Effects of a Single Sub-Anesthetic Dose of Ketamine on Postoperative Emotional Responses and Inflammatory Factors in Colorectal Cancer Patients

Abstract

Objective: To investigate the effect of a single sub-anesthetic dose of ketamine on postoperative anxiety, depression, and inflammatory factors in patients with colorectal cancer.Methods: A total of 104 patients undergoing selective colorectal surgery in our hospital from Jan 2015 to Oct 2017 were included and randomly assigned (1:1:1:1) into a 0.1 mg kg−1 ketamine group (K1 group), 0.2 mg kg−1 ketamine group (K2 group), 0.3 mg kg−1 ketamine group (K3 group), or control group (C group). Corresponding doses of ketamine were given intravenously in the K groups (K1, K2, and K3 groups) 5 min before operation, and the same amount of normal saline was given in the C group. The intravenous analgesia program was identical in the four groups. The patients’ emotional reactions (anxiety and depression) were assessed by the Hospital Anxiety and Depression Scale (HAD), the quality of postoperative recovery was evaluated by the Quality of Recovery-40 (QoR-40) questionnaire, and the levels of IL-6, IL-8, and TNF-α in peripheral blood were detected by enzyme-linked immunosorbent assay (ELISA) on the day before operation and within 24, 48, and 72 h post-operation respectively. Pain was estimated by the visual analog scale (VAS), and sedation was assessed with Ramsay score 30 min after extubation. The time points of anesthetic end and extubation were recorded. The complications during anesthesia and recovery such as cough and agitation 30 min after extubation were recorded.Results: The anxiety score (HAD-A) and depression score (HAD-D) of the K3 group were significantly lower than those of the C group post-operation (p < 0.05). The QoR-40 score of the K3 group was significantly higher than that of the C group (p < 0.05). The serum levels of IL-6, IL-8, and TNF-α in the K3 group were significantly lower than those in the C group (p < 0.05 and p < 0.01). There were no significant differences in HAD-A, HAD-D, and QoR-40 scores or serum levels of IL-6, IL-8, and TNF-α between the K1 and K2 groups and the C group. There were no significant differences in VAS pain score or Ramsay sedation score among the four groups 30 min after extubation. There were no significant differences in extubation time, postoperative cough, emergence agitation, or delirium among the four groups. Dizziness, nausea, vomiting, diplopia, or other adverse reactions were not found 30 min after extubation.Conclusion: A single sub-anesthetic dose (0.3 mg kg−1) of ketamine can significantly improve the postoperative anxiety and depression of colorectal cancer patients and reduce the levels of IL-6, IL-8, and TNF-α.

The efficacy and safety of ketamine for depression in patients with cancer: A systematic review

“…The included studies were conducted between 2014 and 2018. ( Fan et al., 2017 ; Liu et al., 2021 ; Ren et al., 2022 ; J. Wang et al., 2020 ; Xu, Zhan & Chen, 2017 ) All the included studies were randomized clinical trials and were conducted in inpatient settings (i.e., hospitals) in China.…”

“…The studies covered several cancer types including two focused on breast cancer, ( Liu et al., 2021 ; Xu et al., 2017 ) one on cervical cancer, (J. Wang et al., 2020 ) one on colorectal cancer, ( Ren et al., 2022 ) and one study focused on more than one cancer type. ( Fan et al., 2017 ) Characteristics of included studies are shown in Table 1 .…”

“…In all included studies, ketamine was administered intravenously. Three studies used only racemic ketamine (i.e., racemic ketamine hydrochloride), ( Fan et al., 2017 ; Ren et al., 2022 ; Xu et al., 2017 ) and two studies used both S-ketamine and racemic ketamine (both reported that S-ketamine is more effective than racemic ketamine for reducing postoperative depression). ( Liu et al., 2021 ; J.…”

“… Wang et al., 2020 ; Xu et al., 2017 ) one study measured suicidal ideation using the Beck Scale for Suicidal Ideation (BSI) score and the suicidal section of the Montgomery-Asberg Depression Rating Scale (MADRS-SI), ( Fan et al., 2017 ) and one study measured anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). ( Ren et al., 2022 ) All included studies conducted assessments multiple times, and the assessment time points ranged from one day before the operation to three months after the surgery. As a secondary outcome, four studies measured pain (using Visual Analog Scale (VAS)), ( Liu et al., 2021 ; Ren et al., 2022 ; J.…”

Efficacy and safety of perioperative application of ketamine on postoperative depression: A meta-analysis of randomized controlled studies

“…1). Altogether, 15 studies included 3159 adult patients undergoing surgical treatment [23,24,[29][30][31][32][33][34][35][36][37][38][39][40][41].…”