The Effect Of Subanesthetic Dose Of Esketamine On Cardiac Surgery Patients Under Cardiopulmonary Bypass With Preserved Ejection Fraction

Objective: To explore the effect of subanesthetic dose of esketamine on hemodynamics during anesthesia induction and perioperative adverse reactions in patients undergoing cardiopulmonary bypass surgery.Methods: 78 patients with aged ≥18 years,ASA Ⅱ or Ⅲ,NYHA Ⅱ or Ⅲ and left ventricular ejection fraction ≥50%,who underwent cardiopulmonary bypass surgery under general anesthesia in the First Affiliated Hospital of Dalian Medical University from June 2022 to September 2022 were selected.The enrolled patients were divided into 2 groups(39 cases in each group)according to random number table method,which were esketamine group(group E)and control group(group N).Group E was intravenously injected with sufentanil 0.5ug/kg,esketamine 0.2mg/kg,etomidate0.1mg/kg,rocuronium 1mg/kg and sufentanil 0.5ug/kg in anesthesia induction.Group N was intravenously injected with sufentanil 0.5ug/kg,isodose normal saline(0.04ml/kg),etomidate 0.2mg/kg,rocuronium 1mg/kg,sufentanil 0.5ug/kg.Both groups were given sevoflurane and propofol(3 ～10mg/kg/h)to maintain anesthesia,and sufentanil was intermittently given as required during the operation.The depth of anesthesia was continuously monitored during the operation to maintain BIS between 40 ～ 60.Rocuronium bromide was administered intermittently to ensure proper muscle relaxation.General conditions(age,sex,BMI,preoperative diagnosis,ASA classification,NYHA grading,left ventricular ejection fraction)was recorded.Heart rate(HR),systolic blood pressure(SBP),mean arterial pressure(MAP),diastolic blood pressure(DBP),cardiac index(CI),stroke output(SV)and bispectral index(BIS)were recorded before induction of anesthesia(T0),immediately after esketamine or normal saline injection(T1),before intubation(T2),immediately after intubation(T3),1min after intubation(T4),3min after intubation(T5),10 min after intubation(T6),after surgical skin incision(T7)and after sternotomy(T8).The incidence of cough,muscle spasm and adverse cardiovascular events during anesthesia induction were recorded.The use of Vasoactive drug during induction of anesthesia was recorded.Indicators related to surgery and postoperative recovery were recorded: incidence of postoperative adverse reactions(nightmares,nausea,vomiting,dizziness and headache),duration of mechanical ventilation,length of stay in ICU,length of hospital stay and mortality.Result: There were no significant differences in the general information between two groups(p>0.05).At T0,there were no significant differences in HR,SBP,MAP,DBP,CI,SV and BIS between two groups(p>0.05).At T1,HR,SBP,MAP,DBP and CI in group E were significantly higher than those in group N(p>0.05).There were no significant differences in HR,SBP,MAP,DBP,CI,SV and BIS between the two groups at each time of T2～T8(p>0.05).Compared with T0,HR,SBP,MAP and DBP in group E were significantly increased at T1,while HR,SBP and MAP were significantly decreased at T2～T8(p>0.05).Compared with T0,HR,SBP and MAP in group N were significantly decreased at T1～T8(p>0.05).Compared with T2,there was no significant differences in HR and SBP changes in both group E and N at T3 ～ T8(p>0.05).Compared with T0,CI in group E was decreased at T2～T8,while SV was significantly decreased at T2,T3 and T6(p>0.05).Compared with T0,CI and SV in group N were significantly decreased at T1 ～ T8(p>0.05).Compared with T2,there were no significant differences in CI changes in both group E and N at T5～T7,no significant differences in the change of SV in group E at T3～T8(p>0.05).Compared with T2,SV in group N at T4 and T8 were significantly increased(p>0.05).The number of cases of ephedrine use in group E was significantly lower than that in group N(p>0.05).There were no significant differences in sufentanil dosage,anesthesia time,operation time,duration of mechanical ventilation,the length of ICU stay and the length of hospital stay between the two groups(p>0.05).There were significant differences in the incidence of postoperative adverse reactions and postoperative mortality between the two groups(p>0.05).Conclusions: For cardiac surgery patients with preserved ejection fraction,the use of subanesthetic dose of esketamine during anesthesia induction can maintain hemodynamic stability,reduce the use of vasoactive drugs,and do not increase the occurrence of postoperative adverse reactions.