Ketamine and its two enantiomers in anesthesiology and psychiatry: A historical review and future directions

Journal of Anesthesia and Translational Medicine, Journal Year: 2024, Volume and Issue: 3(3), P. 65 - 75

Published: July 11, 2024

Ketamine, a dissociative anesthetic, is widely utilized in both human and veterinary anesthesia. Its (S)-enantiomer, esketamine, similarly employed for anesthesia analgesia. The anesthetic effects of ketamine esketamine arise from their antagonism the N-methyl-D-aspartate receptor (NMDAR). In field psychiatry, rapid-acting antidepressant properties severe depression have generated significant interest, resulting its increased off-label usage United States (U.S.). 2019, nasal spray received approval use U.S. Europe. However, concerns emerged regarding potential adverse effects, including long-term efficacy, addiction risks, suicide risk clinical settings. contrast, arketamine, (R)-enantiomer ketamine, exhibits superior longer-lasting rodent models depression, with fewer side compared to esketamine. Nevertheless, research on efficacy safety arketamine patients remains limited. This article provides concise exploration historical two enantiomers while also delving into future directions application these fields.

Language: Английский

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Esketamine reduces the risk of postpartum depression in women undergoing cesarean section: a systematic review and meta-analysis

Journal of Psychiatric Research, Journal Year: 2025, Volume and Issue: 183, P. 164 - 173

Published: Feb. 14, 2025

Language: Английский

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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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Intraoperative Esketamine and Postpartum Depression Among Women With Cesarean Delivery

JAMA Network Open, Journal Year: 2025, Volume and Issue: 8(2), P. e2459331 - e2459331

Published: Feb. 13, 2025

Importance Esketamine has been found to reduce the incidence of postpartum depression (PPD) in randomized clinical trials. However, current evidence from trials does not reflect esketamine’s efficacy settings. Objective To assess intraoperative esketamine administration for preventing PPD among women who underwent cesarean delivery. Design, Setting, and Participants This trial was conducted at The First Affiliated Hospital Chongqing Medical University Chongqing, China, March 2023 February 2024. Pregnant patients admitted delivery were included, while those with intellectual dysfunction or contraindications excluded. All participants assigned randomly either group control a 1:1 ratio. Data analysis based on intention-to-treat principle. Interventions Patients received an infusion 0.25 mg/kg 20 mL saline over minutes, whereas minutes. Main Outcomes Measures primary outcome 6 weeks post partum. assessed using Edinburgh Postnatal Depression Scale. Results A total 308 pregnant 1 2 groups: (n = 154; mean [SD] patient age, 31.57 [4.26] years) 32.53 [7.74] years). Incidence significantly lower compared partum (10.4% [16] vs 19.5% [30]; relative risk, 0.53; 95% CI, 0.30-0.93; P .02). Conclusions Relevance demonstrated advantage reducing safety warrant further investigation practice. Trial Registration Chinese Clinical Registry Identifier: ChiCTR2200065494

Language: Английский

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Perioperative administration of esketamine during cesarean section is a double-edged sword

Psychiatry Research, Journal Year: 2024, Volume and Issue: 344, P. 116321 - 116321

Published: Dec. 9, 2024

Language: Английский

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