Perioperative use of (es)ketamine significantly reduces the risk of postoperative delirium (POD) but does not prevent postoperative neurocognitive disorder (POND). Subgroup analyses indicate that esketamine is more effective for delirium prevention, whereas racemic ketamine provides better cognitive protection.
The 95% effective dose (ED95) of esketamine for reducing preoperative anxiety in children aged 1–4 years is 0.86 mg/kg, and for children aged 4–6 years it is 0.43 mg/kg, indicating that older children require a lower dose. The study included 80 children undergoing elective general anesthesia, divided into two age groups. Doses were adjusted using a biased coin design, and isotonic regression with bootstrapping calculated the ED95 and 95% confidence intervals. The ED95 values are clinically relevant for covering 95% of patients.