Effects of ketamine on the severity of depression and anxiety following postoperative mechanical ventilation: a single-blind randomized clinical trial in Iran.
Seyedbabak Mojaveraghili, Fatemeh Talebi, Sima Ghorbanoghli, Shahram Moghaddam, Hamidreza Shakouri, Ruzbeh Shamsamiri, Fatemeh Mehravar
Acute and critical care May 1, 2024 DOI: 10.4266/acc.2023.01186 via PubMed
Summary
AI-generated from the abstractIn mechanically ventilated patients after craniotomy, ketamine reduced depression and anxiety more than a combination of midazolam and morphine. Fifty patients were randomly assigned to receive either ketamine or midazolam plus morphine during mechanical ventilation in the ICU. Depression scores were significantly lower in the ketamine group at 2 months and 6 months after discharge. Anxiety scores were significantly lower in the ketamine group at 2 weeks and 6 months after discharge. Ketamine appears effective for long-term prevention and treatment of anxiety and depression in this population, though larger studies are needed to confirm these findings.
Study at a glance
| Characteristics | Randomized single-blind clinical trial Peer reviewed |
|---|---|
| Sample size | 50 |
| Population | Mechanically ventilated patients after craniotomy in the ICU |
| Interventions | Ketamine Midazolam Morphine |
| Dose | 0.5 mg/kg of ketamine infused over 15 minutes then continued at 5 µ/kg/min; midazolam 2-3 mg/hr; morphine 3-5 mg/hr |
| Duration | Intervention during mechanical ventilation; follow-up at 2 weeks, 2 months, and 6 months after ICU discharge |
| Topics | Anxiety Depression Ketamine |
| Keywords | Intensive care unit Midazolam Behavioral health |
| Citations | 1 |
| Key finding | Ketamine significantly reduced depression and anxiety scores compared to midazolam plus morphine in mechanically ventilated patients after ICU discharge. |
Abstract
In this study, we compare the effects of ketamine and the combination of midazolam and morphine on the severity of depression and anxiety in mechanically ventilated patients after discharge from the intensive care unit (ICU). This randomized single-blind clinical trial included 50 patients who were candidates for craniotomy and postoperative mechanical ventilation in the ICU of 5 Azar Teaching Hospital in Gorgan City, North Iran, from 2021 to 2022. Patients were allocated to two groups by quadruple block randomization. In group A, 0.5 mg/kg of ketamine was infused over 15 minutes after craniotomy and then continued at a dose of 5 µ/kg/min during mechanical ventilation. In group B, midazolam was infused at a dose of 2-3 mg/hr and morphine at a dose of 3-5 mg/hr. After patients were discharged from the ICU, if their Glasgow Coma Scale scores were ≥14, Beck's anxiety and depression inventories were completed by a psychologist within 2 weeks, 2 months, and 6 months after discharge. The mean scores of depression at 2 months (P=0.01) and 6 months (P=0.03) after discharge were significantly lower in the ketamine group than in the midazolam and morphine group. The mean anxiety scores were significantly lower in the ketamine group 2 weeks (P=0.006) and 6 months (P=0.002) after discharge. Ketamine is an effective drug for preventing and treating anxiety and depression over the long term in patients discharged from the ICU. However, further larger volume studies are required to validate these results.