Effects Of Esketamine On Cerebral Circulation And Cognitive Function In Gynecological Patients With General Anesthesia

Objective: To explore the effects of Esketamine on cerebral circulation and cognitive function in patients under gynecological general anesthesia,and to better protect the brain in the perioperative period.Methods: Random selection of 72 patients aged 50-60 years old,American Society of Anesthesiologists(ASA)classification Ⅰ or Ⅱ who underwent gynecological general anesthesia at Yanbian Hospital,and were randomly divided into two groups,36 cases in each group(n=36):group S(Sufentanil for anesthesia-inducing analgesia)and group E(Esketamine for anesthesia-inducing analgesia),and the rest of the anesthesia-inducing drugs and anesthesia-maintaining drugs were the same.Make sure that the patients did not move during the operation and that the anesthesic was maintained gently.Observed and recorded the heart rate(HR)and mean arterial pressure(MAP)of both groups of patients at any time after entering the chamber(T0),before tracheal intubation(T1),after tracheal intubation(T2)and 30 minutes after surgery(T3),changes in mean peak cerebral blood flow velocity(Vmean)and pulastility index(PI)should also be recorded;both groups of patients were scored on the Mini-mental State Examination(MMSE),and the scores of both groups before surgery,12 hours after surgery and 36 hours after surgery were recorded,as well as the likelihood of post operative cognitive dysfunction(POCD)being recorded;recorded the number of postoperative adverse events(nausea,vomiting,hypotension,headache,ect.).Result: 1.The effect of Esketamine on MAP and HR.In group S,MAP and HR decreased at T1,increased at T2,decreased at T3,T1< T0(P < 0.01),T2> T0(P < 0.01),and T3< T0(P > 0.05);group E showed the same trend as group S,T1< T0(P < 0.05),T2> T0(P < 0.05),and T3< T0(P > 0.05).There was no significant difference between the two groups compared at T0(P > 0.05),the group E was higher than the group S at T1(P < 0.05),the group E was lower than the group S at T2(P < 0.05),and the group E was higher than the group S at T3(P > 0.05).2.The effect of Esketamine on Vmean and PI.In group S,Vmean and PI decreased at T1,increased at T2,decreased at T3,T1< T0(P < 0.01),T2> T0(P < 0.01),and T3< T0(P < 0.05);group E showed the same trend as group S,T1< T0(P < 0.01),T2> T0(P < 0.01),and T3< T0(P > 0.05).There was no significant difference between the two groups at T0(P > 0.05),the group E was higher than the group S at T1(P < 0.05),the group E was lower than the group S at T2(P < 0.05),and the group E was higher than the group S at T3(P > 0.05).3.The effect of Esketamine on cognitive function.For intra-group comparisons,there was no statistically significant difference in MMSE scores between group S and group E at 12 h and 36 h postoperatively compared to preoperatively(P > 0.05).For comparison between groups,there was no significant difference between preoperative(P > 0.05)and compared to the scores at 12 and 36 hours postoperatively,the scores of group E were significantly higher than those of group S(P < 0.05).Between the two groups,the incidence of POCD at 12 hours after surgery was lower in group S(P < 0.05),and the incidence of POCD at 36 hours after surgery was lower in group E than in group S(P > 0.05).4.Esketamine impact on adverse events that can occur postoperatively.Compared the two groups,the incidence of nausea and vomiting,hypotension and agitation in group E was significantly higher than in group S,but the difference between them was not statistically significant.Conclusion: 1.Esketamine stabilizes hemodynamics and cerebral blood flow and intracranial pressure before and after intubation in patients undergoing gynecological general anesthesia.2.Compare that to Sufentanil,Esketamine may reduce postoperative cognitive dysfunction in patients under gynecological general anesthesia.