The effect of esketamine on delirium and depression in patients with breast cancer during perioperative pe-riod

Zhao Zhiru; Ailaiti Talaiti; Abasi Aimaiti

doi:10.3760/j.issn.1673-4777.2025.11.013

Abstract：Objective To investigate the effect of esketamine on perioperative delirium and depression in patients with breast cancer.Methods A total of 114 patients who planned to undergo radical mastectomy in the First Affiliated Hospital of Xinjiang Medical University from June 2022 to July 2024 were prospectively enrolled.They were divided into control group and observation group by random number table method,with 57 cases in each group.The observation group was given a single dose of esketamine 0.5 mg/kg during anesthesia induction,and continued to pump at 0.25 mg/(kg·h)until 0.5 h before the end of surgery.The control group was given the same dose of normal saline.The incidence of depression,delirium,pain degree,patient-controlled intravenous analgesia(PCIA),inflammatory indicators and adverse reactions were compared between the two groups.Results There were no significant differences in operation time,intraoperative blood loss,postoperative extubation time,and residence time in post-anesthesia monitoring and treatment room between the two groups(all P＞0.05).The Hamilton Depression Scale scores of the two groups at different time points after operation increased with time,and the scores of the observation group were lower than those of the control group(all P＜0.05).Compared with the control group,the total incidence of postoperative delirium in the observation group was lower[8.8％(5/57)vs 22.8％(13/57)](P＜0.05).At different time points after operation,the pain numerical rating scale scores of the two groups showed a decreasing trend with time,and those in the observation group were lower than those in the control group(all P＜0.05).The proportion of PCIA self-control in the observation group was less than that in the control group[5.3％(3/57)vs 19.3％(11/57),P=0.022].At different time points 1 and 3 d after operation,the levels of interleukin-6 and tumor necrosis factor-α in the two groups increased first and then decreased,and those in the observation group were lower than those in the control group(all P＜0.05).There was no significant difference in the incidence of adverse reactions between the two groups(all P＞0.05).Conclusion Esketamine can significantly relieve the depression of breast cancer patients after surgery,reduce the occurrence of delirium,enhance the analgesic effect,inhibit inflammatory response,and has good safety.