Effects of esketamine combined with dexmedetomidine on postoperative sleep and recovery quality in patients undergoing circumferential prolapsed hemorrhoidectomy
Objective To observe the impact of esketamine combined with dexmedetomidine on postoperative sleep and recovery quality in patients undergoing circumferential prolapsed hemorrhoidectomy.Methods Sixty patients undergoing elective circular prolapsed hemorrhoidectomy,including 33 males and 27 females,aged 18-64 years,BMI 18.5-30.0 kg/m2,ASA physical statusⅠ orⅡ,were randomly di-vided into two groups using the random number table method:the esketamine combined with dexmedetomi-dine group(group F)and the opioid anesthesia group(group A),30 patients in each group.In group F,dexmedetomidine was infused at 0.6 μg/kg before anesthesia induction,and esketamine was given at 0.5 mg/kg during induction,with continuous infusion of dexmedetomidine 0.3 μg·kg-1·h-1 and esketamine 0.25 mg·kg-1·h-1 during surgery.In group A,an equal volume of physiological saline was given before induction,sufentanil was given at 0.5 μg/kg during induction,and continuous infusion of ciprofol 0.4 mg·kg-1·h-1 andremifentanil0.1-0.4μg·kg-1·min-1wasmaintainedduringsurgery.Thedurationof surgery,extubation time,and PACU stay time were recorded.The patients'conditions were assessed using the 15-item quality of recovery(QoR-15)scale,sleep quality was evaluated using the Athens insomnia scale(AIS),and pain was assessed using the numeric rating scale(NRS).The VAS pain scores were re-corded immediately after the operation,and at 2,6,12,and 24 hours postoperatively;and record the inci-dence of perioperative adverse reactions,including nausea and vomiting,dizziness,increased oral secre-tions,respiratory depression and difficulty urinating.Results Compared with group A,Group F had signifi-cantly longer extubation times and PACU stay time,with significantly higher QoR-15 scores and significantly lower AIS and NRS scores on the first postoperative day.The incidence of postoperative nausea and difficulty urinating was reduced considerably(P＜0.05).There were no statistically significant differences in opera-tion time,VAS pain scores,and the incidence of perioperative adverse reactions like dizziness,increased o-ral secretions,and respiratory depression between the two groups.Conclusion Esketamine combined with dexmedetomidine can improve postoperative sleep and recovery quality for patients undergoing circumferential prolapsed hemorrhoidectomy,and reduce the incidence of postoperative nausea and difficulty urinating.
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