Objective To investigate the effect of different doses of esketamine on postoperative anxiety and depression in patients with breast cancer.Methods A total of 96 patients undergoing modified radical mastectomy were randomly divided into esketamine L group(0.15mg/kg),M group(0.30mg/kg),high-dose H group(0.50mg/kg),and normal saline group(C group)with 24 cases in each group which will be given during induction of anesthesia.State Anxiety Scale(SAI)score and Montgomery Depression Scale(MADRS)score were recorded 1day before surgery(D1),1day after surgery(D2),3days after surgery(D3),5days after surgery(D4),and 7days after surgery(D5).Data such as the dosage of remifentanil,the dosage of norepinephrine,and the duration of the op-eration(from the beginning of the operation to the end of the operation)were recorded during the operation.The time from the end of an-esthesia to extubation and the postoperative PACU residence time was recorded,and delirium,postoperative nausea and vomiting(PONV),dizziness,drowsiness,and pain relief rate within 24hours after surgery were recorded.Results At D3,group H had a lower SAI score than the other three groups(P＜0.05);compared with D1,the SAI score at D4 and D5 in groups C,L,and M was signifi-cantly decreased(P＜0.05).The SAI score of group H at D3,D4,and D5 was decreased(P＜0.05);the MADRS score of group H was lower than that of the other three groups at D3 and D4(P＜0.05);compared with D1,the MADRS score of all groups gradually de-creased with the extension of time(P＜0.05).Remifentanil consumption in group H was significantly lower than that in the other three groups(P＜0.05).There were no significant differences in the incidence of postoperative delirium,PONA,remedial analgesia,dizzi-ness,lethargy,and fever among the four groups(P＞0.05).Conclusion Intraoperative intravenous injection of esketamine can reduce the SAI and MADRS scores,reduce the perioperative opioid consumption,and not increase the incidence of postoperative adverse reac-tions in breast cancer patients.

Resection of oral and maxillofacial tumors is often accompanied by the inferior alveolar nerve neurectomy, resulting in abnormal sensation in lower lip. It is generally believed that spontaneous sensory recovery in this nerve injury is difficult. However, during our follow-up, patients with inferior alveolar nerve sacrifice showed different degrees of lower lip sensory recovery. In this study, a prospective cohort study was conducted to demonstrate this phenomenon and analyze the factors influencing sensory recovery. A mental nerve transection model of Thy1-YFP mice and tissue clearing technique were used to explore possible mechanisms in this process. Gene silencing and overexpression experiments were then conducted to detect the changes in cell morphology and molecular markers. In our follow-up, 75% of patients with unilateral inferior alveolar nerve neurectomy had complete sensory recovery of the lower lip 12 months postoperatively. Patients with younger age, malignant tumors, and preservation of ipsilateral buccal and lingual nerves had a shorter recovery time. The buccal nerve collateral sprouting compensation was observed in the lower lip tissue of Thy1-YFP mice. ApoD was demonstrated to be involved in axon growth and peripheral nerve sensory recovery in the animal model. TGF-β inhibited the expression of STAT3 and the transcription of ApoD in Schwann cells through Zfp423. Overall, after sacrificing the inferior alveolar nerve, the collateral compensation of the ipsilateral buccal nerve could innervate the sensation. And this process was regulated by TGF-β-Zfp423-ApoD pathway.
Mice ; Animals ; Lip/innervation* ; Prospective Studies ; Mandibular Nerve/pathology* ; Sensation/physiology* ; Trigeminal Nerve Injuries/pathology*