Xue-Li Lv,1,* Qing Liu,1,* Jin-Ping Yu,1 Xue-Chun Cai,1 Lin Wu,1 Jian-Jun Yang,2 Ying-Chun Dong1 

1Department of Anesthesiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ying-Chun Dong, Department of Anesthesiology, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, 30 Zhongyang Road, Nanjing, Jiangsu, 210008, People’s Republic of China, Tel +86-25-83620382, Email dongyingchun@nju.edu.cn Jian-Jun Yang, Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, Henan, 450052, People’s Republic of China, Tel +86-371-66271657, Email yjyangjj@126.com

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, recovery quality, surgery, randomized controlled trial