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艾司氯胺酮联合异丙酚全身麻醉对脑血流速度影响的随机临床试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：王璐 编辑：王波 审校：曹莹
艾司氯胺酮联合异丙酚诱导不增加大脑中动脉血流速度。艾司氯胺酮有利于维持诱导期间的血流动力学稳定性。此外，服用艾氯胺酮并不会导致不良反应发生率增加。
原始文献来源：Yan S,Li Q,He K. The effect of esketamine combined with propofol-induced general anesthesia on cerebral blood flow velocity: a randomized clinical trial. BMC Anesthesiol. 2024;24 (1):66. doi:10.1186/s12871-024-02446-4
The efect of esketamine combined with propofol-induced general anesthesia on cerebral blood fow velocity: a randomized clinical trial
Abstract Background Esketamine is increasingly used in clinical anesthesia. The efect of esketamine on the blood fow velocity of the middle cerebral artery has a clinical guiding efect. To investigate the efect of esketamine combined with propofol-induced general anesthesia for endotracheal intubation on the blood fow velocity of middle cerebral artery and hemodynamics during the induction period.
Methods The randomized clinical trial included 80 patients aged 20-65 years who would undergo non-intracranial elective surgery under general anesthesia in our hospital from May 2022 to May 2023. The participants were divided into two groups based on anesthesia drugs: sufentanil 0.5μg/kg (group C) or 1.5mg/kg esketamine (group E). The primary outcome was variation value in average cerebral blood velocity. The secondary outcomes included cerebral blood fow velocities (CBFV), blood pressure (BP) and heart rate (HR) at four diferent time points: before induction of general anesthesia (T0), 1 min after the induction drug injected (T1), before endotracheal intubation (T2), and 1min after endotracheal intubation (T3). The occurrence of hypotension, hypertension, tearing and choking during induction was also documented.
Results The variation of average CBFV from time T0 to T2(ΔVm1) and the variation from time T3 to T0 (ΔVm2) were not obviously diferent. The median consumption of intraoperative sufentanil in group C was obviously lower than that in group E. At T1, the mean HR of group E was signifcantly higher than that of group C. At T2 and T3, the BP and HR of group E were obviously higher than that of group C. At T2, the CBFV in the group E were obviously higher than those in the group C. The incidence of hypotension was signifcantly reduced in the group E compared with the group C. There were no diferences in the other outcomes.
Conclusions The induction of esketamine combined with propofol does not increase the blood fow velocity of middle cerebral artery. Esketamine is advantageous in maintaining hemodynamic stability during induction. Furthermore, the administration of esketamine did not result in an increased incidence of adverse efects.
