Effects of esketamine on postoperative negative emotions and early cognitive disorders in patients undergoing non-cardiac thoracic surgery: A randomized controlled trial

Mar 24, 2024Journal of clinical anesthesia

Esketamine’s effects on mood and early thinking problems after non-heart chest surgery

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Abstract

The high esketamine group showed significantly lower anxiety and depression scores compared to the control group on postoperative days 1 and 3.

A single intraoperative dose of 0.5 mg/kg esketamine may reduce postoperative anxiety and depression.
Lower pain levels were reported in the esketamine-treated groups compared to the control group at 2 hours and on the first postoperative day.
No significant differences in cognitive function were observed among the three groups.
The high esketamine group had lower levels of the inflammatory marker S100β and the pro-inflammatory cytokine IL-6, along with higher levels of brain-derived neurotrophic factor (BDNF) postoperatively.
Serum levels of acetylcholine and norepinephrine did not show significant differences between the groups.

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STUDY OBJECTIVE: 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.

DESIGN: A prospective single center double blinded randomized placebo-controlled trial.

SETTING: Perioperative period; operating room, post anesthesia care unit and hospital ward.

PATIENTS: 129 adult patients that underwent elective non-cardiac thoracic surgery under general anesthesia.

INTERVENTIONS: 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.

MEASUREMENTS: 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).

MAIN RESULTS: 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.

CONCLUSIONS: 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.

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Effects of esketamine on postoperative negative emotions and early cognitive disorders in patients undergoing non-cardiac thoracic surgery: A randomized controlled trial

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