Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Clin Pharm Ther. 2022 Jun;47(6):759-766. doi: 10.1111/jcpt.13604. Epub 2022 Jan 11.
Esketamine is an N-methyl-D-aspartic acid (NMDA) receptor antagonist, which has stronger sedative and analgesic effects and fewer adverse events than ketamine. The effects of low-dose esketamine on haemodynamics and postoperative quality of recovery in elderly patients have not been evaluated. To evaluate whether low-dose esketamine can be safely used for anaesthesia induction in the elderly.
Eighty elderly patients were selected for unilateral total knee replacement under general anaesthesia from February 2021 to August 2021. Patients were randomly divided into two groups (n = 40): control group (C group) and esketamine group (K group). During induction of anaesthesia, the control group was intravenously injected with normal saline of equal volume, and the esketamine group was intravenously injected with 0.2-mg/kg esketamine. Both groups were induced by etomidate, sufentanil and rocuronium and maintained by combined intravenous and inhaled anaesthesia during operation.
HR, SBP, DBP, MAP and BIS values were recorded before induction of anaesthesia (T ), immediately before endotracheal intubation (T ), 1min(T ) and 5min(T ) after endotracheal intubation, surgical skin incision (T ), 1min(T ) and 5min(T ) after surgical skin incision.
Compared with the C group, SBP, DBP, MAP, HR and BIS of the K group were significantly higher at T -T (p < 0.05). There were no significant differences in SBP, DBP, MAP, HR and BIS between the two groups at T -T (p > 0.05). Compared with T , SBP, MAP and BIS values of the two groups at T -T were decreased (p < 0.05). DBP of the K group at T was not significantly different from DBP at T (p < 0.05), but DBP of the C group decreased from T to T (p < 0.05). Compared with T , HR in both groups decreased at T , T , T , T and T (p < 0.05). Compared with the C group, the incidence of cough in the K group was significantly lower (p < 0.05); There was no significant difference in the number of myoclonus during induction between the two groups (p > 0.05). Compared with the C group, the number of hypotension episodes in the K group during induction was much smaller (p < 0.05). There were no significant differences in the incidence of hypertension, bradycardia and tachycardia (p > 0.05). There were no significant differences in postoperative recovery quality and incidence of adverse events between the two groups (p > 0.05).
Low-dose esketamine for anaesthesia induction in the elderly undergoing knee arthroplasty may better maintain the stability of haemodynamics and has no adverse effect on the quality of early recovery after operation.
依他佐辛是一种 N-甲基-D-天冬氨酸（NMDA）受体拮抗剂，与氯胺酮相比，它具有更强的镇静和镇痛作用，且不良事件更少。小剂量依他佐辛对老年患者血流动力学和术后恢复质量的影响尚未得到评估。评估小剂量依他佐辛是否可安全用于老年患者的麻醉诱导。
选择 2021 年 2 月至 2021 年 8 月在全身麻醉下进行单侧全膝关节置换术的 80 例老年患者。患者被随机分为两组（n=40）：对照组（C 组）和依他佐辛组（K 组）。麻醉诱导时，对照组静脉注射等量生理盐水，依他佐辛组静脉注射 0.2mg/kg 依他佐辛。两组均以依托咪酯、舒芬太尼和罗库溴铵诱导，术中采用静脉-吸入复合麻醉维持。
记录麻醉诱导前（T0）、气管插管即刻（T1）、气管插管后 1min（T2）和 5min（T3）、手术皮肤切口时（T4）、手术皮肤切口后 1min（T5）和 5min（T6）的心率（HR）、收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和脑电双频指数（BIS）值。
与 C 组相比，K 组 T1-T3 时 SBP、DBP、MAP、HR 和 BIS 显著升高（p<0.05）。两组 T1-T3 时 SBP、DBP、MAP、HR 和 BIS 差异均无统计学意义（p>0.05）。与 T0 相比，两组 T1-T3 时 SBP、MAP 和 BIS 值均降低（p<0.05）。K 组 T 时的 DBP 与 T 时的 DBP 无显著差异（p<0.05），但 C 组的 DBP 从 T 降低至 T （p<0.05）。与 T0 相比，两组在 T1、T2、T3、T4 和 T5 时 HR 均降低（p<0.05）。与 C 组相比，K 组咳嗽的发生率明显降低（p<0.05）；两组诱导时肌阵挛的发生例数差异无统计学意义（p>0.05）。与 C 组相比，K 组诱导时低血压发作次数明显减少（p<0.05）。两组高血压、心动过缓和心动过速的发生率差异均无统计学意义（p>0.05）。两组术后恢复质量和不良反应发生率差异均无统计学意义（p>0.05）。
小剂量依他佐辛用于老年膝关节置换术患者的麻醉诱导可更好地维持血流动力学稳定，且对术后早期恢复质量无不良影响。
