高齢者における手術後の妄想や痛みの予防のための手術中のケタミン:国際的,多センター,ダブルブラインド,ランダム化臨床試験
Michael S Avidan1, Hannah R Maybrier1, Arbi Ben Abdallah1
1Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, USA.
Lancet (London, England)
|June 4, 2017
まとめ
大手手術を受けた高齢者の間では,ケタミン療法は術後の妄想を予防しなかった. この研究では,ケタミンとプラセボの間の妄想の割合に有意な差は認められませんでしたが,ケタミンで幻覚や悪夢が増加したことが示されました.
科学分野:
- 麻酔科
- 高齢者医療
- クリティカル ケア 医療
背景:
- 手術後の妄想は 大手術後の高齢者の重大な合併症です
- 麻酔薬であるケタミンは時として鎮痛剤として使用され,妄想を予防する作用がある.
- 術後の妄想を予防するケタミンの有効性に関する証拠は,まだ定かではありません.
研究 の 目的:
- 手術後の妄想を防ぐために,単一の亜麻酔用ケタミンの有効性を評価する.
- 低用量 (0. 5 mg/ kg) と高用量 (1. 0 mg/ kg) のケタミンの影響をプラセボと比較して評価する.
- この患者集団におけるケタミン投与に関連する有害事象を分析する.
主な方法:
- 多センター国際ランダム化,ダブルブラインド,プラセボ対照試験 (PODCAST試験)
- 一般麻酔で心臓外科手術を受けた60歳以上の成人.
- 誘導後の患者はプラセボ,0. 5 mg/ kgのケタミン,または1. 0 mg/ kgのケタミンを受け,妄想は混同評価法で評価された.
主要な成果:
- ケタミンを併用したグループとプラセボの間で妄想発症の有意な差は認められなかった (19. 45% vs 19. 82%).
- 術後の幻覚や悪夢の発生率が増加した.
- 一般的または特定の有害事象 (心血管,腎臓,感染症,胃腸,出血) に関するグループ間での有意な差異はありません.
結論:
- 高齢者における手術後の妄想の予防には,単一の亜麻酔用ケタミン投与は効果的ではありません.
- ケタミンの投与は幻覚や悪夢のような有害な心理的影響のリスクを高める可能性があります.
- ケタミンが老年患者の手術後のケアにおける役割を明らかにするために,さらなる研究が必要である.
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