| Background:In recent years,with the rapid development of day surgery and even "day return" surgery in China,more and more problems have emerged,which have attracted the attention of clinicians,most of which are related to the use of opioids.In addition to the known nausea and vomiting,respiratory depression,dizziness,impaired gastrointestinal function,skin itching and urinary retention,in recent years,the use of opioids in the perioperative period may also be closely related to postoperative hyperalgesia,long-term abuse of opioids after surgery,readmission rates after surgery and even recurrence rates after tumor surgery.From the 1960 s to the present,global opioid use has experienced four drug crises.While various measures have been taken to control opioid use,the problem of opioid abuse and opioid-induced adverse reactions remains acute worldwide.Therefore,how to reduce the use of opioids in the perioperative period and how to completely get rid of the use of opioids during the perioperative period has become a new research direction for anesthesiologists,and the anesthesia strategies of non-opioid anesthesia(OFA)and oligoid anesthesia(ORA)have gradually become research hotspots.Objective:Under the concept of OFA,To investigate the feasibility of general anesthesia using non-opioidesketamine(OFA protocol)and low-dose butorphanol prophylactic analgesia combined with esketamine(ORA protocol),and to evaluate which of the two anesthesia regimens is more advantageous,thereby providing a new reference for day surgery OFA or ORA anesthesia regimens for laparoscopic cholecystectomy(LC).Research Methods:90 patients who underwent laparoscopic cholecystectomy from October 2020 to October 2021 in Huaihe Hospital of Henan University and met the inclusion criteria and exclusion criteria were selected.It was randomly divided into three groups by lottery: sufentanil group(group S),esketamine group(group E),butorphanol combined with esketamine group(group B),and finally 29 patients in group S,27 cases in group E and 28 cases in group B were included that finally met the trial criteria.All patients received atropine 0.5mg and midazolam 0.05 mg/kg intramuscularly 20 min before anesthesia.8 mg of dexamethasone was injected intravenously 5 minutes before anesthesia,10 ug/kg of butorphanol was injected intravenously in the B group.Induction of anesthesia: All patients received propofol 2 mg/kg,rocuronium bromide 0.6 mg/kg,sufentanil 0.3 g/kg in group S,and esketamine 0.5 mg/kg in groups E and B.Maintenance of anesthesia:three groups of patients were given 3% deflurane for continuous inhalation,Intraoperative intravenous pumping of sufentanil and propofol in group S,and intraoperative intravenous pumping of esketamine and propofol in groups E and B.Pumping initiations of sufentanil,esketamine and propofol were 0.5 ug/kg·h,0.5 mg/kg·h,and 6 mg/kg·h,respectively.All patients were given rocuronium bromide 0.15 mg/kg every40 min,and the amount of intravenous anesthesia was adjusted according to the intraoperative hemodynamic changes in the patient.Deflurane,sufentanil,and esketamine are discontinued after gallbladder removal and propofol is discontinued 5min before the end of surgery.SBP,DBP,HR,and Paw at the time of patient’s inception(T0),intubation(T1),5 min after intubation(T2),at the beginning of surgery(T3),at the establishment of the pneumoperitone(T4),10 min after cholecystectomy(T5),1 min after extubation(T6),and 5 min after extubation(T7);Recording of intraoperative dosages of various drugs;Evaluation of the patient’s postoperative extubation time;Ramsay score of 0.5 h and 1 h after extubation;NRS score of 0.5 h after extubation,incidence of adverse reactions in each group 1 h after extubation.Results :1.The SBP,DBP and HR at the time 1～7 of the patients in group E were higher than in group S;The Paw at the time 4～5 of the patients in group E were lower than in group S,The difference was statistically significant.2.The total use of propofol and esketamine in Group E was higher than in group B;The use rate of methoxamine and nalmefene in Group E was lower than in group S,The difference was statistically significant.3.The extubation time in group E was significantly reduced compared to group S;The NRS rating of 0.5h after extubation in group E was higher than in group S and group B;The Ramsay score at 1h after extubation in group E was significantly higher than in groups S and B,The difference was statistically significant.4.The incidence of postoperative nausea and vomiting,respiratory forgetfulness(spontaneous breathing rate less than 5 beats/min)and whether Sp O2 is less than 90% when oxygen is taken out of the mask 0.5h after extubation in Group E was significantly lower than in group S;The incidence of postoperative anxiety,irritability and multilingualism in Group E was significantly higher than in group S and group B;The incidence of intraoperative dreams in Group E was significantly higher than in group S,The difference was statistically significant.Conclusion:1.Compared with traditional sufentanil anesthesia,esketamine anesthesia for LC surgery is beneficial to the stability of hemodynamics and reduce the incidence of postoperative nausea,vomiting,respiratory depression and other adverse reactions,but the postoperative sedation and analgesia score is relatively poor,and a better OFA scheme remains to be studied.2.Compared with esketamine anesthesia,low-dose butorphanol prophylactic analgesia combined with esketamine anesthesia is beneficial to the stability of intraoperative hemodynamics,can significantly reduce the dosage of narcotic drugs,and has a better score of postoperative sedation and analgesia.It retains the advantages of esketamine anesthesia and makes up for its shortcomings.This anesthesia method is safe and effective,However,as this study is a small sample experiment,whether it can be widely used in clinical anesthesia still needs further research. |
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