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

[OBJECTIVE] 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.

[METHODS] 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.

[RESULTS] 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).

[CONCLUSION] 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.