Na Zhou, Chengchuan Chen, Yubei Liu, Zhaolan Yu, Yanhua Chen
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Some studies have shown that intraoperative ketamine/esketamine reduces the incidence of POCD, but this remains controversial.</p><p><strong>Objectives: </strong>We evaluated the effect of intraoperative subanesthetic doses of ketamine/esketamine <i>versus</i> no intervention in adults undergoing general anesthesia surgery on the incidence of POCD.</p><p><strong>Data sources: </strong>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched the PubMed, Embase, Ovid, Cochrane, Scopus, and Web of Science databases for the MeSH terms 'ketamine', 'esketamine', and 'Postoperative Cognitive Complications' from database inception to 25 June 2023.</p><p><strong>Results: </strong>We found no statistically significant difference in the incidence of POCD within 7 days for intraoperative subanesthetic dose of ketamine/esketamine compared with the control group [relative risk (RR) = 0.57, 95% confidence interval (CI): 0.32, 1.01], and the results from the subgroup analysis based on age (>60 years) also revealed that the difference was not statistically significant (RR = 0.49, 95% CI: 0.23, 1.04).</p><p><strong>Conclusion: </strong>Compared with controls, intraoperative subanesthetic dose of ketamine/esketamine has no advantage in preventing POCD in patients, or in elderly patients. 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However, the pathogenesis of POCD is not fully understood, and therefore an optimal solution for preventing POCD has yet to be established. Some studies have shown that intraoperative ketamine/esketamine reduces the incidence of POCD, but this remains controversial.</p><p><strong>Objectives: </strong>We evaluated the effect of intraoperative subanesthetic doses of ketamine/esketamine <i>versus</i> no intervention in adults undergoing general anesthesia surgery on the incidence of POCD.</p><p><strong>Data sources: </strong>We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched the PubMed, Embase, Ovid, Cochrane, Scopus, and Web of Science databases for the MeSH terms 'ketamine', 'esketamine', and 'Postoperative Cognitive Complications' from database inception to 25 June 2023.</p><p><strong>Results: </strong>We found no statistically significant difference in the incidence of POCD within 7 days for intraoperative subanesthetic dose of ketamine/esketamine compared with the control group [relative risk (RR) = 0.57, 95% confidence interval (CI): 0.32, 1.01], and the results from the subgroup analysis based on age (>60 years) also revealed that the difference was not statistically significant (RR = 0.49, 95% CI: 0.23, 1.04).</p><p><strong>Conclusion: </strong>Compared with controls, intraoperative subanesthetic dose of ketamine/esketamine has no advantage in preventing POCD in patients, or in elderly patients. 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引用次数: 0
摘要
背景：术后认知功能障碍（POCD）是麻醉手术后的一种常见并发症，尤其是在老年人中，它可能在手术后持续数周或数月，作为认知能力的短期损伤，甚至持续数年，可能发展为永久性认知功能障碍。然而，POCD的发病机制尚不完全清楚，因此预防POCD的最佳解决方案尚未确定。一些研究表明，术中氯胺酮/氯胺酮可以降低POCD的发生率，但这一点仍有争议。目的：我们评估了在接受全麻手术的成年人中，术中亚麻醉剂量的氯胺酮/爱斯基摩胺与不干预对POCD发生率的影响。数据来源：我们遵循系统评价和荟萃分析的首选报告项目指南，并在PubMed、Embase、Ovid、Cochrane、Scopus和Web of Science数据库中搜索MeSH术语“氯胺酮”、“爱斯基摩胺”，以及从数据库建立到2023年6月25日的“术后认知并发症”。结果：我们发现7天内POCD的发生率没有统计学上的显著差异 与对照组相比，术中氯胺酮/氯胺酮亚麻醉剂量的天数[相对风险（RR） = 0.57,95%置信区间（CI）：0.321.01]，以及基于年龄的亚组分析结果（>60 年）也表明差异在统计学上并不显著（RR = 0.49，95%CI:0.23，1.04）。结论：与对照组相比，术中亚麻醉剂量的氯胺酮/氯胺酮在预防患者或老年患者POCD方面没有优势。本研究为POCD研究和临床药物干预策略提供了参考数据。注册：系统评价前瞻性注册（PROSPERO；注册号CRD42023401159）。
Efficacy of intraoperative subanesthetic dose of ketamine/esketamine in preventing postoperative cognitive dysfunction: a systematic review and meta-analysis.
Background: Postoperative cognitive dysfunction (POCD) is a common complication after anesthesia surgery, especially in older people, that can persist weeks or months after surgery as a short-term impairment of cognitive abilities, or even for a prolonged duration over years, potentially progressing into permanent cognitive dysfunction. However, the pathogenesis of POCD is not fully understood, and therefore an optimal solution for preventing POCD has yet to be established. Some studies have shown that intraoperative ketamine/esketamine reduces the incidence of POCD, but this remains controversial.
Objectives: We evaluated the effect of intraoperative subanesthetic doses of ketamine/esketamine versus no intervention in adults undergoing general anesthesia surgery on the incidence of POCD.
Data sources: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched the PubMed, Embase, Ovid, Cochrane, Scopus, and Web of Science databases for the MeSH terms 'ketamine', 'esketamine', and 'Postoperative Cognitive Complications' from database inception to 25 June 2023.
Results: We found no statistically significant difference in the incidence of POCD within 7 days for intraoperative subanesthetic dose of ketamine/esketamine compared with the control group [relative risk (RR) = 0.57, 95% confidence interval (CI): 0.32, 1.01], and the results from the subgroup analysis based on age (>60 years) also revealed that the difference was not statistically significant (RR = 0.49, 95% CI: 0.23, 1.04).
Conclusion: Compared with controls, intraoperative subanesthetic dose of ketamine/esketamine has no advantage in preventing POCD in patients, or in elderly patients. This study provides reference data for POCD research and clinical drug intervention strategies.
Registration: Prospective Register of Systematic Reviews (PROSPERO; registration number CRD42023401159).
期刊介绍：
Therapeutic Advances in Psychopharmacology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of psychopharmacology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in psychopharmacology, providing a forum in print and online for publishing the highest quality articles in this area.
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