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

In patients undergoing off-pump coronary artery bypass grafting, continuous intravenous infusion of esketamine during surgery reduced the incidence of postoperative delirium within the first seven days by about half compared with a placebo infusion of saline. Esketamine also lowered levels of the inflammatory markers interleukin-6 at 12 and 72 hours after surgery and C-reactive protein at 72 hours. The findings suggest that esketamine can decrease postoperative delirium and short-term inflammatory responses in this patient population.

Study at a glance

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.