Image 1_The effect of esketamine on postoperative delirium in patients undergoing general anesthesia: a systematic review and meta-analysis.jpg
Figshare – November 07, 2025
Source: OpenAlex
Summary
Esketamine significantly reduces the incidence of postoperative delirium (POD) in patients undergoing general anesthesia. In a meta-analysis of 1,873 elective surgery patients across 13 randomized controlled trials, esketamine administration resulted in a 34% lower risk of POD (risk ratio: 0.66). Additionally, rates of postoperative nausea and vomiting (PONV) were decreased in the esketamine group. Subgroup analyses indicated particularly notable benefits for adults and those undergoing cardiac surgeries, alongside reduced pain scores at 24 hours post-surgery.
Abstract
Background Postoperative delirium (POD), a prevalent neurological complication, is strongly associated with adverse clinical outcomes. This meta-analysis aimed to evaluate the efficacy of esketamine in preventing POD among patients receiving general anesthesia. Methods We systematically searched PubMed, Embase, Cochrane Library, Web of Science, clinical trial registries and major conference proceedings for randomized controlled trials (RCTs) examining esketamine’s impact on POD in general anesthesia patients, from inception through 30 June 2025. Statistical analyses were performed using RevMan 5.4 and Stata 12.0. Dichotomous outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI), while continuous variables were analyzed via mean differences (MD). Study bias was assessed with the Cochrane ROB 2.0 tool. Results Thirteen RCTs involving 1,873 elective surgery patients under general anesthesia were included. Esketamine administration was associated with a lower POD incidence (RR: 0.66; 95% CI: 0.49–0.91; P < 0.05). Subgroup analyses revealed potentially significant reductions in adult populations and cardiac surgery cohorts. The postoperative nausea and vomiting (PONV) rate decreased in the esketamine group. Additionally, esketamine was associated with reduced pain scores at 24 h postoperatively. Conclusion Our findings suggest that esketamine may be associated with a lower POD risk following general anesthesia. Further large-scale trials are warranted to validate these preliminary findings. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/recorddashboard.