Ketamine vs Midazolam on Cognitive Function in Elderly in Elective Surgery Three-Months Postoperatively (ketaminvsMDZ)
Status:
Recruiting
Trial end date:
2021-06-20
Target enrollment:
Participant gender:
Summary
Deterioration of posoperative cognitive function (DCPO) is an intermediate state between
normal cognitive aging and dementia, defined as a cognitive alteration greater than expected
for the patient's age and educational level, but which doesn't interfere with the activities
of daily life, in its evolution it can lead to dementia or it can present reversal of the
deterioration with return to a normal cognitive state, or a stabilization with permanence in
a state of moderate alteration. In general, higher cognitive function can be affected by
organic or functional problems, anesthetic-surgical, diseases associated with the elderly and
/ or chronic-degenerative comorbidities. Older patients who undergo regional anesthesia have
special interest, the adverse cardiovascular effects, or prolonged sedation due to a
pharmacokinetics that is altered by age, call special attention to reduce complications in
the postoperative period. In 2010 at the Siglo XXI Hospital in Mexico City, the 68-year-old
population attended was 30% of those with postoperative cognitive dysfunction 26% a week, and
10% persistence at 3 months. The DSM V recommends a neuropsychiatric, psychological and
cognitive evaluation of the patient in the postoperative period, through tests such as the
Mini Mental State Examination. sub-anesthetic doses of ketamine have been recently proposed
to reduce the postoperative markers of inflammation, pain and opioids, in addition to having
an antidepressant effect. There is a pharmacological rationale for using ketamine as a
preventative measure against postoperative delirium based on its N-methyl-D-aspartate (NMDA)
antagonism, It has the potential to protect against such neurological injury.