Effect of lidocaine on median effective dose of esketamine for children undergoing circumcision

doi:10.3969/j.issn.1674-8115.2022.12.008

Abstract

Abstract:

Objective ·To evaluate the median effective dose (ED₅₀) and cardiovascular stability of esketamine in combination with lidocaine for pediatric patients undergoing circumcision. Methods ·Children aged 3?7 years selected for circumcision between April and June 2021 in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicinewere enrolled in this study. All children enrolled were administrated 0.5% lidocaine 1.5 mg/kg intravenously after anesthesia was induced by esketamine. The ED₅₀ of esketamine required for children undergoing circumcision was determined by Dixon's up-and-down method, which calculated the mean of the crossover midpoints. Additionally, ED₅₀ and ED₉₅ of esketamine were estimated by probit regression. Onset time, wake-up time, vital signs including heart rate, pulse oxygen saturation and mean artery pressure, and adverse events were recorded. Differences in age, weight of the patients between the two groups were compared by one-way ANOVA. Differences in onset time, wake-up time, and vital signs including heart rate, pulse oxygen saturation (SpO₂) and mean arterial pressure in each time point between the two groups were compared by using the independent samples t-test. The ED₅₀ values of esketamine was compared between the two groups by Mann-Whitney U test. Results ·When administrated in combination with lidocaine, the ED₅₀ of esketamine for children undergoing circumcision was 1.55 mg/kg (95% CI 1.47?1.63). Compared to the data of our previous study, the ED₅₀ of esketamine required for children undergoing circumcision in combination with lidocaine was significantly lower than that of esketamine solo agent [ED₅₀=1.90 mg/kg (95% CI 1.75?2.05)] (P=0.001). The mean arterial pressure of children pretreated with lidocaine was significantly lower than that of esketamine solo agent at each time point during the surgery (P=0.000, P=0.004, P=0.010), and no significant effect on heart rate was observed. A transient decrease in SpO₂ was observed when esketamine was used in combination with lidocaine. Conclusion ·Anesthesia induced by esketamine combined with lidocaine can significantly reduce the ED₅₀ of esketamine required for pediatric patients undergoing circumcision, and better stability of blood pressure is achieved. However, transient respiratory depression should be noted.

Key words: esketamine, lidocaine, children, circumcision, median effective dose

CLC Number:

R459.9

LI Bo, ZHU Ming, ZHENG Jijian. Effect of lidocaine on median effective dose of esketamine for children undergoing circumcision[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(12): 1706-1711.

Figures/Tables 6

TrendMD

References 25

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Item	Score
State of activity
Able to move four extremities voluntarily or on command	2
Able to move two extremities voluntarily or on command	1
Able to move 0 extremities voluntarily or on command	0
State of respiration
Able to breathe deeply and cough freely	2
Dyspnea or limited breathing	1
Apnea	0
State of circulation
BP ± 20 mmHg of preanesthetic period	2
BP ± 20 to 50 mmHg of preanesthetic period	1
BP ± 50 mmHg of preanesthetic period	0
State of consciousness
Fully awake	2
Arousable on calling	1
No response	0
State of O₂ saturation
> 92% on room air	2
Needs O₂ to maintain SpO₂ > 90%	1
< 90% despite O₂ supplementation	0

Item	Score
State of activity
Able to move four extremities voluntarily or on command	2
Able to move two extremities voluntarily or on command	1
Able to move 0 extremities voluntarily or on command	0
State of respiration
Able to breathe deeply and cough freely	2
Dyspnea or limited breathing	1
Apnea	0
State of circulation
BP ± 20 mmHg of preanesthetic period	2
BP ± 20 to 50 mmHg of preanesthetic period	1
BP ± 50 mmHg of preanesthetic period	0
State of consciousness
Fully awake	2
Arousable on calling	1
No response	0
State of O₂ saturation
> 92% on room air	2
Needs O₂ to maintain SpO₂ > 90%	1
< 90% despite O₂ supplementation	0

Time point	Heart rate/beat·min^-1		SpO₂/%		MAP/mmHg
Time point	Group A	Group B	Group A	Group B	Group A	Group B
T0	89.1 ± 11.5	88.5 ± 11.3	98.8 ± 1.0	98.6 ± 1.0	75.8 ± 8.3	75.1 ± 5.3
T1	110.7 ± 10.1	105.2 ± 10.4	98.1 ± 1.9	93.8 ± 3.5^①	107.7 ± 8.5	92.8 ± 7.1^②
T2	118.5 ± 13.3	115.5 ± 11.2	99.5 ± 0.7	98.8 ± 1.0	120.0 ± 15.3	103.5 ± 9.4^③
T3	110.3 ± 9.1	112.2 ± 13.2	99.5 ± 0.7	99.5 ± 0.8	115.6 ± 11.2	104.8 ± 7.4^④

Time point	Heart rate/beat·min^-1		SpO₂/%		MAP/mmHg
Time point	Group A	Group B	Group A	Group B	Group A	Group B
T0	89.1 ± 11.5	88.5 ± 11.3	98.8 ± 1.0	98.6 ± 1.0	75.8 ± 8.3	75.1 ± 5.3
T1	110.7 ± 10.1	105.2 ± 10.4	98.1 ± 1.9	93.8 ± 3.5^①	107.7 ± 8.5	92.8 ± 7.1^②
T2	118.5 ± 13.3	115.5 ± 11.2	99.5 ± 0.7	98.8 ± 1.0	120.0 ± 15.3	103.5 ± 9.4^③
T3	110.3 ± 9.1	112.2 ± 13.2	99.5 ± 0.7	99.5 ± 0.8	115.6 ± 11.2	104.8 ± 7.4^④

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