Subanesthetic Esketamine for Hemodynamic Stability and Recovery in Elderly Thoracic Surgery Patients

Hebei Medical University

Status: Completed

Conditions: Postoperative Recovery; Hemodynamic Instability; Anesthesia, General; Elderly Patients; Thoracic Surgery

Treatments: Drug: Midazolam; Drug: Normal Saline (0.9% Sodium Chloride); Drug: Sufentanil; Drug: propofol; Drug: Esketamine; Drug: Rocuronium

Study type: Interventional

Funder types: Other

Identifiers

NCT07064408

2023026

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 230 patients

Sex: All

Ages: 65 to 75 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age 65-75 years
• Scheduled for elective thoracic surgery (e.g., lobectomy, bullectomy)
• ASA physical status I-III
• Adequate cardiopulmonary function
• Able to provide informed consent
• Preoperative systolic blood pressure <160 mmHg with stable control
• No cognitive impairment

Exclusion criteria

• Severe cardiovascular disease (e.g., unstable angina, heart failure ≥ NYHA class III)
• History of cerebrovascular disease
• Uncontrolled hypertension (SBP >180 mmHg)
• Severe hepatic or renal dysfunction
• Chronic psychiatric illness or long-term CNS-active drug use
• Allergy to ketamine or its derivatives
• Elevated intracranial or intraocular pressure
• Use of monoamine oxidase inhibitors within 24 hours before surgery
• History of substance abuse

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Quadruple Blind

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230 participants in 2 patient groups, including a placebo group

Esketamine Group

Experimental group

Description:

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.

Treatment:

Drug: Rocuronium

Drug: Esketamine

Drug: propofol

Drug: Sufentanil

Drug: Midazolam

Control Group

Placebo Comparator group

Description:

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.

Treatment:

Drug: Rocuronium

Drug: propofol

Drug: Sufentanil

Drug: Normal Saline (0.9% Sodium Chloride)

Drug: Midazolam