The effect of esketamine on postoperative anxiety and depression in patients with thyroid cancer: A randomized, double-blind, placebo-controlled, parallel-group trial

Medicine (Baltimore). 2025 May 2;104(18):e42284. doi: 10.1097/MD.0000000000042284.

ABSTRACT

BACKGROUND: This study aimed to investigate the effects of a single intravenous injection of esketamine during general anesthesia on postoperative anxiety and depression in patients with thyroid cancer.

METHODS: In this randomized, double-blind, placebo-controlled, parallel-group trial, eighty female patients with thyroid cancer were scheduled to undergo surgery under general anesthesia. The patients were randomly divided into an esketamine group (group E) and a control group (group C), with 40 patients in each group. During the induction period of general anesthesia, group E received an intravenous injection of esketamine (0.5 mg/kg), while group C received an intravenous injection of 0.9% sodium chloride. The Zung Self-Rating Anxiety Scale and Zung Self-Rating Depression Scale scores for all patients were evaluated on the day before surgery and the second day after surgery. At the same time point, venous blood was collected twice from all patients, and the levels of serum factors, such as mature brain-derived neurotrophic factor (mBDNF), 5-hydroxytryptamine (5-HT), insulin-like growth factor-1 (IGF-1), and irisin, were measured. Intraoperative vital signs and general situation were recorded for all patients.

RESULTS: Compared with group C, group E showed a significant decrease in postoperative anxiety and depression scores (P < .05). Compared with group C, group E showed a significant increase in postoperative mBDNF and 5-HT levels (P < .05), and the postoperative IGF-1 level in group E was significantly lower (P < .05). Compared with group C, the proportion of patients in group E who received pump infusion of vasopressors during surgery was significantly reduced (P < .05).

CONCLUSION: Intravenous injection of 0.5 mg/kg esketamine during the induction period of general anesthesia can prevent and alleviate postoperative anxiety and depression in patients with thyroid cancer, and its mechanism may be related to increased mBDNF and 5-HT levels and reduced IGF-1 levels. At the same time, hemodynamics during anesthesia surgery are more stable.

PMID:40324271 | DOI:10.1097/MD.0000000000042284