Esketamine cut the odds of postoperative delirium by 43%, on low-certainty evidence

The edition in brief

A meta-analysis of 17 randomised trials and 2,914 patients aged 60 or over found perioperative esketamine-containing regimens associated with lower postoperative delirium (OR 0.57, 95% CI 0.40 to 0.82, I squared 45.8%, 11 trials) and less nausea and vomiting (OR 0.49, 0.32 to 0.75), without more psychiatric adverse events (OR 1.41, 0.67 to 2.96). Certainty was limited and an exploratory analysis found no relationship between cumulative dose and delirium risk. In adolescent idiopathic scoliosis correction, a multicentre trial randomised 244 children to remifentanil guided by the Analgesia Nociception Index or by haemodynamic parameters. Day-1 morphine consumption was identical - 0.4 mg/kg in both arms, median difference -0.005 (95% CI -0.10 to 0.09), P = 0.93 - although the monitored group received 9.5 micrograms/kg less remifentanil intraoperatively. Persistent pain at six months did not differ. A meta-analysis of 10 studies found erector spinae plane block gave lower pain scores than intercostal nerve block at 1, 24 and 48 hours after thoracic surgery or chest wall trauma, with no difference in morphine equivalents at 24 or 48 hours, length of stay, or time under analgesia. Finally, a post hoc analysis of COP-AF's 3,209 patients showed myocardial injury after non-cardiac thoracic surgery in 29.3% of the 331 with coronary artery disease against 18.2% without (adjusted HR 1.53, 1.22 to 1.92), with no evidence that colchicine worked differently by coronary status.