- Design
- Randomised, double-blind controlled trial
- Population
- 80 adults having thoracoscopic radical lung cancer surgery
- Primary outcome
- Postoperative pulmonary complications on day 1
- Effect
- 37.5% vs 72.5% (P 0.002); no difference on days 3 and 7 or in secondary outcomes
This double-blind trial randomised 80 adults having thoracoscopic radical lung cancer surgery to perioperative esketamine or control, on the hypothesis that its anti-inflammatory effects protect the lung.
Postoperative pulmonary complications on day 1 were lower with esketamine (37.5% vs 72.5%, P 0.002). But there was no difference on days 3 or 7, in severity, nausea and vomiting, pain, drain duration, length of stay, unplanned ICU admission or mortality.
A day-1 difference that vanishes by day 3 and changes nothing downstream is not a reason to add esketamine for lung protection. The trial is small and single-centre, and the very high control-group rate (72.5%) suggests a broad complication definition.
- Do not add esketamine to thoracic anaesthesia for lung protection on this evidence.
- Keep to established lung-protective ventilation, good analgesia and early mobilisation after lung resection.
- Note that esketamine's availability in India for this use is not established.
- Look at how a trial defines pulmonary complications before comparing rates across studies.
Why it matters
It shows how an early, significant primary outcome can mislead when nothing that matters to patients changes afterwards.
Don't overread it
Eighty patients, one centre, and a benefit confined to day 1 with no effect on any later outcome.
The statistics, in plain English
The difference on day 1 is large and statistically significant, but a result confined to the first day, with no effect on length of stay or ICU admission, is unlikely to be clinically significant.
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