Discussion
tumor, mental illness, malignancy, lung tumor, nausea and vomiting, necrotic, pain, PONV, necrosis, cardiac and cardiopulmonary diseases, chronic pain, hyperthermia
TUMOR, ADVERSE EVENTS, LUNG TUMOR, EVENTS, MOTION SICKNESS, NECROTIC, DRUG INTERACTION, NECROSIS, CHRONIC PAIN, RESPIRATORY DEPRESSION, COMPLICATIONS, INFLAMMATORY RESPONSE
This study shows that a single low dose of Esketamine or Sufentanil combined with Dexmedetomidine is both safe and effective for sedation in lung tumor PRFA. Esketamine combined with dexmedetomidine was superior to sufentanil combined with dexmedetomidine because of the better anesthetic controllability, smoother hemodynamics and shorter recovery time.PRFA is based on hyperthermia, which causes localized tumor coagulation and necrosis [Propofol is still the most commonly used sedative drug for short procedures outside the operating room, but it has almost no analgesic effect and may suffer from hemodynamic fluctuation, insufficient arousal and respiratory depression. The majority of these surgical procedures are for elderly and palliative care patients with malignancy, who are more likely to have cardiac and cardiopulmonary diseases. We should be cautious about the type and dosage of sedative drugs we use.Dexmedetomidine is regularly used for pre-operative and/or intra-operative and other procedural sedation in non-intubated patients, and for sedation of patients who are on ventilators in the intensive care unit. In previous studies on the dosage of Dexmedetomidine for awake fiberoptic nasotracheal intubation(AFOI), the loading dose (0.4–1.5 μg/kg over 10 or 15 min) and the maintenance dose (0-0.7 μg/kg·h) provided an acceptable level of sedation for patients to remain responsive and cooperative [Sufentanil is a kind of μ-opioid receptor agonist that is approximately 5 to 10-fold more potent in analgesia than Fentanyl [In clinical practice, synergistic or additive effects are often observed when sedative-hypnotic drugs are used in combination with opioid analgesics [In addition to widely used in general anaesthesia surgery, acute pain and chronic pain treatments, Esketamine has good clinical applications in the treatment of mental illness, emergency and critical illnesses.The effectiveness of Dexmedetomidine in combination with Ketamine for procedural sedation is well documented [Although the depth of sedation is relatively mild, multiple complications have the potential to occur in the perioperative period. Respiratory events due to poor oxygen supply or ventilation are the most common adverse events during extraoperative anesthesia [It has been shown that the inflammatory response to necrotic tissue after ablation is a risk factor for PONV. In addition, preoperative nausea and vomiting, female sex, a history of PONV or motion sickness, age (> 50 years old), chemotherapy, and nonsmokers are all risk factors for PONV [There are some notable limitations to our study. First, we used only a single dose of Esketamine or Sufentanil, which may not be the most appropriate dose. Second, as a single center and a small number of randomized controlled trials (RCTs), further randomized controlled trials in multiple centers and more patients are needed to confirm our findings. Third, the large interference in monitoring the respiratory rate prevents us from accurately monitoring the patient’s respiratory rate. Finally, as a clinical study, further studies are needed to confirm the drug interaction between Esketamine and Dexmedetomidine.