Effect of Esketamine and Etomidate on Postoperative Cognitive Function in Elderly Patients Undergoing Painless retain-->Bronchoscopy: A Randomized Controlled Trial.

Abstract

Purpose: This study aimed to evaluate the effects of different doses of esketamine with etomidate on anesthesia and postoperative cognitive function of elderly patients undergoing painless tracheoscopy.

Design: This was a double-blind, randomized controlled trial.

Methods: In this study, 150 patients over 65 were divided into group A (low-dose: 0.15 mg/kg esketamine + 0.3 mg/kg etomidate), group B (medium-dose: 0.3 mg/kg esketamine + 0.3 mg/kg etomidate), and group C (high-dose: 0.5 mg/kg esketamine + 0.3 mg/kg etomidate), with 50 patients in each group. The primary outcomes included analgesic and sedative effects evaluated via Visual Analog Scale and Ramsay Sedation Score, and cognitive function assessed via the Mini-Mental State Examination preoperatively and at 1 and 3 days postoperatively. Changes in hemodynamic parameters (heart rate and mean arterial pressure), operation duration, and adverse events were also analyzed.

Findings: Demographic characteristics of patients in both groups were comparable. Group C exhibited the best analgesic and sedative effects with more stable hemodynamics, with significant differences in the heart rate and mean arterial pressure. The recovery time was prolonged in group C, while no significant differences were noted in operation duration or adverse events, although group C experienced more complications.

Conclusions: Different doses of esketamine with etomidate had better analgesic and sedative effects, reduced the postoperative cognitive impairment, and provided hemodynamic stability and better safety. A high-dose combination was most effective in analgesia, sedation, and hemodynamic parameter stabilization, while a medium-dose combination yielded the best results for cognitive recovery and fewer adverse effects.