Effect of Remimazolam or Propofol Combined With Esketamine on Anesthesia and Early Perioperative Neurocognitive Disorders in Patients Undergoing Thoracoscopic Partial Lung Resection: A Randomized Clinical Trial.

This study aimed to evaluate the effects of remimazolam in conjunction with esketamine on anesthesia and the incidence of early perioperative neurocognitive disorders (PNDs) in patients undergoing thoracoscopic partial lung resection. Eighty patients scheduled for thoracoscopic lobectomy were randomly assigned 1:1 to either the remimazolam group (group R) or the propofol group (group P). Group R received remimazolam for induction and maintenance of anesthesia, whereas group P received propofol. Both groups received intravenous esketamine before skin incision. The following parameters were compared: mean arterial pressure, heart rate, and perfusion index; extubation time, postanesthesia care unit stay duration, length of stay; arterial blood gas potassium, sodium, and glucose levels; hepatic and renal function markers; incidence of early PNDs and postoperative delirium (POD); safety indicators including visual analog scale scores, injection pain, Richmond Agitation-Sedation Scale sedation scores, and postoperative nausea and vomiting. The incidence of POD and early PNDs did not differ significantly between the 2 groups (P > 0.05). Mean arterial pressure in group R was significantly higher than in group P (P < 0.05). Heart rate in group R was higher than in group P at 1 minute after tracheal intubation (P < 0.05). Perfusion index values did not differ significantly between groups (P > 0.05). Extubation time, postanesthesia care unit stay time, and length of stay were shorter in group R than in group P (P < 0.05), whereas sedation depth was greater in group R (P < 0.05). Within group R, blood glucose decreased at 1 minute after intubation and increased at 10 minutes after extubation (P < 0.05). Although total bilirubin showed significant postoperative elevation in both groups (P < 0.05), all other hepatic/renal function parameters remained comparable (P > 0.05). Visual analog scale scores showed no significant intergroup differences (P > 0.05). The incidence of injection pain and postoperative nausea and vomiting was lower in group R than in group P (P < 0.05). Compared with propofol combined with esketamine, general anesthesia using remimazolam combined with esketamine provides more stable hemodynamics without increasing adverse reactions, has less impact on patient electrolytes and liver/kidney function, and does not increase the incidence of early PNDs or POD; furthermore, it can decrease the hospitalization period as well as the economic pressure on patients. This may offer a novel approach to anesthesia induction and maintenance for clinically elderly patients and those with impaired hepatic or renal function. Chinese Clinical Trial Registry identifier: ChiCTR2500104188; registration date: June 12, 2025; retrospective registration; Website: https://www.chictr.org.cn).