Esketamine for postoperative sleep disturbance: clinical evidence, mechanisms, and future directions.
Frontiers in psychiatry – January 01, 2025
Source: PubMed
Summary
Post-surgery sleep problems are common and can significantly impede recovery. Emerging evidence suggests esketamine, a potent NMDA receptor antagonist and an isomer of ketamine, shows promise in improving postoperative sleep disturbance. This unique anesthetic, with its stronger effects and better safety profile than ketamine, appears to enhance sleep quality, offering a valuable approach to promote patient recovery after operations.
Abstract
Postoperative sleep disturbance (PSD) is a common complication following surgery. Numerous factors can contribute to PSD, including personal factors, intraoperative factors, postoperative complications and environmental factors. PSD can lead to a range of adverse outcomes, severely impairing patients' postoperative recovery and long-term prognosis. Esketamine, a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist and the dextrorotatory isomer of ketamine, which has stronger receptor affinity, more significant analgesic effects and better safety than ketamine. In recent years, in addition to the proven sedative, analgesic and antidepressant properties, emerging evidence highlights that esketamine may improve PSD through a variety of mechanisms, but the existing research results are still controversial. This article reviews the latest research progress of esketamine in improving PSD, and discusses its clinical efficacy and potential mechanism of action, in order to provide theoretical basis and practical guidance for optimizing perioperative anesthesia management and promoting postoperative rehabilitation of patients.