Efficacy And Safety Of Perioperative Esketamine On Thoracic Surgery Under General Anesthesia

Objectives: This study aimed to investigate postoperative thoracic surgery analgesic effect of low-dosage esketamine perioperatively.We also explore the influence of esketamine on postoperative anxiety,depression,cognitive funtion and delirium of patients to evaluate the safety of esketamine.Methods: In this study,86 patients undergoing video-assisted thoracic surgery were selected and randomly divided into two groups,Esketamine Group(Group SK)and Control Group(Group C)in a ratio of 1:1.Group SK received esketamine with a bolus of 0.2mg/kg esketamine during induction of anesthesia and 0.02mg/kg/h in PCIA after surgery while patients of Group C received the same volume of normal saline.The primary outcome is to measure the pain intensity through the NRS score at rest and activity at postoperative 2,4,24 and 48 h respectively,and the supplementary analgesic of opioids after surgery is also included.The secondary outcome is to measure the anxiety and depression through the HADS score preoperatively and 48 h postoperatively.Complications and esketamine-related side effects were recorded to evaluate the safety of esketamine.Results: 80 patients were included in this study,each group 40 patients.There were no significant differences in NRS score at 2h,4h under both conditions and 24 h at rest between two groups(P>0.05).NRS score at 24 h during mobilization and 48 h under both conditions in Group SK was significantly lower than that in Group C(P<0.01).The total consumption of postoperative sufentanil in Group SK was significantly lower than that in Group C(P<0.05).Postoperative HAD-A scores were lower than that preoperatively(P<0.05).Compared with Group C,postoperative HAD-A scores were significantly lower than that in Group C(P<0.05).There were no significant difference in preoperative and postoperative MMSE between two groups(P>0.05).There was no significant difference in postoperative side effects between two groups(P>0.05).Conclusions: Esketamine can alleviate the intensivity of early postoperative pain and reduce the consumption of opioids after video-assisted thoracic surgery,which provides an additional anesthesia method for anesthesiologists in clinical settings.Besides,esketamine can also relieve postoperative depression,and improve the patient outcomes.