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已发表论文
无阿片类药物麻醉联合艾司氯胺酮对老年胸腔镜手术患者术后认知功能障碍的影响：一项前瞻性、随机、对照试验
Authors Zhan Y, Liu Z , Meng S , Luo M, Huang Z , Wang L
Received 15 July 2025
Accepted for publication 10 December 2025
Published 16 December 2025 Volume 2025:19 Pages 11227—11244
DOI https://doi.org/10.2147/DDDT.S553370
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 5
Editor who approved publication: Dr Tuo Deng
Yuening Zhan,* Zhaohui Liu,* Song Meng, Mingze Luo, Zeqing Huang,* Lingfei Wang*
Department of Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Lingfei Wang, Department of Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Xiaoheyan Road, Shenyang, Liaoning, 110042, People’s Republic of China, Tel +86 18900918433, Email wanglingfei.good@163.com Zeqing Huang, Department of Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Xiaoheyan Road, Shenyang, Liaoning, 110042, People’s Republic of China, Tel +86 18900917545, Email huangzeqing1973@163.com
Background: Postoperative cognitive dysfunction (POCD) occurs at a higher rate in elderly patients undergoing thoracoscopic surgery, significantly affecting postoperative recovery and quality of life. However, effective interventions and anesthesia-related risk factors remain poorly understood.
Purpose: This study aimed to evaluate the impact of esketamine-based opioid-free anesthesia (OFA) on POCD in elderly patients undergoing thoracoscopic lung cancer surgery.
Patients and Methods: In this study, 80 elderly patients undergoing thoracoscopic lung cancer surgery were randomly allocated to receive either opioid-free anesthesia with esketamine (OFA group) or opioid-based anesthesia (Control group). The primary outcome was the incidence of POCD within 3 days. Logistic regression was used to identify risk factors for POCD.
Results: The incidence of POCD was 20% and 42.5%, respectively, in the OFA group and the Control group (risk ratio [RR], 0.47; 95% confidence interval [CI], 0.24 to 0.92; risk difference [RD], − 22.5%; 95% CI, − 44.8% to − 0.2%; p = 0.054). Compared to the Control group, patients in the OFA group had lower simple reaction time at 1 and 3 days post-surgery (1-day: p = 0.031; 3-day: p = 0.020). In addition, patients in the OFA group demonstrated higher mean values for mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume (SV), and systemic vascular resistance index (SVRI), as well as smaller variation ranges for these parameters, compared to the Control group (all p < 0.05), Furthermore, age (OR, 2.738; 95% CI, 1.37 to 6.30; p = 0.008), CO range (OR, 4.673; 95% CI, 2.25 to 11.82; p < 0.001), and time to first analgesic request (OR, 0.399; 95% CI, 0.18 to 0.76; p = 0.01) were validated to correlate with POCD.
Conclusion: Esketamine-based OFA did not significantly reduce POCD incidence, and it was associated with improved postoperative reaction time and reduced intraoperative hemodynamic fluctuations.
Keywords: opioid-free anesthesia, esketamine, postoperative cognitive dysfunction, thoracoscopic surgery, hemodynamics
Department of Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Shenyang, Liaoning, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Lingfei Wang, Department of Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Xiaoheyan Road, Shenyang, Liaoning, 110042, People’s Republic of China, Tel +86 18900918433, Email wanglingfei.good@163.com Zeqing Huang, Department of Anesthesiology, Cancer Hospital of Dalian University of Technology, Liaoning Cancer Hospital & Institute, Xiaoheyan Road, Shenyang, Liaoning, 110042, People’s Republic of China, Tel +86 18900917545, Email huangzeqing1973@163.com
Background: Postoperative cognitive dysfunction (POCD) occurs at a higher rate in elderly patients undergoing thoracoscopic surgery, significantly affecting postoperative recovery and quality of life. However, effective interventions and anesthesia-related risk factors remain poorly understood.
Purpose: This study aimed to evaluate the impact of esketamine-based opioid-free anesthesia (OFA) on POCD in elderly patients undergoing thoracoscopic lung cancer surgery.
Patients and Methods: In this study, 80 elderly patients undergoing thoracoscopic lung cancer surgery were randomly allocated to receive either opioid-free anesthesia with esketamine (OFA group) or opioid-based anesthesia (Control group). The primary outcome was the incidence of POCD within 3 days. Logistic regression was used to identify risk factors for POCD.
Results: The incidence of POCD was 20% and 42.5%, respectively, in the OFA group and the Control group (risk ratio [RR], 0.47; 95% confidence interval [CI], 0.24 to 0.92; risk difference [RD], − 22.5%; 95% CI, − 44.8% to − 0.2%; p = 0.054). Compared to the Control group, patients in the OFA group had lower simple reaction time at 1 and 3 days post-surgery (1-day: p = 0.031; 3-day: p = 0.020). In addition, patients in the OFA group demonstrated higher mean values for mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume (SV), and systemic vascular resistance index (SVRI), as well as smaller variation ranges for these parameters, compared to the Control group (all p < 0.05), Furthermore, age (OR, 2.738; 95% CI, 1.37 to 6.30; p = 0.008), CO range (OR, 4.673; 95% CI, 2.25 to 11.82; p < 0.001), and time to first analgesic request (OR, 0.399; 95% CI, 0.18 to 0.76; p = 0.01) were validated to correlate with POCD.
Conclusion: Esketamine-based OFA did not significantly reduce POCD incidence, and it was associated with improved postoperative reaction time and reduced intraoperative hemodynamic fluctuations.
Keywords: opioid-free anesthesia, esketamine, postoperative cognitive dysfunction, thoracoscopic surgery, hemodynamics