Clinical Study Of Subanesthetic Dose Of Esketamine On Patients Undergoing Laparoscopic Surgery For Anxiety And Depression

Objective:To investigate the application of Esketamine in patients with anxiety and depression in laparoscopic surgery and its effect on postoperative acute pain and sleep quality,observe the occurrence of adverse reactions,evaluate its safety,and provide certain clinical reference for comfortable anesthesia in patients with anxiety and depression undergoing laparoscopic surgery.Methods:60 patients with moderate and severe anxiety and depression were selected and randomly divided into experimental group（30 cases）and control group（30 cases）.In the experimental group,0.5mg/kg esketamine was injected intravenously 1min before routine anesthesia induction,and then 0.2mg/kg/h was pumped into esketamine for intraoperative maintenance.Induction drugs were midazolam 0.03mg/kg,cisatracurium 0.2mg/kg,Sufentanil 0.5μg/kg,etomidate 0.2mg/kg,respectively.The dosage of anesthesia induction drugs and esketamine were recorded.After eyelash reflex disappeared,muscle relaxation was satisfactory,BIS was stable at 40,and induction drugs reached their peak value,laryngeal mask or tracheal catheter was inserted,anesthesia machine was connected for mechanical ventilation,tidal volume was set at 8-10ml/kg,respiratory rate was 12-14 times/min,Pet CO₂was maintained at 35-45mm Hg.The anesthesia induction scheme of the control group was the same as that of the experimental group.Esketamine was replaced by normal saline and transfused in the same way according to the experimental dose.Anesthesia maintenance:Sevoflurane 1-2MAC was inhaled continuously during the operation,reifentanil was maintained with 0.1-0.2μg/（kg·min）pump,and cis-atracurium was injected intermittently intravenically to maintain appropriate muscle release depth and anesthesia depth（BIS 40-60）.During the operation,patients’blood pressure,heart rate,pulse oxygen saturation,and body temperature were closely monitored,and the arterial blood pressure fluctuated within±20%of the basic blood pressure value.In all patients,muscle relaxant injection was stopped 20 minutes before the end of surgery,Sufentanil 0.1μg/kg intravenous injection was stopped 15 minutes before the end of surgery,sevoflurane,reifentanil and esketamine were stopped at the end of surgery,and the dosage of anesthesia maintenance drugs and esketamine pumped were recorded.If the patient experienced moderate pain（VAS≥4）,tramadol 50mg was injected intravenously for relief analgesia.The preoperative mental states of the two groups were evaluated,and the scores of the Generalized Anxiety Disorder Scale（GAD-7）and the Patient Health Questionnaire Depression Scale（PHQ-9）were recorded.Data collected during anesthesia were 5min before induction（T0）,immediately after intravenous injection of Esketamine（T1）,immediately before tracheal intubation（T2）,3min after tracheal intubation（T3）,5min after tracheal intubation（T4）,at the beginning of surgery（T5）,15min after surgery（T6）,15min before surgery（T7）,and at the end of surgery（T8）heart rate,pulse oxygen,systolic blood pressure,diastolic blood pressure,mean arterial pressure,BIS,Pet CO₂,body temperature,and the use of vasoactive drugs during the operation.GAD-7 and PHQ-9 scores,VAS pain scores,insomnia severity score（ISI）48h after surgery and the incidence of adverse reactions after anesthesia were recorded on the 1st,3rd and 7th day after surgery.Results:（1）GAD-7 and PHQ-7 and post-VAS pain scores on days 1,3 and 7 were lower compared with the control group,with significant differences（P<0.05）.（2）There was no significant difference in gender composition,age,body mass index,years of education,and mental status between the two groups（P>0.05）.（3）There was no significant difference between the operation time,intraoperative volume,intraoperative volume,extubation time（from end of anesthesia to catheter removal）and postoperative hospital days（P>0.05）.（4）The total dosage of sevoflurane and remifentanl in the test group was lower than that in the control group（P<0.05）;the hemodynamic index was less than that in the control group.（5）The incidence of postoperative adverse reactions in the test group was lower than that in the control group,with a significant difference（P<0.05）.（6）The ISI score was 48 hours than the control group showed a significant difference（P<0.05）.Conclusion:Preoperative anxiety and depression patients with laparoscopic general anesthesia surgery,application of subanesthetic dose esketamine can make anesthesia induction and the hemodynamics more stable,effectively relieve postoperative acute pain,reduce adverse reactions,improve the patient’s sleep quality,improve patients with anxiety and depression,provides a optional reference for clinical work.