Abstract
Objective To explore the effects of subanesthetic dose esketamine in endoscopic thyroidectomy through the chest and breast approach.Methods 68 female patients who underwent complete endoscopic thyroidectomy through the chest and breast approach from August 2023 to February 2024 were selected as the study subjects and divided into a control group(34 cases)and esketamine group(34 cases)by random number table method.In the esketamine group,sufentanil 0.2 μg/kg plus esketamine 0.2 mg/kg.In the control group,sufentanil 0.4 μg/kg intravenous infusion was given.Observe the systolic blood pressure(SBP),mean arterial pressure(MAP),and heart rate(HR)of the patients at each time point post-sedated(T0),immediately after induction(T1),immediately before intubation(T2),3 min after intubation(T3),5 min after intubation(T4),10 min after intubation(T5),immediately after skin incision(T6),5 min after incision skin(T7),and electroencephalogram bispectral index(BIS)of electroencephalogram at time points T1,T2,T3,T4,T5,T6 and T7 time points;The peroperative blood,anesthesia-related conditions[recovery time,PACU stay time and intraoperative utilization rate of vasoactive drugs],the incidence of adverse reactions(choking cough during recovery,incidence of hypotension after induction,tachycardia during induction,postoperative nausea,vomiting)and the degree of postoperative pain were compared between the two groups of patients.Results Compared to the control group,the esketamine group showed significantly higher SBP and MAP at T2,T4,and T5,the differences were statistically significant(P<0.05);There were 3 cases of tachycardia in the control group and 2 cases in the esketamine group.However,there was no statistically significant difference in HR at each time point between the two group(P>0.05).The BIS at T2 time point in the esketamine group was higher than that of the control groups,the difference was statistically significant(P<0.05),there was no statistically significant difference at the other time points(P>0.05).The use of vasoactive drugs of norepinephrine in the esketamine group was significantly lower than that of the control group(P<0.05).There was no statistically significant difference in the recovery time and PACU stay time between the two groups of patients(P>0.05).The esketamine group exhibited fewer cough reflexes during recovery,lower incidence of hypotension at T2 and T5 time points,lower incidences of nausea and vomiting at 12 and 24 h postoperatively,the differences were statistically significant(P<0.05).There were no statistically significant difference in the peroperative blood and incidence of tachycardia during induction between the two groups of patients(P>0.05).There was no statistically significant difference in the visual analogue scale(VAS)score of the two groups of patients 2 h after surgery(P>0.05).The VAS score of the esketamine group at 12 and 24 h after surgery were significantly lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusion The subanesthetic dose of esketamine used in endoscopic thyroidectomy through the chest and breast approach can maintain hemodynamic stability in patients,reduce the incidence of hypotension after induction,decrease postoperative nausea,vomiting and choking cough,and provide long-lasting analgesia.It is worthy of clinical promotion and application.关键词
艾司氯胺酮/经胸乳入路腔镜甲状腺手术/诱导后低血压/视觉模拟评分法(VAS)/术后不良反应Key words
esketamine/endoscopic thyroidectomy through the chest and breast approach/postinduced hypotension/visual analogue scale(VAS)/postoperative adverse reactions分类
临床医学
