In elderly patients (aged 65-75) undergoing pulmonary lobectomy with incision, intraoperative esketamine (0.3 mg/kg/h) was associated with a lower incidence of postoperative cognitive dysfunction on days 1 and 3 after surgery compared to remifentanil. The esketamine group also showed higher serum Aβ42/40 levels and lower tau levels on day 1 postoperatively, along with more stable heart rate, mean arterial pressure, and lower pain scores at the end of surgery. No significant difference in postoperative delirium or adverse events was observed between groups. The findings suggest esketamine may reduce postoperative cognitive decline without increasing safety risks.
Early postoperative pain and neurological dysfunction impair recovery after arthroscopic rotator cuff repair. Esketamine, an NMDA receptor antagonist, may reduce opioid use, inflammation, and protect nerves. This single-center, randomized controlled trial will enroll 234 patients undergoing arthroscopic rotator cuff repair, assigning them to general anesthesia with one of two doses of esketamine or saline. The primary outcome is quality of early recovery measured by the QoR-15 scale on postoperative day 1. Secondary outcomes include QoR-15 scores on day 3, remifentanil consumption, vasoactive drug use, cerebral desaturation, pain scores, delirium, and adverse events. The study aims to assess whether esketamine mitigates effects of controlled hypotension on cerebral oxygen saturation and postoperative delirium.