Prophylactic esketamine for postoperative sore throat: a meta-analysis of randomized evidence.

Postoperative sore throat (POST) is a common and distressing complication following airway instrumentation under general anesthesia, with a significant impact on patient comfort and satisfaction. Esketamine, a potent N-methyl-D-aspartate (NMDA) receptor antagonist, has demonstrated analgesic and anti-inflammatory properties that may reduce airway irritation; however, its role in preventing POST remains unclear. This study aims to evaluate the efficacy and safety of prophylactic esketamine in reducing the incidence and severity of postoperative sore throat. A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Randomized controlled trials assessing esketamine for the prevention of POST in patients undergoing surgery with airway instrumentation were included. Databases (PubMed, Scopus, and Web of Science) were searched from inception to 2026. The primary outcome was the incidence of POST, while secondary outcomes included severity of POST, cough or bucking during extubation, extubation time, and adverse events. Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model. Five randomized controlled trials involving 548 patients were included. Esketamine significantly reduced the incidence of POST compared with control interventions (RR 0.42, 95% CI 0.24-0.71; P = 0.001), with moderate heterogeneity (I