Effect Of Esketamine On Sleep Quality In Patients After Breast Cancer Opearation

Objective:Postoperative sleep disorder(PSD)is a common complication after surgery,which seriously affects the postoperative recovery of patients.Patients undergoing breast cancer surgery have a higher risk of PSD.The purpose of this study was to investigate the effect of esketamine on postoperative sleep quality in patients with breast cancer,and to provide clinical basis for rational use of anesthesia-related drugs to improve postoperative sleep quality.Methods:From October 2022 to January 2023,64 patients with breast cancer who were operated under general anesthesia in our hospital were selected,aged18-65 years old,female,body mass index(BMI)18-30kg/m~2,American Society of Anesthesiologists(ASA)grade I or II.The patients were divided into two groups(n=64)by random number table:Esketamine group(group S)and control group(group C),with 32 cases in each group.Group S received intravenous injection of 0.25 mg/kg Esketamine 5 minutes before skin incision,and then pumped at the rate of 0.125 mg/kg/h,and stopped pumping 30 minutes before theend of surgery.The control group received the same volume of 0.9%sodium chloride injection.Both groups of patients received total intravenous anesthesia,and the fluctuation range of heart rate and mean arterial pressure during the operation was not more than 20%of the base value.After operation,the patient was sent to Postanesthesia care unit(PACU).When the numerical rating scale(NRS)score of pain at rest was>3,sufentanil of 5ug was given.After returning to the ward,when the NRS score at rest was>3,30 mg ketorolac tromethamine was given.Evaluate the sleep quality of the night before operation,the first night after operation and the second night after operation with the Pittsburgh Sleep Quality Index(PSQI)and the Athens Insomnia Scale(AIS).The NRS scores at rest and on movement were recorded at 1h,4h,24h and 48h after operation.The times of sufentanil remedy and ketorolac tromethamine remedy within 48 hours after operation were recorded.Operation time,the duration of anesthesia,extubation time,propofol dosage,remifentanil dosage and the use of vasoactive drugs during operation were recorded.The occurrence of adverse reactions such as nausea,vomiting,blurred vision,nightmares,respiratory depression,transient hallucinations,and insanity within 48 hours after operation was recorded.Results:There was no significant difference in the general condition between the two groups(p>0.05).There was no significant difference between the two groups in operation time,anesthesia maintenance time,extubation time,propofol dosage,remifentanil dosage,remedial analgesia times of sufentanil Remedial analgesia times of ketorolac tromethamine remedy times,and the use of vasoactive drugs(p>0.05).There was no significant difference in PSQI and AIS scores between the two groups on the night before operation(p>0.05).Compared with the night before operation,the PSQI and AIS scores of group C increased on the first and second night after operation(p<0.001).Compared with the night before operation,the PSQI and AIS scores in group S increased on the first night after operation(p<0.001).Compared with group C,the PSQI and AIS scores of group S were lower on the first night and the second night after operation(p<0.001).At 1h and 4h after operation,there was no significant difference in NRS scores at rest and on movement between the two groups(p<0.001).At 24h and 48h after operation,there was no significant difference in NRS score at rest between the two groups(p>0.05).Compared with group C,the NRS score on movement of patients in group S decreased at 24h and 48h after operation(p<0.05).There was no significant difference in the incidence of adverse reactions such as nausea,vomiting,blurred vision,diplopia,nightmares,respiratory depression,transient hallucinations,and insanity between the two groups within 48 hours after operation(p>0.05).Conclusion:Perioperative use of Esketamine can improve the sleep quality of patients undergoing breast cancer surgery without increasing the incidence of adverse reactions.