Effect of esketamine on postoperative depressive symptoms in patients undergoing thoracoscopic lung cancer surgery: A randomized controlled trial

Abstract

BackgroundDepressive symptoms are common among patients with lung cancer. We aimed to assess the effects of esketamine on postoperative depressive symptoms after thoracoscopic lung cancer surgery.MethodsIn this randomized, double-blind, placebo-controlled trial, 156 patients undergoing thoracoscopic lung cancer surgery were randomly allocated in a 1:1 ratio to receive intravenous esketamine (intraoperatively and in patient-controlled analgesia until 48 h postoperatively) or normal saline placebo. The primary outcome was the proportion of patients with depressive symptoms at 1 month postoperatively, assessed using the Beck Depression Inventory-II (BDI-II). Secondary outcomes included depressive symptoms at 48 h postoperatively, hospital discharge and 3 months postoperatively, BDI-II scores, anxious symptoms, Beck Anxiety Inventory scores, Quality of Recovery-15 (QoR-15) scores, and 1- and 3-month mortality.Main resultsA total of 151 patients (75 in the esketamine group and 76 in the normal saline group) completed the 1-month follow-up. The esketamine group had a significantly lower incidence of depressive symptoms at 1 month compared to the normal saline group (1.3% vs. 11.8%; risk difference = −10.5, 95%CI = −19.6% to −0.49%; p = 0.018). After excluding patients without lung cancer diagnosis, the incidence of depressive symptoms was also lower in the esketamine group (1.4% vs. 12.2%; risk difference = −10.8, 95%CI = −20.2% to −0.52%; p = 0.018). The secondary outcomes were similar between groups, except that the esketamine group had higher QoR-15 scores at 1 month postoperatively (median difference = 2; 95%CI = 0 to 5; p = 0.048). The independent risk factors for depressive symptoms were hypertension (odds ratio = 6.75, 95%CI = 1.13 to 40.31; p = 0.036) and preoperative anxious symptoms (odds ratio = 23.83, 95%CI = 3.41 to 166.33; p = 0.001).ConclusionPerioperative administration of esketamine reduced the incidence of depressive symptoms at 1 month after thoracoscopic lung cancer surgery. History of hypertension and preoperative anxious symptoms were independent risk factors for depressive symptoms.Clinical trial registration: Chinese Clinical Trial Registry http://www.chictr.org.cn, Identifier (ChiCTR2100046194).

Effects of ketamine on the severity of depression and anxiety following postoperative mechanical ventilation: a single-blind randomized clinical trial in Iran

“…Several previous studies addressed the controversial effects of ketamine on postoperative depression. In 2023, Gan et al [ 11 ] discussed the effect of esketamine on the occurrence of depressive symptoms in patients undergoing thoracoscopic lung cancer surgery. In that study, 156 patients received ketamine infusion during and 48 hours after surgery.…”

“…Normal saline was administered to the control group and Beck's questionnaire was used to evaluate results. They found that depressive symptoms decreased 1 month after the operation [ 11 ]. In 2023, Zhang et al [ 10 ] examined Crohn's patients undergoing intestinal resection treated with ketamine at a dose of 0.25 mg/kg as an intravenous drip and then with a dose of 0.12 mg/kg/hr.…”

“…As ketamine is simultaneously a strong pain controller and sedative, we predicted that its administration would reduce the use of additional analgesics and sedatives that are associated with worse clinical and mental outcomes. There are a few studies [ 10 , 11 ] about the positive effects of ketamine on postoperative depression and anxiety, but they focus mostly on short term effects. This study was conducted to compare the effects of ketamine on the severity of depression and anxiety with those of a combination of midazolam and morphine in mechanically ventilated post-craniotomy patients from treatment in the ICU until 6 months after discharge.…”

An Intraoperative Sub-Anesthetic Dose of Esketamine on Postoperative Depressive Symptoms in Perimenopausal Women with Breast Cancer Undergoing Modified Radical Mastectomy: Protocol for a Randomized, Triple-Blinded, Controlled Trial

“… 13 , 14 Our recent work also suggested that a perioperative low-dose esketamine infusion reduced postoperative depressive symptoms in patients after thoracoscopic lung cancer surgery. 15 However, as far as we know, there is no study on perioperative use of esketamine in perimenopausal women with breast cancer.…”