The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial
PurposeThis 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).MethodsAll enrolled patients underwent a total intravenous anesth...
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Frontiers Media S.A.
2025-06-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2025.1579908/full |
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| author | Chunyan Lin Chunyan Lin Jianlin Wang Long Zhang Long Zhang Liyong Yuan Guanyi Liu Guanyi Liu Miao Zhu Liangguang Zhang |
| author_facet | Chunyan Lin Chunyan Lin Jianlin Wang Long Zhang Long Zhang Liyong Yuan Guanyi Liu Guanyi Liu Miao Zhu Liangguang Zhang |
| author_sort | Chunyan Lin |
| collection | DOAJ |
| description | PurposeThis 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).MethodsAll 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.ResultsGroup B had lower dosages of propofol (P = 0.021), remifentanil (P = 0.001), and dexmedetomidine (P < 0.001) than the Control Group, while Group C had lower dosages of remifentanil and dexmedetomidine (P < 0.001) than the Control Group. The postoperative mean arterial pressure (MAP) was lower in Group B than in the Control Group (P = 0.028). Patients in Group C experienced a prolonged awakening time (P < 0.001) but had lower VAS pain scores at PACU than those in the Control group (P = 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: P = 0.001, < 0.001, < 0.001; MoCA: P = 0.004, < 0.001, < 0.001). Group B had few postoperative complications.ConclusionThe dose of 0.3 mg/kg/h esketamine is safe and effective for spinal surgery with IONM, improving control of postoperative complications. |
| format | Article |
| id | doaj-art-8b4203cfa0da4090bdff5b9a9fc75fb1 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj-art-8b4203cfa0da4090bdff5b9a9fc75fb12025-08-20T03:31:02ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2025-06-011210.3389/fmed.2025.15799081579908The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trialChunyan Lin0Chunyan Lin1Jianlin Wang2Long Zhang3Long Zhang4Liyong Yuan5Guanyi Liu6Guanyi Liu7Miao Zhu8Liangguang Zhang9Department of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, ChinaNingbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Ningbo, Zhejiang, ChinaDepartment of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, ChinaDepartment of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, ChinaNingbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Ningbo, Zhejiang, ChinaDepartment of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, ChinaNingbo Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Ningbo, Zhejiang, ChinaSpine Surgery Center, Ningbo No. 6 Hospital, Ningbo, Zhejiang, ChinaDepartment of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, ChinaDepartment of Anesthesiology, Ningbo No. 6 Hospital, Ningbo, Zhejiang, ChinaPurposeThis 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).MethodsAll 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.ResultsGroup B had lower dosages of propofol (P = 0.021), remifentanil (P = 0.001), and dexmedetomidine (P < 0.001) than the Control Group, while Group C had lower dosages of remifentanil and dexmedetomidine (P < 0.001) than the Control Group. The postoperative mean arterial pressure (MAP) was lower in Group B than in the Control Group (P = 0.028). Patients in Group C experienced a prolonged awakening time (P < 0.001) but had lower VAS pain scores at PACU than those in the Control group (P = 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: P = 0.001, < 0.001, < 0.001; MoCA: P = 0.004, < 0.001, < 0.001). Group B had few postoperative complications.ConclusionThe dose of 0.3 mg/kg/h esketamine is safe and effective for spinal surgery with IONM, improving control of postoperative complications.https://www.frontiersin.org/articles/10.3389/fmed.2025.1579908/fullesketamineclinical efficacydosespinal surgeryintraoperative neuroelectrophysiological monitoring |
| spellingShingle | Chunyan Lin Chunyan Lin Jianlin Wang Long Zhang Long Zhang Liyong Yuan Guanyi Liu Guanyi Liu Miao Zhu Liangguang Zhang The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial Frontiers in Medicine esketamine clinical efficacy dose spinal surgery intraoperative neuroelectrophysiological monitoring |
| title | The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial |
| title_full | The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial |
| title_fullStr | The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial |
| title_full_unstemmed | The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial |
| title_short | The dose-dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring: a randomized controlled trial |
| title_sort | dose dependent efficacy of esketamine in spinal surgery with intraoperative neuroelectrophysiological monitoring a randomized controlled trial |
| topic | esketamine clinical efficacy dose spinal surgery intraoperative neuroelectrophysiological monitoring |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2025.1579908/full |
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