Interventions
Pain, sinus bradycardia, blood loss, hallucinatory, pain, dizziness, GDM, nausea, vomiting
SINUS BRADYCARDIA, BLOOD LOSS, GDM, ADVERSE EFFECTS, DECUBITUS
We screened 150 patients with GDM undergoing elective cesarean section, and then 140 patients were enrolled based on inclusion, exclusion and withdrawal criteria. They were randomly divided into the esketamine (S) group, esketamine 0.5 mg/kg + sufentanil 150ug + ondansetron 4mg and the control (C) group,sufentanil 150ug + ondansetron 4mg, with 70 in each group.Maternal blood glucose was checked on the morning of the cesarean section. Maternal age, height, weight, gestational week and cesarean section data were recorded. The patients fasted from solid foods for >6 hours and from alcohol for 2 hours before the operation, and no premedication was administrated before the surgery. Patients were educated how to use the PCA pump (FORNIA pump model CPE-101, Zhuhai California Medical Equipment Co., Ltd.) and how to assess pain using a Visual Analog Scale (VAS) before surgery.After entering the operation room, noninvasive blood pressure (NBP), electrocardiogram (ECG), HR, and SPO2 were standard monitored. Oxygen was administered via nasal catheter at 2L/min, compound sodium chloride was injected. The anesthesiologist adjusted the infusion rate according to the patient’s circulatory status. All patients were placed in the left decubitus position, received CSEA at L3-4 space using the needle-through-needle technique. After the epidural space was identified, a spinal needle was used to puncture the dura mater and enter the subarachnoid space, with 15mg ropivacaine was diluted with cerebrospinal fluid to 2 ml for intrathecal injection, and the epidural catheter was immediately inserted cephalad 3–4 cm. The patients were positioned supine and tilted 15° to the left until fetal extraction. The operation was started when T6 was blocked, and additional ropivacaine can be added to the epidural if necessary. The mean intraoperative blood pressure was maintained at ≥65 mmHg, and if the mean blood pressure fell below 65 mmHg, methoxamine was administered and repeated as needed; in addition, in the case of sinus bradycardia (heart rate <50 bpm), 0.3 mg of intravenous atropine was administered and repeated as needed. After delivery, flurbiprofen ester 50 mg and ondansetron 4 mg are administered intravenously. The epidural catheter was removed at the end of the procedure. The duration of the procedure and the blood loss were recorded. After surgery, use PCA pump. Group S received esketamine 0.5mg/kg + sufentanil 150µg + ondansetron 4mg, and group C received sufentanil 150µg + ondansetron 4 mg, both were diluted to 100ml with saline, the sufentanil concentration was1.5ug/mL, the maintenance dose was 2ml/h, PCA bolus 2 ml at lock out interval of 15 minutes. If the VAS score was ≥7, flurbiprofen was readministered and the patient was excluded from the group. Research assistant who was blinded to the randomization recorded the patients’ PCA pump use (sufentanil consumption), and any adverse effects, such as nausea, vomiting, dizziness, and hallucinatory symptoms. Pain was assessed using the score VAS at 6, 24, and 48 hours postoperatively, with “0 “ indicating no pain and “10 “ indicating the most severe pain imaginable. The time to bowel function return, time to first lactation, and neonatal neurobehavioral scores were recorded.