The impact of ketamine on cognitive outcomes in geriatric anesthesia: a comprehensive review
BackgroundKetamine, a dissociative anesthetic with N-methyl-D-aspartate (NMDA) receptor blockade, has become increasingly popular in geriatric anesthesia because of its hemodynamic stability, lack of respiratory depression, and possible neuroprotective properties. Yet, its effect on cognitive functi...
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Frontiers Media S.A.
2025-07-01
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| author | Shuyong You Shuyong You Zhaohui Li |
| author_facet | Shuyong You Shuyong You Zhaohui Li |
| author_sort | Shuyong You |
| collection | DOAJ |
| description | BackgroundKetamine, a dissociative anesthetic with N-methyl-D-aspartate (NMDA) receptor blockade, has become increasingly popular in geriatric anesthesia because of its hemodynamic stability, lack of respiratory depression, and possible neuroprotective properties. Yet, its effect on cognitive function in elderly surgical patients is unknown. Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are frequent complications in elderly surgical patients, resulting in longer hospital stays, higher healthcare costs, and long-term cognitive impairment. Although there is some evidence to support ketamine in decreasing neuroinflammation and maintaining cognitive function, others describe high risks of delirium and hallucination, especially at higher doses.MethodsThis review assessed the existing literature on ketamine’s impact on cognitive outcomes in older anesthesia. A comprehensive review of randomized controlled trials (RCTs was performed, assessing ketamine’s potential to prevent or worsen POCD and POD.ResultsResults show that low-dose ketamine (0.3–0.5 mg/kg) is neuroprotective and decreases the rate of cognitive dysfunction in certain patients. Nevertheless, findings continue to be at odds because study design, population of patients, dosing schedules, and measure of cognition may differ. Secondly, the weighting of ketamine’s neuroprotective and neurotoxic effects is dose-dependent with larger doses inducing unwanted neuropsychiatric impacts.ConclusionIn light of these divergent results, additional large-scale, multicenter RCTs are needed to establish optimal dosing regimens and to identify elderly patient subgroups that could be treated safely with ketamine to avoid cognitive complications. Multimodal techniques of anesthesia and long-term cognitive outcomes will also need to be studied in future studies to further delineate ketamine’s definitive place in geriatric anesthesia. |
| format | Article |
| id | doaj-art-cbb24ec35d38440caddbff50d27a36ab |
| institution | DOAJ |
| issn | 1664-0640 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Psychiatry |
| spelling | doaj-art-cbb24ec35d38440caddbff50d27a36ab2025-08-20T03:09:35ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-07-011610.3389/fpsyt.2025.15947301594730The impact of ketamine on cognitive outcomes in geriatric anesthesia: a comprehensive reviewShuyong You0Shuyong You1Zhaohui Li2Department of Anesthesiology, Luxian People’s Hospital, Luzhou, Sichuan, ChinaDepartment of Anesthesiology, The Second People’s Hospital of Luxian County, Luzhou, Sichuan, ChinaDepartment of Anesthesiology, The Second People’s Hospital of Luxian County, Luzhou, Sichuan, ChinaBackgroundKetamine, a dissociative anesthetic with N-methyl-D-aspartate (NMDA) receptor blockade, has become increasingly popular in geriatric anesthesia because of its hemodynamic stability, lack of respiratory depression, and possible neuroprotective properties. Yet, its effect on cognitive function in elderly surgical patients is unknown. Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are frequent complications in elderly surgical patients, resulting in longer hospital stays, higher healthcare costs, and long-term cognitive impairment. Although there is some evidence to support ketamine in decreasing neuroinflammation and maintaining cognitive function, others describe high risks of delirium and hallucination, especially at higher doses.MethodsThis review assessed the existing literature on ketamine’s impact on cognitive outcomes in older anesthesia. A comprehensive review of randomized controlled trials (RCTs was performed, assessing ketamine’s potential to prevent or worsen POCD and POD.ResultsResults show that low-dose ketamine (0.3–0.5 mg/kg) is neuroprotective and decreases the rate of cognitive dysfunction in certain patients. Nevertheless, findings continue to be at odds because study design, population of patients, dosing schedules, and measure of cognition may differ. Secondly, the weighting of ketamine’s neuroprotective and neurotoxic effects is dose-dependent with larger doses inducing unwanted neuropsychiatric impacts.ConclusionIn light of these divergent results, additional large-scale, multicenter RCTs are needed to establish optimal dosing regimens and to identify elderly patient subgroups that could be treated safely with ketamine to avoid cognitive complications. Multimodal techniques of anesthesia and long-term cognitive outcomes will also need to be studied in future studies to further delineate ketamine’s definitive place in geriatric anesthesia.https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1594730/fullketaminegeriatric anesthesiapostoperative cognitive dysfunctionpost-operative deliriumneuroprotectionNMDA receptor antagonist |
| spellingShingle | Shuyong You Shuyong You Zhaohui Li The impact of ketamine on cognitive outcomes in geriatric anesthesia: a comprehensive review Frontiers in Psychiatry ketamine geriatric anesthesia postoperative cognitive dysfunction post-operative delirium neuroprotection NMDA receptor antagonist |
| title | The impact of ketamine on cognitive outcomes in geriatric anesthesia: a comprehensive review |
| title_full | The impact of ketamine on cognitive outcomes in geriatric anesthesia: a comprehensive review |
| title_fullStr | The impact of ketamine on cognitive outcomes in geriatric anesthesia: a comprehensive review |
| title_full_unstemmed | The impact of ketamine on cognitive outcomes in geriatric anesthesia: a comprehensive review |
| title_short | The impact of ketamine on cognitive outcomes in geriatric anesthesia: a comprehensive review |
| title_sort | impact of ketamine on cognitive outcomes in geriatric anesthesia a comprehensive review |
| topic | ketamine geriatric anesthesia postoperative cognitive dysfunction post-operative delirium neuroprotection NMDA receptor antagonist |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1594730/full |
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