Effect Of Esketamine On Postoperative Cognitive Function In Elderly Diabetic Patients

Objective:To investigate the effect of esketamine in elderly patients with diabetes on postoperative cognitive function.Methods:Sixty elderly diabetic patients who planned to undergo hip replacement were randomly divided into three groups(n=20),the Esketamine group(A),the Dexmedetomidine group(B),and the control group(C).In group A,Esketamine(0.5mg/kg)was injected intravenously during anesthesia induction,and Esketamine(0.5mg/kg/h)was continuously injected intravenously during the operation,until 30 minutes before the end of the operation.Group B was given intravenous Dexmedetomidine at a loading dose of 1ug/kg for 10 min before anesthesia induction,followed by continued pumping at 0.4ug/kg/h until 30 min before the end of surgery.The same amount of saline was given during anesthesia induction to the control group.The differences of systolic blood pressure(SBP),mean arterial pressure(MAP),diastolic blood pressure(DBP),heart rate(HR)and postoperative reactions were recorded 24 hours before surgery(T0),at the induction of anesthesia(T1),30 minutes after anesthesia(T2),at the end of surgery(T3),and 24 hours after surgery(T4).Montreal Cognitive Assessment(Mo CA)and Mini-Mental state Examination(MMSE)scores were recorded 1 day before surgery(T0),24 hours after surgery(T4),and 72 hours after surgery(T5).Serum C-reactive protein(CRP)and white blood cell(WBC)count levels were recorded 1 day before surgery(T0)and 24 hours after surgery(T4).Results:1.Comparison of general conditions: there was no any statistical significance in gender,age,educational level and BMI among the three groups(P>0.05).2.Hemodynamic indexes: Compared with T3,SBP was increased at T4 in group A(P<0.05).Compared with group C,SBP was increased in group A at T3,There were statistically significant differences(P<0.05).Compared with T3,DBP was increased at T4 in group B(P<0.05).Compared with T0,at T2,T3,T4 MAP was increased in group A(P<0.05).Compared with T1,HR was decreased in group B at T2,T3 with statistically significant differences(P<0.05).3.Cognitive function assessment:Compared with group B and group C,Mo CA scores was increased in group A on the first and third days after surgery with statistical significances(P<0.05).Compared with group B and group C,the first day after surgery Mo CA scores were significantly increased in group A,on the third day after surgery MMSE scores in group A were higher than group B with statistical significance(P<0.05).4.Inflammatory response index:Compared with pre-operation,CRP and WBC were increased in all groups with statistical significances(P<0.05).5.Comparison of adverse reactions: There was no statistical differences in the incidence of vomiting and nausea,respiratory depression and delayed awakening among the three groups(P>0.05).Conclusions:Continuous injection of 0.5mg/kg/h esketamine can improve postoperative cognitive function in elderly patients with diabetes during hip replacement.Compared with continuous injection of 0.4ug/kg/h dexmedetomidine during hip replacement in elderly patients with diabetes,continuous injection of 0.5mg/kg/h esketamine can improve postoperative cognitive function effectivly.