Department of Anesthesiology, Nagoya University Hospital, Nagoya, Japan.
Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya J Med Sci. 2022 Feb;84(1):1-6. doi: 10.18999/nagjms.84.1.1.
High-dose opioids induce hyperalgesia and tolerance, which negatively affects postoperative recovery. Prolonged surgery inevitably requires higher opioid doses. Ketamine reduces perioperative opioid consumption and prevents opioid-induced tolerance. However, its effects in cases of prolonged surgery remain unknown. This study aimed to evaluate the dose of intraoperative remifentanil, an ultrashort-acting µ-opioid agonist, administered after an intravenous ketamine bolus during prolonged head and neck surgery. This single-center, retrospective, observational study included 251 patients who underwent head and neck surgery (operation time ≥8 h) between January 2015 and December 2019. The participants were stratified into two groups: those who received an intravenous bolus of ketamine and those who did not (ketamine group and non-ketamine group, respectively). Propensity score-matching was used to match patients in a 1:1 ratio between the two groups, based on their covariates. The difference in intraoperative remifentanil dose administered between the two groups was assessed. After 1:1 propensity score-matching, 89 matched patients were selected from each group. The mean ± standard deviation dose of remifentanil administered was significantly lower in the ketamine group than in the non-ketamine group before (0.15±0.05 vs 0.17±0.05 µg/kg/min; =0.01) and after matching (0.15±0.06 vs 0.17±0.05 µg/kg/min; =0.03). In conclusion, intravenous ketamine administration may reduce the intraoperative dose of remifentanil required during prolonged head and neck surgery. However, further studies are required to evaluate the effect of this finding on enhanced recovery after surgery.
高剂量阿片类药物会引起痛觉过敏和耐受，这会对术后恢复产生负面影响。手术时间延长不可避免地需要更高剂量的阿片类药物。氯胺酮可减少围手术期阿片类药物的消耗，并预防阿片类药物引起的耐受。然而，其在手术时间延长的情况下的效果尚不清楚。本研究旨在评估在长时间头颈部手术中静脉注射氯胺酮冲击后给予超短效μ-阿片类激动剂瑞芬太尼的术中剂量。这是一项单中心、回顾性、观察性研究，纳入了 2015 年 1 月至 2019 年 12 月期间接受头颈部手术（手术时间≥8 小时）的 251 例患者。根据协变量，将患者分为两组：接受静脉注射氯胺酮冲击的患者和未接受静脉注射氯胺酮冲击的患者（分别为氯胺酮组和非氯胺酮组）。采用倾向评分匹配法以 1:1 的比例将两组患者进行匹配。评估两组患者的术中瑞芬太尼剂量差异。在进行 1:1 倾向评分匹配后，从每组中各选择 89 例匹配患者。与非氯胺酮组相比，氯胺酮组的瑞芬太尼给药剂量在匹配前（0.15±0.05 与 0.17±0.05 µg/kg/min；=0.01）和匹配后（0.15±0.06 与 0.17±0.05 µg/kg/min；=0.03）均显著降低。总之，静脉注射氯胺酮可能会减少长时间头颈部手术中所需的瑞芬太尼术中剂量。然而，需要进一步研究来评估这一发现对术后快速康复的影响。
