The Effect of Ketamine Administration on the Incidence of Delirium After Coronary Artery Bypass Graft Surgery: A Scoping Review

Abstract

Context: Delirium is a common complication observed in patients undergoing open-heart surgery, leading to adverse outcomes and increased healthcare costs. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist with analgesic and neuroprotective properties, has been reported to have potential protective effects against delirium. In this scoping review, we aim to explore the existing literature on the effect of ketamine administration in open-heart surgery on the incidence of delirium. Evidence Acquisition: In the latter part of 2023, a retrospective analysis was conducted to investigate the impact of administering ketamine on delirium occurrence following coronary artery bypass surgery. Researchers utilized Medical Subject Headings (MeSH) to identify key terms and searched various databases, including Scopus, Web of Science, PubMed, and Cochrane, as well as search engines like Google Scholar, alongside Iran SID and Iran ISC databases. Following the elimination of duplicates and irrelevant studies, the review encompassed six studies from Iran, Turkey, Canada, the United States, and Thailand. Results: The search strategy yielded 1100 articles, of which 100 were excluded due to duplicates. After excluding conference papers, systematic reviews, unrelated languages, unavailable full texts, and book chapters, 87 full-text studies were reviewed. Finally, 6 studies (5 studies in English and one study in Persian) met the inclusion criteria and were analyzed. Conclusions: Recent trials have shown that the effect of ketamine administration on the incidence of delirium after coronary artery bypass graft (CABG) surgery is equivocal. While some studies suggest that ketamine may serve as a promising solution for reducing the incidence of delirium, others suggest that it may lead to adverse experiences and raise concerns about its safety. Further research in this area is necessary to optimize postoperative recovery and minimize risks. Currently, physicians must carefully evaluate the potential benefits and side effects of ketamine for each patient and be aware of the latest evidence.