Research on Remifentanil-propofol for Manual Reduction of Shoulder Joint Dislocation in Conscious Elderly Patients_West China Medical Journal

Authors：

 XIAOQing-wang , QINCai-juan , SONGHui-fang , XUKai-zhi

Department of Anesthesiology, Luanxian People's Hospital, Luanxian, Hebei 063700, P. R. China;

Corresponding?author：

Keywords：

Remifentanyl; Propofol; Manipulative reduction; Conscious; Brachial plexus; Old age

DOI：

10.7507/1002-0179.20150193

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Objective To study the feasibility of using propofol and remifentanil for reduction of shoulder joint dislocation in the conscious elderly patients, and compare its efficacy with brachial plexus block anesthesia. Methods Seventy elderly patients (American Sociaty of Anesthesiologist physical statusⅠ-Ⅱ) who underwent shoulder dislocation reduction in our hospital between August 2011 and December 2013 were randomly divided into two groups, each group having 35 cases. Patients in group A received brachial plexus nerve block anesthesia downlink gimmick reset, while patients in group B received the use of remifentanil-propofol and lidocaine compound liquid intravenous drop infusion for anesthesia downlink manipulative reduction. After successful anesthesia, two groups of patients were treated with traction and foot pedal method (Hippocrates) to reset. We observed the two groups of patients in the process of reduction, and recorded their hemodynamic changes, reset time, discharge time, postoperative satisfaction, intra-operative memory, breathing forgotten (breathing interval was longer than 15 seconds) and visual analogue scale (VAS) scores, and then comparison was made between the two groups. Results Patients in both the two groups successfully completed manipulative reduction. Compared with group A, patients in group B had more stable hemodynamic indexes during the process of reduction, shorter reduction time, better anesthesia effect and higher postoperative satisfaction degree, and the differences were statistically significant (P<0.05). There was no significant difference in terms of time of leaving the operation room between the two groups (P>0.05). VAS score was higher in group A than that in group B (P<0.05). The occurrence of intra-operative memory amnesia and breathing forgotten phenomenon existed in part of the patients after operation in group B, but they did not occur in patients in group A. Conclusion Remifentanyl propofol-lidocaine compound fluid can be safely used in conscious elderly patients for shoulder joint dislocation reconstructive surgery, and it functions quickly with complete analgesia and stable hemodynamic indexes.

Citation： XIAOQing-wang, QINCai-juan, SONGHui-fang, XUKai-zhi. Research on Remifentanil-propofol for Manual Reduction of Shoulder Joint Dislocation in Conscious Elderly Patients. West China Medical Journal, 2015, 30(4): 673-676. doi: 10.7507/1002-0179.20150193 Copy

1.	陳金紅, 肖計文, 盛思玉, 等. 異丙酚與七氟醚用于老年肩關節脫位復位術的比較[J]. 臨床醫學, 2011, 31(11):70-72.
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6.	余德華, 陳文迪, 樓靜芝. 氯胺酮復合異丙酚在燒傷、大面積換藥等短小手術中的應用體會[J]. 河北醫科大學學報, 2008, 29(2):257-258.
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8.	劉曉芬, 胡憲文, 李云, 等. 帕瑞昔布鈉復合嗎啡對瑞芬太尼致骨科手術患者術后痛覺過敏的影響[J]. 中華麻醉學雜志, 2010, 35(5):545-548.
9.	王鵬, 吳永偉, 劉啟明. 瑞芬太尼在經鼻蝶垂體瘤切除術中合適劑量的臨床觀察[J]. 臨床麻醉學雜志, 2011, 27(8):802.
10.	Loop T, Prebe HJ. Recovery after anesthesia with remifentanil combined with propofol, desflurane, or sevoflurane for otorhinolaryngeal surgery[J], Anesth Analg, 2000, 91(1):123-129.
11.	宋炯, 李明星, 段若望. 芬太尼和舒芬太尼用于無痛纖支鏡檢查的臨床觀察[J]. 臨床麻醉學雜志, 2010, 26(9):808-809.
12.	Murdoch JA, Hyde RA, Kenny GN. Target-controlled remifentanil in combination with propofol for spontaneously breathing day-case patients[J]. Anesthesia, 1999, 54(11):1028-1031.
13.	Egan TD, Kem SE, Muir KT, et al. Remifentanil by bolus injection:a safety, pharmacokinetic, pharmacodynamic, and age effect investigation in human volunteers[J]. Br J Anaesth, 2004, 92(3):335-343.
14.	Reyle-Hahn M, Niggemann B, Max M, et al. Remifentanil and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy[J]. Paediatr Anaesth, 2000, 10(1):59-63.

1. 陳金紅, 肖計文, 盛思玉, 等. 異丙酚與七氟醚用于老年肩關節脫位復位術的比較[J]. 臨床醫學, 2011, 31(11):70-72.
2. 徐艷群. 老年人骨折復位誘發急性腦血管病1例[J]. 河南外科學雜志, 2007, 13(2):144-145.
3. 莊心良, 曾因明, 陳伯鑾. 現代麻醉學[M]. 3版. 北京:人民衛生出版社, 2003:483.
4. Keidan I, Berkenstadt H, Sidi A, et al. Propofol/remifentanil versus propofol alone for bone marrow aspiration in paediatric haemato-oncological patients[J]. Paediatr Anaesth, 2001, 11(3):297-351.
5. 劉茉. 異丙酚復合瑞芬太尼麻醉在關節脫位復位中的應用[J]. 中國醫藥導報, 2009, 6(2):163.
6. 余德華, 陳文迪, 樓靜芝. 氯胺酮復合異丙酚在燒傷、大面積換藥等短小手術中的應用體會[J]. 河北醫科大學學報, 2008, 29(2):257-258.
7. Nyman Y, Von Hofsten K, Georgiadi A, et al. Propofol injection pain in children:a prospective randomized double-blind trial of a new propofol foimulation versus propofol with added lidocaine[J]. Br J Anaesth, 2005, 95(2):222-225.
8. 劉曉芬, 胡憲文, 李云, 等. 帕瑞昔布鈉復合嗎啡對瑞芬太尼致骨科手術患者術后痛覺過敏的影響[J]. 中華麻醉學雜志, 2010, 35(5):545-548.
9. 王鵬, 吳永偉, 劉啟明. 瑞芬太尼在經鼻蝶垂體瘤切除術中合適劑量的臨床觀察[J]. 臨床麻醉學雜志, 2011, 27(8):802.
10. Loop T, Prebe HJ. Recovery after anesthesia with remifentanil combined with propofol, desflurane, or sevoflurane for otorhinolaryngeal surgery[J], Anesth Analg, 2000, 91(1):123-129.
11. 宋炯, 李明星, 段若望. 芬太尼和舒芬太尼用于無痛纖支鏡檢查的臨床觀察[J]. 臨床麻醉學雜志, 2010, 26(9):808-809.
12. Murdoch JA, Hyde RA, Kenny GN. Target-controlled remifentanil in combination with propofol for spontaneously breathing day-case patients[J]. Anesthesia, 1999, 54(11):1028-1031.
13. Egan TD, Kem SE, Muir KT, et al. Remifentanil by bolus injection:a safety, pharmacokinetic, pharmacodynamic, and age effect investigation in human volunteers[J]. Br J Anaesth, 2004, 92(3):335-343.
14. Reyle-Hahn M, Niggemann B, Max M, et al. Remifentanil and propofol for sedation in children and young adolescents undergoing diagnostic flexible bronchoscopy[J]. Paediatr Anaesth, 2000, 10(1):59-63.

West China Medical Journal

Research on Remifentanil-propofol for Manual Reduction of Shoulder Joint Dislocation in Conscious Elderly Patients

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