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The present study was performed to evaluate the effect of subanesthetic dosage of ketamine on awakening and anxiety and depression status among patients undergoing coronary bypass graft (CABG) surgery. In this quasi-experimental study, 50 patients scheduled for elective CABG in a tertiary referral hospital were enrolled. Participants were allocated to the ketamine and control groups. In the ketamine group, infusion began immediately after induction of anesthesia and before skin incision, at 0.375 μg/kg/min, and was discontinued at skin closure. The control group received the equivalent volume of normal saline over the same time frame. Hemodynamic parameters [mean arterial pressure (MAP), heart rate (HR)] were recorded at baseline (before anesthesia induction), after induction but before skin incision, and upon arrival in the intensive care unit ICU. Preoperative and postoperative anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), with postoperative assessment performed 24 hours after extubation to ensure valid cognitive function. Sedation was assessed using the Ramsay Sedation Scale. The ketamine group showed a significantly higher proportion of awake patients at two hours post-operation (80% vs. 42.5%, p = 0.034) and faster recovery of consciousness over time (χ²(3) = 11.18, p = 0.011). Ketamine was associated with significantly lower anxiety (mean difference: -1.64, p < 0.001) and depression scores (mean difference: -1.52, p < 0.001) compared to the control group. A subanesthetic ketamine infusion, initiated after induction and continued until skin closure, significantly improved postoperative recovery in patients undergoing CABG surgery by promoting early awakening and reducing anxiety and depression scores 24 hours after the operation. These results highlight the potential of ketamine as an effective adjunct in perioperative care, warranting further investigation into its broader applications and long-term effects on patient outcomes.
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