A Review of the Role of Ketamine in the Management of Delirium Following Coronary Artery Bypass Graft Surgery and its impact on Timing of Patient Extubation

Background and purpose: Delirium is a disruption of consciousness and cognitive function that frequently occurs in the postoperative period. The incidence of delirium following open-heart surgery has been reported to exceed 90%, potentially leading to delays in extubation among patients admitted to the intensive care unit (ICU). Ketamine, an anesthetic agent with distinct pharmacological properties, may influence the prevention or management of postoperative delirium. However, its precise role in this setting remains unclear and warrants further investigation. Materials and Methods: This narrative review aimed to investigate delirium and extubation time in patients undergoing coronary artery bypass grafting (CABG) surgery. A systematic search was conducted across databases including Scopus, Web of Science, PubMed, Cochrane Library, and Google Scholar, using MeSH terms and relevant keywords covering the past decade. Inclusion criteria consisted of randomized clinical trials, cohort studies, and meta-analyses that addressed postoperative delirium and/or extubation time in CABG patients. Results: This review analyzed 11 key domains, including: the definition of delirium, its epidemiology, and pathophysiology; risk factors for delirium following cardiac surgery; the relationship between postoperative pain control and delirium; the association between sedation levels and delirium after cardiac surgery; complications arising from postoperative delirium; optimal dosing and timing of ketamine administration during cardiac surgery; the effect of ketamine on extubation time; the association between extubation time and postoperative complications; and factors influencing extubation timing. Conclusion: Evidence suggests that ketamine may offer benefits in reducing postoperative delirium following cardiac surgery, particularly due to its anti-inflammatory properties. However, it does not appear to significantly influence extubation time. The heterogeneity among existing studies and the absence of standardized protocols limit the generalizability of these findings. Future research should focus on randomized, controlled trials with standardized methodologies to better evaluate ketamine's role in this context.