Ketamine; Depressive Symptom; Neurosurgery; Perioperative Period
Conditions
Brief summary
Perioperative depression symptom (PDS) is one of the common mental comorbidity, and influences the clinical outcomes and prognosis. However, there is no rapid acting treatment to deal with it during the limited hospital stay. This study aims to determine whether ketamine could improve the depressive symptom of peirioperative patients. It will also examine the safety for administrating ketamine as an antidepressant intraoperatively. Meanwhile, it will show if ketamine could improve anxiety, postoperative pain or delirium. This trial also will bring great concerns on patients with perioperative mental health and explore the measures to improve their psycho-related prognosis.
Interventions
DRUGKetamine
Ketamine will be administrated intravenously at dural opening, with the total dose of 0.5 mg/kg and continual infusion for 40 minutes.
DRUGNormal saline
Normal saline will be administrated intravenously at dural opening, with the total dose of 0.5 ml/kg and continual infusion for 40 minutes.
Sponsors
Beijing Tiantan Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Brain tumor located supratentorial area and need to receive elective craniotomy; 2. Moderate to severe depressive symptom measured by the qualified psychiatric doctors. 3. Ages between 18 and 65 years old. 4. American Society of Anesthesiologists physical status I-III
Exclusion criteria
1. History of epilepsy; 2. Major depression disorder patients undergoing antidepressive therapy within 2 weeks; 3 Psychiatric illness; 4 Drug abuse; 5 History of allergy to the research drug; 6 Tumor located in the Wernick area, Broca area or the frontal pole; 7 Hyperthyroidism; 8 Patients can not cooperate with investigators on psychiatric assessments; 9 Pregnant or breast-feeding woman; 10 refuse to sign inform consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Response rate | Postoperative 3 days | ≥50% reduction in MADRS scores from baseline value.The MADRS is a 10-item tool, with scores ranging from 0 to 60, and determining the severity of depression. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Anxiety symptom | Postoperative 3 days. | The anxious symptom is defined as HADS score no less than 11. |
| Postoperative delirium | Postoperative 1 day. | Postoperative delirium will be assessed by the Confusion Assessment Method for the Intensive Care Unit Scale (CAM-ICU) at 2 hours and 1 day after surgery. |
| The remission rate | Postoperative 3 days and discharge. | The remission rate is defined as the absolute value of MADRS no more than 10. |
| Postoperative 30-day quality of life reported by KPS | Postoperative 30 days | The quality of life will be evaluated by Karnofsky performance status (KPS) at postoperative 30 days. |
| Psychiatric outcomes and complications | Postoperative 3 days and discharge. | Postoperative complications include psychiatric symptoms evaluated by Brief Psychiatric Rating Scale (BPRS), manic symptoms assessed through the 11-item Young Mania Rating Scale (YMRS), and dissociative symptoms measured by the Clinician Administered Dissociative States Scale (CADSS). Moreover, postoperative complications also include aphasia, epilepsy, hemorrhage. |
| Severe pain | Postoperative 3 days. | The incidence of severe pain within first postoperative three days, which is defined as mean and peak numerical rating scale (NRS) are higher than 5. |
Countries
China
Outcome results
None listed