A Prospective Randomised Study to Compare the Effect of Intraoperative Sedation with Dexmedetomidine versus Ketamine on Postoperative Delirium and Expression of Inflammatory Markers in Elderly Patients Undergoing HIP Surgeries

INTRODUCTION: Postoperative delirium (POD) is characterized by a disturbance in attention, awareness, and cognition that develops acutely and fluctuates frequently throughout the course of the condition(1). It is a significant concern leading to prolonged hospital stays, increased healthcare costs, and diminished quality of life. The incidence of POD is reported to be 32.9%(2) among elderly patients undergoing hip surgeries. Both dexmedetomidine and ketamine have shown to reduce the systemic inflammatory response and offer neuroprotective benefits(3,4). OBJECTIVES: This prospective randomized study aimed to compare the incidence of postoperative delirium and evaluate the anti-inflammatory effects of intraoperative infusion of dexmedetomidine versus ketamine in elderly patients undergoing hip surgeries. MATERIALS AND METHODS: Participants were randomised to either the dexmedetomidine group (n = 35), receiving a loading dose of 0.5 μg/kg, followed by a maintenance dose of 0.2-0.4 μg/kg/h or the ketamine group (n = 35), receiving a loading dose of 0.3 mg/kg, followed by a maintenance dose of 0.2-0.3 mg/kg/min. POD assessment was done using the Confusion Assessment Method (CAM) and Diagnostic and Statistical Manual of Mental Disorders (DSM-5) scale. Interleukin 6 (IL-6) and Highly sensitive C-reactive protein (Hs-CRP) levels were measured at T0 (baseline) and T3 (postoperative day 2). RESULTS: The incidence of POD was similar between the ketamine group and the dexmedetomidine group (14.29% vs. 5.71%, respectively) (p = 0.232). CONCLUSIONS: This study elucidates the nuanced interplay between sedation, inflammation, and hemodynamic stability, providing a compelling basis for the tailored application of either dexmedetomidine or ketamine in prevention of postoperative delirium in elderly.