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.
To investigate the protective effect of propofol on ischemia/reperfusion induced spinal cord injury in rabbits and its influence on excitatory amino acid (EAA). Methods Sixty New Zealand white rabbits weighing 2.0-2.5 kg, half males and half females, were selected. The infrarenal circumaortic clamping model was used. And 6 mL/kg different fluids were continuously infused through a catheter into the aorta distal to the clamping site at a speed of 12 mL/(kg?h) during the 30 minutes ischemia period. According to the different infusing l iquids, the rabbits were randomized into 6 groups(n=10 per group): group A, normal sal ine; group B, 10% intral ipid; group C, propofol 30 mg/kg; group D, propofol 40 mg/kg; group E, propofol 50 mg/kg; group F, propofol 60 mg/kg. At 0, 6, 24, and 48 hours after reperfusion, neurologic outcomes were scored on a Tarlov scale system. At 48 hours after reperfusion, the number of normal neurons in the anterior spinal cord was counted, and concentration of EAA in the lumbar spinal cord was measured by high performance l iquid chromatography. Results The neuroethological score was better in groups C, D, E and F than that of groups A and B (P lt; 0.05), the score of group E was the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). The number of normal neurons in the anterior spinal cord of groups C, D, E and F was greater than that of groups A and B (P lt; 0.05), and group E was greater than groups C, D and F (P lt; 0.05). The concentration of EAA in groups A, B, C, D, E and F was greater than that of normal tissue, the group E was the lowest (P lt; 0.05), the groups A and B were the highest (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). Concentrations of glutamate and aspartic acid were negatively correlated to normal neuron numbers in the anterior spinal cord and neuroethological scores 48 hours after reperfusion, and the corresponding correlation coefficient was — 0.613, — 0.536, — 0.874 and — 0.813, respectively (P lt; 0.01). Conclusion Propofol can significantly inhibit the accumulation of EAA in spinal cord and provide a protective effect against the ischemia/reperfusion injury induced spinal cord in rabbits.
Objective To investigate the changes of interleukin-17 ( IL-17) and the effects of propofol in rats with acute lung injury ( ALI) . Methods ALI model was established by hydrochloric acid ( HCl) inhalation in a dose of 2 mL/kg. 35 adultmale SD rats were randomly divided into seven groups, ie.a control group, a HCl group, and five propofol groups ( T24b , T12b , T0 , T1a , T3a groups, respectively) . The T0 ,T24b and T12b groups were pretreated with intraperitoneal propofol injection 0, 24 and 12 hours respectively before HCl inhalation. The T1a and T3a groups were managed by intraperitoneal propofol injection 1 and 3 hours respectively after HCl inhalation. Immunohistochemistry was used to determine the expression of IL-17 in lung tissue. ELISA was adopted to detect the levels of IL-17 and IL-8 in lung tissue homogenate as well as in bronchoalveolar lavage fluid ( BALF) , meanwhile arterial partial pressure of oxygen ( PaO2 ) and myeloperoxidase ( MPO) were measured. Results Those rats in the HCl group appeared respiratory distress, cyanosis, pulmonary edema, and inflammatory cells infiltration in lung tissues after HCl inhalation.The IL-17 levels in lung tissue homogenate as well as in BALF were higher in the HCl group than those in the control group( all P lt; 0. 01) . IL-17 was mainly expressed in alveolar epithelial cells and mononuclear cells in the ALI rats and its expression level was higher than that in the control group. IL-17 concentration in lung tissue homogenate was both correlated with IL-8 concentration in lung tissue homogenate ( r=0. 98, P =0.003) and with the activity of MPO in lung tissue( r=0. 981, P =0. 003) in the HCl group. Mainwhile, a same significant correlation was found between IL-8 level in lung tissue homogenate and the MPO activity in the HCl group( r =0. 961, P =0. 009) . Propofol attenuated lung injury induced by HCl inhalation, especially in T24b group. The concentrations of IL-17 in lung tissue homogenate and in BALF were lower in T24b group when compared with the HCl group( P = 0. 011, P =0. 003, respectively) . Conclusions The expression of IL-17 increases in ALI rats. Pretreatment with propofol by 24 hours has obvious inhibiting effects on inflammatory reaction. Inhibiting IL-17 expression may be one of the mechanisms through which propofol inhibits the inflammatory reaction of ALI.
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.
Objective To assess the safety and efficacy of sufentanil combined with propofol for painless fiberbronchoscopy. Methods A total of 120 patients undergoing fiberbronchoscopy were divided into two groups according to their admission sequence: group S (sufentanil + propofol, n=60) and group F (fentanil + propofol, n=60). Parameters including heart rate (HR), systol ic blood pressure (SBP), diastol ic blood pressure (DBP), saturation of blood oxygen (SPO2), dose of propofol, duration of the procedure, waking time and score of Observer’s Assessment of Alertness/Sedation (OAA/S) scale were recorded. Results The HR increased significantly 3 minutes after drug administration in both groups (Plt;0.05). The SPO2 decreased significantly 3 minutes after drug administration in both groups (Plt;0.05). The average dose of propofol and OAA/a score were similar between the two groups (Pgt;0.05). The waking time was significantly shorter in group S than in group F (Plt;0.05). Conclusion Sufentanil combined with propofol could offer a good sedative/analgesic effect during painless fiberbronchoscopy.
ObjectiveTo systematically review the safety of propofol versus sevoflurane for pediatric surgery.
MethodsEMbase, PubMed, The Cochrane Library, CSCD, CNKI, WanFang Data were searched to collect randomized controlled trials (RCTs) about propofol versus sevoflurane for pediatric surgery from inception to January 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then metaanalysis was performed by using RevMan 5.3 software.
ResultsFifteen RCTs involving 1 065 children were included finally. Meta-analysis results showed that, compared with the sevoflurane group, the propofol group could reduce the incidence of emergence agitation (OR=0.23, 95%CI 0.16 to 0.34, P<0.000 01) and the incidence of postoperative vomiting (OR=0.32, 95%CI 0.20 to 0.51, P<0.000 01). There were no significant differences between the two groups in extubation time (MD=0.98, 95%CI -0.26 to 2.21, P=0.12), eye-opening time (MD=3.32, 95%CI -2.65 to 9.29, P=0.28) and postoperative analgesic requirements (OR=0.60, 95%CI 0.30 to 1.23, P=0.16).
ConclusionIn reducing the incidence of emergence agitation and postoperative vomiting, propofol is superior to sevoflurane, so propofol is safer than sevoflurane for children's surgery.
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.
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 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 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.
