The effects of esketamine on postoperative delirium in older patients with fragile brain function during the non-acute phase following lung cancer surgery: a randomized controlled trial
Honglin Fu, Jianda Hu, Xuewei Zhang, Kaiyun Xie, Lihong Hu
Abstract
Esketamine has been used in the prevention of postoperative neurocognitive disorders in trauma surgery, gastrointestinal surgery and other fields due to its significant anti-inflammatory effect. However, its effect on postoperative delirium (POD) in older patients with fragile brain function after lung cancer remains unclear. This study aims to evaluate the effect of low-dose esketamine on POD in older patients with fragile brain function following lung cancer surgery during the perioperative period. One hundred and eight older patients undergoing thoracoscopic radical lung cancer surgery were randomly assigned to the control group or the esketamine group. All patients received standardized anesthesia without pre-anesthesia medication. Esketamine group received esketamine 0.25 mg/kg during anesthesia induction and esketamine 0.1 mg/kg/h during anesthesia maintenance for 30 min. Control group received an equal volume of normal saline during both induction and maintenance of anesthesia. The Confusion Assessment Method (CAM) was used to evaluate the incidence(%) of POD at 24 h and 72 h post-surgery. Serum concentration of interleukin-6 (IL-6) and calcium-binding protein β(S100β)(mean ± SD) were measured intravenously before and one day after surgery to assess inflammation. Additionally, intraoperative dosages of propofol, sufentanil, and remifentani(mean ± SD)were recorded, along with postoperative extubation time, SpO 2 after extubation (mean ± SD), incidence (% ) of vertigo, remedial analgesia, rates of nausea and vomiting, duration of recovery room stay, and total hospital stay (mean ± SD). Compared with the control group, the incidence of POD was significantly lower in the esketamine group at 24 h post-operation (3.8% vs. 15.1%, P = 0.046),but no difference at 72 h post-operation (0% vs. 7.5%, P = 0.126). No significant difference in serum concentration of IL-6 and S100β was observed between the two groups on the day before surgery ( P > 0.05). However, one day post-operation serum concentration of IL-6 and S100β in the esketamine group were significantly lower than those in the control group (5.14 ± 1.70 vs. 6.03 ± 2.13, P = 0.019;380.08 ± 204.01 vs. 479.32 ± 213.07, P = 0.016). The consumption of sufentanil in the esketamine group was lower than those in the control group (28.06 ± 3.76 vs. 29.85 ± 4.21, P = 0.023). Extubation time, the rate of remedial analgesia, and recovery room stay duration were shorter in the esketamine group compared to the control group(27.08 ± 8.46 vs. 30.4.±7.72, P = 0.035; 5.7% vs. 18.9%, P = 0.038; 58.96 ± 16.98 vs. 65.83 ± 15.31, P = 0.031). After extubation, SpO 2 levels were higher in the esketamine group (98.02 ± 1.65 vs. 97.21 ± 1.56, P = 0.011), and total hospital stay was shorter than in the control group (8.75 ± 2.83 vs. 11 ± 5.96, P = 0.015).There was no significant difference in the incidence of postoperative dizziness, nausea, and vomiting between the two groups. Esketamine may reduce the incidence of early postoperative delirium in older patients with fragile brain function undergoing lung cancer surgery during the non-acute phase, appear to inhibit inflammation levels, and be associated with shortening postoperative recovery time. Chictr.org.cn identifier ChiCTR2400083811 (Date of registry: 05/05/2024, prospectively registered).