Ketamine for Monitored Anesthesia Care During Transcatheter Aortic Valve Replacement.
Chen B Zhao, Jianjian Yu, Maiying Kong and 3 others
PMID 34972624WHAT IT FOUND
Ketamine use was linked to lower 30-day mortality and intraoperative cardiac arrest in TAVR patients, but the paper did not report its stated main outcome of needing fewer other sedatives, and the events were rare.
Key findings
01Ketamine was given as a monitored anesthesia care adjunct to 126 patients, and 29 patients received midazolam, propofol, or both without ketamine.
0230-day mortality and intraoperative cardiac arrest were lower in the ketamine group than in the non-ketamine group.
03There was no difference between groups in stroke, conversion to general anesthesia, postoperative delirium, permanent pacemaker implantation, perivalvular leak, or length of stay.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective chart review, so it cannot prove that ketamine caused the differences. The stated primary outcome, lower need for other sedatives, was not reported. There was no protocol for ketamine or other sedative doses, and an anesthesiologist chose the agents and doses. Other medications were given with ketamine, so the contribution of ketamine alone cannot be separated. Only 1 death and 6 intraoperative cardiac arrests occurred overall. These rare events make the positive findings unstable. The sample was small and came from one center. It may not apply to other settings.
Declared interests
No conflict-of-interest declaration is included in the supplied text. The publication types list NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not conclude that ketamine lowers mortality or cardiac arrest after TAVR. This was a retrospective chart review without a protocol, the anesthesiologist chose drugs and doses, the stated main outcome of needing fewer other sedatives was not reported, and the mortality and cardiac arrest events were rare.