Department of Anaesthesia and Perioperative Medicine, Cancer Hospital, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China.
BMC Anesthesiol. 2023 Jun 20;23(1):214. doi: 10.1186/s12871-023-02161-6.
Postoperative cognitive dysfunction (POCD) is a common postoperative disorder that is frequently observed after general anesthesia, which seriously threatens the quality of patients' life. Existing studies have demonstrated that S-ketamine plays an important role in improving neuroinflammation. This trial aimed to explore the effects of S-ketamine on quality of recovery and cognitive function in patients following modified radical mastectomy (MRM).
Ninety patients aged 45 to 70 years with ASA grades of I or II, who underwent MRM, were selected. Patients were randomly assigned to the S-ketamine or control group. In the S-ketamine group, patients were induced with S-ketamine instead of sufentanil and maintained with S-ketamine and remifentanil. In the control group, patients were induced with sufentanil and maintained with remifentanil. The primary outcome was the Mini-Mental State Examination (MMSE) and Quality of Recovery-15 (QoR-15) score. Secondary outcomes including visual analog scale (VAS) score, cumulative propofol and opioids consumption, post anesthesia care unit (PACU) recovery time, occurrence of remedial analgesia, postoperative nausea and vomiting (PONV), other adverse events, as well as patient satisfaction.
The global QoR-15 scores at postoperative day 1 (POD1) were significantly higher in the S-ketamine group than in the control group (124 [119.5-128.0] vs. 119 [114.0-123.5], P = 0.002), with a median difference of 5 points (95% confidence interval [CI] [-8 to -2]). Similarly, the global QoR-15 scores at postoperative day 2 (POD2) in the S-ketamine group were significantly higher than in the control group (140.0 [133.0-145.0] vs. 132.0 [126.5-141.5], P = 0.004). In addition, among the five subcomponents of the 15-item scale, S-ketamine group had a higher score in terms of physical comfort, pain, and emotional state both at POD1 and POD2. In terms of MMSE score, S-ketamine could promote the recovery of postoperative cognitive function at POD1, but not at POD2. Furthermore, the consumption of opioids, VAS score, and remedial analgesia in the S-ketamine group decreased significantly.
Collectively, our findings support that general anesthesia with S-ketamine as a potential strategy showed high safety and could not only improve the quality of recovery mainly through improving pain, physical comfort, and emotional state but also promote the recovery of cognitive function on POD1 in patients undergoing MRM.
The study was registered in the Chinese Clinical Trial Registry (registration No:ChiCTR2200057226, Date of registration: 04/03/2022).
术后认知功能障碍（POCD）是全身麻醉后常见的术后障碍，严重威胁患者的生活质量。现有研究表明 S-氯胺酮在改善神经炎症方面发挥着重要作用。本试验旨在探讨 S-氯胺酮对改良根治性乳房切除术（MRM）后患者恢复质量和认知功能的影响。
选择 90 名年龄 45-70 岁、ASA 分级 I 或 II 级、接受 MRM 的患者。患者被随机分配到 S-氯胺酮组或对照组。在 S-氯胺酮组，患者使用 S-氯胺酮诱导，而不是舒芬太尼，并使用 S-氯胺酮和瑞芬太尼维持麻醉。在对照组，患者使用舒芬太尼诱导，并用瑞芬太尼维持麻醉。主要结局是简易精神状态检查（MMSE）和恢复质量-15 分（QoR-15）评分。次要结局包括视觉模拟评分（VAS）评分、累积丙泊酚和阿片类药物消耗量、麻醉后监护室（PACU）恢复时间、补救性镇痛的发生、术后恶心和呕吐（PONV）、其他不良事件以及患者满意度。
S-氯胺酮组术后第 1 天（POD1）的全球 QoR-15 评分明显高于对照组（124 [119.5-128.0] vs. 119 [114.0-123.5]，P=0.002），中位数差异为 5 分（95%置信区间 [CI] [-8 至 -2]）。同样，S-氯胺酮组术后第 2 天（POD2）的全球 QoR-15 评分也明显高于对照组（140.0 [133.0-145.0] vs. 132.0 [126.5-141.5]，P=0.004）。此外，在 15 项量表的五个子成分中，S-氯胺酮组在 POD1 和 POD2 时在身体舒适度、疼痛和情绪状态方面的评分更高。就 MMSE 评分而言，S-氯胺酮可促进术后认知功能在 POD1 的恢复，但不能在 POD2 恢复。此外，S-氯胺酮组阿片类药物用量、VAS 评分和补救性镇痛均显著减少。
总的来说，我们的研究结果支持全身麻醉中使用 S-氯胺酮作为一种潜在的策略具有较高的安全性，不仅可以通过改善疼痛、身体舒适度和情绪状态来提高恢复质量，而且可以促进 MRM 术后患者认知功能在 POD1 的恢复。
该研究在中国临床试验注册中心（注册号：ChiCTR2200057226，注册日期：2022 年 4 月 3 日）进行了注册。
