■艾氯胺酮在小儿胃肠内镜检查中的作用尚不清楚。本研究旨在评估艾氯胺酮用于小儿胃肠内镜检查的有效性和安全性。
■在八个常见数据库中搜索了用于小儿胃肠镜检查的艾氯胺酮临床试验,到2023年10月。这些临床试验包括在荟萃分析和试验序贯分析(TSA)中。使用风险比(RR)和加权平均差(WMD)作为二分变量和连续性变量的效应大小,分别。当异质性测试显示I2<50%时,固定效应模型用于荟萃分析和TSA;否则,随机效应模型被用于他们。
■就疗效终点而言,荟萃分析表明,与安慰剂或空白相比,艾氯胺酮显著缩短恢复时间2.34分钟(WMD-2.34;95%置信区间[CI]-3.65,-1.02;p=0.0005)和丙泊酚消耗量0.70mg/kg(WMD-0.70;95%CI-0.98,-0.43;p<0.00001),平均心率增加4.77次/分(WMD4.77;95%CI2.67,6.87;p<0.00001),平均动脉压增加3.10mmHg(WMD3.10;95%CI1.52,4.67;p=0.0001),而诱导时间和平均血氧保持相当。TSA指出了这些益处的确凿证据。就安全终点而言,荟萃分析显示,艾氯胺酮显著减少了59%的不自主运动(RR0.41;95%CI0.22,0.76;p=0.005)和51%的窒息(RR0.49;95%CI0.26,0.92;p=0.03),而头晕显著增加98%(RR1.98;95%CI1.11,3.56;p=0.02),总不良事件无显著差异,呼吸抑制,和呕吐。TSA证明了不自主运动和头晕的确凿证据。低剂量分析表明,≤0.3mg/kg的艾氯胺酮可显著缩短恢复时间,异丙酚消耗和不自主运动,显著增加平均心率,没有增加头晕。Begg检验(p=0.327)和Egger检验(p=0.413)没有明显的发表偏倚,然而漏斗图提示潜在的发表偏倚.
■Esketamine是接受胃肠内窥镜检查的儿童的有效辅助麻醉。然而,一般剂量的艾氯胺酮可能会增加头晕的风险,这可以通过施用低剂量(≤0.3mg/kg)来避免。
UNASSIGNED: The role of esketamine in pediatric gastrointestinal endoscopy is still unclear. This
study aims to evaluate the efficacy and safety of esketamine for pediatric gastrointestinal endoscopy.
UNASSIGNED: Clinical trials of esketamine for pediatric gastrointestinal endoscopy were searched in eight common databases, up to October 2023. These clinical trials were included in the meta-analysis and
trial sequential analysis (TSA). The risk ratio (RR) and weighted mean difference (WMD) were used as the effect sizes for dichotomous variables and continuity variables, respectively. When the heterogeneity test showed I2 < 50%, the fixed effects model was used for the meta-analysis and TSA; Otherwise, the random effects model was used for them.
UNASSIGNED: In terms of efficacy endpoints, the meta-analysis showed that compared with placebo or blank, esketamine significantly decreased recovery time by 2.34 min (WMD -2.34; 95% Confidence interval [CI] -3.65, -1.02; p = 0.0005) and propofol consumption by 0.70 mg/kg (WMD -0.70; 95% CI -0.98, -0.43; p < 0.00001), and increased mean heart rate by 4.77 beats/min (WMD 4.77; 95% CI 2.67, 6.87; p < 0.00001) and mean arterial pressure by 3.10 mmHg (WMD 3.10; 95% CI 1.52, 4.67; p = 0.0001), while induction time and mean blood oxygen remained comparable. TSA indicated conclusive evidence for these benefits. In terms of safety endpoints, the meta-analysis revealed that esketamine significantly reduced involuntary movements by 59% (RR 0.41; 95% CI 0.22, 0.76; p = 0.005) and choking by 51% (RR 0.49; 95% CI 0.26, 0.92; p = 0.03), while significantly increasing dizziness by 98% (RR 1.98; 95% CI 1.11, 3.56; p = 0.02) and there were no significant differences in total adverse events, respiratory depression, and vomiting. TSA demonstrated conclusive evidence for involuntary movements and dizziness. Low-dose analysis showed that esketamine at ≤0.3 mg/kg significantly reduced recovery time, propofol consumption and involuntary movements, and significantly increasing mean heart rate, with no increase in dizziness. The Begg\'s test (p = 0.327) and the Egger\'s test (p = 0.413) indicated no significant publication bias, yet the funnel plot suggested potential publication bias.
UNASSIGNED: Esketamine is an effective adjuvant anesthesia for children undergoing gastrointestinal endoscopy. However, the general dose of esketamine may increase the risk of dizziness, which can be avoided by administering a low dose (≤0.3 mg/kg).