目的 探讨全凭静脉麻醉中腺苷对丙泊酚用量的影响。 方法 2011年1月－12月期间59例行择期手术的患者全凭静脉麻醉，随机分为腺苷静脉持续输注组（A组）和对照组（B组），A组患者麻醉诱导后持续输注腺苷70 μg/（kg·min），直至术毕。B组麻醉后按常规处理。比较两组患者麻醉时间、苏醒时间、瑞芬太尼用量，麻醉过程中平均动脉压（MAP）、心率，以及麻醉过程中丙泊酚的用量。同时记录使用腺苷过程中的不良反应。 结果 两组患者麻醉时间、苏醒时间、瑞芬太尼用量比较均无明显差异，无统计学意义（P＞0.05）。两组患者麻醉过程中MAP、心率比较亦无明显差异，无统计学意义（P＞0.05）。两组患者麻醉过程中丙泊酚平均用量比较，A组明显低于C组，差异有统计学意义（P＜0.05），且不良反应发生率低。 结论 腺苷能明显降低全凭静脉麻醉中丙泊酚的使用剂量。
目的:观察丙泊酚静脉泵注复合腰硬联合麻醉于剖宫产术中的可行性及安全性。方法:50例ASA I~II级行择期剖宫产术产妇,于L2-3行腰硬联合麻醉,确定麻醉平面为T4-6,取出胎儿后静脉缓推丙泊酚1mg/kg,然后2~4mg·kg-1·h-1静脉泵入,连续监测平均动脉压,心率,血氧饱和度,呼吸频率。结果:腰硬联合麻醉及静脉推注负荷剂量丙泊酚后平均动脉压降低,但无临床意义。余心率,氧饱和度,呼吸频率各时点无统计学差异。结论:丙泊酚复合腰硬联合麻醉用于剖宫产术患者生命体征平稳,镇静效果良好。
ObjectiveTo explore the efficacy and safety of different sedative and analgesic methods in emergent endotracheal intubations in RICU. Methods110 cases of tracheal intubation in critically ill patients were divided into 5 groups randomly: ① control group(given no sedative or analgesic drug before intubation); ② fentanyl group(given intravenous fentanyl 2 μg/kg before intubation,followed by fentanyl 2 μg·kg-1·h-1 maintenance); ③ dexmedetomidine hydrochloride+fentanyl group(given dexmedetomidine hydrochloride 1 μg/kg+fentanyl 2 μg/kg before intubation,followed by dexmedetomidine hydrochloride 0.5 μg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ④ midazolam+fentanyl group(given midazolam 0.05 mg/kg+fentanyl 2 μg/kg before intubation,followed by midazolam 0.05 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ⑤ Propofol+fentanyl group(given propofol 1 mg/kg+fentanyl 2 μg/kg before intubation,followed by propofol 0.4 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance).The mean arterial pressure(MAP),heart rate(HR),respiratory frequency(RR),PaO2/FiO2,Riker sedation score and agitation were monitored before,during and after intubations.The one-time success rate of intubation and severe arrhythmia (sinus bradycardia,frequent ventricular premature,ventricular fibrillation,and cardiac arrest) incidence rate were recorded. ResultsThe one-time success rates of intubations of the propofol+fentanyl group (95.4%) and the midazolam+fentanyl group (90.9%) were higher than that in the dexmedetomidine hydrochloride+fentanyl group (86.4%,P<0.05),while one-time intubation success rate of three groups were higher than that of the fentanyl group (45.4%) and the control group (31.8%,P<0.05).5 minutes after intubation,the PaO2/FiO2 index of 5 groups of patients were higher than those before intubation,but the PaO2/FiO2 index of the control group and the fentanyl group were lower than those in the other three groups(P<0.05).The occurrence of serious arrhythmia rate in the dexmedetomidine hydrochloride+fentanyl group (0%),the midazolam+fentanyl group (9%) and the propofol+fentanyl group (9%) were lower than that in the control group (13.6%) and the fentanyl group (18.2%).The MAP during intubation and 2 minutes after intubation of the propofol+fentanyl group and the midazolam+fentanyl group were lower than that in the other three groups(P<0.05).The proportion of patients with Riker sedation and agitation score≤4 at intubation in the dexmedetomidine hydrochloride+fentanyl group (68.2%) was lower than that in the propofol+fentanyl group(90.9%) and the midazolam+fentanyl group (86.4%,P<0.05),but higher than those in the fentanyl group(22.7%)and the control group(18.2%,P<0.05). ConclusionPropofol,midazolam or dexmedetomidine hydrochloride with fentanyl are all effective and safe methods of sedation and analgesia in emergent endotracheal intubation in RICU.Dexmedetomidine hydrochloride with fentanyl is an ideal sedative relatively with less influence on cardiovascular system and less myocardial oxygen consumption.
ObjectiveTo compare the effect of pretreatment with butorphanol or tramadol for prevention of propofol-induced injection pain by intravenous injection or drip, in order to explore a safe and effective method. MethodsWe chose 150 patients of ASAⅠ-Ⅱundergoing elective surgery between October 2012 and March 2013 in Sichuan Orthopedic Hospital as the study subjects. They were randomly divided into five groups with 30 patients in each group:butorphanol injection and drip group (group BI and group BD), tramadol injection and drip group (group TI and group TD), control group (group C). Five minutes before anesthesia induction, patients in group BI, TI and C were respectively injected with butorphanol 2 mg, tramadol 100 mg, and saline; patients in group BD and TD were respectively injected with butorphanol 2 mg and tramadol 100 mg before receiving propofol (2.5 mg/kg) for 2 minutes. Assessment of pain during injection was done by using a four-point scale. ResultsThe pre-injection pain incidence in group BI and TI was significantly higher than that in group BD, TD and C(P < 0.05), and it was significantly higher in group BI than group TI (P < 0.05). The incidence of propofol injection pain in group BI, BD, TI and TD were significantly lower than that in group C (P < 0.05), and it was the lowest in group BD (P < 0.05) followed by group BI (P < 0.05). The total rate of pain in group BD was only 6.67%, significantly lower than other groups (P < 0.05). ConclusionsThe pretreatment with butorphanol and tramadol by intravenous injection or drip can reduce the incidence of propofol injection pain. Pretreatment with butorphanol at 2 mg by intravenous drip is more effective, but should be closely observed to avoid adverse events.
Objective To systematically review the clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
【摘要】 目的 观察丙泊酚在重症监护室（ICU） 外科术后对患者的镇静效果及作用。 方法 2006年7月-2008年7月，对行外科手术后在ICU观察室采用丙泊酚镇静的45例患者的镇静效果、停药苏醒时间及给药前后呼吸、循环参数的变化进行观察，并与治疗前进行比较。 结果 丙泊酚镇静起效快，镇静治疗后大多数患者开始血压有所下降（Plt;0.05）但不久恢复正常，所有患者心率、呼吸频率、血氧饱和度无明显变化（Pgt;0.05），停药后苏醒快。 结论 丙泊酚是外科术后患者较理想的镇静剂，但应根据患者情况调整给药速度、剂量及时间。 【Abstract】 Objective To observe the sedative effect of propofol on the patients after surgical operations in intensive care unit (ICU). Methods Forty-five patients underwent the injection with propofol after surgical operations in ICU from July 2006 to July 2008. The sedative efficacy, recovery time after the propofol administration, and changes of respiratory, circulate parameter before and after medication were observed, which were compared with those before the treatment. Results The sedative reactive time of propofol was short. Most of the patients had decreased blood pressure after injection with propofol (Plt;0.05) but recovered soon. The heart rate, respiratory rate, and pulse oxygen saturation did not significantly changed (Pgt;0.05). The recovery time was short after propofol administration was stopped. Conclusion Propofol is an effective sedative for the patients after surgical operations in ICU, but the medicated speed, amount and time according to state of the patients should be adjusted.
Objective To systematically review the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and VIP were electronically searched from inception to December 2012, for comprehensively collecting randomized controlled trials (RCTs) on the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 692 children were included, of which, six were pooled in the meta-analysis. The results of meta-analysis showed that: a) after anesthesia induction using sevoflurane, intravenous propofol maintenance was associated with a lower incidence of emergence agitation compared with sevoflurane maintenance (RR=0.57, 95%CI 0.39 to 0.84, P=0.004); and b) patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane (RR=0.16, 95%CI 0.06 to 0.39, Plt;0.000 1). Conclusion The incidence of emergence agitation after general anesthesia using sevoflurane is higher than that using propofol. Due to the limited quantity and quality, the application of sevoflurane should be chosen based on full consideration into patients’ conditions in clinic.