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Ketamine vs. haloperidol for prevention of cognitive dysfunction and postoperative delirium: A phase IV multicentre randomised placebo-controlled double-blind clinical trial
- Source :
- Journal of clinical anesthesia. 68
- Publication Year :
- 2020
-
Abstract
- Study objective Delirium is frequently observed in the postoperative and intensive care unit (ICU) population. Due to the multifactorial origin of delirium and according to international guidelines (e.g., American Geriatrics Society; Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) guideline), there are several but no incontestable options for prevention and symptomatic treatment. The purpose of the Baden PRIDe (Prevention and Reduction of Incidence of postoperative Delirium) trial was to determine whether postoperative cognitive dysfunction and delirium could be prevented by the combination of possible preventive agents such as haloperidol and ketamine. In addition, pre- and postoperative levels of the biomarkers cortisol, neuron specific enolase (NSE) and S100β were measured to investigate their dynamics in delirious and non-delirious patients after surgery. Design The Baden PRIDe Trial was an investigator-initiated, phase IV, two-centre, randomised, placebo-controlled, double-blind clinical trial. Setting Perioperative care. Patients 182 adult patients that underwent elective or emergency surgery under general or combined (i.e., general and regional) anaesthesia. Interventions Pre-anaesthetic, pharmacologic prevention of postoperative brain dysfunction with haloperidol, ketamine, and the combination of both vs. placebo. Measurements Assessment of cognitive performance pre- and postoperatively with the MMSE, the DOS, the Nursing Delirium Screening Scale (Nu-DESC) or the Intensive Care Delirium Screening Checklist (ICDSC) during ICU stay. Main results None of the three study arms – haloperidol, ketamine, or both drugs combined - was significantly superior to placebo for prevention of postoperative brain dysfunction and delirium (P = 0.39). Measured levels of postoperative cortisol were significantly higher in delirious patients. S-100β levels were significantly higher in all postoperative outcome groups (cognitive impairment, delirium, no cognitive decline), whereas postoperative NSE levels declined in all groups. Conclusions The study results offer no possibility for a novel recommendation for prevention of postoperative cognitive decline including delirium. Perioperative S-100β trajectories in patients with cognitive deterioration suggest affection of glial cells in particular. Trial registration ClinicalTrials.gov NCT02433041 ; registered on April 7, 2015.
- Subjects :
- Adult
medicine.medical_specialty
Sedation
Population
behavioral disciplines and activities
03 medical and health sciences
0302 clinical medicine
Double-Blind Method
030202 anesthesiology
Intensive care
mental disorders
medicine
Humans
Cognitive Dysfunction
030212 general & internal medicine
Cognitive decline
education
Geriatrics
education.field_of_study
business.industry
Delirium
Perioperative
medicine.disease
Anesthesiology and Pain Medicine
Anesthesia
Haloperidol
Ketamine
medicine.symptom
business
Postoperative cognitive dysfunction
Subjects
Details
- ISSN :
- 18734529
- Volume :
- 68
- Database :
- OpenAIRE
- Journal :
- Journal of clinical anesthesia
- Accession number :
- edsair.doi.dedup.....d2edb91e70c3044619b3020707c9920c