Effect of subanesthetic dose of esketamine on perioperative hemodynamics in patients undergoing lumbar surgery under general anesthesia

Abstract

Objective To analyze the effect of subanesthetic dose of esketamine on perioperative hemodynamics and adverse events in patients undergoing lumbar spine surgery under general anesthesia. Methods The clinical data of 70 patients who underwent general anesthesia lumbar spine surgery and treatment from June 2021 to June 2023 at Nanjing Jinling Hospital, Affiliated Hospital of Nanjing University Medical School, were retrospectively analyzed. According to the way of anesthesia induction, they were divided into the conventional group (conventional intravenous anesthesia induction, n=35) and the esketamine group (subanesthetic dose of esketamine+conventional intravenous anesthesia induction, n=35). Hemodynamic indices ［heart rate (HR), mean arterial pressure (MAP)］, and blood norepinephrine (NE) levels at each time point before induction of anesthesia (T0), in the immediate preoperative period (T1), at the end of the operation (T2), and at the time of postoperative awakening (T3), as well as the dosage of vasoactive medications (atropine and phenylephrine), and the incidence of adverse events (nausea and vomiting, postoperative agitation, respiratory depression, and bradycardia) were compared between the two groups. Results The HR levels of patients in the conventional group were significantly lower at T1 and T2 than that at T0, and significantly higher at point T3 than that at T1 and T2; at T2, the HR in the esketamine group was significantly higher than that in the conventional group (P＜0.05), and the difference in HR levels of patients in the esketamine group at each time point was not statistically significant (P＞0.05). The MAP levels of patients in the esketamine group at T1, T2 and T3 were significantly lower than those at T0, and the MAP levels of patients in the esketamine group were significantly higher than those in the conventional group at T1 and T2, and the MAP levels of patients in the conventional group first decreased and then increased over time, and the difference between the two groups was statistically significant (P＜0.05). The NE levels of patients in both groups showed a decreasing trend at all time points, in which the NE levels of patients in the esketamine group were significantly higher than those in the conventional group at T1, T2 and T3 (P＜0.05). The dosage of atropine and phenylephrine remedial drugs in patients in the esketamine group was significantly lower than that in the conventional group (P＜0.05). The incidence of bradycardia in the esketamine group was significantly lower than that in the conventional group (5.71% vs 22.86%, χ2=4.200， P=0.040). Conclusion The subanesthetic dose of esketamine can stabilize the hemodynamic changes during surgery in patients undergoing lumbar spine surgery under general anesthesia, with a good anesthetic effect, reduce the dosage of anesthetic remedial drugs, reduce the incidence of bradycardia, and with a high degree of safety.

Keywords

• esketamine，subanesthetic dose，〖jp3〗 general anesthesia， lumbar spine surgery， perioperation， hemodynamics