Effect of Esketamine on Postoperative Delirium and Inflammatory Response in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Randomized Controlled Study.
Journal of cardiothoracic and vascular anesthesia – April 10, 2025
Source: PubMed
Summary
A breakthrough in heart surgery recovery shows that esketamine, administered during off-pump coronary bypass procedures, cuts the risk of post-surgery confusion by over 50%. The medication not only reduced postoperative delirium but also lowered inflammation markers significantly. This advancement offers cardiac patients better recovery outcomes with fewer mental complications.
Abstract
To investigate whether continuous intravenous infusion of esketamine during surgery can improve postoperative delirium (POD) and inflammatory response in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Prospective, triple-blind, randomized controlled trial. A single tertiary center. 140 adult patients undergoing elective OPCAB. Patients in Group S (esketamine group) received an infusion of esketamine at a dose of 0.25 mg/kg/h, while those in Group P (placebo group) received an equal volume of saline. The main outcome was the incidence of POD within the first 7 days after surgery. The incidence of POD within 7 days after surgery was significantly lower in Group S compared with Group P (relative risk: 0.474, 95% confidence interval: 0.231-0.970, p = 0.034). Furthermore, the levels of interleukin-6 (IL-6) at 12th and 72nd postoperative hours were significantly lower in Group S than in Group P (Z = -2.697, p = 0.007; Z = -2.022, p = 0.043). The C-reactive protein level at 72nd postoperative hour was also significantly lower in Group S (Z = -2.134, p = 0.003). Esketamine can decrease the incidence of POD, reduce postoperative inflammatory levels, and alleviate short-term inflammatory responses in OPCAB patients.