Li Shiyue, Li Yue, Gao Pengfei
State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
Front Pharmacol. 2025 Jun 9;16:1616843. doi: 10.3389/fphar.2025.1616843. eCollection 2025.
The aim of this study was to investigate the effect of esketamine on emergence delirium in pediatric patients.
We searched Pubmed, Cochrane Controlled Register of Trials, and Embase from inception to December 2024. Studies were independently evaluated for inclusion criteria and exclusion criteria by two reviewers. The primary outcome was the incidence of emergence delirium during the post-anesthesia period. The secondary outcomes were the PAED scores, FLACC scores, PACU stay time, and the incidence of nausea and vomiting.
Ten studies including 853 children were eligible for this meta-analysis. The pooled data revealed that esketamine administration significantly reduced the incidence of emergence delirium in pediatric patients (RR: 0.40, 95% CI: 0.30-0.53, P < 0.00001, I = 4%). Compared with the control group, esketamine also displayed lower PAED scores (MD: -3.66, 95% CI: -5.85-1.47, = 0.001, I = 99%) and FLACC scores (MD: -2.47, 95% CI: -3.32-1.61, < 0.0001, I = 89%). Esketamine had no significant effect on the PACU stay time (MD: 0.5 min, 95% CI: -1.51-2.51, = 0.63, I = 61%) and the incidence of nausea and vomiting (RR: 0.7, 95% CI: 0.46-1.06, = 0.09, I = 0%).
The administration of esketamine can reduce the incidence of emergence delirium without prolonging PACU stay time and increasing the risk of nausea and vomiting in pediatric patients. Subgroup analysis indicated that a single bolus esketamine before anesthesia induction or at the end of surgery would better reduce the risk of ED than intraoperative continuous infusion.
本研究旨在探讨艾司氯胺酮对小儿患者苏醒期谵妄的影响。
我们检索了从建库至2024年12月的PubMed、Cochrane对照试验注册库和Embase。由两名 reviewers 独立评估研究的纳入标准和排除标准。主要结局是麻醉后期间苏醒期谵妄的发生率。次要结局是小儿麻醉苏醒期躁动（PAED）评分、面部表情、腿活动、活动、哭闹、安慰（FLACC）评分、麻醉后监护病房（PACU）停留时间以及恶心和呕吐的发生率。
10项研究（包括853名儿童）符合本荟萃分析的条件。汇总数据显示，给予艾司氯胺酮可显著降低小儿患者苏醒期谵妄的发生率（风险比：0.40，95%置信区间：0.30 - 0.53，P < 0.00001，I² = 4%）。与对照组相比，艾司氯胺酮还显示出较低的PAED评分（平均差：-3.66，95%置信区间：-5.85 - 1.47，P = 0.001，I² = 99%）和FLACC评分（平均差：-2.47，95%置信区间：-3.32 - 1.61，P < 0.0001，I² = 89%）。艾司氯胺酮对PACU停留时间（平均差：0.5分钟，95%置信区间：-1.51 - 2.51，P = 0.63，I² = 61%）以及恶心和呕吐的发生率（风险比：0.7, 95%置信区间：0.46 - 1.06, P = 0.09, I² = 0%）无显著影响。
给予艾司氯胺酮可降低苏醒期谵妄的发生率，且不会延长小儿患者的PACU停留时间或增加恶心和呕吐的风险。亚组分析表明，在麻醉诱导前或手术结束时单次推注艾司氯胺酮比术中持续输注能更好地降低苏醒期谵妄的风险。
