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

Summary

This study assesses the efficacy and safety of intravenous esketamine administration in elderly prostate cancer patients undergoing laparoscopic radical prostatectomy, focusing on hemodynamic stability, postoperative recovery, and adverse events.

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.

Introduction

Prostate cancer is a common malignancy of the male genitourinary system¹, predominantly affecting elderly men. Its incidence rises with age, ranking second only to lung cancer among cancers in this population². In recent years, advances in medical technology have improved diagnostic and therapeutic approaches, with transperitoneal laparoscopic surgery emerging as a key clinical intervention that significantly enhances surgical outcomes and accelerates postoperative recovery³. However, elderly patients undergoing this surgery face unique anesthesia-related challenges. During the anesthetic awakenin....

Protocol

This study was conducted in accordance with institutional human research ethics guidelines and was approved by the Ethics Committee of the First People's Hospital of Yongkang City, Zhejiang Province (Approval ID: YZ--20200657). We secured a signed informed consent form from every participant.

Study design

This retrospective clinical study analyzed the efficacy and safety of intravenous esketamine infusion in elderly patients undergoing laparoscopic prostate cancer surgery. A total of 186 elderly patients admitted between 2021 and 2024 were divided into an esketamine group (n = 95) and a control group (n = 91) a....

Results

Table 1 presents a comparison of baseline characteristics and preoperative data between the esketamine group (n = 95) and the control group (n = 91). The variables included age, body mass index (BMI), TNM cancer stage, American Society of Anesthesiologists (ASA) physical status classification, and the prevalence of comorbidities such as hypertension, tobacco and alcohol history, diabetes, coronary heart disease, asthma, and abnormal liver or kidney function. Original data for both groups are also shown i.......

Discussion

Prostate cancer is a prevalent urological malignancy among middle-aged and elderly men, with a high incidence rate. In China, both the incidence and mortality of prostate cancer have continued to rise annually¹⁸. For early-stage cases, surgical resection remains the primary approach to extend patients' lifespan. Laparoscopic radical prostatectomy is widely used clinically due to its minimal invasiveness, fewer complications, faster recovery, and lower pain levels¹⁹. Des.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
BIS Vista Monitor	Medtronic	185-0151	Used to monitor BIS, guiding propofol infusion rate to maintain BIS at 40-60
Cis-atracurium	Hengrui Pharmaceutical	0594502	Used in both groups for induction (0.2 mg/kg); 0.1 mg/kg added if necessary during operation
Esketamine	Hengrui Medicine	KH080601	Used in the experimental group: 0.2 mg/kg for induction; 0.2 mg/(kg·h) via intravenous pump for maintenance (stopped 30 min before surgery end)
G*Power			software for sample size estimation
Patient Monitoring Machine	Heal Force Bio-meditech Holdings Limited	ZD120	Monitor blood pressure, electrocardiogram, blood oxygen saturation and end-expiratory carbon dioxide, etc
Propofol	Fresenius	4463021	Used in both groups for induction (1.5 mg/kg) and maintenance. Maintenance rate adjusted by BIS (4-8 mg/(kg·h)), maintaining BIS at 40-60
Remifentanil	Yichang Renfu	H20030197	Used in both groups for maintenance at 6-12 μg/(kg·h), maintaining SPI at 20-50
SPSS 26.0	IBM Corp., Armonk, NY, USA
Sufentanil	Yichang Renfu	1170118	Used in both groups for induction (0.3 μg/kg). Additional 0.15 μg/kg given 5 min before skinning and 30 min before surgery end. Included in analgesic pump (2 μg/kg)
Tolansetron	Hengrui Pharmaceuticals	H20061193	Included in analgesic pump (0.15 mg/kg)