Effect of Esketamine on Perioperative Inflammatory Factors and Postoperative Analgesic Outcomes in Patients with Obstructive Sleep Apnea Syndrome: A Randomized Controlled Trial.

Abstract

<h4>Purpose</h4>The effect of esketamine on perioperative inflammatory factors and postoperative analgesic outcomes in patients with Obstructive sleep apnea syndrome (OSAS) remains unclear. This trial assesses whether 0.25 mg · kg^- esketamine during general anesthesia can reduce the inflammatory level and relieve postoperative pain in OSAS patients.<h4>Patients and methods</h4>96 adult patients with OSAS underwent palatopharyngoplasty under general anesthesia was included in our research. Following anesthetic introduction, subjects were randomized to either 0.25 mg · kg^- esketamine (in 20mL solution; esketamine group) or an equivalent volume of saline (Control group). The primary result was the level of IL-6 and TNF-α before the infusion of esketamine, 40min, 4h, and 24h after the esketamine infusion. Secondary outcomes was NRS scores immediately after tracheal extubation, 4h after the infusion, postoperative day 1 (POD1), postoperative day 2 (POD 2) and postoperative day 7 (POD 7).<h4>Results</h4>The esketamine group demonstrated significantly reduced IL-6 and TNF-α levels at 40 minutes post-infusion (<i>P</i><0.001) and showed lower the numerical rating scale(NRS)scores with less rescue analgesia immediately after extubation (<i>P</i><0.001) compared to the control group, despite prolonged extubation and post-anesthesia care unit (PACU) stay (<i>P</i><0.001). Across POD1-2, the esketamine group maintained reduced NRS scores (<i>P</i><0.001) and analgesic doses (<i>P</i>=0.021), higher quality of recovery-15 (QoR-15) scores and patient satisfaction scores (<i>P</i><0.001) relative to control group. It is important to note that the significant differences in inflammatory markers and pain scores between groups were not sustained at the 24-hour assessment and on postoperative day 7, respectively, indicating transient effects.<h4>Conclusion</h4>Intraoperative infusion of 0.25 mg·kg^- esketamine provided transient suppression of inflammatory responses and reduced early postoperative pain in OSAS patients. However, these benefits were exploratory and time-limited, and must be weighed against prolonged extubation and PACU stay.

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