TY - JOUR
T1 - Preoperative ketamine administration for prevention of postoperative neurocognitive disorders after major orthopedic surgery in elderly patients
T2 - A multicenter randomized blinded placebo-controlled trial
AU - Verdonk, Franck
AU - Lambert, Pierre
AU - Gakuba, Clément
AU - Nelson, Anais Charles
AU - Lescot, Thomas
AU - Garnier, Fanny
AU - Constantin, Jean Michel
AU - Saurel, Danielle
AU - Lasocki, Sigismond
AU - Rineau, Emmanuel
AU - Diemunsch, Pierre
AU - Dreyfuss, Lucas
AU - Tavernier, Benoît
AU - Bezu, Lucillia
AU - Josserand, Julien
AU - Mebazaa, Alexandre
AU - Coroir, Marine
AU - Nouette-Gaulain, Karine
AU - Macouillard, Gerard
AU - Glasman, Pauline
AU - Lemesle, Denis
AU - Minville, Vincent
AU - Cuvillon, Philippe
AU - Gaudilliere, Brice
AU - Quesnel, Christophe
AU - Abdel-Ahad, Pierre
AU - Sharshar, Tarek
AU - Molliex, Serge
AU - Gaillard, Raphael
AU - Mantz, Jean
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/8/1
Y1 - 2024/8/1
N2 - 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).
AB - 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).
KW - Delayed neurocognitive recovery
KW - Frailty
KW - Ketamine
KW - Orthopaedic surgery
KW - Postoperative neurocognitive disorder
UR - http://www.scopus.com/inward/record.url?scp=85197312597&partnerID=8YFLogxK
U2 - 10.1016/j.accpm.2024.101387
DO - 10.1016/j.accpm.2024.101387
M3 - Article
C2 - 38710325
AN - SCOPUS:85197312597
SN - 2352-5568
VL - 43
JO - Anaesthesia Critical Care and Pain Medicine
JF - Anaesthesia Critical Care and Pain Medicine
IS - 4
M1 - 101387
ER -