Abstract
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(0-14)). Parameters recorded included hemodynamics, wake time, remifentanil dosage, and so on. At T(0), T(10), T(13), and T(14), TNF-α, IL-2, IL-10, MMP-9, and VEGF-C were measured. RESULTS: Compared with T(0), 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(10) and T(13) (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.