Effect of esketamine on negative postoperative behavioural outcomes after tonsillectomy in preschool children

doi:10.11958/20221915

Abstract

Abstract:

Objective To investigate the effect of esketamine on negative postoperative behavioral changes (NPOBCs) in preschool children after tonsillectomy. Methods Seventy eight preschool children with tonsillectomy were selected and divided into the test group and the control group by random number table method, with 39 cases in each group. During anesthesia induction, patients in the test group were intravenously injected with 0.5 mg/kg esketamine. In contrast, those of the control group were intravenously injected with 0.5 mg/kg normal saline in the same way. Heart rate (HR) and mean arterial pressure (MAP) of children were recorded at entering the operating room (T₀), 2 min after induction (T₁), intubation (T₂), the beginning of operation (T₃) and the recovery of spontaneous breathing (T₄). The paediatric anaesthesia emergence delirium (PAED) scores and m-CHEOPS were performed 30 min after operation, and the PHBQ scores were performed 7 and 30 days after operation. The occurrence of NPOBCs was recorded in the two groups. The operation time, recovery time, PACU stay time and negative postoperative behavioral changes were recorded. Results The PAED score and m-CHEOPS score were lower in the test group than those of the control group, and the differences were statistically significant (P<0.05 ). PAED score was positively correlated with the m-CHEOPS score (r_s=0.628, P<0.01). Separation anxiety at 7 days after operation was positively correlated with PAED score and m-CHEOPS score (r_s were 0.331 and 0.401, all P<0.01). The incidence of separation anxiety and overall NPOBCs was higher in children in the control group at day 7 postoperatively compared to those of the test group (P<0.05). The incidence of NPOBCs was higher at 7 days than that at 30 days post-operatively in the control group. The recovery time and PACU stay time were significantly lower in the test group than those in the control group (P<0.05). Conclusion Esketamine is beneficial to the rapid recovery of preschool children after tonsillectomy.

Key words: tonsillectomy, child, preschool, esketamine, negative postoperative behavioral changes

CLC Number:

R614.2

Figures/Tables 4

References 19

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组别		患儿
组别		性别（男/女）	年龄/月			BMI/（kg/m²）	ASA分级（Ⅰ/Ⅱ）
对照组		24/15	63.28±13.04			17.56±3.31	32/7
试验组		22/17	65.56±11.66			18.01±5.02	31/8
χ²或t		0.212	0.815			0.460	0.830
组别	监护人
组别	性别（男/女）			年龄/岁	学历（本科以下/本科及以上）
对照组	5/34			33.77±2.96	31/8
试验组	5/34			33.10±4.26	30/9
χ²或t	0.000			0.401	0.075

组别		患儿
组别		性别（男/女）	年龄/月			BMI/（kg/m²）	ASA分级（Ⅰ/Ⅱ）
对照组		24/15	63.28±13.04			17.56±3.31	32/7
试验组		22/17	65.56±11.66			18.01±5.02	31/8
χ²或t		0.212	0.815			0.460	0.830
组别	监护人
组别	性别（男/女）			年龄/岁	学历（本科以下/本科及以上）
对照组	5/34			33.77±2.96	31/8
试验组	5/34			33.10±4.26	30/9
χ²或t	0.000			0.401	0.075

组别		PAED评分/分		m-CHEOPS评分/分
对照组		12.28±1.12		3（3，3）
试验组		10.36±1.44		2（2，3）
t或Z		6.573^＊＊		3.954^＊＊
组别	手术时间/min		苏醒时间/min		PACU停留时间/min
对照组	32.87±13.79		13.18±3.71		12.72±2.45
试验组	33.72±12.79		11.08±4.36		10.74±2.23
t或Z	0.281		2.294^＊		3.721^＊＊

组别		PAED评分/分		m-CHEOPS评分/分
对照组		12.28±1.12		3（3，3）
试验组		10.36±1.44		2（2，3）
t或Z		6.573^＊＊		3.954^＊＊
组别	手术时间/min		苏醒时间/min		PACU停留时间/min
对照组	32.87±13.79		13.18±3.71		12.72±2.45
试验组	33.72±12.79		11.08±4.36		10.74±2.23
t或Z	0.281		2.294^＊		3.721^＊＊

组别		HR/（次/min）
组别		T₀			T₁	T₂			T₃		T₄		F
对照组	101.62±13.34				98.15±13.25	102.51±15.13^b			102.26±13.85^b		106.36±13.76^ab		8.205^＊＊
试验组	101.97±11.59				98.77±12.56	99.44±12.59			98.36±13.52		104.87±12.59^bcd		2.841^＊＊
t	0.127				0.210	0.976			1.258		0.498
组别			MAP/mmHg
组别			T₀	T₁			T₂	T₃		T₄		F
对照组			71.72±4.05	69.41±3.51^a			69.62±3.62^a	69.54±3.14^a		71.23±2.45^bcd		15.516^＊＊
试验组			71.41±3.41	69.51±3.58^a			68.77±3.33^ab	68.41±3.04^ab		70.67±2.86^bcd		14.160^＊＊
t			0.363	0.128			1.074	1.611		0.935