{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:14:38Z","timestamp":1793373278588,"version":"4.5.0"},"reference-count":72,"publisher":"The Korean Society of Anesthesiologists","issue":"2","license":[{"start":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T00:00:00Z","timestamp":1746662400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Catholic Medical Center Research Foundation"}],"content-domain":{"domain":["ekja.org"],"crossmark-restriction":true},"short-container-title":["Korean J Anesthesiol"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:p>Background: The effects of perioperative ketamine and esketamine on postoperative nausea and vomiting (PONV) remain unclear. This study aimed to clarify their impact on PONV and related adverse events.Methods: We performed a meta-analysis of randomized controlled trials and observational studies comparing ketamine or esketamine with control agents. The primary outcome was a pooled analysis of PONV and nausea-only data. PONV, postoperative nausea (PON), and postoperative vomiting (POV) were also analyzed separately. Subgroup analyses were conducted by comparator type (placebo, opioid, or non-opioid) and dose categories. Meta-regression was used to assess dose-response relationships.Results: Fifty-five studies (n = 6676) were included. Ketamine and esketamine did not significantly reduce the incidence of pooled PONV risk (risk ratio [RR]: 0.95, 95% CI [0.87\u20131.04], P = 0.274). No benefit was found versus placebo. Compared with opioids, PONV was reduced (RR = 0.50, 95% CI [0.32\u20130.77], P = 0.002), but not in the pooled analysis (RR = 0.69, 95% CI [0.43\u20131.08], P = 0.107). Conversely, compared with non-opioid controls, ketamine\/esketamine increased the pooled PONV risk (RR = 1.46, 95% CI [1.03\u20132.05], P = 0.032). No significant dose-response relationship was found. Both agents increased hallucinations (RR = 1.73, 95% CI [1.35\u20132.20], P = 0.0002) and drowsiness (RR = 2.18, 95% CI [1.13\u20134.21], P = 0.024).Conclusions: Ketamine and esketamine did not significantly reduce PONV overall. While they showed benefits compared with opioid-based regimens, they may be less effective than non-opioid adjuvants. However, their neuropsychiatric and sedative risks warrant cautious use.<\/jats:p>","DOI":"10.4097\/kja.24930","type":"journal-article","created":{"date-parts":[[2025,5,8]],"date-time":"2025-05-08T19:45:52Z","timestamp":1746733552000},"page":"182-200","update-policy":"https:\/\/doi.org\/10.4097\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The effect of perioperative ketamine and esketamine administration on postoperative nausea and vomiting in patients undergoing general anesthesia: a systematic review and meta-analysis"],"prefix":"10.4097","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4397-9207","authenticated-orcid":true,"given":"Kwon Hui","family":"Seo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6565-2112","authenticated-orcid":true,"given":"Shu Chung","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9034-3645","authenticated-orcid":true,"given":"Jueun","family":"Kwak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7280-9579","authenticated-orcid":true,"given":"Na Jin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2573","reference":[{"key":"ref1","first-page":"94","volume-title":"Postoperative nausea and vomiting","author":"Smith","year":"2012"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-6576.2002.460801.x"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-017-2363-x"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2016.00612"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.2174\/0125896458278196231229121146"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.818822"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpain.2005.10.005"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14080881"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000006851"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0310751"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aei148"},{"key":"ref12","first-page":"727","volume-title":"Preemptive ketamine during general anesthesia for postoperative analgesia in patients undergoing laparoscopic cholecystectomy","author":"Launo","year":"2004"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003583"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/76.2.186"},{"key":"ref15","first-page":"181","volume-title":"Target-controlled infusion systems: role in anaesthesia and analgesia","author":"van den Nieuwenhuyze","year":"2000"},{"key":"ref16","first-page":"217","volume-title":"Comparison of the effect of oral pregabalin with intravenous ketamine on reducing pain after abdominal hysterectomy: a randomized double-blind clinical trial study","author":"Ghadami","year":"2021"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-018-4939-z"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijso.2021.100392"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.4103\/joacp.joacp_251_20"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.991559"},{"key":"ref21","first-page":"608","volume-title":"Is preemptive analgesic effect of ketamine dose dependent? 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