Efficacy and safety of esketamine in preventing perioperative neurocognitive disorders: a meta-analysis of randomized controlled studies

Systematic Reviews, Journal Year: 2025, Volume and Issue: 14(1)

Published: March 22, 2025

Perioperative neurocognitive disorders (POND) are common in older adults and associated with adverse outcomes. This meta-analysis aimed to evaluate the efficacy safety of esketamine for prophylaxis POND. Electronic databases were comprehensively searched from inception April 1, 2024, identify randomized controlled trials (RCTs) exploring impact perioperative on POND adult patients. The primary outcomes incidence level postoperative cognitive function. secondary included recovery characteristics (i.e., respiratory depression, extubation time, agitation, hallucinations, nightmares) inflammatory markers. Subgroup meta-regression analyses conducted investigate heterogeneity effect dosage. A total 24 RCTs (n = 2,130 patients), all China relatively short follow-up periods (≤ 3 months), included. Esketamine was found significantly reduce risk (risk ratio:0.53, 95%confidence interval [CI]: 0.43–0.67) improved function day 1 (standardized mean difference [SMD]:1.22, 95%CI:0.85–1.59) (SMD:0.94, 95%CI: 0.46–1.43) compared controls, without impacting characteristics. Furthermore, lower pain scores, reduced nausea/vomiting, decreased levels markers (IL-6, TNF-α, S100β). revealed that age, quality studies, type administration, dosage did not have a significant evidence showed moderate certainty risk, low POD several complications (agitation, PONV, issues, biomarkers (TNF-α, s100β), very cognition, pain, IL-6 levels. is potentially effective reducing improving patients, regardless age Nevertheless, (e.g., 3). Given studies periods, further high-quality diverse populations longer warranted validate these findings.

Language: Английский

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Effect of intravenous esketamine on postoperative sleep disturbance, anxiety, and depression in elderly patients undergoing laparoscopic abdominal surgery: a randomized controlled trial

BMC Geriatrics, Journal Year: 2025, Volume and Issue: 25(1)

Published: March 5, 2025

The population of elderly individuals undergoing surgical procedures is increasing, necessitating effective postoperative management strategies. Postoperative sleep disturbance, anxiety, and depression are significant contributors to overall recovery in this demographic, especially following laparoscopic abdominal surgery. This study included 200 records patients Patients were divided into an esketamine group, receiving intravenous esketamine, a control normal saline. Parameters such as surgery anesthesia duration, fluid volume, blood loss, urine output, depression, pain assessment, adverse events compared between the two groups. group had significantly fewer disturbances, lower anxiety scores on days 1 3, Visual Analog Scale (VAS) (P < 0.05). They also required less rescue analgesia, used opioids, consumed non-opioid analgesics However, experienced higher incidence dissociative symptoms 0.05), while other similar Overall, improved reduced but increased risk symptoms. Intravenous administration was associated with scores, decreased analgesia requirements, opioid consumption, use analgesic medications. clinical registered at Chinese Clinical Trial Registry (ChiCTR, ChiCTR2400087795).

Language: Английский

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The effect of esketamine combined with sufentanil based patient-controlled intravenous analgesia for postoperative pain in patients undergoing third molar surgery and maxillofacial trauma: a randomized clinical trial

BMC Oral Health, Journal Year: 2024, Volume and Issue: 24(1)

Published: Dec. 2, 2024

This study aims to investigate the effects of combining esketamine with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) in patients undergoing elective impacted tooth surgery or open reduction and internal fixation. In this single-center, prospective, double-blinded, randomized, parallel-controlled trial, 91 were randomly divided into two groups. The experimental group (group ES, n = 46) received a combination 1.5 µg/kg 1.0 mg/kg, while control S, 45) 2 alone PCIA after surgery. Primary outcome was assessed using Visual Analogue Scale (VAS) at rest during mouth opening 6 h, 12 24 48 h post-surgery. Secondary outcomes included Ramsay Sedation (RSS) scores, Quality Recovery-15 (QoR-15) patient satisfaction analgesia, occurrence adverse events within frequency button presses number requiring rescue also recorded. resting VAS scores mouth-opening post-surgery significantly lower Group ES than S (P < 0.05). Additionally, RSS higher 0.032) 0.021) ES. use decreased QoR-15 increased 0.001 P 0.001, respectively). incidences dizziness nausea/vomiting reduced 0.045 0.036, respectively) but one event nightmare observed. There no significant difference between combined third molar maxillofacial trauma can alleviate short-term pain, improve quality recovery. Esketamine is worth promoting clinical application oral retrospectively registered chictr.org.cn identifier: ChiCTR2400086662 on 08/07/2024.

Language: Английский

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Esketamine and neurocognitive disorders in adult surgical patients: a meta-analysis

BMC Anesthesiology, Journal Year: 2024, Volume and Issue: 24(1)

Published: Dec. 5, 2024

Prior meta-analyses have established the potential of intravenous ketamine in safeguarding against neurocognitive impairment, but efficacy esketamine for prevention perioperative disorders (PND) remains uncertain. The primary aim this meta-analysis was to conduct a comprehensive evaluation effects on PND adult surgical patients undergoing general anesthesia. We searched several electronic databases and clinical trial registries find relevant trials. Randomized controlled trials use adjuvant were included analysis. main outcome measured risk postoperative delirium(POD) cognitive dysfunction (POCD). Secondary outcomes assessment status, pain scores (VAS/NRS), remifentanil consumption occurrence nausea vomiting (PONV). Thirteen studies encompassing procedures such as abdominal, thoracoscopic lung, gastrointestinal, laparoscopic gynecological, spinal surgery, modified radical mastectomy, A cohort comprising 1068 underwent anesthesia, with 584 assigned group 484 designated placebo group. administration anesthesia augmented by infusion esketamine, comparative analysis conducted relation alternative pharmacological interventions or placebo. application during period observed decrease POD ( RR 0.46; 95% CI: 0.32, 0.66, p < 0.0001, GRADE = High) exhibited protective influence POCD (RR 0.50; 95%CI: 0.30, 0.84, 0.009, I2 0%, Moderate). Significant improvements at 4, 24 48 h post-surgery when comparing (4 h: SMD -0.78, -1.24, -0.32, 0.0009, 58%, Low; -0.92, -1.40, -0.44, 0.0002, 86%, -0.9, -1.68, -0.12, 0.02, 89%, Low), intraoperative significantly reduced (SMD -0.56; − 0.86, 0.27, 62%, moderate). notable reduction PONV group(RR 0.64; 0.49, 0.001, High). an may represent potentially beneficial strategy reducing susceptibility PND, benefits preventing POCD. Furthermore, it can opioid alleviate intensity without increasing incidence PONV. This registered PROSPERO (CRD42023453714).

Language: Английский

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Progress in the Clinical Application of Esketamine

Advances in Clinical Medicine, Journal Year: 2024, Volume and Issue: 14(10), P. 1592 - 1599

Published: Jan. 1, 2024

Language: Английский

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