The analgesic effect of esmketamine in general anesthesia with double-lumen endotracheal intubation for thoracoscopic pneumonectomy

Zhang Huanhuan; Kong Jing; Meng Lu; Yao Jingman; Hu Youyang; Ma Dongchun

doi:10.3760/j.issn.1673-4777.2025.04.010

Abstract：Objective To observe the analgesic effect of esmketamine in general anesthesia with double-lumen endotracheal intubation for thoracoscopic pneumonectomy.Methods A total of 118 patients who underwent thoracoscopic pneumonectomy in Anhui Chest Hospital from July 1,2022 to June 30,2023 were selected as the research objects.They were divided into the control group and the observation group by simple random method,with 59 cases in each group.The control group was given propofol and remifentanil for anesthesia maintenance after anesthesia induction,and the observation group was added esketamine for combined anesthesia maintenance on the basis of the control group after anesthesia induction.The intraoperative hemodynamics,perioperative opioid consumption,postoperative analgesia and adverse reactions were compared between the two groups.Results There was no significant difference in mean arterial pressure(MAP)and heart rate between the two groups before anesthesia induction(T0)(both P＞0.05).The MAP and heart rate immediately after intubation(T1)and at 5 min after double-lumen tube insertion(T2)were lower than those at T0 in both groups(all P＜0.05).There was no significant difference between 10 min after removal of double-lumen tube(T3)and T0 in the same group(all P＞0.05).The MAP and heart rate of the observation group at T,were higher than those of the control group at the same time point,but there were no statistically significant differences in MAP and heart rate between the two groups at T2 and T3(all P＞0.05).The perioperative doses of remifentanil and sufentanil in the observation group were lower than those in the control group(both P＜0.001).The time of first pressing analgesic pump after surgery in the obser-vation group was later than that in the control group[(80±12)min vs(46±8)min],the actual and effective pressing times within 24 hours and the dosage of ketochromate tromethamine were less than those in the control group[(5.8±3.2)times vs(10.3±4.1)times,(5.9±3.0)times vs(10.3±4.3)times,(304±20)mg vs(712±29)mg](all P＜0.05).However,there was no significant difference in the incidence of visual analogue scale score＞4 between the two groups(P＞0.05).The levels of prostaglandin E2,cortisol and norepinephrine in the two groups at 24 hours after operation were higher than those before operation,but those in the observation group were lower than those in the control group(all P＜0.05).The incidence of nausea and vomiting in the observation group was lower than that in the control group,and the difference was statistically significant(P=0.038).However,there was no significant difference in the incidence of dizziness,respiratory depression,pruritus,restlessness and hallucination between the two groups(all P＞0.05).Conclusion The application of esmketamine in general anesthesia with double-lumen endotracheal intubation in thoracoscopic pneumonectomy can stabilize hemodynamics,reduce the dosage of opioids,and have good analgesic effect.