Esketamine versus dexmedetomidine for oxygenation and postoperative quality of recovery in thoracoscopic surgery: a randomized, double-blind, non-inferiority controlled trial.

Abstract

<h4>Purpose</h4>One-lung ventilation (OLV) frequently induces hypoxemia. This study investigated whether intraoperative esketamine is non-inferior to dexmedetomidine in maintaining oxygenation during OLV and evaluated its impact on postoperative recovery.<h4>Methods</h4>In this prospective, double-blind, non-inferiority trial, 126 adults undergoing thoracoscopic surgery were randomized to saline (Control), dexmedetomidine, or esketamine. The primary outcome was PaO₂/FiO₂ (P/F) ratio at 60 min after OLV initiation. The key secondary outcome was Quality of Recovery-15 (QoR-15) at 24 h. Linear mixed effects models were used.<h4>Results</h4>A total of 120 patients were included in the modified intention-to-treat analysis. At T3, esketamine was noninferior to dexmedetomidine for P/F ratio (adjusted mean difference [MD] - 1.92 mmHg; 95% CI: - 41.06 to 37.20). Compared with the control group, esketamine showed more favorable intraoperative respiratory mechanics and lower opioid requirements. Furthermore, esketamine was associated with higher global QoR-15 scores at 24 h postoperatively compared with the Control group (adjusted MD 8.10; 95% CI 2.99 to 13.21) and the Dexmed group (adjusted MD 6.47; 95% CI 1.36 to 11.59). However, the incidence of postoperative pulmonary complications did not differ significantly among the groups (P = 0.86).<h4>Conclusion</h4>Intraoperative esketamine is non-inferior to dexmedetomidine for maintaining oxygenation during OLV. Furthermore, it was associated with lower perioperative opioid/anesthetic requirements and higher early postoperative recovery scores, although it did not significantly reduce clinical pulmonary complications.

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