Effect of Subanesthetic Dose of Esketamine on Liver Function Following Microvascular Reconstruction for Head and Neck Cancer: A Randomized Controlled Trial

Abstract

Purpose: Abnormal liver function is common post-surgery and is linked to poor prognosis. We investigated whether intraoperative subanesthetic esketamine could improve postoperative liver function and recovery quality by reducing surgery-induced inflammation in patients with head and neck squamous cell carcinoma (HNSCC).

Patients and methods: In this randomized controlled trial, 172 hNSCC patients were randomly assigned to receive esketamine or saline intravenously. The primary outcome was serum alanine aminotransferase (ALT) on postoperative day (POD) 1. Secondary outcomes included aspartate aminotransferase (AST), abnormal liver function event (ALFE), inflammatory markers (serum C-reactive protein [CRP], white blood cell [WBC] count, neutrophil percentage (NE%) and the neutrophil-to-lymphocyte ratio [NLR]) on POD1, and recovery quality measured by the quality of recovery (QoR)-40 questionnaire on POD1 and POD7.

Results: The esketamine group showed a lower mean [standard deviation, SD] ALT (27.72 [13.04] vs 50.74 [20.14] U/L; P = 0.001), AST (20.88 [8.60] vs 26.05 [15.31] U/L; P =0. 007), rate of ALFE (12% vs 31%; odds ratio [OR], 95% confidence interval [CI]: 0.308, 0.138 to 0.688; P = 0.003), CRP (53.30 [22.98] vs 60.70 [23.51] mg/L; P = 0.039), WBC count (13.37 [3.40] vs 15.02 [3.97] 10⁹/L; P = 0.004), NE% (85.58 [4.77] vs 87.38 [4.02]; P = 0.008), and NLR (15.05 [6.08] vs 17.25 [7.04]; P = 0.042), and higher QoR-40 scores on POD1 (171 [169 to 174] vs 168 [166 to 171]; P < 0.001) and POD7 (177 [174 to 180] vs 175 [172 to 178]; P < 0.001) compared to the control group.

Conclusion: Subanesthetic esketamine improved postoperative liver function and recovery quality in HNSCC patients, possibly by reducing surgery-induced inflammation.

Keywords: esketamine; inflammation; liver; randomized controlled trial; recovery quality; surgery.

Figure 1

Participant Flowchart.

Figure 2

QoR-40 scores between the two groups (A) Total QoR-40 scores at different time points; (B) Sub-dimension QoR-40 score on POD1; (C) Sub-dimension QoR-40 score on POD7. * P < 0.05.