Effect of esketamine on postoperative pulmonary complications after radical surgery for lung cancer

Background: Thoracoscopic radical resection for lung cancer is widely performed, but postoperative pulmonary complications (PPCs) remain one of the most common and severe perioperative adverse events, which prolong hospital stay and increase postoperative morbidity. Esketamine exerts anti-inflammatory and lung-protective properties, while its effect on reducing PPCs after thoracoscopic lung cancer surgery still requires further clinical verification. This study aimed to investigate whether perioperative application of esketamine could reduce the incidence of PPCs in patients undergoing thoracoscopic radical resection for lung cancer. Methods: A total of 80 adult patients scheduled for thoracoscopic radical lung cancer surgery were enrolled. The primary outcome was the overall incidence of PPCs on postoperative day 1. Secondary outcomes included the incidence of PPCs on postoperative days 3 and 7, PPC severity score, postoperative nausea and vomiting, postoperative hospital stay, indwelling time of the thoracic drainage tube, 24-hour postoperative resting visual analog pain score, unplanned intensive care unit admission, and postoperative mortality. Results: The incidence of PPCs on postoperative day 1 was significantly lower in the esketamine group than in the control group (37.5% vs 72.5%, P  = .002). No significant between-group differences were observed in the incidence of PPCs on postoperative days 3 and 7 or in any of the other secondary outcomes. Conclusion: Perioperative esketamine administration can effectively decrease the early postoperative (postoperative day 1) incidence of PPCs in patients undergoing thoracoscopic radical lung cancer surgery, with no obvious impact on other secondary clinical outcomes.