Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: A randomized controlled trial
Background: Postoperative delirium (POD) is a common complication in cardiac surgery especially in elderly population which can lead to a delay of weaning from ventilator and extubation. Cardiopulmonary bypass (CPB)-induced inflammation is related to POD. Anti-inflammatory effect of anesthetic agent...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Annals of Cardiac Anaesthesia |
| Subjects: | |
| Online Access: | http://www.annals.in/article.asp?issn=0971-9784;year=2021;volume=24;issue=3;spage=294;epage=301;aulast=Siripoonyothai |
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| author | Sutira Siripoonyothai Wacharin Sindhvananda |
| author_facet | Sutira Siripoonyothai Wacharin Sindhvananda |
| author_sort | Sutira Siripoonyothai |
| collection | DOAJ |
| description | Background: Postoperative delirium (POD) is a common complication in cardiac surgery especially in elderly population which can lead to a delay of weaning from ventilator and extubation. Cardiopulmonary bypass (CPB)-induced inflammation is related to POD. Anti-inflammatory effect of anesthetic agent might attenuate POD.
Aims: The present study was primarily aimed to compare within-24-h POD between ketamine-based anesthesia and propofol-based anesthesia during CPB. The secondary objective was to identify risk factors associated with within-24-h POD.
Setting and Design: Our study was a randomized controlled trial in patients undergoing cardiac surgery with CPB. Enrolling patients were aged >65 years, and able to comprehensive communication. Exclusion criteria were aortic surgery, cognitive disorders, cerebrovascular and carotid disease, and positive result of preoperative CAM-ICU.
Materials and Methods: Patients were randomly assigned to group Ketamine infusion of 1 mg/kg/h and group Propofol infusion of 1.5-6 mg/kg/h during CPB. POD was evaluated by validated Thai version CAM-ICU at 8-24 hour after ICU arrival.
Statistics: Chi-square, Fisher exact and t-test tests, univariate analysis and multivariate logistic regression were utilized. Results: Total 82 patients entered this study and 64 patients remained after exclusion (Group Ketamine = 32 and Group Propofol = 32). Within-24-h POD were 31.25% and 56.25% (P = 0.04) and mean arterial pressure (MAP) were 71.45 and 65.53 mmHg (P = 0.01) respectively in Ketamine and Propofol group. Postoperative leukocytosis was a significant risk to POD (adjusted OR 124.5).
Conclusion: With limitations of the study, prevention of 24-h POD in general by ketamine was inconclusive. In comparison with propofol, ketamine leaded to less events of 24-h POD and kept higher MAP. Severity of postoperative inflammation was a significant prediction of 24-h POD. |
| first_indexed | 2024-12-19T21:35:12Z |
| format | Article |
| id | doaj.art-714c3703d7d9444794c0f42615e43046 |
| institution | Directory Open Access Journal |
| issn | 0971-9784 |
| language | English |
| last_indexed | 2024-12-19T21:35:12Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Annals of Cardiac Anaesthesia |
| spelling | doaj.art-714c3703d7d9444794c0f42615e430462022-12-21T20:04:49ZengWolters Kluwer Medknow PublicationsAnnals of Cardiac Anaesthesia0971-97842021-01-0124329430110.4103/aca.ACA_85_20Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: A randomized controlled trialSutira SiripoonyothaiWacharin SindhvanandaBackground: Postoperative delirium (POD) is a common complication in cardiac surgery especially in elderly population which can lead to a delay of weaning from ventilator and extubation. Cardiopulmonary bypass (CPB)-induced inflammation is related to POD. Anti-inflammatory effect of anesthetic agent might attenuate POD. Aims: The present study was primarily aimed to compare within-24-h POD between ketamine-based anesthesia and propofol-based anesthesia during CPB. The secondary objective was to identify risk factors associated with within-24-h POD. Setting and Design: Our study was a randomized controlled trial in patients undergoing cardiac surgery with CPB. Enrolling patients were aged >65 years, and able to comprehensive communication. Exclusion criteria were aortic surgery, cognitive disorders, cerebrovascular and carotid disease, and positive result of preoperative CAM-ICU. Materials and Methods: Patients were randomly assigned to group Ketamine infusion of 1 mg/kg/h and group Propofol infusion of 1.5-6 mg/kg/h during CPB. POD was evaluated by validated Thai version CAM-ICU at 8-24 hour after ICU arrival. Statistics: Chi-square, Fisher exact and t-test tests, univariate analysis and multivariate logistic regression were utilized. Results: Total 82 patients entered this study and 64 patients remained after exclusion (Group Ketamine = 32 and Group Propofol = 32). Within-24-h POD were 31.25% and 56.25% (P = 0.04) and mean arterial pressure (MAP) were 71.45 and 65.53 mmHg (P = 0.01) respectively in Ketamine and Propofol group. Postoperative leukocytosis was a significant risk to POD (adjusted OR 124.5). Conclusion: With limitations of the study, prevention of 24-h POD in general by ketamine was inconclusive. In comparison with propofol, ketamine leaded to less events of 24-h POD and kept higher MAP. Severity of postoperative inflammation was a significant prediction of 24-h POD.http://www.annals.in/article.asp?issn=0971-9784;year=2021;volume=24;issue=3;spage=294;epage=301;aulast=Siripoonyothaicardiac surgeryketaminepostoperative deliriumpropofol |
| spellingShingle | Sutira Siripoonyothai Wacharin Sindhvananda Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: A randomized controlled trial Annals of Cardiac Anaesthesia cardiac surgery ketamine postoperative delirium propofol |
| title | Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: A randomized controlled trial |
| title_full | Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: A randomized controlled trial |
| title_fullStr | Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: A randomized controlled trial |
| title_full_unstemmed | Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: A randomized controlled trial |
| title_short | Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine: A randomized controlled trial |
| title_sort | comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine a randomized controlled trial |
| topic | cardiac surgery ketamine postoperative delirium propofol |
| url | http://www.annals.in/article.asp?issn=0971-9784;year=2021;volume=24;issue=3;spage=294;epage=301;aulast=Siripoonyothai |
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