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Effects of esketamine combined with dexmedetomidine on postoperative delirium and quality of recovery in elderly patients undergoing thoracoscopic radical lung cancer surgery: a randomized controlled trial

Published online by Cambridge University Press:  20 November 2024

Cong-Li Zhang ,
Yan Yan ,
Yang Zhang ,
Han-Lin Bai ,
Qin Zhuang ,
Nan-Nan Song ,
Chuan-Jiang Feng ,
Li-Juan Xie ,
Si-Yi Wang  and
Xiao-Hong Li
...Show all authors
Cong-Li Zhang
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Yan Yan
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Yang Zhang
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Han-Lin Bai
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Qin Zhuang
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Nan-Nan Song
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Chuan-Jiang Feng
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Li-Juan Xie
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Si-Yi Wang
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Xiao-Hong Li
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Di Liu
Affiliation:
Department of Anesthesiology, First Affiliated Hospital of Bengbu Medical University, Bengbu, Anhui, China
Li Ren*
Affiliation:
School of Laboratory Medicine, Bengbu Medical University, Bengbu, Anhui, China
*
Corresponding author: Li Ren; Email: [email protected]
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Abstract

Objective

This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.

Methods

In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery−15 (QoR − 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3+, CD4+, and CD8+ were detected from T0 to T5.

Results

Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR − 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8+ were significantly decreased, and IL − 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3+ and CD4+/CD8+ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4+ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.

Conclusions

Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.

Keywords

esketaminedexmedetomidinethoracoscopic radical lung cancer surgerypostoperative deliriumquality of recovery
Type
Original Research
Information
CNS Spectrums , Volume 29 , Issue 5 , October 2024 , pp. 441 - 450
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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Footnotes

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These authors contribute equally

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