To investigate the application and effect of esmketamine combined with sevoflurane and pediatric ibuprofen suppository in the treatment of hypertrophic scar after burns in children under non intubation general anesthesia with ultra pulsed fractional carbon dioxide laser (UFCL).

From January 2020 to April 2021, 89 children with hypertrophic scar after burns in the outpatient Department of Burns and skin surgery, First Affiliated Hospital of Air Force Military Medical University were included in this randomized controlled clinical trial. The children were randomly divided into ketamine + propofol group [42 cases, 22 males and 20 females, age (44.33±14.87) months] and compound anesthesia and analgesia group (esmketamine + sevoflurane + pediatric ibuprofen anal suppository) [47 cases, 24 males and 23 females, age (44.47±14.65) months]. Hemodynamic indexes and OAA/S scores were monitored before anesthesia and during operation. The pain degree of children was evaluated by children′s pain assessment scale (the face, legs, activity, cry, consolability behavioral tool, FLACC) during awake anesthesia (T0), 1 h after awake anesthesia (T1) and 2 h after awake anesthesia (T2). Vancouver scar scale (VSS) was used to score scars before operation and 6 months after operation. Data were statistically analyzed with independent sample t test and chi-square test.

Pre anesthesia hemodynamics and OAA /S score in ketamine + propofol group [mean arterial pressure (63.71±3.40) mmHg, heart rate (107.21±9.45) times / min, respiration (25.29±2.34) times / min, oxygen saturation (99.00±0.80)%, OAA/S (4.64±0.49) points] and compound anesthesia analgesia group [mean arterial pressure (63.87±3.57) mmHg, heart rate (109.34±12.21) times / min, respiration (26.47±3.53) times/min, oxygen saturation (98.77±0.91)%, OAA/S (4.57±0.50) points], there were no significant differences(t=-0.213, 0.490, -1.840, 1.280, 0.204; P>0.05). Ketamine + propofol group [mean arterial pressure (56.29±2.43) mmHg, heart rate (94.48±7.01) times / min, respiration (21.07±3.03) times/min, oxygen saturation (96.12±1.64)%, OAA/S (2.07±0.71) points] and compound anesthesia analgesia group [mean arterial pressure (62.87±3.56) mmHg, heart rate (108.79±11.93) times/min, respiration (26.52 ± 3.48) times / min, oxygen saturation (99.23±0.67)%, OAA/S (1.45±0.50) points], there were significant statistical differences (t=-10.068, -6.794, -7.824, -11.960, 4.820; P<0.05). (2) The FLACC score of the ketamine + propofol group was higher than that of the compound anesthesia analgesia group [(1.32±0.96), (0.43±0.62), (0.13±0.34)], indicating the high degree of pain, the differences of data were statistically significant (t=10.139, 3.669, 2.794; P< 0.05). (3) Scar score before and 12 months after operation: there were no significant differences between ketamine + propofol group [(9.33 ± 1.60), (4.48±1.11) points] and compound analgesia group [(8.43±2.04), (4.26±1.04) points] (t=2.320, 0.940; P>0.05).

The application of compound anesthesia and analgesic measures in the treatment of hypertrophic scar aftern burns in children under non intubation general anesthesia with UFCL has a good effect. It can make the children have stable hemodynamics, good intraoperative sedation, low postoperative pain, and has no effect on the effect of laser treatment.