Effect of subanesthetic doses of esketamine combined with dexmedetomidine on the postoperative anxiety-depression and inflammatory response of patients undergoing gynecological general anesthesia
Objective To investigate the effect of subanesthetic doses of esketamine combined with dexmedetomidine on the postoperative anxiety-depression and inflammatory response of patients undergoing gynecological general anesthesia.Methods Two hundred patients who underwent elective gynecological surgery under general anesthesia in the First Affiliated Hospital of Xinxiang Medical University from February 2022 to October 2022 were selected as the research subjects.According to random number table method,the patients were divided into the subanesthetic dose of esketamine combined with dexmedeto-midine group(combination group),esketamine group,dexmedetomidine group,and conventional group,with 50 cases in each group.The patients in the four groups were routinely fasted for solids and liquids before the operation and inhaled oxygen at a rate of 3 L·min-1 through the face mask.Patients in the combination group received dexmedetomidine intravenously 5 minutes before the anesthesia induction,and the dexmedetomidine injection was maintained at a rate of 0.3 μg·kg-1·h-1 until 30 minutes before the end of operation;additionally,a single intravenous injection of esketamine(0.2 mg·kg-1)was administered 5 minutes before operation.Patients in the esketamine group received a single intravenous injection of esketamine(0.5 mg·kg-1)5 minutes before operation,at a rate of 0.2 mg·kg-1·h-1 until 30 minutes before operation.Patients in the dexmedetomidine group received intravenous infusion of dexmedetomidine 5 minutes before anesthesia induction,at a rate of 0.3 µg·kg-1·h-1 until 30 minutes before operation.Patients in the conventional group received intravenous infusion of propofol(2.5 mg·kg-1)5 minutes before anesthesia induction,at a rate of 0.6 mg·kg-1·h-1 until 30 minutes before operation.The patients in the four groups were given the same anesthesia induction.Before and 48 hours after operation,the anxiety and depression levels of patients in the four groups were evaluated using the Anxiety Visual Analogy Test(AVAT)score,Hospital Anxiety and Depression Scale(HADS)score,Self-rating Anxiety Scale(SAS)score,and Self-rating Depression Scale(SDS)score.One day before operation,1,3 and7 days after operation,2 mL peripheral blood was collected from patients in the four groups,and the serum interleukin-6(IL-6),interleukin-10(IL-10),and tumor necrosis factor-α(TNF-α)levels were detected by the enzyme-linked immunosorbent assay.Results There was no significant difference in AVAT,HADS,SAS and SDS scores of patients before operation and 48 hours after operation in the conventional group(P＞0.05),while the AVAT,HADS,SAS and SDS scores 48 hours after operation in the combination group,esketamine group and dexmedetomidine group were significantly lower than those before operation(P＜0.05).Forty-eight hours after operation,the AVAT,HADS,SAS and SDS scores of patients in the combination group,esketamine group and dexmedetomidine group were significantly lower than those in the conventional group;the A VAT,HADS,SAS and SDS scores of patients in the combination group were significantly lower than those in the esketamine and dexmedetomidine groups(P＜0.05);and there was no statistically significant difference in AVAT,HADS,SAS,and SDS scores between the esketamine group and the dexmedetomidine group(P＞0.05).1,3 and 7 days after operation,the serum IL-6,IL-10,and TNF-α levels of patients in the four groups were significantly higher than those 1 day before surgery(P＜0.05).The serum IL-6 and IL-10 levels 3 and 7 days after operation in the four groups were significantly lower than those 1 day after operation,while the serum TNF-α level was significantly higher than that 1 day after operation(P＜0.05).The serum IL-6 and IL-10 levels 7 days after operation in the four groups were significantly lower than those 3 days after operation(P＜0.05).There was no statistically significant difference in serum IL-6,IL-10,and TNF-αlevels of patients among the four groups 1 day before surgery(P＞0.05).1,3 and 7 days after operation,the serum IL-6,IL-10,and TNF-α levels of patients in the combination group,esketamine group,and dexmedetomidine group were significantly lower than those in the conventional group(P＜0.05);the serum IL-6,IL-10,and TNF-α levels of patients in the combination group and esketamine group were significantly lower than those in the dexmedetomidine group(P＜0.05);and the serum IL-6,IL-10,and TNF-α levels of patients in the combination group were significantly lower than those in the esketamine group(P＜0.05).Conclusion A subanesthetic dose of esketamine combined with dexmedetomidine can significantly relieve postoperative anxiety-depression and inflammatory response of patients undergoing gynecological general anesthesia.
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