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Esketamine is an antagonist of the N-methyl-D-aspartate (NMDA) receptor and exerts antianxiety, hypnotic, sedative, and analgesic effects by interacting with NMDA receptors, opioid receptors, M - choline receptors, monoamine receptors, adenosine receptors, and other purine receptors. As the more potents isomer of ketamine, it is about twice as potent as ketamine. Compared with ketamine, esketamine has the characteristics of rapid onset and metabolism, strong analgesia, slight respiratory depression, rapid recovery of cognitive function, and low incidence of psychiatric side effects. It has become a new choice of pediatric anesthesia drugs. This article reviews the pharmacological properties of esketamine and its recent application in pediatric anesthesia, and provides reference for the safe use of esketamine in pediatric perioperative period.
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Remimazolam is a new ultra-short-acting sedative, with rapid onset and recovery, metabolism independent of liver and kidney function, light respiratory inhibition, stable hemodynamics, long time application without accumulation. Carboxylic acid metabolites have no pharmacological effects, and can be rapidly reversed by antagonist flumazenil, which is expected to become a new choice of clinical sedative. In this paper, pharmacological characteristics and recent research progress of remimazolam are reviewed, which can provide reference for clinical safe drug use.
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Objective To observe the effects of preoperative acute hypervolemic hemodilution (AHH) on coagulation and fibrinolysis on the elderly patients undergoing hepatic carcinectomy.Methods Thirty ASA Ⅰ～Ⅱ liver cancer patients over sixty years old undergoing scheduled elective hepatic carcinectomy were random divided into AHH group ( n = 15) and control group ( n = 15).AHH was performed by infusing 15 ～20ml/kg 6% Voluven ( 130/0.4) in a rate of 30ml/min on patients in AHH group,and the patients in control group were infused routinely lactated Ringer's solution.Blood samples were collected for measuring coagulation function and platelet activation before anesthesia (T1) ,30 minutes after AHH (T2),1 hour ( T3 ), immediately (T4) and 24 hours (T5) after operation in group AHH, and the similar procure was used in control group.Results There was significant difference in the volume of allergenic blood transfusions between the two groups(20% vs 53.3%, P ＜0.05).PT and APTT in both groups prolonged significantly after T2, but they all remained in normal range.TT and DD had no significant changes between the two groups.SFMC and F1 + 2 increased in both groups, but it had no significant changes.PAC-1 and CD62P expressions of group AHH were significantly lower T2, T3 ,respectively ( 1.37 ±0.4) %, (1.28 ±0.4) %, than those at T1 [( 1.96 ± 0.6) %] ( P ＜ 0.05 ).Compared with control group, CD62P was significantly lower in AHH group at T2 and T5.Conclusion It is safe to take AHH of Hct 25% to 30% during hepatic carcinectomy for elderly liver cancer patients without cardiac and pulmonary disease.And it could decrease allergenic blood transfusions, with no apparently influence on coagulation function.