Volume 23 Issue 4
Apr.  2025
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LI Bingqing, SHI Siren, HUANG Changjun, WU Meihua. Application of opioid-free anesthesia combined with Esketamine in elderly laparoscopic surgery[J]. Chinese Journal of General Practice, 2025, 23(4): 600-603. doi: 10.16766/j.cnki.issn.1674-4152.003960
Citation: LI Bingqing, SHI Siren, HUANG Changjun, WU Meihua. Application of opioid-free anesthesia combined with Esketamine in elderly laparoscopic surgery[J]. Chinese Journal of General Practice, 2025, 23(4): 600-603. doi: 10.16766/j.cnki.issn.1674-4152.003960
shu

Application of opioid-free anesthesia combined with Esketamine in elderly laparoscopic surgery

doi: 10.16766/j.cnki.issn.1674-4152.003960

  • Department of Anesthesiology, the First People' s Hospital of Linping District, Hangzhou, Zhejiang 311100, China

Funds:

 2024KY270

 2022452

 B20240136

  • Received Date: 2024-07-11
    Available Online: 2025-06-30
    Abstract
  •   Objective  To explore the application effect of esketamine combined with dexmedetomidine in the induction of opioid anesthesia in elderly patients, and to analyze its influence on their hemodynamics during laparoscopic surgery.  Methods  In the period spanning April to July 2022, a total of 60 elderly patients who underwent laparoscopic surgery at the First People' s Hospital of Linping District in Hangzhou were methodically divided into two groups. This division was conducted through the utilization of a random number table method, with 30 patients in the opioid-based anesthesia (OBA) group receiving conventional opioid anesthesia and the remaining 30 patients in the opioid-free anesthesia (OFA) group receiving de-opioid anesthesia. The hemodynamics, intraoperative sedation index, visual analogue scale (VAS) and Rasmay scores at varying times of rest and exercise, and the incidence of adverse reactions were then compared between the two groups.  Results  Post-operative extubation time and postanest-hesia care unit (PACU) stay time in the OFA group were found to be significantly found to be significantly longer than those in the OBA group (P < 0.05); this was the case at the following time points: after anesthesia induction (T1), after tracheal intubation (T2), at skin incision (T3), at the beginning of pneumoperitoneum (T4), and 5 minutes after pneumoperitoneum (T5). Heart rate (HR) in the OFA group was higher than that in the OBA group (P < 0.05); mean arterial pressure (MAP) in the OFA group at T2-T5 was lower than that in the OBA group (P < 0.05); bispectral index (BIS) index in the OFA group at T2-T3 was higher than that in the OBA group at T4-T5 was lower than that in the OBA group (P < 0.05); Rasmay score in the OFA group was higher than that in the OBA group at 30 min after surgery (P < 0.05). The VAS score in the OFA group was lower than that in the OBA group at the end of surgery and 30 min after surgery (P < 0.05). Nausea and vomiting occurred in 2 cases in the OFA group (6.67%) compared to 8 cases in the OBA group (26.67%, χ2=4.320, P=0.038).  Conclusion  The use of opioid anesthesia in elderly patients undergoing laparoscopic surgery may better maintain hemodynamic stability, reduce postoperative adverse events, and play a role in postoperative sedation and analgesia.

     

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    • References(20)
  • [1]
    孙晓佳, 汪业铭, 孟晨雪, 等. 超声引导下腰方肌外侧路阻滞联合少阿片类药物麻醉对老年腹腔镜肾癌根治术患者的影响[J]. 中国现代医学杂志, 2023, 33(23): 85-91.

    SUN X J, WANG Y M, MENG C X, et al. Effect of ultrasound-guided lateral lumbar block combined with less opioid anesthesia on elderly patients undergoing laparoscopic radical nephrectomy[J]. China Journal of Modern Medicine, 2023, 33(23): 85-91.
    [2]
    刘新泽, 郑观荣, 楚云超, 等. ERAS理念下无阿片类药物全身麻醉在老年患者腹腔镜肾囊肿去顶术中的应用观察[J]. 山东医药, 2020, 60(32): 67-70.

    LIU X Z, ZHENG G R, CHU Y C, et al. Observation on the application of general anesthesia without opioid drugs under ERAS concept in laparoscopic unroofing of renal cysts in elderly patients[J]. Shandong Medical Journal, 2020, 60(32): 67-70.
    [3]
    仲洁, 廖刃. 区域阻滞技术在无阿片类药物麻醉中的应用进展[J]. 临床外科杂志, 2024, 32(6): 661-663.

    ZHONG J, LIAO R. Progress in application of regional block technique in opioid-free anesthesia[J]. Journal of Clinical Surgery, 2024, 32(6): 661-663.
    [4]
    周斌, 余艳丽, 邱珍, 等. 艾司氯胺酮在老年患者去阿片全身麻醉诱导中的应用[J]. 中国新药与临床杂志, 2022, 41(3): 162-166.

    ZHOU B, YU Y L, QIU Z, et al. Application of Esketamine in the induction of general anesthesia in elderly patients[J]. Chinese Journal of New Drugs and Clinical Remedies, 2022, 41(3): 162-166.
    [5]
    王玉茜, 张亚文, 黄培盈, 等. 腹腔镜手术老年患者术前痛阈与术后谵妄的相关性[J]. 临床麻醉学杂志, 2022, 38(6): 665-668.

    WANG Y Q, ZHANG Y W, HUANG P Y, et al. Correlation between preoperative pain threshold and postoperative delirium in elderly patients undergoing laparoscopic surgery[J]. Journal of Clinical Anesthesiology, 2022, 38(6): 665-668.
    [6]
    王标, 王雷原, 樊迪, 等. 去阿片化麻醉在泌尿外科短小手术中的应用[J]. 临床麻醉学杂志, 2022, 38(12): 1282-1285. doi: 10.12089/jca.2022.12.010

    WANG B, WANG L Y, FAN D, et al. Application of de-opioid anesthesia in short urological surgery[J]. Journal of Clinical Anesthesiology, 2022, 38(12): 1282-1285. doi: 10.12089/jca.2022.12.010
    [7]
    CHEN L, HE W, LIU X, et al. Application of opioid-free general anesthesia for gynecological laparoscopic surgery under ERAS protocol: a non-inferiority randomized controlled trial[J]. BMC Anesthesiol, 2023, 23(1): 34. doi: 10.1186/s12871-023-01994-5
    [8]
    罗文文, 罗文姿, 张满和, 等. 右美托咪定联合艾司氯胺酮对老年乳腺癌根治术患者术后镇痛、镇静、PCA和不良反应的效果[J]. 中国老年学杂志, 2023, 43(21): 5205-5208.

    LUO W W, LUO W Z, ZHANG M H, et al. Effects of dexmedetomidine combined with esmketamine on postoperative analgesia, sedation, PCA and adverse reactions in elderly patients undergoing radical mastectomy[J]. Chinese Journal of Gerontology, 2023, 43(21): 5205-5208.
    [9]
    王会会, 张东江, 刘国旗. 硅胶泪道扩张引流管与医用自交联透明质酸钠凝胶在鼻内镜泪囊鼻腔吻合术患者中应用效果比较[J]. 中国民康医学, 2023, 35(24): 166-168.

    WANG H H, ZHANG D J, LIU G Q. Comparison of the application effect of silicone lacrimal duct dilation drainage tube and medical self-crosslinking sodium hyaluronate gel in patients undergoing endoscopic dacryocystorhinostomy[J]. Medical Journal of Chinese People' s Health, 2023, 35(24): 166-168.
    [10]
    丁志清, 喻灿明, 颜峰. 腰痹通胶囊联合椎间孔镜治疗腰椎间盘突出症疗效观察及对VAS、JOA评分的影响[J]. 新中医, 2023, 55(23): 120-124.

    DING Z Q, YU C M, YAN F. Clinical observation of Yaobitong capsule combined with intervertebral foramen mirror in the treatment of lumbar disc herniation and its influence on VAS and JOA scores[J]. Journal of New Chinese Medicine, 2023, 55(23): 120-124.
    [11]
    LU M, BI J, LI Y, et al. Effect of obesity on venous hemodynamics of the lower limbs during laparoscopic cholecystectomy[J]. Phlebology, 2022, 37(5): 381-385.
    [12]
    WANG H, GONG C, ZHANG Y, et al. Intelligent algorithm-based echocardiography to evaluate the effect of lung protective ventilation strategy on cardiac function and hemodynamics in patients undergoing laparoscopic surgery[J]. Comput Math Methods Med, 2022, 2022: 9349027. DOI: 10.1155/2022/9349027.
    [13]
    LO TESORIERE R, FORCHENO F, FRACASSO M, et al. Color doppler intraoperative ultrasonography evaluation of hepatic hemodynamics for laparoscopic parenchyma-sparing liver resections[J]. J Gastrointest Surg, 2022, 26(10): 2111-2118.
    [14]
    LI J, WANG Z, WANG A, et al. Clinical effects of low-dose esketamine for anaesthesia induction in the elderly: a randomized controlled trial[J]. J Clin Pharm Ther, 2022, 47(6): 759-766.
    [15]
    LIN Z, LI S, ZHOU Y, et al. A comparative study of esketamine-dexmedetomidine and sufentanil-dexmedetomidine for sedation and analgesia in lung tumor percutaneous radiofrequency ablation (PRFA): a randomized double-blind clinical trial[J]. BMC Anesthesiol, 2023, 23(1): 304.
    [16]
    KIM Y S, CHANG H W, KIM H, et al. Comparison of the effects of dexmedetomidine and remifentanil on perioperative hemodynamics and recovery profile of patients undergoing laryngeal microsurgery: a prospective randomized double-blinded study[J]. Medicine (Baltimore), 2021, 100(34): e27045. DOI: 10.1097/MD.0000000000027045.
    [17]
    郑丽花, 杨淑芬, 兰允平, 等. 艾司氯胺酮复合顺阿曲库铵麻醉诱导在急诊剖宫产中的效果观察[J]. 中华全科医学, 2022, 20(4): 602-605. doi: 10.16766/j.cnki.issn.1674-4152.002410

    ZHENG L H, YANG S F, LAN Y P, et al. Observation on the effect of anesthesia induction with escitalopram combined with cisatracurium in emergency cesarean section[J]. Chinese Journal of General Practice, 2022, 20(4): 602-605. doi: 10.16766/j.cnki.issn.1674-4152.002410
    [18]
    VEITH S B, NICKL R, RISSEL T, et al. Hemodynamics and cutaneous microcirculation during induction of general anesthesia with and without esketamine[J]. Clin Hemorheol Microcirc, 2023, 84(4): 385-398.
    [19]
    MA J, WANG F, WANG J, et al. The effect of low-dose esketamine on postoperative neurocognitive dysfunction in elderly patients undergoing general anesthesia for gastrointestinal tumors: a randomized controlled trial[J]. Drug Des Devel Ther, 2023, 17: 1945-1957.
    [20]
    CHEN H Y, MENG X Y, GAO H, et al. Esketamine-based opioid-free anaesthesia alleviates postoperative nausea and vomiting in patients who underwent laparoscopic surgery: study protocol for a randomized, double-blinded, multicentre trial[J]. Trials, 2023, 24(1): 13.
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