Esketamine-containing regimens were associated with less delirium in older surgical patients

Design

Systematic review and meta-analysis of randomised trials

Population

17 trials, 2,914 surgical patients aged 60 and over

Primary outcome

Postoperative delirium incidence

Effect

OR 0.57 (95% CI 0.40 to 0.82); PONV OR 0.49 (0.32 to 0.75)

This meta-analysis, published 14 September in BMC Geriatrics, pooled 17 randomised trials with 2,914 adults aged 60 and over given perioperative esketamine-containing regimens; 11 trials contributed to the primary delirium analysis.

Esketamine was associated with lower postoperative delirium (OR 0.57, 95% CI 0.40 to 0.82; I² 45.8%) and less nausea and vomiting (OR 0.49), without more psychiatric adverse events (OR 1.41, 0.67 to 2.96). Four trials suggested less postoperative cognitive dysfunction (OR 0.39), but certainty was very low. There was no dose–response relationship.

Most trials were from single centres with varied anaesthetic and analgesic regimens, and esketamine is not available everywhere. The signal is consistent enough to justify larger standardised trials, not yet to add esketamine for delirium prevention alone.

• Esketamine-containing regimens were associated with less delirium in patients over 60.
• They were also associated with less postoperative nausea and vomiting.
• No increase in psychiatric adverse events was seen, although the confidence interval was wide.
• Continue proven delirium prevention — orientation, sleep, avoiding benzodiazepines — as the foundation.

Why it matters

Adds a possible pharmacological lever to delirium prevention, which has few.

Don't overread it

Mostly small single-centre trials with varied co-interventions; the review was registered retrospectively.

The statistics, in plain English

An odds ratio of 0.57 suggests about 40% lower odds of delirium. Moderate heterogeneity (I² 46%) means trials differed, and the very-low-certainty cognitive result should not be quoted as established.

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