Effects of Esketamine on Emergence Delirium in Children Undergoing Sevoflurane Anesthesia: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis.
Paediatr AnaesthAug 6, 2026 (epub)
Munder Lateiresh, Abdelaziz Louat, Mukhtar Alwefati et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the efficacy of esketamine in preventing emergence delirium in 916 pediatric patients undergoing sevoflurane anesthesia. Esketamine significantly reduced the incidence of emergence delirium compared to placebo (risk ratio = 0.35; 95% CI: 0.26-0.48; p < 0.0001) and improved postoperative pain scores.
Key findings
- Esketamine reduced emergence delirium incidence compared to placebo (risk ratio = 0.35; 95% CI: 0.26-0.48; p < 0.0001).
- Postoperative pain scores were significantly lower with esketamine (standardized mean difference = -0.58; 95% CI: -0.79 to -0.37; p < 0.0001).
- Esketamine was associated with a modest increase in extubation time (mean difference = 1.72 min; p = 0.0267).
- Postoperative nausea and vomiting were significantly reduced with esketamine (risk ratio = 0.69; 95% CI: 0.49-0.97; p = 0.0304).
Why it matters
Emergence delirium is a common complication in pediatric anesthesia, leading to distress and prolonged recovery. The findings suggest that esketamine may be an effective strategy to mitigate this issue, enhancing postoperative outcomes for children.