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.
Objective To investigate the effect of penehyclidine hydrochloride on postoperative nausea and vomiting (PONV) in patients undergoing ambulatory laparoscopic cholecystectomy. Methods The medical records of patients who underwent laparoscopic cholecystectomy in ambulatory surgery mode at General Hospital of Northern Theater Command between October 2024 and October 2025 were retrospectively collected. According to whether penehyclidine hydrochloride was used during operation, the patients were divided into a study group (penehyclidine hydrochloride used during operation) and a control group (penehyclidine hydrochloride not used during operation). The general information, perioperative period indicators, the overall incidence of PONV within 48 hours after surgery, the severity and incidence of PONV at different postoperative periods, the incidence of adverse reactions and patient satisfaction of the two groups of patients were compared. Results A total of 110 patients were included, among whom 55 were in the study group and 55 were in the control group. Compared with the control group, the overall incidence of PONV within 48 hours after surgery in the study group decreased (34.5% vs. 56.4%; χ2=5.280, P=0.022), the severity and incidence of PONV at each time period from 0 to 6 hours, 6 to 12 hours, and 12 to 24 hours decreased (P<0.05), and the usage rate of rescue antiemetic drugs decreased (10.9% vs. 29.1%; χ2=5.682, P=0.017). The incidence of dry mouth (30.9% vs. 10.9%; χ2=6.652, P=0.010) and patient satisfaction [85 (75, 85) vs. 75 (70, 75); Z=5.531, P<0.001] in the study group were higher than those in the control group. There was no statistically significant difference in the general data of the patients, perioperative indicators except rescue antiemetic drugs, the severity and incidence of PONV from 24 to 48 hours after surgery, or dizziness, drowsiness, blurred vision, urinary retention, skin itching or other adverse reactions between the two groups (P>0.05). Conclusions The intraoperative use of penehyclidine hydrochloride in patients undergoing laparoscopic cholecystectomy in ambulatory mode can effectively reduce the incidence and severity of postoperative PONV. The overall safety is good and the patient satisfaction is high. It can be promoted and applied in the clinical anesthesia of ambulatory surgery.