Risk of esketamine anesthesia on the emergence delirium in preschool children after minor surgery: a prospective observational clinical study

Chen, Sai; Yang, Jin-Jin; Zhang, Yue; Lei, Lei; Qiu, Di; Lv, Hui-Min; Sun, Zhentao; Hashimoto, Kenji; Yang, Jianjun

doi:10.1007/s00406-023-01611-z

Cited by 6 publications

(2 citation statements)

References 51 publications

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“…Chen Sai et al found that exposure to esketamine was one of the independent risk factors for emergence delirium (ED) during recovery from anesthesia in preschool children. To reduce the incidence of ED, the dose of esketamine used during induction of anesthesia should be ≤ 0.3 mg/kg [ 17 ]. Therefore, the dose of esketamine at the induction of anesthesia in this study was set at 0.3 mg/kg.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of perioperative low-dose esketamine infusion for postoperative pain management in pediatric urological surgery: a prospective clinical trial

Xie,

Liang,

Chen

et al. 2024

BMC Anesthesiol

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Background Postoperative pain is common in pediatric urological surgery. The study assess the impact of perioperative intravenous infusion of low-dose esketamine on postoperative pain in pediatric urological surgery. Methods Pediatric patients (n = 80) undergoing urological surgery were randomized into four groups. Patients in the control group were administered an analgesic pump containing only hydromorphone at a dose of 0.1 mg/kg (Hydromorphone Group 1, H1) or 0.15 mg/kg (Hydromorphone Group 2, H2). Patients in the experimental group were injected intravenously with 0.3 mg/kg of esketamine (Esketamine group 1, ES1) or equal volume of saline (Esketamine Group 2, ES2) during anesthesia induction. Esketamine 1.0 mg/kg and hydromorphone 0.1 mg/kg were added to the analgesic pump. Face, Leg, Activity, Crying, and Comfort (FLACC) scale or the Numerical Rating Scale (NRS) and adverse effects were recorded at 2, 6, 24, and 48 h postoperatively. Additionally, total and effective PCA button presses were recorded. Results In comparison to the H1 group, the pain scores were notably reduced at all postoperative time points in both the ES1 and H2 groups. The ES2 group exhibited lower pain scores only at 24 and 48 h postoperatively. When compared to the H2 group, there were no significant differences in pain scores at various postoperative time points in the ES2 group. However, the ES1 group demonstrated significantly lower pain scores at 6, 24 and 48 h postoperatively, and these scores were also significantly lower than those observed in the ES2 group. The total and effective number of PCA button presses in the ES1, ES2 and H2 group were lower than that in the H1 group (P < 0.001). The incidence of adverse effects within 48 h after surgery was 15% in ES1, 22% in ES2, 58% in H1, and 42% in H2, respectively (P = 0.021). Conclusions The use of low-dose esketamine infusion in analgesia pump can effectively alleviates postoperative pain in pediatric urological patients, leading to a significant reduction in the number of analgesic pump button press. The combined approach of perioperative anesthesia induction and analgesia pump administration is recommended for optimal pain management in these patients. Trial registration Chinese Clinical Trial Registry- ChiCTR2300073879 (24/07/2023).

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Section: Discussionmentioning

confidence: 99%

Effectiveness of perioperative low-dose esketamine infusion for postoperative pain management in pediatric urological surgery: a prospective clinical trial

Xie,

Liang,

Chen

et al. 2024

BMC Anesthesiol

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“…Esketamine, a novel intravenous anesthetic drug, is the dextro-isomer of ketamine. It shares similar pharmacological effects with ketamine but exhibits a higher binding affinity to N-methyl-D-aspartate (NMDA) receptors, resulting in stronger sedative and analgesic effects (4). As the side effects of ketamine are dose-dependent, using esketamine at a lower dose can reduce the incidence of adverse reactions after anesthesia, making it more suitable for clinical practice (5).…”

Section: Introductionmentioning

confidence: 99%

Effect of Esketamine Applied in Fiberoptic Bronchoscopy on Negative Postoperative Behavioral Changes of Children

Zhang,

Yao,

Yang

et al. 2023

Iran J Pediatr

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Background: Fiberoptic bronchoscopy is currently the most commonly used invasive examination method in clinical practice. Objectives: This study aimed to assess the impact of esketamine administration during fiberoptic bronchoscopy on the occurrence of negative postoperative behavioral changes (NPOBCs) in children. Methods: Ninety children undergoing fiberoptic bronchoscopy were enrolled and randomly assigned to 3 groups: the control group (group C, n = 30), treatment group 1 (group D1, n = 30), and treatment group 2 (group D2, n = 30). Group C received intratracheal surface anesthesia and sevoflurane inhalation, along with an intravenous injection of 5 mL of normal saline. Group D1 received intratracheal surface anesthesia and sevoflurane inhalation in addition to an intravenous injection of 0.5 mg/kg of esketamine diluted to 5 mL. Group D2 received intratracheal surface anesthesia and sevoflurane inhalation, with an intravenous injection of 0.75 mg/kg of esketamine diluted to 5 mL. Results: The incidence of NPOBCs was lower in groups D1 and D2 compared to group C at 1, 7, 14, and 30 days after the examination (P < 0.05). The pediatric anesthesia emergence delirium (PAED) scores were lower in groups D1 and D2 than in group C, with group D2 scoring lower than group D1 (P < 0.05). Groups D1 and D2 had a longer time to awaken than group C (P < 0.05), with group D2 having a longer time than group D1. The face, legs, activity, cry, and consolability (FLACC) scores in groups D1 and D2 were significantly lower than in group C, and group D2 had a lower score than group D1 (P < 0.05). The incidence of adverse reactions was lower in groups D1 and D2 compared to group C, and the rate was even lower in group D2 than in group D1 (P < 0.05). Conclusions: Administration of esketamine at a dose of 0.75 mg/kg may yield better clinical outcomes.

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Beneficial and adverse effects of ketamine and its enantiomers, and the underlying mechanisms of ECT and rTMS efficacy

Hashimoto

2024

Eur Arch Psychiatry Clin Neurosci

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Risk of esketamine anesthesia on the emergence delirium in preschool children after minor surgery: a prospective observational clinical study

Cited by 6 publications

References 51 publications

Effectiveness of perioperative low-dose esketamine infusion for postoperative pain management in pediatric urological surgery: a prospective clinical trial

Effectiveness of perioperative low-dose esketamine infusion for postoperative pain management in pediatric urological surgery: a prospective clinical trial

Effect of Esketamine Applied in Fiberoptic Bronchoscopy on Negative Postoperative Behavioral Changes of Children

Beneficial and adverse effects of ketamine and its enantiomers, and the underlying mechanisms of ECT and rTMS efficacy

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