The safety and efficacy of esketamine in comparison to dexmedetomidine during drug-induced sleep endoscopy in children with obstructive sleep apnea hypopnea syndrome: A randomized, controlled and prospective clinical trial.

Background and Purpose: Data and high-quality studies of anesthetic methods for children with obstructive sleep apnea hypopnea syndrome (OSAHS) who undergo drug-induced sleep endoscopy (DISE) are limited. Research on pediatric DISE using esketamine has never been reported before. To test the safety and efficacy of esketamine during DISE in children with OSAHS, we compare esketamine (Group K) with dexmedetomidine (Group D) in this study. Methods: 100 children with ASA Ⅰ∼Ⅱ grade, prepared for an elective adenotonsillectomy under general anesthesia, were enrolled in this study and randomized into two groups. Midazolam 0.1 mg/kg was administered intravenously for both groups. In Group D a 1 µg/kg bolus of dexmedetomidine was given over 10 min followed by the infusion rate 1 µg/kg/hr to the end of DISE. Group K received a 1.0 mg/kg IV bolus of esketamine over 10 s followed by the infusion rate 1 mg/kg/hr to the end of DISE. Results: Group K had a higher percentage of success than Group D (p = 0.008). The onset time of Group K was shorter than that of Group D (p = 0.000). The University of Michigan Sedation Scale (UMSS) score of Group K was higher than that of Group D (p = 0.005). The risk of adverse effects (AEs) was lower in Group K (p = 0.000). In Group D, systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) all decreased, while in Group K, SBP, DBP, and HR hardly changed. Conclusion: Esketamine in comparison to dexmedetomidine provides more effective and safer depth of anesthesia for OSAHS pediatric DISE by ensuring short onset time, deep sedation, and few AEs. Clinical Trial Registration: ClincalTrials.gov, identifier NCT04877639.

Research progress about effects of lung protective ventilation strategy on respiratory function in the elderly with laparoscopic surgery / 中国医师杂志

With the further study of the ventilation model,pulmonary protective ventilation has been paid increasing attention by more and more scholars.Recent studies have shown that lung protective ventilation strategy has been proved to improve oxygenation and reduce postoperative pulmonary complications.Due to the special physiological function of the elderly,they are more likely to have postoperative pulmonary complications after mechanical ventilation.The article discusses which ventilation mode is more suitable for elderly patients undergoing laparoscopic surgery.This article reviews some theories about the physiological function of the elderly,and the effect of laparoscopy on the respiratory function of the elderly.It also reviews the related progress and controversy of low tidal volume,positive end expiratory pressure,recruitment maneuvers and other pulmonary protective strategies.