艾司氯胺酮在胃镜喉罩无阿片麻醉下内镜黏膜下剥离术中的应用

The application of ketamine in endoscopic submucosal exfoliation during opioid free anesthesia of gastroscopy laryngeal mask

目的评价使用艾司氯胺酮的无阿片麻醉在胃镜喉罩全麻下内镜黏膜下剥离术中的应用效果。方法选取2022年1月至12月于南京医科大学附属南京医院60例择期行全麻胃镜喉罩下内镜黏膜下剥离术的患者,随机数字表法分为常规麻醉组和无阿片麻醉组,每组各30例。常规麻醉组使用阿片类药物,无阿片麻醉组使用艾司氯胺酮代替阿片类药物。记录两组患者术后恶心呕吐发生率;记录两组患者麻醉前(T_(0))、插管时(T_(1))、手术开始10 min(T_(2))以及术毕(T_(3))的平均动脉压(MAP)和心率(HR);记录两组患者拔管后最低脉搏氧饱和度(SpO_(2));同时记录手术时间、丙泊酚用量、拔管时间、麻醉复苏室(PACU)监护时间、术后恶心呕吐发生率、患者满意度以及其他不良反应。结果常规麻醉组与无阿片麻醉组手术时间,T_(0)~T_(3)的MAP和HR,拔管后最低SpO_(2)差异无统计学意义(均P>0.05);与常规麻醉组相比,无阿片麻醉组患者术后恶心呕吐发生率更低,丙泊酚用量更少,拔管时间及PACU监护时间更短,患者满意度更高(均P<0.05);两组患者均无严重不良反应发生。结论艾司氯胺酮应用于胃镜喉罩无阿片麻醉中内镜黏膜下剥离术,患者术后苏醒快、恶心呕吐发生率低、患者满意度高,较常规使用阿片类药物的麻醉有一定优势。

Objective To evaluate the application effect of non opioid anesthesia using ketamine in endoscopic submucosal dissection under general anesthesia of gastroscopy and laryngeal mask.Methods Sixty patients who underwent elective endoscopic submucosal dissection under general anesthesia gastroscopy and laryngeal mask at Nanjing Medical University Affiliated Nanjing Hospital from January to December 2022 were randomly divided into a conventional anesthesia group and a non opioid anesthesia group using a random number table method,with 30 cases in each group.The conventional anesthesia group used opioid drugs,while the non opioid anesthesia group used ketamine instead of opioid drugs.We recorded the incidence of postoperative nausea and vomiting in two groups of patients;Recorded the mean arterial pressure(MAP)and heart rate(HR)of two groups of patients before anesthesia(T_(0)),during intubation(T_(1)),at the start of surgery(T_(2)),and after surgery(T_(3));We also recorded the lowest pulse oxygen saturation(SpO_(2))after extubation in two groups of patients;At the same time,the surgical time,propofol dosage,extubation time,monitoring time in the anesthesia and resuscitation unit(PACU),incidence of postoperative nausea and vomiting,patient satisfaction,and other adverse reactions were recorded.Results The difference in surgical time,MAP and HR from T_(0) to T_(3),and the lowest SpO_(2) after extubation between the conventional anesthesia group and the non opioid anesthesia group was not statistically significant(all P>0.05);Compared with the conventional anesthesia group,the non opioid anesthesia group had a lower incidence of postoperative nausea and vomiting,lower dosage of propofol,shorter extubation time and PACU monitoring time,and higher patient satisfaction(all P<0.05);Both groups of patients had no serious adverse reactions.Conclusions The application of ketamine in endoscopic submucosal dissection during non opioid anesthesia of gastroscopy laryngeal mask has certain advantages over conventional use of opioid drugs,including fast postoperative recovery,low incidence of nausea and vomiting,and high patient satisfaction.