Effect of esketamine on postoperative delirium in general anesthesia patients undergoing elective surgery: a meta-analysis of randomized controlled trials DOI Creative Commons
Wenhui Zhang, Di Wang,

Siru Li

и другие.

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

Опубликована: Ноя. 28, 2024

Postoperative delirium is a common neurological complication, especially in older patients undergoing surgery, which closely related to the poor prognosis of patients. The objective was investigate effects esketamine on postoperative with general anesthesia. databases PubMed, Embase, Cochrane Library and Chinese National Knowledge Infrastructure were searched for all available randomised controlled trials induction elective anesthesia from inception until April 21, 2024. We used RevMan5.4 software data analysis. Dichotomous analyzed by risk ratios(RR) 95% confidence interval(CI), continuous mean differences(MD). also evaluated literature bias using Bias Risk Assessment tool. included total 17 randomized trials, including 1286 In studies, significantly reduced incidence (RR: 0.43; 95%CI: 0.33 ~ 0.57; p < 0.001). Five studies examined adverse events (nausea, vomiting, dizziness resporatory depression) showed no statistically significant difference between group control (normal saline or dexmedetomidine) 0.82; 0.65 1.03; = 0.08). addition, this study found that had lower hypotension 0.24; 0.12 0.48; 0.001) score visual analogue scale 24 h after surgery (MD: -0.44; -0.54 -0.33; According our meta-analysis, use during without increasing reactions.

Язык: Английский

Insights for the Next Generation of Ketamine for the Treatment of Depressive Disorder DOI
Allana Cristina Faustino Martins, Bretton Badenoch, Roberto da Silva Gomes

и другие.

Journal of Medicinal Chemistry, Год журнала: 2025, Номер unknown

Опубликована: Янв. 5, 2025

Treatment-resistant depression responds quickly to ketamine. As an N-methyl-d-aspartate receptor (NMDAR) antagonist, ketamine may affect prefrontal cortex (PFC) neurons. Recent investigations reveal that the (R)-enantiomer is most effective and least abuseable antidepressant. The Food Drug Administration approves only (S)-enantiomer for medical usage. (2R,6R)-Hydroxynorketamine (HNK) inhibits mGlu2, linked a Gi, in presynaptic glutamatergic neurons, increasing brain-derived neurotrophic factor (BDNF) release, which autocrinely activates Tropomyosin kinase B (TrkB) promotes synaptogenesis. Ketamine, originally anesthetic, has garnered attention its many pharmacological effects, including potential as rapid-acting antidepressant recreational use. In this Perspective, we explore synthesis, pharmacology, metabolism, effects of metabolites animal human studies explain difference biological activity between enantiomers.

Язык: Английский

Процитировано

0
Esketamine mitigates systemic inflammation via modulating phenotypic transformation of monocytes in patients undergoing thoracic surgery DOI
Weiyun Shen, Yan Yan, Wenjuan Zhang

и другие.

Life Sciences, Год журнала: 2025, Номер unknown, С. 123594 - 123594

Опубликована: Март 1, 2025

Язык: Английский

Процитировано

0
Opioid-Free Using Ketamine versus Opioid-Sparing Anesthesia during the Intraoperative Period in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial DOI Open Access
Hoon Choi, Jae‐Won Huh, Min-Ju Kim

и другие.

Journal of Personalized Medicine, Год журнала: 2024, Номер 14(8), С. 881 - 881

Опубликована: Авг. 21, 2024

Opioids effectively manage perioperative pain but have numerous adverse effects. Opioid-free anesthesia (OFA) eliminates intraoperative opioid use; however, evidence for its use in video-assisted thoracoscopic surgery (VATS) is limited. This study assessed the effect of OFA using ketamine VATS patients compared to opioid-sparing (OSA). A total 91 undergoing lobectomy or segmentectomy were randomized either group (ketamine) OSA (remifentanil). The primary outcome was quality recovery (QoR) on postoperative day (POD) 1, measured with QoR-40 questionnaire. Secondary outcomes included scores and events. Both groups had comparable baseline surgical characteristics. On POD score higher than (164.3 ± 10.8 vs. 158.7 10.6; mean difference: 5.6, 95% CI: 1.1, 10.0; p = 0.015), though this did not meet pre-specified minimal clinically important difference 6.3. visual analog scale lower as at 0–1 h (4.2 2.3 6.2 2.1; < 0.001) 1–4 after (3.4 1.8 4.6 1.9; 0.003). a incidence PONV (2 [4.4%] 9 [19.6%]; 0.049) shivering (4 [8.9%] 13 [28.3%]; 0.030) surgery. Using proved feasible, indicated by stable hemodynamics absence awareness. Patients showed statistically significant, insignificant, QoR improvement those receiving remifentanil.

Язык: Английский

Процитировано

2
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 DOI Creative Commons
Xue Li, Xin He, Mengya Li

и другие.

BMC Oral Health, Год журнала: 2024, Номер 24(1)

Опубликована: Дек. 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.

Язык: Английский

Процитировано

1
Esketamine and neurocognitive disorders in adult surgical patients: a meta-analysis DOI Creative Commons
Lin Xing, Xin Liu, H. Huang

и другие.

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

Опубликована: Дек. 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).

Язык: Английский

Процитировано

1
Progress in the Clinical Application of Esketamine DOI

宇 乔

Advances in Clinical Medicine, Год журнала: 2024, Номер 14(10), С. 1592 - 1599

Опубликована: Янв. 1, 2024

Язык: Английский

Процитировано

0
Opioid-free strategies for patient-controlled intravenous postoperative analgesia: a review of recent studies DOI Creative Commons
Xin Luo,

Pan-Guo Rao,

Xing-Heng Lei

и другие.

Frontiers in Pharmacology, Год журнала: 2024, Номер 15

Опубликована: Окт. 31, 2024

Postoperative pain management has consistently been a critical topic in the medical field, with patient-controlled intravenous analgesia (PCIA) being one of most commonly utilized methods for postoperative analgesia. Currently, opioids remain primary choice PCIA clinical practice. However, recent years, an increasing number studies have explored analgesic strategies aimed at reducing or eliminating use to mitigate associated side effects and dependence. This article systematically reviews progress research on opioid-free through comprehensive analysis relevant literature.

Язык: Английский

Процитировано

0
Effect of esketamine on postoperative delirium in general anesthesia patients undergoing elective surgery: a meta-analysis of randomized controlled trials DOI Creative Commons
Wenhui Zhang, Di Wang,

Siru Li

и другие.

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

Опубликована: Ноя. 28, 2024

Postoperative delirium is a common neurological complication, especially in older patients undergoing surgery, which closely related to the poor prognosis of patients. The objective was investigate effects esketamine on postoperative with general anesthesia. databases PubMed, Embase, Cochrane Library and Chinese National Knowledge Infrastructure were searched for all available randomised controlled trials induction elective anesthesia from inception until April 21, 2024. We used RevMan5.4 software data analysis. Dichotomous analyzed by risk ratios(RR) 95% confidence interval(CI), continuous mean differences(MD). also evaluated literature bias using Bias Risk Assessment tool. included total 17 randomized trials, including 1286 In studies, significantly reduced incidence (RR: 0.43; 95%CI: 0.33 ~ 0.57; p < 0.001). Five studies examined adverse events (nausea, vomiting, dizziness resporatory depression) showed no statistically significant difference between group control (normal saline or dexmedetomidine) 0.82; 0.65 1.03; = 0.08). addition, this study found that had lower hypotension 0.24; 0.12 0.48; 0.001) score visual analogue scale 24 h after surgery (MD: -0.44; -0.54 -0.33; According our meta-analysis, use during without increasing reactions.

Язык: Английский

Процитировано

0