Effects of esketamine-based anaesthesia on the Systemic Inflammatory Response in Thoracic Surgical Patients: a prospective, single-center, randomized, controlled trial

Abstract

Abstract Background Thoracic surgery with one-lung ventilation (OLV) leads to a postoperative inflammatory response. In this prospective randomized study, we compared the effect of esketamine-based anaesthesia on perioperative inflammatory cytokine levels in patients under routine anaesthesia with opioids undergoing thoracic surgery with OLV. Methods Adult patients undergoing wedge resections or total lobectomies under video-assisted thoracic surgery (VATS) were randomly assigned (1:1) to receive esketamine-based anaesthesia (Esketamine group, n = 22) or sufentanil-based anaesthesia (Sufentanil group, n = 22). Blood samples for measurement of inflammatory factors were collected from the radial artery at three time points: before anaesthesia induction (T1); 1 h after OLV (T2) and 2 h after surgery (T3). Peripheral venous blood was collected 24 hours before surgery (Preop) and 24 hours after surgery (Postop) to measure leukaemia cell lines and C-reactive protein (CRP). Results Compared with the sufentanil group, the increase in proinflammatory cytokines interleukin (IL)-6 (10.23 ± 5.60 vs. 20.97 ± 18.22 pg/ml, P = 0.029) and IL-8 secretions (4.88 ± 18.29 vs. 81.69 ± 130.34 pg/ml, P = 0.026) was significantly lower in the esketamine group 2 h after the intrathoracic procedure. CRP levels (24.36 ± 12.64 vs. 49.71 ± 29.60 mg/L, P < 0.001) and blood loss volumes (11.14 ± 4.86 ml vs. 28.18 ± 18.16 ml, P < 0.001) were significantly lower in the esketamine group than in the sufentanil group (24.36 ± 12.64 vs. 49.71 ± 29.60, P < 0.001). There was no difference in biometric data, surgical procedures, duration of surgery, OLV and mechanical ventilation, or length of hospital stay among the groups. Conclusions Our study demonstrates that esketamine possesses potent anti-inflammatory properties. Anaesthesia with esketamine may play a beneficial role in reducing both the OLV-induced systemic inflammatory response and intraoperative blood loss. Trial registration: ChiCTR2200065915. Registered on 18/11/2022.