Anästhesie zur Sectio caesarea

Adams, H A; Meyer, P; Stoppa, A. M.; Müller-Goch, A; Bayer, Péter; Hecker, H.

doi:10.1007/s00101-002-0440-4

Cited by 14 publications

(7 citation statements)

References 17 publications

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“…[7] Compared with opioids, esketamine has no significant effect of respiratory inhibitory, so it is used in pediatric anesthesia, obstetric anesthesia and auxiliary analgesia. [8] The results of this study showed that postoperative analgesia combined with esketamine can significantly reduce the amount of sufentanil and effective presses, and high-dose esketamine was significantly superior to medium and low doses. In addition, the rate of postoperative rescue analgesia and the occurrence of nausea and vomiting in the test group were significantly lower than those in the control group.…”

Section: Discussionmentioning

confidence: 92%

Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial

Wang

Ling

et al. 2022

Medicine

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Background: The aim of this randomized double-blind placebo controlled clinical trial was to investigate the effects of different doses of esketamine combined with sufentanil for postoperative intravenous controlled analgesia after cesarean section and the incidence of postpartum depression. Methods: One hundred and sixty patients undergoing elective cesarean section, with a singleton term pregnancy and American Society of Anesthesiologists physical status II were selected. All patients were treated by a combined epidural with spinal anesthesia. They were randomly divided into 4 groups according to patient controlled intravenous analgesia formula. The consumption of sufentanil, times of effective press and remediate analgesia at 48 hours after cesarean section, incidence of postpartum depression (PPD) at 1 week and 6 weeks after the operation were recorded. Results: Comparison of cumulated dosage of sufentanil, times of effective press and rescue analgesia at 48 hours after operation: Group H was significantly lower than Group M, Group L, and Group C (P < .05), Group M significantly lower than group L and Group C (P < .05), and Group L significantly lower than Group C (P < .05). Comparison of the incidence of PPD at 1 week and 6 weeks later: Group H was significantly lower than Group M, Group L, and Group C (P < .01), Group M significantly lower than Group L and Group C (P < .01) and Group L significantly lower than Group C (P < .01). Compared with Group C, the incidence of nausea and vomiting was significantly reduced in Group H, Group M, and Group L (P < .05). Conclusion: Esketamine combined with sufentanil used for patient controlled intravenous analgesia after elective cesarean section can reduce the consumption of sufentanil, improve postoperative analgesia, decrease the incidence of PPD at 1 week and 6 weeks and postoperative nausea and vomiting.

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Section: Discussionmentioning

confidence: 92%

Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial

Wang

Ling

et al. 2022

Medicine

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“…Esketamine can stimulate the sympathetic nervous system and increase blood pressure and heart rate, especially when given in high doses. 31 In the study by Zhang et al, 27 use of low-dose esketamine (0.15 mg/kg) was associated with a decreased incidence of hypotension during spinal anesthesia for cesarean delivery. It is therefore recommended that ketamine and esketamine should be considered for women undergoing elective cesarean delivery and at a high risk of hypotension.…”

Section: Discussionmentioning

confidence: 97%

“…Maternal hypotension frequently occurs during epidural anesthesia for cesarean delivery and, if severe, will lead to adverse maternal or fetal outcomes. Esketamine can stimulate the sympathetic nervous system and increase blood pressure and heart rate, especially when given in high doses . In the study by Zhang et al, use of low-dose esketamine (0.15 mg/kg) was associated with a decreased incidence of hypotension during spinal anesthesia for cesarean delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Ketamine was approved for clinical anesthesia in 1970. 32 For women undergoing cesarean delivery, ketamine or esketamine has been used for induction of general anesthesia, 31 as an adjuvant for neuraxial anesthesia, 11 , 27 or for postoperative analgesia. 33 Placental transfer is always a concern when administering ketamine before childbirth.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery

Wang

Deng

et al. 2023

JAMA Netw Open

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ImportanceEpidural anesthesia is a primary choice for cesarean delivery, but supplemental analgesics are often required to relieve pain during uterine traction.ObjectiveTo investigate the sedative and analgesic effects of intravenous esketamine administered before childbirth via cesarean delivery with the patient under epidural anesthesia.Design, Setting, and ParticipantsThis multicenter, double-blind randomized clinical trial assessed 903 women 18 years or older who had full-term single pregnancy and were scheduled for elective cesarean delivery with epidural anesthesia in 5 medical centers in China from September 18, 2021, to September 20, 2022.InterventionPatients were randomized to receive intravenous injection of 0.25 mg/kg of esketamine or placebo before incision.Main Outcomes and MeasuresThe coprimary outcomes included scores on the numeric rating scale of pain (an 11-point scale, with 0 indicating no pain and 10 indicating the worst pain; a difference of ≥1.65 points was clinically meaningful) and Ramsay Sedation Scale (a 6-point scale, with 1 indicating restlessness and 6 indicating deep sleep without response; a difference of ≥2 points was clinically meaningful) immediately after fetal delivery. Secondary outcomes included neonatal Apgar score assessed at 1 and 5 minutes after birth.ResultsA total of 600 women (mean [SD] age, 30.7 [4.3] years) were enrolled and randomized; all were included in the intention-to-treat analysis. Immediately after fetal delivery, the score on the numeric rating scale of pain was lower with esketamine (median [IQR], 0 [0-1]) than with placebo (median [IQR], 0 [0-2]; median difference, 0; 95% CI, 0-0; P = .001), but the difference was not clinically important. The Ramsay Sedation Scale scores were higher (sedation deeper) with esketamine (median [IQR], 4 [3-4]) than with placebo (median [IQR], 2 [2-2]; median difference, 2; 95% CI, 2-2; P &lt; .001). The neonatal Apgar scores did not differ between the 2 groups at 1 minute (median difference, 0; 95% CI, 0-0; P = .98) and at 5 minutes (median difference, 0; 95% CI, 0-0; P = .27). Transient neurologic or mental symptoms were more common in patients given esketamine (97.7% [293 of 300]) than in those given placebo (4.7% [14 of 300]; P &lt; .001).Conclusions and RelevanceFor women undergoing cesarean delivery under epidural anesthesia, a subanesthetic dose of esketamine administered before incision produced transient analgesia and sedation but did not induce significant neonatal depression. Mental symptoms and nystagmus were common but transient. Indications and the optimal dose of esketamine in this patient population need further clarification, but study should be limited to those who require supplemental analgesia.Trial RegistrationClinicalTrials.gov Identifier: NCT04548973

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“…Mix 1.3-1.5 MAC sevoflurane (Maruishi Pharmaceutical Co., Ltd., Osaka, Japan) in oxygen (30%) to maintain anesthesia, with positive-pressure ventilation using Carestation 650 anesthesia system (General-Electric Medical System (China) Co., Ltd., Wuxi, China). About 3 min before surgery began, the research drug, 0.5 mg kg À1 esketamine (Jiangsu Hengrui Pharmaceutical Co. Ltd., Lianyungang, China), 15,16 or 0.125 μg kg À1 sufentanil, was administered intravenously. Fluids given were determined by the length of fasting and the weight of the patient.…”

Section: Interventionsmentioning

confidence: 99%

Esketamine versus Sufentanil Applied Prior to Placement of Suspension Laryngoscope

et al. 2023

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ObjectiveIn laryngeal microsurgery, the insertion of the suspension laryngoscope is a strong stimulus that may cause hemodynamic fluctuations and adverse cardiovascular events. The purpose of this study was to compare the effect of preemptive treatment with esketamine and sufentanil on maintaining hemodynamics and reducing the occurrence of adverse cardiovascular events during the insertion of suspension laryngoscope.MethodsIn this double‐blind randomized controlled trial, patients undergoing general anesthesia for laryngeal microsurgery were randomly assigned (1:1) to esketamine 0.5 mg kg−1 (esketamine group) and sufentanyl 0.125 μg kg−1 (sufentanil group) before inserting the laryngoscope, respectively.ResultsDuring the insertion of suspension laryngoscope, the incidence of bradycardia (HR < 60 beats/min) was 39.3% (22/56) in esketamine group, lower than 60.0% (33/55) in sufentanil group (odds ratio [OR], 2.32 [95% CI, 1.11–5.08]; p = 0.029). The incidence of hypotension (MAP <65 mmHg) was 33.9% (19/56) in esketamine group, lower than 56.4% (31/55) in sufentanil group (odds ratio [OR], 2.52 [95% CI, 1.91–5.27]; p = 0.018). The frequency of hypotension in esketamine group was lower than that in sufentanil group (0.36 ± 0.52 vs. 0.56 ± 0.50, p = 0.035). The time‐weighted average of HR dropping above 30% of baseline was smaller in esketamine group than in sufentanil group (0.52 ± 2.06 vs. 1.08 ± 2.77, p = 0.006).ConclusionsThese findings showed that compared with preemptive treatment of sufentanil (0.125 μg kg−1), esketamine (0.5 mg kg−1) was effective in reducing the incidence of cardiovascular adverse events, including bradycardia and hypotension induced by the insertion of suspension laryngoscope during the laryngeal microsurgery.Level of Evidence2 Laryngoscope, 2023

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Anästhesie zur Sectio caesarea

Cited by 14 publications

References 17 publications

Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial

Effects of esketamine on analgesia and postpartum depression after cesarean section: A randomized, double-blinded controlled trial

Efficacy and Safety of Esketamine for Supplemental Analgesia During Elective Cesarean Delivery

Esketamine versus Sufentanil Applied Prior to Placement of Suspension Laryngoscope

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