Feng Miaomiao, Shi Gaoxiang, Cui Wenjing, Zhang Ning, Xie Qipeng, Zhang Weiwei
Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Pharmacol. 2022 Oct 20;13:1034236. doi: 10.3389/fphar.2022.1034236. eCollection 2022.
We designed a four-arm randomized controlled trial to investigate the median effective concentration (EC) of propofol in combination with different doses of esketamine inducing appropriate depth of anaesthesia during gastrointestinal endoscopy in adults. One hundred patients aged 18-65 years planning for gastrointestinal endoscopy were divided into four groups randomly: esketamine 0, 0.15, 0.25 and 0.5 mg/kg groups ( = 25). Propofol doses followed the Dixon and Massey up-and-down method with different starting between groups. The primary endpoint was the EC of propofol. Secondary outcomes included the cumulative dose of propofol, the duration of the procedure, recovery time, and adverse effects. The EC (median, 95% confidence interval) of propofol was significantly less in the esketamine 0.5 mg/kg group compared with the esketamine 0, 0.15, and 0.25 mg/kg groups [1.34 (1.15, 1.54) vs. 3.48 (3.25, 3.71), 2.82 (2.58, 3.07), and 2.36 (2.11, 2.61), respectively; < 0.001]. The total dose of propofol (mean ± SD) required for the whole procedure was significantly less in the esketamine 0.5 mg/kg group compared with the esketamine 0, 0.15, and 0.25 mg/kg groups [95.5 ± 43.1 vs. 277.4 ± 49.0, 207.8 ± 31.6, and 135.1 ± 27.7, respectively; < 0.001]. The recovery time was significantly longer in esketamine 0 and 0.5 mg/kg group compared with other two groups ( < 0.001). More patients in the esketamine 0.5 mg/kg group experienced visual disturbance compared with the other groups ( = 0.016). Additionally, the incidence of hypotensionin the esketamine 0 mg/kg group after inducation was higher compared with other groups ( < 0.001). In summary, the administration of esketamine significantly and dose-dependently reduced the dose of propofol required to accomplish procedures.
我们设计了一项四臂随机对照试验，以研究丙泊酚与不同剂量艾司氯胺酮联合使用时，在成人胃肠内镜检查中诱导适宜麻醉深度的丙泊酚半数有效浓度（EC）。100例计划行胃肠内镜检查、年龄在18至65岁的患者被随机分为四组：艾司氯胺酮0、0.15、0.25和0.5mg/kg组（每组n = 25）。丙泊酚剂量采用Dixon和Massey上下法，各组起始剂量不同。主要终点是丙泊酚的EC。次要结局包括丙泊酚的累积剂量、手术持续时间、恢复时间和不良反应。与艾司氯胺酮0、0.15和0.25mg/kg组相比，艾司氯胺酮0.5mg/kg组丙泊酚的EC（中位数，95%置信区间）显著更低[分别为1.34（1.15，1.54） vs. 3.48（3.25，3.71）、2.82（2.58，3.07）和2.36（2.11，2.61）；P < 0.001]。与艾司氯胺酮0、0.15和0.25mg/kg组相比，艾司氯胺酮0.5mg/kg组整个手术所需丙泊酚的总剂量（均值±标准差）显著更低[分别为95.5±43.1 vs. 277.4±49.0、207.8±31.6和135.1±27.7；P < 0.001]。与其他两组相比，艾司氯胺酮0和0.5mg/kg组的恢复时间显著更长（P < 0.001）。与其他组相比，艾司氯胺酮0.5mg/kg组更多患者出现视觉障碍（P = 0.016）。此外，诱导后艾司氯胺酮0mg/kg组低血压的发生率高于其他组（P < 0.001）。总之，艾司氯胺酮的使用显著且剂量依赖性地降低了完成手术所需丙泊酚的剂量。
