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| Effect of Esketamine on Hemodynamics and Incidence of Postoperative Delirium in Patients Undergoing Coronary Artery Bypass Grafting |
| SUN Yanbin, WANG Wenxi, AN Haiyan, et al |
| Chengde Central Hospital, Hebei Chengde 067000, China |
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Abstract Objective: To study the effect of esketamine on hemodynamics and postoperative delirium incidence in patients undergoing cardiac coronary artery bypass grafting.Methods: Totally 80 patients undergoing cardiac coronary artery bypass grafting (CABG) under extracorporeal circulation (CPB) in our hospital from January 2019 to June 2021 were randomly divided into a trial group and a control group, with 40 patients in each group. After admission to the operating room, the test group received 0.5mg/kg of esketamine intravenously during the induction period and 0.5mg/kg.h intravenously during the maintenance period, and the infusion was stopped at the end of the operation. In the control group, an equal amount of saline was administered. Heart rate and blood pressure were recorded at the time points of immediate admission (T0), after tracheal intubation (T1), at the time of skin incision (T2), at the time of sternotomy (T3), before CPB (T4), 10 min after CPB stop (T5), immediately after admission to ICU (T6), 6h after admission to ICU (T7), and 12h after admission to ICU (T8), respectively. The changes of left ventricular stroke volume (SV), left ventricular ejection fraction (LVEF) and cardiac output (CO) were measured by transesophageal echocardiography(TEE) at T2 and T5.The duration of mechanical ventilation, ICU stay, postoperative analgesic drug dosage and occurrence of delirium after awakening were compared.Results: The SBP of the control group at the moment of T1 was smaller than that at the moment of T0, with a statistically significant difference of P<0.05. The SBP of the experimental group at the moment of T5 was significantly higher than that of the control group; the SBP of the control group was significantly lower than that at the moment of T0 and T2; the difference was statistically significant at P<0.05. The heart rate of the experimental group was significantly higher than that of the control group at T5, with a statistically significant difference of P<0.05. The SBP of the control group at T6 was lower than that at T0, with a statistically significant difference of P<0.05. The echocardiographic cardiac function results showed that the LVEF, SV and CO levels of the experimental group were significantly better than those of the control group at T5, with a statistically significant difference of P<0.05. The incidence of delirium at 12h, 24h and 72h after removal of the tracheal tube was significantly higher than that of the control group. There was no statistically significant difference in the incidence of delirium between the two groups at 12h, 24h and 72h after extubation. The difference in the duration of mechanical ventilation and ICU stay between the two groups was statistically significant, P<0.05, with the experimental group being shorter than the control group. The amount of sufentanil used in the first 24h after surgery was less in the experimental group than in the control group, with a statistically significant difference of P<0.05.Conclusion: The use of esketamine in patients undergoing CABG with extracorporeal circulation does not increase the incidence of postoperative delirium and can make the patient more haemodynamically stable, and has the effect of reducing postoperative sufentanil dosage, shortening the duration of mechanical ventilation and ICU stay, and accelerating the patient's recovery.
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2022, Vol. 28 
