丙泊酚复合阿片类药物可减少丙泊酚用量,提高内镜检查的安全性。然而,在接受胃十二指肠镜检查的儿童中,关于异丙酚联合S-氯胺酮的研究很少。我们旨在确定不同剂量的S-氯胺酮联合丙泊酚在接受胃十二指肠镜检查的学龄儿童中的镇静作用和安全性。
这是一个潜在的,随机试验。完全正确,将120名接受胃十二指肠镜检查的学龄儿童随机分为P组,S0.3组、S0.5组和S0.7组。在感应过程中,P组儿童,组S0.3、组S0.5和组S0.7接受0、0.3mg。kg-1,0.5mg。kg-1和0.7mg。kg-1S-氯胺酮,分别,3mg以下。kg-1异丙酚注射液。在胃十二指肠镜检查期间,1mg。根据患儿的病情和BIS(双频指数)值添加异丙酚kg-1。主要结果是第一次内窥镜插入的顺利放置率。次要结果是追加异丙酚的次数,异丙酚的总量,不良事件,恢复时间,PACU(麻醉后监护病房)住院时间和内窥镜医师满意度。
P组中第一次插入内窥镜的顺利放置率,S0.3组和S0.5组明显低于S0.7组(16.70%,34.50%,50.00%vs.83.30%,分别,P<0.001)。S0.3组追加异丙酚的次数(P=0.018),S0.5组(P=0.014)和S0.7组(P=0.001)明显少于P组。S0.7组丙泊酚总量明显少于P组(P<0.001)。S0.5组和S0.7组的术中低血压发生率较低。S0.7组术后头晕发生率明显高于对照组(P=0.003),与P组比较,PACU停留时间更长(P=0.018),内窥镜医师满意度更高(P=0.001)。组间恢复时间无差异。
S-氯胺酮(0.7mg。kg-1)与丙泊酚联用可以提供令人满意的镇静效果,并减少接受胃十二指肠镜检查的学龄儿童的丙泊酚剂量,但术后头晕发生率较高,PACU停留时间较长。
Propofol combined with opioids can reduce the dosage of propofol and improve the safety of endoscopy. However, there are few studies on propofol combined with S-ketamine in children undergoing gastro-
duodenoscopy. We aim to determine the sedative effect and safety of different doses of S-ketamine in combination with propofol in school-aged children undergoing gastro-
duodenoscopy.
This is a prospective, randomized trial. Totally, 120 school-aged children who underwent gastro-
duodenoscopy were randomly allocated into Group P, Group S0.3, Group S0.5 and Group S0.7. During induction, children in Group P, Group S0.3, Group S0.5 and Group S0.7 received 0, 0.3 mg.kg-1, 0.5 mg.kg-1 and 0.7 mg.kg-1 S-ketamine, respectively, following 3 mg.kg-1 propofol injection. During gastro-
duodenoscopy, 1 mg.kg-1 of propofol was added according to the condition of the children and the BIS (bispectral index) value. The primary outcome was smooth placement rate of the first endoscope insertion. The secondary outcome was the times of additional propofol, the total amount of propofol, adverse events, recovery time, length of PACU (post anesthesia care unit) stay and endoscopist satisfaction.
The smooth placement rate of the first endoscope insertion in Group P, Group S0.3 and Group S0.5 was significantly lower than that in Group S0.7 (16.70%, 34.50%, 50.00% vs. 83.30%, respectively, P < 0.001). The times of additional propofol in Group S0.3 (P = 0.018), Group S0.5 (P = 0.014) and Group S0.7 (P = 0.001) were significantly less than Group P. The total amount of propofol in Group S0.7 was significantly less than Group P (P < 0.001). The incidence of intraoperative hypotension in Group S0.5 and Group S0.7 was low. Group S0.7 had significantly higher incidence of postoperative dizziness (P = 0.003), longer PACU stay (P = 0.018) and higher endoscopist satisfaction (P = 0.001) than Group P. There was no difference in the recovery time among groups.
S-ketamine (0.7 mg.kg-1) in combination with propofol can provide satisfactory sedative effect and reduce the dosage of propofol in school-aged children undergoing gastro-
duodenoscopy, but there are higher incidence of postoperative dizziness and longer PACU stay.