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
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
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
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
目的探讨亚麻醉剂量艾司氯胺酮术后持续泵注在改善乳腺癌患者术后早期抑郁情绪应用的可行性和有效性。方法选择2021年3月~2022年5月我院收治的,年龄在35~73岁的女性乳腺癌患者62例,ASAⅠ~Ⅱ级,采用随机表法将所有患者随机分为两组:观察...目的探讨亚麻醉剂量艾司氯胺酮术后持续泵注在改善乳腺癌患者术后早期抑郁情绪应用的可行性和有效性。方法选择2021年3月~2022年5月我院收治的,年龄在35~73岁的女性乳腺癌患者62例,ASAⅠ~Ⅱ级,采用随机表法将所有患者随机分为两组:观察组(K组)和对照组(C组),每组31例。K组:在手术结束时连接镇痛泵(配方:舒芬太尼2.6μg·kg^(-1)、托烷司琼10 mg、艾司氯胺酮0.2 mg·kg^(-1)加入到一定量的生理盐水中稀释到100 mL)持续镇痛泵注48 h。C组:镇痛泵配方中除不含艾司氯胺酮外,其他镇痛方案与K组相同。观察两组患者术后12、24、48 h VAS疼痛评分,镇痛期间不良反应发生率,采用抑郁自评量表(SDS)及24项汉密尔顿抑郁评分(HDRS)评价两组患者术前1天(T_(0))、术后第3天(T_(3))、术后第5天(T_(5))、术后第7天(T_(7))抑郁评分。结果与C组相比,K组12、24、48 h VAS镇痛评分均明显降低,两组对比差异均有统计学意义(P<0.05);镇痛期间不良反应发生率对比,K组显著低于C组,两组对比差异均有统计学意义(P<0.05);术后T_(3)、T_(5)、T_(7)三个时间点抑郁评分对比,K组SDS和HDRS抑郁评分均显著低于C组,两组对比差异均有统计学意义(P<0.05)。结论亚麻醉剂量艾司氯胺酮持续泵注能有效改善乳腺癌患者术后早期抑郁情绪,并降低镇痛期间不良反应发生率,该方法在临床上具有一定的应用和推广价值。展开更多
目的研究单次亚麻醉剂量艾司氯胺酮对全身麻醉下结直肠癌根治术患者术后早期情绪反应及恢复情况的影响。方法采用回顾性分析,选取2022年10月至2023年4月南京大学医学院附属鼓楼医院收治的120例全身麻醉下结直肠癌根治术患者为观察对象,...目的研究单次亚麻醉剂量艾司氯胺酮对全身麻醉下结直肠癌根治术患者术后早期情绪反应及恢复情况的影响。方法采用回顾性分析,选取2022年10月至2023年4月南京大学医学院附属鼓楼医院收治的120例全身麻醉下结直肠癌根治术患者为观察对象,按照麻醉方式不同分为研究组(n=60)与对照组(n=60)。研究组全身麻醉诱导之前给予0.3 mg/kg体重艾司氯胺酮一次性静脉推注,对照组正常麻醉;两组患者全身麻醉诱导、手术过程中麻醉维持、手术完成之后静脉镇痛药物及方式一致。比较两组患者手术前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分与术后(24、48 h)恢复质量评分量表(QOR40)评分、术后(1、3、6、18、24 h)视觉模拟评分法(VAS)评分、术后(24、48 h)改良警觉/镇静评分(MOAA/S)量表评分、术后苏醒时间、术后首次排气时间、术后下床时间及术后不良反应发生率。结果术后48 h,研究组患者SAS、SDS评分均明显低于术前,差异均有统计学意义(P<0.05);对照组手术前后SAS、SDS评分比较,差异均无统计学意义(P>0.05);研究组术后48 h SAS、SDS评分分别为(44.21±4.58)、(41.26±5.09)分,均低于对照组[(52.84±5.69)、(51.03±6.48)分],差异均有统计学意义(P<0.05)。研究组患者术后24、48 h QOR40评分分别为(142.51±4.86)、(150.84±5.73)分,均高于对照组[(134.06±5.17)、(142.49±5.52)分],差异均有统计学意义(P<0.05)。研究组患者术后1、3、6、18、24 h VAS评分分别为(2.49±0.74)、(2.27±0.68)、(2.11±0.64)、(1.97±0.63)、(1.86±0.65)分,均低于对照组[(2.97±0.81)、(2.71±0.75)、(2.58±0.69)、(2.47±0.65)、(2.33±0.67)分],差异均有统计学意义(P<0.05)。研究组患者术后24、48 h MOAA/S评分分别为(141.42±14.51)、(150.28±14.86)分,均低于对照组[(133.19±13.18)、(142.22±13.47)分],差异均有统计学意义(P<0.05)。研究组患者术后首次排气、下床时间分别为(39.01±4.73)、(33.31±4.57)h,均明显短于对照组[(43.86±5.25)、(37.65±5.19)h],差异均有统计学意义(P<0.05);两组患者术后苏醒时间比较,差异无统计学意义(P>0.05)。两组患者术后总不良反应发生率比较,差异无统计学意义(P>0.05)。结论单次亚麻醉剂量艾司氯胺酮用于全身麻醉下结直肠癌根治术麻醉可有效缓解患者情绪反应,提升术后早期镇痛、镇静效果,缓解疼痛程度,提高术后恢复质量及速度,且不良反应少。展开更多
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.
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).
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.
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.
文摘目的探讨亚麻醉剂量艾司氯胺酮术后持续泵注在改善乳腺癌患者术后早期抑郁情绪应用的可行性和有效性。方法选择2021年3月~2022年5月我院收治的,年龄在35~73岁的女性乳腺癌患者62例,ASAⅠ~Ⅱ级,采用随机表法将所有患者随机分为两组:观察组(K组)和对照组(C组),每组31例。K组:在手术结束时连接镇痛泵(配方:舒芬太尼2.6μg·kg^(-1)、托烷司琼10 mg、艾司氯胺酮0.2 mg·kg^(-1)加入到一定量的生理盐水中稀释到100 mL)持续镇痛泵注48 h。C组:镇痛泵配方中除不含艾司氯胺酮外,其他镇痛方案与K组相同。观察两组患者术后12、24、48 h VAS疼痛评分,镇痛期间不良反应发生率,采用抑郁自评量表(SDS)及24项汉密尔顿抑郁评分(HDRS)评价两组患者术前1天(T_(0))、术后第3天(T_(3))、术后第5天(T_(5))、术后第7天(T_(7))抑郁评分。结果与C组相比,K组12、24、48 h VAS镇痛评分均明显降低,两组对比差异均有统计学意义(P<0.05);镇痛期间不良反应发生率对比,K组显著低于C组,两组对比差异均有统计学意义(P<0.05);术后T_(3)、T_(5)、T_(7)三个时间点抑郁评分对比,K组SDS和HDRS抑郁评分均显著低于C组,两组对比差异均有统计学意义(P<0.05)。结论亚麻醉剂量艾司氯胺酮持续泵注能有效改善乳腺癌患者术后早期抑郁情绪,并降低镇痛期间不良反应发生率,该方法在临床上具有一定的应用和推广价值。
文摘目的研究单次亚麻醉剂量艾司氯胺酮对全身麻醉下结直肠癌根治术患者术后早期情绪反应及恢复情况的影响。方法采用回顾性分析,选取2022年10月至2023年4月南京大学医学院附属鼓楼医院收治的120例全身麻醉下结直肠癌根治术患者为观察对象,按照麻醉方式不同分为研究组(n=60)与对照组(n=60)。研究组全身麻醉诱导之前给予0.3 mg/kg体重艾司氯胺酮一次性静脉推注,对照组正常麻醉;两组患者全身麻醉诱导、手术过程中麻醉维持、手术完成之后静脉镇痛药物及方式一致。比较两组患者手术前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分与术后(24、48 h)恢复质量评分量表(QOR40)评分、术后(1、3、6、18、24 h)视觉模拟评分法(VAS)评分、术后(24、48 h)改良警觉/镇静评分(MOAA/S)量表评分、术后苏醒时间、术后首次排气时间、术后下床时间及术后不良反应发生率。结果术后48 h,研究组患者SAS、SDS评分均明显低于术前,差异均有统计学意义(P<0.05);对照组手术前后SAS、SDS评分比较,差异均无统计学意义(P>0.05);研究组术后48 h SAS、SDS评分分别为(44.21±4.58)、(41.26±5.09)分,均低于对照组[(52.84±5.69)、(51.03±6.48)分],差异均有统计学意义(P<0.05)。研究组患者术后24、48 h QOR40评分分别为(142.51±4.86)、(150.84±5.73)分,均高于对照组[(134.06±5.17)、(142.49±5.52)分],差异均有统计学意义(P<0.05)。研究组患者术后1、3、6、18、24 h VAS评分分别为(2.49±0.74)、(2.27±0.68)、(2.11±0.64)、(1.97±0.63)、(1.86±0.65)分,均低于对照组[(2.97±0.81)、(2.71±0.75)、(2.58±0.69)、(2.47±0.65)、(2.33±0.67)分],差异均有统计学意义(P<0.05)。研究组患者术后24、48 h MOAA/S评分分别为(141.42±14.51)、(150.28±14.86)分,均低于对照组[(133.19±13.18)、(142.22±13.47)分],差异均有统计学意义(P<0.05)。研究组患者术后首次排气、下床时间分别为(39.01±4.73)、(33.31±4.57)h,均明显短于对照组[(43.86±5.25)、(37.65±5.19)h],差异均有统计学意义(P<0.05);两组患者术后苏醒时间比较,差异无统计学意义(P>0.05)。两组患者术后总不良反应发生率比较,差异无统计学意义(P>0.05)。结论单次亚麻醉剂量艾司氯胺酮用于全身麻醉下结直肠癌根治术麻醉可有效缓解患者情绪反应,提升术后早期镇痛、镇静效果,缓解疼痛程度,提高术后恢复质量及速度,且不良反应少。
