The Effect of Esketamine on Peripheral Vascular Resistance in Elderly Patients During Anesthesia Induction: A Single-Center, Double-Blind, Prospective, Randomized Controlled Study.

PURPOSE: To investigate the effect of esketamine on peripheral vascular resistance in elderly patients during anesthesia induction.

PATIENTS AND

METHODS

Eighty elderly patients undergoing elective surgery were randomly assigned to two groups (n=40 each): the esketamine group (Group A) received esketamine 0.3 mg/kg, while the control group (Group B) received an equal volume of normal saline. Both groups received the same standard anesthesia induction (etomidate, sufentanil, rocuronium). Hemodynamic parameters (SBP, DBP, MAP, HR) and peripheral vascular resistance assessed by the snuffbox radial artery resistance index (SBRI) were recorded at seven time points: before induction (T1), 1 min (T2) and 5 min (T3) after induction, during intubation (T4), and 1 min (T5), 5 min (T6), and 10 min (T7) after intubation. Adverse events during induction and postoperative recovery were also documented. This double-blind study masked drug administration and outcome assessment.

RESULTS

No significant baseline differences existed between groups (P>0.05). MAP in Group A was significantly higher than in Group B at T2-T7 (P<0.05). SBRI in Group A was significantly higher than in Group B at T2 and T3 (P<0.05), but not at T4-T7. Group A had lower incidences of hypotension (14.3% vs 56.4%), muscle tremor (8.6% vs 33.3%), and vasoactive drug use (5.7% vs 38.5%) (all P<0.05). No significant differences were observed in other adverse events or postoperative recovery scores. Postoperative VAS pain score was slightly lower in Group A (P<0.05).

CONCLUSION

Esketamine used during anesthesia induction shows promise in mitigating early-phase blood pressure decline, increasing peripheral vascular resistance (T2-T3), maintaining hemodynamic stability, and reducing hypotension, muscle tremor, and vasoactive drug use in elderly patients, without compromising recovery.