Effect Of Esketamine For Postoperative Analgesia On Postoperative Depression In Patients Undergoing Cardiac Surgery Under Cardiopulmonary Bypass

Objective To investigate the effect of esketamine for postoperative analgesia on postoperative depression in patients undergoing cardiac surgery under cardiopulmonary bypass and to provide references for clinical application.Methods One hundred and two patients,aged 18-75 yr,with BMI of 18.5-28.0kg/m²,of ASAⅡ-Ⅲ,undergoing elective cardiac surgery under cardiopulmonary bypass under general anesthesia,were divided into 2 groups using the random number table method:control group（group C,n=51）and esketamine group（group E,n=51）.Anesthesia was induced by midazolam,etomidate,sufentanil,cisatracurium and maintained by sufentanil,cisatracurium,propofol,sevoflurane.At the end of the operation,1.25μg·kg^-1·min^-1 of esketamine was continuously pumped with a micropump in group E,and the same volume of normal saline was continuously pumped in group C for 48 h.Both groups were connected with patient-controlled intravenous analgesia（PCIA）.The analgesic was sufentanil 1μg·ml^-1,and the parameters were set as follows:background dose 2μg·h^-1,single dose 2μg,single dose lock 10 min,maximum dose 10μg per hour,duration 48 h.Visual analog scale（VAS）≥4 branches were used for rescue analgesia,and morphine 2 mg was injected.Baseline characteristics such as age,body mass index（BMI）,gender,surgical procedure,aortic occlusion time,cardiopulmonary bypass time,the amount of sufentanil used during the operation,intraoperative fluid infusion volume,intraoperative suspended red blood cell infusion volume,the usage of noradrenaline within 2 days after operation,extubation time,intensive care unit（ICU）length of stay,and discharge time were recorded.Beck Depression Inventory（BDI）scores and the incidence of postoperative depression were recorded 1 day before operation and 1,2,3 and 7 days after operation.Resting VAS scores were recorded 1,2,3 and 7 days after operation.Blood samples were collected 1day before operation and 3 days after operation,and serum interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）and C-reactive protein（CRP）were detected by enzyme-linked immunosorbent assay（ELISA）.Cardiac troponin I（c Tn I）and creatine kinase isoenzymes（CK-MB）were detected 1 day before operation and 1,2,and 3 days after operation.Mean arterial pressure（MAP）,heart rate（HR）and central venous pressure（CVP）were recorded before induction of anesthesia,5 min after endotracheal intubation,10 min after cardiopulmonary bypass,end of surgery,12 h,24 h and 48 h after surgery.The number of effective PCIA compressions,the total number of compressions,the number of rescue analgesia within 2 days after operation and the incidence of adverse reactions within 7 days after operation were recorded.Results 156 patients undergoing cardiac surgery under cardiopulmonary bypass under elective general anesthesia were preliminarily included,54 patients were excluded before surgery,and 102 patients were included and divided into two groups by random number table method:51 patients in group C and 51 patients in group E.11patients were lost to follow-up after surgery in two groups,including 44 patients in group C and 47 patients in group E.1.There were no significant differences in age,BMI,gender,surgical procedure,the incidence of postoperative depression,aortic occlusion time,cardiopulmonary bypass time,the amount of sufentanil used during the operation,intraoperative fluid infusion volume,intraoperative suspended red blood cell infusion volume,the usage of noradrenaline within 2 days after operation,extubation time,ICU length of stay,discharge time,intraoperative and postoperative hemodynamic changes between the two groups（P>0.05）.2.The incidence of depression before surgery was 30.8%in all patients,and there were no significant differences in BDI scores and incidence of depression 1 day before surgery between the two groups（P>0.05）.Compared with group C,BDI scores and incidence of depression were lower in group E at 1,2,3 and 7 days after surgery（P<0.05）.3.There were no significant differences in resting VAS scores 1,2,3 and 7 days after surgery between the two groups（P>0.05）.Compared with group C,the number of effective PCIA compressions,the total number of compressions in group E within 2days after surgery were reduced（P<0.05）.4.There were no significant differences in inflammatory indexes 1 day before surgery,and in TNF-α3 days after surgery between the two groups（P>0.05）.Compared with group C,IL-6 and CRP in group E were decreased at 3 days after surgery（P<0.05）.There were no significant differences in c Tn I and CK-MB the two groups 1 day before surgery and 1,2 and 3 days after surgery（P>0.05）.5.There was no significant difference in the incidence rate of adverse reactions within 7 days after surgery between the two groups（P>0.05）.Conclusions Esketamine for postoperative analgesia can effectively improve postoperative short-term depression in patients undergoing cardiac surgery under cardiopulmonary bypass,and does not increase the incidence of related adverse reactions.