Effects of sub-anesthetic doses of esketamine on immune function and postoperative negative emotions in acoustic neuroma patients: a randomized clinical trial.

Abstract

<h4>Background</h4>Patients undergoing acoustic neuroma (AN) surgery often experience postoperative negative emotions, including anxiety, depression, and immune function suppression. This trial evaluated whether perioperative sub-anesthetic esketamine improves early postoperative negative emotions and immune function.<h4>Methods</h4>In this single-center, double-blind, randomized trial, 84 patients scheduled for AN surgery were assigned to esketamine (<i>n</i> = 42) or placebo (<i>n</i> = 42). The esketamine cohort received a continuous intravenous infusion of esketamine at 0.2 mg·kg^-1·h^-1 during anesthesia, followed by 1 mg·kg^-1 esketamine as an adjuvant in patient-controlled intravenous analgesia (PCIA). The placebo group received saline. The primary outcome was the incidence of depression on postoperative day (POD1), defined as a Hospital Anxiety and Depression Scale-Depression subscale (HADS-D) score > 7.<h4>Results</h4>Seventy-seven patients completed the study (39 in the esketamine group, 38 in the placebo group). Esketamine significantly reduced the incidence of depression at POD1 (7.7% <i>versus</i> 31.6%; relative risk 0.24, 95% CI: 0.08-0.80, <i>p</i> = 0.008) and POD3 (0.0% <i>versus</i> 15.8%, relative risk 0.00, 95% CI: 0.00-0.47, <i>p</i> = 0.031) compared with placebo. The incidences of anxiety on POD1 and 3 and sleep disturbances on POD1 were also significantly reduced (<i>p</i> < 0.05). Notably, no significant differences were observed between the two groups in terms of immune function, postoperative pain scores, or intraoperative morphine equivalent. Adverse events did not differ between the groups.<h4>Conclusion</h4>Perioperative sub-anesthetic esketamine reduced postoperative depression and anxiety, and improve sleep quality after AN surgery, without significant effects on early immune function or acute postoperative analgesia.<h4>Trial registration</h4>Chinese Clinical Trial Registry, ChiCTR2400084537.

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