手术室外麻醉：艾司氯胺酮联合丙泊酚的安全性

本文由“小麻哥的日常”授权转载

摘要译文（供参考）

亚麻醉剂量艾司氯胺酮联合丙泊酚用于肥胖患者无痛胃镜检查的疗效和安全性：

前瞻性、双盲、随机对照研究

目的：

肥胖患者更易发生低氧血症。接受无痛胃镜检查的肥胖患者的麻醉管理对麻醉师来说是一个严峻的挑战。艾司氯胺酮是一种NMDA拮抗剂，由于其拟交感神经效应，已被证明对改善呼吸抑制有益；然而，没有关于其在肥胖患者中使用的相关报告。我们设计了一项随机对照试验来评估艾司氯胺酮是否可以作为在接受无痛胃镜检查的肥胖患者中丙泊酚镇静的理想辅助剂。

患者和方法：

104例接受无痛胃镜检查的肥胖患者随机分为C(丙泊酚+生理盐水)组和S(丙泊酚+艾司氯胺酮 0.25mg/kg)组，麻醉诱导采用丙泊酚2mg/kg加生理盐水或艾司氯胺酮。

记录丙泊酚用量、血流动力学参数、手术时间、诱导时间、术后苏醒时间、定向恢复时间，并记录不良事件和满意度评分。

结果：

丙泊酚用量

C组为274.4±22.6mg，

S组为201.3±16.6mg，

诱导时间

C组为25.4±2.3s，

S组为17.8±1.9s，

术后苏醒时间

C组为6.2±1.1min，

S组为4.8±1.3min。

与C组相比，S组血流动力学参数更稳定。不良事件如注射疼痛、低氧血症、低血压、心动过缓、窒息和身体运动的发生率在S组显著降低。内镜医师和麻醉医师的满意度评分分别为(4.58 ± 0.49 vs 3.71 ± 0.83)及(4.75 ± 0.44 vs 3.33 ± 0.92)。

结论：

丙泊酚与艾司氯胺酮(0.25mg/kg)联合应用可提高肥胖患者无痛胃镜检查的安全性，减少不良反应的发生率，值得临床推广应用。

关键词：艾司氯胺酮；无痛胃镜检查；肥胖患者；丙泊酚。

原文摘要

Efficacy and Safety of a Subanesthetic Dose of Esketamine Combined with Propofol in Patients with Obesity Undergoing Painless Gastroscopy: A Prospective, Double-Blind, Randomized Controlled Trial

Purpose: Patients with obesity are more susceptible to hypoxemia. Anesthetic management for patients with obesity undergoing painless gastroscopy presents a severe challenge for anesthesiologists. Esketamine is a NMDA antagonist that has been proven to be beneficial for ameliorating respiratory depression owing to its sympathomimetic effect; however, there are no relevant reports on its use in patients with obesity. We designed a randomized controlled trial to evaluate whether esketamine can be the ideal adjuvant to propofol sedation in patients with obesity undergoing painless gastroscopy.

Patients and methods: A total of 104 patients with obesity undergoing painless gastroscopy were randomly divided into group C (propofol+saline) and group S (propofol+esketamine 0.25 mg/kg). Anesthesia was induced by 2 mg/kg propofol with saline or esketamine. The consumption of propofol, hemodynamic parameters, duration of procedure, induction time, postoperative awakening time, and orientation recovery time were recorded. Adverse events and satisfaction scores were also recorded.

Results: Propofol consumption was 274.4±22.6 mg and 201.3±16.6 mg in groups C and S, respectively. The induction time of groups C and S were 25.4±2.3 s and 17.8±1.9 s, respectively. The postoperative awakening times of groups C and S were 6.2±1.1 min and 4.8±1.3 min, respectively. Hemodynamic parameters were more stable in group S than in group C. The incidence of adverse events such as injection pain, hypoxemia, hypotension, bradycardia, choking, and body movement were significantly lower in group S. The satisfaction scores of the endoscopist and anesthesiologist were (4.58±0.49 vs 3.71±0.83) and (4.75±0.44 vs 3.33±0.92), respectively.

Conclusion: The combination of propofol and esketamine (0.25 mg/kg) improves the safety and reduces the incidence of adverse events in patients with obesity during painless gastroscopy. Thus, this method is worthy of clinical application.

Clinical trials registration: ChiCTR 2200062547.

Keywords: esketamine; painless gastroscopy; patients with obesity; propofol.

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本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiLu.米鹭

校对：Michel.米萱 

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