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Effect of Esketamine on Postoperative Delirium and Inflammatory Response in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: A Randomized Controlled Study.

Liang-Yu Ju, Guo-Qiang Liu, Li Yuan, Lin Lyu, Yu Su, Ai-Jie Liu

Journal of Cardiothoracic and Vascular Anesthesia April 10, 2025 DOI: 10.1053/j.jvca.2025.04.013 (opens in new tab)

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Study at a glance

AI-extracted from the abstract
Characteristics Randomized controlled trial Peer reviewed
Sample size 140
Population Adult patients undergoing elective off-pump coronary artery bypass grafting
Intervention Esketamine
Dose 0.25 mg/kg/h
Topics Esketamine
Keywords Postoperative delirium Postoperative inflammation Anesthesia-medication Medical-breakthrough Cardiac-surgery Surgical-recovery Postoperative-care
Citations 4
Key findings Esketamine infusion during surgery significantly reduced the incidence of postoperative delirium within seven days and lowered postoperative inflammatory markers compared with placebo.

Abstract

To investigate whether continuous intravenous infusion of esketamine during surgery can improve postoperative delirium (POD) and inflammatory response in patients undergoing off-pump coronary artery bypass grafting (OPCAB). Prospective, triple-blind, randomized controlled trial. A single tertiary center. 140 adult patients undergoing elective OPCAB. Patients in Group S (esketamine group) received an infusion of esketamine at a dose of 0.25 mg/kg/h, while those in Group P (placebo group) received an equal volume of saline. The main outcome was the incidence of POD within the first 7 days after surgery. The incidence of POD within 7 days after surgery was significantly lower in Group S compared with Group P (relative risk: 0.474, 95% confidence interval: 0.231-0.970, p = 0.034). Furthermore, the levels of interleukin-6 (IL-6) at 12th and 72nd postoperative hours were significantly lower in Group S than in Group P (Z = -2.697, p = 0.007; Z = -2.022, p = 0.043). The C-reactive protein level at 72nd postoperative hour was also significantly lower in Group S (Z = -2.134, p = 0.003). Esketamine can decrease the incidence of POD, reduce postoperative inflammatory levels, and alleviate short-term inflammatory responses in OPCAB patients.

Comparable studies

Other randomized controlled trials on esketamine, most cited first.

Study Year Design Participants
Efficacy and Safety of Flexibly Dosed Esketamine Nasal Spray Combined With a Newly Initiated Oral Antidepressant in Treatment-Resistant Depression: A Randomized Double-Blind Active-Controlled Study Adults with moderate to severe nonpsychotic depression and a history of nonresponse to... 2019 Phase 3, double-blind, active-controlled, multicenter randomized controlled trial n = 227
Efficacy of Esketamine Nasal Spray Plus Oral Antidepressant Treatment for Relapse Prevention in Patients With Treatment-Resistant Depression Adults with treatment-resistant depression who achieved stable remission or stable... 2019 Phase 3, multicenter, double-blind, randomized withdrawal study n = 297
Efficacy and Safety of Intranasal Esketamine Adjunctive to Oral Antidepressant Therapy in Treatment-Resistant Depression Adults with DSM-IV-TR diagnosis of major depressive disorder and history of inadequate... 2017 Phase 2, double-blind, doubly randomized, delayed-start, placebo-controlled study n = 67
Efficacy and Safety of Intranasal Esketamine for the Rapid Reduction of Symptoms of Depression and Suicidality in Patients at Imminent Risk for Suicide: Results of a Double-Blind, Randomized, Placebo-Controlled Study Depressed patients at imminent risk for suicide 2018 Randomized controlled trial n = 68
Efficacy and Safety of Fixed-Dose Esketamine Nasal Spray Combined With a New Oral Antidepressant in Treatment-Resistant Depression: Results of a Randomized, Double-Blind, Active-Controlled Study (TRANSFORM-1) Adults with moderate-to-severe depression and nonresponse to at least two... 2019 Randomized controlled trial n = 346

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