Effects of Esketamine-assisted Brachial Plexus Block Anesthesia on Hemo-dynamics,OAA/S Score and Stress Injury in Children Undergoing Surgery for Upper Limb Fractures
ZHANG Yu
MA Wei
LI Lei
GAO Yan
Abstract：Objective To investigate the effects of Esketamine-assisted brachial plexus block anesthesia on hemody-namics,observer's assessment of alertness/sedation(OAA/S)score and stress injury in children undergoing surgery for upper limb fractures.Methods A total of 120 children undergoing surgery for upper limb fractures from October 2021 to October 2023 were selected and divided into laryngeal mask general anesthesia group(n=60)and Esketamine group(n=60)by ran-dom number table method.Laryngeal mask general anesthesia-assisted brachial plexus block anesthesia was given in the laryn-geal mask general anesthesia group,while Esketamine-assisted brachial plexus block anesthesia was given in Esketamine group.Brachial plexus block anesthesia,anesthesia induction and anesthesia maintenance were the same in the two groups.Anesthesia-related indexes[duration of operation,length of postanesthesia care unit(PACU)stay,postoperative recovery time,Behavioral Pain Assessment Scale score]were compared between the two groups.The changes of mean arterial pressure(MAP)and heart rate(HR)before anesthesia(T0),at incision(T1),at 30 min after surgery(T2),at the end of surgery(T3),and at the time of recovery(T4),as well as OAA/S score and bispectral(BIS)index at T0,T1,T2 and T3 were compared.The levels of stress injury indexes[cortisol(Cor),epinephrine(E),norepinephrine(NE)and blood glucose]before and at 1 d after surgery,and the adverse reactions of anesthesia in the two groups were recorded.Results Length of PACU stay and postoperative recovery time in Esketamine group were shorter than those in laryngeal mask anesthesia group(P＜0.01).MAP and HR in the two groups increased first and then decreased at T0-T4,which were higher in Esketamine group than in laryngeal mask general anesthesia group at T1,T2 and T3(P＜0.05),but there was no statistical significance at T0 and T4(P＞0.05).OAA/S scores and BIS values in the two groups decreased first and then increased at T0-T3,which were slightly higher in Esketamine group than in laryngeal mask general anesthesia group at T1 and T2,but there was no sta-tistical significance between groups(P＞0.05).There was no significant difference in OAA/S score and BIS value at T0 and T3 between the two groups(P＞0.05).At 1 d after surgery,Cor,E,NE and blood glucose in the two groups were higher than those before surgery(P＜0.05),but there was no statistical significance between the two groups(P＞0.05).There was no significant difference in adverse reactions to anesthesia between the two groups(P＞0.05).Conclusion Esketamine-assisted brachial plexus block anesthesia has better sedation effect and can shorten the postoperative recovery time of children,but laryngeal mask general anesthesia-assisted brachial plexus block anesthesia has more advantages in maintaining the hemo-dynamic level during the operation,and neither of them will increase the postoperative stress injury and adverse reactions.
Keywords：Upper limb surgeryChildrenAnesthesiaEsketamineHemodynamicsObserver's assessment of alert-ness/sedationStress injury
Publication Date：2024-09-15
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 64-69 )