The impact of intraoperative esketamine infusion on postoperative sleep in patients undergoing general surgery

Abstract

Objective: Major abdominal surgery frequently induces circadian sleep-wake disturbances, characterized by increased daytime rapid eye movement (REM) sleep and prolonged nocturnal wakefulness. This study investigated the effects of perioperative continuous esketamine infusion (0.3 mg/kg/h) on postoperative sleep disturbance in patients under general anesthesia. Intraoperative electroencephalography (EEG) monitoring was implemented with focused analysis of relative wavelength frequencies. Methods:. Patients undergoing surgery received a continuous intraoperative esketamine infusion at a dose of 0.3 mg/kg/h. Concurrent electroencephalography (EEG)monitoring was performed, with the analysis specifically focusing on relative power percentages of the EEG signal.Preoperatively, levels of melatonin (quantified using mass spectrometry), Interleukin-6 (IL-6), and C-Reactive Protein (CRP)were measured.Postoperative sleep quality was then assessed on days 1 and 3 using the Athens Insomnia Scale (AIS), where a score > 6 was defined as sleep disturbance. Results: The esketamine group exhibited significantly lower rates of sleep disturbance on postoperative day 1 (37/75 [49.3%] vs. 19/75 [25.3%];P = 0.002) and day 3 (27/75 [36.0%] vs. 14/75 [18.7%];P = 0.017). Significant intergroup differences in acute postoperative pain were observed. The EEG analysis demonstrated that the slow-wave activity composite index (PCI) serves as a robust predictor for postoperative sleep disturbance risk(OR = 0.25, 95% CI:0.139–0.479;P < 0.001).Multivariate logistic regression identified independent predictors of postoperative sleep disturbance (PSD): Esketamine administration (OR 0.274; 95% CI 0.088–0.854);Preoperative melatonin levels (per-unit increase: OR 1.039; 95% CI 1.013–1.065);Preoperative HADS-A anxiety score (OR 1.396; 95% CI 1.075–1.813);preoperative IL-6 levels (OR 1.274; 95% CI 1.025–1.583);Postoperative pain score (OR 2.340; 95% CI 1.483–3.692);PC1 (OR 0.25, 95% CI: 0.139–0.479). Conclusion: Perioperative esketamine administration significantly reduces postoperative sleep disturbance (PSD) incidence and early postoperative pain severity. Independent risk factors for PSD include preoperative melatonin deficiency, anxiety symptoms (HADS-A), preoperative IL-6 elevation, and acute postoperative pain. Crucially, the slow-wave activity composite index (PCI)-reflecting esketamine-induced prefrontal delta synchronization (δ/α ratio + Delta power)-emerges as a robust predictor of PSD risk (OR = 0.25, 95% CI: 0.139–0.479;P < 0.001). Registry: ChiCTR Trial Registration Number (TRN): ChiCTR2400092868 Registration date: 25 November 2024.