In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poo...In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poor management of postcesarean pain is associated with decreased maternal care for the baby,longer hospitalization,and higher risk of developing postpartum depression.Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies.However,due to its potential adverse effects on the neurological and hemodynamic status of patients,it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain.Before any recommendation for routine perioperative use of esketamine,more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.展开更多
BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting ma...BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting maternal emotional wellbeing,daily activities,breastfeeding,and neonatal care.It may also impede maternal organ function recovery,leading to escalated opioid usage,heightened risk of postpartum depression,and the development of chronic postoperative pain.Both the Chinese Enhanced Recovery After Surgery(ERAS)guidelines and the American ERAS Society guidelines consistently advocate for the adoption of multimodal analgesia protocols in post-cesarean section pain management.Esketamine,functioning as an antagonist of the N-Methyl-D-Aspartate receptor,has been validated for pain management in surgical patients and has exhibited effectiveness in depression treatment.Research has suggested that incorporating esketamine into postoperative pain management via pain pumps can lead to improvements in short-term depression and pain outcomes.This study aims to assess the efficacy and safety of administering a single dose of esketamine during cesarean section.AIM To investigate the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.METHODS A total of 315 women undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized into three groups:low-dose esketamine(0.15 mg/kg),high-dose esketamine(0.25 mg/kg),and control(saline).Postoperative Visual Analog Scale(VAS)scores were recorded at 6 hours,12 hours,24 hours,and 48 hours.Edinburgh Postnatal Depression Scale(EPDS)scores were noted on 2 days,7 days and 42 days.Ramsay sedation scores were assessed at specified intervals post-injection.Postoperative adverse reactions were also recorded.RESULTS Low-dose group and high-dose group compared to control group,had significantly lower postoperative VAS pain scores at 6 hours 12 hours,and 24 hours(P<0.05),with reduced analgesic usage(P<0.05).EPDS scores and postpartum depression rates were significantly lower on 2 days and 7 days(P<0.05).No significant differences in first exhaust and defecation times were observed(P>0.05),but ambulation times were shorter(P<0.05).Ramsay scores were higher at 5 minutes,15 minutes,and upon room exit(P<0.05).Low-dose group and high-dose group had higher incidences of hallucination,lethargy,and diplopia within 2 hours(P<0.05),and with low-dose group had lower incidences of hallucination,lethargy,and diplopia than high-dose group(P<0.05).CONCLUSION Esketamine enhances analgesia and postpartum recovery;a 0.15 mg/kg dose is optimal for cesarean sections,balancing efficacy with minimized adverse effects.展开更多
Emergency cesarean section is associated with the development of postpartum depression.Esketamine has been demonstrated to have a rapid onset of antide-pressant effects.Randomized controlled trials and meta-analyses h...Emergency cesarean section is associated with the development of postpartum depression.Esketamine has been demonstrated to have a rapid onset of antide-pressant effects.Randomized controlled trials and meta-analyses have demon-strated the efficacy of esketamine in preventing postpartum depression after ce-ssarean section.However,the data included in these analyses were derived from elective cesarean sections and differed in the dose and timing of esketamine ad-ministration.Esketamine is a dissociative anesthetic with a dose-dependent risk of inducing psychotic symptoms,including hallucinations.In the setting of cesarean section,esketamine should be administered with caution and only if the potential benefits outweigh the risks.展开更多
BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is m...BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.展开更多
Objective:To explore the half-effective dose(ED_(50))of remazolam toluenesulfonate combined with subthreshold amounts of esketamine for inhibiting cardiovascular response to tracheal intubation in elderly patients.Met...Objective:To explore the half-effective dose(ED_(50))of remazolam toluenesulfonate combined with subthreshold amounts of esketamine for inhibiting cardiovascular response to tracheal intubation in elderly patients.Method:We included 42 patients,aged 65-75,who required general anesthesia and single-lumen endotracheal intubation for elective surgery.The first patient was administered remazolam toluenesulfonate at a dose of 0.20 mg/kg.Once the patient lost consciousness,their alertness/sedation score(OAA/S score)was≤1,and their BIS score was≤60,and a subthreshold dose(0.3 mg/kg)of esketamine was given.The subsequent doses were adjusted using a sequential approach based on the cardiovascular response to tracheal intubation observed in the previous patient.The dose was modified in increments or decrements of 0.01 mg/kg.The ED_(50)and 95%CI of remazolam toluenesulfonate were calculated using the Dixon and Massey sequential distribution test method.Result:The inhibition of endotracheal intubation response was positively correlated with the dose of remazolam toluenesulfonate,and the depth of sedation could not be achieved when the amount was≤0.22 mg/kg.The ED_(50)of remazolam toluenesulfonate combined with a subthreshold dose of esketamine in inhibiting cardiovascular response to tracheal intubation in elderly patients was 0.30(0.28,0.33)mg/kg.There was no statistically significant difference in blood pressure between the induction of anesthesia and before the operation.Conclusion:When compounded with 0.3 mg/kg esketamine,the ED_(50)of Remazolam toluenesulfonate in inhibiting cardiovascular response to endotracheal intubation in elderly patients was 0.30 mg/kg(95%CI0.28-0.33 mg/kg).展开更多
Objective:Postpartum depression and postoperative pain affect postpartum physical and psychological rehabilitation.Esketamine,as a dexer of ketamine,has analgesic and antidepressant effects.This study was to investiga...Objective:Postpartum depression and postoperative pain affect postpartum physical and psychological rehabilitation.Esketamine,as a dexer of ketamine,has analgesic and antidepressant effects.This study was to investigate the effect of intravenous infusion of esmololone on postoperative analgesia and postpartum depression in parturients undergoing cesarean section.Methods:435 parturients undergoing cesarean section under combined spinal and epidural anesthesia were randomly divided into three groups.All of the subjects were given continuous intravenous infusion 5 minutes after delivery of the fetus.HE:0.4 mg/kg esketamine;LE:0.2 mg/kg esketamine;C:saline.Intraoperative records of MAP and HR at entry operating room(T0),skin resection(T1),beginning of test drug pumping(T2),10 min of pumping(T3)20min of pumping(T4),end of pumping(T5),end of operation(T6)and the adverse reactions before leaving the room were recorded.Postoperative analgesia with intravenous analgesia pump:2.5 ug/kg Sufentanil+8 mg Ondansetron+100 mL Saline.VAS score and sufentanil consumption and adverse reactions were recorded at 2 h(T0’)4 h(T1’)、8 h(T2’)、12 h(T3’)、24 h(T4’)after operation.The Edinburgh Postpartum Depression Scale(EPDS)was used to evaluate the depression status of pregnant women 1 day before operation,1 d,3 d,1 w and 6 w after operation.Result:There was no significant difference in mean arterial pressure(MAP)and heart rate(HR)among the three groups(P>0.05).Compared with C,the incidence of dizziness and diplopia was higher in HE and LE(P<0.05).Compared with C,VAS scores,the sufentanil dosage,and EPDS scores decreased at 1 and 3d postoperatively in both the HE and LE.(P<0.05).Conclusion:The analgesic effect of esketamine after cesarean section is remarkable,which can reduce the use of opioids and improve the short-term depression of pregnant women.展开更多
Background Anesthesia induction is challenging in patients with hemodynamic instability.Esketamine has hypnotic,analgesic,and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension.Th...Background Anesthesia induction is challenging in patients with hemodynamic instability.Esketamine has hypnotic,analgesic,and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension.Therefore,it may be more suitable for patients with hypovolemic shock.Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours.Menstruation of the patient was regular,her self-reported urine pregnancy test was positive half a month earlier,and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test.Gynecological ultrasonography demonstrated no pregnancy sac in utero,confirming ectopic pregnancy.Emergency laparoscopy for ectopic pregnancy should be performed immediately.We administered esketamine for induction.Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.展开更多
Depression is a common,recurrent mental disorder and one of the leading causes of disability and global burden of disease worldwide.Up to 15%-40%of cases do not respond to diverse pharmacological treatments and,thus,c...Depression is a common,recurrent mental disorder and one of the leading causes of disability and global burden of disease worldwide.Up to 15%-40%of cases do not respond to diverse pharmacological treatments and,thus,can be defined as treatment-resistant depression(TRD).The development of biomarkers predictive of drug response could guide us towards personalized and earlier treatment.Growing evidence points to the involvement of the glutamatergic system in the pathogenesis of TRD.Specifically,the N-methyl-D-aspartic acid receptor(NMDAR)andα-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor(AMPAR),which are targeted by ketamine and esketamine,are proposed as promising pathways.A literature search was performed to identify studies on the genetics of the glutamatergic system in depression,focused on variables related to NMDARs and AMPARs.Our review highlights GRIN2B,which encodes the NR2B subunit of NMDAR,as a candidate gene in the pathogenesis of TRD.In addition,several studies have associated genes encoding AMPAR subunits with symptomatic severity and suicidal ideation.These genes encoding glutamatergic receptors could,therefore,be candidate genes for understanding the etiopathogenesis of TRD,as well as for understanding the pharmacodynamic mechanisms and response to ketamine and esketamine treatment.展开更多
文摘In this editorial,we comment on a recent article by Chen et al,that addressed the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.Poor management of postcesarean pain is associated with decreased maternal care for the baby,longer hospitalization,and higher risk of developing postpartum depression.Esketamine is a more potent S-enantiomer of ketamine which has shown promising analgesic and antidepressant properties for managing post-cesarean pain and depression in clinical studies.However,due to its potential adverse effects on the neurological and hemodynamic status of patients,it is recommended that its usage in low doses should be limited to cesarean candidates experiencing unbearable pain.Before any recommendation for routine perioperative use of esketamine,more standardized clinical trials are needed to strengthen our existing knowledge of its effectiveness in reducing postpartum pain and depression.
基金the Project of Science and Technology Bureau of Shijiazhuang,Hebei Province,No.201460823.
文摘BACKGROUND Following cesarean section,a significant number of women encounter moderate to severe pain.Inadequate management of acute pain post-cesarean section can have far-reaching implications,adversely impacting maternal emotional wellbeing,daily activities,breastfeeding,and neonatal care.It may also impede maternal organ function recovery,leading to escalated opioid usage,heightened risk of postpartum depression,and the development of chronic postoperative pain.Both the Chinese Enhanced Recovery After Surgery(ERAS)guidelines and the American ERAS Society guidelines consistently advocate for the adoption of multimodal analgesia protocols in post-cesarean section pain management.Esketamine,functioning as an antagonist of the N-Methyl-D-Aspartate receptor,has been validated for pain management in surgical patients and has exhibited effectiveness in depression treatment.Research has suggested that incorporating esketamine into postoperative pain management via pain pumps can lead to improvements in short-term depression and pain outcomes.This study aims to assess the efficacy and safety of administering a single dose of esketamine during cesarean section.AIM To investigate the effect of intraoperative injection of esketamine on postoperative analgesia and postoperative rehabilitation after cesarean section.METHODS A total of 315 women undergoing elective cesarean section under combined spinal-epidural anesthesia were randomized into three groups:low-dose esketamine(0.15 mg/kg),high-dose esketamine(0.25 mg/kg),and control(saline).Postoperative Visual Analog Scale(VAS)scores were recorded at 6 hours,12 hours,24 hours,and 48 hours.Edinburgh Postnatal Depression Scale(EPDS)scores were noted on 2 days,7 days and 42 days.Ramsay sedation scores were assessed at specified intervals post-injection.Postoperative adverse reactions were also recorded.RESULTS Low-dose group and high-dose group compared to control group,had significantly lower postoperative VAS pain scores at 6 hours 12 hours,and 24 hours(P<0.05),with reduced analgesic usage(P<0.05).EPDS scores and postpartum depression rates were significantly lower on 2 days and 7 days(P<0.05).No significant differences in first exhaust and defecation times were observed(P>0.05),but ambulation times were shorter(P<0.05).Ramsay scores were higher at 5 minutes,15 minutes,and upon room exit(P<0.05).Low-dose group and high-dose group had higher incidences of hallucination,lethargy,and diplopia within 2 hours(P<0.05),and with low-dose group had lower incidences of hallucination,lethargy,and diplopia than high-dose group(P<0.05).CONCLUSION Esketamine enhances analgesia and postpartum recovery;a 0.15 mg/kg dose is optimal for cesarean sections,balancing efficacy with minimized adverse effects.
文摘Emergency cesarean section is associated with the development of postpartum depression.Esketamine has been demonstrated to have a rapid onset of antide-pressant effects.Randomized controlled trials and meta-analyses have demon-strated the efficacy of esketamine in preventing postpartum depression after ce-ssarean section.However,the data included in these analyses were derived from elective cesarean sections and differed in the dose and timing of esketamine ad-ministration.Esketamine is a dissociative anesthetic with a dose-dependent risk of inducing psychotic symptoms,including hallucinations.In the setting of cesarean section,esketamine should be administered with caution and only if the potential benefits outweigh the risks.
文摘BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.
文摘Objective:To explore the half-effective dose(ED_(50))of remazolam toluenesulfonate combined with subthreshold amounts of esketamine for inhibiting cardiovascular response to tracheal intubation in elderly patients.Method:We included 42 patients,aged 65-75,who required general anesthesia and single-lumen endotracheal intubation for elective surgery.The first patient was administered remazolam toluenesulfonate at a dose of 0.20 mg/kg.Once the patient lost consciousness,their alertness/sedation score(OAA/S score)was≤1,and their BIS score was≤60,and a subthreshold dose(0.3 mg/kg)of esketamine was given.The subsequent doses were adjusted using a sequential approach based on the cardiovascular response to tracheal intubation observed in the previous patient.The dose was modified in increments or decrements of 0.01 mg/kg.The ED_(50)and 95%CI of remazolam toluenesulfonate were calculated using the Dixon and Massey sequential distribution test method.Result:The inhibition of endotracheal intubation response was positively correlated with the dose of remazolam toluenesulfonate,and the depth of sedation could not be achieved when the amount was≤0.22 mg/kg.The ED_(50)of remazolam toluenesulfonate combined with a subthreshold dose of esketamine in inhibiting cardiovascular response to tracheal intubation in elderly patients was 0.30(0.28,0.33)mg/kg.There was no statistically significant difference in blood pressure between the induction of anesthesia and before the operation.Conclusion:When compounded with 0.3 mg/kg esketamine,the ED_(50)of Remazolam toluenesulfonate in inhibiting cardiovascular response to endotracheal intubation in elderly patients was 0.30 mg/kg(95%CI0.28-0.33 mg/kg).
基金Clinical Application Research and Medical Training Fund Project(No.2021SQCJ2065)。
文摘Objective:Postpartum depression and postoperative pain affect postpartum physical and psychological rehabilitation.Esketamine,as a dexer of ketamine,has analgesic and antidepressant effects.This study was to investigate the effect of intravenous infusion of esmololone on postoperative analgesia and postpartum depression in parturients undergoing cesarean section.Methods:435 parturients undergoing cesarean section under combined spinal and epidural anesthesia were randomly divided into three groups.All of the subjects were given continuous intravenous infusion 5 minutes after delivery of the fetus.HE:0.4 mg/kg esketamine;LE:0.2 mg/kg esketamine;C:saline.Intraoperative records of MAP and HR at entry operating room(T0),skin resection(T1),beginning of test drug pumping(T2),10 min of pumping(T3)20min of pumping(T4),end of pumping(T5),end of operation(T6)and the adverse reactions before leaving the room were recorded.Postoperative analgesia with intravenous analgesia pump:2.5 ug/kg Sufentanil+8 mg Ondansetron+100 mL Saline.VAS score and sufentanil consumption and adverse reactions were recorded at 2 h(T0’)4 h(T1’)、8 h(T2’)、12 h(T3’)、24 h(T4’)after operation.The Edinburgh Postpartum Depression Scale(EPDS)was used to evaluate the depression status of pregnant women 1 day before operation,1 d,3 d,1 w and 6 w after operation.Result:There was no significant difference in mean arterial pressure(MAP)and heart rate(HR)among the three groups(P>0.05).Compared with C,the incidence of dizziness and diplopia was higher in HE and LE(P<0.05).Compared with C,VAS scores,the sufentanil dosage,and EPDS scores decreased at 1 and 3d postoperatively in both the HE and LE.(P<0.05).Conclusion:The analgesic effect of esketamine after cesarean section is remarkable,which can reduce the use of opioids and improve the short-term depression of pregnant women.
基金This study was supported by Youth Funding of the Affiliated Hospital of Qingdao University.
文摘Background Anesthesia induction is challenging in patients with hemodynamic instability.Esketamine has hypnotic,analgesic,and sympathomimetic effects and is the only anesthetic that can increase sympathetic tension.Therefore,it may be more suitable for patients with hypovolemic shock.Case summary A 40-year-old female patient presented to the emergency department with new-onset abdominal pain and vaginal bleeding for 2 hours.Menstruation of the patient was regular,her self-reported urine pregnancy test was positive half a month earlier,and she had been diagnosed at another hospital 12 days earlier based on a positive blood human chorionic gonadotropin test.Gynecological ultrasonography demonstrated no pregnancy sac in utero,confirming ectopic pregnancy.Emergency laparoscopy for ectopic pregnancy should be performed immediately.We administered esketamine for induction.Conclusion Esketamine-based total intravenous anesthesia results in mild hypotension in ectopic pregnancies with hemorrhagic shock.
文摘Depression is a common,recurrent mental disorder and one of the leading causes of disability and global burden of disease worldwide.Up to 15%-40%of cases do not respond to diverse pharmacological treatments and,thus,can be defined as treatment-resistant depression(TRD).The development of biomarkers predictive of drug response could guide us towards personalized and earlier treatment.Growing evidence points to the involvement of the glutamatergic system in the pathogenesis of TRD.Specifically,the N-methyl-D-aspartic acid receptor(NMDAR)andα-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor(AMPAR),which are targeted by ketamine and esketamine,are proposed as promising pathways.A literature search was performed to identify studies on the genetics of the glutamatergic system in depression,focused on variables related to NMDARs and AMPARs.Our review highlights GRIN2B,which encodes the NR2B subunit of NMDAR,as a candidate gene in the pathogenesis of TRD.In addition,several studies have associated genes encoding AMPAR subunits with symptomatic severity and suicidal ideation.These genes encoding glutamatergic receptors could,therefore,be candidate genes for understanding the etiopathogenesis of TRD,as well as for understanding the pharmacodynamic mechanisms and response to ketamine and esketamine treatment.
