{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:42:10Z","timestamp":1792802530555,"version":"4.5.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science of Liaoning Province","award":["2020-MS-041"],"award-info":[{"award-number":["2020-MS-041"]}]},{"name":"Applied Basic Research Project of Liaoning Province","award":["2023JH2\/101300075"],"award-info":[{"award-number":["2023JH2\/101300075"]}]},{"name":"Research Projects of Xiang yang Central Hospital","award":["2024YJ07B"],"award-info":[{"award-number":["2024YJ07B"]}],"id":[{"id":"https:\/\/ror.org\/042g3qa69","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec018\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardio-biliary reflex can lead to cardiac arrest, brady-arrhythmia, cardiogenic shock, and other severe complications. NMDA receptor antagonists have been shown to have the effect of anti-vagal reflex. However, the regulation of vagus reflex by esketamine, an NMDA receptor antagonist, remains unclear. Our study aims to investigate intravenous low-dose esketamine on cardio-biliary reflex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec019\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this randomized controlled trial, adult patients undergoing laparoscopic cholecystectomy were allocated in a 1:1 ratio to esketamine group or control group. 5 minutes before surgical incision, participants in the esketamine group received 0.3\u2009mg\/kg of esketamine, while the control group received an equivalent volume of normal saline. The primary outcome was the occurrence of cardio-biliary reflex. Postoperative pain was assessed using the Visual Analogue Scale (VAS) on days 1, 2, and 3 post-surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec020\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our final analysis included 140 participants. The incidence of the cardio-biliary reflex occurred in 15 patients (21.4%) in the control group compared with 6 patients (8.6%) in the esketamine group (relative risk 0.34; 95%confidence interval (95% CI): 0.125\u20130.947;\n                      <jats:italic>P\u2009<\/jats:italic>\n                      &lt;\u20090.05). Patients in the esketamine group reported lower pain intensity with movement on postoperative days (POD)1, 2, and 3 with mean differences (MD) of 0.59, 0.70, and 0.47 points respectively (all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Additionally, pain intensity at rest was also lower in the esketamine group at all observation time points (POD1: MD 0.51, POD2: MD 0.40, POD3: MD 0.30, all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec021\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Therapeutic use of low-dose esketamine significantly reduces the occurrence of cardio-biliary reflex and postoperative pain in patients undergoing laparoscopic cholecystectomy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0321892","type":"journal-article","created":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T13:50:26Z","timestamp":1748872226000},"page":"e0321892","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effect of 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