[Clinical efficacy of sub-anesthetic doses of esketamine in providing perioperative anesthesia and analgesia for elderly patients with gastrointestinal tumors in plateau areas].

Abstract

To investigate the clinical anesthetic and analgesic effects of sub-anesthetic doses of esketamine in elderly patients with gastrointestinal tumors during the perioperative period in plateau areas, a prospective study was conducted to include elderly patients (≥60 years) undergoing laparoscopic radical resection of gastrointestinal tumors under general anesthesia at the Affiliated Hospital of Qinghai University from June 2023 to October 2024. They were randomly divided into an experimental group and a control group. The experimental group received an intravenous infusion of esketamine at 0.2 mg·kg⁻¹·h⁻¹ from 10 min before anesthesia induction until 10 min before the end of surgery, while the control group was administered an equal-volume infusion of normal saline at the same rate during the same period. The perioperative clinical data and differences in anesthesia and pain-related indicators at different time points were compared between the two groups. Finally, 67 patients were included for analysis, including 33 patients in the control group [23 males, aged (68.8±6.2) years] and 34 patients in the experimental group [24 males, aged (67.7±5.1) years]. There were no significant differences in age, gender, American Society of Anesthesiologists classification, and operation duration between the two groups (all P>0.05). The mean arterial pressure in the experimental group was higher than that in the control group at 1 min of pneumoperitoneum and 30 min of extubation [(87.6±8.5) mmHg vs (81.7±8.8) mmHg; (95.6±10.3) mmHg vs (90.1±9.0) mmHg (1 mmHg=0.133 kPa), all P<0.05]. The visual analog scale for pain in the experimental group was lower than that in the control group at 2, 12, and 24 h after surgery (all P<0.05). The amount of propofol, remifentanil, norepinephrine, and fluid infusion in the experimental group were all lower than those in the control group (all P<0.05), and the recovery time of spontaneous breathing [(8.6±2.6) min vs (13.4±4.1) min, P<0.05] and the awakening time [(11.6±3.5) min vs (16.4±5.2) min, P<0.05] were both shorter than those in the control group. This study suggests that in elderly patients with gastrointestinal tumors undergoing general anesthesia in plateau areas, the combination of sub-anesthetic doses of esketamine can improve the efficacy of anesthesia and analgesia without affecting recovery, and reduce the amount of other anesthetic drugs used.