Esketamine-led opioid-free anaesthesia reduces postoperative pulmonary complications in bariatric surgery patients: a prospective randomized controlled trial.

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

BMC Anesthesiology Pub Date : 2026-05-06 DOI:10.1186/s12871-026-03886-w

He-Liang Sun, Han-Yu Liu, Chen-Qi Jiang, Zi-Feng Wu, Wen-Li Wang, Si-Qi Yang, Hui Liang, Shi-Bo Lin, Cun-Ming Liu, Chun Yang

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引用次数: 0

Abstract

Background: Perioperative management of bariatric surgery patients presents multiple challenges for anesthesiologists, particularly optimizing airway and respiratory outcomes. This study investigated the feasibility of esketamine-led opioid-free anesthesia (OFA) for bariatric surgery and assessed postoperative pulmonary complications (PPCs).

Methods: Patients scheduled for laparoscopic bariatric surgery under combined intravenous-inhalation anesthesia were randomized to receive either esketamine-led OFA (S-Ket group) or opioid-balanced anesthesia with sufentanil and remifentanil (SR-Fen group). The primary outcome was post-surgical PPC incidence, and secondary outcomes were total morphine milligram equivalents (MME) and visual analogue scale (VAS) pain scores at multiple postoperative times.

Results: Of the 263 patients screened, 100 were enrolled. Incidence of PPCs was significantly lower in the S-Ket group than the SR-Fen group (26.0% vs. 50.0%, risk ratio (RR) 0.52; 95% CI: 030-0.89; P = 0.013), with a notable reduction in hypoxemia (22.0% vs. 42.0%, RR 0.52, 95% CI: 0.28-0.97, P = 0.032). Although VAS scores were comparable between groups at all postoperative time points, opioid consumption within the first 24 h post-surgery was significantly reduced in the S-Ket group (P = 0.025). Nystagmus (56.0% vs. 0; P < 0.001) was observed exclusively in the S-Ket group, while there were no other significant group differences in safety outcomes. Post-anesthesia care unit (PACU) stay was longer in the S-Ket group (P = 0.039).

Conclusions: Esketamine-led OFA for laparoscopic bariatric surgery reduced PPC incidence, particularly hypoxemia. However, reduced opioid consumption did not reach the clinical significance threshold (10 MME), and the regimen may prolong PACU stay.

Trial registration: This study was registered at the Chinese Clinical Trial Registry ChiCTR2200057066 (Date:27/02/2022).

查看原文本刊更多论文

艾氯胺酮主导的无阿片类麻醉减少减肥手术患者术后肺部并发症：一项前瞻性随机对照试验

背景：减肥手术患者的围手术期管理对麻醉医师提出了多重挑战，特别是优化气道和呼吸预后。本研究探讨了艾氯胺酮主导的无阿片类药物麻醉（OFA）用于减肥手术的可行性，并评估了术后肺部并发症（PPCs）。方法：计划在静脉-吸入联合麻醉下进行腹腔镜减肥手术的患者随机接受艾氯胺酮主导的OFA （S-Ket组）或阿片类药物平衡的舒芬太尼和瑞芬太尼麻醉（SR-Fen组）。主要终点是术后PPC发生率，次要终点是术后多次吗啡毫克当量（MME）和视觉模拟评分（VAS）疼痛评分。结果：在筛选的263例患者中，有100例入组。S-Ket组PPCs发生率显著低于SR-Fen组(26.0% vs 50.0%，风险比（RR） 0.52；95% ci: 030-0.89；P = 0.013)，低氧血症显著降低（22.0%比42.0%,RR 0.52, 95% CI: 0.28-0.97, P = 0.032）。虽然术后各时间点各组间VAS评分具有可比性，但S-Ket组术后24小时内阿片类药物消耗明显减少（P = 0.025）。结论：在腹腔镜减肥手术中，以艾氯胺酮为主导的OFA可降低PPC的发生率，尤其是低氧血症。然而，减少阿片类药物的消耗没有达到临床意义阈值（10 MME），该方案可能延长PACU的停留时间。试验注册：本研究已在中国临床试验注册中心ChiCTR2200057066注册（日期：27/02/2022）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Anesthesiology ANESTHESIOLOGY-

CiteScore

3.50

自引率

4.50%

发文量

349

审稿时长

>12 weeks

期刊介绍： BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.