Goh P K, Chiu C L, Wang C Y, Chan Y K, Loo P L
Department of Anaesthesia and Intensive Care, Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
Anaesth Intensive Care. 2005 Apr;33(2):223-8. doi: 10.1177/0310057X0503300211.
The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg x kg(-1) (n = 30), fentanyl 1 microg x kg(-1) (n = 30) or normal saline (n = 30), before induction of anaesthesia with propofol 2.5 mg x kg(-1). Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P = 0.010) or saline (P = 0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0-8.0)] and fentanyl groups [median 7.0, interquartile range (6.0-8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75-9.25); P = 0.024]. The incidence of prolonged apnoea (> 120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg x kg(-1) improves haemodynamics when compared to fentanyl 1 microg x kg(-1), with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).
这项前瞻性、双盲、随机、安慰剂对照临床试验的目的是研究在丙泊酚诱导前给予氯胺酮是否能改善其相关的血流动力学特征和喉罩气道（LMA）插入条件。90名成年患者被随机分配，在使用2.5mg/kg丙泊酚诱导麻醉前，分别接受0.5mg/kg氯胺酮（n = 30）、1μg/kg芬太尼（n = 30）或生理盐水（n = 30）。在注射丙泊酚60秒后插入LMA。在诱导前（基线）、诱导后即刻、LMA插入前即刻、LMA插入后即刻以及LMA插入后3分钟内每分钟测量动脉血压和心率。LMA插入后，由一名盲法麻醉医生使用1至3级的有序量表对以下六个主观终点进行分级：张口、 gag反射、吞咽、运动、喉痉挛和插入难易程度。氯胺酮组的收缩压显著高于芬太尼组（P = 0.010）或生理盐水组（P = 0.0001）。描述总体插入条件的中位数（四分位间距）总分在氯胺酮组[中位数7.0，四分位间距（6.0 - 8.0）]和芬太尼组[中位数7.0，四分位间距（6.0 - 8.0）]中相似。两者均明显优于生理盐水组[中位数8.0，四分位间距（6.75 - 9.25）；P = 0.024]。芬太尼组[23.1%（7/30）]长时间呼吸暂停（> 120秒）的发生率高于氯胺酮组[6.3%（2/30）]和生理盐水组[3.3%（1/30）]。我们得出结论，与1μg/kg芬太尼相比，添加0.5mg/kg氯胺酮可改善血流动力学，减少长时间呼吸暂停，并且与比安慰剂（生理盐水）更好的LMA插入条件相关。
