Dexmedetomidine combined with propofol improves hemodynamic stability and recovery in elderly patients undergoing thoracoscopic lung cancer resection.

Objective: To evaluate the effects of dexmedetomidine combined with propofol versus propofol alone on intraoperative hemodynamic stability and postoperative recovery in elderly patients undergoing thoracoscopic lung cancer resection.

Methods: This retrospective comparative study included 123 patients aged ≥ 65 years scheduled for thoracoscopic lung cancer resection. Patients were divided into two groups: the dexmedetomidine-propofol group (observation group, n = 61) and the propofol-only group (control group, n = 62). Hemodynamic parameters - heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) - were recorded at predefined time points. Postoperative recovery times, stress and inflammatory markers (tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]), adverse events, sedation scores, and pain scores were assessed. Multivariable regression and subgroup analyses were conducted to identify independent treatment effects and explore heterogeneity across patient subgroups.

Results: The observation group demonstrated significantly more stable hemodynamic profiles, with lower HR, MAP, SBP, and DBP fluctuations across time points (all P < 0.05). Postoperative awakening and orientation recovery times were significantly shorter in the observation group (both P < 0.05). Levels of norepinephrine, epinephrine, TNF-α, and IL-6 were significantly lower postoperatively in the observation group (all P < 0.05). Incidences of respiratory depression and nausea/vomiting were also reduced (all P < 0.05). Multivariable analysis confirmed the independent benefit of the combined regimen. Subgroup analyses revealed greater efficacy in patients with ASA class II and those over 75 years of age.

Conclusion: The combination of dexmedetomidine and propofol enhances intraoperative hemodynamic stability, accelerates recovery, reduces perioperative stress and inflammation, and lowers the incidence of adverse events in elderly patients undergoing thoracoscopic lung cancer resection. These results support its clinical value, particularly in high-risk subpopulations. Further studies are needed to refine dosing strategies and optimize safety.