PMID- 38446699
OWN - NLM
STAT- Publisher
LR  - 20240306
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Linking)
DP  - 2024 Mar 6
TI  - Effect of Esketamine on Postoperative Delirium in Patients Undergoing Cardiac 
      Valve Replacement with Cardiopulmonary Bypass: A Randomized Controlled Trial.
LID - 10.1213/ANE.0000000000006925 [doi]
AB  - BACKGROUND: The aim of this study was to investigate the effects of esketamine on 
      the risk of postoperative delirium (POD) in adults undergoing on-pump cardiac 
      valve surgery. METHODS: In this randomized, triple-blind, controlled trial, 116 
      adult patients with an American Society of Anesthesiologists (ASA) grade Ⅱ or Ⅲ 
      and a New York Heart Association (NYHA) grade Ⅱ or Ⅲ who underwent cardiac valve 
      surgery with cardiopulmonary bypass were included. Esketamine (0.25 mg/kg) or 
      normal saline was administered intravenously before anesthesia induction. The 
      primary outcome was POD, defined as a positive delirium assessment according to 
      the 3-minute confusion assessment method (CAM) or the confusion assessment method 
      for the intensive care unit (CAM-ICU) on a twice-daily basis for 7 days after 
      surgery. Delirium duration and the delirium subtype were also recorded. The 
      cognitive status of patients was measured according to the Mini-Mental State 
      Examination at baseline, discharge, 30 days postoperatively and 3 months 
      postoperatively. RESULTS: A total of 112 patients (mean age, 52 years; 53.6% 
      female) were enrolled; 56 were assigned to receive esketamine, and 56 were 
      assigned to receive placebo. POD occurred in 13 (23.2%) patients in the 
      esketamine group and in 25 (44.6%) patients in the placebo group (relative risk 
      [RR], 0.52, 95% confidence interval [CI], 0.28-0.91; P = .018). Thirteen patients 
      (23.2%) in the esketamine group and 24 (42.9%) patients in the placebo group had 
      multiple episodes of delirium (RR, 0.54, 95% CI, 0.28-0.92), and 13 (23.2%) vs 22 
      (39.3%) patients exhibited the hyperactive subtype. CONCLUSIONS: A single dose of 
      esketamine (0.25 mg/kg) injected intravenously before anesthesia induction 
      reduced the incidence of delirium in relatively young patients with ASA grade Ⅱ 
      or Ⅲ who underwent on-pump cardiac surgery.
CI  - Copyright (c) 2024 International Anesthesia Research Society.
FAU - Xiong, Xinglong
AU  - Xiong X
AD  - From the Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical 
      University, Guiyang, P. R. China.
FAU - Shao, Yi
AU  - Shao Y
AD  - From the Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical 
      University, Guiyang, P. R. China.
FAU - Chen, Dongxu
AU  - Chen D
AD  - Department of Anesthesiology, West China Second Hospital, Sichuan University, 
      Chengdu, P. R. China.
FAU - Chen, Bo
AU  - Chen B
AD  - From the Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical 
      University, Guiyang, P. R. China.
FAU - Lan, Xin
AU  - Lan X
AD  - From the Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical 
      University, Guiyang, P. R. China.
FAU - Shi, Jing
AU  - Shi J
AD  - From the Department of Anesthesiology, The Affiliated Hospital of Guizhou Medical 
      University, Guiyang, P. R. China.
LA  - eng
GR  - 21NSFCP11/Science and Technology Plan Project of Guizhou province/
PT  - Journal Article
DEP - 20240306
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
SB  - IM
COIS- The authors declare no conflicts of interest.
EDAT- 2024/03/06 18:42
MHDA- 2024/03/06 18:42
CRDT- 2024/03/06 13:02
PHST- 2024/03/06 18:42 [medline]
PHST- 2024/03/06 18:42 [pubmed]
PHST- 2024/03/06 13:02 [entrez]
AID - 00000539-990000000-00781 [pii]
AID - 10.1213/ANE.0000000000006925 [doi]
PST - aheadofprint
SO  - Anesth Analg. 2024 Mar 6. doi: 10.1213/ANE.0000000000006925.