| Objective:To compare the anesthesia effects of different doses of esketamine on laparoscopic radical colorectal cancer resection in elderly patients,in order to explore the optimal selection of esketamine in related anesthesia and provide a reference for anesthesia management.Methods:Between September 2021 and December 2022,90 elderly patients with colorectal cancer underwent laparoscopic radical resection,including 60cases of colon cancer and 30 cases of rectal cancer.Patients were randomly assigned to one of three groups,with 30 cases each:control group（C）,low dose group（L）,and high dose group（H）.Propofol and remifentanil were given total intravenous anesthesia,and compound normal saline was continuously pumped in group C by micropump.Group L was continuously pumped with 0.25 mg·kg-1·h-1esmketamine micropump;In group H,0.50mg·kg-1·h-1Esketamine micropump was continuously pumped.Five time points were selected,after admission,when the invasive artery is finished（T0）,when the operation started（T1）,when the operation ended（T2）,when waking up（T3）and when leaving the room（T4）,and the hemodynamic indexes of heart rate（HR）and mean arterial pressure（MAP）were recorded at each time point.The sedation index（WLi）and pain index（PTi）of HXD-I multi-function monitor was recorded at T1,T2,T3and T4respectively.The recovery time,propofol dosage and remifentanil dosage were observed and recorded after operation.After the procedure,rest,VAS,and Ramsay were tracked and submitted at 6,12,24,and 48 hours.The time of using analgesic drugs for the first time after operation,the recovery after operation and the occurrence of adverse reactions during and after operation were recorded.Results:1.Comparison of general informationAge,sex,ASA grade,BMI,length of the procedure,and the distribution of the three groups’diseases did not differ significantly from one another（P>0.05）.2.Comparison of hemodynamic indicatorsIncluding HR and MAP.Intra-group comparison:HR and MAP of patients in the three groups at T1and T2were lower than T0（P<0.05）;HR and MAP in T3,T4and H groups from T2to T4were higher than T0（P<0.05）;HR and MAP between T2and T4in group L and T0is not significant difference（P>0.05）.Comparison between groups:There weren’t any obvious contrasts in HR and MAP between the three groups at time T0（P>0.05）.At T1and T2,HR and MAP in group L and group H increased compared with those in group C（P<0.05）.At T3and T4,HR and MAP in group C increased compared with those in group L（P<0.05）.Between T2to T4,compared to the L group,the H group’s HR and MAP increased（P<0.05）,and there was no major shift（P>0.05）at any of the other time points.3.Comparison of sedation（WLi）and analgesia（PTi）levelsThere is no substantial variation in WLi across the three groups from T1to T4（P>0.05）.The difference in PTi between the three groups at time points T1and T2is not statically meaningful（P>0.05）.The PTi of groups L and H reduced at T3and T4when compared to group C（P<0.05）.At T3and T4,there is no discernible change in PTi between group L and group H（P>0.05）.4.Comparison of propofol and remifentanil dosagePropofol and remifentanil dosages in groups L and H were lower than in group C（P<0.05）.In comparison to group H,group L was given a greater dose of propofol and remifentanil（P<0.05）.5.Comparison of waking-up timeIn terms of waking-up,none of the three groups differed noticeably（P>0.05）.6.Comparison of postoperative VAS scoresDuring 6 hours following surgery,the relaxing and movement VAS scores in group C were higher than those in groups L and H（P<0.05）,whereas there was no discernible discrepancy between the resting and exercise VAS ratings in groups L and H（P>0.05）.Throughout 12 hours,24hours,and 48 hours post treatment,there were not any appreciable changes between the three groups in the remaining and exertion VAS evaluations（P>0.05）.7.Comparison of Ramsay scores after operationAt 6h,12h,24h,and 48h following surgery,there was no appreciable variation in Ramsay scores between the three groups（P>0.05）.8.Comparison of the time of first use of analgesic drugs after operationIn comparison to groups L and H,group C took less time after surgery to use analgesic medications for the first time（P<0.05）.Despite the fact that group L was smaller than group H,this variation was not clinically important（P>0.05）.9.Comparison of postoperative capacity recoveryPostoperative capacity recovery between the three groups is not significant difference（P>0.05）.10.Comparison of occurrence of adverse reactionsIntraoperative adverse reactions:number of cases of high/low blood pressure.In comparison to group H,groups C and L had a lower incidence of hypertension（P<0.05）.Fewer people in groups L and H developed hypotension than people in group C did（P<0.05）.Postoperative adverse reactions:nausea and vomiting,vertigo and headache.There was no substantial distinction between the incidence of nausea and vomiting in groups C and H（P>0.05）,however both groups C and H experienced higher rates of nausea and vomiting than group L（P<0.05）.There is no discernible variation in the frequency of headaches and vertigo across the three groups（P>0.05）.Conclusions:Continuous pump injection of esketamine at the dose of 0.25 mg·kg-1·h-1is the best for laparoscopic radical resection of colorectal cancer in elderly patients combined with total intravenous anesthesia. |
