The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial.
Frontiers in medicine – January 01, 2025
Source: PubMed
Summary
Protecting nerve function during spinal surgery is vital. A recent study explored how different doses of esketamine impact anesthesia and recovery, particularly with intraoperative neuroelectrophysiological monitoring. Researchers found that a specific esketamine dose of 0.3 mg/kg/h significantly improved clinical efficacy. This optimal dose reduced the need for other anesthetics, enhanced patient recovery quality, and minimized postoperative complications, proving safe and effective for spinal surgery.
Abstract
This study aims to validate the efficacy and safety of combining different doses of esketamine with propofol, remifentanil, and dexmedetomidine in spinal surgery under intra-operative neuroelectrophysiological monitoring (IONM). All enrolled patients underwent a total intravenous anesthesia (TIVA) maintenance regimen, which included propofol, remifentanil, and dexmedetomidine. The patients were randomly assigned to four groups based on the use and dosage of esketamine: Group Control (TIVA + NS), Group A (TIVA + Esketamine 0.1 mg/kg/h), Group B (TIVA + Esketamine 0.3 mg/kg/h), and Group C (TIVA + Esketamine 0.5 mg/kg/h). The study measured vital signs, consumption of anesthetics, operation time, blood loss, awakening time in the postanesthesia care unit (PACU), visual analog scale (VAS) pain score, quality of recovery (QoR) -15 score, and dosage of supplementary analgesics. Additionally, adverse postoperative reactions were recorded. Group B had lower dosages of propofol (P = 0.021), remifentanil (P = 0.001), and dexmedetomidine (P < 0.001) than the Control Group, while Group C had lower dosages of remifentanil and dexmedetomidine (P < 0.001) than the Control Group. The postoperative mean arterial pressure (MAP) was lower in Group B than in the Control Group (P = 0.028). Patients in Group C experienced a prolonged awakening time (P < 0.001) but had lower VAS pain scores at PACU than those in the Control group (P = 0.044). Both QoR-15 scores and MoCA scores were significantly higher for patients in Groups A, B, and C compared to those of the Control group (QoR-15: P = 0.001, < 0.001, < 0.001; MoCA: P = 0.004, < 0.001, < 0.001). Group B had few postoperative complications. The dose of 0.3 mg/kg/h esketamine is safe and effective for spinal surgery with IONM, improving control of postoperative complications.