Effect of low-dose esketamine on postoperative delirium in elderly frail patients undergoing laparoscopic radical resection of gastrointestinal tumor / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the effect of low-dose esketamine on postoperative delirium (POD) in elderly frail patients undergoing laparoscopic radical resection of the gastrointestinal tumor.Methods:Ninety-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ frail patients of both sexes, aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2 and preoperative Fried frailty phenotype scale score≥3, scheduled for elective laparoscopic radical resection of the gastrointestinal tumor under general anesthesia, were divided into 2 groups ( n=47 each) using a random number table method: control group (group C) and low-dose esketamine group (group K). In group K, esketamine 0.5 mg/kg was given during induction of anesthesia, and esketamine 0.25 mg·kg -1·h -1 was continuously infused during operation until the end of operation.In group C, the equal volume of normal saline was given at the corresponding time point.After induction of anesthesia and before skin incision (T 1), at 1 day after operation (T 2) and at 3 days after operation (T 3), blood samples from the internal jugular vein were collected for determination of the concentrations of S100β protein and neuron-specific enolase (NSE) in serum by enzyme-linked immunosorbent assay.The intraoperative consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded.POD was evaluated by Confusion Assessment Method within 3 days after operation. Results:Compared with the baseline at T 1, the concentrations of serum S100β and NSE were significantly increased at T 2, 3 in both groups ( P<0.05). Compared with group C, the incidence of POD was significantly decreased (30% vs.13%), the intraoperative consumption of propofol and remifentanil was decreased, and concentrations of serum S100β protein and NSE were decreased at T 2, 3 in group K ( P<0.05). Conclusions:Low-dose esketamine can decrease the occurrence of POD in elderly frail patients undergoing laparoscopic radical resection of gastrointestinal tumor.