Esketamine

This research aims to compare the effects of three drugs used for sedation before surgery in children aged 2 to 5 years. It focuses on finding the best medication plan to provide safer, more effective, and personalized sedation options for young patients. The study also examines how these drugs affect agitation after surgery, helping improve overall management of pediatric anesthesia. Participants will be randomly assigned to one of three groups receiving different drugs: remimazolam at 0.3 mg/kg, dexmedetomidine at 1 g/kg, or esketamine at 0.5 mg/kg. Each drug is given through an intravenous line before the child enters the operating room, with a parent present during administration. This study uses a triple-blind design to assess each drug's effects. During the study, researchers will monitor sedation success rate, time to sedation onset, and anxiety levels related to parent-child separation at multiple time points after drug injection. Additional assessments include mask acceptance, adverse reactions during sedation and anesthesia induction, restlessness during awakening, and vital signs such as heart rate, blood pressure, respiratory rate, and oxygen levels. The total participation covers the period before surgery and immediate recovery, providing detailed data on sedation and safety.

Researchers are evaluating the effects of dexmedetomidine and esketamine on sleep quality after heart surgery. The study aims to find out if these drugs can prevent postoperative sleep disturbances and which is more effective, comparing them to a saline placebo. This is a Phase 4 randomized trial focused on patients undergoing cardiac surgery with extracorporeal circulation. Participants are randomly assigned to receive an intraoperative continuous infusion of either dexmedetomidine at 0.3 ug/kg/h, esketamine at 0.3 mg/kg/h, or saline until the surgery ends. The study involves three groups: a dexmedetomidine group, an esketamine group, and a saline control group. The infusion happens during surgery only. During the first and third days after surgery, participants' sleep is assessed using a sleep rating scale. Researchers also monitor pain levels at 24 and 48 hours, use of pain medications, anxiety and depression at 1 and 3 days, postoperative complications at 48 hours, and delirium from day 1 to 7. The study runs from October 2024 to September 2025 and involves detailed monitoring of recovery quality and sleep outcomes.

This research aims to explore the effective dose levels (ED50 and ED95) and clinical effects of combining intranasal dexmedetomidine and esketamine for preoperative sedation in children aged 1 to 6 years undergoing general anesthesia. The study focuses on improving sedation compliance to reduce adverse behavioral effects after surgery and provides a theoretical basis for using these drugs together for sedation in pediatric patients. Children are divided into two age groups: toddlers (1-3 years) and preschool children (3-6 years). Both groups receive an initial intranasal dose of dexmedetomidine (1 µg/kg) combined with esketamine (0.5 mg/kg). The dexmedetomidine dose is adjusted in increments of 0.25 µg/kg based on sedation success using a biased coin design. Sedation depth is assessed every 5 minutes with the Ramsay Sedation Scale, and sedation onset time is recorded. Intravenous cannulation and emotional state assessments occur 30 minutes after drug administration. Participants undergo continuous monitoring of vital signs including blood pressure, heart rate, respiratory rate, and oxygen saturation before and after drug administration. Sedation onset, surgical time, awakening time, and emergence delirium are recorded. The study also evaluates intravenous cannulation success and adverse effects up to 24 hours. The total observation includes perioperative and postoperative periods to assess sedation effectiveness and safety.

Sleep disturbances are common after major surgery and can delay recovery. This trial evaluates whether a combination of dexmedetomidine and esketamine used during general anesthesia and postoperative pain control can reduce sleep disturbances in adults undergoing major noncardiac surgery. The study builds on earlier findings that this drug combination helped improve sleep quality after scoliosis surgery and aims to test this effect more broadly. Participants receive either the dexmedetomidine-esketamine combination or a placebo (normal saline) during anesthesia and afterward as part of patient-controlled intravenous analgesia. The combination is infused before and during surgery, followed by patient-controlled analgesia with specific doses of dexmedetomidine, esketamine, and sufentanil for up to 72 hours after surgery. The placebo group receives saline and sufentanil in similar amounts and timing. During the study, researchers will monitor participants for sleep disturbances within three days after surgery as the primary outcome. They will also assess recovery quality, sleep quality over three nights, pain levels, anxiety and depression on day three, and sleep quality on day 30. The trial involves close monitoring of sleep, pain, and mood, with a follow-up period extending to one month after surgery. The study is randomized, double-blind, and placebo-controlled, ensuring careful evaluation of results.

Chronic postsurgical pain (CPSP) is pain that begins or worsens after surgery and lasts longer than three months, affecting up to 75% of patients after spinal correction surgery. This trial evaluates different doses of esketamine combined with dexmedetomidine as supplements to opioids for pain relief after scoliosis correction surgery. The study aims to see if higher esketamine doses can improve pain control and reduce chronic pain over time. Participants receive patient-controlled intravenous analgesia with varying doses of esketamine (50 mg, 100 mg, or 150 mg) combined with a fixed dose of dexmedetomidine and sufentanil. The analgesia is delivered through programmed boluses and background infusion after surgery. This trial compares three groups receiving low, medium, or high esketamine doses to assess long-term outcomes after surgery. During the study, participants are monitored for chronic postsurgical pain at 3, 6, and 12 months after surgery. Researchers assess pain severity, sleep quality, depression levels, quality of life, and use of pain medications. This follow-up monitors the effectiveness of the treatments and overall recovery over one year, with safety and event-free survival also tracked.

Catheter-related bladder discomfort (CRBD) is a common issue for patients waking up from general anesthesia with a urinary catheter, especially after transurethral urological surgeries. This trial explores how dexmedetomidine, esketamine, and their combination may affect the occurrence of CRBD. The study is designed as a 2x2 factorial randomized trial to observe these effects in patients undergoing surgeries like transurethral resection of bladder tumor or prostate. Participants are randomly assigned to one of four groups: a placebo group receiving normal saline, a dexmedetomidine group receiving 0.5 bcg/kg, an esketamine group receiving 0.25 mg/kg, or a combination group receiving both drugs. Each treatment is infused intravenously at a set rate after anesthesia induction but before surgery. The trial uses triple masking and aims to compare the incidence of CRBD among these groups. During the study, participants will be monitored for CRBD incidence and severity within 24 hours after surgery, along with pain intensity, sleep quality, patient satisfaction, anxiety, and depression at various time points. Assessments include subjective sleep quality on the night of surgery and follow-up evaluations up to 30 days after surgery. The study tracks these outcomes to understand how the treatments influence CRBD and related post-surgical recovery factors.

Researchers are studying the effect of giving a low dose of esketamine during surgery on the consciousness of patients who have prolonged disorders of consciousness and are undergoing general anesthesia. The study focuses on patients aged 16 to 65 years with this condition, aiming to understand how esketamine affects their conscious state under sevoflurane anesthesia. This is a prospective, randomized, exploratory study led by Beijing Tiantan Hospital. Participants will receive either an intravenous infusion of esketamine at 0.3 mg/kg dissolved in saline or a placebo saline infusion. This infusion is given at a constant speed within 30 minutes after tracheal intubation or pneumatectomy fixation during surgery. There are two study groups: one receiving esketamine and the other receiving normal saline as a placebo. During and after surgery, researchers will assess patients using various tools, including the Coma Recovery Scale-Revised, Glasgow Coma Scale, Full Outline of UnResponsiveness scores, and SedLine multi-channel electroencephalogram. They will also monitor patient state indexes, power spectral density, burst-suppression ratio, spectral edge frequency, and perioperative adverse events. These assessments occur during surgery, at about 3 days after surgery, and at 1, 3, and 6 months post-surgery to track changes in consciousness and safety outcomes.

Delirium is a sudden brain disorder that causes confusion, attention problems, and changes in consciousness, especially common in older patients after surgery. It can lead to serious consequences like more complications, higher risk of death, poorer thinking skills, and lower quality of life. This trial studies the effect of low-dose esketamine, a drug with anti-inflammatory and brain-protecting effects, on preventing delirium in older high-risk patients undergoing major non-heart-related surgery. Participants will be randomly assigned to receive either esketamine or a placebo during surgery and after surgery. Esketamine is given first as a 0.2 mg/kg dose over 10 minutes after anesthesia starts, then continuously at a lower dose until shortly before surgery ends. After surgery, pain control is managed with patient-controlled intravenous analgesia (PCIA) using a mix of esketamine and sufentanil in the esketamine group or sufentanil alone in the placebo group. The study is conducted across multiple centers, with a single-blind design. Participants will be monitored for delirium symptoms for up to five days after surgery, along with recovery quality, pain levels, opioid use, cognitive function, and complications up to 30 days post-surgery. Various assessments and questionnaires will be used to track outcomes. Safety and side effects will also be closely observed throughout the study. The total participation period lasts about one month after surgery.

Researchers are investigating whether low doses of esketamine can improve sleep quality in patients undergoing modified radical mastectomy for breast cancer after chemotherapy. This study focuses on managing postoperative sleep disturbances, which are common and can negatively affect recovery. The trial involves 184 female participants aged 18 to 65 who have breast cancer and are receiving neoadjuvant chemotherapy. Sleep disturbances after surgery can affect pain, inflammation, and overall recovery, and this study aims to explore whether esketamine can help reduce these problems. Participants will be randomly assigned to one of two groups. One group will receive a continuous infusion of esketamine (0.3 mg/kg/h) during their surgery after anesthesia induction, while the other group will receive a placebo infusion of normal saline. The infusion continues until the end of the operation. The study includes assessments before surgery, on the day after surgery, and three days after surgery to evaluate sleep quality, pain, anxiety, depression, and blood markers related to inflammation and brain function. Participants will complete several rating scales such as the Athens Insomnia Scale, Visual Analog Pain Rating Scale, and the Hospital Anxiety and Depression Scale at multiple time points. Blood samples will be collected to measure inflammatory and other biological markers. Researchers will monitor analgesic use and follow up on sleep disturbances three days after surgery. The main outcome measured is the incidence of postoperative sleep disturbance on the first day after surgery. Additional assessments will occur on other days to track pain, mood, and biological changes. The study will last from admission to three days post-surgery.

Researchers are assessing the use of regional anesthesia with subthalamic nucleus deep brain stimulation (STN-DBS) to improve motor symptoms in Parkinson's disease (PD). Since many PD patients require awake sedation during this surgery, the study compares the effects of two sedation methods on brain electrical signals recorded during the procedure. This prospective, randomized, placebo-controlled, double-blind study aims to evaluate whether combining Dexmedetomidine with Esketamine influences neural activity differently than Dexmedetomidine alone in PD patients undergoing bilateral STN-DBS surgery. Participants will be randomly assigned to one of two groups: one receiving Dexmedetomidine alone, and the other receiving Dexmedetomidine combined with Esketamine during surgery. Both groups receive a loading dose and continuous infusion of Dexmedetomidine, but the second group also receives an infusion of Esketamine after craniotomy until electrode implantation is complete. Blood pressure and heart rate are closely monitored throughout the surgery to maintain stability. During the study, participants will undergo microelectrode recording (MER) of brain signals to measure neural activity using the normalized root mean square (NRMS) method, which is the primary outcome. Secondary outcomes include analysis of beta oscillation power, assessments of postoperative delirium, sleep quality, depression, anxiety, and any adverse events. Patient satisfaction with the surgical experience and DBS therapy will also be evaluated. The study will monitor participants from surgery through 30 days post-operation, with follow-up assessments to track recovery and well-being.