Research advances in the clinical application of esketamine

Abstract

Esketamine is dextrorotatory ketamine, which is an enantiomer of ketamine. Compared with ketamine, it has the advantages of a fast metabolism, fewer side effects, and strong pharmacological effects, so it is more suitable for clinical use. Esketamine has a powerful analgesic effect and has little effect on breathing. It has a wide range of applications in the fields of pediatric anesthesia, conscious sedation anesthesia, and emergency analgesia. In addition, it is also used for pain that is difficult to relieve with conventional drugs and to prevent postoperative pain. Various routes of administration are also suitable for patients who need short‐term analgesia and sedation. As a drug, esketamine inevitably brings some side effects when it is used clinically. In this article, by introducing the mechanism of action and pharmacological characteristics of esketamine, its clinical application is reviewed, and it provides a reference for the more reasonable and safe clinical application of esketamine.

Safety and tolerability of esketamine in propofol based sedation for endoscopic variceal ligation with or without injection sclerotherapy: Randomized controlled trial

“…It has both anesthetic and analgesic effects and causes less hypotension than other anesthetics due to its sympathomimetic effect 12 . Esketamine is an S (+) enantiomer of ketamine, which has stronger sedative potency and possibly fewer psychomimetic effects than racemic ketamine 13 . There is limited evidence to prove its efficacy as an adjuvant drug in propofol based sedation for cirrhotic patients receiving EVL.…”

“…12 Esketamine is an S (+) enantiomer of ketamine, which has stronger sedative potency and possibly fewer psychomimetic effects than racemic ketamine. 13 There is limited evidence to prove its efficacy as an adjuvant drug in propofol based sedation for cirrhotic patients receiving EVL. We performed this randomized study to investigate the safety and tolerability of esketamine as an adjuvant to propofol for EVL, assuming that combination of esketamine and propofol would provide safe sedation with less hemodynamic instability and respiratory depression.…”

Anaesthesia administered as S(+)-ketamine for cardiac intervention in children with common congenital heart disease

“…Thus, use of S(+)-ketamine in combinations with anesthetics such as propofol can provide additional advantages in clinical settings, especially for pediatric surgeries conducted in the catheterization room. [2] Importantly, S(+)-ketamine use leads to increases in salivary and bronchial secretions, which can induce laryngospasm in severe cases, requiring routine use of cholinergic receptor blockers (e.g., atropine) before anesthesia is administered in order to inhibit glandular secretory activities. Although in this study atropine was used preoperatively to elevate the HR in order to avoid propofol-induced HR decrease along with the abovementioned measures to ensure adequate cardiac output, it also inhibited cholinergic receptor activities to reduce glandular secretion of saliva.…”

“…Thus, use of S(+)-ketamine in combinations with anesthetics such as propofol can provide additional advantages in clinical settings, especially for pediatric surgeries conducted in the catheterization room. [2]…”

“…S(+)-ketamine (esketamine) is a spin isomer of ketamine that has high potency with fewer adverse effects as compared with ketamine. [1,2] However, use of combinations of S(+)-ketamine and propofol in clinical settings have not frequently been reported in China, prompting this study. Here, safety and efficacy were assessed of different doses of S(+)-ketamine administered with propofol during surgical cardiac interventions conducted in pediatric CHD patients in China.…”