Ketamine and Dexmedetomidine for Delirium in Joint Arthroplasty

NCT ID: NCT06963294

Last Updated: 2025-05-09

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-05-05

Study Completion Date

2026-07-15

Brief Summary

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This prospective, randomized, double-blind, placebo-controlled clinical trial aims to evaluate the effects of intraoperative ketamine and dexmedetomidine on the incidence of postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) in patients undergoing total joint arthroplasty. Given the high incidence of neurocognitive complications in elderly patients following major orthopedic surgeries, neuroprotective strategies during anesthesia are of growing interest. Both ketamine and dexmedetomidine have shown potential in reducing neuroinflammation and improving postoperative cognitive outcomes in previous studies.

Eighty adult patients (ASA I-III, aged 18-100) scheduled for elective total hip or knee arthroplasty under spinal anesthesia will be randomized into four groups: control (saline infusion), ketamine infusion, dexmedetomidine infusion, and combined ketamine + dexmedetomidine. Cognitive assessments will be performed preoperatively and on postoperative days 2 and 15 using the Mini Mental State Examination (MMSE). Delirium assessments will be conducted using the Confusion Assessment Method (CAM) postoperatively on days 1, 3, and 15.

Secondary outcomes include perioperative levels of cortisol, CRP, and fibrinogen, as well as postoperative pain scores (VAS) and analgesic consumption. The results are expected to clarify whether intraoperative administration of ketamine or dexmedetomidine can reduce the incidence of POD/POCD and improve postoperative recovery.

Detailed Description

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Conditions

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Postoperative Delirium Postoperative Cognitive Dysfunction

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Saline Infusion

Participants receive 0.9% saline at 30 mL/hour during surgery.

Group Type PLACEBO_COMPARATOR

Ketamine

Intervention Type DRUG

Ketamine will be administered as an intravenous infusion at 0.1 mg/kg/hour during surgery

Ketamine Infusion

Participants receive ketamine at 0.1 mg/kg/hour as intraoperative infusion

Group Type EXPERIMENTAL

Ketamine

Intervention Type DRUG

Ketamine will be administered as an intravenous infusion at 0.1 mg/kg/hour during surgery

Dexmedetomidine Infusion

Participants receive dexmedetomidine at 0.5 mcg/kg/hour as intraoperative infusion

Group Type EXPERIMENTAL

Ketamine

Intervention Type DRUG

Ketamine will be administered as an intravenous infusion at 0.1 mg/kg/hour during surgery

Ketamine + Dexmedetomidine

Participants receive a combination of ketamine (0.3 mg/kg/hour) and dexmedetomidine (0.5 mcg/kg/hour) as intraoperative infusion.

Group Type EXPERIMENTAL

Ketamine

Intervention Type DRUG

Ketamine will be administered as an intravenous infusion at 0.1 mg/kg/hour during surgery

Interventions

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Ketamine

Ketamine will be administered as an intravenous infusion at 0.1 mg/kg/hour during surgery

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Scheduled for elective total joint arthroplasty (hip or knee)
* ASA physical status I-III
* Age between 18 and 100 years
* Ability to provide informed consent and comply with cognitive assessments

Exclusion Criteria

* Pre-existing cognitive dysfunction or diagnosed neurodegenerative disease
* Hearing or language impairment interfering with MMSE/CAM evaluation
* Known allergy to ketamine or dexmedetomidine
* Significant cardiac arrhythmia (e.g., supraventricular tachycardia, 2nd or 3rd degree AV block)
* Renal insufficiency (GFR \<30 mL/min/1.73 m²)
* Severe hepatic dysfunction
Minimum Eligible Age

18 Years

Maximum Eligible Age

100 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Istinye University

OTHER

Sponsor Role lead

Responsible Party

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İlke Dolgun

Assoc. prof

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Istinye Üniversity

Istanbul, Merkez Mahallesi, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

Central Contacts

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ilke dolgun

Role: CONTACT

+905555485632

References

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Hovaguimian F, Tschopp C, Beck-Schimmer B, Puhan M. Intraoperative ketamine administration to prevent delirium or postoperative cognitive dysfunction: A systematic review and meta-analysis. Acta Anaesthesiol Scand. 2018 Oct;62(9):1182-1193. doi: 10.1111/aas.13168. Epub 2018 Jun 26.

Reference Type RESULT
PMID: 29947091 (View on PubMed)

Singh A, Brenna CTA, Broad J, Kaustov L, Choi S. The Effects of Dexmedetomidine on Perioperative Neurocognitive Outcomes After Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Ann Surg. 2022 May 1;275(5):864-871. doi: 10.1097/SLA.0000000000005196. Epub 2021 Aug 27.

Reference Type RESULT
PMID: 35543164 (View on PubMed)

Other Identifiers

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Haseki berna

Identifier Type: -

Identifier Source: org_study_id

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