Effect of Intraoperative Low-Dose Esketamine on Postoperative High-Sensitivity Troponin T in Elderly Patients Undergoing Ivor Lewis Esophagectomy

Hai Zhou,1,2,* Yifei Pan,1,2,* Xinran Feng,1,2,* Meiyan Zhou,2,3 Zixuan Yang,1,2 Fan Zhou,1,2 Jiao Chen,1,3 Wenjing Xu,1,2 Yu Qi,1,3 Liangyu Cai,4 Liwei Wang1– 3 1The Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, Xuzhou Central Hospital, Xuzhou, Jiangsu, People’s Republic of China; 3Anesthesiology Department, Xuzhou Central Hospital, Southeast University, Xuzhou, Jiangsu, People’s Republic of China; 4Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Liwei Wang, The Xuzhou Clinical College of Xuzhou Medical University, Anesthesiology Department, Xuzhou Central Hospital, Southeast University, Xuzhou, Jiangsu, People’s Republic of China, Email [email protected] Liangyu Cai, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, Jiangsu, People’s Republic of China, Email [email protected]: Ivor Lewis esophagectomy impacts circulatory and cardiac function significantly, often leading to elevated postoperative troponin levels. This study aimed to investigate the effect of low-dose esketamine on postoperative levels of the myocardial injury marker high-sensitivity cardiac troponin T in elderly patients undergoing this procedure.Patients and Methods: 70 elderly patients scheduled for elective Ivor Lewis esophagectomy were randomly assigned using a random number table to the Control group (Group C, n=35) or the Esketamine group (Group K, n=35). In Group K, in addition to conventional anesthetic drugs, intravenous esketamine 0.25 mg/kg was administered during anesthesia induction, followed by continuous intraoperative infusion at 0.125 mg/kg/h as an adjunct to balanced anesthesia. The Control group received conventional anesthesia induction and maintenance. The primary outcome was hs-cTnT concentration at 24 h postoperatively.Results: In Group K, hs-cTnT concentrations were significantly lower than in the control group at 24h (12.1 ± 3.5 vs 18.7 ± 4.7, P < 0.0001) postoperatively, as well as at 6– 12h and 48h postoperatively. Although the incidence of myocardial injury within 2 days postoperatively (11.4% vs 22.9%, P = 0.205) and perioperative severe arrhythmias (2.9% vs 11.4%, P = 0.164) was lower in Group K than in Group C, the differences were not statistically significant. Compared to the control group, Group K indicated more stable hemodynamics. Among postoperative complications, the incidence of dreaming was higher in Group K, with no significant differences in other complications. For postoperative pain, Group K had lower Numerical Rating Scale (NRS) scores at PACU discharge and on postoperative day 1 to day 3. The PACU stay was shorter in Group K.Conclusion: Intraoperative low-dose esketamine effectively reduced hs-cTnT concentrations within 2 days postoperatively in elderly patients undergoing Ivor Lewis esophagectomy, demonstrating a potential beneficial effect in preventing myocardial injury and cardiovascular adverse events.Keywords: high-sensitivity cardiac troponin T, myocardial injury, esketamine, Ivor-Lewis esophagectomy, elderly patients