Efficacy and Safety of S-ketamine in Elderly Patients Undergoing Non-cardiac Surgery: a RCT（ESSENCE）

Inclusion criteria

• 1) Aged > 65 years old, no gender limitation;
• 2) patients undergoing elective thoracic, abdominal and orthopedic surgery;
• 3) ASA score is Class I-Class ~III;
• 4) 18 kg/ m2<BMI<30kg/m2；
• 5) The operation time is estimated to be 2 h-4 h;
• 6) Know clearly and voluntarily participate in this study, and sign informed consent form by oneself.

Exclusion criteria

• 1) patients with severe chronic pain;
• 2) Anemia or thrombocytopenia, Hb < 90 g/L, PLT < 80 × 109/L;
• 3) Severe liver dysfunction, AST and/or ALT≥2.5×ULN, and TBIL ≥ 1.5 × ULN;
• 4) severe renal dysfunction, blood creatinine is greater than the upper limit of normal;
• 5) Severe cardiovascular history (such as myocardial ischemia, heart failure and arrhythmia); Angina pectoris (unstable angina pectoris) caused by insufficient blood supply to the coronary vessels of the heart, or myocardial infarction in the past 6 months; QT interval prolongation (≥460ms in males and ≥ 470 ms in females);
• 6) Patients with hypertension whose blood pressure is not satisfactorily controlled by antihypertensive drugs (systolic blood pressure in sitting position during screening stage ≥180 mmHg, and/or diastolic blood pressure during screening stage ≥ 100 mmHg);
• 7) Patients with craniocerebral injury, possible intracranial hypertension, cerebral aneurysm, cerebrovascular accident history and central nervous system disease history;
• 8) patients with glaucoma or serious increase in intraocular pressure risk;
• 9) patients with mental system diseases (schizophrenia, mania, bipolar disorder, mental disorder, etc.) and drug history and cognitive dysfunction; History of cognitive psychiatric disorders such as postoperative delirium; Pregnant or lactating women;
• 10) high risk surgery, is expected to enter the ICU after surgery;
• 11) to moxa ketamine hydrochloride and its drug components allergy or taboo;
• 12) Being a subject and having participated in clinical trials for other drugs in the past three months;
• 13) There is communication disorder;
• 14) Patients considered by the investigator to be ineligible for participation in this trial.