Department of Anesthesiology, Pain and Perioperative Medicine, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, People's Republic of China.
2 papers in the library · 33 citations · publishing 2024-2025
A randomized controlled trial tested whether low-dose esketamine reduces postoperative delirium in elderly patients after total hip or knee replacement. Two hundred sixty participants received either esketamine (a loading dose of 0.20 mg/kg, infusion of 0.125 mg/kg/h, and 0.5 mg/kg for postoperative pain) or a placebo of normal saline. Delirium occurred in 8.5% of the esketamine group and 10.8% of the placebo group, a difference that was not statistically significant. The timing, duration, and subtype of delirium also did not differ between groups. Esketamine provided more stable blood pressure after anesthesia induction and lowered pain with movement during the first two days after surgery, but increased dizziness. Repeated low-dose esketamine did not reduce delirium in the first three days after surgery.
A meta-analysis of five randomized controlled trials involving 664 patients with major depressive disorder or bipolar depression found that intravenous (IV) ketamine produced a greater reduction in depressive symptoms 24 hours after the first treatment compared to electroconvulsive therapy (ECT). However, by the end of treatment, both approaches showed similar rates of response and remission. Neurocognitive outcomes were inconsistent across studies. IV ketamine caused more dissociation, blurred vision, dizziness, and double vision, while ECT led to more muscle pain. The faster onset of antidepressant effects with IV ketamine does not translate into superior long-term outcomes, and larger trials are needed to assess lasting efficacy and safety.