Article description

Summary:

• The study aimed to determine whether continuous intravenous infusion of esketamine during off-pump coronary artery bypass graft surgery (OPCAB) could reduce postoperative delirium (POD) and modulate the inflammatory response.
• A single-center, prospective, triple-blind, randomized controlled trial.
• A total of 140 adult patients undergoing OPCAB were enrolled.
• During anesthesia maintenance, patients in Group S (esketamine group) received an esketamine infusion at 0.25 mg/kg/h, while those in Group P (placebo group) received an equal volume of saline.
• The incidence of postoperative delirium within 7 days after surgery was significantly lower in Group S compared to Group P (relative risk: 0.474; 95% confidence interval: 0.231–0.970; p = 0.034)
• Compared to Group P, patients in Group S had significantly lower serum IL-6 levels at both the 12th and 72nd postoperative hours (Z = ?2.697, p = 0.007; Z = ?2.002, p = 0.043), as well as significantly lower CRP levels at the 72nd postoperative hour (Z = ?2.134, p = 0.033).

Conclusions:

• Intraoperative esketamine infusion (0.25 mg/kg/h) may lower the risk of postoperative delirium and reduce short-term inflammation in OPCAB patients.
• Further studies are needed to assess how different dosing regimens and quantities of esketamine affect long-term cognitive function post-cardiac surgery.