Effect Of Esketamine On Catheter-Related Bladder Discomfort In Patients Undergoing Ureteroscopic Holmium Laser Lithotripsy

Objective:To evaluate its effects on catheter-related bladder discomfort of esketamine in patients undergoing ureteroscopic holmium laser lithotripsy and the safety and efficacy.Methods:180 patients who underwent ureteroscopic holmium laser lithotripsy under general anesthesia from January 2021 to June 2022,and all patients were divided into experimental group（Group K）and control group（Group C）using the random number table method,with 90 patients in each group.Etomidate,sufentanil and cisatracurium were used for anesthesia induction and laryngeal mask implantation in both groups.Propofol(4-12mg·kg^-1·h^-1)and remifentanil(0.05-0.2μg·kg^-1·min^-1)were used for intraoperative anesthesia maintenance,and cisatracurium 0.03mg/kg was injected for necessary time statically to maintain muscle relaxation to meet surgical needs.Dynamically adjust the rate of anesthetic maintenance drug according to BIS value to maintain BIS between 40 and 60.At the beginning of the operation,Group K was given 0.15mg/kg esketamine and diluted with normal saline to 10ml intravenous injection slowly,while Group C was given the same dose 0.9%sodium chloride injection at the same time.The mean arterial pressure,heart rate and oxygen saturation were observed and recorded at the time of entry（T₀）,immediately after surgery（T₁）,immediately after laryngeal mask removal（T₂）,1 hour after laryngeal mask removal（T₃）,2 hours after laryngeal mask removal（T₄）,and 6 hours after laryngeal mask removal（T₅）.The occurrence and severity of CRBD,Riker sedation-agitation score,Ramsay score,VAS pain score and the occurrence of various adverse reactions were recorded at T₂,T₃,T₄and T₅.Results:There was no significant difference in the general conditions（age,body mass index,ASA grade,operation duration,anesthesia duration and recovery time）between the two groups（P>0.05）.In Group K,HR and MBP at T1 were significantly higher than those in Group C,and the difference was statistically significant（P<0.05）.There was no significant difference in blood pressure,heart rate and pulse oxygen saturation between the two groups at other times（P>0.05）.Compared with the Group C,the incidence of CRBD at T₂,T₃,T₄and T₅in Group K was decreased,and the severity of CRBD at T₂,T₃and T₄was significantly decreased（P<0.05）.It was found that the VAS scores of T₂,T₃and T₄in Group K were lower（P<0.05）.Compared with Group C,Ramsay score was higher and SAS score was lower in Group K at T₂（P<0.05）,and Ramsay score and sedation-agitation SAS score were not statistically significant between the two groups at other time points（P>0.05）.There was no significant difference in the probability of hypertension,respiratory depression,dizziness and headache between the two groups（P<0.05）.Compared with Group C,the incidence of postoperative nausea and vomiting in Group K was significantly reduced（P<0.05）,and patients with moderate and severe CRBD in Group K requiring additional tramadol were significantly less than those in Group C,the difference was statistically significant（P<0.05）.Conclusion:The application of esketamine in ureteroscopic holmium laser lithotripsy can effectively reduce the incidence and severity of CRBD,and has sedative and analgesic effects,which is conducive to stable perioperative hemodynamics of patients and improve the quality of patients’resuscitation.