Abstract
This study aimed to evaluate the effects of esketamine combined with remimazolam tosylate on hemodynamic stability, cerebral oxygen metabolism, and cognitive outcomes in patients undergoing heart valve replacement. Seventy-eight patients were randomized to Group C (dexmedetomidine hydrochloride) or Group R (esketamine + remimazolam tosylate). The following parameters were measured: multiple time points, including mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), arterial-jugular vein oxygen content difference (Da-jvO(2)), cerebral oxygen uptake rate (CERO(2)), and biomarkers of myocardial injury (cTnI, CK-MB, FABP) at baseline (T0), incision (T1), sternotomy (T2), pre-cardiopulmonary bypass (T3), and post-surgery (T4). Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and Confusion Assessment Method (CAM). Group R showed prolonged values of lower RR in T1 to T4 than Group C (p < 0.05). The Da-jvO(2) and CERO(2) were found to be much higher in Group R in T2, T3, and T4 (p < 0.05). This is an indication of improved cerebral oxygen metabolism. MMSE scores were elevated in Group R: the incidence of delirium and CAM Scores were lower compared with Group C (p < 0.05). This indicates better cognitive outcomes. Also, cTnI, CK-MB, and FABP, myocardial injury markers, were significantly reduced in Group R at postoperative 24 and 72 h (p < 0.05), indicating reduced myocardial injury. The combination of esketamine and remimazolam tosylate offers hemodynamic stability, enhances cerebral oxygen metabolism, improves cognitive function, and reduces myocardial injury in patients undergoing heart valve replacement surgery. This approach might provide significant benefits in cardiovascular anesthesia.