To observe the influence of propofol injection emulsion combined with esketamine injection on hemodynamics and postoperative recovery quality in elderly patients after lower limb arthroplasty.

The elderly patients undergoing lower limb joint replacement were divided into low-dose group (0.25 mg·kg^-1 esketamine), high-dose group (0.50 mg·kg^-1 esketamine) and control group (equal volume of 0.9% NaCl) according to the cohort method. Hemodynamics [heart rate (HR), mean arterial pressure (MAP)], postoperative recovery quality scale-15 (QoR-15) scores, dosages of anesthetic drugs, Ramsay sedation score, recovery quality and adverse reactions were compared among the three groups.

In this study, 39 cases were enrolled in the low-dose group, 40 cases in the high-dose group and 42 cases in the control group. The HR of patients in low-dose group, high-dose group and control group immediately after operation (T1) was (76.39±5.77), (77.16±5.24) and (73.21±4.79) beat·min^-1, respectively; MAP values were (85.11±5.22), (85.21±5.37) and (82.79±4.86) mmHg, respectively; at 15 min after operation, the HR of T2 were (78.36±5.11), (78.24±5.02) and (80.67±4.57) beat·min^-1; the MAP were (85.75±5.11), (85.39±4.97) and (87.93±3.67) mmHg, respectively; the QoR-15 scores 24 h after operation were (108.19±10.29), (109.56±10.12) and (99.66±10.21) points, respectively; the dosage of propofol were (220.66±25.19), (211.66±27.88) and (283.37±26.28) mg, respectively; the dosage of remifentanil were (2.37±0.42), (2.24±0.38) and (2.89±0.35) mg, respectively; Ramsay sedation scores were (1.56±0.27), (1.61±0.22) and (1.58±0.24) points at T0; and (3.18±0.33), (3.29±0.34) and (2.67±0.29) points at T3, respectively. Compared with the control group, there were statistically significant differences in the above indexes between the low-dose group and the high-dose group (all P<0.05), while there were no statistically significant differences in the above indexes between the low-dose group and the high-dose group (all P>0.05). Adverse drug reactions included respiratory depression, nausea/vomiting, dizziness, restlessness, hypotension, etc. The total incidence of adverse drug reactions were 2.56% (1 case /39 cases) in the low-dose group, 15.00% (6 cases/40 cases) in the high-dose group, and 26.19% (11 cases /42 cases) in the control group. The total incidence of adverse drug reactions of low-dose group was significantly lower than the control group, and the difference was statistically significant (P<0.05).

The application of propofol combined with esketamine can reduce the intraoperative dosages of propofol and remifentanil in elderly patients undergoing knee arthroplasty, enhance the sedation effect, improve the hemodynamics, and promote the postoperative recovery.