Objective: To investigate the effect of remimazolam combined with esmketamine adjuvant medicines on anaesthetic effect and mental symptom in puerperae undergoing cesarean section.
Methods: Ninety-six full-term puerperae during cesarean section under combined spinal-epidural anesthesia, aged 24-38 years, BMI 24-35 kg/m2, ASA physical status Ⅰ or Ⅱ. All the puerperae were divided into three groups using random number table: remimazolam combined with esketamine group (group RK), esketamine group (group K), and control group (group C), 32 puerperae in each group. After the delivery of the fetus, puerperae in group RK were given intravenous injection of remimazolam 0.1 mg/kg, and then intravenous pumping of estaketamine 0.25 mg/kg which was diluted to 20 ml with normal saline (finished in 30 minutes), puerperae in group K were given intravenous pumping of estaketamine 0.25 mg/kg which was diluted to 20 ml with normal saline (finished in 30 minutes), puerperae in group C were given the same dose of normal saline. All puerperae were given PCIA after operation. The anesthetic effect from the fetus delivery to the end of operation were recorded (grade Ⅰ, no pain; grade Ⅱ, slight pain; grade Ⅲ, with significant pain). The adverse reactions such as hypertension, tachycardia, and mental symptoms (nystagmus, dizziness, nightmares and hallucinations) during surgery were recorded. The score of Edinburgh postpartum depression scale (EPDS) and incidence of postpartum depression (PPD) at 1 week and 4 weeks after surgery were recorded.
Results: Compared with group C, the proportion of grade Ⅰ anesthetic effect in groups, RK and K was significantly increased, and the proportion of grade Ⅲ anesthetic effect was significantly decreased (P < 0.05), the EPDS score and the incidence of PPD were significantly decreased at 1 week and 4 weeks after surgery (P < 0.05). Compared with group K, the incidence of mental symptoms during surgery in group RK was significantly decreased (P < 0.05), EPDS score was significantly decreased at 1 week and 4 weeks after surgery (P < 0.05). There were no significant differences in the incidences of hypertension, tachycardia between the three groups.
Conclusion: Remimazolam combined with esketamine for cesarean section can improve the anesthetic effect during surgery, reduce the incidence of intraoperative mental sympton, decrease the postpartum EPDS score, optimize postpartum depression. |
