The Effect Of Intraoperative Application Of Ketamine On The Postoperative Depression-like Mood And Inflammatory Mediators During One Lung Ventilation In Patients With Esophageal Cancer Radical Surgery

Background and Objective Esophageal cancer is a common malignant tumor.Studies have shown that one lung ventilation(OLV)during esophageal cancer radical surgery led to the lung damage.In addition,cancer patients with heavy psychological pressure seriously affect their quality of life and psychosomatic health,and accelerate the development of cancer.In recent years,the studies found that low dose ketamine not only avoided its mental side effects,but also showed good effect on analgesia,anti-inflammatory and anti-depression.The main purpose of the study was to observe the effect of low dose ketamine on inflammatory mediators during one lung ventilation and postoperative depression-like mood in patients with esophageal cancer radical surgery.Methods60 patients who underwent esophageal cancer radical surgery with age41-70 and ASAⅠ-Ⅲ were randomly divided into ketamine group(K)and control group(C).Group K: ketamine was given with injection of 0.5mg/kg(0.05ml/kg)at the time of intravenous anesthesia induction,then continuous infusion with 0.25mg/kg.h(0.025ml/kg.h)ketamine for 30 minutes.Group C:saline was given with injection of 0.05ml/kg,then continuous infusion with0.025ml/kg.h.In the two groups,blood samples were collected after anesthesia induction(T1),one-lung ventilation for 30 min(T2)and double-lung ventilation for 30 min(T3),and the concentration of serum tumor necrosis factor alpha(TNF-α),interleukin(IL)-6 and IL-10 concentration was analyzed by ELISA.Patient Health Questionair-9(PHQ-9)score was collected at 1 day before operation and 5 days after operation and visual analog pain score(VAS)was recorded at postoperative 24 h,48h,72 h.The volume of blood loss,operative time,one lung ventilation time and related adverse reactions were recorded.Results Gender,age,preoperative PHQ-9,operative time,one lung ventilation time and blood loss volume had no statistic difference(P>0.05)between the two groups.The PHQ-9 scores of the C group had no statistic difference between the preoperation and 5 d after operation(P>0.05),but the PHQ-9scores of the K group at the 5d after operation was significantly lower than that at the 1d before operation(p<0.05);Compared with PHQ-9 scores of 5d after operation in the C group,the PHQ-9 scores in the K group obviously were decreased(P<0.05).The concentration of serum TNF-α,IL-6 and IL-10 at T1 time of the two groups had no statistic difference(P>0.05),but were significantly increased at T2 time of the two groups(P<0.05);Compared with group C,there was no statistical difference in the levels of TNF-α,IL-6 and IL-10 in group K at T2 and T3 time(P>0.05).The VAS scores were significantly decreased in group K at 24 h,48h and 72 h after operation compared with group C(P<0.05).Conclusion1.The levels of inflammatory mediators in the blood were enhanced by one lung ventilation in patients with esophageal cancer radical surgery.2.Intraoperative application of low dose ketamine has no obvious effect on the concentration of blood TNF-α,IL-6 and IL-10 during one lung ventilation in patients with esophageal cancer radical surgery.3.Low dose ketamine may alleviate postoperative depression-like mood in esophageal cancer radical surgery.