Comparison of Target-Controlled Infusion with Etomidate versus Propofol Combined with Intravenous Esketamine for Ultrasound-Guided Segmental Mastectomy in Benign Breast Tumors: A Single-Center, Randomized, Controlled Study

Abstract Objective To investigate the clinical efficacy and safety of two different anesthesia protocols (etomidate-esketamine vs. propofol-esketamine) in ultrasound-guided segmental resection of benign breast tumors. Patients and Methods: Ninety-five patients who were scheduled for segmental resection of benign breast tumors under nonintubated general anesthesia were randomly assigned via a random number table to either the etomidate-esketamine combination group (Group E) or the propofol-esketamine combination group (Group P). The primary outcome assessed was the incidence of respiratory depression (defined as a respiratory rate ≤ 8 breaths/min, apnea ≥ 15 s, or SpO₂ ≤ 95% for > 10 s). The secondary outcomes included the number of airway interventions, recovery time, surgeon satisfaction scores, hemodynamic parameters (pulse oximetry, blood pressure, heart rate), and perioperative adverse reactions or events. Results Ultimately, 47 patients composed Group E and 48 Group P. The incidence of respiratory depression was markedly lower in Group E than in Group P (10.6% vs 35.4%; P < 0.05). While Group P required more airway interventions than Group E did (10.42% vs 2.13%, P = 0.204), this difference was not statistically significant. Injection pain occurred significantly more frequently in Group P than in Group E (20.8% vs. 6.4%, P = 0.040). The incidence of Myoclonus in Group E was 10.6% (5/47). Hemodynamic parameters demonstrated greater stability in Group E than in Group P. No significant differences emerged between the groups concerning recovery time, surgeon satisfaction scores, or the incidence of adverse events within 24 hours. Conclusion In patients who underwent breast segmentectomy under nonintubated general anesthesia with esketamine analgesia, the etomidate-esketamine protocol yielded a significantly lower incidence of respiratory depression than did the propofol-esketamine protocol while maintaining superior hemodynamic stability.