Lung-protective effects of esketamine in patients undergoing video-assisted thoracoscopic surgery: a randomized controlled trial.

Abstract

<h4>Background</h4>Video-assisted thoracoscopic surgery (VATS) is associated with pulmonary function impairment due to the nature of the surgical site. The use of esketamine, which acts on multiple receptors, has become widespread in general anesthesia, but its function in pulmonary protection remains unclear. We examined whether esketamine can improve pulmonary function during VATS, further investigated the underlying mechanisms of its effect, and evaluated its dose-effect relationship.<h4>Methods</h4>Patients aged 18-65 years scheduled for VATS were included in the study. Patients were assigned randomly to the low-dose esketamine group (group K1), high-dose esketamine group (group K2), or control group (group C). The primary outcome was arterial-alveolar oxygen partial pressure ratio (a/A ratio). The secondary outcomes included other pulmonary parameters, intraoperative hemodynamics, adverse events, postoperative pain scores, inflammatory biomarkers, and postoperative pulmonary complications (PPCs).<h4>Results</h4>In total, 145 eligible patients were enrolled in the study. Compared with the patients in the esketamine groups, those in the control group had a lower a/A ratio and oxygenation index (OI), a higher respiratory index (RI) and alveolar-arterial partial pressure difference of oxygen (A-aDO₂) at discharge from the intensive care unit (ICU) and 24 hours postoperatively (all P values <0.05), a higher incidence of PPCs (P<0.05), a higher resting and movement numerical rating scale at 24 and 48 hours postoperatively, and greater fluctuations of blood pressure and heart rate intraoperatively. Meanwhile, the time of tracheal extubation, length of ICU stay, serum levels of procalcitonin, and incidence of postoperative adverse events were similar among all the groups.<h4>Conclusions</h4>Esketamine administration was effective in protecting pulmonary function in patients undergoing VATS by ameliorating oxygenation and reducing hemodynamic fluctuation and postoperative pain. However, the relationship between the optimal dosage and minimal adverse events requires further investigation.<h4>Trial registration</h4>This randomized controlled trial was registered in the Chinese Clinical Trials Registry (registration No. ChiCTR2100051518).

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