Esketamine as an adjunct with propofol and fentanyl to avoid perioperative hypotension

1. The use of esketamine in combination with propofol significantly reduced the risk of perioperative hypotension during abortive surgery compared to propofol and fentanyl.

Evidence Rating Level: 1 (Excellent)

Opioid analgesics commonly used in anesthesia practice such as fentanyl and propofol are associated with respiratory and circulatory system depression. Esketamine is a N-methyl-D-aspartate receptor (NMDA) antagonist which has a milder respiratory depression effect and lower circulatory excitation compared to its other analgesic counterparts due to its rapid onset and offset action. However, many studies have not explored the effect of esketamine in patients undergoing painless abortion surgery. This prospective, double-blinded, randomized controlled trial divided 180 patients into either the fentanyl and propofol group or one of four esketamine and propofol groups. The primary outcome examined by this study was the incidence of perioperative hypotension. The results showed that the incidence of hypotension was significantly lower in all the groups inducing with esketamine and propofol compared to the fentanyl and propofol group (0% vs 20%, respectively). Additionally, incidence of hypoxia was lower among patients with esketamine compared to fentanyl. In conclusion, this study confirms that various doses of esketamine in combination with propofol significantly reduce the risk of perioperative hypotension during abortive surgery compared to a fentanyl and propofol. However, this study has several limitations. For instance, as esketamine and fentanyl belong to separate drug classes and have differing mechanisms of action, it can be difficult to compare them directly. As well, this study only included one population in its sample, specifically pregnant women undergoing abortive surgery. The effect of esketamine for induction during other surgeries or various patient demographics cannot be determined by these results. Nevertheless, these findings do suggest benefits of esketamine as an adjunctive induction agent to propofol and further research should be conducted examining this drug in different surgical contexts.

Click to read the study in BMC Anesthesiology

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