Date of Electronic Publication: 2024 May 06. - Publication Year :
- 2024
-
Abstract
- Background: Preventive anesthetic impact on the high rates of postoperative neurocognitive disorders in elderly patients is debated. The Prevention of postOperative Cognitive dysfunction by Ketamine (POCK) study aimed to assess the effect of ketamine on this condition.<br />Methods: This is a multicenter, randomized, double-blind, interventional study. Patients ≥60 years undergoing major orthopedic surgery were randomly assigned in a 1:1 ratio to receive preoperative ketamine 0.5 mg/kg as an intravenous bolus (n = 152) or placebo (n = 149) in random blocks stratified according to the study site, preoperative cognitive status and age. The primary outcome was the proportion of objective delayed neurocognitive recovery (dNR) defined as a decline of one or more neuropsychological assessment standard deviations on postoperative day 7. Secondary outcomes included a three-month incidence of objective postoperative neurocognitive disorder (POND), as well as delirium, anxiety, and symptoms of depression seven days and three months after surgery.<br />Results: Among 301 patients included, 292 (97%) completed the trial. Objective dNR occurred in 50 (38.8%) patients in the ketamine group and 54 (40.9%) patients in the placebo group (OR [95% CI] 0.92 [0.56; 1.51], p = 0.73) on postoperative day 7. Incidence of objective POND three months after surgery did not differ significantly between the two groups nor did incidence of delirium, anxiety, apathy, and fatigue. Symptoms of depression were less frequent in the ketamine group three months after surgery (OR [95% CI] 0.34 [0.13-0.86]).<br />Conclusions: A single preoperative bolus of intravenous ketamine does not prevent the occurrence of dNR or POND in elderly patients scheduled for major orthopedic surgery. (Clinicaltrials.gov NCT02892916).<br /> (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)
- Subjects :
- Humans
Double-Blind Method
Aged
Male
Female
Middle Aged
Aged, 80 and over
Postoperative Complications prevention & control
Postoperative Complications epidemiology
Neurocognitive Disorders prevention & control
Neuropsychological Tests
Delirium prevention & control
Ketamine administration & dosage
Ketamine therapeutic use
Orthopedic Procedures adverse effects
Postoperative Cognitive Complications prevention & control
Preoperative Care methods
Subjects
Details
- Language :
- English
- ISSN :
- 2352-5568
- Volume :
- 43
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Anaesthesia, critical care & pain medicine
- Publication Type :
- Academic Journal
- Accession number :
- 38710325
- Full Text :
- https://doi.org/10.1016/j.accpm.2024.101387