Optimizing esketamine administration for postoperative depression: a comprehensive study on laparoscopic bariatric...

Area of Science:

• Anesthesiology
• Psychiatry
• Pharmacology

Background:

• Conflicting evidence exists on esketamine's efficacy for postoperative depression.
• Anesthesia's impact on brain function suggests timing of esketamine administration is crucial.
• Previous studies show subanesthetic esketamine is effective for treatment-resistant depression.

Purpose of the Study:

• To investigate the effect of esketamine timing relative to anesthesia on postoperative depression.
• To determine if preoperative or postoperative esketamine administration impacts depression scores and BDNF levels.

Main Methods:

• 120 patients undergoing laparoscopic bariatric surgery were randomized into three groups: pre-anesthesia esketamine (Pre-ESK), post-anesthesia esketamine (Post-ESK), and placebo.
• Esketamine (0.2 mg/kg) was administered intravenously.
• Depression was assessed using Patient Health Questionnaire-9 (PHQ-9) scores, and plasma brain-derived neurotrophic factor (BDNF) levels were measured.

Main Results:

• The Pre-ESK group showed significantly lower PHQ-9 scores and depression incidence/severity on postoperative day 1 compared to Post-ESK and placebo groups.
• Plasma BDNF levels were significantly higher in the Pre-ESK group than in the other two groups.
• A negative correlation was observed between PHQ-9 scores and plasma BDNF levels.

Conclusions:

• Subanesthetic esketamine can alleviate postoperative depression symptoms after laparoscopic bariatric surgery.
• Preoperative esketamine administration is more effective than postoperative administration in managing postoperative depression.
• Anesthetic drugs significantly influence the efficacy of esketamine for postoperative depression.