Effect of intraoperative low dose esketamine on TNF-α and IL-6 in patients with colorectal cancer

The purpose of this study was to investigate the effects of intraoperative medium dose esketamine on serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels in colorectal cancer patients, evaluate its anti-inflammatory effect and postoperative analgesia. A total of 60 elderly patients (aged 60–85 years, Body Mass Index (BMI) 18.5–25 kg/m², American Society of Anesthesiologists (ASA) grade I-II) were selected for elective laparoscopic radical resection of colorectal cancer. A single-center randomized double-blind trial was conducted. During anesthesia maintenance, the experimental group was injected with low-dose esketamine (0.2mg/kg/h) pump, while the control group was injected with normal saline. The main outcome measures were the concentration of TNF-α before surgery, 0.5 h and 16 h after surgery. Secondary parameters included IL-6 concentration, recovery time, extubation time, intraoperative dosage of propofol and ropivacaine, total number of Patient-Controlled Analgesia (PCA) compression, postoperative pain scale (VAS), and incidence of adverse reactions. Esketamine significantly reduced TNF-α at 0.5h (8.01 ± 3.13 vs. 13.48 ± 9.64 pg/mL, P < 0.05) and 16h (11.46 ± 4.99 vs. 23.17 ± 5.56 pg/mL, P < 0.05), with 66.3% lower propofol requirements (150[120–200] vs. 445[400–495] mg, P < 0.001). Recovery time (8.19 ± 6.65 vs. 11.95 ± 6.95 min, P = 0.022) and VAS scores (6-72h post-op, all P < 0.05) were improved without increased adverse events. Intraoperative medium dose esketamine (0.2 mg/kg/h) can effectively reduce the production of serum TNF-α and reduce the amount of propofol in colorectal cancer patients. It can also effectively shorten the anesthesia recovery time, tracheal catheter extraction time, hospital stay and reduce postoperative pain, and does not increase the incidence of postoperative adverse reactions, which is conducive to improving anesthesia and treatment satisfaction.