Precision application of target-controlled infusion of esketamine combined with sufentanil in anesthesia for thoracoscopic surgery and its effect on hemodynamics, postoperative pain, and safety.

We aimed to expound the precise application of target-controlled infusion (TCI) of esketamine combined with sufentanil in anesthesia for video-assisted thoracoscopic surgery (VATS) and its effect on hemodynamics, postoperative pain, and safety. Eighty patients scheduled for thoracoscopic procedures were randomly assigned to either a control group [n=40, conventional empiric anesthesia (sufentanil plus propofol)] or an observation group [n=40, TCI of esketamine and sufentanil]. Hemodynamic indices [mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), stroke volume (SV), cardiac output (CO), systemic vascular resistance (SVR), and oxygen saturation (SpO2)] were recorded before anesthesia (T0), after induction of anesthesia (T1), 30 min of anesthesia (T2), and at the end of surgery (T3). Recovery profiles [length of stay in the post-anesthesia care unit (PACU), awakening time], Ramsay sedation scores (T0-T3), visual analog scale (VAS) pain scores at 2, 24, and 48 h post-op, and adverse event rates were compared. The observation group showed smaller hemodynamic fluctuations from T1 to T3. At T3, this group had higher MAP, SV, and CO (P<0.05), steadier CVP and SVR, faster recovery (PACU stay and awakening times shorter, P<0.01), lower VAS scores at 24 and 48 h, higher Ramsay scores at T2 and T3, and lower overall adverse event rates (P=0.018) than the control group. TCI of esketamine plus sufentanil improved intraoperative hemodynamic stability, shortened recovery, enhanced early analgesia, and reduced adverse reactions in VATS, supporting its precision and safety.