SYSTEMATIC REVIEW article
Front. Pharmacol.
Sec. Neuropharmacology
The effect of esketamine on postoperative delirium in patients undergoing general anesthesia: a systematic review and meta-analysis
Provisionally accepted
- 1Jiashan First People’s Hospital, Jiaxing, China
- 2First Hospital of Jiaxing, Jiaxing, China
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Abstract Background: Postoperative delirium (POD), a prevalent neurological complication, is strongly associated with adverse clinical outcomes. This meta-analysis aimed to evaluate the efficacy of esketamine in preventing POD among patients receiving general anesthesia. Methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, clinical trial registries and major conference proceedings for randomized controlled trials (RCTs) examining esketamine's impact on POD in general anesthesia patients, from inception through June 30, 2025. Statistical analyses were performed using RevMan 5.4 and Stata 12.0. Dichotomous outcomes were expressed as risk ratios (RR) with 95% confidence intervals (CI), while continuous variables were analyzed via mean differences (MD). Study bias was assessed with the Cochrane ROB 2.0 tool. Results: Thirteen RCTs involving 1,873 elective surgery patients under general anesthesia were included. Esketamine administration was associated with a lower POD incidence (RR: 0.66; 95% CI: 0.49 – 0.91; P < 0.05). Subgroup analyses revealed potentially significant reductions in adult populations and cardiac surgery cohorts. The postoperative nausea and vomiting (PONV) rate decreased in the esketamine group. Additionally, esketamine was associated with reduced pain scores at 24 hours postoperatively. Conclusion: Our findings suggest that esketamine may be associated with a lower POD risk following general anesthesia. Further large-scale trials are warranted to validate these preliminary findings.
Keywords: Esketamine, postoperative delirium, Meta-analysis, POD, PONV (postoperative nausea and vomiting)
Received: 07 Aug 2025; Accepted: 29 Oct 2025.
Copyright: © 2025 Xu, Tong, Shen and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jing Zhao, 13666720652@163.com
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