Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea.
Eur Rev Med Pharmacol Sci. 2019 Feb;23(4):1807-1815. doi: 10.26355/eurrev_201902_17144.
The effect of ketamine on intubation condition, when used as an induction agent with low-dose rocuronium, is unknown. This study aimed to compare the effects of three doses of ketamine used with 0.3 mg/kg rocuronium and 1 µg/kg fentanyl on intubation conditions in children undergoing short elective surgery.
The study was performed as a prospective, randomized double-blind clinical trial. A total of 60 children aged 2 to 12 years, who were scheduled for inguinal herniorrhaphy under general anesthesia, were randomly allocated into three groups on the basis of ketamine dose: 1 mg/kg (Group K1, n = 20), 1.5 mg/kg (Group K1.5, n = 20), and 2 mg/kg (Group K2, n = 20). The primary outcome was the intubation condition. Other assessments included hemodynamic data, recovery profile, adverse events in the postanesthetic care unit (PACU) and use of fentanyl as a rescue analgesic in the PACU were also assessed.
The occurrence of a clinically acceptable intubation condition increased with the use of an increased dose (≥ 1.5 mg/kg) (K1/K1.5/K2: 30%/65%/65%; p=0.038, for trends p=0.028). Hemodynamic data, recovery profile and adverse events in PACU showed no difference among groups. Fentanyl dose used in the PACU was higher in K1 than K2 and the number of patients requiring rescue analgesics in the PACU decreased in accordance with the dose of ketamine (K1/K1.5/K2: 30%/15%/0%; p=.031, for trends p=0.013).
Different intubation conditions were observed on the basis of ketamine dose used in conjunction with 0.3 mg/kg rocuronium and fentanyl 1 µg/kg. Ketamine dose ≥ 1.5 mg/kg with low-dose rocuronium should be used to improve intubation conditions in pediatrics.
氯胺酮作为一种低剂量罗库溴铵的诱导剂，其对插管条件的影响尚不清楚。本研究旨在比较三种剂量的氯胺酮与 0.3mg/kg 罗库溴铵和 1μg/kg 芬太尼联合应用于行择期短小手术的儿童的插管条件的影响。
本研究为前瞻性、随机、双盲临床试验。选择拟在全身麻醉下行腹股沟疝修补术的 60 例 2-12 岁儿童，根据氯胺酮剂量随机分为三组：1mg/kg 组（K1 组，n=20）、1.5mg/kg 组（K1.5 组，n=20）和 2mg/kg 组（K2 组，n=20）。主要结局为插管条件。其他评估包括血流动力学数据、恢复情况、麻醉后恢复室（PACU）中的不良事件以及在 PACU 中使用芬太尼作为解救性镇痛剂的情况。
随着剂量的增加（≥1.5mg/kg），出现临床可接受的插管条件的发生率增加（K1/K1.5/K2：30%/65%/65%；p=0.038，趋势检验 p=0.028）。各组间 PACU 中的血流动力学数据、恢复情况和不良事件无差异。K1 组在 PACU 中使用的芬太尼剂量高于 K2 组，需要在 PACU 中解救性镇痛的患者人数随着氯胺酮剂量的减少而减少（K1/K1.5/K2：30%/15%/0%；p=0.031，趋势检验 p=0.013）。
根据使用的氯胺酮剂量与 0.3mg/kg 罗库溴铵和 1μg/kg 芬太尼联合使用，观察到不同的插管条件。在低剂量罗库溴铵的基础上，使用 1.5mg/kg 以上的氯胺酮剂量可改善儿科的插管条件。
