关键词: 艾司氯胺酮, 全身麻醉, 麻醉诱导, 血流动力学, 腰椎手术

Abstract: Objective　To observe the effect of esketamine in induction of general anesthesia for lumbar surgery on hemodynamics and the extubation period. Methods　A total of 60 patients [American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ] who were scheduled to undergo lumbar surgery under general anesthesia at 970th Hospital of the PLA were enrolled in this study. They were divided into an esketamine group (group E) and a fentanyl group (group F) by the random number table method, with 30 cases in each group. There were 16 males and 14 females in group E, and they were (58.0±7.5) years old. There were 18 males and 12 females in group F, and they were (57.4±7.2) years old. During induction of anesthesia, etomidate 0.3 mg/kg and atracurium 0.3 mg/kg were intravenously injected in all the patients, and group E took esketamine 0.5 mg/kg and group F took fentanyl 5 μg/kg. The hemodynamic changes, such as heart rate (HR) and mean arterial pressure (MAP), were observed and recorded before anesthesia induction (T0), immediately before endotracheal intubation (T1), and 1 min (T2) and 5 min (T3) after intubation. The extubation times and accurate activity times of both lower limbs, and postoperative adverse reactions in both groups were recorded. One-way ANOVA, t test, and χ² test were applied. Results　There were no statistical differences in HR and MAP between two groups at T0 (both P>0.05). The MAP's in group E [(90.5±7.9) mmHg vs. (99.6±8.2) mmHg] and group F [(89.0±9.8) mmHg vs. (97.5±5.7) mmHg] at T1 were significantly lower than those at T0 (both P<0.05). The MAP recovered rapidly in group E after endotracheal intubation, and the MAP's at T2 [(101.4±10.9) mmHg] and T3 [(99.5±7.3) mmHg] were not statistically different from that at T0 (both P>0.05). The MAP's at T2 [(91.5±6.9) mmHg] and T3 [(92.1±7.9) mmHg] of group F were significantly lower than that at T0 (both P<0.05). After induction of anesthesia, the HR at T1 [(61.4±7.5) beats/min] was significantly lower and the HR at T3 [(73.1 ±10.1) beats/min] was significantly higher than that at T0 [(67.7±10.7) beats/min] in group F (both P<0.05). There were no significant changes in HR of group E (all P>0.05). The postoperative extubation time and accurate activity time of both lower limbs in group E were significantly shorter than those in group F [(10.3±0.8) min vs. (13.5±1.5) min and (7.9±2.3) min vs. (9.1±2.8) min], with statistical differences (both P<0.05). The incidence of agitation during waking period of postoperative in group E was significantly lower than that in group F [3.33% (1/30) vs. 20.00% (6/30)]. Conclusion　Esketamine for induction of anesthesia is benificial to stable hemodynamic change and recovery of postoperative cognitive function and could reduce the incidence of adverse reactions such as agitation during the waking period.

Key words: Esketamine, General anesthesia, Anesthesia induction, Hemodynamics, Lumbar surgery