Effects Of Esketamine On Perioperative Intestinal And Renal Function In Patients With Cardiac Valve Replacement

Objective:This study is to investigate the pharmacological characteristics and mechanism of esketamine,and to observe whether it affects the recovery of postoperative intestinal and renal function in patients undergoing cardiac surgery.To explore whether esketamine provides more options for the application of this drug in other surgeries and special patients.Methods:This study is a single-center retrospective study.The clinical data of patients,who undergoing elective operations of cardiac surgery,in the electronic medical record information system of a hospital from November 2021 to June 2022 were retrieved.A total of 60 patients were collected in this study.30 patients who undergoing cardiac surgery under general anesthesia were selected as group A（control group）.The scheme is as follows:The anesthesia induction program adopts the anesthesia protocol of our hospital’s conventional cardiopulmonary bypass under the guidance of the drug insert,treating midazolam 0.02～0.04mg/kg,sufentanil 1.0～1.5μg/kg,rocuronium bromide 0.6～1mg/kg,etomidate 0.2～0.3mg/kg.sufentanil 0.5～1μg/（kg·h）,propofol 4～12mg/（kg·h）,rocuronium bromide 0.6～0.8 mg/（kg·h）were pumped to maintain anesthesia.30 patients who undergoing cardiac surgery under general anesthesia and supplemented with esketamine were selected as group B（Esketamine group）.The scheme was as follows:on the basis of group A,0.3 mg/kg of esketamine was infused intravenously during anesthesia induction,0.3mg/（kg·h）was pumped during operation,and pumped until the end of surgery.Recording the general data of the patients which includes:gender,body mass index,ASA grade,operation duration,left ventricular ejection fraction,hemoglobin,extracorporeal circulation time,aortic occlusion time,tube time.The amount of intraoperative general anesthetic drugs midazolam,propofol,rocuronium bromide and sufentanil was recorded,and the average arterial pressure of the two groups before anesthesia induction（T₀）,after anesthesia induction（T₁）,10 minutes after the start of CPB（T₂）,10 minutes after the opening of the aorta（T₃）,at the end of CPB（T₄）,and at the end of surgery（T₅）were recorded.and the lactate and blood glucose concentrations of the two groups at four time points during the operation:5 min after anesthesia induction,5 min before cardiopulmonary bypass,after cardiopulmonary bypass,and after surgery.The postoperatively intestinal function indexes of the two groups were recorded,including the time of first feeding,the time of first exhausting,the time of first defecation and the time of first getting out of bed.The IAP of 6h,12h,24h,and 36h after surgery was recorded in both groups.The glomerular filtration rates,urea nitrogen and creatinine values were recorded for the last time before operation and 24h,48h and 72h after operation.and the urine output of 0～12h,12～24h,24～36h after surgery Results:（1）Analysis of lactic acid level at four time points during the operation between the two groups:after the end of cardiopulmonary bypass,the first lactic acid concentration in group B is significantly lower than that in group A（P<0.05）.The concentrations of lactic acid at the other three time points have no statistical difference（P>0.05）.（2）There is no statistical difference in blood glucose concentration between the two groups at the time point of operation（P>0.05）.（3）In postoperatively intestinal function indexs,the time of first feeding,first exhausting and first defecation in group B are significantly shorter than those in group A（P<0.05）.There is no statistical difference in the first time of getting out of bed（P>0.05）.IAP in group B was significantly lower than that in group A at 24 hours after surgery（P<0.05）.（4）There is no statistical difference in renal function and urine output between the two groups（P>0.05）.（5）The dosage of sufentanil in group B is significantly less than that in group A in perioperative period（P<0.05）.（6）There is no statistical difference in the general data of patients（P>0.05）.Conclusions:Perioperative general anesthesia combined with appropriate dose of esketamine can improve the level of anaerobic metabolism during cardiopulmonary bypass,reduce the use of opiates during perioperative period,and provide better postoperative recovery of intestinal function.That not only reduces the use of opioids during the perioperative period,but also not affects the postoperative analgesic effect.