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The exclusion criteria encompassed participants aged 18\u00a0years and older, reviews or meta-analyses, fundamental animal studies, articles published solely in abstract form, letters to the editor, case reports, editorial notes, methodological protocols, and publications not in English.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1142 children were included in ten randomized controlled trials (RCTs) and one cohort study, revealing that esketamine significantly reduces the risk of ED\/EA in pediatric patients following surgery when compared to the control group (OR\u2009=\u20090.70, 95% CI: (0.51, 0.97), I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200980%,\n                      <jats:italic>P<\/jats:italic>\n                      for effect\u2009=\u20090.03). Subgroup analysis indicated that low-dose esketamine was particularly effective in mitigating postoperative ED or EA (OR\u2009=\u20090.33, 95% CI: (0.20, 0.53), I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200919%,\n                      <jats:italic>P<\/jats:italic>\n                      for effect\u2009&lt;\u20090.00001), as well as reducing postoperative pain scores (SMD\u2009=\u2009-1.30, 95% CI: (-2.28, -0.32), I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200995%, P for effect\u2009=\u20090.009). Furthermore, it did not elevate the incidence of postoperative nausea and vomiting (PONV) (OR: [0.44\u20131.19], I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200927%,\n                      <jats:italic>P<\/jats:italic>\n                      for effect\u2009=\u20090.20).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In comparison to the control group, esketamine significantly decreases the incidence of emergence delirium or emergence agitation (ED\/EA) in pediatric patients, with a markedly lower heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      ) observed at lower dosages(esketamine\u2009&lt;\u20090.5\u00a0mg\/kg). Additionally, esketamine effectively mitigates postoperative pain scores in children without elevating the occurrence of PONV.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Prospero registration ID:CRD42024583287. Link:PROSPERO (york.ac.uk).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-026-03748-5","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T14:15:03Z","timestamp":1773670503000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The effect of esketamine on emergence delirium or agitation in children after anesthesia-a systematic review and meta-analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Wei","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"He","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"issue":"16","key":"3748_CR1","doi-asserted-by":"publisher","first-page":"2729","DOI":"10.2147\/JPR.S419677","volume":"7","author":"T Liu","year":"2023","unstructured":"Liu T, Luo F. 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