艾司氯胺酮预防低温等离子刀扁桃体腺样体切除术儿童麻醉恢复期躁动的效果

Efficacy of esketamine in preventing restlessness in anesthesia recovery period in children undergoing low-temperature plasma knife tonsil adenoidectomy

目的观察不同剂量艾司氯胺酮预防儿童低温等离子刀扁桃体腺样体切除术麻醉恢复期躁动的效果。方法全身麻醉(全麻)下行低温等离子刀扁桃体腺样体切除术儿童90例随机分为三组,每组30例。E1组和E2组麻醉诱导时分别给予0.3 mg/kg和0.5 mg/kg艾司氯胺酮,C组给予生理盐水。记录拔管后即刻(T0)、15 min(T1)及1 h(T2)Ramsay镇静评分、麻醉苏醒期躁动发生率、术中芬太尼追加用量、术后苏醒时间和不良反应发生情况。结果T1时,C组和E1组Ramsay镇静评分低于E2组(P<0.05),而C组和E1组Ramsay镇静评分比较差异无统计学意义(P>0.05)。C组麻醉苏醒期躁动发生率高于E1组和E2组(50.00%vs.15.39%和7.14%)(P<0.05)。C组术中芬太尼追加量大于E1组和E2组(P<0.05)。三组苏醒时间、分泌物增加及恶心呕吐发生率比较差异无统计学意义(P>0.05)。结论全麻诱导期静脉注射艾司氯胺酮0.5 mg/kg能减少儿童低温等离子刀扁桃体腺样体切除术中芬太尼用量和苏醒期躁动。

Objective To observe the efficacy of different doses of esketamine in the prevention of the restlessness during anesthesia recovery period in the children undergoing low-temperature plasma knife tonsil adenoidectomy.Methods A total of 90 pediatric patients undergoing low-temperature plasma knife tonsil adenoidectomy under general anesthesia were randomly divided into three groups with 30 cases each.During anesthesia induction,group E1 and group E2 were injected intravenously with esketamine 0.3 mg/kg and 0.5 mg/kg,respectively.Group C was given normal saline as the control.Ramsay sedation scores were evaluated at the time points of immediately after extubation(T0),15 minutes(T1),and 1 hour(T2)after extubation.The incidence of restlessness during the waking period of anesthesia,adverse reactions,the additional dosage of fentanyl used in surgery and the waking up time after operation were compared among the three groups.Results At T1,Ramsay sedation score of group C and group E1 was lower than that of group E2(P<0.05),which of group E1 was similar to that of group C(P>0.05).The incidence of restlessness during the waking period of anesthesia was higher in group C than that in groups of E1 and E2(50.00%vs.15.39%and 7.14%)(P<0.05).The amount of fentanyl added during surgery in group C was more than that in groups of E1 and E2(P<0.05).There were no statistical differences in wakening up time,increased secretion,and the incidence of nausea and vomiting among the three groups(P>0.05).Conclusion Intravenous injection of esketamine 0.5 mg/kg during general anesthesia can reduce fentanyl dosage and restlessness during the waking period in the children undergoing low-temperature plasma knife tonsil adenoidectomy.