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Purpose <p>One-lung ventilation (OLV) frequently induces hypoxemia. This study investigated whether intraoperative esketamine is non-inferior to dexmedetomidine in maintaining oxygenation during OLV and evaluated its impact on postoperative recovery.</p> Methods <p>In this prospective, double-blind, non-inferiority trial, 126 adults undergoing thoracoscopic surgery were randomized to saline (Control), dexmedetomidine, or esketamine. The primary outcome was PaO₂/FiO₂ (P/F) ratio at 60 min after OLV initiation. The key secondary outcome was Quality of Recovery-15 (QoR-15) at 24 h. Linear mixed effects models were used.</p> Results <p>A total of 120 patients were included in the modified intention-to-treat analysis. At T3, esketamine was noninferior to dexmedetomidine for P/F ratio (adjusted mean difference [MD] − 1.92 mmHg; 95% CI: − 41.06 to 37.20). Compared with the control group, esketamine showed more favorable intraoperative respiratory mechanics and lower opioid requirements. Furthermore, esketamine was associated with higher global QoR-15 scores at 24 h postoperatively compared with the Control group (adjusted MD 8.10; 95% CI 2.99 to 13.21) and the Dexmed group (adjusted MD 6.47; 95% CI 1.36 to 11.59). However, the incidence of postoperative pulmonary complications did not differ significantly among the groups (<i>P</i> = 0.86).</p> Conclusion <p>Intraoperative esketamine is non-inferior to dexmedetomidine for maintaining oxygenation during OLV. Furthermore, it was associated with lower perioperative opioid/anesthetic requirements and higher early postoperative recovery scores, although it did not significantly reduce clinical pulmonary complications.</p>

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Esketamine versus dexmedetomidine for oxygenation and postoperative quality of recovery in thoracoscopic surgery: a randomized, double-blind, non-inferiority controlled trial

  • 期刊论文

  • 发表日期：

    2026年8月3日

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  • Rui Feng,
  • Zhuoran Wang,
  • Yuqiao Yang,
  • Quan Wang,
  • Yu Zhao,
  • Xi Qian,
  • Jinqiao Qian

摘要

Purpose

One-lung ventilation (OLV) frequently induces hypoxemia. This study investigated whether intraoperative esketamine is non-inferior to dexmedetomidine in maintaining oxygenation during OLV and evaluated its impact on postoperative recovery.

Methods

In this prospective, double-blind, non-inferiority trial, 126 adults undergoing thoracoscopic surgery were randomized to saline (Control), dexmedetomidine, or esketamine. The primary outcome was PaO₂/FiO₂ (P/F) ratio at 60 min after OLV initiation. The key secondary outcome was Quality of Recovery-15 (QoR-15) at 24 h. Linear mixed effects models were used.

Results

A total of 120 patients were included in the modified intention-to-treat analysis. At T3, esketamine was noninferior to dexmedetomidine for P/F ratio (adjusted mean difference [MD] − 1.92 mmHg; 95% CI: − 41.06 to 37.20). Compared with the control group, esketamine showed more favorable intraoperative respiratory mechanics and lower opioid requirements. Furthermore, esketamine was associated with higher global QoR-15 scores at 24 h postoperatively compared with the Control group (adjusted MD 8.10; 95% CI 2.99 to 13.21) and the Dexmed group (adjusted MD 6.47; 95% CI 1.36 to 11.59). However, the incidence of postoperative pulmonary complications did not differ significantly among the groups (P = 0.86).

Conclusion

Intraoperative esketamine is non-inferior to dexmedetomidine for maintaining oxygenation during OLV. Furthermore, it was associated with lower perioperative opioid/anesthetic requirements and higher early postoperative recovery scores, although it did not significantly reduce clinical pulmonary complications.