Effect of Preoperative Esketamine Nebulized Inhalation on Cough Reflex, Sedation, and Postoperative Sore Throat in Extubation of Surgical Patients: A Prospective, Double-Blind, Randomized Controlled Trial

Purpose: This study aims to explore the effect of preoperative esketamine nebulized inhalation on cough reflex during extubation for surgical patients who received general anesthesia. Patients and methods: A total of 84 patients scheduled for thoracolumbar spine surgery were included in the study. All patients were randomly divided into two groups. Patients in the experimental group (Group K) received 5 mL of esketamine solution (50 mg esketamine + 3 mL of saline) by nebulized inhalation for 15 minutes. Patients in the control group (Group S) received an equal volume of saline as placebo. The incidence and intensity of the cough reflex were evaluated. The Riker Sedation-Agitation Scale score, Ramsay sedation score, and Monitoring of sore throat following surgery were performed at 0, 2, 4, 6, 12, and 24 hours post-surgery. Results: The incidence of cough reflex was lower in Group K (31.0%) than in Group S (71.4%), and cough intensity was milder in Group K than in Group S ( P < 0.001). The Ramsay sedation scale score post-extubation was higher in Group K than in Group S ( P =0.002). The incidence and severity of postoperative sore throat in Group K were lower than in Group S at 2, 4, 6, 12, and 24 hours following extubation (all P < 0.05). Conclusion: Preoperative esketamine nebulized inhalation has a potential inhibitory effect on the cough reflex during extubation for patients who received general anesthesia via tracheal intubation. Keywords: esketamine, nebulized inhalation, cough reflex, tracheal extubation