| Peer-Reviewed

The Use of Esketamine in Clinical Anesthesia Practice

Received: 3 June 2023    Accepted: 28 June 2023    Published: 6 July 2023
Views:       Downloads:
Abstract

Esketamine, a new noncompetitive antagonist of the N-Methyl-D-Aspartate (NMDA) receptor, has been approved by Food and Drug Administration of the United States of America and recently permitted to apply in Chinese medical institutions. By binding to NMDA receptor, esketamine exerts analgesic, sedative and antidepressant effects with no suppression of respiratory and circulatory system, which is similar to ketamine. However, as the right hand enantiomer of ketamine, esketamine shows higher efficiency, which means that a lower dose can exert comparable effects of ketamine. Meanwhile, the security of esketamine is higher due to less severe adverse events observed in preliminary clinical trials. With more advantages and less disadvantages, anesthesiologists have attached much attention to esketamine. Previous studies have explored the applications of esketamine in clinical practice, such as pediatric anesthesia, painless endoscopy, intubation or non-intubation surgery. These studies focused on the dosage, effectiveness, merits and demerits under different circumstances. In this review, we retrospected recent clinical trials, summarized the efficiency and safety of esketamine by classification of applying scenarios. Either anesthetic or subanesthetic dosage, bolus or continuous infusion made a significance in perioperative management. We also promoted some promising applications of esketamine in anesthesia. However, these novel ideas need more high-quality trials to reconfirm. Anyway, esketamine is a superior choice for anesthesiologists.

Published in Clinical Medicine Research (Volume 12, Issue 4)
DOI 10.11648/j.cmr.20231204.11
Page(s) 61-64
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Esketamine, Analgesic, Sedative, Antidepressant, Anesthesia

References
[1] Jelen LA, Young AH, Stone JM. Ketamine: A tale of two enantiomers. J Psychopharmacol. 2021; 35 (2): 109-23.
[2] Lima TM, Visacri MB, Aguiar PM. Use of ketamine and esketamine for depression: an overview of systematic reviews with meta-analyses. Eur J Clin Pharmacol. 2021.
[3] Lu C, Ren J, Guo X, et al. Effects of Remimazolam Combined with Esketamine Anesthesia on Circulatory and Respiratory Function during Painless Gastroenteroscopy. Contrast Media Mol Imaging. 2022; 2022: 1079099.
[4] Chen J, Zou X, Hu B, et al. Effect of different doses of esketamine compared with fentanyl combined with propofol on hypotension in patients undergoing painless abortion surgery: a prospective, randomized, double-blind controlled clinical trial. BMC Anesthesiol. 2022; 22 (1): 305.
[5] Chen L, He W, Liu X, et al. Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial. BMC Anesthesiol. 2023; 23 (1): 34.
[6] Qiu D, Wang XM, Yang JJ, et al. Effect of Intraoperative Esketamine Infusion on Postoperative Sleep Disturbance After Gynecological Laparoscopy: A Randomized Clinical Trial. JAMA Netw Open. 2022; 5 (12): e2244514.
[7] Wang J, Pu M. Effects of esketamine combined with ultrasound-guided nerve block on cognitive function in children with lower extremity fractures. Am J Transl Res. 2021; 13 (7): 7976-82.
[8] Zhan Y, Liang S, Yang Z, et al. Efficacy and safety of subanesthetic doses of esketamine combined with propofol in painless gastrointestinal endoscopy: a prospective, double-blind, randomized controlled trial. BMC Gastroenterol. 2022; 22 (1): 391.
[9] Liu W, Sun R, Gao X, et al. Effects of preoperative nasal spray esketamine on separation anxiety and emergence agitation in pediatric strabismus surgery: A randomized clinical trial. Medicine (Baltimore). 2022; 101 (51): e32280.
[10] Rugg C, Woyke S, Ausserer J, et al. Analgesia in pediatric trauma patients in physician-staffed Austrian helicopter rescue: a 12-year registry analysis. Scand J Trauma Resusc Emerg Med. 2021; 29 (1): 161.
[11] Yongping Z, Xinyi L, Aming S, et al. The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial. Front Pharmacol. 2022; 13: 1036509.
[12] Xu SX, Shan XS, Gao JM, et al. Effect of esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3Tesla magnetic resonance imaging: a randomized, double-blind, controlled trial. Eur J Med Res. 2022; 27 (1): 258.
[13] Xin N, Xu H, Yue C. Comparison between dexmedetomidine and esketamine in pediatric dentistry surgery. Transl Pediatr. 2021; 10 (12): 3159-65.
[14] Li Q, Fan J, Zhang W. Low-dose esketamine for the prevention of emergency agitation in children after tonsillectomy: A randomized controlled study. Front Pharmacol. 2022; 13: 991581.
[15] Shen J, Song C, Lu X, et al. The effect of low-dose esketamine on pain and post-partum depression after cesarean section: A prospective, randomized, double-blind clinical trial. Front Psychiatry. 2022; 13: 1038379.
[16] Wang W, Ling B, Chen Q, et al. Effect of pre-administration of esketamine intraoperatively on postpartum depression after cesarean section: A randomized, double-blinded controlled trial. Medicine (Baltimore). 2023; 102 (9): e33086.
[17] Wang Q, Xiao M, Sun H, et al. A Study on the Preventive Effect of Esketamine on Postpartum Depression (PPD) after Cesarean Section. Comput Math Methods Med. 2022; 2022: 1524198.
[18] Wang Y, Zhang Q, Dai X, et al. Effect of low-dose esketamine on pain control and postpartum depression after cesarean section: a retrospective cohort study. Ann Palliat Med. 2022; 11 (1): 45-57.
[19] Wang W, Xu H, Ling B, et al. Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial. Medicine (Baltimore). 2022; 101 (47): e32010.
[20] Esketamine. Drugs and Lactation Database (LactMed®). Bethesda (MD): National Institute of Child Health and Human Development; 2006.
[21] Eberl S, Koers L, van Hooft J, et al. The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography: A randomised controlled multicentre trial. Eur J Anaesthesiol. 2020; 37 (5): 394-401.
[22] Yi X, Xu W, Li A. The Clinical Application of Remimazolam Benzenesulfonate Combined with Esketamine Intravenous Anesthesia in Endoscopic Retrograde Cholangiopancreatography. Biomed Res Int. 2022; 2022: 5628687.
[23] Tan M, Zhang C, Zeng W, et al. Determining the effective dose of esketamine for mitigating pain during propofol injection by Dixon's up-and-down method: a double-blind, prospective clinical study of drug dose response. BMC Anesthesiol. 2022; 22 (1): 368.
[24] Huang X, Ai P, Wei C, et al. Comparison of the Effects of Esketamine/Propofol and Sufentanil/Propofol on the Incidence of Intraoperative Hypoxemia during Bronchoscopy: Protocol for a Randomized, Prospective, Parallel-Group Trial. J Clin Med. 2022; 11 (15).
[25] Gautam CS, Mahajan SS, Sharma J, et al. Repurposing Potential of Ketamine: Opportunities and Challenges. Indian J Psychol Med. 2020; 42 (1): 22-9.
[26] Zheng L, Zhang X, Ma Q, et al. Application of multimodal analgesia combined with opioid-free anesthetics in a non-intubated video-assisted thoracoscopic surgery bullectomy: A case report. Front Surg. 2023; 10: 1116523.
[27] Zhu T, Zhao X, Sun M, et al. Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study. BMC Anesthesiol. 2022; 22 (1): 354.
[28] Yuan J, Chen S, Xie Y, et al. Intraoperative Intravenous Infusion of Esmketamine Has Opioid-Sparing Effect and Improves the Quality of Recovery in Patients Undergoing Thoracic Surgery: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Pain Physician. 2022; 25 (9): E1389-e97.
[29] Yu L, Zhou Q, Li W, et al. Effects of Esketamine Combined with Ultrasound-Guided Pectoral Nerve Block Type II on the Quality of Early Postoperative Recovery in Patients Undergoing a Modified Radical Mastectomy for Breast Cancer: A Randomized Controlled Trial. J Pain Res. 2022; 15: 3157-69.
[30] Hublet S, Galland M, Navez J, et al. Opioid-free versus opioid-based anesthesia in pancreatic surgery. BMC Anesthesiol. 2022; 22 (1): 9.
[31] Ren YL, Yuan JJ, Xing F, et al. Effects of Different Doses of Esketamine on Pain Sensitivity of Patients Undergoing Thyroidectomy: A Randomized Controlled Trial. Pain Ther. 2023.
[32] Wang J, Huang J, Yang S, et al. Pharmacokinetics and Safety of Esketamine in Chinese Patients Undergoing Painless Gastroscopy in Comparison with Ketamine: A Randomized, Open-Label Clinical Study. Drug Des Devel Ther. 2019; 13: 4135-44.
[33] Su Y, Zhang J, Wang H, et al. The use of Esketamine in CT-guided percutaneous liver tumor ablation reduces the consumption of remifentanil: a randomized, controlled, double-blind trial. Ann Transl Med. 2022; 10 (12): 704.
Cite This Article
  • APA Style

    Yanqing Song, Rui Zhou. (2023). The Use of Esketamine in Clinical Anesthesia Practice. Clinical Medicine Research, 12(4), 61-64. https://doi.org/10.11648/j.cmr.20231204.11

    Copy | Download

    ACS Style

    Yanqing Song; Rui Zhou. The Use of Esketamine in Clinical Anesthesia Practice. Clin. Med. Res. 2023, 12(4), 61-64. doi: 10.11648/j.cmr.20231204.11

    Copy | Download

    AMA Style

    Yanqing Song, Rui Zhou. The Use of Esketamine in Clinical Anesthesia Practice. Clin Med Res. 2023;12(4):61-64. doi: 10.11648/j.cmr.20231204.11

    Copy | Download

  • @article{10.11648/j.cmr.20231204.11,
      author = {Yanqing Song and Rui Zhou},
      title = {The Use of Esketamine in Clinical Anesthesia Practice},
      journal = {Clinical Medicine Research},
      volume = {12},
      number = {4},
      pages = {61-64},
      doi = {10.11648/j.cmr.20231204.11},
      url = {https://doi.org/10.11648/j.cmr.20231204.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20231204.11},
      abstract = {Esketamine, a new noncompetitive antagonist of the N-Methyl-D-Aspartate (NMDA) receptor, has been approved by Food and Drug Administration of the United States of America and recently permitted to apply in Chinese medical institutions. By binding to NMDA receptor, esketamine exerts analgesic, sedative and antidepressant effects with no suppression of respiratory and circulatory system, which is similar to ketamine. However, as the right hand enantiomer of ketamine, esketamine shows higher efficiency, which means that a lower dose can exert comparable effects of ketamine. Meanwhile, the security of esketamine is higher due to less severe adverse events observed in preliminary clinical trials. With more advantages and less disadvantages, anesthesiologists have attached much attention to esketamine. Previous studies have explored the applications of esketamine in clinical practice, such as pediatric anesthesia, painless endoscopy, intubation or non-intubation surgery. These studies focused on the dosage, effectiveness, merits and demerits under different circumstances. In this review, we retrospected recent clinical trials, summarized the efficiency and safety of esketamine by classification of applying scenarios. Either anesthetic or subanesthetic dosage, bolus or continuous infusion made a significance in perioperative management. We also promoted some promising applications of esketamine in anesthesia. However, these novel ideas need more high-quality trials to reconfirm. Anyway, esketamine is a superior choice for anesthesiologists.},
     year = {2023}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - The Use of Esketamine in Clinical Anesthesia Practice
    AU  - Yanqing Song
    AU  - Rui Zhou
    Y1  - 2023/07/06
    PY  - 2023
    N1  - https://doi.org/10.11648/j.cmr.20231204.11
    DO  - 10.11648/j.cmr.20231204.11
    T2  - Clinical Medicine Research
    JF  - Clinical Medicine Research
    JO  - Clinical Medicine Research
    SP  - 61
    EP  - 64
    PB  - Science Publishing Group
    SN  - 2326-9057
    UR  - https://doi.org/10.11648/j.cmr.20231204.11
    AB  - Esketamine, a new noncompetitive antagonist of the N-Methyl-D-Aspartate (NMDA) receptor, has been approved by Food and Drug Administration of the United States of America and recently permitted to apply in Chinese medical institutions. By binding to NMDA receptor, esketamine exerts analgesic, sedative and antidepressant effects with no suppression of respiratory and circulatory system, which is similar to ketamine. However, as the right hand enantiomer of ketamine, esketamine shows higher efficiency, which means that a lower dose can exert comparable effects of ketamine. Meanwhile, the security of esketamine is higher due to less severe adverse events observed in preliminary clinical trials. With more advantages and less disadvantages, anesthesiologists have attached much attention to esketamine. Previous studies have explored the applications of esketamine in clinical practice, such as pediatric anesthesia, painless endoscopy, intubation or non-intubation surgery. These studies focused on the dosage, effectiveness, merits and demerits under different circumstances. In this review, we retrospected recent clinical trials, summarized the efficiency and safety of esketamine by classification of applying scenarios. Either anesthetic or subanesthetic dosage, bolus or continuous infusion made a significance in perioperative management. We also promoted some promising applications of esketamine in anesthesia. However, these novel ideas need more high-quality trials to reconfirm. Anyway, esketamine is a superior choice for anesthesiologists.
    VL  - 12
    IS  - 4
    ER  - 

    Copy | Download

Author Information
  • Department of Anesthesiology, Deyang People’s Hospital, Deyang City, China

  • Department of Anesthesiology, Deyang People’s Hospital, Deyang City, China

  • Sections