去阿片麻醉：艾司氯胺酮的应用

本文由“小麻哥的日常"授权转载

摘要译文

基于艾司氯胺酮的阿片类减少的全身麻醉在妇科日间手术中的应用： 一项随机双盲对照研究 背景： 去阿片麻醉可通过减少阿片类药物相关的副作用来加速术后康复。 本研究的目的是探讨基于艾司氯胺酮的去阿片类全麻的可行性，并与传统阿片全身麻醉方案相比，观察妇科日间手术中术后恶心呕吐（PONV）、术后疼痛、血流动力学和其他不良反应。 

方法： 本研究为前瞻性平行组随机对照试验。 共有141名成年女性接受妇科日间手术。 患者被随机分配到使用阿芬太尼的传统阿片类药物的全麻（C组）或阿片类减少的全麻（中度阿片组（MO组）和低阿片类的全麻组（LO组），（使用艾司氯胺酮和阿芬太尼）。 对于麻醉诱导，三组分别接受20、20、10μg/kg阿芬太尼，LO组额外接受0.2 mg/kg艾司氯胺酮。 为了维持麻醉，C组患者接受40μg/kg/h阿芬太尼，MO组和LO组患者接受0.5mg/kg/h艾司氯胺酮。

结果： 三组患者的临床和手术数据相当。 C组33.3%的患者、MO组18.4%的患者和LO组43.2%的患者符合主要终点（p=0.033）， MO组术后24小时内恶心的发生率低于LO组（p<0.05）。 三组患者的拔管时间、术后平均住院时间和术后疼痛视觉模拟评分（VAS）相似。 MO 1（0，2）和LO 0（0，1）组的不良血流动力学事件频率显著降低（p<0.05）。 与C组相比，LO组麻醉后复苏室（PACU）的中位住院时间增加，分别为60.0（36.25，88.75）分钟和42.5（25，73.75）分钟（p<0.05）。

结论： 基于艾司氯胺酮的阿片类减少的全麻是可行的，可为患者提供有效的镇痛。 艾司氯胺酮具有积极的镇痛作用，阿片类药物减少组血流动力学更稳定。 然而，较少或不使用阿片类药物并不能导致更舒适的预后。

图1患者登记图

图2 PACU停留时间

图3围手术期血流动力学不良事件的频率

原文摘要

Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study 

Background:

Opioid-reduced anesthesia may accelerate postoperative rehabilitation by reducing opioid-related side effects. The objective was to investigate the feasibility of opioid-reduced general anesthesia based on esketamine and to observe postoperative nausea and vomiting (PONV), postoperative pain, hemodynamics and other adverse reactions in gynecological day surgery compared with the traditional opioid-based anesthesia program.

Method:

This study was conducted as a prospective parallel-group randomized controlled trial. A total of 141 adult women undergoing gynecological day surgery were included. Patients were randomly assigned to receive traditional opioid-based anesthesia (Group C) with alfentanil, or opioid-reduced anesthesia (a moderate-opioid group (Group MO) and low-opioid group (Group LO) with esketamine and alfentanil). For anesthesia induction, the three groups received 20, 20, 10 μg/kg alfentanil respectively and Group LO received an additional 0.2 mg/kg esketamine. For maintenance of anesthesia, the patients in Group C received 40 μg/kg/h alfentanil, and those in Group MO and Group LO received 0.5 mg/kg/h esketamine.

Results:

Patients in the three groups had comparable clinical and surgical data. A total of 33.3% of patients in Group C, 18.4% of patients in Group MO and 43.2% of patients in Group LO met the primary endpoint (p = 0.033), and the incidence of nausea within 24 hours after surgery in Group MO was lower than in Group LO (p < 0.05). The extubation time, median length of stay in the hospital after surgery and visual analog scale (VAS) of postoperative pain were equivalent in the three groups. The frequencies of adverse hemodynamic events in the MO 1(0, 2) and LO 0(0, 1) groups were significantly decreased (p < 0.05). Compared with Group C, the median length of stay in the postanesthesia care unit (PACU) in Group LO was increased, 60.0 (36.25, 88.75) vs. 42.5 (25, 73.75) minutes (p < 0.05).

Conclusions:

Opioid-reduced anesthesia based on esketamine is feasible and provides effective analgesia for patients. Esketamine provided a positive analgesic effect and the opioid-reduced groups showed more stable hemodynamics. However, less or no use of opioids did not result in a more comfortable prognosis.

Fig. 1 Patients enrollment diagram Fig. 2 The length of stay in the PACU Fig. 3 The frequency of periopertive hemodynamic adverse event

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校对：Michel.米萱

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