Effect of Combined Etomidate-Ketamine Anesthesia on Perioperative Electrocardiogram and Postoperative Cognitive Dysfunction of Elderly Patients with Rheumatic Heart Valve Disease Undergoing Heart Valve Replacement.

Ling Yang,Dan Hou,Jingyang Xie

doi:10.1155/2022/6205757

Abstract

Objective To explore the effect of combined etomidate-ketamine anesthesia on perioperative electrocardiogram (ECG) and postoperative cognitive dysfunction (POCD) of elderly patients with rheumatic heart valve disease (RHVD) undergoing heart valve replacement. Methods The data of 100 elderly RHVD patients treated in our hospital from May 2019 to May 2020 were selected for the retrospective analysis, and by adopting the double-blind method, the patients were divided into the ketamine group (n = 50) and the combined group (n = 50) according to the anesthesia methods. During the induction of anesthesia, the patients of the two groups were given a small dose of ketamine (0.5 mg/kg) at 5 μg/kg/min continuously via pump injection until the end of surgery, and on this basis, with the same anesthesia measures, those in the combined group were given etomidate (0.3 mg/kg) additionally. The patients' perioperative ECG indicators, POCD scores, and Numeric Rating Scale (NRS) scores were compared between the two groups. Results Compared with the ketamine group, the combined group presented significantly lower incidence of ST-T wave changes after anesthesia induction and at the time of intubation and skin incision (P < 0.05), significantly lower average magnitude of ST-segment depression after anesthesia induction (P < 0.001), significantly lower average magnitude of ST-segment elevation after anesthesia induction and extubation (P < 0.001), significantly lower POCD incidence (6.%, P < 0.05), and significantly better NRS score after surgery (P < 0.001). Conclusion Combined etomidate-ketamine anesthesia can stabilize the perioperative ECG indicators of elderly RHVD patients undergoing heart valve replacement, improve their postoperative cognitive function, and reduce their pain sensation, which should be promoted and applied in practice.

Highlights

Rheumatic heart valve disease (RHVD) refers to the heart disease caused by rheumatic valve inflammation, with valvular heart disease being the main pathological feature
Reports show that the success rate of valve replacement is over 98% [4, 5] and most patients have a good prognosis, but RHVD patients are usually complicated with cardiac function injury and experience greater risk of hemodynamic fluctuation during anesthesia [6]; in particular, elderly patients with multiple underlying diseases are more demanding in anesthesia and have poor physical performance. erefore, the selection of suitable anesthetic drugs is the key to guarantee the effect of valve replacement
Zhai et al found that low-dose ketamine can attenuate cognitive dysfunction induced by anesthetics such as sevoflurane in aged rats [11] and at the same time alleviate fentanyl-induced postoperative hyperalgesia, indicating that it can be applied in elderly patients undergoing heart valve replacement

Summary

Introduction

Rheumatic heart valve disease (RHVD) refers to the heart disease caused by rheumatic valve inflammation, with valvular heart disease being the main pathological feature. Surgical procedure is the most effective treatment for RHVD, and percutaneous transluminal balloon mitral or aortic valvuloplasty, valvular commissurotomy, and prosthetic valve replacement are commonly performed. Some studies have shown that the advantages of etomidate for elderly patients are extremely obvious; for example, it can reduce the likelihood of postoperative cognitive dysfunction in them and is beneficial for shortening their postoperative hospital stay [10]. Zhai et al found that low-dose ketamine can attenuate cognitive dysfunction induced by anesthetics such as sevoflurane in aged rats [11] and at the same time alleviate fentanyl-induced postoperative hyperalgesia, indicating that it can be applied in elderly patients undergoing heart valve replacement. There are few clinical studies on etomidate and ketamine, and the effect of applying the two to elderly RHVD patients is still unclear. The study was carried out, and the results are summarized as follows

Methods

Results

Conclusion