The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial.

Abstract

<h4>Purpose</h4>This study aims to validate the efficacy and safety of combining different doses of esketamine with propofol, remifentanil, and dexmedetomidine in spinal surgery under intra-operative neuroelectrophysiological monitoring (IONM).<h4>Methods</h4>All enrolled patients underwent a total intravenous anesthesia (TIVA) maintenance regimen, which included propofol, remifentanil, and dexmedetomidine. The patients were randomly assigned to four groups based on the use and dosage of esketamine: Group Control (TIVA + NS), Group A (TIVA + Esketamine 0.1 mg/kg/h), Group B (TIVA + Esketamine 0.3 mg/kg/h), and Group C (TIVA + Esketamine 0.5 mg/kg/h). The study measured vital signs, consumption of anesthetics, operation time, blood loss, awakening time in the postanesthesia care unit (PACU), visual analog scale (VAS) pain score, quality of recovery (QoR) -15 score, and dosage of supplementary analgesics. Additionally, adverse postoperative reactions were recorded.<h4>Results</h4>Group B had lower dosages of propofol (<i>P</i> = 0.021), remifentanil (<i>P</i> = 0.001), and dexmedetomidine (<i>P</i> < 0.001) than the Control Group, while Group C had lower dosages of remifentanil and dexmedetomidine (<i>P</i> < 0.001) than the Control Group. The postoperative mean arterial pressure (MAP) was lower in Group B than in the Control Group (<i>P</i> = 0.028). Patients in Group C experienced a prolonged awakening time (<i>P</i> < 0.001) but had lower VAS pain scores at PACU than those in the Control group (<i>P</i> = 0.044). Both QoR-15 scores and MoCA scores were significantly higher for patients in Groups A, B, and C compared to those of the Control group (QoR-15: <i>P</i> = 0.001, < 0.001, < 0.001; MoCA: <i>P</i> = 0.004, < 0.001, < 0.001). Group B had few postoperative complications.<h4>Conclusion</h4>The dose of 0.3 mg/kg/h esketamine is safe and effective for spinal surgery with IONM, improving control of postoperative complications.

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