Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Medicine (Baltimore). 2022 Nov 4;101(44):e31624. doi: 10.1097/MD.0000000000031624.
Safety and efficacy were assessed of different S(+)-ketamine doses combined with propofol administered as anesthesia to common pediatric congenital heart disease (CHD) patients undergoing cardiac interventional surgery to provide reference data as guidance for use in clinical settings.
Sixty CHD children admitted to Beijing Anzhen Hospital, Capital Medical University from December 2020 to December 2021 who underwent elective cardiac intervention were assigned to 3 groups (H, L, M, 20 patients/group) using a random number table-based method. Patients received 1% propofol (2 mg/kg) and intravenous injections of S(+)-ketamine (Group L, 0.4 mg/kg; Group M, 0.5 mg/kg; Group H, 0.6 mg/kg) followed by intravenous pumping of 1% propofol (4-6 mg/kg/h). Heart rate (HR), mean arterial pressure, and pulse oxygen saturation were recorded preoperatively (T0), at the time of anesthesia maintenance (T1), at the time of arteriovenous puncture (T2), and when they awakened (T3). Additionally, propofol dose and incidence rates of intraoperative body movement, postoperative agitation, and postoperative nausea/vomiting were recorded.
For the 3 groups, Group H awakening time was significantly longer than that of Group L (P = .039). Notably, intergroup intraoperative propofol times differed significantly (P = .009). Meanwhile, T0 to T3 intragroup HR values differences were significant (P = .017; P = .001; P = .005, respectively). Group L HR was significantly elevated at T2 relative to T0 (P = .003), Group M HR was significantly elevated at T1 and T2 relative to T0 (P = .019; P = .003, respectively), and Group H HR values were significantly elevated at T1 and T2 relative to T0 (P = .012; P = .005, respectively). At all 4 time points no statistically significant intergroup differences in mean arterial pressure values were observed (P = .587). T1 to T3 pulse oxygen saturation values for all 3 groups were significantly greater than corresponding T0 values. Although intergroup intraoperative body movement incidence differed significantly (P = .044), intergroup differences in awakening time agitation and postoperative nausea/vomiting incidence rates were insignificant (P = .732, P = .887, respectively).
Use of 0.6 mg/kg S(+)-ketamine with propofol was most effective as anesthesia for common pediatric CHD patients undergoing cardiac interventional surgery.
评估不同剂量 S(+)-氯胺酮联合丙泊酚在接受心脏介入手术的常见小儿先天性心脏病（CHD）患者中的安全性和疗效，为临床应用提供参考数据。
采用随机数字表法将 2020 年 12 月至 2021 年 12 月首都医科大学附属北京安贞医院收治的 60 例拟行择期心脏介入的 CHD 患儿分为 3 组（H、L、M 组，每组 20 例）。患者给予 1%丙泊酚（2mg/kg）和静脉注射 S(+)-氯胺酮（L 组：0.4mg/kg；M 组：0.5mg/kg；H 组：0.6mg/kg），然后静脉泵注 1%丙泊酚（4-6mg/kg/h）。记录术前（T0）、麻醉维持时（T1）、动静脉穿刺时（T2）和苏醒时（T3）的心率（HR）、平均动脉压和脉搏血氧饱和度。此外，记录丙泊酚用量、术中体动、术后躁动和术后恶心/呕吐的发生率。
3 组中，H 组苏醒时间明显长于 L 组（P =.039）。值得注意的是，组间术中丙泊酚时间差异有统计学意义（P =.009）。同时，T0 至 T3 时组内 HR 值差异有统计学意义（P =.017；P =.001；P =.005）。L 组 T2 时 HR 明显高于 T0（P =.003），M 组 T1 和 T2 时 HR 明显高于 T0（P =.019；P =.003），H 组 T1 和 T2 时 HR 值明显高于 T0（P =.012；P =.005）。在所有 4 个时间点，组间平均动脉压值差异无统计学意义（P =.587）。T1 至 T3 时 3 组的脉搏血氧饱和度值均明显大于相应的 T0 值。虽然术中体动发生率组间差异有统计学意义（P =.044），但苏醒时间躁动和术后恶心/呕吐发生率组间差异无统计学意义（P =.732，P =.887）。
对于接受心脏介入手术的常见小儿 CHD 患者，使用 0.6mg/kg S(+)-氯胺酮联合丙泊酚作为麻醉效果最佳。
