Effect of intraoperative intravenous ketamine infusion on postoperative depressive emotion of living liver donors applied to right hepatectomy

Aim: The cadaveric liver has become an important source of organs for patients on the waiting list for liver transplantation. Cadeveric liver failure has led to increased death rates on the organ waiting list and more recently the use of more innovative and risky approaches to transplantation, including living donor liver transplantation. The organ transplant process is inherently stressful and involves several stages that can have negative psychological effects on recipients and donors. As with the transplant process, there is not much literature on the psychiatric complications and psychological consequences of donation on donors. Depression and anxiety were reported to be the most common psychiatric disorders in donors after organ donation. There is also increasing evidence of serious psychiatric complications, such as suicide, in donors. Postoperative depression is a perioperative psychological complication that seriously affects the patient's recovery and quality of life. In extreme cases, it can lead to suicidal behavior. Approximately 24% of non-cardiac surgery patients and 47% of cardiac surgery patients experience depressive symptoms postoperatively. In the surgical population, perioperative and patient factors such as pain, coronary artery bypass grafting, extreme obesity, bariatric surgery, and postpartum hormone fluctuations may contribute to changes in psychological status. The presence of postoperative depressive symptoms is associated with an increased risk of infection and cognitive dysfunction. Addressing depressive symptoms after surgery represents an important aspect of the care of surgical patients, but effective strategies have yet to be identified. Numerous randomized controlled trials have demonstrated the antidepressant effects of ketamine. Proposed mechanisms for these antidepressant effects include increased hippocampal neurogenesis, rebalancing of glutamate release, and reversal of stress-induced synaptic deficiencies. These data suggest a possible role for routine ketamine use in perioperative settings for the prevention and relief of depressive symptoms after surgery. Considering the lack of current literature, we planned to conduct this study in living liver donors, considering that it would be beneficial to focus on the evaluation of psychiatric outcomes in donors. Our primary aim was to examine the effect of low-dose ketamine infusion on the level of depression in living liver donors. Our secondary aim is to investigate the incidence of preoperative and postoperative depression in living liver donors. Materials and Methods: American Society of Anesthesiologists (ASA) score I-II and 90 liver transplant donors aged 18-65 years who underwent right hepatectomy were included in our study. The cases were randomly divided into two groups. The cases in which ketamine was administered intraoperatively, the ketamine group and the group in which physiological saline was administered were assigned as the control group. After the patients were taken to the operating room, standard anesthesia (ECG, peripheral oxygen saturation, blood pressure) and BIS (Bispectral Index) monitoring were performed. Anesthesia induction; with propofol and fentanyl, and rocuronium for muscle relaxation. Maintenance was continued with a mixture of desflorane and air. Desfloran dose of 0.6 and a minimum alveolar concentration (MAC) of 1 were applied so that the BIS value was 40-60. To the Ketamine Group; After induction, a bolus of 0.5 mg/kg ketamine was administered and 0.25 mg/kg/hour ketamine infusion was initiated with the initiation of anesthesia maintenance. For the control group, they administered a masked saline bolus and saline infusion after induction and with the start of anesthesia maintenance. At the end of the surgical procedure, the infusions administered to both groups were terminated. The patient was followed up for 45 minutes in the recovery after extubation. Depression mood of the cases was evaluated with Beck depression scale. Beck depression scale was performed preoperatively and on the 7th postoperative day. The correlation between the gender, education, employment, marital and kinship status of the cases and depression was examined. Results:There was no statistically significant difference between the groups in terms of preoperative and postoperative depression scores. In the ketamine group; There was no statistically significant change in the postoperative period according to the preoperative depression score. In the control group; The increase in the postoperative period according to the preoperative depression score was statistically significant (p:0.031). In the control group, both preoperative and postoperative depression scores were higher in women than in men. In the control group, people who did not work had a higher depression score than those who worked. Educational status, marital status, and kinship status were not associated with depression. Conclusion: We found that intraoperative time-limited low-dose ketamine infusion in living liver donors did not make a significant difference in improved scores for postoperative depressive mood. However, there was no significant change in the postoperative depression score in the ketamine group compared to the preoperative period, while in the control group; The postoperative depression score was significantly higher than the preoperative period. Keywords: Ketamine, Depression, Live liver donors