■进行了这项研究,以评估静脉内使用艾氯胺酮作为成人和儿童手术室外镇静或镇痛的佐剂的安全性和有效性。
■PubMed,Embase,Cochrane中央对照试验登记册(中央),WebofScience,我们搜索了Scopus潜在的随机对照研究,随机对照试验比较了艾氯胺酮联合药物与任何其他单一或联合药物方案在手术室外的镇静或镇痛作用.
■本综述纳入了25项研究,共有3,455名参与者。成人的汇总结果显示,与对照组的药物治疗方案相比,静脉注射艾氯胺酮组合与氧饱和度降低的风险显着相关(RR=0.49,95%CI=[0.34,0.70]);低血压(RR=0.38,95%CI=[0.31,0.46]);心动过缓(RR=0.23,95%CI=[0.12,0.43]);注射疼痛(RR=0.37,95%CI=0.53-0.60%,[=0.64]但精神症状的风险增加(RR=3.10,95%CI=[2.11,4.54])(RR=相对风险;CI=置信区间;SMD=标准化平均差).亚组分析显示,仅艾司氯胺酮和丙泊酚的组合可显著降低成人呼吸和心血管不良事件的上述发生率。此外,儿童的汇总结果显示,与对照组的药物治疗方案相比,艾司氯胺酮和异丙酚联合给药可显著降低低血压风险(RR=0.59,95%CI=[0.37,0.95]),但可增加视力障碍风险(RR=6.62,95%CI=[2.18,20.13])和头晕风险(RR=1.99,95%CI=[1.17,3,37])。亚组分析表明,>0.5mg/kg的艾氯胺酮可显著降低低血压的发生率,但增加了儿童头晕的风险。
■静脉注射艾氯胺酮,特别是与异丙酚合用,可以提高手术室外镇静和镇痛的安全性和有效性,尽管潜在的精神副作用值得关注。未来的研究建议研究艾氯胺酮与异丙酚以外的药物的作用。
UNASSIGNED: This study was conducted to evaluate the safety and efficacy of intravenous esketamine as an adjuvant for
sedation or analgesia outside the operating room in adults and children.
UNASSIGNED: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus were searched for potential randomized controlled studies randomized controlled trials comparing drug combinations of esketamine to any other single or combination drug regimens for
sedation or analgesia outside the operating room.
UNASSIGNED: Twenty-five studies with a total of 3,455 participants were included in this
review. The pooled results of adults showed that compared with drug regimens of the control group, intravenous esketamine combinations were significantly associated with decreased risk of oxygen desaturation (RR = 0.49, 95% CI = [0.34, 0.70]); hypotension (RR = 0.38, 95% CI = [0.31, 0.46]); bradycardia (RR = 0.23, 95% CI = [0.12, 0.43]); injection pain (RR = 0.37, 95% CI = [0.25, 0.53]); body movement (RR = 0.60, 95% CI = [0.41, 0.88]); and propofol consumption (SMD = -1.38, 95% CI = [-2.64, -0.11]), but an increased risk of psychiatric symptoms (RR = 3.10, 95% CI = [2.11, 4.54]) (RR = relative risk; CI = confidence intervals; SMD = standardized mean difference). Subgroup analysis showed that only the combination of esketamine and propofol significantly reduced the above incidence of respiratory and cardiovascular adverse events in adults. In addition, the pooled results of children showed that compared with drug regimens of the control group, esketamine and propofol co-administration significantly reduced the risk of hypotension (RR = 0.59, 95% CI = [0.37, 0.95]) but increased the risk of visual disturbance (RR = 6.62, 95% CI = [2.18, 20.13]) and dizziness (RR = 1.99, 95% CI = [1.17, 3,37]). Subgroup analysis indicated that esketamine>0.5 mg/kg significantly reduced the incidence of hypotension, but increased the risk of dizziness in children.
UNASSIGNED: Intravenous use of esketamine, particularly in combination with propofol, may improve the safety and efficacy of
sedation and analgesia outside the operating room, although the potential for psychiatric side effects warrants attention. Future research is recommended to investigate the role of esketamine with agents other than propofol.