Qiu Jinpeng,Cao Huixia,Zhu Zhirui,et al.Effects of S-ketamine on emergence agitation during general anesthesia of pediatric ambulatory laparoscopy[J].Journal of Clinical Pediatric Surgery,2023,22(05):447-453.[doi:10.3760/cma.j.cn101785-202205084-009]
S-氯胺酮对小儿日间腹腔镜手术全身麻醉苏醒期躁动的影响研究
- Title:
- Effects of S-ketamine on emergence agitation during general anesthesia of pediatric ambulatory laparoscopy
- Keywords:
- Ketamine; Laparoscopes; Anesthesia; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨S-氯胺酮对小儿日间腹腔镜手术全身麻醉苏醒期躁动的影响。方法 本研究为前瞻性研究。以2022年3月至2022年5月浙江大学医学院附属儿童医院行日间腹腔镜疝修补术的114例患儿为研究对象,采用随机数字表法分为S-氯胺酮组(S组)和生理盐水组(N组),每组各57例。S组麻醉诱导时静脉给予S-氯胺酮0.5 mg/kg,N组麻醉诱导时静脉给予等量生理盐水。记录患儿麻醉前(T0)、气管插管后(T1)、气腹即刻(T2)、术毕时(T3)的平均血压(mean blood pressure,MBP)和心率(heart rate,HR);记录气管插管拔管时间、苏醒时间、麻醉恢复室(postanesthesia care unit,PACU)停留时间;记录气管插管拔管即刻(T4)、气管插管拔管后10 min(T5)、气管插管拔管后20 min(T6)、气管插管拔管后30 min(T7)的Richmond躁动-镇静评分(Richmond agitation and sedation scale,RASS)和FLACC(face,legs,activity,crying,consolability)评分;记录苏醒期躁动(emergence agitation,EA)、严重EA、中重度疼痛及术后不良反应发生情况。结果 共有105例患儿(S组53例、N组52例)顺利完成本研究,S组和N组T1时的MBP分别为(71.90±8.76)mmHg和(66.55±9.51)mmHg;T2时的MBP分别为(69.52±7.21)mmHg和(65.38±7.36)mmHg;拔管时间分别为11.00(8.75,15.00)min和9.50(8.00,11.00)min;苏醒时间分别为24.50(16.00,32.25)min和12.00(8.75,18.00)min;T4时的RASS分别为-4(-4,-2.75)和-4(-4,+2);T5时的RASS分别为-3(-4,-1)和0(-2,+2);T6时的RASS分别为-2(-3.25,0)和0(-2,+1);T7时的RASS分别为0(-2,+1)和+1(0,+1);T4时的FLACC分别为0(0,0)和0(0,5);T5时的FLACC分别为0(0,0)和0(0,5);T7时的FLACC分别为0(0,2)和0(0,3);EA分别为24例(24/53,45.3%)和41例(41/52,78.9%);严重EA分别为10例(10/53,18.9%)和32例(32/52,61.5%);中重度疼痛分别为8例(8/53,15.1%)和22例(22/52,42.3%);上述指标差异均有统计学意义(P＜0.05)。S组和N组麻醉恢复室(postanesthesia care unit,PACU)停留时间分别为34.00(30.00,38.00)min和33.00(30.00,35.25)min;术后发生恶心呕吐分别为1例(1/53,1.9%)和0例(0/52,0.0%),低氧血症分别为2例(2/53,3.8%)和1例(1/52,1.9%),流涎分别为1例(1/53,1.9%)和1例(1/52,1.9%);上述指标差异均无统计学意义(P＞0.05)。结论 麻醉诱导期静脉注射S-氯胺酮0.5 mg/kg可降低小儿日间腹腔镜手术全身麻醉苏醒期躁动的发生率,不增加术后恶心呕吐和低氧血症的发生率,不延长PACU停留时间,但延长气管插管拔管时间和苏醒时间。
- Abstract:
- Objective To explore the effects of S-ketamine on the emergence agitation during general anesthesia of pediatric ambulatory laparoscopy.Methods From March 2022 to May 2022,114 children underwent ambulatory laparoscopic hernia repair.They were randomized into two groups of S-ketamine (S) and normal saline (N) (n=57 each).Then group S received an intravenous injection of S-ketamine 0.5 mg/kg while group N had the same volume of normal saline during anesthetic induction.Noninvasive measurements of mean blood pressure (MBP) and heart rate (HR) were recorded before anesthesia (T0),after endotracheal intubation (T1),immediately after pneumoperitoneum (T2) and after surgery (T3).Also extubation time,recovery time and PACU residence time were measured.Scores of Richmond agitation and sedation scale (RASS) and Face Legs Activity Cry Consolability (FLACC) behavioral pain were recorded immediately post-extubation (T4),10 min post-extubation (T5),20 min post-extubation (T6) and 30 min post-extubation (T7).Emergence agitation(EA),severe EA,moderate to severe pain and incidence of postoperative adverse reactions were recorded.Results A total of 105 patients (group S:53,group N:52) were recruited.MBP of groups S and N was (71.90±8.76) vs.(66.55±9.51) mmHg at T1,MBP (69.52±7.21) vs.(66.55±9.51) mmHg at T2,extubation time[11.00(8.75,15.00) vs.9.50(8.00,11.00) min],recovery time[24.50(16.00,32.25) vs.12.00(8.75,18.00) min],RASS[-4(-4,-2.75) vs.-4(-4,+2)]at T4,RASS[-3(-4,-1) vs. 0(-2,+2)]at T5,RASS[-2(-3.25,0) vs. 0(-2,+1)]at T6,RASS[0(-2,+1) vs.+1(0,+1)]at T7,FLACC behavioral pain[0(0,0) vs. 0(0,5)]at T4,FLACC[0(0,0) vs. 0(0,5)]at T5,FLACC[0(0,2) vs. 0(0,3)]at T7,EA 24 cases (24/53,45.3%) vs.41 cases(41/52,78.9%),severe EA 10cases(10/53,18.9%)vs.32 cases(32/52,61.5%),moderate to severe pain 8 cases(8/53,15.1%) vs. 22 cases(22/52,42.3%), and the differences were statistically significant (P<0.05).Residence time in postanesthesia care unit (PACU) of groups S and N was[34.00(30.00,38.00) vs. 33.00(30.00,35.25) min],postoperative nausea & vomiting[(1/53,1.9%) vs. (0/52,0.0%),hypoxemia［(2/53,3.8%) vs. (1/52,1.9%)]and salivation[(1/53,1.9%) vs. (1/52,1.9%)]and the differences were not statistically significant (P>0.05).Conclusion Intravenous injection of S-ketamine 0.5 mg/kg during anesthesia induction may lower the incidence of emergence agitation during general anesthesia of pediatric ambulatory laparoscopy without a greater incidence of postoperative nausea,vomiting and hypoxemia.There is no extension of residence time in PACU.However,extubation time and recovery time become prolonged.
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备注/Memo
收稿日期:2022-5-29。
基金项目:国家自然科学基金(81601358)
通讯作者:金海燕,Email:jinhaiyan@zju.edu.cn