Effect of additional equipotent fentanyl or sufentanil administration on recovery profiles during propofol-remifentanil-based anaesthesia in patients undergoing gynaecologic laparoscopic surgery: a randomized clinical trial

Inhibitory effect of low-dose esketamine on cough induced by sufentanil during the induction of anesthesia and postoperative impact on mental health status: a prospective, single-center, randomized controlled trial

BACKGROUND

Intravenous administration of sufentanil during anesthesia induction induces cough (SIC), sometimes triggers a severe reaction. We wanted to investigate the inhibitory effect of low-dose esketamine on cough induced by sufentanil during the induction of general anesthesia, as well as its postoperative impact on mental status (MMSE score, RSS, and VAS-A).

METHODS

A total of 256 adult patients were randomly allocated to receive either esketamine (Group EK) or normal saline (Group C). One minute before the administration of sufentanil, Group EK and Group C were injected with esketamine (0.05 mg/kg, diluted with normal saline to 3 ml) and normal saline (3 ml), respectively. The primary outcomes were the incidence (the basis of the presence or absence of cough) and severity (the frequency of cough episodes) of cough within 2 min after sufentanil injection.The secondary outcomes included hemodynamic variables (MAP, HR, and SPi), mental status (MMSE score, RSS, and VAS-A) and postoperative events (time to awareness, duration of orientation recovery and degree of satisfaction with anesthesia).

RESULTS

A total of 236 adult patients were randomized into two groups (n = 236): Group EK (n = 118) and Group C (n = 118). The incidence of cough in Group EK (21.2%) was significantly lower than that in Group C (40.7%) (P < 0.05). The incidence rates for each grade were as follows: 9.3% and 16.9% for Grade 2, and 0% and 4.2% for Grade 3, respectively.The differences had statistical senses.The MAP and HR at T4 (during tracheal intubation) and T5 (1 min post-intubation) were significantly lower in Group EK (P < 0.05). There were no significant differences in MMSE score, RSS, and VAS-A, time to awareness, duration of orientation recovery or satisfaction with anesthesia.

CONCLUSION

Pretreatment with low-dose esketamine can reduce the incidence and severity of cough induced by sufentanil and maintain hemodynamic stability during anesthesia induction without increasing mental status (MMSE score, RSS, and VAS-A).

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2400084940, date of registration: 05/28/2024).

Comparing Different Anesthesia Methods on Anesthetic Effect and Postoperative Pain in Patients with Early Gastric Cancer during Endoscopic Submucosal Dissection

Endoscopic submucosal dissection (ESD) is a minimally invasive technique to completely peel the pathological mucosa from the submucosa under endoscopy, which has been often utilized to treat early gastric cancer. During the operation, anesthesia is required to reduce the discomfort due to the complexity, high risk, and longtime operation of ESD. In this study, we compared different anesthesia methods on anesthetic effect and postoperative pain in patients (≥65 years old) with early gastric cancer during ESD. For this purpose, 60 patients with early gastric cancer who were more than 65 years old were selected from January 2019 to December 2021, where 30 patients treated with simple intravenous general anesthesia were divided into the simple group and 30 patients treated with intravenous combined inhalation general anesthesia were regarded as the composite group. The hemodynamic index, wake-up time, postoperative pain intensity, operation time, and the incidence of adverse reactions were compared between the two groups. For the hemodynamic index before incision, after incision, and at the end of the operation, the mean arterial pressure (MAP) in the composite group was higher than that in the simple group (P < 0.05) and the heart rate (HR) was lower than that in the simple group (P < 0.05). After the ESD operation, the wake-up time and visual analogue scale (VAS) in the composite group were lower than those in the simple group (P < 0.05). In addition, the ESD operation time and incidence of adverse reactions in the composite group was significantly lower than that in the simple group (P < 0.05). These results showed that intravenous combined inhalation general anesthesia had a good anesthetic effect, stable hemodynamics during ESD operation, and slight postoperative pain.