Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, No. 1 Maoyuan Nan South Road, Nanchong City, Sichuan Province, China.
Sci Rep. 2024 Oct 24;14(1):25153. doi: 10.1038/s41598-024-75902-3.
The objective of this study is to investigate the effects of various doses of esketamine on the median effective concentration (EC) of propofol required for inhibiting body movement during hysteroscopy. Additionally, this research aims to explore the pharmacodynamic interactions between esketamine and propofol. Prospective, double-blind, up-down sequential allocation study. Operating room, post-anesthesia care unit (PACU), and general ward. A total of 90 patients were allocated into three groups in a randomized, double-blinded manner as follows: 0.1 mg/kg esketamine combined with propofol intravenous injection (EP) group, 0.2 mg/kg esketamine combined with propofol intravenous injection (EP) group, 0.3 mg/kg esketamine combined with propofol of intravenous injection (EP) group. For the initial patient in each group, the starting effector target concentration of propofol was set at 4 µg/ml. Each patient received an initial intravenous injection of 0.04 mg/kg midazolam, followed by the administration of the appropriate dose of esketamine. Ten seconds after the esketamine injection, propofol was administered intravenously to achieve the target concentration. In accordance with the sequential method principle, the concentration of propofol for the subsequent patient was adjusted based on the response of the previous patient. Effective inhibition of body movement was defined as the absence of any involuntary body movements throughout the entire surgical process. If the previous patient exhibited body movements, the propofol concentration for the next patient was increased by 0.5 µg/ml; conversely, if no movements were observed, it was decreased by 0.5 µg/ml. The up-down sequential allocation method and probit regression were used to calculate the EC of propofol. Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Depression (HADS-D) score, adverse events, hemodynamic changes, demographic data and clinical characteristics. The EC of propofol was 3.849 μg/ml (95% CI: 3.419-4.281) in the EP group, 3.641 μg/ml (95% CI: 2.807-4.200) in the EP group, and 3.417 μg/ml (95% CI: 2.845-3.852) in the EP group. These findings suggest that esketamine can dose-dependently reduce the EC of propofol. Esketamine can dose-dependently reduce the EC of propofol in hysteroscopy, while concurrently lowering patients' HADS-A and HADS-D scores 24 h post-operation. It is concluded that the optimal dose of esketamine, when combined with propofol for hysteroscopy, is 0.3 mg/kg.
本研究旨在探讨不同剂量的依托咪酯对宫腔镜检查中抑制体动所需的丙泊酚中位有效浓度（EC）的影响。此外，本研究旨在探讨依托咪酯和丙泊酚之间的药效学相互作用。前瞻性、双盲、上下序贯分配研究。手术室、麻醉后监护室（PACU）和普通病房。90 名患者被随机分为三组，采用双盲方式：0.1mg/kg 依托咪酯联合丙泊酚静脉注射（EP）组、0.2mg/kg 依托咪酯联合丙泊酚静脉注射（EP）组、0.3mg/kg 依托咪酯联合丙泊酚静脉注射（EP）组。对于每组中的第一个患者，起始效应器目标丙泊酚浓度设定为 4μg/ml。每位患者接受初始静脉注射 0.04mg/kg 咪达唑仑，然后给予适当剂量的依托咪酯。依托咪酯注射后 10 秒，静脉给予丙泊酚以达到目标浓度。根据序贯法原理，根据前一个患者的反应，调整下一个患者的丙泊酚浓度。有效抑制体动定义为整个手术过程中没有任何不自主的躯体运动。如果前一个病人有躯体运动，下一个病人的丙泊酚浓度增加 0.5μg/ml；相反，如果没有观察到运动，则减少 0.5μg/ml。采用上下序贯分配法和概率回归法计算丙泊酚的 EC。医院焦虑和抑郁量表-焦虑（HADS-A）和抑郁（HADS-D）评分、不良事件、血流动力学变化、人口统计学数据和临床特征。EP 组丙泊酚 EC 为 3.849μg/ml（95%CI：3.419-4.281），EP 组丙泊酚 EC 为 3.641μg/ml（95%CI：2.807-4.200），EP 组丙泊酚 EC 为 3.417μg/ml（95%CI：2.845-3.852）。这些发现表明依托咪酯可以剂量依赖性降低丙泊酚的 EC。依托咪酯可剂量依赖性降低丙泊酚在宫腔镜检查中的 EC，同时降低患者术后 24 小时 HADS-A 和 HADS-D 评分。结论是，当依托咪酯与丙泊酚联合用于宫腔镜检查时，最佳剂量为 0.3mg/kg。
