右美托咪定或丙泊酚复合瑞芬太尼用于功能神经外科术中唤醒的比较

目的比较右美托咪定(Dex)或丙泊酚复合瑞芬太尼用于功能神经外科术中唤醒的效果。方法功能神经外科需术中唤醒的患者48例,ASAⅠ或Ⅱ级,男21例,女27例,年龄12~65岁,随机均分为Dex复合瑞芬太尼组(D组)和丙泊酚复合瑞芬太尼组(P组),分别以Dex复合瑞芬太尼和丙泊酚复合瑞芬太尼维持麻醉实施术中唤醒。记录两组血流动力学、苏醒时间、自主呼吸恢复时间、唤醒成功率及唤醒期间的呛咳、躁动、呼吸抑制等不良事件发生率。结果两组唤醒成功率相似。D组苏醒更快,自主呼吸恢复时间短,且呛咳、躁动显著低于P组(P<0.05)。D组用药初期血压升高,心率减慢(P<0.05),但唤醒期间组间差异无统计学意义。结论与丙泊酚复合瑞芬太尼相比,右美托咪定复合瑞芬太尼麻醉下能有效实施术中唤醒,唤醒期间血流动力学平稳,不良事件发生率更低。     

不同麻醉方法用于神经外科术中唤醒的比较

<正>术中唤醒麻醉技术主要用于神经外科手术中对患者语言功能进行监测,以便于外科医师最大限度切除病变部位同时最大程度地保留患者语言功能。选择合适的麻醉方法和技术对成功术中唤醒并减少并发症至关重要,目前常见的麻醉方法主要分为以下3种:睡眠-清醒-睡眠麻醉(asleep-awake-asleep,SAS)、麻醉监护下镇静(monitored anaeshesia     

右美托咪定用于丙泊酚麻醉下改良电休克治疗的研究进展

改良电休克治疗(modified electroconvulsive therapy,MECT)是目前临床上用于治疗严重精神疾病的有效物理方法。右美托咪定(dexmedetomidine,Dex)是一种亲脂性的α羟甲基衍生物,具有镇静、止痛和阻滞交感神经的作用,易于唤醒,利于稳定循环,近年来Dex也开始用于MECT的麻醉。文章就Dex用于常规丙泊酚麻醉下MECT的临床应用进展进行综述,描述MECT手术的麻醉特点以及Dex用于MECT手术麻醉的安全性与临床效果。     

右旋美托咪定对脊柱侧弯矫形术患者术中唤醒的影响

目的 探讨右旋美托咪定(dexmedetomidine,Dex)对脊柱侧弯矫形术患者术中唤醒的影响. 方法 40例择期全麻下行脊柱侧弯矫形手术患者,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级.采用完全随机分组法均分为Dex组(D组)和对照组(C组)(每组20例).D组麻醉诱导前10 min给予0.8 μg/kg Dex,C组给予同等剂量的生理盐水,分别在10 min内静脉泵入,随后行常规诱导插管.术中D组使用维持剂量Dex 0.2 μg·kg-1·h-1至术毕.唤醒试验开始时两组停用麻醉维持药物(D组Dex不停用),从停用所有麻醉药物(Dex除外)到患者活动脚趾的时间定为唤醒时间,唤醒后维持药物继续使用至术毕.记录唤醒试验开始时、唤醒时患者脑电双频指数(bispectralindex,BIS)值、心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)指标,记录唤醒时间、唤醒质量评分及唤醒期间出血量. 结果 两组唤醒时间差异无统计学意义;唤醒试验开始时两组患者的MAP、HR比较差异无统计学意义;唤醒时D组患者MAP和HR分别为(79±6) mm Hg(1 mm Hg=0.133 kPa)和(80±9)次/min,低于对照组MAP(88±6)mm Hg和HR(98±7)次/min(P＜0.05);D组患者的唤醒质量要明显高于C组(P＜0.01);D组患者在唤醒期间的出血量为(269±34) ml,小于C组同时期出血量(328±50) ml(P＜0.05). 结论 Dex能明显提高脊柱侧弯矫形手术术中唤醒质量,不延长唤醒时间;并且能维持唤醒期间血流动力学稳定,减少唤醒期间出血量.     

右美托咪定在心血管手术麻醉中的应用价值和进展

背景右美托咪定(dexmedetomidine,Dex)是高选择性α2肾上腺素能受体激动剂,具有镇静、镇痛、抗焦虑及抑制交感和应激反应的作用,已广泛应用于临床麻醉,近期研究表明Dex在心血管手术麻醉中有一定的应用价值.目的 阐述Dex在心血管手术麻醉中应用的适用性、有效性和安全性,为临床应用提供参考.内容概述Dex在心血管手术麻醉围手术期具有的稳定血流动力学、抗心律失常、器官保护、防治术后谵妄和抗炎作用以及副作用的防范.趋向Dex在心血管手术麻醉中有一定的应用价值,但需要进一步研究明确Dex的临床应用范围、副作用及处理措施,以便更好地应用于临床.     

右美托咪定的药物相互作用

背景 右美托咪定(dexmedetomidinne,Dex)是一种高选择性的α2肾上腺素能受体激动剂,兼具有镇静、镇痛、降低交感神经张力等作用,同时无呼吸抑制和脑电干扰等副作用,现已广泛应用于临床.大量研究表明Dex和麻醉药物之间存在药物相互作用. 目的 综述国内外Dex和麻醉药物在药代学和药效学上的相互作用研究,为临床合理应用提供参考. 内容 探讨Dex与麻醉药物之间相互作用所产生的临床效应,如减少麻醉药物用量、减少药物副作用的发生率、稳定血流动力学等,并探讨其发生的相关机制. 趋向 随着研究的不断深入,期望Dex能在临床应用中得到更广泛的应用.     

右美托咪定与产科麻醉镇痛相关的研究及探讨

背景目前国内关于右美托咪定(dexmedetomidine,Dex)用于产科临床研究相对较少,然而越来越多的研究结果显示Dex在产科麻醉镇痛方面具有独特优势.目的 对近年来Dex应用于产科麻醉镇痛的相关研究进行介绍,并进一步探讨.内容Dex已被证实可安全应用于新生儿全身麻醉而无或极少有副作用,同时不少临床研究报道证实了其减少七氟醚和氯胺酮引起毒性反应的作用.Dex已被用于产科静脉复合麻醉及蛛网膜下腔麻醉.在这些应用中,Dex体现出了减轻围产期寒战、恶心呕吐,维持全身麻醉剖宫产正常宫缩的作用.Dex较轻的呼吸抑制作用和可唤醒镇静使之适用于产科清醒插管;然而Dex在产科麻醉镇痛方面的用药目前仍属超说明书范围用药,用药指南仍需更多的临床研究得以实现.趋向为优化产科麻醉与镇痛提供新的药物选择.     

右美托咪定和丙泊酚用于硬膜外麻醉下妇科手术患者镇静的比较

目的 比较右美托咪定(Dex)和丙泊酚用于硬膜外麻醉下妇科手术患者的镇静效果.方法 硬膜外麻醉下择期行子宫或(和)卵巢切除患者100例,随机均分成Dex组(D组)和丙泊酚组(P组),应用Ramsay镇静评分和脑电双频指数(BIS)对两组患者术中镇静效果进行观察.记录给药前(T0)、切皮前即给药后15 min(T1)、手术开始后15 min(T2)、30 min(T3)、45 min(T4)、术毕(T5)及术后1 h(T6)患者HR、MAP、BIS、Ramsay镇静评分及呼吸抑制情况.结果 T1～T5时D组BIS,MAP明显低于T0时和P组,Ramsay镇静评分低于P组,HR慢于T0时和P组(P<0.05).低血压的发生率P组明显高于D组(P<0.05).结论 Dex用于硬膜外麻醉下妇科手术患者镇静是安全和可行的.     

右美托咪定在脑功能区癫痫病灶切除术中的应用

目的 探讨右美托咪定(dexmedetomidine,Dex)在脑功能区癫痫病灶切除术中应用时,不影响脑电图及电生理监测情况的适宜剂量. 方法 美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级择期行脑功能区癫痫病灶切除术患者60例,男性34例,女性26例,年龄18岁～45岁,体重40 kg～74 kg,采用随机数字表法分为4组(每组15例):对照组(C组)、Dex 0.25 μg·kg1·h-1组(D1组)、0.50 μg·kg-1·h-1组(D2组)和1.00 μg·kg-1·h-1组(D3组).C组持续输注丙泊酚,其余3组于监测开始前15 min停用丙泊酚,先静脉输注Dex负荷剂量0.5 μg/kg,然后分别以0.25、0.50 μg· kg-1·h-1或1.00 μg· kg-1·h-1速率静脉输注Dex至手术结束.记录术中皮质脑电图及电生理监测的情况,脑电双频指数(bispectral index,BIS)、血压、心率变化情况,发生的副作用,丙泊酚用量以及术毕苏醒时间. 结果 与C组BIS(62±7)比较,D1组(55±4)、D2组(51±6)和D3组(44±3)的BIS值明显降低(P＜0.05);C组脑电图波幅较高,夹杂的干扰波比较多,偶尔可见丙泊酚引起的突发性抑制;D3组脑电图较前3组波幅明显低平,降幅大于30％;D1和D2组的脑电图波幅适中. 结论 术中静脉输注Dex的剂量范围在0.25 μg·kg-1·h-1和0.50 μg·kg-1·h-1之间比较适合皮层脑电图及电生理监测,有利于提高脑功能区癫痫病灶切除术中定位致痫灶的准确性.     

听觉诱发电位指数监测与靶控输注在神经外科术中唤醒的应用

近年来一些脑功能区手术尝试最大限度地在唤醒麻醉下切除病灶,麻醉医师常根据麻醉方法及经验估计患者的苏醒时间,需反复呼唤直至患者对指令产生正确反应.听觉诱发电位指数(AAI)监测仪作为一种新型的麻醉深度监测设备,能够鉴别意识的存在和消失[1],而靶控输注(TCI)丙泊酚能准确地预测患者的血药浓度,我们将AAI监测和TCI丙泊酚复合瑞芬太尼静脉麻醉在神经外科术中唤醒,取得了较满意的效果,现报道如下.     

Anesthesia for functional neurosurgery: review of complications

The use of functional stereotactic neurosurgery is increasing for treatment of patients with movement disorders and other chronic illnesses. The anesthetic considerations include the influence of the anesthetic agents on the microelectrode recordings and stimulation testing of an awake patient. The purpose of this study was to review the anesthetic management and incidences of intraoperative complications during functional neurosurgery in our institution. One hundred seventy-eight patients underwent an ablative procedure (n = 6) or the insertion of deep brain stimulator (n = 172) under monitored anesthesia care for movement disorders (n = 124), chronic pain (n = 20), and other procedures (n = 34). Local anesthetic was used for head frame pin sites and burr holes. No sedation/analgesia was administered to 57 (32%) patients. One patient required conscious sedation and another general anesthesia for the entire procedure. The remainder received small increments (mean +/- SD) of propofol (113 +/- 73 mg), midazolam (1.6 +/- 0.8 mg), and/or fentanyl (93 +/- 55 mug). Intraoperative complications that occurred in 16% of the patients included seizures (n = 8), change in neurologic status (n = 5), airway obstruction (n = 2), and hypertension (n = 7). Functional neurosurgery can be performed with minimal anesthesia in many patients. Awareness and vigilance can improve the identification and early treatment of intraoperative complications such as seizures, loss of airway, and changes in the neurologic status.     

Brain protection during neurosurgery

The initial concept of brain protection during neurosurgery is based on research done in the 1970s-1980 which established the concept that by decreasing cerebral metabolic rate the brain could survive longer periods of ischemia. The first section of this chapter reviews some of this initial research that promoted the use of barbiturates for cerebral protection. The second section reviews current anesthetic drugs and their potential for cerebral protection in addition to the benefits of blood pressure, temperature and glucose control. The final section discusses the "new mechanisms of cerebral protection" and the role old and new drugs may play in the future for brain protection during neurosurgery.     

Present state of anesthetic management for awake craniotomy in Japan

To avoid the neurological deficits after neurosurgical procedures, awake craniotomy applying intraoperative awake functional brain mapping has been employed. Anesthesia for awake craniotomy requires particular attention to airway management, control of seizures and measures for decreasing the anxiety of the patients. We investigated the current status of anesthetic management for awake craniotomy in Japan to establish a standard procedure for safe anesthesia. A questionnaire was sent to 80 universities with departments of anesthesia in Japan and 34 (43%) responded. In 19 institutes, awake craniotomies are being practiced. The first experience of awake craniotomy was in 1996 in Japan and since then most of the institutes have experienced only three or fewer cases. Airway management, control of nausea and vomiting, stable awakening during functional mapping and control of seizures were pointed out as problems during awake craniotomy. Based on the present results, our experience and the information from previous investigations, standard anesthetic management for awake craniotomy in our country will be documented.     

Neuroanesthesia for the pregnant woman

Neuroanesthesia for the pregnant patient is required infrequently, and evidence-based recommendations for neuroanesthetic management are sparse. We present a framework for a practical approach to anesthesia of the pregnant patient with subarachnoid or intracerebral hemorrhage, intracranial tumor, traumatic brain injury, spinal tumor, or spinal injury. The importance of a team-approach is emphasized. The anesthesiologist may have to anesthetize the pregnant patient for neurosurgery well before delivery, for cesarean delivery at the time of the neurosurgical procedure, or for delivery after neurosurgery. These scenarios are discussed along with fetal safety and anesthetic considerations for interventional neuroradiology.     

Manejo anestésico en neurocirugía de paciente con síndrome de Eisenmenger y síndrome de Down. Reporte de un caso

Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger Syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.     

Anestesia para la craneotomía en el paciente consciente

Craniotomy in the conscious patient (CPC) enables the neurological changes to be assessed during the mapping in epilepsy surgery, the location of the electrodes during deep brain stimulation surgery, and tumor resection in eloquent areas of the brain. CPC is a useful technique for radical surgery in order to minimize the damage to the functional areas of the brain. The anesthesiologist must ensure, adequate patient comfort, analgesia and ensure optimal collaboration. The appropriate selection of potential candidates for CPC should be made jointly with all professionals involved in the case. Knowledge of the different phases of CPC, coordination and communication among specialists, the right management of the pharmacology, and anesthetic techniques specific to CPC, along with the ability of psycho-emotional communication with the patient, determine the success of the procedure to be performed in the culture of patient safety. The aim of this review was to describe the anesthetic management, comprehensive considerations, and intraoperative neurophysiological tests for CPC.     

术中磁共振影像神经导航手术的麻醉管理

目的 探讨术中磁共振(iMR)影像神经导航辅助神经外科手术的麻醉管理.方法 22例神经外科手术患者采用核磁兼容或核磁可用的麻醉材料和设备,在全身麻醉(静吸复合或全凭静脉麻醉)下行iMR影像神经导航辅助颅内肿瘤切除术,术中监测心率、有创血压、脉搏血氧饱和度、呼气末二氧化碳分压、七氟醚浓度、中心静脉压以及动脉血气.结果 22例患者肿瘤的全切率从60.0%提高到86.4%.术中患者iMR扫描次数2～5次,手术时间延长1～3 h,术中未发生与麻醉和iMR相关的并发症和意外事件.结论 在iMR影像神经导航下行颅内肿瘤切除术的围术期麻醉处理中关注iMR影像神经导航外科相关的信息、手术室应用环境、麻醉技术和药物的选择以及围术期管理对患者的安全是重要的.     

神经外科麻醉时麻醉药物的选择

大多数情况下，麻醉药物的选择对神经外科手术的过程和患者的转归并无决定性影响。深入理解CNS的生理学、神经生理学和麻醉药物对大脑的影响，掌握熟练的麻醉技术，才是决定神经外科手术患者转归的关键。     

Transcranial Doppler and anesthetics

Transcranial Doppler (TCD) is widely used to investigate the effects of anesthetic drugs on cerebral blood flow. Its repeatability and non-invasivity makes it an ideal, first choice method. Anesthesia providers are required to be conscious of the cerebral hemodynamic effects of drugs given in their practice, especially in neurosurgery and in subjects with impaired brain functions. The purpose of this review is to present the basic concepts of the TCD technique and the effects on cerebral hemodynamics of the most popular anesthetic drugs evaluated using TCD ultrasonography.