艾司氯胺酮诱导对眼压的影响

摘要译文（供参考）

不同剂量的艾司氯胺酮联合丙泊酚和舒芬太尼静脉诱导对小儿斜视手术中眼压的影响：一项随机临床试验

背景： 

众所周知，在眼科手术期间将眼内压（IOP）稳定地维持在正常范围内很重要。艾司氯胺酮因其良好的镇痛和镇静作用，是小儿全身麻醉中常用的药物。然而，它在眼科手术中的应用是有限的，因为它可以增加眼压。艾司氯胺酮联合其他常见麻醉剂对眼压的影响研究不足。

目的：

本研究旨在探讨小儿斜视手术静脉诱导全身麻醉时不同剂量艾司氯胺酮联合丙泊酚和舒芬太尼对眼压的影响。

方法： 

共招募181例在全身麻醉下接受单侧眼科手术的斜视患儿。静脉诱导包括使用0.1μg/kg舒芬太尼、3mg/kg异丙酚和艾司氯胺酮。根据艾司氯胺酮的剂量，将患者随机分为三组：低艾司氯胺酮（EL）组0.25mg/kg（n = 62），艾司氯胺酮高（EH）组0.5mg/kg（n = 60）和生理盐水（NS）组（n = 59）。记录各组血流动力学参数、呼吸参数和非手术眼眼压，并对不同时间点的结构进行比较：诱导前（T₀），诱导后1分钟、喉罩置入前（T₁），喉罩置入后立即（T₂），以及喉罩置入后 2 分钟（T₃).

结果：

3组患者年龄、性别、体重指数（BMI）和T0时呼吸参数差异无统计学意义。

在所有三组中，T ₁，T₂和 T₃时的眼压低于 T ₀时。

EH 组（12.6 ± 1.6 mmHg）在 T₁时的眼压显著高于 EL 组（12.0 ± 1.6 mmHg）和 NS 组（11.6 ± 1.7 mmHg）。

然而，在任何时间点，EL组和NS组之间都没有发现差异。

收缩压 （SBP） 和心率 （HR） 在 T₁， T₂和 T₃时低于基线，T ₂时SBP和HR高于T₁时。

此外，EH组在T₁的HR明显比其他两组更高。

三组舒张压（DBP）在任何时候均无显著差异。

结论： 

丙泊酚联合舒芬太尼在诱导全身麻醉期间显着降低IOP。

尽管与低剂量组和对照组相比，0.5 mg/kg艾司氯胺酮剂量在诱导后IOP升高，但眼压仍低于基线。

0.25 mg/kg艾司氯胺酮联合丙泊酚和舒芬太尼对眼压影响不大。

因此，在小儿斜视手术中，与基线相比，最大剂量为0.5mg/kg的艾司氯胺酮联合丙泊酚和舒芬太尼不会升高眼压。

原文摘要

Effect of intravenous induction with different doses of Esketamine combined with propofol and sufentanil on intraocular pressure among pediatric strabismus surgery: a randomized clinical trial

Background:It is well-established that maintaining stable intraocular pressure (IOP) within the normal range during ophthalmic surgery is important. Esketamine is a commonly used drug in pediatric general anesthesia due to its good analgesic and sedative effects. However, its application in ophthalmic surgery is limited because it can increase IOP. The effect of esketamine combined with other common anesthetics on IOP has been underinvestigated. This study aimed to investigate the effect of different doses of esketamine combined with propofol and sufentanil on IOP during intravenous induction of general anesthesia for pediatric strabismus surgery.

Methods:A total of 181 children with strabismus undergoing unilateral eye surgery under general anesthesia were recruited. Intravenous induction included the use of sufentanil 0.1 µg/kg, propofol 3 mg/kg, and esketamine. Base on the dosage of esketamine, the patients were randomly allocated into three groups: esketamine low (EL) group with 0.25 mg/kg (n = 62), esketamine high (EH) group with 0.5 mg/kg (n = 60), and normal saline (NS) group (n = 59). Hemodynamic parameters, respiratory parameters, and IOP of the non-surgical eye were recorded and compared among the three groups at different time points: before induction (T₀), 1 min after induction but before laryngeal mask insertion (T₁), immediately after laryngeal mask insertion (T₂), and 2 min after laryngeal mask insertion (T₃).

Results:There were no significant differences in age, gender, body mass index (BMI), and respiratory parameters among the three groups at T₀. The IOP at T₁, T₂, and T₃ was lower than that at T₀ in all three groups. The EH group (12.6 ± 1.6 mmHg) had a significantly higher IOP than the EL group (12.0 ± 1.6 mmHg) and the NS group (11.6 ± 1.7 mmHg) at T₁. However, no difference was found between the EL and NS groups at any time point. Systolic blood pressure (SBP) and heart rate (HR) at T₁, T₂, and T₃ were lower than at baseline, and SBP and HR were higher at T₂ than at T₁. Additionally, the EH group had a significantly higher HR at T₁ than the other two groups. There was no significant difference in diastolic blood pressure (DBP) among the three groups at any time point.

Conclusion:Propofol combined with sufentanil significantly decreased IOP during the induction of general anesthesia. Although a dose of 0.5 mg/kg esketamine elevated IOP compared to the low-dose and control groups after induction, the IOP remained lower than baseline. 0.25 mg/kg esketamine combined with propofol and sufentanil had little effect on IOP. Therefore, we advocate that a maximum dose of 0.5 mg/kg esketamine combined with propofol and sufentanil will not elevate IOP compared to baseline in pediatric strabismus surgery.