Home E-Weekly June 6, 2017

Study: Ketamine Didn't Decrease Delirium or Pain

Published: June 5, 2017

REAL-WORLD RESULTS The findings measured the effectiveness of how anesthesia providers are currently practicing.

Anesthesia providers often administer ketamine during surgery to help manage post-op pain and prevent delirium, but a new study published in the journal The Lancet suggests the drug does neither in older patients.

A team of investigators from Washington University School of Medicine in St. Louis and the University of Michigan Medical School in Ann Arbor compared the outcomes of 672 surgical patients older than 60 years who received no ketamine, low-dose ketamine (0.5 mg/kg) or high dose ketamine (1.0 mg/kg) — doses typically used by anesthesia providers — after induction and before incisions were made.

"Unfortunately, we didn't find a decrease in delirium," says study lead author Michael Avidan, MBBCh, a professor of anesthesiology and surgery at Washington University. "Unexpectedly, we also didn't find a decrease in pain and opioid consumption."

Those were important findings, says Dr. Avidan, because there's been a recent uptick in ketamine use to prevent pain after surgery in a way that's safer than opioids. He says increasing the dose of ketamine might prove more effective, but he also cautioned that higher doses increased incidences of post-op hallucinations and nightmares among the study's patients.

Dr. Avidan believes more research is needed to explore the effectiveness of other opioid alternatives and suggests anesthesia providers should reconsider the common practice of administering low doses of ketamine during surgery.

Daniel Cook

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