Clinical trial of esketamine combined with dexmedetomidine in the treatment of pediatric laparoscopic hernia surgery
Objective To observe the clinical efficacy and safety of esketamine injection combined with dexmedetomidine injection combined with sacral block in pediatric laparoscopic hernia surgery.Methods The pediatric patients undergoing laparoscopic hernia repair were randomly divided into control group and treatment group.Both groups received caudal block anesthesia with 0.25%ropivacaine plus dexamethasone.In the control group,anesthesia induction was achieved with 0.2-0.4 μg·kg-1 sulfentanil,2.0 mg·kg-1 propofol,midazolam 2 mg,and 0.15 mg·kg-1 cisatracurium.Maintenance anesthesia was maintained with intravenous infusion of 0.10-0.25 μg·kg-1·min-1 remifentanil,combined with inhalation of 0.8-1.5 minimum alveolar concentration of sevoflurane.In the treatment group,anesthesia induction was conducted with 0.5 mg·kg-1 ketamine,2.0 mg·kg-1 propofol,midazolam 2 mg,and 0.15 mg·kg-1 cisatracurium.Maintenance anesthesia was maintained with continuous intravenous infusion of 0.3 μg·kg-1·h-1 dexmedetomidine plus 0.25 mg·kg-1·h-1 ketamine,combined with inhalation of 0.8-1.5 minimum alveolar concentration of sevoflurane.The surgical time,postoperative awakening time,extubation time,time spent in the anesthesia recovery room,serum levels of C-reactive protein(CRP),serotonin and P-substance,and safety were compared between the two groups.Results In the treatment group,90 cases were enrolled,2 cases dropout,and 88 cases were included in the statistical analysis.In the control group,90 cases were enrolled,3 cases dropout,and 87 cases were included in the statistical analysis.The postoperative recovery time of treatment and control groups was(8.27±2.90)and(14.09±3.61)min;the extubation time was(6.69±1.48)and(9.01±2.15)min;the anesthesia room retention time was(42.35±7.14)and(50.49±6.07)min;the levels of CRP were(8.92±1.76)and(10.46±2.07)mg·L-1;the levels of 5-hydroxytryptamine were(34.61±7.29)and(42.19±7.81)ng·mL-1;the levels of P-substance were(63.05±12.07)and(75.91±13.27)ng·mL-1,respectively.The differences of above indexes in two groups were statistically significant(all P<0.05).The adverse drug reactions of two groups were sedation,postoperative vomiting and bradycardia.The total incidences of adverse drug reactions in the treatment and control groups were 12.50%and 11.49%without significant difference(P>0.05).Conclusion The application of ketamine injection combined with dexmedetomidine injection in pediatric laparoscopic hernia surgery can help shorten the postoperative recovery time of children,reduce the risk of postoperative neurological damage,and have good safety.