The effects of esketamine on blood pressure and hypotension incidence during induction of bariatric surgery: A randomized controlled trial

Abstract

Background: The prevalence of obesity is high. Bariatric surgery is an effective treatment for severe obesity; however, the induction phase of anesthesia in these patients poses a risk of hypotension. Esketamine, known for its sympathetic nervous system stimulation, may stabilize blood pressure during induction. This study aimed to investigate the effects of esketamine on blood pressure in bariatric surgery patients. Methods: This randomized controlled trial included 145 patients undergoing bariatric surgery. Patients were randomly assigned to receive esketamine or a control intervention during induction. Blood pressure and other vital signs were measured and compared between the 2 groups using statistical analyses. Results: Administration of esketamine increased blood pressure before intubation (T2). The incidence of hypotension was lower in the esketamine group at multiple time points during induction. Postoperatively, the esketamine group exhibited lower pain scores at 24 hours and a reduced need for rescue analgesics. Conclusion: A single dose of 0.2 mg/kg esketamine during the induction phase of bariatric surgery can improve blood pressure stability and decrease the incidence of hypotension. Furthermore, it is associated with reduced postoperative pain. Future studies could explore the effects of higher esketamine doses and validate these findings in a larger and more diverse patient population.

Effect of esketamine on the EC50 of remifentanil for blunting cardiovascular responses to endotracheal intubation in female patients under general anesthesia: a sequential allocation dose-finding study

“…During induction of general anesthesia, esketamine can significantly reduce the dosage of opioid analgesic drugs [ 12 ], improve the analgesic effect, reduce the incidence of opioid side effects [ 13 , 14 ], and have protective effects on the respiratory systems [ 15 ]. For the circulatory system, esketamine increases cardiac output in a dose-dependent manner, to some extent counteracting the inhibitory effects of other anesthetic drugs on circulation, thereby maintaining the stability of patient circulation during anesthesia induction [ 16 , 17 ]. However, the excitatory effect of this cardiovascular system is not always beneficial, and esketamine are known to increase myocardial VO2 and increase MAP, which may pose certain risks when applied to patients with cardiovascular diseases such as hypertension and coronary heart disease.…”