Efficacy and safety of esketamine hydrochloride injection at different dosages for patients undergoing radical thyroidectomy for thyroid cancer: a randomized trial

This study aims to the combination of remimazolam toluene sulfonate and esketamine hydrochloride in reducing postoperative complications and improving recovery outcomes in thyroid surgery patients.

One hundred twenty patients undergoing radical thyroidectomy were randomly assigned to four groups: control group (Group C) and three esketamine groups (Groups S1, S2, S3). Before peeling, groups S1, S2, and S3 were administered with 0.15, 0.25, and 0.35 mg/kg of esketamine via slow intravenous injection, respectively. The primary outcomes was recovery quality (QoR-15). Secondary outcomes included postoperative pain (NRS scores), incidence of coughing (Minogue score), hemodynamic stability, emotional recovery (HADS scores), extubation time, adverse reactions, and sufentanil consumption.

Baseline data showed no significant differences (p > 0.05). Pain and HADS scores were significantly lower in Groups S2 and S3 (p < 0.05). QoR-15 scores were significantly higher in all esketamine groups (p < 0.05). Postoperative recovery and extubation times were longer in Groups S2 and S3 (p < 0.05), with Group S3 having the longest. Postoperative cough severity and incidence were significantly lower in Groups S2 and S3 (p < 0.05). HR and SBP increased at t1 in Groups S2 and S3 but normalized by t4, with less pronounced changes in Group S2. No significant differences in adverse reactions (p > 0.05).

Esketamine at doses of 0.25 mg/kg/h and 0.35 mg/kg/h improves recovery, reduces pain and coughing, and maintains hemodynamic stability. A dose of 0.25 mg/kg/h offers optimal clinical benefits with faster recovery.