Esketamine Accelerates Emergence from Propofol Anesthesia in Patients Undergoing Laparoscopic Gynecological Surgery: A Randomized Controlled Trial

Yu Qi,1– 3,* Ying Ren,1,3,* Wenjing Xu,1,3,* Jiao Chen,2,3 Long Wang,2,3 Hanchao Huang,1,3 Meiyan Zhou,2,3 Liwei Wang1– 3 1The Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, Xuzhou Central Hospital, Southeast University, Xuzhou, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China*These authors contributed to the work equallyCorrespondence: Meiyan Zhou, Email zhoumeiyandoctor@126.com Liwei Wang, Email doctorlww@sina.comPurpose: While esketamine has shown promise in enhancing the quality of anesthesia recovery, its effect on a critical recovery endpoint—extubation time—has yielded inconsistent results across clinical studies. Therefore, this study investigated the effect of esketamine on extubation time in patients undergoing general anesthesia.Methods: In this single-center, randomized, double-blind, placebo-controlled trial (RCT), we enrolled 154 patients scheduled for elective laparoscopic hysterectomy. Patients were randomly assigned to receive either intravenous esketamine (a bolus of 0.2 mg/kg at induction, followed by a continuous infusion of 0.125 mg/kg/h) or an equivalent volume of normal saline as placebo. For all patients, a transversus abdominis plane (TAP) block was performed with 0.25% ropivacaine at the end of surgery. The primary analysis was conducted according to a modified intention-to-treat (mITT) principle, including all randomized patients who received the allocated intervention and had the primary outcome assessed. The sample size was calculated to provide 90% power to detect a 4-minute difference in extubation time. The primary outcome was the time to extubation in the post-anesthesia care unit (PACU). The Bonferroni correction was applied to secondary outcomes to adjust for multiple comparisons.Results: A total of 141 patients completed the study (Esketamine group: n=70; Control group: n=71). Compared to the control group, the esketamine group had a significantly shorter extubation time (23.2 ± 5.2 minutes vs. 28.5 ± 5.3 minutes; mean difference − 5.3 minutes, 95% CI: − 7.1 to − 3.5; P< 0.001). PACU stay duration was also reduced (60.2 ± 7.3 minutes vs. 65.8 ± 6.9 minutes; P< 0.001). Furthermore, patients receiving esketamine reported lower postoperative pain scores and required less opioid consumption, with no significant increase in adverse effects.Conclusion: Adjunctive low-dose esketamine during propofol-based total intravenous anesthesia significantly shortens extubation time and PACU stay, reduces intraoperative opioid consumption, and no significant increase in adverse effects was observed in this cohort. The reduction in postoperative pain scores did not remain significant after Bonferroni correction and requires further confirmation.