Perioperative esketamine-containing strategies and postoperative neurocognitive outcomes in older surgical patients: a systematic review and meta-analysis of randomized controlled trials with certainty assessment.
Ruirui Qi, Yuchen Wu, Lin Zhang et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the impact of perioperative esketamine on postoperative delirium (POD) in older surgical patients (≥60 years). The analysis included 17 randomized controlled trials with 2,914 participants. Esketamine-containing regimens were associated with a reduced POD incidence (OR = 0.57, 95% CI 0.40-0.82; P = 0.002) compared to control interventions.
Key findings
- Esketamine reduced POD incidence compared to control interventions (OR = 0.57, 95% CI 0.40-0.82; P = 0.002).
- There was a suggested reduction in postoperative cognitive dysfunction (OR = 0.39, 95% CI 0.22-0.71; P = 0.002), but with very low evidence certainty.
- Esketamine was associated with reduced postoperative nausea and vomiting (OR = 0.49, 95% CI 0.32-0.75; P = 0.001).
- No increase in psychiatric adverse events was observed (OR = 1.41, 95% CI 0.67-2.96; P = 0.37).
Why it matters
Postoperative delirium is a significant concern in older adults, leading to adverse outcomes. Understanding the potential benefits of esketamine in reducing POD can inform perioperative management strategies and improve patient care in this vulnerable population.
What to keep in mind
The evidence certainty was very low for some outcomes, and there was heterogeneity in perioperative management across studies.