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Clinical Benefits and Challenges of Esketamine in Elderly Patients During the Perioperative Period
Shuai Zhang1, Chen Bai1, Mingcan Xu1
1Department of Anesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.
Abstract:
Ketamine is a classic intravenous anesthetic. Esketamine is a dextro-isomer of ketamine, with similar mechanism of action, mainly through non-competitive antagonism of N-methyl-D-aspartate receptors, higher potency and fewer adverse effects. The characteristics of esketamine include circulatory stimulation, bronchodilatation, inhibition of inflammation and dissociative anesthetic properties. Esketamine was approved for clinical practice in China in 2019, and has significant advantages for use in pediatric, maternal, elderly or shock patients. The clinical use of esketamine is currently receiving widespread attention. This article reviews the recent progress and limitations of clinical studies on the perioperative use of esketamine in elderly patients, covering its pharmacological properties, hemodynamic effects, analgesic benefits, and impacts on depression, sleep, and neurocognitive function, to provide theoretical reference for its application in anesthesia and offer dosage recommendations for elderly patients.
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