Effect of esketamine vs sufentanil adjunct to propofol deep sedation on the incidence of oxygen-desaturation in elderly patients undergoing urologic surgeries: a randomized, double-blind, controlled trial.

Authors

Si-Qi Hao, Xue Zhang, Fang-Yu Zhang, Li-Xin An, Xin Luo

Published in

BMC anesthesiology. Volume 25. Issue 1. Pages 499. Oct 14, 2025. Epub Oct 14, 2025.

Abstract

Propofol deep sedation/anesthesia combined with analgesics is always used in minimally invasive urologic surgeries in elderly patients.Oxygen-desaturation is one of the most frequent respiratory complications susceptible to other life-threatening accidents for elderly patients during propofol sedation. The purpose of this study is to evaluate the efficacy and safety of low-dose esketamine adjunct to propofol sedation on the occurrence of oxygen-desaturation, hypotension, propofol requirements and other related adverse events compared to sufentanil for elderly patients undergoing urologic surgeries.
Ninety four elderly male patients undergoing transurethral bladder lesion resection or ureteroscopic ureteral laser lithotripsy were randomly enrolled into esketamine/propofol group (SK group, n = 47) or sufentanil/propofol group (SF group, n = 47). The patients in SK group received 0.25 mg/kg esketamine and 1.5 mg/kg propofol for anesthetic induction and SF group received 0.1 μg/kg sufentanil and 1.5 mg/kg propofol. Sedation was Maintained with 4-6 mg/kg/h propofol infusion. The primary outcome was the incidence of oxygen-desaturation during the surgeries. Second outcomes included induction time, hemodynamic changes, intraoperative propofol dosage, operation duration and anesthesia duration, recovery time, other related adverse events and rescue medication.
The incidence of oxygen-desaturation was 34.0% (16 of 47) in SK group compared to 68.1% (32 of 47) in SF group with a significant difference (risk ratio, 0.50; 95% confidence interval, 0.32-0.78; P < 0.001). The overall severity of hypoxiemia was mild in SK group (22/9/16 vs 6/9/32, P = 0.00072). Propofol requirements, induction time were all much lower in SK group than those in SF group (P < 0.001). More hemodynamic stability was observed in SK group compared to SF group. The protective factors of oxygen-desaturation were esketamine (OR:0.26, CI: 0.08 to 0.86, P = 0.027), transurethral bladder lesion resection (OR:0.14, CI: 0.03 to 0.64, P = 0.011). Weight was a hazard factor of OD (OR:1.07, CI: 1.00 to 1.15, P = 0.048). Postoperative sedation score, MMSE, VAS score, incidence of nausea and vomiting were similar in both groups (P > 0.05).
Esketamine combined with propofol sedation used in minimal invasive urologic surgeries, could reduce the incidence of oxygen-desaturation, decrease propofol requirements, stabilize hemodynamics and didn't affect the postoperative recovery and neurological function of elderly patients.
Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn .

PMID:
41087943
Bibliographic data and abstract were imported from PubMed on 15 Oct 2025.

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