Impact of Esketamine Adjunct to Anesthesia Induction on Hemodynamics and Postoperative Cognitive Function in Elderly Patients Undergoing Laparoscopic Tension-free Hernia Repair

ZOU Zhiyong; ZHANG Yunmeng; LI Xiaoshan

doi:10.16458/j.cnki.1007-0893.2024.18.004

Abstract：Objective This study aims to examine the effects of incorporating a small dose of esketamine into the anesthesia induction protocol on hemodynamic stability and postoperative cognitive function in elderly patients undergoing laparoscopic tension-free hernia repair(TFH).Methods A total of 80 elderly patients scheduled for laparoscopic TFH at the Jiujiang University Affiliated Hospital between January and June 2024 were randomly allocated into two groups(n=40 each)using a randomized envelope method.Group I received standard anesthesia,while Group Ⅱ received standard anesthesia plus esketamine.Hemodynamic parameters and postoperative cognitive function were assessed and compared between the groups.Results There were no significant differences in heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)between Group I and Group Ⅱ at baseline(T0)and during anesthesia induction(T1)(P>0.05).At 5 minutes after anesthesia induction(T2),5 minutes after tracheal intubation(T3),and when BIS<60(T4),Group Ⅱ exhibited significantly higher HR,MAP,and BIS values compared to Group I(P<0.05).HR,MAP,and BIS values in Group Ⅱ remained stable from T1 to T4 when compared to T0(P>0.05).In contrast,Group I showed no significant changes at T1 relative to T0(P>0.05),but significant decreases in HR,MAP,and BIS values from T2 to T4 compared to T0(P<0.05).No significant differences in percutaneous arterial oxygen saturation(SpO2)were observed between groups at all time points(P>0.05).Mini-Mental State Examination(MMSE)scores did not differ significantly before anesthesia and at 72 hours postoperatively within Group I(P>0.05).MMSE scores at 6,24,and 48 hours postoperatively were lower in Group I compared to pre-anesthesia,whereas Group Ⅱ had higher scores at these time points,with statistically significant differences(P<0.05).MMSE scores in Group Ⅱ remained consistent from pre-anesthesia through 72 hours postoperatively(P>0.05).Conclusion The administration of a small dose of esketamine during anesthesia induction in elderly patients undergoing laparoscopic TFH appears to enhance hemodynamic stability and improve postoperative cognitive function.