Association between intraoperative ketamine and the incidence of emergence delirium in laparoscopic surgeries: an observational study
Associação entre cetamina intraoperatória e incidência de delírio de emergência em cirurgias laparoscópicas: estudo observacional
Hélder David Ribeiro Pereira, Maria Vaz Antunes, Daniel Teles, Luís Guimarães Pereira, Fernando Abelha
Abstract
Background
Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries.
Methods
A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison.
Results
One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED.
Conclusion
In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.
Keywords
Resumo
Introdução
O Delírio de Emergência (DE) é condição essencial no pós-operatório imediato. A revisão sistemática e a meta-análise de ensaios clínicos randomizados concluíram que o efeito da cetamina no delirium pós-operatório permanece obscuro. O presente estudo procurou avaliar se o uso intraoperatório de cetamina para analgesia pós-operatória está associado à DE pós-operatória em cirurgias laparoscópicas.
Métodos
Um estudo observacional prospectivo foi realizado na Sala de Recuperação Pós-Anestésica (SRPA) para avaliar pacientes submetidos à cirurgia laparoscópica sob protocolo rígido de anestesia intraoperatória de julho de 2018 a janeiro de 2019. Pacientes submetidos à cirurgia laparoscópica para colecistectomia, ooforectomia ou salpingectomia com pontuação ≥1 na Escala de Avaliação de Sedação de Richmond (RASS) ou ≥2 na Escala de Triagem de Delirium de Enfermagem (Nu-DESC) foram considerados portadores de DE. O teste t, o teste Qui-Quadrado ou o teste exato de Fisher foram utilizados para comparação.
Resultados
Cento e quinze pacientes foram estudados após cirurgia laparoscópica. Dezessete pacientes (14,8%) desenvolveram DE, e a incidência de DE em pacientes que receberam cetamina não foi diferente da de outros pacientes (18,3% vs. 10,6%, p = 0,262). Pacientes com DE apresentaram mais dor pós-operatória e necessidade de morfina na SRPA (p = 0,005 e p = 0,025, respectivamente). O tipo de cirurgia (cirurgia geral, OR = 6,4, IC 95% 1,2-35,2) e dor pós-operatória (OR = 3,7, IC 95% 1,2-11,4) foram fatores de risco para DE.
Conclusão
Neste estudo, não foi encontrada associação entre DE e administração intraoperatória de cetamina em cirurgias laparoscópicas. O tipo de cirurgia e a dor pós-operatória foram fatores de risco para DE.
Palavras-chave
References
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Submitted date:
07/18/2022
Accepted date:
10/09/2022
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