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This retrospective study evaluated the effects of a subanesthetic dose of esketamine (0.25 mg/kg) on intraoperative hemodynamic stability and postoperative recovery quality in elderly patients (aged 65-75) undergoing thoracic surgery under general anesthesia. A total of 230 patients were included and randomly assigned to receive either esketamine or placebo during anesthesia induction. Key outcomes included blood pressure and heart rate stability, catecholamine levels, recovery time, incidence of adverse events such as delirium or nausea, and opioid use.
Elderly patients are at increased risk for anesthesia-related complications due to reduced physiological reserves and comorbidities. Thoracic surgery further increases this risk by inducing significant cardiovascular and sympathetic stress. Esketamine, the S-enantiomer of ketamine, possesses sympathomimetic and analgesic properties that may help stabilize circulation and reduce postoperative complications when used at subanesthetic doses.
In this single-center, randomized controlled trial, patients aged 65-75 scheduled for elective thoracic surgery were administered either 0.25 mg/kg esketamine or normal saline during anesthesia induction. Hemodynamic parameters (mean arterial pressure, heart rate), plasma catecholamine concentrations (norepinephrine, epinephrine), and adverse cardiovascular responses were recorded. Postoperative outcomes included emergence time, PACU stay, incidence of delirium, hallucinations, nausea and vomiting, and opioid consumption.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Esketamine Group | Experimental | Participants in this group received a subanesthetic dose of esketamine (0.25 mg/kg) intravenously during induction of general anesthesia. The esketamine was administered slowly over approximately 30 seconds after midazolam and sufentanil, and prior to propofol and rocuronium. Standard anesthesia induction and maintenance protocols were followed thereafter. |
|
| Control Group | Placebo Comparator | Participants in this group received an equivalent volume of 0.9% normal saline intravenously during induction of general anesthesia, administered in the same manner and time frame as in the esketamine group. The saline was administered after midazolam and sufentanil, and prior to propofol and rocuronium. All other aspects of anesthesia management were identical to the esketamine group. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Esketamine | Drug | Intravenous administration of a subanesthetic dose of esketamine (0.25 mg/kg) during induction of general anesthesia. The drug was administered slowly over approximately 30 seconds after midazolam (2 mg) and sufentanil (50 µg), and prior to propofol (2 mg/kg) and rocuronium (0.6 mg/kg). The goal was to evaluate its effect on intraoperative hemodynamic stability and postoperative recovery in elderly patients undergoing thoracic surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Maximum Decrease in Mean Arterial Pressure (MAP) During Anesthesia Induction | The lowest value of MAP recorded between the time of anesthesia induction and skin incision, compared to baseline MAP before induction. This outcome evaluates the degree of hemodynamic depression associated with induction agents and the protective effect of esketamine. | From anesthesia induction to skin incision (approximately 15 minutes) |
| Measure | Description | Time Frame |
|---|---|---|
| Time to Eye Opening After Surgery | The duration between the end of surgery and the patient's spontaneous eye opening, measured in minutes in the PACU. | Postoperative period in PACU (within 30 minutes after surgery) |
| Incidence of Hypotension During Anesthesia Induction |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Fourth Hospital of Hebei Medical University | Shijiazhuang | Hebei | 050011 | China |
IPD will not be shared due to ethical and privacy considerations and the absence of participant consent for data sharing.
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|
| Normal Saline (0.9% Sodium Chloride) | Drug | Intravenous administration of an equivalent volume of 0.9% normal saline during anesthesia induction, matching the timing and method of the esketamine group. Used as a placebo comparator. |
|
| Midazolam | Drug | Intravenous administration of 2 mg midazolam during anesthesia induction for sedation. Administered prior to study drug. |
|
| Sufentanil | Drug | Intravenous administration of 50 µg sufentanil for analgesia during anesthesia induction. Administered prior to study drug. |
|
| propofol | Drug | Intravenous administration of 2 mg/kg propofol for loss of consciousness during anesthesia induction. Administered after study drug. |
|
| Rocuronium | Drug | Intravenous administration of 0.6 mg/kg rocuronium to facilitate neuromuscular blockade and endotracheal intubation. |
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Defined as mean arterial pressure (MAP) < 65 mmHg or the need for vasopressor intervention (norepinephrine) between induction and intubation. |
| From anesthesia induction to intubation (approximately 5 minutes) |
| Incidence of Postoperative Delirium | Evaluated using the Confusion Assessment Method for the ICU (CAM-ICU) during the recovery period. | From PACU admission to hospital discharge (up to 24 hours postoperatively) |
| Postoperative Morphine Requirement | Number of patients requiring morphine for pain relief and total dose (mg) administered in the PACU. | Within 1 hour after surgery in PACU |
| ID | Term |
|---|---|
| C000629870 | Esketamine |
| D000077330 | Saline Solution |
| D012965 | Sodium Chloride |
| D008874 | Midazolam |
| D017409 | Sufentanil |
| D015742 | Propofol |
| D000077123 | Rocuronium |
| ID | Term |
|---|---|
| D000077324 | Crystalloid Solutions |
| D007552 | Isotonic Solutions |
| D012996 | Solutions |
| D004364 | Pharmaceutical Preparations |
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
| D017670 | Sodium Compounds |
| D001569 | Benzodiazepines |
| D001552 | Benzazepines |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
| D006571 | Heterocyclic Compounds |
| D005283 | Fentanyl |
| D010880 | Piperidines |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D010636 | Phenols |
| D001555 | Benzene Derivatives |
| D006841 | Hydrocarbons, Aromatic |
| D006844 | Hydrocarbons, Cyclic |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D000732 | Androstanols |
| D000731 | Androstanes |
| D013256 | Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
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