Efficacy and Safety of Intravenous Esketamine in Elderly Patients Undergoing Laparoscopic Radical Prostatectomy.

In elderly patients undergoing laparoscopic prostate cancer surgery, adding intravenous esketamine to conventional anesthesia was associated with reduced need for other anesthetics (remifentanil, propofol, and muscle relaxants), better hemodynamic stability (higher heart rate and blood pressure just after intubation, lower values one hour into surgery), slightly longer awakening time but less agitation and severe coughing, shorter postanesthesia care unit stays, lower pain scores immediately and at 6 and 24 hours after surgery, higher scores on a mental status exam at 1 and 7 days postoperatively, and a lower incidence of postoperative cognitive dysfunction. The only adverse event that differed was more mild drowsiness in the esketamine group. The findings suggest esketamine may benefit recovery and cognitive outcomes in this population.

Study at a glance

Abstract

While perioperative esketamine use has grown increasingly prevalent, evidence supporting its efficacy and safety in elderly patients undergoing laparoscopic prostate cancer surgery remains limited. This retrospective study evaluated intravenous esketamine's performance in this population by analyzing 186 elderly patients treated between 2021 and 2024, divided into a control group (n = 91; conventional anesthesia) and an esketamine group (n = 95; conventional anesthesia plus esketamine). Esketamine infusion was discontinued 30 min before surgery completion. Hemodynamic parameters-heart rate (HR) and mean arterial pressure (MAP)-were recorded at five time points: pre intubation (T1), 1 min post intubation (T2), 1 h intraoperatively (T3), skin closure (T4), and 5 min post extubation (T5). Secondary outcomes included anesthesia duration, extubation time, awakening time, analgesic use, Riker Sedation-Agitation Scale scores, visual analog scale (VAS) pain scores (immediately, and at 6 and 24 h postoperatively), Mini-Mental State Examination (MMSE) scores, postoperative cognitive dysfunction (POCD), and adverse events. Compared with the control group, the esketamine group required significantly less remifentanil, propofol, and muscle relaxant (P < 0.05). Hemodynamically, HR and MAP were higher at T2 and lower at T3 in the esketamine group (P < 0.05). Postoperatively, esketamine prolonged awakening time slightly but reduced agitation and severe coughing (P < 0.05), shortened postanesthesia care unit (PACU) stay (P < 0.05), and improved VAS pain scores (P < 0.05). MMSE scores at 1 and 7 days post surgery were higher, and POCD incidence was lower (P < 0.05). The only notable adverse event difference was a higher rate of mild drowsiness (P < 0.05); other adverse events did not differ. These findings suggest that esketamine may help maintain hemodynamic stability and enhance postoperative recovery in elderly patients undergoing laparoscopic radical prostatectomy, reducing anesthetic requirements and improving cognitive outcomes with minimal additional risk.