Esketamine in addition to propofol and fentanyl may prevent perioperative hypotension

CHINA: According to a study published in BMC Anesthesiology, using esketamine along with propofol dramatically decreased the incidence of perioperative hypotension during abortive surgery compared to using propofol plus fentanyl.

Respiratory and circulatory depression are linked to opioid analgesics, which are frequently used during abortion surgeries. Esketamine is a popular painkiller and an antagonist of the NMDA receptor. The medication provides a number of benefits, including a quick onset and offset and less cardiorespiratory depression. Esketamine's effects on individuals undergoing painless abortion surgery have not yet been studied, though.

In order to determine the best esketamine dose for this population, the current study examined the effects of fentanyl and various esketamine doses on the incidence of perioperative hypotension in patients undergoing painless abortion procedure.

There were 178 female patients who underwent painless abortion procedure in total for this purpose. The patients were classified as having a class I or II physical status under the American Society of Anesthesiologists (ASA) criteria and ranged in age from 18 to 45. They also had a body mass index (BMI) of 18 to 28 kg m2. The patients were divided into four groups at random, as follows: group F (n = 45), which received 1 μg kg - 1 fentanyl intravenously (IV), followed by 2 mg kg - 1 propofol, and groups EL, EM, and EH (n = 45, 44, 44), which received 0.2 mg kg - 1, 0.25 mg kg -1, and 0.3 mg kg -1 esketamine, respectively, followed by IV 2 mg kg - 1 propofol IV.

Key results of the study:

• In comparison to patients in group F (20%) (χ2 = 19.648; P = 0.000), incidence of hypotension was considerably lower in subjects in groups EL, EM, and EH (0, 0, 0%)
• Subjects in groups EL, EM, and EH had substantially lower rates of hypoxia (0, 2.3, and 2.3%) compared to those in group F (11.1%) (χ2 = 8.622; P = 0.035).
• In comparison to patients in groups F and EL (26.7, 15.6%) (χ2 = 10.254; P = 0.016), participants in groups EM and EH had a substantially lower incidence of somatic motor reactions (9.1, 4.5%)
• Patients in group EH had a substantially greater incidence of nausea, vomiting, and possible mental symptoms (15.9, 11.4%) than did individuals in group F (2.2, 0%), group EL (4.4, 0%) and group EM (2.3, 2.3%) (χ2 = 7.493; P = 0.038 and χ2 = 8.248; P = 0.003).
• In comparison to patients in group F, subjects in groups EL, EM, and EH had more stable mean arterial pressure (MAP) and heart rates (HR).
• In comparison to group F and EL (9.1, 4.5%), group EM and EH experienced significantly fewer instances of the supplementary propofol dose (26.7%, 17.8%) (χ2 = 10.254; P = 0.016).
• Compared to subjects in groups F, EL, and EH, patients in group EM had considerably shorter dischargeable times.

"Esketamine possesses advantageous pharmacological traits such a quick beginning of action, a quick metabolism, and a quick awakening. According to the study's findings, there was no statistically significant difference in anesthetic induction times between the four subject groups," wrote the authors.

In summary, this research demonstrates that different esketamine dosages combined with propofol considerably lower the incidence of perioperative hypotension during abortive surgery when compared to fentanyl plus propofol.

REFERENCE

Chen, J., Zou, X., Hu, B. et al. Effect of different doses of esketamine compared with fentanyl combined with propofol on hypotension in patients undergoing painless abortion surgery: a prospective, randomized, double-blind controlled clinical trial. BMC Anesthesiol 22, 305 (2022). https://doi.org/10.1186/s12871-022-01848-6