• Acta Anaesthesiol Scand · Aug 2009

    Randomized Controlled Trial

    Ketamine attenuates post-operative cognitive dysfunction after cardiac surgery.

    • J A Hudetz, Z Iqbal, S D Gandhi, K M Patterson, A J Byrne, A G Hudetz, P S Pagel, and D C Warltier.
    • Department of Anesthesiology, Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI. judith.hudetz@va.gov
    • Acta Anaesthesiol Scand. 2009 Aug 1;53(7):864-72.

    BackgroundPost-operative cognitive dysfunction (POCD) commonly occurs after cardiac surgery. Ketamine exerts neuroprotective effects after cerebral ischemia by anti-excitotoxic and anti-inflammatory mechanisms. We hypothesized that ketamine attenuates POCD in patients undergoing cardiac surgery concomitant with an anti-inflammatory effect.MethodsPatients randomly received placebo (0.9% saline; n=26) or an i.v. bolus of ketamine (0.5 mg/kg; n=26) during anesthetic induction. Anesthesia was maintained with isoflurane and fentanyl. A nonsurgical group (n=26) was also included as control. Recent verbal and nonverbal memory and executive functions were assessed before and 1 week after surgery or a 1-week waiting period for the nonsurgical controls. Serum C-reactive protein (CRP) concentrations were determined before surgery and on the first post-operative day.ResultsBaseline neurocognitive and depression scores were similar in the placebo, ketamine, and nonsurgical control groups. Cognitive performance after surgery decreased by at least 2 SDs (z-score of 1.96) in 21 patients in the placebo group and only in seven patients in the ketamine group compared with the nonsurgical controls (P<0.001, Fisher's exact test). Cognitive performance was also significantly different between the placebo- and the ketamine-treated groups based on all z-scores (P<0.001, Mann-Whitney U-test). Pre-operative CRP concentrations were similar (P<0.33, Mann-Whitney U-test) in the placebo- and ketamine-treated groups. The post-operative CRP concentration was significantly (P<0.01, Mann-Whitney U-test) lower in the ketamine-treated than in the placebo-treated group.ConclusionsKetamine attenuates POCD 1 week after cardiac surgery and this effect may be related to the anti-inflammatory action of the drug.

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