The Effects Of Different Doses Of Esmketamine On Anesthesia In Pediatric Orthopedic Surgery

Objective Clinically,it is inevitable to perform orthopaedic surgery on children with upper respiratory tract infection.Due to physiological and psychological characteristics,assistance of general anesthesia drugs is necessary for peripheral nerve block in pediatric surgery.As a common drug for pediatric anesthesia,S-ketamine has both analgesic and sedative effects.This study investigated the effect of S-mketamine combined with propofol assisted nerve block in pediatric short orthopaedic surgery with upper respiratory tract infection.Methods According to the sample size calculation formula,120 children with mild upper respiratory tract infection undergoing orthopedic short surgery,aged 1-12 years,weighing9-53kg,ASA I-II,based on the random number table method,the children were randomly divided into 2 mg/kg propofol induced control group（Group C）,0.5 mg/kg S-ketamine combined with 1 mg/kg propofol induced observation group（Group E₁）,and 1.0 mg/kg S-mketamine combined with 1 mg/kg propofol induced observation group（group E₂）.The nerve block will be performed in the three groups after induction.The effects of somatic reaction and perioperative adverse reactions such as cough,laryngeal spasm,breath holding,hypoxemia,hypertension and restlessness were observed during awakening;MAP and HR were recorded before anesthesia induction（T₀）,after anesthesia induction（T₁）,during nerve block stimulation（T₂）,at the beginning of surgery（T₃）,and at the end of surgery（T₄）in the three groups;the postoperative recovery time of the three groups was recorded.Count data were tested byχ2 test.The measurement data were statistically calculated by one-way ANOVA and repeated measurement design ANOVA when consistent with normal distribution.Results There were statistically significant differences between the three groups in body movement response at time T₂,the number of perioperative sputum aspiration>2 times,and the incidence of laryngeal spasm(χ²⁼6.771～14.892,P<0.05).Compared with group C,there was no significant difference in the above incidence in group E₁（P>0.05）,there was significant difference in the above incidence in group E₂（P<0.05）,and there was a significant difference in the incidence in group E₂compared with group E₁（P<0.05）.The incidence in group E₂was lower than that in group E₁and group C.There were no significant differences in perioperative cough,breath-holding,hypoxemia,hypertension,and agitation during recovery（P>0.05）.The MAP difference of the three groups at time T₁was statistically significant（F=13.861,P<0.05）,there was a significant difference between the E₁group and C group（P<0.05）,there was a significant difference between the E₂group and C group（P<0.05）,there was no significant difference between E₂group and E₁group（P>0.05）,E₁and E₂groups were higher than C group,and there was no significant difference at other time points（P>0.05）,there was a statistically significant difference in HR between the three groups at time T₂（F=10.579,P<0.05）.There was no significant difference between group E₁and group C（P>0.05）,and there was a significant difference between group E₂and group C（P<0.05）,There was a significant difference between the E₂group and E₁group（P<0.05）.The HR of children in the E₂group was significantly lower than that in the C group and E₁group,and there was no significant difference at other time points（P>0.05）.In terms of awakening time,there was a significant difference between E₁and E₂group（P<0.05）,there was no significant difference between the E₂group and E₁group（P>0.05）,and the children in the E₁and E₂groups were significantly shorter than that in C group.Conclusions 1mg/kg S-ketamine combined with 1mg/kg propofol assisted nerve block exerted significant effects on pediatric orthopedic surgery with mild upper respiratory tract infection,with good analgesic effect,less body movement reaction,shortening recovery time and low incidence of respiratory adverse events.