To investigate the clinical efficacy and safety of general anesthesia induced by benzenesulfonate remimazolam for injection combined with esketamine hydrochloride injection in elderly patients with severe knee osteoarthritis undergoing total knee arthroplasty.

The elderly patients with severe knee osteoarthritis undergoing total knee arthroplasty were divided into control group and treatment group according to the method of anesthesia induction. The treatment group received intravenous injection of 0.1 mg·kg^-1 benzenesulfonate remimazolam for injection combined with 0.5 mg·kg^-1 esketamine hydrochloride injection for anesthesia induction. The control group received 0.05 mg·kg^-1 midazolam injection combined with 1 mg·kg^-1 propofol emulsion injection for anesthesia induction. The other anesthesia methods were consistent between the two groups. The recovery time, hemodynamics, postoperative pain score (VAS), postoperative sedation score (Ramsay sedation scale), anxiety and depression score (HAD), mini-mental state examination score (MMSE), incidence of delirium (POD) and adverse anesthetic events were compared between the two groups.

A total of 232 patients were enrolled, with 115 cases in control group and 117 cases in treatment group. The recovery time of the control group and the treatment group were (26.30±4.84) and (24.52±4.66) min, respectively; heart rate after induction were (71.84±4.17) and (73.58±4.36) beats·min^-1, respectively; heart rate at the end of operation were (74.59±4.46) and (76.13±4.32) beats·min^-1, respectively; mean arterial pressure after induction were (81.90±5.69) and (84.11±5.72) mmHg, respectively; mean arterial pressure at the end of operation were (86.73±5.57) and (88.51±6.42) mmHg, respectively; VAS scores at 6 h after operation were (3.77±0.54) and (3.53±0.69) points, respectively; VAS scores at 12 h after operation were (3.21±0.64) and (3.00±0.66) points, respectively; the postoperative 1-hour Ramsay sedation scores were (3.82±0.66) and (3.21±0.57) points, respectively, and the postoperative 6-hour Ramsay scores were (2.65±0.48) and (2.31±0.46) points, respectively; at 3 d after operation, HAD-A scores were (10.53±1.86) and (9.94±1.73) points, respectively; HAD-D scores were (10.56±2.10) and (9.86±2.05) points, respectively; MMSE scores were (21.34±1.82) and (22.22±1.93) points, respectively; within 7 d after operation, the incidences of POD were 15.65% (18 cases/115 cases) and 6.84% (8 cases/117 cases), respectively; during anesthesia induction, the incidence of adverse drug reactions were 20.87% (24 cases/115 cases) and 9.40% (11 cases/117 cases), respectively. The differences of above indicators were all statistically significant comparing between the two group (P<0.05,P<0.01). The main adverse drug reactions during the anesthesia induction period in treatment group and control group included hypotension, hypertension, bradycardia and tachycardia.

Compared with the regimen of midazolam injection combined with propofol emulsion injection, the regimen of benzenesulfonate remimazolam for injection combined with esketamine hydrochloride injection for anesthesia induction can shorten recovery time, maintain stable hemodynamics, improve analgesic effect, relieve anxiety and depression, improve cognitive function, and have good safety.