Esketamine attenuates hemodynamic oscillations during anesthesia induction in elderly gastrointestinal surgical patients: a randomized trial

作者：C.-Y. Zhang, Daqing Liu, Biyun Chen, Cong Geng, Y. H. Tan, Huiming Zeng, Zhuo Zhen, Jianhua He, Hanbing Wang · 发表于：BMC Anesthesiology · 年份：2025 · DOI：10.1186/s12871-025-03384-5 · 被引用次数：1 · 研究领域：Anesthesia and Sedative Agents、Anesthesia and Pain Management、Cancer, Stress, Anesthesia, and Immune Response

BACKGROUND: Patients undergoing gastrointestinal tumor surgery face heightened susceptibility to hemodynamic instability during anesthesia induction, a risk further exacerbated by preoperative fasting. Oscillatory blood pressure fluctuations increase perioperative risks. Esketamine's sympathomimetic properties may counteract propofol-induced hypotension. This study aimed to evaluate the impact of adjunctive esketamine on hemodynamic instability incidence during induction. METHODS: This prospective, double-blind RCT (ChiCTR2200060641, registered on June 6, 2022) enrolled ASA I-III patients (18-75 years) scheduled for gastrointestinal tumor surgery at Foshan First People's Hospital (Jun 2022-May 2023). Patients were randomized 1:1 to receive IV esketamine (0.2 mg/kg) or saline placebo during induction. Anesthesia was induced with propofol (1.5-2.0 mg/kg), sufentanil (0.2 µg/kg), and cisatracurium (0.3 mg/kg). The primary outcome was the incidence of hemodynamic instability (defined as hypertension [MAP > 20% baseline], hypotension [MAP < 65 mmHg or > 20% decrease], tachycardia [HR > 100 bpm], bradycardia [HR < 50 bpm], or vasopressor use) from induction to 5 min post-intubation. The secondary outcomes included intraoperative ephedrine consumption, postoperative recovery time, extubation time, duration of post-anaesthesia care unit (PACU) stay, emergence agitation, cough during intubation, and other adverse effects. RESULTS: The incidence of hemodynamic instability was significa...