BMC anesthesiology · 2025
Effect of esketamine vs sufentanil adjunct to propofol deep sedation on the incidence of oxygen-desaturation in elderly patients undergoing urologic surgeries: a randomized, double-blind, controlled trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Hao Si-Qi, Zhang Xue, Zhang Fang-Yu, An Li-Xin, Luo Xin
Аннотация
BACKGROUND: Propofol deep sedation/anesthesia combined with analgesics is always used in minimally invasive urologic surgeries in elderly patients.Oxygen-desaturation is one of the most frequent respiratory complications susceptible to other life-threatening accidents for elderly patients during propofol sedation. The purpose of this study is to evaluate the efficacy and safety of low-dose esketamine adjunct to propofol sedation on the occurrence of oxygen-desaturation, hypotension, propofol requirements and other related adverse events compared to sufentanil for elderly patients undergoing urologic surgeries.
METHODS: Ninety four elderly male patients undergoing transurethral bladder lesion resection or ureteroscopic ureteral laser lithotripsy were randomly enrolled into esketamine/propofol group (SK group, n = 47) or sufentanil/propofol group (SF group, n = 47). The patients in SK group received 0.25 mg/kg esketamine and 1.5 mg/kg propofol for anesthetic induction and SF group received 0.1 μg/kg sufentanil and 1.5 mg/kg propofol. Sedation was Maintained with 4-6 mg/kg/h propofol infusion. The primary outcome was the incidence of oxygen-desaturation during the surgeries. Second outcomes included induction time, hemodynamic changes, intraoperative propofol dosage, operation duration and anesthesia duration, recovery time, other related adverse events and rescue medication.
RESULTS: The incidence of oxygen-desaturation was 34.0% (16 of 47) in SK group compared to 68.1% (32 of 47) in SF group with a significant difference (risk ratio, 0.50; 95% confidence interval, 0.32-0.78; P < 0.001). The overall severity of hypoxiemia was mild in SK group (22/9/16 vs 6/9/32, P = 0.00072). Propofol requirements, induction time were all much lower in SK group than those in SF group (P < 0.001). More hemodynamic stability was observed in SK group compared to SF group. The protective factors of oxygen-desaturation were esketamine (OR:0.26, CI: 0.08 to 0.86, P = 0.027), transurethral bladder lesion resection (OR:0.14, CI: 0.03 to 0.64, P = 0.011). Weight was a hazard factor of OD (OR:1.07, CI: 1.00 to 1.15, P = 0.048). Postoperative sedation score, MMSE, VAS score, incidence of nausea and vomiting were similar in both groups (P > 0.05).
CONCLUSIONS: Esketamine combined with propofol sedation used in minimal invasive urologic surgeries, could reduce the incidence of oxygen-desaturation, decrease propofol requirements, stabilize hemodynamics and didn't affect the postoperative recovery and neurological function of elderly patients.
TRIAL REGISTRATION: Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn .
METHODS: Ninety four elderly male patients undergoing transurethral bladder lesion resection or ureteroscopic ureteral laser lithotripsy were randomly enrolled into esketamine/propofol group (SK group, n = 47) or sufentanil/propofol group (SF group, n = 47). The patients in SK group received 0.25 mg/kg esketamine and 1.5 mg/kg propofol for anesthetic induction and SF group received 0.1 μg/kg sufentanil and 1.5 mg/kg propofol. Sedation was Maintained with 4-6 mg/kg/h propofol infusion. The primary outcome was the incidence of oxygen-desaturation during the surgeries. Second outcomes included induction time, hemodynamic changes, intraoperative propofol dosage, operation duration and anesthesia duration, recovery time, other related adverse events and rescue medication.
RESULTS: The incidence of oxygen-desaturation was 34.0% (16 of 47) in SK group compared to 68.1% (32 of 47) in SF group with a significant difference (risk ratio, 0.50; 95% confidence interval, 0.32-0.78; P < 0.001). The overall severity of hypoxiemia was mild in SK group (22/9/16 vs 6/9/32, P = 0.00072). Propofol requirements, induction time were all much lower in SK group than those in SF group (P < 0.001). More hemodynamic stability was observed in SK group compared to SF group. The protective factors of oxygen-desaturation were esketamine (OR:0.26, CI: 0.08 to 0.86, P = 0.027), transurethral bladder lesion resection (OR:0.14, CI: 0.03 to 0.64, P = 0.011). Weight was a hazard factor of OD (OR:1.07, CI: 1.00 to 1.15, P = 0.048). Postoperative sedation score, MMSE, VAS score, incidence of nausea and vomiting were similar in both groups (P > 0.05).
CONCLUSIONS: Esketamine combined with propofol sedation used in minimal invasive urologic surgeries, could reduce the incidence of oxygen-desaturation, decrease propofol requirements, stabilize hemodynamics and didn't affect the postoperative recovery and neurological function of elderly patients.
TRIAL REGISTRATION: Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn .