氯胺酮在肥胖和非肥胖患者中的作用和优势:围介入期考虑

A. Weinbroum
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引用次数: 2

摘要

肥胖和病态肥胖患者是一个日益增长的群体,在全球范围内产生了医疗、社会和经济问题。他们接受各种需要麻醉和/或镇痛的干预。尽管他们看起来很健康,但这些人的身体状况被评为高ASA,主要是因为他们的呼吸和心血管疾病受损,以及他们身体经历的代谢变化。阿片类药物是围手术期镇痛的默认药物。然而,它们的使用在世界范围内已达到可怕的流行病程度。多模式镇痛方案已被推荐作为围手术期护理标准,特别是对肥胖患者。这些方案采用阿片类药物和非阿片类化合物的组合,增强了患者的镇痛效力,从而在休息、运动或努力时提供卓越的疼痛缓解,同时减少阿片类药物的消耗及其相关的不良反应。目前使用的最重要的围手术期静脉辅助药物是氯胺酮,在不同医学专业的医生中再次出现。在总结肥胖患者围手术期的缺点后,本文将阐述氯胺酮的神经药理学,并将描述其作为镇痛辅助剂的治疗作用。由于关于肥胖患者使用该药的数据很少,因此也将简要说明其在非肥胖人群中的益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role and Advantageousness of Ketamine in Obese and Non-Obese Patients: Peri-Interventional Considerations
Obese and morbidly obese patients are a growing group of individuals that generates medical, social and economic problems worldwide. They undergo various interventions that require anesthesia and/or analgesia. Despite their healthy look, these individuals are graded at high ASA physical status, mainly because of their impaired respiratory and cardiovascular conditions, and the metabolic changes their body undergoes. Opioids are the default drugs for perioperative analgesia. Nevertheless, their use has reached a frightening epidemic-like condition worldwide. Multimodal analgesia regimens have been recommended as a perioperative standard of care, particularly for the obese. These regimens employ combinations of opioids and non-opioid compounds that augment the formers' analgesic potencies, thus providing superior pain relief at rest, movement, or on effort, while reducing opioid consumption and their concerned adverse effects. The most important perioperative IV adjuvant currently employed is ketamine that sees resurgence among physicians from diverse medical specialties. After summarizing obese patients' perioperative drawbacks, this review will illustrate ketamine’s neuropharmacology, and will describe its therapeutic usefulness as an analgesic adjuvant. Since data regarding the use of the drug in obese patients is scarce, brief examplifications of its benefits in non-obese cohorts will be portrayed as well.
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