艾司氯胺酮的临床麻醉应用进展

岩 王(承德医学院附属医院，中国)
莺春 宋(承德医学院附属医院，中国)
丽娜 张(承德医学院附属医院，中国)
子薇 张(承德医学院附属医院，中国)
韵超 郄(承德医学院附属医院，中国)

摘要

艾司氯胺酮是氯胺酮的右旋异构体，主要通过非竞争性结合NMDA受体发挥镇静、镇痛作用。艾司氯胺酮在药理作用上与氯胺酮相似，但麻醉效价更高、镇静镇痛效果强、对呼吸抑制轻微、术中血流动力学平稳、苏醒时间更短，不良反应少。此外，艾司氯胺酮兼具有快速抗抑郁作用，目前已被广泛应用于治疗难治性抑郁症，效果安全可靠。作为一种新型的麻醉药物，艾司氯胺酮临床中获得了广泛关注，论文拟对艾司氯胺酮作用机制、在临床麻醉中的应用及疼痛管理方面进行综述，为临床用药提供借鉴和参考。

关键词

艾司氯胺酮；作用机制；临床麻醉；疼痛管理

参考

ZHANG J, WANG F, DANG J, et al. Effect of Intraoperative

Infusion of Esketamine on Quality of Postoperative Recovery

in Patients Undergoing Laparoscopic Bariatric Surgery: A

Randomized Controlled Trial[J]. Pain Ther, 2023,12(4): 979-992.

LEI Y, LIU H, XIA F, et al. Effects of Esketamine on Acute and

Chronic Pain After Thoracoscopy Pulmonary Surgery Under

General Anesthesia: A Multicenter-Prospective, Randomized,

Double-Blind, and Controlled Trial[J]. Front Med (Lausanne),

,8: 693594.

SUBRAMANIAN S, HAROUTOUNIAN S, PALANCA B,

et al. Ketamine as a therapeutic agent for depression and pain:

mechanisms and evidence[J]. J Neurol Sci, 2022,434: 120152.

LIU P, ZHANG S S, LIANG Y, et al. Efficacy and Safety of

Esketamine Combined with Antidepressants for TreatmentResistant Depression: A Meta-Analysis[J]. Neuropsychiatr Dis

Treat, 2022,18: 2855-2865.

YANG Y, MAHER D P, COHEN S P. Emerging concepts on the

use of ketamine for chronic pain[J]. Expert Rev Clin Pharmacol,

,13(2): 135-146.

JAVORCIKOVA Z, DANGOISSE M, NIKIS S, et al. The place of

S-ketamine in fibromyalgia treatment (ESKEFIB): study protocol

for a prospective, single-center, double-blind, randomized, parallelgroup, dose-escalation controlled trial[J]. Trials, 2021,22(1): 853.

MA X, YAN J, JIANG H. Application of Ketamine in Pain

Management and the Underlying Mechanism[J]. Pain Res Manag,

,2023: 1928969.

ZANOS P, MOADDEL R, MORRIS P J, et al. Ketamine and

Ketamine Metabolite Pharmacology: Insights into Therapeutic

Mechanisms[J]. Pharmacol Rev, 2018,70(3): 621-660.

PHAM T H, DEFAIX C, NGUYEN T, et al. Cortical and raphe

GABA(A), AMPA receptors and glial GLT-1 glutamate transporter

contribute to the sustained antidepressant activity of ketamine[J].

Pharmacol Biochem Behav, 2020,192: 172913.

HESS E M, RIGGS L M, MICHAELIDES M, et al. Mechanisms

of ketamine and its metabolites as antidepressants[J]. Biochem

Pharmacol, 2022,197: 114892.

PEREIRA V S, ROMANO A, WEGENER G, et al. Antidepressantlike effects induced by NMDA receptor blockade and NO

synthesis inhibition in the ventral medial prefrontal cortex of rats

exposed to the forced swim test[J]. Psychopharmacology (Berl),

,232(13): 2263-2273.

ZANOS P, GOULD T D. Mechanisms of ketamine action as an

antidepressant[J]. Mol Psychiatry, 2018,23(4): 801-811.

MCINTYRE R S, ROSENBLAT J D, NEMEROFF C B, et

al. Synthesizing the Evidence for Ketamine and Esketamine

in Treatment-Resistant Depression: An International Expert

Opinion on the Available Evidence and Implementation[J]. Am J

Psychiatry, 2021,178(5): 383-399.

TRIMMEL H, HELBOK R, STAUDINGER T, et al. S(+)-ketamine :

Current trends in emergency and intensive care medicine[J]. Wien

Klin Wochenschr, 2018,130(9-10): 356-366.

PERSSON J, HASSELSTROM J, MAURSET A, et al.

Pharmacokinetics and non-analgesic effects of S- and R-ketamines

in healthy volunteers with normal and reduced metabolic

capacity[J]. Eur J Clin Pharmacol, 2002,57(12): 869-875.

HUANG J, LIU D, BAI J, et al. Median effective dose of

esketamine for intranasal premedication in children with

congenital heart disease[J]. BMC Anesthesiol, 2023,23(1): 129.

FRESTADIUS A, GREHN F, KILDAL M, et al. Intranasal

dexmedetomidine and rectal ketamine for young children undergoing

burn wound procedures[J]. Burns, 2022,48(6): 1445-1451.

LI J, WANG Z, WANG A, et al. Clinical effects of low-dose

esketamine for anaesthesia induction in the elderly: A randomized

controlled trial[J]. J Clin Pharm Ther, 2022,47(6): 759-766.

ZHOU N, LIANG X, GONG J, et al. S-ketamine used during

anesthesia induction increases the perfusion index and mean

arterial pressure after induction: A randomized, double-blind,

placebo-controlled trial[J]. Eur J Pharm Sci, 2022,179: 106312.

ZHANG Y Y, ZHU S, YANG X, et al. Esketamine versus Sufentanil

Applied Prior to Placement of Suspension Laryngoscope[J].

Laryngoscope, 2023,133(11): 3021-3027.

LIU F, KONG F, ZHONG L, et al. Preoperative Esketamine Alleviates

Postoperative Pain after Endoscopic Plasma Adenotonsillectomy in

Children[J]. Clin Med Res, 2023,21(2): 79-86.

TAN M, ZHANG C, ZENG W, et al. Determining the effective61

dose of esketamine for mitigating pain during propofol injection by

Dixon’s up-and-down method: a double-blind, prospective clinical

study of drug dose response[J]. BMC Anesthesiol, 2022,22(1): 368.

XU Y, HE L, LIU S, et al. Intraoperative intravenous low-dose

esketamine improves quality of early recovery after laparoscopic

radical resection of colorectal cancer: A prospective, randomized

controlled trial[J]. PLoS One, 2023,18(6): e286590.

MA J, WANG F, WANG J, et al. The Effect of Low-Dose Esketamine

on Postoperative Neurocognitive Dysfunction in Elderly Patients

Undergoing General Anesthesia for Gastrointestinal Tumors: A

Randomized Controlled Trial[J]. Drug Des Devel Ther, 2023,17:

-1957.

YUAN J, CHEN S, XIE Y, et al. Intraoperative Intravenous

Infusion of Esmketamine Has Opioid-Sparing Effect and Improves

the Quality of Recovery in Patients Undergoing Thoracic Surgery:

A Randomized, Double-Blind, Placebo-Controlled Clinical Trial[J].

Pain Physician, 2022,25(9): E1389-E1397.

QIU D, WANG X M, YANG J J, et al. Effect of Intraoperative

Esketamine Infusion on Postoperative Sleep Disturbance After

Gynecological Laparoscopy: A Randomized Clinical Trial[J].

JAMA Netw Open, 2022,5(12): e2244514.

REN Q, HUA L, ZHOU X, et al. Effects of a Single Sub-Anesthetic

Dose of Ketamine on Postoperative Emotional Responses and

Inflammatory Factors in Colorectal Cancer Patients[J]. Front

Pharmacol, 2022,13: 818822.

GAN S L, LONG Y Q, WANG Q Y, et al. Effect of esketamine

on postoperative depressive symptoms in patients undergoing

thoracoscopic lung cancer surgery: A randomized controlled

trial[J]. Front Psychiatry, 2023,14: 1128406.

XU C, HE L, REN J, et al. Efficacy and Safety of Remimazolam

Besylate Combined with Alfentanil in Painless Gastroscopy: A

Randomized, Single-Blind, Parallel Controlled Study[J]. Contrast

Media Mol Imaging, 2022,2022: 7102293.

ZHAN Y, LIANG S, YANG Z, et al. Efficacy and safety of

subanesthetic doses of esketamine combined with propofol in

painless gastrointestinal endoscopy: a prospective, double-blind,

randomized controlled trial[J]. BMC Gastroenterol, 2022,22(1): 391.

ZHENG L, WANG Y, MA Q, et al. Efficacy and Safety of a

Subanesthetic Dose of Esketamine Combined with Propofol

in Patients with Obesity Undergoing Painless Gastroscopy: A

Prospective, Double-Blind, Randomized Controlled Trial[J]. Drug

Des Devel Ther, 2023,17: 1347-1356.

LU C, REN J, GUO X, et al. Effects of Remimazolam Combined

with Esketamine Anesthesia on Circulatory and Respiratory

Function during Painless Gastroenteroscopy[J]. Contrast Media

Mol Imaging, 2022,2022: 1079099.

FENG Y, Du T, WANG J, et al. Low dose of esketamine combined

with propofol in painless fibronchoscopy in elderly patients[J].

Medicine (Baltimore), 2022,101(50): e31572.

GAN T J. Poorly controlled postoperative pain: prevalence,

consequences, and prevention[J]. J Pain Res, 2017,10: 2287-2298.

WANG P, SONG M, WANG X, et al. Effect of esketamine on

opioid consumption and postoperative pain in thyroidectomy: A

randomized controlled trial[J]. Br J Clin Pharmacol, 2023,89(8):

-2551.

RICCARDI A, GUARINO M, SERRA S, et al. Narrative Review:

Low-Dose Ketamine for Pain Management[J]. J Clin Med,

,12(9).

de KONING R, ZWART G, DAHAN A, et al. Esketamine in the

treatment of chronic endometriosis-induced pain: a case report[J].

Journal of Endometriosis and Pelvic Pain Disorders, 2023,15(1):

-52.

CALSINA-BERNA A, ALVARO P M, CUCURULL S M, et al.

Oral ketamine for neuropathic cancer pain[J]. BMJ Support Palliat

Care, 2023.

FEENEY A, PAPAKOSTAS G I. Pharmacotherapy: Ketamine and

Esketamine[J]. Psychiatric Clinics, 2023.

DOI: http://dx.doi.org/10.12345/yzlcyxzz.v6i12.14888