Abstract
Objective To explore the effect of subanesthetic dose of esketamine combined with propofol on hypotension and hypoxemia during painless gastroscopy.Methods A total of 179 patients who underwent elective painless gastroscopy from April 2023 to March 2024 were selected and randomly divided into the esketamine group(esketamine with propofol,EP group,90 cases)and the control group(sufentanil combined with propofol,SP group,89 cases).The EP group was intravenously injected with esketamine at a dose of 0.20 mg/kg,the SP group was intravenously injected with sufentanil at a dose of 0.10 μg/kg,and both groups were intravenously injected with propofol at a dose of 1.50 mg/kg.Gastroscopy was initiated when the patient's eyelash reflex disappeared and deep sedation[modified observer's assessment of alertness/sedation scale(MOAA/S)≤1].Add 0.50 to 1.00 mg/kg of propofol when necessary.The perioperative indicators of the two groups of patients(the occurrence of adverse cardiopulmonary events such as hypotension and hypoxemia,the total dosage of propofol,the time of anesthesia induction,the time anesthesia induction to endoscopy,the time of gastroscopy,the awakening time and the recovery time)and the lowest percutaneous arterial oxygen saturation(SpO2)during gastroscopy were recorded.Record the mean arterial pressure(MAP),heart rate(HR),and SpO2 of the two groups of patients before anesthesia induction(T0),before gastroscopy implantation(T1),3 minutes after gastroscopy implantation(T2),immediately after the end of gastroscopy(T3),and before leaving the recovery room(T4).Record the incidence of complications(nausea,vomiting,dizziness and dreaming)and patient satisfaction in the two groups of patients.Results Compared with the SP group,the incidence of hypotension and hypoxemia in the EP group was significantly lower,the lowest SpO2 during gastroscopy was significantly higher,the dosage of propofol was increased,and the awakening time was prolonged.The differences were statistically significant(P<0.05).There were no statistically significant differences in time of anesthesia induction,anesthesia induction to endoscopy,gastroscopy examination and recovery between the two groups of patients(P>0.05).Compared with the T0 time point,the MAP of patients in both groups decreased at T1,T2,T3 and T4 time points,and the decrease was more obvious in the SP group.At T1 time point,the HR of patients in the EP group was higher than that at T0 time point,while the HR at T2,T3 and T4 time points in the SP group was lower than that at T0 time point.At T2 time point,SpO2 in both groups of patients decreased compared with that at time point T0,and the differences were statistically significant(P<0.05).Compared with the EP group,MAP and HR at time points T1,T2,T3 and T4 in the SP group were significantly decreased,and SpO2 at time points T2,T3 and T4 was significantly decreased.The differences were statistically significant(P<0.05).Compared with the SP group,the EP group had more dreamers,but none of them had nightmares.There were no statistically significant differences in the incidence of dizziness,nausea and vomiting after examination,as well as satisfaction between the two groups(P>0.05).Conclusion The subanesthetic dose(0.20 mg/kg)of esketamine combined with propofol can be safely and effectively used in painless gastroscopy,reducing the incidence of adverse cardiopulmonary events such as hypotension and hypoxemia,maintaining hemodynamic stability in patients,and not increasing drug-related side effects.It is worth applying in clinical practice.关键词
艾司氯胺酮/丙泊酚/无痛胃镜/低血压/低氧血症Key words
esketamine/propofol/painless gastroscopy/hypotension/hypoxemia分类
医药卫生
