鞘内注射小剂量氯胺酮增强吸脂麻醉中右美托咪定和瑞芬太尼的镇静和镇痛效果：一项前瞻性、双盲、随机对照试验。
Subanesthetic Dose of Esketamine Improves the Sedative and Analgesic Effects of Dexmedetomidine and Remifentanil in Liposuction Anesthesia: A Prospective, Double-Blinded, Randomized Controlled Trial.
机构信息
Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
出版信息
Drug Des Devel Ther. 2024 Aug 20;18:3645-3658. doi: 10.2147/DDDT.S470891. eCollection 2024.
PURPOSE
Esketamine have anesthetic and analgesic properties. This study aimed to observe the enhancing effect of subanesthetic doses of esketamine (0.15-0.3 mg/kg/h) with dexmedetomidine and remifentanil during anesthesia for liposuction surgery.
PATIENTS AND METHODS
A total of 155 subjects were randomized with a 1:1 ratio to Group E (esketamine-dexmedetomidine/remifentanil, n=78) or Group C (saline-dexmedetomidine/remifentanil group, n=77). The primary outcome was satisfaction of patient and surgical team with the procedure. The secondary outcomes were the postoperative Athens Insomnia Scale (AIS) and Hospital Anxiety and Depression Scale (HADS) scores, hemodynamic and respiratory changes, drug consumption, adverse event rates, and predictors associated with patient satisfaction.
RESULTS
Patient and surgical team satisfaction with the procedure was significantly higher in Group E than in Group C (4.7 ± 0.6 vs 4.2 ± 0.7, P < 0.001; 4.7 ± 0.5 vs 4.4 ± 0.7, P = 0.005). The postoperative AIS (4 [1, 6] vs 5 [2, 9], P = 0.012) and HADS-A (1 [0, 3] vs 2 [0, 6], P = 0.012) scores were significantly lower in Group E than in Group C. Hemodynamic and respiratory parameters were more stable in Group E than in Group C, with the lower opioids consumption of sufentanil (0 [0, 4] vs 5 [2.5, 7.7], P < 0.001) and remifentanil (700 [480, 900] vs 800 [500, 1200], P = 0.023) in Group E compared to Group C. On ordinal logistics regression, postoperative sleep quality (OR, 0.70; 95% CI, 0.62-0.79), anxiety level (OR, 0.77; 95% CI, 0.62-0.95) and recovery time in post-anesthesia care unit (PACU) (OR, 0.69; 95% CI, 0.56-0.98) were identified as significant predictors associated with patient satisfaction.
CONCLUSION
A subanesthetic dose of esketamine (0.15-0.3 mg/kg/h) as an adjuvant can improves the sedative and analgesic effects of dexmedetomidine and remifentanil during anesthesia for liposuction surgery.
CLINICAL TRIAL REGISTRATION
ChiCTR2400080363.
目的
氯胺酮具有麻醉和镇痛作用。本研究旨在观察亚麻醉剂量氯胺酮（0.15-0.3mg/kg/h）联合右美托咪定和瑞芬太尼在吸脂手术麻醉中的增强作用。
患者和方法
共 155 例患者按 1:1 比例随机分为 E 组（氯胺酮-右美托咪定/瑞芬太尼组，n=78）或 C 组（生理盐水-右美托咪定/瑞芬太尼组，n=77）。主要结局是患者和手术团队对手术过程的满意度。次要结局为术后雅典失眠量表（AIS）和医院焦虑抑郁量表（HADS）评分、血流动力学和呼吸变化、药物消耗、不良事件发生率以及与患者满意度相关的预测因素。
结果
E 组患者和手术团队对手术过程的满意度明显高于 C 组（4.7±0.6 比 4.2±0.7，P＜0.001；4.7±0.5 比 4.4±0.7，P=0.005）。E 组术后 AIS（4[1,6]比 5[2,9]，P=0.012）和 HADS-A（1[0,3]比 2[0,6]，P=0.012）评分明显低于 C 组。E 组血流动力学和呼吸参数较 C 组更稳定，E 组舒芬太尼（0[0,4]比 5[2.5,7.7]，P＜0.001）和瑞芬太尼（700[480,900]比 800[500,1200]，P=0.023）的消耗量较低。在有序逻辑回归中，术后睡眠质量（OR，0.70；95%CI，0.62-0.79）、焦虑水平（OR，0.77；95%CI，0.62-0.95）和麻醉后恢复室（PACU）恢复时间（OR，0.69；95%CI，0.56-0.98）被确定为与患者满意度相关的显著预测因素。
结论
亚麻醉剂量氯胺酮（0.15-0.3mg/kg/h）作为佐剂可增强右美托咪定和瑞芬太尼在吸脂手术麻醉中的镇静和镇痛作用。
临床试验注册
ChiCTR2400080363。
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