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The purpose of this study was to compare the effect of preemptive treatment with esketamine and sufentanil on maintaining hemodynamics and reducing the occurrence of adverse cardiovascular events during the insertion of suspension laryngoscope.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this double\u2010blind randomized controlled trial, patients undergoing general anesthesia for laryngeal microsurgery were randomly assigned (1:1) to esketamine 0.5\u2009mg\u2009kg<jats:sup>\u22121<\/jats:sup>(esketamine group) and sufentanyl 0.125\u2009\u03bcg\u2009kg<jats:sup>\u22121<\/jats:sup>(sufentanil group) before inserting the laryngoscope, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the insertion of suspension laryngoscope, the incidence of bradycardia (HR\u2009&lt;\u200960 beats\/min) was 39.3% (22\/56) in esketamine group, lower than 60.0% (33\/55) in sufentanil group (odds ratio [OR], 2.32 [95% CI, 1.11\u20135.08];<jats:italic>p<\/jats:italic>\u2009=\u20090.029). The incidence of hypotension (MAP &lt;65\u2009mmHg) was 33.9% (19\/56) in esketamine group, lower than 56.4% (31\/55) in sufentanil group (odds ratio [OR], 2.52 [95% CI, 1.91\u20135.27];<jats:italic>p<\/jats:italic>\u2009=\u20090.018). The frequency of hypotension in esketamine group was lower than that in sufentanil group (0.36\u2009\u00b1\u20090.52 vs. 0.56\u2009\u00b1\u20090.50,<jats:italic>p<\/jats:italic>\u2009=\u20090.035). The time\u2010weighted average of HR dropping above 30% of baseline was smaller in esketamine group than in sufentanil group (0.52\u2009\u00b1\u20092.06 vs. 1.08\u2009\u00b1\u20092.77,<jats:italic>p<\/jats:italic>\u2009=\u20090.006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These findings showed that compared with preemptive treatment of sufentanil (0.125\u2009\u03bcg\u2009kg<jats:sup>\u22121<\/jats:sup>), esketamine (0.5\u2009mg\u2009kg<jats:sup>\u22121<\/jats:sup>) was effective in reducing the incidence of cardiovascular adverse events, including bradycardia and hypotension induced by the insertion of suspension laryngoscope during the laryngeal microsurgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>2<jats:italic>Laryngoscope<\/jats:italic>, 133:3021\u20133027, 2023<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.30699","type":"journal-article","created":{"date-parts":[[2023,4,19]],"date-time":"2023-04-19T10:08:15Z","timestamp":1681898895000},"page":"3021-3027","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Esketamine versus Sufentanil Applied Prior to Placement of Suspension Laryngoscope"],"prefix":"10.1002","volume":"133","author":[{"given":"Yi\u2010Ying","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Xiangya Hospital Central South University Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sha","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xiangya Hospital Central South University Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xiangya Hospital Central South University Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian\u2010Xi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xiangya Hospital Central South University Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao\u2010Shen","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xiangya Hospital Central South University Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Head and Neck Surgery Xiangya Hospital Central South University Changsha China"},{"name":"National Clinical Research Center for Geriatric Disorders Xiangya Hospital Central South University Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qu\u2010Lian","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xiangya Hospital Central South University Changsha China"},{"name":"National Clinical Research Center for Geriatric Disorders Xiangya Hospital Central South University Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0535-1865","authenticated-orcid":false,"given":"Chang\u2010Sheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Xiangya Hospital Central South University Changsha China"},{"name":"National Clinical Research Center for Geriatric Disorders Xiangya Hospital Central South University Changsha 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