Ketamine and Esketamine for the Prevention of Delirium in Surgical Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Journal of Intensive Care Medicine January 7, 2026 Nestor Cordeiro Dos Santos Neto, R. Rolim Neto, Esther Frota Gomes et al. 1 citation
A systematic review and meta-analysis of eight randomized controlled trials with 1,645 patients found that ketamine or esketamine reduced the incidence of delirium by about half (odds ratio 0.50) compared to placebo. The benefit was significant in older adults (mean age over 60) but not in younger patients. However, neuropsychiatric adverse events such as hallucinations and nightmares were more common with ketamine (odds ratio 1.60). No consistent effects were seen on pain scores, opioid use, or length of hospital or ICU stay. The authors conclude that ketamine may help prevent delirium in older surgical patients, but the risk of neuropsychiatric side effects must be considered.