Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563100, China; Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi 563100, China.
Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi 563100, China.
J Clin Anesth. 2024 Aug;95:111447. doi: 10.1016/j.jclinane.2024.111447. Epub 2024 Mar 23.
To investigate whether a single dosage of esketamine injection in the anesthesia period could improve postoperative negative emotions and early cognitive function in patients undergoing non-cardiac thoracic surgery.
A prospective single center double blinded randomized placebo-controlled trial.
Perioperative period; operating room, post anesthesia care unit and hospital ward.
129 adult patients that underwent elective non-cardiac thoracic surgery under general anesthesia.
During the operation, pharmacologic prevention of postoperative negative emotion and early cognitive disorder with 0.2 mg/kg (Low esketamine group) and 0.5 mg/kg esketamine (High esketamine group) vs. placebo.
Emotion and early cognitive performance were assessed on the day before surgery (POD-1), postoperative day 1 (POD1) and day 3 (POD3) using HADS-A, HADS-D, Pain Visual Analogue Scale (VAS), Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and serum biomarkers (S100β, BDNF, IL-6, acetylcholine, and norepinephrine).
The high esketamine group showed significantly lower HADS-A and HADS-D scores than control group on POD1 and POD3. No significant differences were observed between the low esketamine group and the control group. The esketamine-treated groups showed lower pain VAS scores than the control group at 2 h and on the first day after operation. There were no significant differences among the three groups in CAM and MMSE scores. However, the high esketamine group had lower S100β and IL-6 levels, and higher BDNF levels postoperatively, while serum acetylcholine and norepinephrine were not significantly different.
A single intraoperative injection of 0.5 mg/kg esketamine can alleviate postoperative anxiety, depression, and pain to some extent. Although cognitive function behavioral evaluation did not show obvious benefits, it can also reduce the production of pro-inflammatory and brain injury-related factors while promoting the generation of brain-derived neurotrophic factor. Registration Trial registry: http://www.chictr.org.cn/; Identifier: ChiCTR2100047067.
探讨麻醉期单次使用氯胺酮注射是否能改善非心脏胸部手术患者的术后负性情绪和早期认知功能。
前瞻性单中心双盲随机安慰剂对照试验。
围手术期；手术室、麻醉后护理单元和医院病房。
129 名接受全身麻醉下择期非心脏胸部手术的成年患者。
在手术期间，用 0.2mg/kg（低氯胺酮组）和 0.5mg/kg 氯胺酮（高氯胺酮组）与安慰剂一起预防术后负性情绪和早期认知障碍的药物治疗。
在手术前一天（POD-1）、术后第 1 天（POD1）和第 3 天（POD3）使用 HADS-A、HADS-D、疼痛视觉模拟量表（VAS）、意识模糊评估方法（CAM）、简易精神状态检查（MMSE）和血清生物标志物（S100β、BDNF、IL-6、乙酰胆碱和去甲肾上腺素）评估情绪和早期认知表现。
高氯胺酮组在 POD1 和 POD3 时的 HADS-A 和 HADS-D 评分明显低于对照组。低氯胺酮组与对照组之间无显著差异。氯胺酮治疗组在术后 2 小时和第 1 天的疼痛 VAS 评分低于对照组。三组之间的 CAM 和 MMSE 评分无显著差异。然而，高氯胺酮组术后 S100β 和 IL-6 水平较低，BDNF 水平较高，而血清乙酰胆碱和去甲肾上腺素无明显差异。
单次术中注射 0.5mg/kg 氯胺酮可在一定程度上减轻术后焦虑、抑郁和疼痛。虽然认知功能行为评估没有明显的益处，但它还可以减少促炎和与脑损伤相关的因素的产生，同时促进脑源性神经营养因子的产生。
