Effects of Opioid-free General Anesthesia with Esketamine on Neurogenic Inflammatory Factors,Cerebral Oxygen Metabolism,Anesthesia and Re-covery Quality in Elderly Patients Undergoing Total Hip Arthroplasty
XU Tongsheng
SUN Weinan
CHEN Xiaodong
WANG Meng
Abstract：Objective To investigate the effects of opioid-free general anesthesia with Esketamine on neurogenic in-flammatory factors,cerebral oxygen metabolism,anesthesia and recovery quality in elderly patients undergoing total hip re-placement(THR).Methods A total of 86 elderly patients who received elective THR from April 2022 to April 2023 were randomly divided into observation group(n =43)and control group(n =43).The observation group received opioid-free an-esthesia with Esketamine and the control group received conventional anesthesia.The hemodynamics[mean arterial pressure(MAP)and heart rate(HR)],neurogenic inflammatory factors[nerve growth factor(NGF),prostaglandin E2(PGE2),Substance P(SP)and neurokinin A(NKA)]and cerebral protection indicators[cerebral oxygen uptake rate(CERO2),ar-terio-jugular bulbar hypoxia(Da-jvO2),neuron-specific enolase(NSE)and S-100β protein]of the two groups were com-pared before anesthesia induction,at endotracheal intubation(T2),at skin resection(T3),and at withdrawal of endotracheal catheter(T4).Visual analogue scale(VAS)pain score,postoperative nausea and vomiting(PONV)score at 1,2 and 3 d after surgery,Mini-Mental State Examination(MMSE)scores at 1,3,and 7 d after surgery,quality of recovery,and intraop-erative and postoperative adverse reactions were compared between the two groups.Results At T2-T4,MAP and HR showed an increasing trend,while NGF,PGE2,SP,NKA,CERO2,Da-jvO2,NSE and S-100β showed a decreasing trend.MAP and HR in observation group were higher than those in control group,while NGF,PGE2,SP,NKA,CERO2,Da-jvO2,NSE and S-100β protein were lower than those in control group(P<0.05).At 1,2 and 3 d after operation,VAS and PONV scores of both groups showed a decreasing trend,while MMSE scores showed an increasing trend at 1,3,and 7 d after operation.VAS and PONV scores in observation group were lower than those in control group at 1,2 and 3 d after operation,while MMSE scores were higher than those in control group at 1,3,and 7 d after operation(P<0.05).The time to extubation and recov-ery time of observation group were shorter than those of control group,and the Ramsay score at 10 min after extubation was lower than that of control group(P<0.05).During and after operation,the incidence of adverse reactions in the observation group was 11.63%(5/43),which was lower than that in the control group[37.21%(16/43)](P<0.05).Conclusion Opioid-free general anesthesia with Esketamine is beneficial to stable hemodynamics,improve postoperative recovery quali-ty,relieve pain in elderly patients with THR,improve cerebral oxygen metabolism,and reduce the incidence of adverse reac-tions,which may be related to the regulation of neurogenic inflammatory response.
Keywords：ArthroplastyreplacementhipElderlyEsketamineNon-opioid AnesthesiaMean arterial pressureNerve growth factorCerebral oxygen uptake rateVisual analogue scale of pain
Publication Date：2023-12-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 350-356 )