Objective To investigate the effect of postoperative sleep disturbance by infusion of low dose esketamine during ambulatory laparoscopic cholecystectomy. Methods Patients undergoing ambulatory laparoscopic cholecystectomy under general anesthesia in General Hospital of Northern Theater Command between August and November 2024 were selected. They were randomly divided into esketamine group and control group based on a random number generator. Patients in the esketamine group received a continuous infusion of esketamine [0.3 mg/(kg·h)] during the operation. Patients in the control group received the equivalent volume of saline. The scores of the Athens Insomnia Scale on the first day before surgery, the first day after surgery, and the third day after surgery, the incidence of sleep disturbance and the Hospital Anxiety and Depression Scale score on the first day and the third day after surgery, mean artial pressure and heart rate during surgery, operation time, anesthesia time, recovery time, total dosage of remifetanil and vasoactive drug, postoperative adverse reactions, and the Visual Analogue Scale score on the day of surgery and the first day after surgery were compared between the two groups. Results A total of 105 patients were included, including 52 in the control group and 53 in the esketamine group. The differences were statistically significant in the incidence of sleep disorders on the first day after surgery (22.64% vs. 46.15%; χ2=6.440, P=0.011), the Athens Insomnia Scale score on the first day after surgery [4 (1.5, 5) vs. 5 (4, 7); Z=−2.933, P=0.003] , the cumulative amount of remifentanil used during surgery [884 (600, 1 112) vs. 572 (476, 872) μg; Z=−2.774, P=0.006], and the Visual Analogue Scale score on the day of surgery [2 (2, 3) vs. 3 (2, 3); Z=−2.488, P=0.013] between the esketamine group and the control group. There was no significant difference in mean arterial pressure, heart rate, operation time, anesthesia time, recovery time, vasoactive drug dosage, Hospital Anxiety and Depression Scale score or incidence of postoperative adverse reactions between the two groups (P＞0.05). Conclusion Continuous intraoperative infusion of low dose esketamine can improve postoperative sleep disturbance, without increasing the incidence of postoperative adverse reactions in patients undergoing ambulatory laparoscopic cholecystectomy.
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
目的:观察静脉应用小剂量氯胺酮超前镇痛法对接受腹腔镜下子宫切除手术患者术后疼痛及认知功能的影响。方法:38例择期接受腹腔镜下子宫切除术患者(ASA分级12)随机分为氯胺酮组和对照组。氯胺酮组于手术开始前5min静脉滴注氯胺酮015mg·kg-1,术中持续泵注3μg·kg-1·min-1至手术结束;对照组使用生理盐水。记录术中使用氯胺酮后心率,平均动脉压的变化;术后24h内静脉使用芬太尼的剂量,VAS疼痛评分,头晕、恶心、呕吐等不良反应,中枢神经系统症状以及术后2h患者认知功能。结果:两组患者在24h内静脉使用芬太尼的剂量,VAS疼痛评分,不良反应,中枢神经系统症状以及术后2h的认知功能方面没有统计学差异。〖HTH〗结论:〖HTSS〗静脉使用小剂量氯胺酮超前镇痛并不能减少术后芬太尼的用量,不能降低术后疼痛评分。尽管使用小剂量氯胺酮并没有增加患者术后的不良反应,也不影响患者术后认知功能障碍,不建议作为腹腔镜下子宫切除术患者常规使用。
目的 评估术后亚麻醉剂量的氯胺酮提高布托啡诺自控静脉镇痛(patient sey-controlled intravenous analgesia， PCIA）效果的可行性及应用价值。 方法 将2008年6月-2009年5月收治的68例美国麻醉师协会（ASA）分级Ⅰ~Ⅱ级的择期外科手术患者随机分为B组(0.2 mg/mL布托啡诺组）和BK组(0.2 mg/mL布托啡诺和4 mg/mL氯胺酮混合液组），每组34例。患者于手术结束后连接自控镇痛泵行自控PCIA。观察并记录拔除气管导管后及PCIA后1、4、8、12、24 h患者疼痛评分视觉模拟评分（VAS）、镇静评分、血压、心率、血氧饱和度（SPO2）、按压次数和布托啡诺消耗量，以及呼吸抑制(SPO2≤92%）、恶心呕吐、尿潴留等并发症。 结果 BK组24 h布托啡诺用量减少40%，VAS评分降低，与B组比较差异均有统计学意义(Plt;0.05）。同时VASgt;3的发生率明显减少(Plt;0.05）。镇静评分和过度镇静发生率降低，但差异无统计学意义(Pgt;0.05）。恶心呕吐的发生率两组差异无统计学意义(Pgt;0.05）。 结论 布托啡诺配伍亚麻醉剂量的氯胺酮在术后患者PCIA中能增强布托啡诺的镇痛效果，不良反应无明显增加。
Objective To systemically review the clinical application of esketamine for postoperative analgesia in cesarean section. Methods Databases including CNKI, VIP, WanFang Data, PubMed, EMbase, Web of Science, and The Cochrane Library were searched for randomized controlled trials (RCTs) on esketamine in cesarean section from inception to January 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 16 RCTs involving 1 715 cesarean section patients were included. The results of meta-analysis showed that esketamine decreased the patients’ visual analog scale scores after surgery (MD=−0.67, 95%CI −0.86 to −0.49, P<0.000 01) and reduced the need for analgesics for 48 hours after surgery (MD=−2.38, 95%CI −3.15 to −1.62, P<0.000 01) compared with the control drugs (such as opioids, ropivacaine, and normal saline), without increasing adverse reactions such as nausea and vomiting (RR=0.84, 95%CI 0.62 to 1.12, P=0.23), hallucinations (RR=3.00, 95%CI 0.37 to 24.43, P=0.30), drowsiness (RR=1.49, 95%CI 0.16 to 13.99, P=0.73), itching (RR=1.05, 95%CI 0.79 to 1.41, P=0.72), hypotension (RR=0.31, 95%CI 0.04 to 2.40, P=0.26), bradycardia (RR=0.40, 95%CI 0.01 to 11.24, P=0.59), and dizziness (RR=2.24, 95%CI 0.63 to 7.94, P=0.21). Compared with the control drugs, esketamine extended the operation time (MD=2.23, 95%CI 1.73 to 2.74, P<0.000 01), accelerated heart rate (MD=1.31, 95%CI 0.25 to 2.37, P=0.02), and increased the mean arterial pressure (MD=3.88, 95%CI 0.19 to 7.56, P=0.04) during surgery. Additionally, esketamine improved the Apgar score of neonates (MD=0.45, 95%CI 0.26 to 0.63, P<0.000 01) and the Edinburgh postnatal depression scale score of mothers (MD=−1.12, 95%CI −1.87 to −0.55, P=0.000 3), having no effects on the cord blood pH of neonates (MD=0.03, 95%CI −0.01 to 0.07, P=0.14). Conclusion Esketamine has certain advantages when used for postoperative analgesia in cesarean section. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to further verify the above conclusion.
【摘要】 目的 观察在腹腔镜胆囊切除术中，氯胺酮超前镇痛对瑞芬太尼麻醉后急性疼痛的影响。 方法 2009年10月-2010年1月，将择期行腹腔镜胆囊切除术患者90例，随机分为对照组（C组）、氯胺酮超前镇痛组（K组）、氯胺酮术毕镇痛组（K1组），每组30例。所有患者均采用瑞芬太尼复合丙泊酚静脉麻醉，K组在切皮前静脉给予氯胺酮0.5 mg/kg，K1组在关腹前静脉给予氯胺酮0.5 mg/kg，C组不给予任何药物。记录术毕患者麻醉恢复情况，各时间点疼痛程度。 结果 K组、K1组躁动发生率均明显低于C组（Plt;0.05）；术后2、4、8、24 h，K组VAS评分及镇痛药使用率明显低于C组和K1组（Plt;0.05）。 结论 氯胺酮超前镇痛能明显降低瑞芬太尼术后疼痛，并且不增加并发症发生率。【Abstract】 Objective To evaluate the preemptive analgesia of ketamine on remifentanil induced acute postoperative pain after laparoscopic cholecystectomy. Methods Ninty patients scheduled for laparoscopic cholecystectomy between october 2009 to Jannary 2010 were randomly assigned to three groups (n=30). Group K was administrated with 0. 5 mg/kg ketamine intravenously before skin incision, and Group K1 were administrated with 0. 5 mg/kg ketamine intravenously before abdominal closure, while Group C received nothing. The recovery and the side effects were recorded, the VAS at two, four, eight and 24 hours after surgery, and the use of anodyne were recorded. Results The incidence of restlessness in Groups K and K1 was remarkably lower than that of Group C (Plt;0. 05). The analgesic effects two, four, eight and 24 hours after surgery were obviously better in group K than those of Group C and Group K1 (Plt;0. 05). Conclusion Ketamine can produce preemptive analgesia to relieve remifentanil-induced acute pain, and it would not increase incidence of side effects.
目的 观察七氟烷吸入复合骶管阻滞、基础麻醉复合骶管阻滞及单纯静脉全麻在小儿腹股沟区手术的应用。 方法 将2008年5月-2009年8月收治的90例ASAⅠ~Ⅱ级择期手术患儿分为3组：Ⅰ组为七氟烷吸入复合骶管阻滞组，Ⅱ组为静脉麻醉复合骶管阻滞组，Ⅲ组为全凭静脉麻醉组。每组30例，观察3组麻醉效果。 结果 Ⅰ组患儿心率、平均动脉压、呼吸频率变化不明显，Ⅱ组和Ⅲ组患儿术中和术后心率、平均动脉压较术前升高（Plt;0.05），呼吸频率明显低于术前；Ⅲ组患儿苏醒时间明显延长，Ⅰ组和Ⅱ组患儿苏醒期并发症低于Ⅲ组，其中Ⅲ组患儿术后躁动与哭闹多见。 结论 七氟烷吸入复合骶管阻滞用于小儿腹股沟区手术，患儿易于接受，麻醉过程中呼吸循环功能稳定，苏醒快，清醒质量高，苏醒期不良反应少，是临床上值得推广的麻醉方法。
目的 研究氯胺酮能否降低咪达唑仑诱导急诊危重患者气管插管对血压的影响。 方法 将2010年6月－2011年12月收治的56例急诊危重呼吸衰竭成年患者，随机分成咪达唑仑+芬太尼（MF）组和咪达唑仑+氯胺酮（MK）组，气管插管前咪达唑仑0.05 mg/kg静脉注入，然后MF组芬太尼2 μg/kg静脉注入，MK组氯胺酮0.5 mg/kg静脉注入，待患者达镇静状态后实施气管插管。记录用药前和插管后10 min的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）的变化，观察低血压的发生情况。 结果 实施药物诱导气管插管后血压下降以MF组更明显（P＜0.01）。低血压发生率MF组为51.7%，MK组为18.5%，两组比较差异有统计学意义（χ2=6.715，P=0.01）。 结论 急诊危重患者气管插管应用氯胺酮可减少咪达唑仑所致低血压的发生率。