S-ketamine as an adjuvant in patient-controlled intravenous analgesia for preventing postpartum depression: a randomized controlled trial

BMC Anesthesiology, Год журнала: 2022, Номер 22(1)

Опубликована: Фев. 16, 2022

Abstract Background Postpartum depression (PPD) is a common complication of cesarean section. S-ketamine given intravenously during surgery can help prevent PPD. However, whether in patient-controlled intravenous analgesia (PCIA) reduce the incidence PPD unknown. This study assessed effect as an adjuvant PCIA for preventing women undergoing delivery. Methods A total 375 parturients scheduled to undergo section and then receive were recruited from single center randomly assigned control (C) group (sufentanil 2 μg/kg + tropisetron 10 mg) or (S) (S-ketamine 0.5 mg/kg sufentanil mg). The primary outcome was measured by Edinburgh postnatal scale (EPDS) after surgery. secondary outcomes EPDS scores, visual analog (VAS) Ramsay sedation (RSS) rate adverse events, including headache, nausea, dizziness, drowsiness, vomit. Results 275 puerperal included study. parturient on postoperative days 3, 14, 28 C S 17.6 8.2% ( p < 0.05), 24.2 9.8% (p 19.0 17.2% = 0.76) respectively. scores 3,14, 7.65 ± 3.14 6.00 2.47 7.62 6.38 2.67 7.35 3.17 6.90 2.78 0.15), events headache 3.3 4.1% 0.755), nausea 5.9 0.481), dizziness 9.2 12.3% 0.434), drowsiness 6.5 10.7%( 0.274), vomit 5.7% 0.585). Conclusions (0.01 mg/kg/h) significantly reduces within 14 relieves pain 48 h delivery, without increasing reactions. Trial registration Registered Chinese Clinical Registry ChiCTR2100050263 ) August 24, 2021.

Язык: Английский

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Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery

JAMA Network Open, Год журнала: 2023, Номер 6(4), С. e239321 - e239321

Опубликована: Апрель 21, 2023

Importance Epidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction. Objective To investigate the sedative and analgesic effects of intravenous esketamine administered before childbirth via delivery with patient under epidural anesthesia. Design, Setting, Participants This multicenter, double-blind randomized clinical trial assessed 903 women 18 years or older who had full-term single pregnancy were scheduled elective in 5 medical centers China from September 18, 2021, 20, 2022. Intervention Patients receive injection 0.25 mg/kg placebo incision. Main Outcomes Measures The coprimary outcomes included scores on numeric rating scale (an 11-point scale, 0 indicating no 10 worst pain; difference ≥1.65 points was clinically meaningful) Ramsay Sedation Scale (a 6-point 1 restlessness 6 deep sleep without response; ≥2 immediately after fetal delivery. Secondary neonatal Apgar score at minutes birth. Results A total 600 (mean [SD] age, 30.7 [4.3] years) enrolled randomized; all intention-to-treat analysis. Immediately lower (median [IQR], [0-1]) than [0-2]; median difference, 0; 95% CI, 0-0; P = .001), not important. higher (sedation deeper) 4 [3-4]) 2 [2-2]; 2; 2-2; &amp;lt; .001). did differ between groups minute .98) .27). Transient neurologic mental symptoms more common patients given (97.7% [293 300]) those (4.7% [14 300]; Conclusions Relevance For undergoing anesthesia, subanesthetic dose incision produced transient analgesia sedation induce significant depression. Mental nystagmus transient. Indications optimal this population need further clarification, study should be limited require analgesia. Trial Registration ClinicalTrials.gov Identifier: NCT04548973

Язык: Английский

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Efficacy of a single low dose of esketamine after childbirth for mothers with symptoms of prenatal depression: randomised clinical trial

BMJ, Год журнала: 2024, Номер unknown, С. e078218 - e078218

Опубликована: Апрель 10, 2024

Abstract Objective To determine whether a single low dose of esketamine administered after childbirth reduces postpartum depression in mothers with prenatal depression. Design Randomised, double blind, placebo controlled trial two parallel arms. Setting Five tertiary care hospitals China, 19 June 2020 to 3 August 2022. Participants 364 aged ≥18 years who had at least mild as indicated by Edinburgh postnatal scale scores ≥10 (range 0-30, higher indicating worse depression) and were admitted hospital for delivery. Interventions randomly assigned 1:1 receive either 0.2 mg/kg or infused intravenously over 40 minutes once the umbilical cord been clamped. Main outcome measures The primary was prevalence major depressive episode 42 days post partum, diagnosed using mini-international neuropsychiatric interview. Secondary outcomes included score seven partum 17 item Hamilton rating 0-52, depression). Adverse events monitored until 24 hours childbirth. Results A total (mean age 31.8 (standard deviation 4.1) years) enrolled randomised. At observed 6.7% (12/180) participants group compared 25.4% (46/181) (relative risk 0.26, 95% confidence interval (CI) 0.14 0.48; P<0.001). lower (median difference −3, CI −4 −2; P<0.001) (−3, also (−4, −6 −3; overall incidence adverse (45.1% (82/182) v 22.0% (40/182); P<0.001); however, symptoms lasted less than day none required drug treatment. Conclusions For depression, decreases episodes about three quarters. Neuropsychiatric more frequent but transient did not require intervention. Trial registration ClinicalTrials.gov NCT04414943 .

Язык: Английский

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Effects of ketamine and esketamine on preventing postpartum depression after cesarean delivery: A meta-analysis

Journal of Affective Disorders, Год журнала: 2024, Номер 351, С. 720 - 728

Опубликована: Янв. 28, 2024

Ketamine and esketamine has been suggested to have potential efficacy in preventing postpartum depression (PPD) recent years. The aim of this meta-analysis was evaluate the effectiveness ketamine on PPD after cesarean delivery.

Язык: Английский

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Effects of perioperative use of esketamine on postpartum depression risk in patients undergoing cesarean section: A randomized controlled trial

Journal of Affective Disorders, Год журнала: 2023, Номер 339, С. 815 - 822

Опубликована: Июль 22, 2023

Postpartum depression (PPD) is a prevalent public health issue. Although ketamine has prophylactic effects on PPD in women undergoing cesarean section, the of esketamine remain unclear. This trial aimed to evaluate efficacy perioperative infusion risk by assessing Edinburgh Postnatal Depression Scale (EPDS) scores and blood biomarkers.A total 150 participants elective section were randomly allocated receive either or normal saline. Since 27 excluded due consent withdrawal loss follow-up, 123 patients included. The primary outcome was prevalence risk. Secondary outcomes included postpartum anxiety (PPA) risk, levels biomarkers, postoperative pain intensity, cumulative sufentanil consumption.The PPA at 3 days, 42 months, 6 months did not differ between two groups. Furthermore, EPDS scores, intensity rest, during coughing days (POD) 1 2 Sufentanil consumption 0-12 h, 12-24 0-24 0-48 h postoperatively significantly lower group compared control group. Blood biomarkers groups POD 3.The sample size small. simply screened, diagnosed.Perioperative administration decrease incidence after section. However, reduced opioid consumption.

Язык: Английский

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Efficacy and safety of perioperative application of ketamine on postoperative depression: A meta-analysis of randomized controlled studies

Molecular Psychiatry, Год журнала: 2023, Номер unknown

Опубликована: Янв. 20, 2023

Abstract Ketamine, a commonly used general anesthetic, can produce rapid and sustained antidepressant effect. However, the efficacy safety of perioperative application ketamine on postoperative depression remains uncertain. We performed meta-analysis to determine effect intravenous administration depression. Randomized controlled trials comparing with placebo in patients were included. Primary outcome was scores. Secondary outcomes included visual analog scale (VAS) scores for pain adverse effects associated ketamine. Fifteen studies 1697 receiving 1462 controls enrolled. Compared controls, group showed reduction scores, by standardized mean difference (SMD) −0.97, 95% confidence interval [CI, −1.27, −0.66], P < 0.001, I 2 = 72% day (POD) 1; SMD−0.65, CI [−1.12, −0.17], 94% POD 3; SMD−0.30, [−0.45, −0.14], 0% OD 7; SMD−0.25, [−0.38, −0.11], 59% over long term. Ketamine reduced VAS 1 (SMD−0.93, [−1.58, −0.29], 0.005, 97%), but no significant found between two groups PODs 3 7 or distinctly increased risk effects, including nausea vomiting (risk ratio [RR] 1.40, [1.12, 1.75], 0.003, 30%), headache (RR 2.47, [1.41, 4.32], 0.002, 19%), hallucination 15.35, [6. 4, 37.34], 89%), dizziness 3.48, [2.68, 4.50], 89%) compared controls. In conclusion, reduces effects.

Язык: Английский

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Intraoperative Esketamine and Postpartum Depression Among Women With Cesarean Delivery

JAMA Network Open, Год журнала: 2025, Номер 8(2), С. e2459331 - e2459331

Опубликована: Фев. 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

Язык: Английский

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Effect of esketamine on postoperative depression in women with breast cancer and preoperative depressive symptoms: The EASE randomized trial

Journal of Clinical Anesthesia, Год журнала: 2025, Номер 103, С. 111821 - 111821

Опубликована: Март 29, 2025

Язык: Английский

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A single intravenous administration of a sub-anesthetic ketamine dose during the perioperative period of cesarean section for preventing postpartum depression: A meta-analysis

Psychiatry Research, Год журнала: 2022, Номер 310, С. 114396 - 114396

Опубликована: Янв. 17, 2022

Язык: Английский

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Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail

BMC Anesthesiology, Год журнала: 2024, Номер 24(1)

Опубликована: Янв. 10, 2024

Abstract Background Postpartum depression (PPD) is a common mental disease in postpartum women, which has received more and attention society. Ketamine been confirmed for its rapid antidepressant effect women with PPD. We speculate that esketamine, an enantiomer of ketamine, pretreatment during cesarean can also reduce the incidence Methods All parturients enrolled study were randomly assigned to two groups: esktamine group (0.2 mg/kg esketamine) control (a same volume saline). drugs pumped 40 min started from beginning surgery. The Amsterdam Anxiety Information Scale (APAIS) scores before surgery, Edinburgh postnatal scale (EPDS) at 4 d 42 after Pain Numerical Rating (NRS) 6 h, 12 24 h 48 post-operation evaluated, as well adverse reactions recorded. Results A total 319 analyzed study. PPD (EPDS score > 9) esketamine was lower than days surgery (13.8% vs 23.1%, P = 0.0430) but not ( 0.0987). Esketamine 0.2 could NRS h,12 use vasoactive < 0.05). incidences maternal dizziness (17.0%), blurred vision (5%), illusion (3.8%) drowsiness higher those Conclusions Intraoperative injection mg/kg) prevented occurrence delivery days. reduced side effects such dizziness, vision, hallucination increased. Trial registration Registered Chinese Clinical Registry (ChiCTR2100053422) on 20/11/2021.

Язык: Английский

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