Date of this Version

12-2-2025

Document Type

DNP Project

Rights

default

Abstract

Background: Postoperative cognitive dysfunction (POCD) is an anesthesia concern that affects the elderly population who are undergoing surgical procedures. Ketamine and esketamine are promising interventions to prevent POCD in this population due to their neuroprotective properties.

Methods: A Boolean search identified 3,548 articles. Of those found, 11 articles of level 1 or 2 evidence within the last 5 years were selected for a comprehensive literature review. An educational module with pre- and post-tests were used to assess participants’ knowledge acquisition after implementation of an educational intervention on the utilization of subanesthetic doses of ketamine versus esketamine to mitigate POCD in elderly patients undergoing surgery.

Results: Thirteen certified registered nurse anesthetists (CRNAs) completed pre- and post-testing that evaluated knowledge and attitudes toward POCD and using ketamine and esketamine in preventing POCD. Post-test scores showed increased accuracy in identifying intraoperative risk factors from 69% to 85%, diagnostic timeframes from 69% to 92%, and biomarker identification and significance from 46% to 85%. Provider willingness to use subanesthetic doses of ketamine or esketamine as part of their anesthesia increased from 15% to 54% (extremely likely).

Discussion: This quality improvement project enhanced anesthesia providers' knowledge of POCD and use of subanesthetic doses of ketamine or esketamine in elderly patients undergoing surgery. Provider attitudes towards utilizing ketamine and esketamine in their anesthesia practice to prevent POCD increased. Limitations of this study include a small sample size, single-facility research, and a short data collection period.

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