Efficacy and Safety of Esketamine-Lidocaine for Anesthesia Induction in Elderly Patients Undergoing Elective Surgery: A Randomized Controlled Trial.

Abstract

<h4>Background</h4>Esketamine, the S-enantiomer of ketamine, has sympathomimetic and analgesic properties. Intravenous lidocaine provides sedative and analgesic adjuvant effects and blunts airway reflexes during anesthesia induction. However, the role of their combination in elderly patients remains unclear. This study aimed to compare the efficacy and safety of esketamine-lidocaine-propofol induction with those of sufentanil-propofol induction in this population.<h4>Methods</h4>In this prospective, double-blind, randomized trial, 116 elderly patients undergoing elective surgery were assigned to receive esketamine (0.5 mg·kg^-1), lidocaine (1.5 mg·kg^-1), and propofol (Group E) or sufentanil (0.4 μg·kg^-1) and propofol (Group S) for anesthesia induction. The primary outcomes were the incidence of hypotension and the absolute area under the curve (AUC) of mean arterial pressure (MAP) deviation, measured during anesthesia induction (from the initiation of anesthetic drug administration to 5 minutes after tracheal intubation).<h4>Results</h4>The absolute AUC for Group E was smaller than that for Group S (93.83 [79.74-130.78] mmHg·min vs.147.50 [99.38-210.62] mmHg·min), with a median difference of -51.09 mmHg·min (95% confidence interval (CI), -84.53- -14.00; <i>P</i> = 0.005). The incidence of hypotension in the Group E was lower than Group S (62.1% vs 82.8%), with a relative risk of 0.750 (95% CI, 0.594-0.947; <i>P</i> = 0.013). The incidence of coughing (<i>P</i> < 0.001) and total phenylephrine dose (<i>P</i> < 0.001) were significantly lower in Group E than Group S, whereas BIS values at 2-5 minutes post-intubation were significantly higher (<i>P</i> < 0.05). There were no serious adverse events in either group.<h4>Conclusion</h4>Esketamine-lidocaine-propofol improved hemodynamic stability and reduced adverse events compared with sufentanil-propofol, supporting its use for anesthesia induction in elderly patients.

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