Clinical observation of low-dose esketamine combined with remimazolam for intrathecal anesthesia in elderly patients undergoing total hip replacement
Objective To observe the clinical efficacy of low-dose esketamine combined with remimazolam for intrathecal anesthesia in elderly patients undergoing total hip replacement.Methods A total of 72 elderly patients were selected to receive the unilateral total hip replacement at the First Affiliated Hospital of Henan University from March to December 2022.The patients were divided into a control group(Group P,n=36)and an observation group(Group R,n=36)using a random number table method.Group P was injected with esketamine and propofol,while Group R was injected with esketamine and remimazolam.Combined spinal-epidural anesthesia was conducted at the lumbar3-4(L3-4)interspace,and the maintenance plane was below thoracic8(T8).Before skin incision:Group P received intravenous injection of 0.5 mg/kg propofol,maintained at 1.0-1.5 mg/(kg·h)afterward,and intravenous infusion of 0.05-0.1 mg/(kg·h)esketamine.Group R received intravenous injection of 0.05 mg/kg remimazolam,maintained at 0.1-0.2 mg/(kg·h)afterward,and intravenous infusion of 0.05-0.1 mg/(kg·h)esketamine.Heart rate(HR),invasive blood pressure(IBP),blood oxygen saturation(SPO2),and electroencephalographic bispectral index(BIS)values were recorded at the time of entry(T0),after anesthesia plane block(T1),and at 5(T2),15(T3),30(T4),and 60(T5)min of intravenous infusion of remimazolam or propofol.Intraoperative vasoactive drug administration,time to awakening after stopping pumping medication,and the occurrence of postoperative adverse reactions were recorded.Results At T2-T5 time point,there was no significant difference in BIS between the two groups(P>0.05),and SPO2 was maintained at a high level in Group R compared with Group P,with statistically significant difference(P<0.05).HR and mean arterial pressure(MAP)were maintained in the normal range in the two groups,but at a higher level in Group R compared with Group P,with statistically significant difference(P<0.05).intraoperative ephedrine and atropine utilization rates were significantly lower in Group R than in Group P,with statistically significant differences(P<0.05).the awakening time of patients in Group R was significantly shorter than that in Group P after stopping pumping medication,with statistically significant difference(P<0.05).and there was no statistically significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion Low-dose esketamine can be combined with remimazolam for sedation in elderly patients receiving total hip replacement under intrathecal anesthesia.It has minimal respiratory and hemodynamic effects,fast postoperative recovery,and a low incidence of adverse reactions.
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