To Explore The Effect Of Scopolamine On The Mood And Postoperative Outcome Of Perioperative Anxiety And Depression High-risk Groups

BackgroundAnxiety and depression are the most common psychological problems in patients during the perioperative period.The overall incidence of preoperative anxiety before elective surgery is as high as 11%-80%,and the incidence of preoperative depression is about 24%-43%.Perioperative anxiety and depression can bring many adverse effects to patients and directly affect the prognosis of surgery.The potential,rapid and robust anti-anxiety and anti-depression effects of scopolamine have been observed in previous clinical trials on patients diagnosed with anxiety disorders or treatment-resistant depression and animal studies,but its anti-anxiety and anti-depression effects have not been adequately evaluated in the high-risk groups of perioperative anxiety and depression.ObjectivesTo investigate the status of anxiety and depression in patients undergoing elective gynecological surgery under general anesthesia in Guangdong Provincial People’s Hospital,and to explore.whether scopolamine can alleviate perioperative anxiety and depression and its effect on postoperative outcome.MethodsWe used the validated scale(Hospital Anxiety and Depression Scale,HADS)to evaluate the preoperative anxiety and depression of patients undergoing elective gynecological surgery under general anesthesia in Guangdong Provincial People’s Hospital from November 1,2021 to April 31,2022.Subsequently,the positive patients with anxiety or(and)depression symptoms were randomly(1:1)assigned to the scopolamine group(intravenous injection of 0.3 mg scopolamine before induction of anesthesia)or the placebo group(intravenous injection of equal volume of normal saline before induction of anesthesia).The subjects were followed up on the day 1,3 and 7 after surgery,and the HADS scale and PSQI scale were evaluated again.At the same time,postoperative recovery,postoperative complications and side effects of drug were recorded.The primary outcome measure was the remission rate of anxiety and depression on the day 1,3 and 7 after surgery.And the secondary outcome measure included the HADS scale scores,the PSQI scale scores,the ADL scale scores,average hospitalization time after operation,short-term postoperative complications and side effects of drug.ResultsThe incidence of preoperative anxiety in gynecological patients in our hospital was 21.4%(125/583),and the incidence of preoperative depression was 15.4%(90/583),of which 13.4%(78/583)had both anxiety and depression symptoms.On the day 3 after operation,the anxiety remission rate of the scopolamine group was higher than that of the placebo group(18.52%vs 3.85%,p=0.045).And on the seventh day after operation,the anxiety remission rate and the depression remission rate of the scopolamine group were higher than that of the placebo group(The anxiety remission rate:35.19%vs 7.69%,p=0.001;The depression remission rate:11.11%vs 0.00%,p=0.013).In addition,scopolamine also significantly reduced the anxiety scores of the subjects on the day 1,3 and 7 after surgery(The postoperative day 1:0(0 to 1)vs 0(0 to 0),p=0.000;The postoperative day 3:0.5(0 to 2)vs 0(0 to 0),p=0.000;The postoperative day 7:1.5(0 to 2)vs 0(0 to 1),p=0.000)and postoperative day 7 depression score(0(0 to 1)vs 0(0 to 0),p=0.020).The postoperative hospital stay(d)of the scopolamine group was significantly shorter than that of the placebo group(4.13±3.24 vs 6.83±5.15,p=0.000).The daily behavioral ability scores of the scopolamine group on the day of surgery and the day 1 after operation were higher those of the placebo group(The day of surgery:15.96±16.27 vs 12.13±7.24,p=0.017;The first day after operation:68.92±20.70 vs 62.22±17.47,p=0.017).The was no significant difference in the incidence of adverse drug reactions(drowsiness,dry mouth,lightheadedness,diplopia,blurred vision,palpitation,nervousness,restlessness,vertigo,mental clouding,irritability and cognitive disorder and so on)between the scopolamine group and the placebo group.ConclusionScopolamine can significantly alleviate perioperative anxiety and depression in patients undergoing gynecological surgery,help to improve postoperative daily behavioral ability,reduce postoperative complications and shorten postoperative hospitalization time.And the incidence of drug adverse reactions is extremely low and well tolerated.