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 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.
MethodsSeventy 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.
ResultsPatients 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.
ConclusionRemifentanyl 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.
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.
摘要:目的:分析與比較七氟醚吸入麻醉和丙泊酚靜脈復合麻醉應用于三聚氰胺致嬰幼兒輸尿管結石手術的麻醉效果。方法:60例輸尿管結石患兒隨機分為七氟醚(Sev)組(n=30)和丙泊酚(Pro)組(n=30)。觀察并記錄誘導時間、氣管內插管時間、蘇醒時間、拔除氣管插管時間、PACU滯留時間。記錄麻醉誘導和蘇醒期的不良反應。另外記錄兩組病人誘導前、插管前、插管后3 min、5 min、15 min、30 min時點的血壓、心率、脈搏血氧飽和度(SPO2)。結果:七氟醚組誘導時間(63.2±6.9)s長于丙泊酚組(38.2±12.7)s,七氟醚組拔除氣管插管時間(11.9±4.7)min短于丙泊酚組(15.6±8.2)min,兩組相比有統計學意義(Plt;0.05)。七氟醚組躁動發生率53.3%顯著高于丙泊酚組13.3%(Plt;0.01)。七氟醚組在插管前、插管后各時點的血壓、心率與誘導前相比,差異無統計學意義(Pgt;0.05),丙泊酚組插管前、插管后3 min、5 min與誘導前相比血壓、心率顯著降低(Plt;0.05),與同時間點七氟醚組相比血壓顯著降低(Plt;0.05)。結論:兩種麻醉方法均可安全有效用于嬰幼兒輸尿管結石手術,七氟醚組血流動力學更平穩,但躁動發生率較高。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.
ObjectiveTo determine whether there was a clinical relevant association between anesthetic regimen (propofol or inhalational anesthetics) and the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery.MethodsThis retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass (CPB) at West China Hospital of Sichuan University between October 2018 and March 2019. The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen (including CPB). The primary outcome was the occurrence of POD during first 3 days after surgery. Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD.ResultsA total of 197 patients who met the inclusion criteria were included, with an average age of 53 years, and 51.8% (102/197) were females. POD occurred in 21.3% (42/197) patients. The incidence of POD was 21.4% in the propofol group and 21.2% in the inhalational anesthetics group; there was no significant difference between the two groups (RR=1.01, 95%CI 0.51-2.00, P=0.970). Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors (OR=1.05, 95%CI 0.48-2.32, P=0.900).ConclusionAnesthetic regimen (propofol or inhalational anesthetics) is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.
Objective To investigate the preventive effect of rapid preoxygenation technique on hypoxia caused by respiratory depression during outpatient obstetrics-gynecology operations. Methods According to a computer-generated random sequence, a total of 120 ASA I-II patients undergoing outpatient obstetrics-gynecology operations were randomly allocated into the trial group or the control group, 60 in each group. Patients in the control group received preoxygenation with tidal volume breathing. Patients in the trial group received preoxygenation with eight deep breaths (DB) in 1 min before anesthesia. All patients were induced with midazolam 1 mg, fentanyl 1μg /kg and propofol 2 mg/kg, and were maintained with propofol when needed. The following parameters were observed, including the incidences of respiratory depression and apnea, the onset time of anesthesia, the total doses of propofol as well as the changes in PetCO2 and SpO2. Results No significant differences were observed in demographic characteristics, the onset time of anesthesia, the total doses of propofol, and the incidences of respiratory depression and apnea between the two groups (P gt;0.05). However, the SpO2 in the control group was decreased significantly with a higher incidence of hypoxia (Plt;0.05). Conclusions Rapid preoxygenation technique may increase the oxygen reserves and improve the tolerance to hypoxia. It is effective in avoiding hypoxia caused by respiratory depression and apnea during outpatient obstetrics-gynecology operations.
【摘要】 目的 探討腰硬聯合麻醉復合丙泊酚恒速輸注清醒鎮靜的可行性、理想的藥物劑量、術中知曉情況以及麻醉質量和效果。 方法 收集2009年3-12月480例美國麻醉醫師協會（ASA）Ⅰ～Ⅲ級擬在腰硬聯合麻醉下行下腹部、會陰部、下肢手術的患者480例，隨機分為咪達唑侖組（M組）、丙泊酚Ⅰ組（PA組）、丙泊酚Ⅱ組（PB組）、丙泊酚Ⅲ組（PC組），每組各120例。四組患者均于腰2-3或腰3-4行腰硬聯合麻醉，蛛網膜下腔注入輕比重0.2 %布比卡因12～15 mg，麻醉平面確切后，M組予以咪達唑侖0.04~0.06 mg/kg，PA組先予以負荷量丙泊酚0.50 mg/kg再以2.00 mg/（kg?h）劑量持續泵注，PB組予以負荷量丙泊酚0.75 mg/kg再以3.00 mg/（kg?h）劑量持續泵注，PC組予以負荷量丙泊酚1.00 mg/kg再以3.75 mg/（kg?h）劑量持續泵注。觀察患者給藥前（T0）、給藥1（T1）、3（T2）、5（T3）、10（T4）、30（T5）、60 min（T6）各時點血流動力學平均動脈血壓（MAP）、心率（HR）的變化、腦電雙頻指數（BIS）值及鎮靜評分、術中所看到的圖片的回憶及不良反應。 結果 各組在給予鎮靜藥后MAP、HR均有所下降，但測量值的變化在正常范圍內；在T3時間點，各組BIS值及鎮靜/警醒OAA/S評分降低，與T0比較，差異有統計學意義（Plt;0.05）；與其他3組比較，在T4、T5、T6時點PC組BIS值與OAA/S評分降低，差異有統計學意義（Plt;0.05），PC組的鎮靜遺忘滿意率高于其他3組；各組間未見發生嚴重的舌后墜、呼吸暫停和血氧飽和度（SpO2）lt;90%。 結論 在下腹部、下肢手術中，應用腰硬聯合麻醉復合1.00 mg/kg負荷量的丙泊酚繼而以3.75 mg/（kg?h）劑量持續泵注，可取得良好的鎮靜效果，不良反應小。【Abstract】 Objective To investigate the feasibility, ideal dose, intra-operative awareness as well as the quality and effectiveness of constant infusion of propofol under combined spinal-epidural anesthesia (CSEA) for conscious sedation. Methods A total of 480 patients at ASA grade Ⅰ-Ⅲ to be operated in the lower abdomen, perineum and lower limbs under CSEA from March to December 2009 were randomly divided into four groups: midazolam group (M group), propofol group Ⅰ (PA group), propofol group Ⅱ (PB group), and propofol group Ⅲ (PC group), with 120 patients in each group. All four groups of patients underwent CSEA at L2-3 or L3-4 and accepted pinal injection of 12-15 mg of 0.2% hypobaric bupivacaine. After the anesthetic plane was confirmed, patients in M group accepted 0.04-0.06 mg/kg of midazolam; patients in PA group accepted propofol at a loading dose of 0.50 mg/kg followed by continuous infusion at a dose of 2.00 mg/(kg?h); patients in PB group accepted propofol at a loading dose of 0.75 mg/kg followed by continuous infusion at a dose of 3.00 mg/(kg?h); patients in PC group accepted propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg?h). The change of hemodynamics including the mean arterial pressure (MAP) and the heart rate (HR), bispectral index (BIS) values, sedation scores, memory of pictures seen during operation and adverse effects before drug administration (T0), at minute 1 (T1), 3 (T2), 5 (T3), 10 (T4), 30 (T5) and 60 (T6) after drug administration were observed. Results MAP and HR decreased in all the four groups after administration of sedatives, but the changes of measured values were within normal ranges. BIS value and the Observer’s Assessment of Alertness and Sedation (OAA/S) scale decreased in all groups at T3, compared with those at T0 (Plt;0.05). Compared with the other 3 groups, BIS valueand OAA/S scale were significantly lower in PC group at T4, T5 and T6 (Plt;0.05), and the satisfaction rate of sedation and amnesia was much higher. No serious glossocoma, apnea and SpO2 below 90% was observed in all the four groups. Conclusion During the surgery of lower abdomen and lower limbs, application of CSEA combined with propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg?h) can achieve a good sedative effect, with little side effect.
