A pre-anesthetic bolus of ketamine versus dexmedetomidine for prevention of postoperative delirium in elderly patients undergoing emergency surgery: a randomized, double-blinded, placebo-controlled study

• Published in: BMC anesthesiology Vol. 23; no. 1; p. 407
• Main Authors: Ghazaly, Huda F, Hemaida, Tarek S, Zaher, Zaher Z, Elkhodary, Omar M, Hammad, Soudy S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11.12.2023; BioMed Central; BMC
• Subjects: Aged patients; Analysis; Anesthesia; Clinical trials; Cognitive ability; Delirium; Dexmedetomidine; Elderly patients; Emergency surgery; Extubation; Fentanyl; General anesthesia; Ketamine; Medical research; Medicine, Experimental; Nalbuphine; Older people; Patients; Placebos; Postoperative delirium; Postoperative period; Regression analysis; Surgery; Variance analysis; Ketamine; Postoperative delirium; Emergency surgery; Elderly patients; Dexmedetomidine
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-023-02367-8

We aimed to evaluate whether a single dose of ketamine or dexmedetomidine before induction of general anesthesia could reduce the incidence of postoperative delirium (primary outcome) or cognitive dysfunction (secondary outcome) in elderly patients undergoing emergency surgery. This randomized, double-blinded, placebo-controlled trial included 60 elderly patients who were scheduled for emergency surgery. The patients were randomly assigned into one of three groups (n = 20): group I received 0.9% normal saline, group II received 1 µg/kg dexmedetomidine, and group III received 1 mg/kg ketamine right before anesthesia induction. Patients were observed for three days after surgery and tested for postoperative delirium and cognitive dysfunction using the delirium observation screening scale and the mini-mental state examination score, respectively. The dexmedetomidine group had the lowest incidence of delirium (p = 0.001) and cognitive dysfunction (p = 0.006) compared to the ketamine and placebo groups. The multivariate logistic regression model revealed that dexmedetomidine reduced the incidence of postoperative delirium by 32% compared to placebo (reference) (OR = 0.684, 95% CI: 0.240-0.971, p = 0.025), whereas ketamine increased the risk by threefold (OR = 3.012, 95% CI: 1.185-9.681, p = 0.013). Furthermore, dexmedetomidine reduced the incidence of postoperative cognitive dysfunction by 62% (OR = 0.375, 95% CI: 0.091-0.543, p = 0.012), whereas ketamine increased the risk by 4.5 times (OR = 4.501, 95% CI: 1.161-8.817, p = 0.006). A single pre-anesthetic bolus of dexmedetomidine is a practical choice for preventing postoperative delirium in elderly patients undergoing emergency surgery. This study was approved by the Ethics Committee of Aswan University Hospital (approval number: aswu/548/7/2021; registration date: 06/07/2021) and registered on ClinicalTrials.gov (NCT05341154) (22/04/2022).