Effect of Subanesthetic Dose of Esketamine on Perioperative Neurocognitive Disorders in Elderly Undergoing Gastrointestinal Surgery: A Randomized Controlled Trial

Chao Han; Haiyan Ji; Yaxin Guo; Yuanhui Fei; Chunhui Wang; Yanbo Yuan; Zhihui Ruan; Tieliang Ma

doi:10.2147/DDDT.S401161

Effect of Subanesthetic Dose of Esketamine on Perioperative Neurocognitive Disorders in Elderly Undergoing Gastrointestinal Surgery: A Randomized Controlled Trial

Drug Des Devel Ther. 2023 Mar 21:17:863-873. doi: 10.2147/DDDT.S401161. eCollection 2023.

Authors

Chao Han^{1

2}, Haiyan Ji¹, Yaxin Guo¹, Yuanhui Fei¹, Chunhui Wang¹, Yanbo Yuan¹, Zhihui Ruan¹, Tieliang Ma^{1

2}

Affiliations

¹ Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, 214200, People's Republic of China.
² Yixing Clinical College, Medical College of Yangzhou University, Yixing, Jiangsu, 214200, People's Republic of China.

Abstract

Background: Perioperative neurocognitive disorders (PND), including delayed neurocognitive recovery (dNCR) and postoperative cognitive dysfunction (POCD), are common postoperative complications in elderly patients and adversely affect their prognosis. The study was designed to explore the effects of esketamine on postoperative cognitive function in elderly patients who underwent gastrointestinal surgery under general anesthesia and its potential mechanism.

Methods: Eighty-four patients aged 65 and above undergoing gastrointestinal surgery were randomly divided into 2 groups: the esketamine group (group S) and the control group (group C). Group S received intravenous sub-anesthetic doses of esketamine (0.15 mg/kg) 5 minutes before the initiation of surgery, while group C received the same volume of saline. A battery of neuropsychological tests was used to assess cognitive function before surgery, 7 days, and 3 months after surgery. The primary outcome was the incidence of dNCR at 7 days postoperatively and POCD at 3 months postoperatively in both groups. The secondary outcome measures included changes in the levels of serum interleukin-6 (IL-6) and calcium-binding protein β (S100β) before and 1 day after surgery.

Results: The incidence of dNCR in group S was lower than that of group C (18.15% vs 38.24% P=0.033). Contrarily, there was no difference in both groups regarding POCD 3 months postoperatively (6.06% vs 14.37% P=0.247). Plasma IL-6 and S100β levels were significantly elevated in both groups on postoperative day 1 (p<0.05), but esketamine pretreatment reduced these levels to some extent compared with group C (p<0.05).

Conclusion: Sub-anesthetic doses of esketamine might reduce the incidence of dNCR and improve early postoperative cognitive function in elderly patients undergoing gastrointestinal surgery, which might be related to the anti-neuroinflammation effects of esketamine.

Keywords: elderly; esketamine; gastrointestinal surgery; neuroinflammatory; perioperative neurocognitive disorders.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Anesthetics, Intravenous
Cognition Disorders*
Digestive System Surgical Procedures* / adverse effects
Humans
Interleukin-6
Postoperative Complications / prevention & control

Substances

Esketamine
Interleukin-6
Anesthetics, Intravenous

Grants and funding

This study was supported by the General Program of Health Commission of Wuxi (grant number, MS201934), the Double hundred top talent project of Wuxi (grant number, HB2020109), and the General Program of Health Commission of Jiangsu (grant number, M2021069).