Effects comparison of esketamine and magnesium sulfate on hemodynamics,stress reaction and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy
- VernacularTitle:艾司氯胺酮与硫酸镁用于腹腔镜胆囊切除术对老年患者血流动力学、应激反应及术后镇痛的影响比较
- Author:
Song HOU
1
;
Zhengxiang AI
1
;
Shiqing HUO
1
Author Information
- Publication Type:Journal Article
- Keywords: esketamine; elderly; magnesium sulfate; laparoscopic cholecystectomy(LC); hemodynamics; stress reaction; analgesia
- From: China Journal of Endoscopy 2025;31(2):45-54
- CountryChina
- Language:Chinese
- Abstract: Objective To compare the effects of esketamine and magnesium sulfate on hemodynamics,stress reaction and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy(LC).Methods The subjects of this study,156 elderly patients who underwent LC from June 2021 to October 2023,were randomly divided into 3 groups,each with 52 cases.15 min prior to anesthesia induction,the esketamine group was administered with esketamine hydrochloride injection 0.20 mg/kg intravenously,magnesium sulfate group received intravenous infusion of magnesium sulfate injection 50.00 mg/kg,and physiological saline group received intravenous infusion of equivalent stroke-physiological saline solution.The heart rate(HR)and blood pressure(BP)of three groups were monitored using a monitor immediately after entering the room(T0),immediately after anesthesia induction(T1),immediately after tracheal intubation(T2),immediately after pneumoperitoneum(T3),immediately after cholecystectomy(T4),and immediately before tracheal extubation(T5).The levels of serum stress reaction indicators[cortisol(Cor)and norepinephrine(NE)]in three groups were tested at T0,T4,and T5 respectively.Intraoperative anesthetic dosage and use of atropine and phenylephrine,sufentanil dosage 24 h after surgery,awakening time,extubation time,and directional force recovery time were compared among the three groups.Patients'pain level was assessed respectively 2,6,12 and 24 h after the operation.Adverse reactions were compared among the three groups.Results The magnesium sulfate group and physiological saline group saw much lower HR,systolic blood pressure(SBP),and diastolic blood pressure(DBP)at T1 than they did at T0,the differences were statistically significant(P<0.05),while the physiological saline group had significant higher HR,SBP,DBP at T2,T3,T4,T5 than it did at T0,the differences were statistically significant(P<0.05).Compared with the esketamine group over the same period,the magnesium sulfate group showed a significant decrease in HR at T1 and T2,and a remarkable decrease in SBP and DBP at T1,the differences were statistically significant(P<0.05).At T1,HR,SBP,and DBP in the physiological saline group were much lower,while the HR,SBP,and DBP in this group at T2,T3,T4,and T5 were obviously higher than those in esketamine group,the differences were statistically significant(P<0.05).The physiological saline group witnessed much higher HR,SBP and DBP at T1,T2,T3,T4,T5 as compared with the magnesium sulfate group over the same period,the differences were statistically significant(P<0.05).All the three groups had significantly higher Cor and NE levels at T4 and T5 than they did at T0(P<0.05).The serum Cor and NE levels at T4 and T5 in the esketamine group and magnesium sulfate group were significantly lower than those in the physiological saline group during the same period,the differences were statistically significant(P<0.05).There was no significant difference in serum Cor and NE levels between the esketamine group and magnesium sulfate group at T4 and T5 over the same period,the differences were not statistically significant(P>0.05).The intraoperative consumption of propofol and remifentanil in the esmketamine group and the magnesium sulfate group were significantly less than those in the physiological saline group,and the esmketamine group was significantly more than the magnesium sulfate group(P<0.05).There were no significant difference in the utilization rate of intraoperative atropine and phenylephrine among the three groups(P>0.05).Sufentanil dosage 24 h after surgery in magnesium sulfate group and esketamine group were less than that of physiological saline group,the differences were statistically significant(P<0.05).However,there was no significant difference in the consumption of sufentanil dosage 24 h after surgery between the magnesium sulfate group and the esmketamine group(P>0.05).Extubation time and directional force recovery time in magnesium sulfate group and esketamine group were shorter than those of physiological saline group,the differences were statistically significant(P<0.05),but the differences were not statistically significant between the magnesium sulfate group and esketamine group(P>0.05).The pain visual analogue scale(VAS)score at 2,6,12,and 24 h after the operation in the esketamine group and magnesium sulfate group were significantly lower than those in the physiological saline group,the differences were statistically significant(P<0.05),but the differences were not statistically significant between the magnesium sulfate group and esketamine group(P>0.05).There was no significant difference in postoperative adverse reactions among the three groups(P>0.05).Conclusion In treating elderly people undergoing LC,esketamine and magnesium sulfate are alike in effects on stabilizing hemodynamics,inhibiting stress reaction,and mitigating postoperative pain.
