1
|
Zhang B, Li M, Han Y, Zhao X, Duan C, Wang J. Effective dose of propofol combined with intravenous esketamine for smooth flexible laryngeal mask airway insertion in two distinct age groups of preschool children. BMC Anesthesiol 2024; 24:50. [PMID: 38317070 PMCID: PMC10840216 DOI: 10.1186/s12871-024-02421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND There is limited research on the combined use of propofol and esketamine for anesthesia induction during flexible laryngeal mask airway (FLMA) in pediatric patients, and the effective dosage of propofol for FLMA smooth insertion remains unclear. We explored the effective dose of propofol combined with intravenous esketamine for the smooth insertion of FLMA in two distinct age groups of preschool children. METHODS This is a prospective, observer-blind, interventional clinical study. Based on age, preschool children scheduled for elective surgery were divided into group A (aged 1-3 years) and group B (aged 3-6 years). Anesthesia induction was started with intravenous administration of esketamine (1.0 mg.kg- 1) followed by propofol administration. The FLMA was inserted 2 min after propofol administration at the target dose. The initial dose of propofol in group A and group B was 3.0 mg.kg- 1 and 2.5 mg.kg- 1, respectively. The target dose of propofol was determined with Dixon's up-and-down method, and the dosing interval of propofol was 0.5 mg.kg- 1. If there was smooth insertion of FLMA in the previous patient, the target dose of propofol for the next patient was reduced by 0.5 mg.kg- 1; otherwise, it was increased by 0.5 mg.kg- 1. The median 50% effective dose (ED50) for propofol was estimated using Dixon's up-and-down method and Probit analysis, while the 95% effective dose (ED95) was estimated through Probit analysis. Vital signs and adverse events during induction were recorded. RESULTS Each group included 24 pediatric patients. Using Dixon's up-and-down method, the ED50 of propofol combined with esketamine for smooth insertion of FLMA in group A was 2.67 mg.kg- 1 (95%CI: 1.63-3.72), which was higher than that in group B (2.10 mg. kg- 1, 95%CI: 1.36-2.84) (p = 0.04). Using Probit analysis, the ED50 of propofol was calculated as 2.44 (95% CI: 1.02-3.15) mg.kg- 1 in group A and 1.93 (95% CI: 1.39-2.32) mg.kg- 1 in group B. The ED95 of propofol was 3.72 (95%CI: 3.07-15.18) mg.kg- 1 in group A and 2.74 (95%CI: 2.34-5.54) mg.kg- 1 in group B. In Group B, one pediatric patient experienced laryngospasm. CONCLUSION The effective dose of propofol when combined with intravenous esketamine for smooth insertion of FLMA in children aged 1-3 years is 2.67 mg.kg- 1, which is higher than that in children aged 3-6 years (2.10 mg. kg- 1). TRIAL REGISTRATION Chinese Clinical Trial Registry Center (Registration Number: ChiCTR2100044317; Registration Date: 2021/03/16).
Collapse
Affiliation(s)
- Bin Zhang
- Department of Anesthesiology, Jinan Children's Hospital (Qilu Children's Hospital of Shandong University), Jinan, 250000, China
- School of Pharmacy, Linyi University, Linyi, 276000, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250000, China
| | - Yuejiao Han
- Department of Anesthesiology, Jinan Children's Hospital (Qilu Children's Hospital of Shandong University), Jinan, 250000, China
| | - Xianliang Zhao
- Department of Anesthesiology, Jinan Children's Hospital (Qilu Children's Hospital of Shandong University), Jinan, 250000, China
| | - Chunhong Duan
- Department of Pediatrics, Jinan Children's Hospital (Qilu Children's Hospital of Shandong University), Jinan, 250000, China.
| | - Junxia Wang
- Department of Pediatrics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250000, China.
| |
Collapse
|
2
|
Liu J, Han H, Yang S, Zhan X, Cao B, Peng Y. Esketamine use is associated with shortened postoperative hospital stay in patients after knee arthroscopic surgery: a propensity score-matched cohort study. BMC Anesthesiol 2024; 24:27. [PMID: 38233828 PMCID: PMC10792950 DOI: 10.1186/s12871-023-02376-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Previous studies have examined anesthetics to improve postoperative prognosis after knee arthroscopic surgery. However, it is currently unknown whether perioperative anesthetics can influence postoperative hospital stay. We investigated the impact of esketamine after knee arthroscopic surgery on post-operative length of stay, fever and surgical site infection. METHODS This study included 455 patients who underwent knee surgery between January2020 and August 2021at a tertiary hospital in China. Patient characteristics, preoperative laboratory values, intra-operative anesthetic data, and postoperative outcomes were collected. Univariate and multivariate logistic regression analyses with or without propensity score matching were performed to identify factors related to post-operative discharge within 3 days(PD3). RESULTS A total of 297 cases met our inclusion criteria. The mean age of patients was 42 ± 14 years, mean body mass index, 24.1 ± 3.5 kg/m2, 157(53%) patients were male. Meniscus-related procedures accounted for the most part of all the procedures with a percentage of 40.4%, followed by combined procedures of 35.4%. After we adjusted for demographic and intraoperative characteristics with propensity score matching, esketamine use was significantly associated with PD3 with the highest odds ratio of 2.28 (95% confidence interval (CI): 1.18-4.41, p = 0.014). CONCLUSION Esketamine use was associated with PD3 in patients underwent knee arthroscopic surgery. The findings of this study will be useful to anesthesiologists in making informed decisions regarding the choice of anesthetics for knee joint diseases. TRIAL REGISTRATION This study was approved by the Ethics Committee (Approval No.:2023-041-01) of the Eighth Affiliated Hospital, Sun Yat-sen University and retrospectively registered.
Collapse
Affiliation(s)
- Jing Liu
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Hong Han
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Shangze Yang
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Xiaoxuan Zhan
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China
| | - Bingbing Cao
- Department of Anesthesiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Yue Peng
- Department of Anesthesiology, the Eighth Affiliated Hospital, Sun Yat-sen University, No.3025 Shennan Road, Futian District, Shenzhen City, Guangdong Province, China.
| |
Collapse
|
3
|
Yang T, Mudabbar MS, Xu M, Xiang Q, Liu B, Fu Q. The effects of esketamine on blood pressure and hypotension incidence during induction of bariatric surgery: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e36754. [PMID: 38134077 PMCID: PMC10735083 DOI: 10.1097/md.0000000000036754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The prevalence of obesity is high. Bariatric surgery is an effective treatment for severe obesity; however, the induction phase of anesthesia in these patients poses a risk of hypotension. Esketamine, known for its sympathetic nervous system stimulation, may stabilize blood pressure during induction. This study aimed to investigate the effects of esketamine on blood pressure in bariatric surgery patients. METHODS This randomized controlled trial included 145 patients undergoing bariatric surgery. Patients were randomly assigned to receive esketamine or a control intervention during induction. Blood pressure and other vital signs were measured and compared between the 2 groups using statistical analyses. RESULTS Administration of esketamine increased blood pressure before intubation (T2). The incidence of hypotension was lower in the esketamine group at multiple time points during induction. Postoperatively, the esketamine group exhibited lower pain scores at 24 hours and a reduced need for rescue analgesics. CONCLUSION A single dose of 0.2 mg/kg esketamine during the induction phase of bariatric surgery can improve blood pressure stability and decrease the incidence of hypotension. Furthermore, it is associated with reduced postoperative pain. Future studies could explore the effects of higher esketamine doses and validate these findings in a larger and more diverse patient population.
Collapse
Affiliation(s)
- Ting Yang
- Department of Anesthesiology, The Third People's Hospital of Chengdu Affiliated to Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Muhammad Saqib Mudabbar
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Mingxing Xu
- Department of Anesthesiology, The Third People's Hospital of Chengdu Affiliated to Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Qingmei Xiang
- Department of Anesthesiology, The Third People's Hospital of Chengdu Affiliated to Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Wuhou District, Chengdu, Sichuan Province, China
| | - Qiang Fu
- Department of Anesthesiology, The Third People's Hospital of Chengdu Affiliated to Southwest Jiaotong University, Chengdu, Sichuan, China
| |
Collapse
|
4
|
Liang J, Liu J, Qiu Z, Sun G, Xiang P, Hei Z, Li X. Effect of Esketamine Gargle on Postoperative Sore Throat in Patients Undergoing Double-Lumen Endobronchial Intubation: A Randomised Controlled Trial. Drug Des Devel Ther 2023; 17:3139-3149. [PMID: 37876501 PMCID: PMC10591602 DOI: 10.2147/dddt.s430077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
Background Postoperative sore throat is a frequent adverse event after double-lumen endobronchial tube (DLT) intubation. The aim of this study was to investigate whether esketamine gargle has a preventive effect on the incidence of postoperative sore throat in patients undergoing DLT intubation. Methods This trial included 140 patients undergoing elective thoracic surgery at the third affiliated hospital of Sun Yat-Sen University. Patients were randomly allocated into the following two groups of 70 patients each: the control group, gargling with saline of 30 mL, and the esketamine group, gargling with an esketamine solution of 30 mL (2 mL/50 mg esketamine in 28 mL saline), 5 min prior to anaesthesia induction. The primary outcome was the incidence of sore throat 24 h after surgery. The main secondary outcomes included the incidence of sore throat and hoarseness at 1 h and 48 h after surgery, as well as the intraoperative haemodynamic responses. Results The incidence of sore throat was significantly higher in the control group (47.1%, 33/70 patients) compared with the esketamine group (12.9%, 9/70 patients) at 24 h after surgery (RD, 0.41; 95% confidence interval, 0.26-0.57; p < 0.001). Furthermore, the incidence of sore throat at 1 h (p = 0.027), 24 h (p = 0.019), and seventh day (p = 0.031) as well as hoarseness at 1 h (p = 0.027), 24 h (p = 0.019), and 48 h (p = 0.031) after surgery were reduced in the esketamine group. Significant differences were seen in the peak levels of systolic blood pressure, mean arterial blood pressure, and heart rate between the groups during the intubation (p < 0.05). Besides, no patient developed an adverse reaction to esketamine. Conclusion Preoperative gargling of esketamine can provide an effect against sore throat after DLT intubation without adverse side effects and effectively inhibit sharp elevations in heart rate and blood pressure during double-lumen intubation procedures.
Collapse
Affiliation(s)
- Jianfen Liang
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Jun Liu
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Zhuolin Qiu
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Guoliang Sun
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Ping Xiang
- Department of Medical Quality Management, Nanfang Hospital, Southern Medical University, Guangzhou, 510630, People’s Republic of China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Xiang Li
- Department of Anesthesiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| |
Collapse
|
5
|
Yue L, Ma X, Li N, Chen J, Wang J, Wan Z, Yang L. Remimazolam versus propofol in combination with esketamine for surgical abortion: A double-blind randomized controlled trial. Clin Transl Sci 2023; 16:1606-1616. [PMID: 37337399 PMCID: PMC10499404 DOI: 10.1111/cts.13572] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023] Open
Abstract
Remimazolam is a new benzodiazepine with a short half-life, good efficacy, and safety profiles in general anesthesia. Combining esketamine with propofol (P + E) could reduce propofol consumption and injection pain. It is, however, unclear if a low dose of remimazolam co-administrated with esketamine (R + E) is comparable to the increasingly used P + E for surgical abortion with general anesthetic. We conducted a double-blind randomized controlled trial to compare the efficacy and safety of R + E and P + E. Two hundred patients scheduled for a surgical abortion were randomized to receive remimazolam 0.3 mg/kg plus esketamine 0.3 mg/kg (R + E), and propofol 2 mg/kg plus esketamine 0.3 mg/kg (P + E). Sedative effectiveness was evaluated by measuring the time to lose consciousness (LOC), recovery time, and successful sedation rate. Safety was assessed by hemodynamics and adverse events during and postoperation. The time to LOC and recovery time in R + E was 5 s shorter and 1 min longer than that in P + E, respectively (both p < 0.001). Success sedation rate did not differ between groups (p = 0.73). Bradycardia incidence and injection site pain were less frequent in the R + E group than that in the P + E group. More rash was observed in the R + E group compared with the P + E group (32% vs. 5%, p < 0.001), but all were mild (only chest rash) and resolved subsequently. Low dose of remimazolam when combined with esketamine has favorable profiles with rapid onset and recovery, but mild hemodynamic side effects and adverse events. It can be used as an alternative for surgical abortion with general anesthetic.
Collapse
Affiliation(s)
- Linli Yue
- Department of AnaesthesiologyMaternal and Child Health Hospital of Hubei ProvinceWuhanChina
| | - Xiaoling Ma
- Department of AnaesthesiologyMaternal and Child Health Hospital of Hubei ProvinceWuhanChina
| | - Na Li
- Department of AnaesthesiologyMaternal and Child Health Hospital of Hubei ProvinceWuhanChina
| | - Jing Chen
- School of NursingHong Kong Polytechnic UniversityHong Kong, SARChina
| | - Jun Wang
- Department of AnaesthesiologyMaternal and Child Health Hospital of Hubei ProvinceWuhanChina
| | - Zhenzhen Wan
- Department of AnaesthesiologyMaternal and Child Health Hospital of Hubei ProvinceWuhanChina
| | - Lin Yang
- School of NursingHong Kong Polytechnic UniversityHong Kong, SARChina
| |
Collapse
|
6
|
Xu C, Wei X, Zhang C, Huang X, Lan H, Xu Y, Wu X, Li F, Guan X. Esketamine prevents propofol-induced injection pain: Randomized controlled trial. Front Pharmacol 2022; 13:991559. [PMID: 36204223 PMCID: PMC9530822 DOI: 10.3389/fphar.2022.991559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Propofol is widely used during anesthesia. However, propofol-induced injection pain (PIP) is considered an unpleasant perioperative outcome. This study aimed to investigate the efficacy of a mixture of esketamine and propofol in preventing propofol injection pain in patients undergoing general anesthesia.Methods: This was a prospective, double-blind, multicenter, and randomized controlled trial. We included 252 adult patients with the American Society of Anesthesiologists physical status I to II who underwent surgery under general anesthesia. Patients were randomly allocated in a 1:1:1:1 ratio to four groups (n = 63 per group). Group NS received a mixture of 1% propofol (20 ml) and 0.9% normal saline (1 ml), group ESK-4 received a mixture of 1% propofol (20 ml) and esketamine 4 mg (diluted with 0.9% normal saline, 1 ml), group ESK-12 received a mixture of 1% propofol (20 ml) and esketamine 12 mg (diluted with 0.9% normal saline, 1 ml), and group ESK-20 received a mixture of 1% propofol (20 ml) and esketamine 20 mg (diluted with 0.9% normal saline, 1 ml) as sedative drugs during anesthesia. The primary outcome was the incidence and distribution of different degrees of PIP. The secondary outcomes were vital signs, characteristics of surgery and anesthesia, and adverse events.Results: The incidence of PIP in group ESK-20 (33.3%) was significantly lower than that in groups NS, ESK-4, and ESK-12 (63.3%, 62.2%, and 49.1%, respectively; p < 0.01). The incidence of moderate PIP in group NS (33.3%) and group ESK-4 (22.6%) was higher than that in groups ESK-12 (7.5%) and ESK-20 (6.7%). The incidence of severe PIP in group NS (6.7%) and group ESK-4 (9.4%) was higher than that in groups ESK-12 (1.9%) and ESK-20 (0%). There were no differences in the vital signs, characteristics of surgery and anesthesia, or adverse events between the groups.Conclusion: Our results indicated that the esketamine–propofol admixture reduced the incidence of PIP in patients undergoing general anesthesia without severe side effects.
Collapse
Affiliation(s)
- Chaozhi Xu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaotang Wei
- Department of Anesthesiology, The People`s Hospital of Baise, Base, China
| | - Cuiwen Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaofang Huang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hongmeng Lan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yanping Xu
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaoyan Wu
- Department of Anesthesiology, The Second People`s Hospital of Qinzhou, Qinzhou, China
| | - Fuping Li
- Department of Anesthesiology, The Second People`s Hospital of Qinzhou, Qinzhou, China
| | - Xuehai Guan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Xuehai Guan,
| |
Collapse
|