The Potential Role of Ketamine in Preventing Delirium among Critically Ill Patients Following Coronary Artery Bypass Grafting: A Review

Mesbah Kiaei, Mehrdad; Mohaghegh Dolatabadi, Mahmoud Reza; Abbasi, Mohsen; Amouzegar Zavareh, Seyed Mohammadreza; Moshki, Ali; Sangi, Siavash; Aligholizade, Maryam

doi:10.30491/tm.2025.552666.1890

The Potential Role of Ketamine in Preventing Delirium among Critically Ill Patients Following Coronary Artery Bypass Grafting: A Review

Document Type : Narrative Review

Authors

Mehrdad Mesbah Kiaei ¹

Mahmoud Reza Mohaghegh Dolatabadi ¹

Mohsen Abbasi ¹

Seyed Mohammadreza Amouzegar Zavareh ²

Ali Moshki ¹

Siavash Sangi ³

Maryam Aligholizade ³

¹ Department of Anesthesiology and pain medicine, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran

² Atherosclerosis research center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

³ Department of Anesthesiology and Operating Room, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

10.30491/tm.2025.552666.1890

Abstract

Introduction: Coronary artery bypass grafting (CABG) remains a cornerstone procedure in cardiovascular medicine; however, postoperative delirium is a frequent and serious complication, particularly among critically ill patients in the intensive care unit. Ketamine, known for its analgesic and N-methyl-D-aspartate (NMDA) receptor–modulating properties, has been proposed as a potential agent to reduce the incidence of delirium following cardiac surgery.
Method: A review was conducted by searching reputable scientific databases for studies addressing postoperative delirium, cardiac surgery, coronary artery bypass grafting, and postoperative cognitive dysfunction. Relevant literature examining the relationship between ketamine administration and the incidence or severity of post-CABG delirium was identified, analyzed, and synthesized.
Result: Eight thematic areas were explored: definitions and diagnostic criteria of delirium; epidemiology of postoperative delirium; pathophysiological mechanisms; risk factors for post-cardiac surgery delirium; associations between pain control, sedation practices, and delirium; complications of delirium in the critical care setting; and the timing, dosage, and efficacy of ketamine administration during and after CABG.
Conclusion: Current evidence regarding ketamine’s effectiveness in preventing postoperative delirium after CABG remains inconclusive, with studies reporting mixed outcomes. Further standardized, high-quality research is needed to clarify optimal dosing strategies, assess safety profiles, and determine ketamine’s true role in delirium prevention among critically ill cardiac surgery patients.

Keywords

Ketamine

Coronary Artery Bypass Grafting

Postoperative Delirium

Critical Care

Subjects