ObjectiveTo evaluate the feasibility and efficiency of patient-controlled analgesia and sedation (PCAS) with propofol and remifentanil for colonoscopy in elderly patients. MethodsSixty elderly patients preparing for painless colonoscopy between May and September 2015 were randomly allocated into PCAS group and total intravenous anesthesia (TIVA) group with 30 patients in each. In the PCAS group, the mixture of remifentanil and propofol at 0.6 mL/(kg·h) was pumped continuously after an initial bolus of 0.05 mL/kg mixture. The examination began three minutes after the infusion was finished. Patients could press the self-control button. Each bolus delivered 1 mL and the lockout time was 1 minute. In the TIVA group, patients received fentanyl at 1 μg/kg and midazolam at 0.02 mg/kg intravenously, and accepted intravenous propofol at 0.8-1.0 mg/kg two minutes later. The examination began when the patients lost consciousness. ResultsA significant decline of mean arterial blood pressure was detected within each group after anesthesia (P < 0.05). The decrease of mean blood pressure in the TIVA group was more significant than that in the PCAS group (P < 0.05). The heart rate, pulse oxygen saturation and respiratory rate decreased significantly after anesthesia in both the two groups (P < 0.05), while end-tidal CO2 increased after anesthesia without any significant difference between the two groups (P > 0.05). The induction time, time to insert the colonoscope to ileocecus, and total examination time were not significantly different between the two groups (P > 0.05). As for the time from the end of examination to OAA/S score of 5 and to Aldrete score of 9, the PCAS group was significantly shorter than the TIVA group (P < 0.05). ConclusionPCAS with remifentanil and propofol can provide sufficient analgesia, better hemodynamic stability, lighter sedation, and faster recovery compared with TIVA.
ObjectiveTo study the feasibility of using propofol and remifentanil for tracheal intubation in patients who are awake, and investigate the influence of tracheal intubation on such vital signs as blood pressure and heart rates. MethodsEighty ASA I-Ⅱ patients who underwent general anesthesia in our hospital between December 2012 and April 2013 were randomly divided into two groups. Patients in group A received fentanyl-propofol, while patients in group B received remifentanyl-propofol-lidocaine. There was no significant difference between the two groups in gender, age, and body weight (P>0.05). Conventional intubation induction method was used for group A:0.05-0.10 mg/kg midazolam, 4 μg/kg fentanyl, 1.0-1.5 mg/kg propofol, and 0.6-0.9 mg/kg atracurium were given and tracheal intubation was performed after muscle relaxation. Group B patients were treated with remifentanyl propofol-lidocaine compound liquid slow intravenous injection, and compound cricothyroid membrane puncture method before endotracheal intubation. We observed the two groups of patients for vital signs before and after induction, and choking cough reactions. ResultsPatients in both the two groups were all able to complete tracheal intubation. Circulation change and incidence of tachycardia in patients of group A were significantly higher than those in group B (P<0.05). The rates of bradycardia, hypoxemia, and choking cough response were low in both groups with no statistically significant difference (P>0.05). ConclusionRemifentanyl propofol-lidocaine compound liquid can be safely used for implementation of endotracheal intubation in patients who are awake, and the hemodynamic stability can be maintained.
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.
Objective To evaluate the sedative and analgesic efficacy and adverse effect of dexmedetomidine versus propofol on the postoperative patients in intensive care unit (ICU). Methods The relevant randomized controlled trials (RCTs) were searched in The Cochrane Library, MEDLINE, PubMed, SCI, SpringerLinker, ScinceDirect, CNKI, VIP, WanFang Data and CBM from the date of their establishment to November 2011. The quality of the included studies was evaluated after the data were extracted by two reviewers independently, and then the meta-analysis was performed by using RevMan 5.1. Results Ten RCTs involoving 793 cases were included. The qualitative analysis results showed: within a certain range of dosage as dexmedetomidine: 0.2-2.5 μg/(kg·h), and propofol: 0.8-4 mg/(kg·h), dexmedetomidine was similar to propofol in sedative effect, but dexmedetomidine group needed smaller dosage of supplemental analgesics during the period of sedative therapy. The results of meta-analysis showed: the percentage of patients needing supplemental analgesics in dexmedetomidine group was less than that in propofol group during the period of sedative therapy (OR=0.24, 95%CI 0.08 to 0.68, P=0.008). Compared with the propofol group, the duration of ICU stay was significantly shorter in the dexmedetomidine group (WMD= –1.10, 95%CI –1.88 to –0.32, P=0.006), but the mechanical ventilated time was comparable between the two groups (WMD=0.89, 95%CI –1.15 to 2.93, P=0.39); the incidence of adverse effects had no significant difference between two groups (bradycardia: OR=3.57, 95%CI 0.86 to 14.75, P=0.08; hypotension: OR=1.00, 95%CI 0.30 to 3.32, P=1.00); respiratory depression seemed to be more frequently in propofol group, which however needed further study. Mortalities were similar in both groups after the sedative therapy (OR=1.03, 95%CI 0.54 to 1.99, P=0.92). Conclusion Within an exact range of dosage, dexmedetomidine is comparable with propofol in sedative effect. Besides, it has analgesic effect, fewer adverse effects and fewer occurrences of respiratory depression, and it can save the extra dosage of analgesics and shorten ICU stay. Still, more larger-sample, multi-center RCTs are needed to provide more evidence to support this outcome.
摘要:目的:分析与比较七氟醚吸入麻醉和丙泊酚静脉复合麻醉应用于三聚氰胺致婴幼儿输尿管结石手术的麻醉效果。方法:60例输尿管结石患儿随机分为七氟醚(Sev)组(n=30)和丙泊酚(Pro)组(n=30)。观察并记录诱导时间、气管内插管时间、苏醒时间、拔除气管插管时间、PACU滞留时间。记录麻醉诱导和苏醒期的不良反应。另外记录两组病人诱导前、插管前、插管后3 min、5 min、15 min、30 min时点的血压、心率、脉搏血氧饱和度(SPO2)。结果:七氟醚组诱导时间(63.2±6.9)s长于丙泊酚组(38.2±12.7)s,七氟醚组拔除气管插管时间(11.9±4.7)min短于丙泊酚组(15.6±8.2)min,两组相比有统计学意义(Plt;0.05)。七氟醚组躁动发生率53.3%显著高于丙泊酚组13.3%(Plt;0.01)。七氟醚组在插管前、插管后各时点的血压、心率与诱导前相比,差异无统计学意义(Pgt;0.05),丙泊酚组插管前、插管后3 min、5 min与诱导前相比血压、心率显著降低(Plt;0.05),与同时间点七氟醚组相比血压显著降低(Plt;0.05)。结论:两种麻醉方法均可安全有效用于婴幼儿输尿管结石手术,七氟醚组血流动力学更平稳,但躁动发生率较高。Abstract: Objective: To analyze and compare sevoflurane with propofol for anesthesia in infants with Melamineinduced ureteral stone surgery. Methods: Sixty infants who were to undergo Melamineinduced ureteral stone surgery were randomly divided into sevoflurane (Sev) group (n=30) and propofol (Pro) group (n=30). Observe and record the induction of anesthesia time, intubation time, awakening time, time to extubation, time to stay at PACU. Record adverse effects during induction of anesthesia and the awake period. In addition, recorded BP, HR, SPO2 of two groups before induction and intubation, after 3min、5min、15min、30min after intubation. Results: Induction time ［（63.2 ± 6.9） s］ in sevoflurane group was longer than propofol group ［(38.2±12.7） s］,but extubation time ［（11.9 ± 4.7） min］ was shorter than propofol group ［(15.6 ± 8.2） min］, there was significantly different between two groups (Plt;0.05). The incidence of restlessness in sevoflurane group 53.3% was significantly higher than propofol group 13.3% (Plt;001). In sevoflurane group the BP, HR before intubation compare with after intubation has no significant difference (Pgt;0.05). Compared with before induction,the BP, HR before induction, after intubation 3 min, 5 min, decreased significantly (Plt;0.05) in propofol group.when compared the same point with sevoflurane group, blood pressure decreased significantly (Plt;0.05). Conclusion: Both propofol and sevoflurane can be used effectively and safely for anesthesia of ureteral calculi stone surgery in pediatric. The hemodynamics is more stable but restlessness is more common in sevoflurane group.
Objective To systematically assess the effectiveness and safety of 5-HT3 receptor antagonists in preventing propofol injection induced pain. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2012), CNKI, CBM, VIP and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials (RCTs) about 5-HT3 receptor antagonists in preventing propofol injection induced pain. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 15 RCTs involving 1 413 patients were included. The results of meta-analysis showed that: a) the incidence of propofol injection induced pain in the 5-HT3 group was obviously lower than the control group (RR=0.14, 95%CI 0.09 to 0.21, Plt;0.000 01); b) as to the severity of pain, there was no statistical difference between the two groups (RR=0.84, 95%CI 0.56 to 1.26, P=0.39); the 5-HT3 group was obviously lower that the control group in the incidence of both moderate pain (RR=0.25, 95%CI 0.19 to 0.34, Plt;0.000 01) and severe pain (RR=0.16, 95%CI 0.10 to 0.24, Plt;0.000 01); and c) as to the incidence of postoperative adverse reaction: the 5-HT3 group was obviously lower that the control group in the incidence of nausea and vomiting (RR=0.19, 95%CI 0.11 to 0.34, Plt;0.000 01) and shivering (RR=0.20, 95%CI 0.12 to 0.33, Plt;0.000 01) as well. Conclusion 5-HT3 receptor antagonists can effectively prevent the propofol injection induced pain, alleviate its severity, and reduce the postoperative adverse reactions. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.
ObjectiveTo evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB).MethodsThe electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay.ResultsThere was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05).ConclusionNo association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.
Objective To explore the effects of propofol and thiopental sodium injection on convulsive seizure in electro-convulsive therapy(ECT) and to provide evidence to help the selection of intravenous anaesthetics in improved ECT. Methods Total of 111 patients who received ECT in the 3rd Pepole’s Hospital of Panzhihua from July to December 2005 were divided into a thiopental sodium group (n =62) and a propofol group (n =49). These patients received intravenous anaesthesia with suxamethonium plus thiopental sodium or propofol for the implementation of ECT, respectively. The status of convulsive seizure was compared between the two groups. Results There were no significant differences between the two groups in terms of main demographic data, disease category and ECT parameters (Pgt;0.05). Motor seizure and electricity discharge lasted significantly longer in the propofol group than in the thiopental sodium group (Plt;0.01). Conclusion Thiopental sodium can increase the excitation threshold of brain cortical neurons and decrease the level of convulsive seizure induced by ECT. Propofol may decrease the excitation threshold, and increase the level of convulsive seizure under the same ECT parameters, but may have the potential to induce epileptic seizure.
【摘要】 目的 比较瑞芬太尼、丙泊酚、艾司洛尔用于支撑喉镜手术气管插管时患者的心血管反应。 方法 选取2009年1-3月就诊的60例拟于全身麻醉下行择期支撑喉镜下声带息肉切除术的患者，随机分为丙泊酚组、艾司洛尔组和瑞芬太尼组，每组20例。麻醉诱导采用咪达唑仑、芬太尼和丙泊酚，患者意识消失后给予琥珀胆碱。1 min后各组分别给予丙泊酚2 mg/kg、艾司洛尔1 mg/kg和瑞芬太尼1 μg/kg。30 s后进行气管插管。记录患者诱导前及插管前、插管后1、3、5 min的心率和血压水平。 结果 各组插管前的收缩压和心率较诱导前明显降低，插管后1、3 min的收缩压和心率较插管前升高（Plt;0.05)。丙泊酚组和艾司洛尔组插管后的收缩压较瑞芬太尼组升高（Plt;0.05)。丙泊酚组插管后心率较瑞芬太尼组增加（Plt;0.05)。 结论 对行支撑喉镜手术的患者，气管插管前30 s给予1 μg/kg瑞芬太尼较2 mg/kg丙泊酚和1 mg/kg艾司洛尔能更有效地减轻气管插管时的血流动力学反应。【Abstract】 Objective To assess the different effects of remifentanil, propofol, and esmolol on hemodynamic responses during intubation in CO2 laser endolaryngeal microsurgery (CO2-LELM). Methods A total of 60 patients aged from 18 to 65 years, admitted from January to March 2009 and scheduled to undergo elective CO2-LELM under general anesthesia for treatment of vocal cord polyp were randomly assigned to a propofol group, an esmolol group, and a remifentanil group. Anesthesia was induced with midazolam (0.015-0.02 mg/kg), fentanyl (1 μg/kg), and propofol (1 mg/kg). After the patients became unconscious, succinylcholine (1 mg/kg) was given one minute later. Then the patients in the three groups received propofol (2 mg/kg), esmolol (1 mg/kg), and remifentanil (1 μg/kg), respectively. Intubation was performed 30 secconds later. Heart rate (HR) and systolic blood pressure (SBP) were measured noninvasively before general anesthesia induction (baseline, Tb), just before intubation(Ti), and one, three, and five minutes after intubation (T1, T3, T5). Results The demographic data including age, sex and body weight were comparable in the three groups. Tracheal intubation caused significant increases in SBP and HR in all groups compared with Ti (Plt;0.05). After intubation, SBP in the propofol group and the esmolol group were significantly higher than that in remifentanil group (Plt;0.05), and HR in the propofol group was significantly higher than that in the remifentanil group (Plt;0.05). Conclusion In patients with CO2-LELM, remifentanil (1 μg/kg) administrated 30 seconds before intubation is maximal effective compared with propofol (2 mg/kg) or esmolol (1 mg/kg) in attenuating the hemodynamic responses to oraltracheal intubation.