Comparison Of Effects Of Pre-injections Of Esketamine Or Dexmedetomidine In Patients Undergoing Laparoscopic Cholecystectomy

Objective:The purpose of this study was to examine the effects of pre-injections of esketamine or dexmedetomidine before anesthesia in patients undergoing laparoscopic cholecystectomy and to offer an evidence-based basis for therapeutic usage of the medicines.Methords:Ninety patients undergoing elective laparoscopic cholecystectomy in our hospital were randomly divided into normal saline group（Group C）,dexmedetomidine group（Group D）and esketamine group（Group S）,30patients in each group:saline 0.5m L/kg,dexmedetomidine 0.75μg/kg and esketamine 0.5mg/kg were injected intravenously at a constant rate with 10minutes before induction of anaesthesia.Intravenous anesthesia were used to maintain the anesthesia state.The changes in mean arterial pressure and heart rate were recorded five times:before pretreatment administration（T₀）,following anesthesia induction（T₁）,immediately endotracheal intubation（T₂）,at the start of pneumoperitoneum（T₃）,tracheal extubation instantly（T₄）.T₀,T₄,postoperative 6 hours（T₅）,postoperative 24 hours（T₆）,inflammatory factor levels were recorded.Total intraoperative amounts of propofol and remifentanil,extubation time were recorded.The VAS scores when coughing were recorded at 2 hours,6 hours,12 hours,and 24 hours after operation,as well as postoperative adverse reactions.Results:1.Hemodynamics:T₁was the end of anesthesia induction,MAP and HR were significantly higher in group S than in groups C and D at this point（P<0.05）;T₂,T₃and T₄were the time points of greater stimulation during anesthesia,the MAP and HR of Groups S and D were considerably lower than those of Group C at these three time intervals（P<0.05）;Group S’s HR was significantly higher than that of Group D（P<0.05）.2.Inflammatory factors:CRP and IL-6 levels were considerably lower in groups S and D than in group C at T₅and T₆time points（P<0.05）,and lower in group S than in group D（P<0.05）.3.Anesthetic dosage and extubation time:intraoperative propofol and remifentanil dosages were considerably lower in groups S and D than in group C（P<0.05）,with remifentanil dosage significantly lower in group S than in group D（P<0.05）.There was no statistically significant difference in extubation time between the three groups（P>0.05）.4.Postoperative pain:Groups S and D had significantly lower VAS scores than Group C within 24 hours after surgery（P<0.05）,Group S had significantly lower VAS scores than Group D at postoperative 2 hours and postoperative 6 hours（P<0.05）,but there was no significant difference in VAS scores at 12 hours and 24 hours after surgery compared to Group D（P>0.05）.5.Postoperative adverse reactions:None of the three groups experienced dreams or hallucinations,the incidence of nausea,vomiting,and increased oral discharge was modest,with no significant difference between groups（P>0.05）.Conclusions:Pre-injection of Esketamine can provide more stable hemodynamics for patients undergoing laparoscopic cholecystectomy,reduce the amount of anesthetic drugs,have a stronger ability to inhibit perioperative inflammatory reactions,early postoperative analgesia,and no increase in adverse reactions when compared to pre-injection of dexmedetomidine.