Zhang Keyao, Bao Yuan, Han Xue, Zhai Wenshan, Yang Yi, Luo Meng, Gao Fang
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Front Med (Lausanne). 2023 Mar 22;10:1124743. doi: 10.3389/fmed.2023.1124743. eCollection 2023.
There are presently no consensuses on the optimal sedation strategy for obese patients during gastrointestinal endoscopy. This study aim to explore the effects of opioid-free propofol or remimazolam balanced anesthesia on hypoxemia incidence in patients with obesity. A total of 264 patients were randomized to remimazolam + esketamine group (group R) or propofol + esketamine group (group P). Anesthesia in group P was administrated by propofol, esketamine and in group R by remimazolam, esketamine. The primary outcome was incidence of hypoxemia. Secondary outcomes were the time to loss of consciousness (LoC) and to recovery and the incidence of intraoperative and postoperative adverse reactions. We found the incidence of mild hypoxemia in group R was similar to that in group P (14.2% vs. 11.5%, = 0.396). The incidence of severe hypoxemia in group R was significantly lower than Group P (4.2% vs. 9.2%, = 0.019). The time to LoC in group R was longer than group P [Median (interquartile range, IQR): 53 s (45 to 61) vs. 50 s (42 to 54), = 0.001]. The time to recovery from anesthesia in group R was less than group P [Median (IQR): 48 min (41 to 58) vs. 55.5 min (46 to 67), <0.001]. There was no significant difference in the incidence of adverse events ( > 0.05 for all). We concluded that compared with propofol combined with esketamine, remimazolam combined with esketamine can reduce the incidence of severe hypoxemia during gastrointestinal endoscopy in obese patients. www.chictr.org.cn, Identifier: ChiCTR2200065575.
目前，对于肥胖患者在胃肠内镜检查期间的最佳镇静策略尚无共识。本研究旨在探讨无阿片类药物的丙泊酚或瑞马唑仑平衡麻醉对肥胖患者低氧血症发生率的影响。总共264例患者被随机分为瑞马唑仑+艾司氯胺酮组（R组）或丙泊酚+艾司氯胺酮组（P组）。P组麻醉采用丙泊酚、艾司氯胺酮，R组采用瑞马唑仑、艾司氯胺酮。主要结局是低氧血症发生率。次要结局是意识消失时间和恢复时间以及术中和术后不良反应的发生率。我们发现R组轻度低氧血症发生率与P组相似（14.2%对11.5%，P = 0.396）。R组严重低氧血症发生率显著低于P组（4.2%对9.2%，P = 0.019）。R组意识消失时间长于P组[中位数（四分位间距，IQR）：53秒（45至61）对50秒（42至54），P = 0.001]。R组麻醉恢复时间短于P组[中位数（IQR）：48分钟（41至58）对55.5分钟（46至67），P<0.001]。不良事件发生率无显著差异（所有P>0.05）。我们得出结论，与丙泊酚联合艾司氯胺酮相比，瑞马唑仑联合艾司氯胺酮可降低肥胖患者胃肠内镜检查期间严重低氧血症的发生率。 www.chictr.org.cn，标识符：ChiCTR2200065575。
