title: Effect of intraoperative application of ketamine on postoperative depressed mood in patients undergoing elective orthopedic surgery.
abstract: OBJECTIVE
  A depressed mood frequently occurs in perioperative patients, negatively impacting patient recovery. Recent studies suggested that ketamine has a rapid, obvious, and persistent antidepressant effect. The purpose of this study was to investigate the impact of intraoperative application of ketamine on postoperative depressive mood in patients undergoing elective orthopedic surgery.
  
  
  METHODS
  This was a randomized, double-blind, controlled study. A total of 120 patients (ASA grade I-II) undergoing elective orthopedic surgery were divided randomly into a ketamine group (group K) and a control group (group C). In the K group, 0.5 mg/kg (0.05 ml/kg) ketamine was given at induction of anesthesia, followed by 0.25 mg/kg/h (0.025 ml/kg/h) continuous infusion for 30 min. In the C group, 0.05 ml/kg 0.9 % saline was used at induction of anesthesia, followed by 0.025 ml/kg/h continuous infusion of saline for 30 min. PHQ-9 score was recorded preoperatively (1 day before surgery) and postoperatively (on day 1 and day 5 following surgery). Blood at these time points was drawn for serum brain-derived neurotrophic factor (BDNF) level analysis. Intraoperative blood loss, surgery time, postoperative visual analog scale pain scores and perioperative complications were also recorded.
  
  
  RESULTS
  There were no differences in age, sex, surgery time, blood loss, and preoperative PHQ-9 scores between the two groups (P > 0.05). There were no differences in PHQ-9 scores preoperatively and postoperatively for the C group (P > 0.05); however, the PHQ-9 postoperative scores were lower than the preoperative PHQ-9 scores in the K group (P < 0.01). Postoperative PHQ-9 scores of K group were lower than those of C group (P < 0.05). There were no differences in serum BDNF levels in C group pre- to postoperatively (P > 0.05). Compared with the preoperative BDNF levels of K group, postoperative BDNF levels in K group increased significantly (P < 0.01). An inverse correlation between PHQ-9 score and serum BDNF level was shown.
  
  
  CONCLUSIONS
  Intraoperative application of ketamine was associated with improved scores for depressed mood and increased serum BDNF levels in patients undergoing elective orthopedic surgery.
authors.affiliation: Department of Anesthesiology, The 1st Affiliated Hospital of Sichuan Medical University, Luzhou, 646000, Sichuan Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Jiang
authors.affiliation: Department of Anesthesiology, The 1st Affiliated Hospital of Sichuan Medical University, Luzhou, 646000, Sichuan Province, China.
authors.forename: Mao-Hua
authors.initials: MH
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, The 1st Affiliated Hospital of Sichuan Medical University, Luzhou, 646000, Sichuan Province, China. wangxiaobin67@163.com.
authors.forename: Xiao-Bin
authors.initials: XB
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, The 1st Affiliated Hospital of Sichuan Medical University, Luzhou, 646000, Sichuan Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, The 1st Affiliated Hospital of Sichuan Medical University, Luzhou, 646000, Sichuan Province, China.
authors.forename: Jia-Li
authors.initials: JL
authors.lastname: Wu
authors.affiliation: Department of Anesthesiology, The 1st Affiliated Hospital of Sichuan Medical University, Luzhou, 646000, Sichuan Province, China.
authors.forename: Xiao-Lin
authors.initials: XL
authors.lastname: Yang
authors.affiliation: Department of Anesthesiology, The 1st Affiliated Hospital of Sichuan Medical University, Luzhou, 646000, Sichuan Province, China.
authors.forename: Xue-Ru
authors.initials: XR
authors.lastname: Liu
authors.affiliation: Department of Pharmacology, Rush Medical College, Rush University, Chicago, IL, 60612, USA.
authors.forename: Chun-Xiang
authors.initials: CX
authors.lastname: Zhang
mesh_terms: D000328:Adult; D019208:Brain-Derived Neurotrophic Factor / Q000097:blood*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007649:Ketamine / Q000627:therapeutic use*; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy; D011184:Postoperative Period
chemical_list: D019208:Brain-Derived Neurotrophic Factor; D007649:Ketamine; C579455:BDNF protein, human
keywords: BDNF; Ketamine; PHQ-9 score