Objective To investigate the effect of postoperative sleep disturbance by infusion of low dose esketamine during ambulatory laparoscopic cholecystectomy. Methods Patients undergoing ambulatory laparoscopic cholecystectomy under general anesthesia in General Hospital of Northern Theater Command between August and November 2024 were selected. They were randomly divided into esketamine group and control group based on a random number generator. Patients in the esketamine group received a continuous infusion of esketamine [0.3 mg/(kg·h)] during the operation. Patients in the control group received the equivalent volume of saline. The scores of the Athens Insomnia Scale on the first day before surgery, the first day after surgery, and the third day after surgery, the incidence of sleep disturbance and the Hospital Anxiety and Depression Scale score on the first day and the third day after surgery, mean artial pressure and heart rate during surgery, operation time, anesthesia time, recovery time, total dosage of remifetanil and vasoactive drug, postoperative adverse reactions, and the Visual Analogue Scale score on the day of surgery and the first day after surgery were compared between the two groups. Results A total of 105 patients were included, including 52 in the control group and 53 in the esketamine group. The differences were statistically significant in the incidence of sleep disorders on the first day after surgery (22.64% vs. 46.15%; χ2=6.440, P=0.011), the Athens Insomnia Scale score on the first day after surgery [4 (1.5, 5) vs. 5 (4, 7); Z=−2.933, P=0.003] , the cumulative amount of remifentanil used during surgery [884 (600, 1 112) vs. 572 (476, 872) μg; Z=−2.774, P=0.006], and the Visual Analogue Scale score on the day of surgery [2 (2, 3) vs. 3 (2, 3); Z=−2.488, P=0.013] between the esketamine group and the control group. There was no significant difference in mean arterial pressure, heart rate, operation time, anesthesia time, recovery time, vasoactive drug dosage, Hospital Anxiety and Depression Scale score or incidence of postoperative adverse reactions between the two groups (P＞0.05). Conclusion Continuous intraoperative infusion of low dose esketamine can improve postoperative sleep disturbance, without increasing the incidence of postoperative adverse reactions in patients undergoing ambulatory laparoscopic cholecystectomy.
ObjectiveThe Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) model and its Portsmouth (P-POSSUM) modification are used extensively to predict post-operative mortality and morbidity in general surgery. The aim was to analysis the predictive value of these models in patients undergoing hepatobiliary surgery. MethodsEligible articles were identified by searching such electronic databases as PubMed, The Cochrane Library (Issue 10, 2013), Science Citation Index, CNKI, WanFang Data and CBM from 1991 to October 2013. Each study was assessed according to the inclusion and exclusion criteria. Then data were extracted, pooled, and analyzed using Comprehensive Meta Analysis Version 2. ResultsTen studies were included. The morbidity analysis included five studies and 683 patients on POSSUM with a weighted O/E ratio 0.71 (95%CI 0.60 to 0.81). The mortality analysis included seven studies with 1 291 patients on POSSUM and six studies with 1 793 patients on P-POSSUM. Weighted O/E ratios for mortality were 0.42 (95%CI 0.27 to 0.57) for POSSUM and 0.74 (95%CI 0.53 to 0.95) for P-POSSUM. ConclusionPOSSUM significantly overestimates postoperative morbidity in patients undergoing hepatobiliary surgery. Compared with the original POSSUM, P-POSSUM is more accurate for predicting post-operative mortality. Modifications to POSSUM and P-POSSUM are needed for audit in hepatobiliary surgery.