Effects Of Anesthesia Induction With S-ketamine And Propofol On Circulation And Stress Response In Bracing Laryngoscope Surgery

Objective: to investigate the effects of S-ketamine combined with propofol on circulatory stability,perioperative stress response and safety of propofol in patients undergoing bracing laryngoscope surgery.Methods: ninety patients scheduled for bracing laryngoscope surgery were randomly divided into propofol induction group(group P),S-ketamine induction group(group K),and S-ketamine combined with propofol induction group(group KP).Group P: propofol 2.5mg/kg,cisatracurium 0.2mg/kg,sufentanil 0.5ug/kg were injected intravenously sequentially.Group K: S-ketamine 1mg/kg,cisatracurium0.2mg/kg,sufentanil 0.5ug/kg were injected intravenously sequentially.Group KP:propofol 1.25mg/kg,S-ketamine 0.5mg/kg,cisatracurium 0.2mg/kg,sufentanil0.5ug/kg were injected intravenously.All three groups were maintained with propofol4mg/(kg ·h)and remifentanil 5ug/(kg ·h)pump during operation.Peripheral blood samples were collected by before operation,5min after intubation and 6 hours after operation through peripheral blood vessels,and cortisol,norepinephrine and epinephrine were detected.The changes of heart rate,systolic blood pressure,diastolic blood pressure and adverse reactions were recorded at the time of entering the operating room(T0),intubation(T1),5 minutes after intubation(T2),supporting laryngoscope stimulating epiglottis(T3)and at the end of operation(T4).Results: at T1,T2,T3 and T4,the heart rate in group P and KP was lower than that in group K(P < 0.05).The level of systolic blood pressure in group K was higher than that in group KP,and that in group KP was higher than that in group P(P <0.05).The diastolic blood pressure in group K was higher than that in group KP,and that in group KP was higher than that in group P(P < 0.05).The occurrence probability of vagus nerve reflex in group K and KP was significantly lower than that in group P(P < 0.05).There was no significant difference in the levels of cortisol and epinephrine among group P,K and KP(P > 0.05).The recovery time and the incidence of adverse reactions in group K,P and KP were similar,and there was no significant difference among groups P,K and KP.at the moment of extubation,there was significant difference in VAS score among groups P,K and KP(P < 0.05),and the level of group K and KP was lower than that of group P.Six hours after operation,there was no significant difference in VAS score among the three groups.Conclusion: the combination of S-ketamine and propofol for anesthesia induction in bracing laryngoscope surgery can obtain a more stable hemodynamic level,and compared with propofol alone,it can reduce the probability of bradycardia caused by pharyngeal vagus nerve reflex.It is no significantly different from the traditional induction of propofol in terms of safety and adverse reactions,and can be safely used in anesthesia for bracing laryngoscope surgery.