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Combined Esketamine and Dexmedetomidine Decreases the Risk of Postoperative Delirium in Neurosurgical Pediatrics: A
Chen-Yu Wen1, Ju Bao1, Yin Zhou2
1Department of Anesthesiology, Peking University First Hospital, Beijing, People's Republic of China.
Insights
Combined esketamine and dexmedetomidine significantly reduced postoperative delirium and emergence delirium in pediatric neurosurgery patients. This anesthesia approach also lowered medical costs without increasing complications.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Neuroscience
Background:
- Postoperative delirium (POD) is a significant concern in pediatric neurosurgery.
- Identifying effective anesthetic strategies to mitigate POD risk is crucial.
Purpose of the Study:
- To investigate the efficacy of combined esketamine and dexmedetomidine in reducing the incidence of POD in pediatric neurosurgery patients.
- To evaluate secondary outcomes including emergence delirium, complications, hospital stay, and medical costs.
Main Methods:
- A prospective, randomized controlled study involving pediatric patients (aged 2-16 years) undergoing selective neurosurgery.
- Patients received either combined esketamine (0.5 mg/kg) and dexmedetomidine (0.5 μg/kg) or placebo at anesthesia induction.
- Delirium was assessed using the Cornell Assessment of Pediatric Delirium (CAPD) twice daily for five days postoperatively.
Main Results:
- The esketamine-dexmedetomidine group showed a significantly lower incidence of POD compared to the placebo group (22.8% vs 38.0%, P=0.025).
- Incidence of emergence delirium was markedly reduced in the esketamine-dexmedetomidine group (20.7% vs 50.0%, P<0.001).
- This group also experienced lower medical costs, with no significant differences in other complications or hospital stay duration.
Conclusions:
- Combined esketamine and dexmedetomidine is an effective strategy for decreasing the risk of postoperative and emergence delirium in pediatric neurosurgery.
- This anesthetic combination offers a promising approach to improve patient outcomes and reduce healthcare costs.
Purpose:
Present study was designed to investigate whether combined esketamine and dexmedetomidine could decrease the risk of postoperative delirium in neurosurgical pediatric.
Patients And Methods:
In this prospective randomized controlled study, pediatrics (aged 2-16 years) who were scheduled for selective neurosurgery were enrolled. Patients were randomized to receive combined esketamine (0.5 mg/kg) and dexmedetomidine (0.5 μg/kg) or normal saline as placebo at anesthesia induction. Primary outcome was the incidence of delirium within postoperative the first five days which was assessed twice daily using the Cornell Assessment of Pediatric Delirium (CAPD). CAPD≥ 10 at any assessment point was considered as delirium. Secondary outcomes included the incidence of emergence delirium, non-delirium complications within postoperative 30 days, postoperative length of in-hospital stay, and medical cost during hospitalization. The change of systematic inflammation was reflected by Neutrophil-to-Lymphocyte Ratio.
Results:
From July 2021 to March 2023, 270 patients were screened, and 190 patients were randomized. Median age of enrolled patients was similar between two groups (63.0 [43.3, 111.3] vs 70.0 [46.3, 114.8] months, P = 0.883). Patients in esketamine-dex group suffered lower incidence of postoperative delirium than control group (intention-to-treat analysis: 22.8% [21/92] vs 38.0% [35/92], RR = 0.600, 95% CI 0.380-0.948, P = 0.025; per-protocol analysis: 22.0% [20/91] vs 38.2% [34/89], RR = 0.575, 95% CI 0.360-0.919, P = 0.018). The incidence of emergence delirium was lower in esketamine-dex group than control group (20.7% [19/92] vs 50.0% [46/92], RR = 0.413, 95% CI 0.263-0.648, P < 0.001). Patients in esketamine-dex group had lower medical cost (P < 0.001), and there was no statistical significance in the incidence of non-delirium complications within postoperative 30 days and postoperative length of in-hospital stay. The neutrophil-to-lymphocyte ratios at postoperative first and third day were comparable between two groups. Safety outcomes such as bradycardia and hypotension were comparable between groups.
Conclusion:
Combined esketamine and dexmedetomidine could decrease the risk postoperative delirium and emergence delirium in pediatrics after neurosurgery.
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