Lung-protective effect of low-dose esketamine in patients undergoing radical resection of lung cancer
Authors: Zhao Jiahui , Song Dongdong , Jiang Rui , Gao Junyu , Duan Fengmei 
Published: April 2024

Objective To explore the lung-protective effect of low-dose esketamine in patients undergoing radical resection of lung cancer.
Methods Eighty patients with ASA grade II–III and body mass index 18.5–23.9 kg/m2 were selected for elective thoracoscopic lobectomy at the Affiliated Hospital of Chengde Medical College from January 2022 to August 2023. The patients were 60–75 years old. They were randomly divided into the esketamine group (group E) and the control group (group C), with 39 cases in each group. In group E, 0.2 mg/kg esketamine was injected intravenously during anesthesia induction, and 0.15 mg/(kg·h) was injected intravenously for anesthesia maintenance. Group C was given equal volume of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the time of entry (T0), immediately after twin-lumen tracheal catheter placement (T1), beginning of single-lung ventilation (T2), beginning of surgery (T3), end of single-lung ventilation (T4), and after surgery (T5). Alveolar arterial oxygen differential pressure (A-aDO2), respiratory index (RI), and dynamic lung compliance (Cdyn) were calculated immediately after intubation, 30 min after single-lung ventilation, and after surgery. Serum levels of TNF-α, IL-6, IL-10, malondialdehyde (MDA), and superoxide dismutase (SOD) were detected before operation, immediately after operation, and 24 h after operation. Resting pain visual analogue scale (VAS) was recorded at 2 (V1) ,6(V2) ,12 (V3) ,24 (V4), and 48 h (V5) after operation, and Mini Mental State Score (MMSE) was recorded on the 1st day before and 7th day after operation.
Results A total of 78 cases were included, namely 39 cases in group E and 39 cases in group C. Compared with group C, the MAP of group E was higher at T3–T5 (P < 0.05). Cdyn in group E was higher than that in group C (P > 0.05), while A-aDO2 and RI in group E were lower than those in group C (P < 0.05). Compared with group C, plasma TNF-α and IL-10 levels in group E were lower after surgery and 24 h after surgery (P < 0.05), plasma IL-6 level was lower after surgery (P < 0.05), plasma MDA level was lower after surgery and 24 h after surgery (P < 0.05), and plasma SOD activity was increased (P > 0.05). The VAS pain scores at 2, 6, 12, 24, and 48 h after operation, the number of efective patient-controlled intravenous analgesia (PCIA) compressions, and the total number of PCIA compressions within 48 h after operation were signifcantly decreased (P < 0.05). The scores of MMSE in Group E were lower than those in Group C on the first day after operation (P < 0.05), but the scores of MMSE in Group E were lower than those in Group C. Compared with Group C, the scores of MMSE in Group E were higher on the 1st and 7th day after operation (P < 0.05).
Conclusion The use of low-dose esketamine during induction and maintenance of anesthesia is conducive to maintaining hemodynamic stability, inhibiting inflammatory response and oxidative stress response in patients with single-lung ventilation during radical lung cancer surgery, and protecting lung function.