Esketamine during anesthesia induction improves early postoperative sleep quality in female patients undergoing laparoscopic surgery: A randomized trial

Abstract

Objective: To evaluate the effect of intravenous esketamine administration during anesthesia induction on postoperative sleep quality in female patients undergoing laparoscopic surgery.

Methodology: This study was designed as a prospective, double-blind, single-center randomized controlled trial and was conducted at Huzhou Maternity & Child Health Care Hospital between December 5, 2025, and January 31, 2026. One hundred ASA I-II female patients (25-50 years) undergoing elective laparoscopic surgery (Dec 2025-Jan 2026) were randomized to control (Group C, n=50) or esketamine (Group S, n=50). Both groups received propofol 2 mg/kg, cisatracurium 0.15 mg/kg, and sufentanil 0.3 μg/kg for induction; Group-S additionally received esketamine 0.3 mg/kg, while Group-C received normal saline. Anesthesia was maintained with propofol (4–6 mg/kg/h) and remifentanil (0.1–0.2 μg/kg/min) via infusion pumps to maintain the Bispectral Index (BIS) between 40 and 60 and end-tidal carbon dioxide (PETCO₂) between 35 and 45 mmHg. Outcomes included Pittsburgh Sleep Quality Index (PSQI) on postoperative days (POD) one, three, seven; intraoperative sufentanil use; 6/24 h VAS pain scores; 24 hours rescue analgesia rate; adverse events; emergence time; and PACU stay.

Results: Ninety eight patients (Group C: 49; Group S: 49) completed the study. Group-S had lower PSQI scores on POD one and three (P<0.05), reduced intraoperative sufentanil consumption (P<0.05), lower 6/24 hours VAS scores (P<0.05), and lower 24 hours rescue analgesia rate (P<0.05). No significant differences in emergence time, PACU duration, or adverse event rates were observed (P>0.05), with no severe adverse events.

Conclusion: Administration of 0.3 mg/kg esketamine during anesthesia induction reduces opioid consumption, improves early postoperative sleep quality, and decreases sleep disturbance incidence in female laparoscopic patients without increasing adverse event risks.