Evidence map›Paper›PMID 40398929›Full record

SynthesisBMJ open2025

Impact of perioperative esketamine on the perioperative neurocognitive dysfunction: a systematic review and meta-analysis of randomised controlled studies.

Xuesen Su, Lu Chen, Yanan Zhao, Chao Li, Shufang Liu, Zixuan Wang, Jiayu Zhu, Xin Yuan, Yihe Tian, Shouyuan Tian

2 registry-linked trialsAbstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 5 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07576517 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Perioperative Use of Dexmedetomidine-esketamine Combination and Transcranial Direct Current Stimulation for Prevention of Neurocognitive Complications in Older Patients After Non-cardiac Surgery: a 2×2 Factorial Trial

TypeinterventionalSponsorPeking University First HospitalRan2026 to 2030Enrolled1,160ConditionsOlder Patients, Surgery, Dexmedetomidine, EsketamineArmsDex-Esk, Placebo, Active tDCS, Sham tDCS
NCT07576543 phase4not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Long-term Follow-up of Perioperative Dexmedetomidine-esketamine Combination and Transcranial Direct Current Stimulation for Prevention of Neurocognitive Complications in Older Patients After Non-cardiac Surgery

TypeinterventionalSponsorPeking University First HospitalRan2026 to 2031Enrolled1,160ConditionsOlder Patients, Surgery, Dexmedetomidine, EsketamineArmsDex-Esk, Placebo, Active tDCS, Sham tDCS
3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Xuesen SuThe Anesthesiology Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi, China.
Lu ChenCancer Hospital Affiliated to Shanxi Medical University, Shanxi Medical University, Taiyuan, Shanxi, China.
Yanan ZhaoThe College of Anesthesia, Shanxi Medical University, Taiyuan, Shanxi, China.
Chao LiThe Anesthesiology Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi, China.
Shufang LiuThe Anesthesiology Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi, China.
Zixuan WangThe Anesthesiology Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi, China.
Jiayu ZhuThe Anesthesiology Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi, China.
Xin YuanDepartment of Anesthesiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Yihe TianJohn Muir College, University of California San Diego, La Jolla, California, USA.
Shouyuan TianThe Anesthesiology Department of Shanxi Provincial People's Hospital, Shanxi Medical University, Taiyuan, Shanxi, China chinatsyjj@sxmu.edu.cn.ORCID http://orcid.org/0009-0006-2680-9918

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe effect of esketamine on perioperative neurocognitive dysfunction (PND) remains controversial. This systematic review and meta-analysis aimed to evaluate the impact of perioperative esketamine administration on PND.

designSystematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, Web of Science and Cochrane Library were searched from their inception to 25 April 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included the randomised controlled trials (RCTs) that compared single or continuous intravenous infusion of esketamine to saline among adult surgical patients without pre-existing neurocognitive disorders. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted pertinent information from the included studies. Risk of bias was assessed using Cochrane's risk of bias criteria. Risk ratios (RRs) and their corresponding 95% CIs were synthesised using a random-effects model. The overall evidence quality was appraised using the Grading of Recommendations Assessment, Development and Evaluation framework.

results10 RCTs were included in our meta-analysis, involving 854 surgical patients. Perioperative esketamine was associated with a reduced risk of postoperative delirium (POD) (relative risk (RR): 0.46, 95% CI: 0.30 to 0.71, p<0.001) and delayed neurocognitive recovery (dNCR) (RR: 0.41, 95% CI: 0.21 to 0.78, p<0.001). However, no statistically significant difference was found in the risk of postoperative neurocognitive disorder (post-NCD) at 3 months postsurgery between the esketamine and control groups (RR: 0.57, 95% CI: 0.19 to 1.73, p=0.40). Additionally, pain severity was reduced on postoperative day 1, with no difference in the risk of adverse events or length of hospital stay.

conclusionPerioperative esketamine reduces the risk of short-term PND, including POD and dNCR, without significantly affecting the incidence of adverse events or length of hospital stay. However, no significant differences were observed in the risk of post-NCD at 3 months following surgery. This systematic review and meta-analysis offers valuable data for PND research and clinical drug intervention strategies. PROSPERO REGISTRATION NUMBER: CRD42024538438.

Indexed as

KetamineNeurocognitive DisordersPerioperative CarePostoperative ComplicationsHumansRandomized Controlled Trials as TopicEsketamineKetamineAdult anaesthesiaMeta-AnalysisSystematic Review

Identifiers

PMID40398929
PMCPMC12096981

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.