| Objective:To observe the effect of subclinical doses of ketamine in the inhibition of remifentanil hyperalgesia response after surgical operation, and determine to the best time and dose of the applications of ketamine.Methods:80ASA Ⅰ～Ⅱ grade patients who were randomized into a、b、 c、d four groups (n=20) with rectal cancer or colon cancer surgery for endotracheal intubation. Group a is the control group:10ml saline injectived before incision, saline was perfused intraoperatively with the rate as same as ketamine,10ml saline injectived when sewing the skin, group b:10ml saline injectived before incision,5μg/kg/min ketamine was perfused intraoperatively,10ml saline injectived when sewing the skin.group c was manipulated with ketamine0.25mg/kg (using saline configuration for a total capacity of10ml) before incision and5μg/kg/min perfused intraoperatively,10ml saline injectived when sewing the skin; group d:10ml saline injectived before incision,5μg/kg/min ketamine was perfused intraoperatively and0.25mg/kg ketamine (using saline configuration for a total capacity of10ml) injedated when sewing the skin. All patients received routine anesthesia induction:midazolam0.1mg/kg,propofol2mg/kg, remifentanil1μg/kg, vecuronium0.1mg/kg. Intraoperative continuous target-controlled infusion effect-site concentration of4μg/L remifentanil, intermittent intravenous vecuronium0.05mg/kg,4-8mg/kg propofol continuous infusion to maintain the appropriate anesthetic depth. To detect of intraoperative anesthetic depth with BIS, and maintain BIS values between40and60for intraoperative anesthetic depth. Using postoperative analgesia pump (formula:fentanyl20μg/kg+droperidol5mg, plus saline to100ml, pumping rate2ml/h). Observed and recorded the BIS value and MAP、 HR for before intubation [T1]、intubation [T2]、skin incision [T3]、 abdominal exploration [T4]、the abdomen [T5]、extubation [T6] in surgical procedures. Recorded the Ramsay score of recovery time、 extubation time、5min after extubation. Recorded0min and15min oral pain score after extubation,and1,2,4,6,12,24,48h the VAS values after extubation were recorded. Recorded postoperative respiratory depression, agitation, hallucinations, nightmares, other adverse events in48h. Recorded4groups the total amount of remifentanil intraoperatively and fentanyl postoperatively.Results:1.There were not statistically significant (P>0.05) for four groups patient’s age, weight, gender, operative time. Four groups patients’BIS values and MAP、HR of before anesthesia induction [T1], intubation time [T2], incision time [T3], abdominal exploration time [T4], the abdomen time [T5], extubation time [T6], were not statistically significant (P>0.05). Four patients with postoperative respiratory depression, agitation, hallucinations, nightmares, nausea, vomiting and other adverse events compared no significant difference between the groups.2. Four patients regained consciousness, extubation time compared: A, B, C were, no significant difference in regained consciousness and extubation time(P>0.05). There was statistically significant between d group and a, b, c group in regained consciousness, extubation time (P<0.05). Compared four groups of the five minutes Ramsay scores after extubation:the5minutes Ramsay scores for a, b, c groups patients after extubation was no statistically significant. Compared group d with a, b, c groups, the5minute Ramsay score after extubation was lower, the difference was statistically significant (P<0.05).3. Four groups patients’0min and15min oral pain scores after extubation comparison:c group of patients with pain scores lower than other groups, was statistically significant (P<0.05), group b、d group compared with a group is also statistically significant (P<0.05), there were statistically significant for b group with a group (P<0.05), b group and d group showed no statistically significant. Four groups patients compared VAS score:four groups of patients after1h,2h,4h,6 h,12h,24h,48h recording VAS score comparison,.In1h,2h,4h,6h VAS score comparison, c group scores were significantly lower with the other three groups (P<0.05). b, d group score lower than a group, was statistically significant (P<0.05). b group compared with d group, no statistically significant. Four groups after12h,24h,48h VAS scores comparison, four groups was not statistically significant(P>0.05).4.Four groups patients with intraoperative remifentanil and postoperative fentanyl the total consumption compared:four groups of patients in remifentanil use was not statistically significant.a group used more fentanyl after0-12hours than the other three groups, was statistically significant (P<0.05).b group compared with the d group was not statistically significant.c group compared with d group was statistically significant (P<0.05). c group compared with d group was statistically significant (P<0.05). Four groups of12to48hours use of fentanyl compared was not statistically significant.Conclusion:1. Subclinical doses of ketamine on postoperative pain sensitivity of remifentanil induced significant inhibition.2. Advanced use of subclinical doses of ketamine can better inhibit postoperative pain hypersensitivity of remifentanil. |
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