依托咪酯诱导插管时鞘内注射氯胺酮对老年男性输尿管镜插入术的影响：一项随机对照试验。
Effect of esketamine on the ED of propofol for successful insertion of ureteroscope in elderly male patients: a randomized controlled trial.
机构信息
Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China.
Department of Anesthesiology, Jingmei Group General Hospital, Beijing, China.
出版信息
BMC Anesthesiol. 2024 May 31;24(1):195. doi: 10.1186/s12871-024-02580-z.
BACKGROUND
Propofol is effective and used as a kind of routine anesthetics in procedure sedative anesthesia (PSA) for ureteroscopy. However, respiratory depression and unconscious physical activity always occur during propofol-based PSA, especially in elderly patients. Esketamine has sedative and analgesic effects but without risk of cardiorespiratory depression. The purpose of this study is to investigate whether esketamine can reduce the propofol median effective dose (ED) for successful ureteroscope insertion in elderly male patients.
MATERIALS AND METHODS
49 elderly male patients undergoing elective rigid ureteroscopy were randomly divided into two groups: SK Group (0.25 mg/kg esketamine+propofol) and SF Group (0.1 µg/kg sufentanil+propofol). Patients in both two groups received propofol with initial bolus dose of 1.5 mg/kg after sufentanil or esketamine was administered intravenously. The effective dose of propofol was assessed by a modified Dixon's up-and-down method and then was adjusted with 0.1 mg/kg according to the previous patient response. Patients' response to ureteroscope insertion was classified as "movement" or "no movement". The primary outcome was the ED of propofol for successful ureteroscope insertion with esketamine or sufentanil. The secondary outcomes were the induction time, adverse events such as hemodynamic changes, hypoxemia and body movement were also measured.
RESULT
49 patients were enrolled and completed this study. The ED of propofol for successful ureteroscope insertion in SK Group was 1.356 ± 0.11 mg/kg, which was decreased compared with that in SF Group, 1.442 ± 0.08 mg/kg (P = 0.003). The induction time in SK Group was significantly shorter than in SF Group (P = 0.001). In SK Group, more stable hemodynamic variables were observed than in SF Group. The incidence of AEs between the two groups was not significantly different.
CONCLUSION
The ED of propofol with esketamine administration for ureteroscope insertion in elderly male patients is 1.356 ± 0.11 mg/kg, significantly decreased in comparsion with sufentanil.
TRIAL REGISTRATION
Chinese Clinical Trial Registry, No: ChiCTR2300077170. Registered on 1 November 2023. Prospective registration. http://www.chictr.org.cn .
背景
异丙酚是一种有效的常规麻醉剂，常用于输尿管镜检查的镇静麻醉（PSA）。然而，在基于异丙酚的 PSA 中，呼吸抑制和无意识的躯体运动始终会发生，尤其是在老年患者中。依托咪酯具有镇静和镇痛作用，但没有心肺抑制的风险。本研究旨在探讨依托咪酯是否可以降低老年男性患者行输尿管镜检查时异丙酚的半数有效剂量（ED）。
材料与方法
49 例择期行硬性输尿管镜检查的老年男性患者被随机分为两组：SK 组（0.25mg/kg 依托咪酯+异丙酚）和 SF 组（0.1μg/kg 舒芬太尼+异丙酚）。两组患者在静脉注射依托咪酯或舒芬太尼后均给予异丙酚初始负荷剂量 1.5mg/kg。采用改良 Dixon 上下法评估异丙酚的有效剂量，然后根据前一位患者的反应调整 0.1mg/kg。将患者对输尿管镜插入的反应分为“运动”或“不运动”。主要结局是依托咪酯或舒芬太尼用于成功插入输尿管镜的异丙酚 ED。次要结局包括诱导时间、血流动力学变化、低氧血症和躯体运动等不良事件。
结果
49 例患者入组并完成了本研究。SK 组异丙酚成功插入输尿管镜的 ED 为 1.356±0.11mg/kg，低于 SF 组的 1.442±0.08mg/kg（P=0.003）。SK 组的诱导时间明显短于 SF 组（P=0.001）。SK 组观察到更稳定的血流动力学参数。两组间不良事件的发生率无显著差异。
结论
老年男性患者行输尿管镜检查时，依托咪酯联合异丙酚的 ED 为 1.356±0.11mg/kg，明显低于舒芬太尼。
试验注册
中国临床试验注册中心，编号：ChiCTR2300077170。于 2023 年 11 月 1 日注册。前瞻性注册。http://www.chictr.org.cn。
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