Effect of esketamine on postoperative delirium in elderly patients undergoing hip fracture surgery

SHAO Changhui; HUANG Weiyan; LU Yanping; ZHANG Dongyu; FENG Qi; TANG Xuefu; OU Shan

doi:10.3969/j.issn.2096-2681.2025.04.007

Abstract：Objective To investigate the effect of esketamine on postoperative delirium(POD)in elderly patients undergoing surgery for hip fracture.Methods A total of 100 patients,including 32 males and 68 females,aged 65-95 years,with body mass index(BMI)18.0-27.9 kg/m2,of American Society of Anesthesiologists(ASA)Physical Status classification Ⅰ-Ⅲ,scheduled for hip fracture surgery under general anesthesia,from October 2024 to March 2025 were selected and randomly divided into the control group(group C,n=50)and the esketamine group(group E,n=50).After tracheal intubation,group E received continuous infusion of esketamine at a rate of 0.3 mg/(kg·h)intraoperatively until the beginning of skin incision closure.Group C received equivalent volumes and rates of 0.9％normal saline;the injection methods were in accordance with those in group E.The dosages of propofol and remifentanil were re-corded during surgery.The incidence of POD in three days after surgery were evaluated using the confusion assessment method.Postoper-ative pain scores at rest using the numeric rating scale(NRS)were recorded at 24,48,and 72 h postoperatively,and the rate of rescue analgesia was recorded.The incidence of adverse events including nausea,vomiting,dizziness,hallucinations,and nightmares,were re-corded in three days after surgery.30-day all-cause mortality was recorded.Results Compared with group C,the incidence of POD was lower in group E(12％ vs 30％,P=0.027),along with the decreasing dosage of remifentanil(1153.9±120.2 μg vs 1210.2±116.1 μg,P=0.019),and the NRS score at rest significantly decreased at 24,48 h after surgery(P＜0.05).Conclusion Esketamine could reduce the incidence of POD and postoperative pain,and would not increase the risk of adverse effects in elderly patients undergoing hip fracture surgery.