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Objective To study the antidepressant effect of subanesthestic dose ketamine in anesthesia after cesarean section. Methods One hundred and twenty-six parturients who had underwent cesarean section were divided into ketamine group and control group with 63 cases each, The parturients in control group were given intravenous 0.9%sodium chloride 20 ml after childbirth, and the parturients in ketamine group were given subanesthetic dose ketamine after childbirth (0.5 mg/kg + 20 ml 0.9%sodium chloride). The parturients were evaluated by hospital anxiety and depression scale (HADS) and postpartum depression screening scale (PDSS). Results The scores of HADS and PDSS 5 and 10 d after parturition in ketamine group were significantly lower than those in control group, HADS:(7.67 ± 2.53) scores vs. (10.48 ± 2.48) scores and (7.96 ± 2.61) scores vs. (11.24 ± 2.74) scores, PDSS:(52.58 ± 13.36) scores vs. (71.34 ± 15.19) scores and (53.73 ± 13.28) scores vs. (73.41 ± 15.37) scores, and there were statistical differences (P<0.01). The incidences of depression 5 and 10 d after parturition in ketamine group were significantly lower than those in control group:4.8%(3/63) vs. 15.9%(10/63) and 4.8%(3/63) vs. 17.5% (11/63), and there were statistical differences (P<0.05). There were no serious adverse reactions in the 2 groups. Only 2 cases had mild nausea in control group, and the symptoms disappeared after adjustment. Conclusions The use of subanesthestic dose ketamine can significantly reduce the incidence of postoperative depression in cesarean section, and it has a good antidepressant effect.
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Objective To study the antidepressant effect of subanesthestic dose ketamine in anesthesia after cesarean section. Methods One hundred and twenty-six parturients who had underwent cesarean section were divided into ketamine group and control group with 63 cases each, The parturients in control group were given intravenous 0.9%sodium chloride 20 ml after childbirth, and the parturients in ketamine group were given subanesthetic dose ketamine after childbirth (0.5 mg/kg + 20 ml 0.9%sodium chloride). The parturients were evaluated by hospital anxiety and depression scale (HADS) and postpartum depression screening scale (PDSS). Results The scores of HADS and PDSS 5 and 10 d after parturition in ketamine group were significantly lower than those in control group, HADS:(7.67 ± 2.53) scores vs. (10.48 ± 2.48) scores and (7.96 ± 2.61) scores vs. (11.24 ± 2.74) scores, PDSS:(52.58 ± 13.36) scores vs. (71.34 ± 15.19) scores and (53.73 ± 13.28) scores vs. (73.41 ± 15.37) scores, and there were statistical differences (P<0.01). The incidences of depression 5 and 10 d after parturition in ketamine group were significantly lower than those in control group:4.8%(3/63) vs. 15.9%(10/63) and 4.8%(3/63) vs. 17.5% (11/63), and there were statistical differences (P<0.05). There were no serious adverse reactions in the 2 groups. Only 2 cases had mild nausea in control group, and the symptoms disappeared after adjustment. Conclusions The use of subanesthestic dose ketamine can significantly reduce the incidence of postoperative depression in cesarean section, and it has a good antidepressant effect.
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BACKGROUND: Brain injury often causes secondary cerebral ischemia and hypoxia, which aggravate the brain damages. Cerebral surgery can induce the increase of oxygen free radical in plasma, which may aggravate brain damage. As a new drug to induce and maintain anesthesia, the role of propofol in brain protection is more conspicuous.OBJECTIVE: To observe the effect of propofol on the serum concentration of S100B in patients undergoing neurosurgery, analyze its relation with the score of mini-mental state examination (MMSE) after 6 months, and evaluate the brain protective effects of propofol.DESIGN: A randomized and concurrent controlled trail.SETTINGS: Department of Anesthesiology, Department of Neurosurgery,Central Laboratory, Wuhan General Hospital of Chinese PLA; Staff Room of Anesthesiology, Zhongnan Hospital of Wuhan University.PARTICIPANTS: Thirty patients with acute craniocerebral injury, who were randomly selected from the Department of Neurosurgery, Wuhan General Hospital of Chinese PLA from January to June 2004, were divided into propofol group (n=15) and isoflurane group (n=15) according to the method of random number table.METHODS: The patients accepted the removal of intracranial hematoma and/or focal cerebral contusion and laceration by craniotomy under general anesthesia. In the propofol group, the patients were pumped with propofol (4-8 mg/kg per hour) perioperatively, and the anesthesia was maintained with intravenous injections of fentanvl (1-2 μg/kg per hour) and vecuronium (0.02-0.03 mg/kg per hour). In the isoflurane group, the patients inhaled isoflurane (0.8-1.2 MAC) perioperatively, and the anesthesia was maintained with intravenous injections of fentanvl (1-2 μg/kg per hour)and vecuronium (0.02-0.03 mg/kg per hour). The serum concentration of S100B was detected with enzyme-linked immunoabsorbent assay (ELISA)before operation, at 2 hours after the beginning of the operation and at the end of the operation respectively. After 6 months, 23 patients were evaluated by the indexes of localization, recordance, calculation and attention,memory, speech and spatial sense in MMSE, and the scores were recorded.The total score of MMSE was 30 points, the higher the scores, the better their intelligence.MAIN OUTCOME MEASURES: The changes of the brain injury marker of S100B at each time point perioperatively, MMSE scores at 6 months postoperatively, and the correlation between them were mainly observed in both groups. RESULTS: The blood samples of the 30 patients were all involved. For the follow-up after 6 months, 3 and 4 cases died in the propofol group and isoflurane group respectively, and totally 23 patients were followed up and evaluated by MMSE. ① The serum S100B at 2 hours perioperatively and that at the end of the operation were increased as compared with the preoperative one in both groups; At the end of the operation, it was significantly lower in the propofol group than in the isoflurane group (P ＜ 0.05).The S100B showed an ascending process before the operation, at 2 hours after the beginning of the operation and at the end of the operation. ② The MMSE score in the propofol group was not significantly higher than that in the isoflurane group [(22.33±5.96), (19.91±6.13), t=0.9603, P ＞ 0.05). ③ The S100B content at the end of the operation had a significant negative correlation with the MMSE score after 6 month (r=-0.487, P ＜ 0.05).CONCLUSION: The clinical anesthetic dose of propofol can reduce the increase of the serum concentration of S100B perioperatively, ameliorate the cognitive ability of the patients at 6 months postoperatively, and attenuate the occurrence of dysnoesia.
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Objective To investigate the changes in neuron-spe ci fic enolase (NSE) and S100B in patient′s serum before, during and after surgery of acute cerebral trauma, and to examine the influence of propofol, a venous an esthetic, on these changes, so as to evaluate the brain-protective effects of t his agent. Methods Ten patients with no cerebral injury and sch eduled for urological operation served as control group. Thirty patients with ce rebral trauma were randomly allocated to either propofol group (n=15) or iso flurane group (n=15). NSE and S100B were measured by ELISA in both propofol and isoflurane groups before surgery, 2 hours after cranial surgery started, and after surgery. The same measurement was done in the control group only before s urgery. Glasgow scores of patients with cerebral trauma were estimated and recor ded. Results Before surgery, the NSE and S100B in the patients with cerebral trauma were significantly higher than that in the control group ( P
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Objective To study the effects of propofol pretreatment on S100? and neurosecretion enzyme (NSE) of brain tissues with global cerebral ischemia-reperfusion in rat, and to evaluate the effects of propofol in protection of brain. Methods 30 SD male rats were randomly divided into 3 groups: sham operation group (group A, n=10); single cerebral ischemia-reperfusion group (group B, n=10); propofol pretreatment at 2h before ischemia group (group C, n=10), in which propofol (100mg/kg) was given intraperitoneally (ip) before ischemia. 24h after ischemia-reperfusion, the neuroethology scores were recorded and evaluated, and S100? and NSE in rat brain were determined. Results The neuroethology scores of group A were higher than those of group B (P