Intravenous esketamine as a detumescence agent for intraoperative penile erection during urological surgeries: a retrospective clinical analysis

Abstract

Background: Intraoperative penile erection (IPE) is an uncommon yet complex issue, and numerous approaches to achieving detumescence fall short of providing consistently satisfactory outcomes. Esketamine, with its sympathomimetic properties, may offer a promising solution for managing this condition. The present study aimed to evaluated the efficiency and safety of intravenous esketamine in addressing IPE.

Methods: We conducted a review of 3,848 patients who underwent endourological, penile or testicular surgeries under general anesthesia from 2021 to 2023, and cases with IPE and received pharmacological intervention were included in this study. Intravenous esketamine or ephedrine were preferred for managing IPE. The primary outcomes evaluated were the rate of successful penile detumescence, time to detumescence, rapid response rate, remedial measures, intraoperative hypertension, tachycardia and neuropsychiatric adverse events. Additionally, data regarding age, body mass index (BMI), American Society of Anesthesiologists (ASA) grade, type of surgeries, anesthesia methods, medication dosage, and recovery time were documented. We performed meticulously statistical analyses to evaluate the endpoints.

Results: Overall, 37 cases with IPE were assigned to an esketamine group (K group, n = 27) or an ephedrine group (E group, n = 10) based on intraoperative medication. No statistically significant differences were noted regarding age, BMI, ASA grade, type of surgeries, anesthesia methods, rate of successful penile detumescence (96.3% vs. 80.0%), recovery time or the occurrence of postoperative psychiatric complications such as dizziness, restlessness or delirium(P > 0.05). However, compared to ephedrine, esketamine produced a shorter time to detumescence (3.0 ± 0.4 min vs. 5.5 ± 1.1 min, log-rank P = 0.006)), higher rapid response rate achieved detumescence ≤ 3 min (85.2% vs. 50%, P = 0.041), and a lower incidence of cardiovascular adverse events (intraoperative hypertension and tachycardia) (P < 0.05).

Conclusion: Our research establishes intravenous esketamine as a practical and reliable therapeutic intervention for prompt resolution of IPE, demonstrating high clinical efficacy with rapid symptom alleviation.

Keywords: Detumescence; Esketamine; Intraoperative penile erection; Urological surgeries.

Fig. 1

The evaluation of time to detumescence. (A) Esketamine demonstrated superior performance faster detumescence than ephedrine (3.0 ± 0.4 min vs. 5.5 ± 1.1 min, log-rank test P=0.006). (B) Subgroup analysis by age showed comparable detumescence times between patients aged <50 and ≥50 years in either group, however, esketamine demonstrated numerically faster resolution in younger patients compared to ephedrine. * P<0.05.