Preoperative ketamine administration for prevention of postoperative neurocognitive disorders after major orthopedic surgery in elderly patients: A multicenter randomized blinded placebo-controlled trial - Sorbonne Université Access content directly
Journal Articles Anaesthesia Critical Care & Pain Medicine Year : 2024

Preoperative ketamine administration for prevention of postoperative neurocognitive disorders after major orthopedic surgery in elderly patients: A multicenter randomized blinded placebo-controlled trial

Pierre Lambert
Anais Charles Nelson
  • Function : Author
Jean-Michel Constantin
Lucillia Bezu
Julien Josserand
  • Function : Author
Alexandre Mebazaa
  • Function : Author
Marine Coroir
  • Function : Author
Karine Nouette-Gaulain
  • Function : Author
Gerard Macouillard
  • Function : Author
Pauline Glasman
  • Function : Author
Denis Lemesle
  • Function : Author
Vincent Minville
  • Function : Author
Philippe Cuvillon
  • Function : Author
Brice Gaudilliere
  • Function : Author
Christophe Quesnel
  • Function : Author
Pierre Abdel-Ahad
  • Function : Author
Tarek Sharshar
  • Function : Author
Serge Molliex
Raphael Gaillard
  • Function : Author
Jean Mantz
  • Function : Author

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. 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. 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]). 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.).
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hal-04572879 , version 1 (13-05-2024)

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Franck Verdonk, Pierre Lambert, Clément Gakuba, Anais Charles Nelson, Thomas Lescot, et al.. Preoperative ketamine administration for prevention of postoperative neurocognitive disorders after major orthopedic surgery in elderly patients: A multicenter randomized blinded placebo-controlled trial. Anaesthesia Critical Care & Pain Medicine, 2024, pp.101387. ⟨10.1016/j.accpm.2024.101387⟩. ⟨hal-04572879⟩
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