The Early Effects of Esketamine on the Tumor Metastatic Microenvironment in Postoperative Lung Cancer Patients.

Background: To investigate the early effect of esketamine on the tumor metastatic microenvironment in patients with lung cancer.

Methods: Sixteen adults aged 45-80 years with the American Society of Anesthesiologists (ASA) 1 to 3 were randomly divided into the experimental group (group E) and the control group (group C). Group E received esketamine at 1 mg/kg during anesthesia induction and a continuous infusion of 0.5 mg/kg/h during the surgery. Group C was given the same amount of normal saline infusion. Patient-controlled intravenous analgesia (PCIA) in group E was administered using dexmedetomidine (0.5 mg/kg) + esketamine (50 mg) + dexamethasone (5 mg). PCIA in group C was the same dose of dexmedetomidine and dexamethasone. Data were recorded at 14 points from admission to the third day after surgery (T). Parameters recorded included hemodynamics, wake time, remifentanil dosage, and so on. At T, T, T, and T, TNF-α, IL-2, IL-10, MMP-9, and VEGF-C were measured.

Results: Compared with T, the differences of tumor necrosis factor-α (TNF-α), interleukin-2 (IL-2), matrix metallopeptidase 9 (MMP-9), and vascular endothelial growth factor-C (VEGF-C) in the two groups were statistically significant (p < 0.05). When compared to group C, VEGF-C in group E was reduced at T and T (p < 0.05). For both groups, there were intragroup differences in the changes of MMP-9 and VEGF-C levels (p < 0.05). Compared to group C, on the postoperative, group E exhibited a lower change rate of TNF-α and VEGF-C (p < 0.05).

Conclusion: Perioperative application of esketamine in patients with lung cancer provided significant sedative and analgesic effects and affected cytokines in the tumor microenvironment.