超声引导下腹横平面阻滞联合氯胺酮麻醉与单纯氯胺酮麻醉用于小儿腹股沟疝手术的临床效果

目的探讨超声引导下腹横平面阻滞联合氯胺酮麻醉与单纯氯胺酮麻醉用于小儿腹股沟疝手术的效果及安全性。 方法选择2018年9月至2020年3月川北医学院附属医院收治的80例腹股沟疝患儿作为研究对象,并按照麻醉方案的不同将患者分为观察组与试验组,每组患儿40例。观察组的麻醉方案为单纯氯胺酮静脉麻醉;试验组的麻醉方案为超声引导下腹横平面阻滞联合氯胺酮麻醉。对比2组患儿不同时间点[切皮前（T0）、切皮后10 min（T1）、切皮后15 min（T2）、探查疝囊（T3）]的生命体征、麻醉质量以及进入麻醉恢复室后不同时间点[进入即刻（T4）、进入后20 min（T5）、进入后40 min（T6）]的疼痛情况和镇静情况,及2组患儿的不良反应情况。 结果试验组患儿T1、T2、T3时心率、平均动脉压均显著低于观察组患儿（P<0.05）;2组患儿麻醉诱导时间对比,差异无统计学意义（P>0.05）;试验组苏醒时间均显著低于观察组患儿（P<0.05）;试验组患儿T4、T5、T6时东安大略儿童医院疼痛量表评分、Watcha镇静评分均显著低于观察组患儿（P<0.05）;试验组患儿的不良反应发生率显著低于观察组患儿（P<0.05）。 结论超声引导下腹横平面阻滞联合氯胺酮麻醉对小儿腹股沟疝手术的麻醉效果显著,其麻醉方案不仅能获得更稳定的需流动力学特征,缩短患儿的麻醉苏醒时间,还能改善患儿术后的疼痛及镇静情况。     

氯胺酮炎症调节作用围术期应用进展

背景 氯胺酮是临床上常用的麻醉药物,但其除了具有传统的麻醉作用外,近年来对氯胺酮抗炎作用的研究已经取得了较大进展. 目的 综述氯胺酮抗炎作用在临床应用中的研究进展,为其在围术期应用提供参考. 内容 氯胺酮有炎症调节作用,能够及时防止局部炎症反应的恶化,又避免了过度抑制促炎反应.氯胺酮是免疫调节剂,而非免疫抑制剂. 趋向 如何优化氯胺酮的给药剂量、方式和时机,是未来的研究趋势.     

氯胺酮对疼痛抑郁共病大鼠行为学及吲哚胺2,3二加氧酶信号通路的影响

目的观察氯胺酮对疼痛抑郁共病大鼠行为学及吲哚胺2,3二加氧酶(IDO)信号通路的影响。方法健康成年雄性SD大鼠24只,2月龄,体重200~250g,随机分为三组:对照组(S组)、生理盐水组(N组)和氯胺酮组(K组),每组8只。N组及K组大鼠均接受右踝关节腔内完全弗氏佐剂(CFA)50μl注射,建立疼痛抑郁共病模型;S组大鼠则注射生理盐水50μl作为对照。CFA注射后1、7、14d分别测定机械性缩足反射阈值(MWT)及不动时间。第14天行为学测试后,N组大鼠腹腔注射生理盐水1ml,K组则注射20 mg/kg氯胺酮1 ml。三组大鼠于腹腔注射后1h测定MWT及不动时间。随后取大鼠海马、前额皮层、扣带回组织及血浆,采用ELISA法测定IL-6浓度及IDO活性。结果与S组比较,N组及K组CFA注射后1、7、14dMWT明显降低(P0.05),CFA注射后7、14d不动时间明显延长(P0.05)。与N组比较,K组MWT明显升高(P0.05),不动时间明显缩短(P0.05),大鼠海马、前额皮层、扣带回IL-6浓度和IDO活性均明显下降(P0.05)。结论氯胺酮可有效治疗疼痛抑郁共病,这可能与其抑制大鼠不同脑区IDO信号通路活性有关。     

Study pharmacologic of the GABAergic and glutamatergic drugs on seizures and status epilepticus induced by pilocarpine in adult Wistar rats

This work was designed to study the influence of drugs during seizures and status epilepticus (SE) induced by pilocarpine and mortality in adult rats. Glutamate (10 and 20 mg/kg), N-methyl-d-aspartate (NMDA, 5 and 10 mg/kg), ketamine (1.5 and 2.0 mg/kg), gabapentin (200 and 250 mg/kg), phenobarbital (50 and 100 mg/kg) and vigabatrin (250 and 500 mg/kg) were administered intraperitoneally, 30 min prior to pilocarpine (400 mg/kg, i.p.). The animals were observed (24 h) to determine: number of peripheral cholinergic signs, tremors, stereotyped movements, seizures, SE, latency to first seizure and number of deaths after pilocarpine treatment. NMDA and glutamate had pro-convulsive effects in both doses tested. Smaller and higher doses of these drugs no protected and increased pilocarpine-induced seizures and/or mortality. Gabapentin, vigabatrin, phenobarbital and ketamine protected against seizures and increased the latency to first seizure. Thus, these results suggest that caution should be taken in the selection of pharmacotherapy and dosages for patients with seizures and SE because of the possibility of facility the convulsive process toxicity, SE and the mortality of adult animals in this seizures model that is similar temporal lobo epilepsy in humans.     

Rapid antidepressant effect of S-ketamine in schizophrenia

Rapid anti-suicidal and antidepressant effects of ketamine have repeatedly been confirmed in unipolar and bipolar depression. Although meaningful antidepressant efficacy of ketamine has also been shown in depressed patients with a history of psychotic symptoms, its administration in psychotic disorders has largely been neglected due to its potential to exacerbate dissociative or psychotic symptoms. Presenting a case of a young female inpatient suffering from schizophrenia with a severe post-psychotic depression, we demonstrate a robust anti-suicidal and antidepressant effect of S-ketamine infusions administered thrice weekly for 3 weeks in total. Importantly, no relevant psychotic or dissociative symptoms occurred during the whole augmentation treatment period leading to a sustained remission of depressive symptoms and suicidality. Our safe and effective experience with intravenous S-ketamine might encourage researchers and clinicians to widen its administration range beyond the diagnosis of depression to enrich the current knowledge of ketamine effects in psychotic disorders.     

Regulation of cytochrome P450 gene expression by ketamine: a review

Introduction: Although used as an anesthetic drug for decades, ketamine appears to have garnered renewed interest due to its potential therapeutic uses in pain therapy, neurology, and psychiatry. Ketamine undergoes extensive oxidative metabolism by cytochrome P450 (CYP) enzymes. Considerable efforts have been expended to elucidate the ketamine-induced regulation of CYP gene expression. The safety profile of chronic ketamine administration is still unclear. Understanding how ketamine regulates CYP gene expression is clinically meaningful.

Areas covered: In this article, the authors provide a brief review of clinical applications of ketamine and its metabolism by CYP enzymes. We discuss the effects of ketamine on the regulation of CYP gene expression, exploring aspects of cytoskeletal remodeling, mitochondrial functions, and calcium homeostasis.

Expert opinion: Ketamine may inhibit CYP gene expression through inhibiting calcium signaling, decreasing ATP levels, producing excessive reactive oxygen species, and subsequently perturbing cytoskeletal dynamics. Further research is still needed to avoid possible ketamine–drug interactions during long-term use in the clinic.     

Suicidal behavior-advances in clinical and neurobiological research and improvement of prevention strategies

Suicide is the 14^th leading cause of death worldwide. It is responsible for 1%-5% of all mortality. This article highlights the latest developments in universal, selective, and indicated prevention strategies. Concerning universal suicide prevention, current research has shown that strategies such as restricting access to lethal means (e.g., control of analgesics and hot-spots for suicide by jumping) and school-based awareness programs are most efficacious. Regarding selective prevention, substantial progress can be expected in psychological screening methods for suicidal behavior. The measurement of implicit cognition proved to be more valid in predicting future suicide attempts than classic clinical assessment. Latest developments are smartphone-based interventions and real-time monitoring of suicidal behavior. Great effort has been made to establish valid neurobiological screening methods (e.g., genetic and epigenetic risk factors for suicide, hypothalamic-pituitary-adrenal axis) without yielding a major bre-akthrough. Potentially, multiple biomarkers rather than a single one are necessary to identify individuals at risk. With regard to indicated prevention in form of psychopharmacological treatment, recent pharmacoepidemiological studies and meta-analyses have supported a protective role of antidepressants, lithium, and clozapine. However, the data concerning a specific anti-suicidal effect of these drugs are currently not consistent. Promising results exist for ketamine in reducing suicidal ideation, independently of its antidepressant effect. Concerning psychotherapy, recent findings suggest that psychotherapeutic interventions specifically designed to prevent suicide re-attempts are most efficacious. Specifically, cognitive behavioral therapy and psychodynamic therapy approaches proved to decrease the number of suicide re-attempts significantly.     

听觉诱发电位指数对无痛人流术麻醉深度的调控

目的评价异丙酚和异丙酚复合氯胺酮用于无痛人工流产的临床效果。方法50例早期妊娠分成异丙酚组（Ⅰ组）和异丙酚复合氯胺酮组（Ⅱ组）各25例，观察两组用药总量、手术各时点听觉诱发电位指数（AAI）、呼吸循环参数改变。采用A—LINE无创麻醉深度监测仪监测AAI值。结果Ⅰ组异丙酚用量明显多于Ⅱ组；两组AAI值在给药后及整个手术期间均明显降低（P〈0．01），Ⅱ组AAI下降的时间及恢复时间滞后于Ⅰ组，Ⅰ组在术后7分钟、Ⅱ组在术后10分钟升至给药前水平；给药后两组平均动脉压（MAP）均有下降（P〈0．05）；Ⅱ组与Ⅰ组相比，SpO2在给药后、手术开始时、手术1分钟及术后1、4分钟时差异有显著性意义（P〈0．05）；Ⅰ组在给药后、手术前4分钟与术后前4分钟SpO2降低（P〈0．05），Ⅱ组SpO2在给药后各时点无明显变化；Ⅰ组术中体动6例，Ⅱ组中无体动。结论AAI的监测更能保证手术的顺利进行和患者的安全。     

靶控输注丙泊酚-氯胺酮静脉麻醉在剖宫产手术中的临床观察

目的：探讨靶控输注丙泊酚-氯胺酮静脉麻醉在剖宫产手术中的临床效果。方法172例择期剖宫产术的产妇,分为观察组86例和对照组86例。观察组采用静脉复合麻醉,麻醉药为丙泊酚、氯胺酮,进行靶控输注。对照组采用脊麻。对观察组和对照组胎儿娩出前和胎儿娩出后产妇的血氧饱和度（SpO2）、心率（HR）、收缩压（SBP）和舒张压（DBP）进行监测,新生儿1 min、5 min和10 min时的Apgar评分进行记录。结果观察组和对照组在胎儿娩出前、后SpO2、HR、SBP、DBP比较差异无统计学意义（P＞0.05）,新生儿1 min、5 min和10 min时的Apgar评分比较差异无统计学意义（P＞0.05）。结论在剖宫产手术中应用靶控输注丙泊酚-氯胺酮静脉麻醉是可行的。     

Use of naltrexone in ketamine dependence

Ketamine is used as a cheap alternative to anaesthetic agents in developing countries. It is also misused as a rave drug because of its psychedelic effect. There are no guidelines for effective management of ketamine withdrawal effects or dependence. Herein we report a case of ketamine dependence and its successful treatment with opioid receptor antagonist naltrexone.