Application Of Esketamine In The Induction Of Opioid-free General Anesthesia In Laparoscopic Cholecystectomy

Objective:To observe the effects on hemodynamic fluctuations,postoperative analgesia,analgesic consumption,and incidence of postoperative nausea and vomiting by using esketamine for induction of opioid-free general anesthesia in laparoscopic cholecystectomy.Methods:82 patients undergoing elective laparoscopic cholecystectomy were selected,aged 18-65 years,ASAI-II,without increase in intraocular pressure and intracranial pressure,untreated or poorly controlled hypertension,long-term use of opioid analgesics or chronic pain,known allergy or contraindications to the drugs used.Patients were randomly divided into esketamine（E）and sufentanil（S）with 41 cases in each group.Both groups were given dexmedetomidine 0.5μg/kg intravenous injection by syringe pump before induction,and oxycodone hydrochloride 0.1 mg/kg intravenous injection after surgery.Group E was given esketamine 0.5mg/kg,propofol 2mg/kg,rocuronium0.6mg/kg,group S was given sufentanil 0.5μg/kg,propofol 2mg/kg,rocuronium0.6mg/kg for anesthesia induction,and sevoflurane and refentanil were used for anesthesia maintenance.Mean arterial pressure（MAP）,heart rate（HR）when entering the operating room（T₀）,before intubation（T₁）,after intubation（T₂）,before pneumoperitoneum（T₃）,after pneumoperitoneum（T₄）,after extubation（T₅）,were observed and recorded;bispectral index（BIS）when entering the operating room;immediately after the end of induction drug injection,10 minutes after induction,20minutes after induction,30 minutes after induction,and 40 minutes after induction;NRS scores at 30min,6h,12h,24h,48h after extubation,postoperative nausea and vomiting（PONV）,and number of people using analgesics after surgery were recorded.Results:1.There were no significant differences of age,height,weight,BMI,ASA grade,duration of surgery,MAP and HR when entering the operating room between the two groups（P>0.05）.2.The MAP and HR immediately after intubation in the two groups increased significantly,the MAP and HR at each time point in group E were higher than those in group S,and the MAP and HR at each time point in group E were closer to the baseline,and the difference between the two groups was statistically significant（P<0.05）.3.There was no significant difference in NRS score between the two groups at 30 min after surgery（P>0.05）,and the NRS score in group E decreased significantly at 6h,24h and 48h,and the difference between the two groups was statistically significant（P<0.05）.4.The number of patients in group E who need to use oxycodone hydrochloride to relieve pain after surgery was lower than that in group S,and the comparison between the two groups was statistically significant（P<0.05）;5.There was no significant difference in BIS values when entering the operating room and immediately after induction between the two groups,and the BIS values in patients in group E increased significantly at 10min,20min,30min,and 40min after induction,which was statistically significant compared with group S（P<0.05）.6.There was no significant difference in the incidence of hypotension、bradycardia、PONV between the two groups（P>0.05）.Conclusion:Esketamine can be safely and effectively used to opioid-free induction in patients undergoing laparoscopic cholecystectomy and maintain hemodynamic stability,It can effectively reduce the postoperative NRS score and reduce the demand for opioids after surgery.