Int Immunopharmacol. 2025 Nov 17;168(Pt 2):115860. doi: 10.1016/j.intimp.2025.115860. Online ahead of print.
ABSTRACT
BACKGROUND: This study evaluated the lung-protective effects of esketamine and dexmedetomidine administered before anesthesia induction in patients with mild-to-moderate chronic obstructive pulmonary disease (COPD) undergoing video-assisted thoracoscopic surgery (VATS).
METHODS: Sixty patients with mild-to-moderate COPD scheduled for VATS who completed the study and were included in the statistical analysis were randomly assigned to four groups (n = 15 per group): Control (Group C, saline), Dexmedetomidine (Group D, 0.8 μg/kg), Esketamine (Group E, 0.25 mg/kg), and Combination (Group ED, dexmedetomidine 0.8 μg/kg plus esketamine 0.25 mg/kg). Arterial blood gases, peak airway pressure (Ppeak), plateau pressure (Pplat), dynamic lung compliance (Cdyn), heart rate (HR), and mean blood pressure (MBP) were measured at different time points. Inflammatory markers (IL-6, IL-8, IL-10, TNF-α), oxidative stress markers (MDA, SOD), intraoperative drug use, postoperative recovery, pain scores, and adverse events were recorded.
RESULTS: At T4 (2 h after one-lung ventilation), peak airway pressure (Ppeak) and plateau pressure (Pplat) were significantly lower, and dynamic lung compliance (Cdyn) significantly higher, in Groups E and ED compared to Groups C and D (P < 0.05). At the same time point, levels of IL-6 and IL-8 were significantly lower in Groups E and ED than in Groups C and D (P < 0.05). TNF-α levels were significantly lower in Groups E and ED compared to Group C, and significantly lower in Group ED than in Group D (P < 0.05). IL-10 levels were significantly higher in Groups E and ED than in Groups C and D, with Group E showing higher levels than Group ED (P < 0.05). Similarly, SOD levels were significantly elevated in Groups E and ED compared to Groups C and D, and higher in Group E than in Group ED (P < 0.05). MDA levels were significantly reduced in Groups E and ED compared to Group C, and lower in Group ED than in Group D (P < 0.05). Additionally, PaO2 at T4 was significantly higher in Group ED than in Groups C and D (P < 0.05).
CONCLUSIONS: Low-dose esketamine combined with dexmedetomidine, administered before anesthesia induction, improved intraoperative pulmonary mechanics and oxygenation, and attenuated inflammation and oxidative stress in patients with mild-to-moderate COPD undergoing VATS. The combination also helped maintain hemodynamic stability and reduced postoperative pain, contributing to enhanced perioperative recovery.
PMID:41252770 | DOI:10.1016/j.intimp.2025.115860
