【罂粟摘要】经鼻单独应用艾司氯胺酮与联合应用艾司氯胺酮-右美托咪定用于儿童斜视手术术前用药的疗效比较

术前恐惧和焦虑在接受手术的儿童中普遍存在。艾司氯胺酮与右美托咪定联合应用被认为是一种有前景的术前镇静和镇痛。本研究比较了单独鼻内使用艾氯胺酮和艾氯胺酮-右美托咪啶组合在接受斜视手术的儿科患者中的术前用药效果。

180名2-6岁学龄前儿童计划接受斜视手术，随机分配到三组：艾氯胺酮2mg/公斤（K组），艾氯胺酮1mg/公斤+右美托咪定1μg/公斤（KD1组），艾氯胺酮0.5mg/公斤+右美托咪定2μg/公斤（KD2组）。主要结果是治疗后的镇静水平，通过改良的耶鲁术前焦虑量表（mYPAS）和镇静量表（SS）进行测量。次要结果包括镇静起效时间、外周静脉置管成功率、父母分离焦虑量表（PSAS）、面罩接受量表（MAS）、苏醒时间、麻醉恢复室（PACU）停留时间以及用药前相关不良反应。

术前用药后，三组患者的mYPAS评分逐渐下降，K组的1、5、10 min值均低于KD1组和KD2组。KD1组和KD2组的SS评分在给药前40 min前稳定增加，而K组的SS在给药前5 min内增加，并在剩余时间内保持一致水平。K组患者的镇静时间（11.4±7.8 min）明显快于KD1组（18.1±7.5 min，p=0.006）和KD2组（18.4±6.8 min，p<0.001）。PSAS评分、分离状态、外周静脉置管成功率和MAS在各组间具有可比性。各组间PACU苏醒时间及停留时间均无统计学差异。K组中胃肠道事件较多（p<0.001）。

与艾氯胺酮和右美托咪定联合使用相比，经鼻预给药2 mg/kg的艾氯胺酮镇静起效更快，但伴有更多的胃肠道反应。

原始文献来源：Hui, Qiao,Yan, Zhuang,Peipei, Lv et al. Intranasal esketamine versus esketamine-dexmedetomidine combination for premedication in pediatric patients undergoing strabismus surgery: a randomized controlled trial.[J] .Transl Pediatr, 2024;13(8):1327-1335.

Intranasal esketamine versus esketamine-dexmedetomidine combination for premedication in pediatric patients undergoing strabismus surgery: a randomized controlled trial

Background: Preoperative fear and anxiety are prevalent in children undergoing surgery. The combination of esketamine and dexmedetomidine has been proposed as a promising premedication for enhancing preoperative sedation and analgesia. This study compared the premedication efficacy of intranasal esketamine alone and esketamine-dexmedetomidine combination in pediatric patients undergoing strabismus surgery.

Methods: One hundred and eighty preschool children aged 2–6 years scheduled for strabismus surgery were enrolled and randomly assigned to one of the three groups: intranasal premedication with esketamine 2 mg/kg (Group K), esketamine 1 mg/kg and dexmedetomidine 1 μg/kg (Group KD1), or esketamine 0.5 mg/kg and dexmedetomidine 2 μg/kg (Group KD2). The primary outcome was the level of sedation following the intervention, as measured by the modified Yale preoperative anxiety scale (mYPAS) and sedation scale (SS). Secondary outcomes included onset time of sedation, the successful rate of peripheral intravenous cannulation, parental separation anxiety scale (PSAS), mask acceptance scale (MAS), wake-up time, duration of stay in the post-anesthesia care unit (PACU), and premedication-related adverse effects.

Results: After premedication, the mYPAS score gradually decreased in the three groups, with lower values in Group K than in Group KD1 and Group KD2 patients in 1, 5, and 10 min. SS in Group KD1 and Group KD2 steadily increased until 40 min after premedication, while SS in Group K increased in the first 5 min after premedication and maintained consistent levels during the remaining time. Sedation onset was substantially faster in Group K patients (11.4±7.8 min) than Group KD1 (18.1±7.5 min, P=0.006) and Group KD2 (18.4±6.8 min, P<0.001). PSAS, separation status, the successful rate of peripheral intravenous cannulation, and MAS were comparable among groups. There was no significant difference in terms of emergence time or duration of stay in the PACU among groups. More gastrointestinal events were observed in Group K (P<0.001).

Conclusions: Intranasal premedication with 2 mg/kg esketamine produced a more rapid onset of sedation accompanied by more gastrointestinal reactions compared with a combination of esketamine and dexmedetomidine.