小儿七氟醚麻醉苏醒期躁动的预防处理

目的观察静注咪达唑仑、芬太尼对七氟醚吸入麻醉患儿苏醒期躁动的预防作用。方法择期行腹股沟斜疝疝囊高位结扎术的患儿40例,年龄1～6岁。随机分为咪达唑仑、芬太尼静注组（A组）及对照组（B组）,每组20例。两组患儿均给予8％七氟醚＋吸氧（5L/min）诱导。A组在麻醉诱导后静注咪达唑仑0．1mg/kg、芬太尼2～3μg/kg,七氟醚2％～3％＋吸氧（2L／min）维持麻醉。B组七氟醚3％～5％＋吸氧（2L／min）维持麻醉。结果两组的手术时间、苏醒时间差异无统计学意义。与B组相比,A组躁动发生率明显下降。结论静注咪达唑仑、芬太尼可以有效地预防小儿七氟醚吸入麻醉术后苏醒期躁动的发生。     

不同药物配伍用于小儿手术麻醉的效果比较

目的比较氯胺酮、七氟醚、舒芬太尼、瑞芬太尼用于小儿头颈部手术麻醉的血流动力学变化及苏醒质量。方法选择择期头颈手术小儿100例,随机分为A组:氯胺酮;B组:氯胺酮、瑞芬太尼;C组:七氟醚;D组:舒芬太尼、丙泊酚;E组:瑞芬太尼、丙泊酚(n=20)。记录插管前、插管时、术中10min、手术结束时和清醒拔管时的平均动脉压(MAP)、心率(HR),观察手术结束至患儿的自主呼吸恢复时间、睁眼时间、拔管时间及拔管后躁动情况。结果插管时和清醒拔管时的MAP和HR,B、C、D、E组低于A组(P<0.05),术毕自主呼吸恢复时间、睁眼时间、苏醒拔管时间C、E组短于A组(P<0.01),B、D组也短于A组(P<0.05)。结论与氯胺酮比较,瑞芬太尼、舒芬太尼用于小儿手术的麻醉更有利于血流动力学的稳定和缩短苏醒时间,舒适度高。     

探究丙泊酚、舒芬太尼、咪达唑仑在静脉复合麻醉中的运用效果

目的:在静脉复合麻醉中应用舒芬太尼、丙泊酚、咪达唑仑的临床影响效果分析.方法将我院84例ASAⅠ-Ⅱ的择期手术患者随机分为2组:A组(应用舒芬太尼+丙泊酚+罗库溴铵注射液)与B组(应用咪达唑仑+丙泊酚+罗库溴铵注射液、舒芬太尼),各42例,对2组患者的苏醒质量评分状况进行对比.结果:B组的苏醒质量评分状况优于A组,P<0.05.结论:舒芬太尼、丙泊酚、咪达唑仑在静脉复合麻醉中的临床效果显著,适合推广.     

七氟醚、舒芬太尼与氯胺酮对疝气手术患儿的影响

目的:探究七氟醚复合舒芬太尼与氯胺酮麻醉对疝气腹腔镜手术患儿的临床效果.方法:抽取90例行疝气腹腔镜手术的患儿,45例患儿接受七氟醚复合舒芬太尼进行麻醉(观察组);另外45例患儿接受氯胺酮麻醉(对照组).结果:手术时间,两组患儿无明显差异;麻醉诱导时间和苏醒时间,观察组患儿较对照组患儿优良;不良反应发生率,观察组患儿较对照组患儿低,差异具有统计学意义(P<0.05).结论:七氟醚复合舒芬太尼麻醉比氯胺酮麻醉对疝气腹腔镜手术患儿的临床效果更加优良,能够减少麻醉诱导时间、苏醒时间并降低不良反应发生率.两种麻醉方式均对血液流变学影响小,综合比较,七氟醚复合舒芬太尼麻醉更值得推广应用.     

右美托咪啶在预防儿童七氟醚麻醉苏醒期躁动的临床效果分析

目的临床实践分析右美托咪啶预防小儿七氟醚麻醉苏醒阶段躁动症的作用效果。方法随机选取福建省宁德市医院麻醉科2013年9月至2014年6月间参与的64例小儿七氟醚麻醉手术,对照分析右美托咪啶在患儿麻醉苏醒阶段出现的躁动症的预防效果及生命指标变化情况。结果两组患儿在麻醉期间HR、MAP值均有明显上升,但是实验组患儿上升值明显低于对照组;实验组患儿在嗜睡程度方面高于对照组,但是在躁动程度方面则低于对照组。结论经过临床实证研究证实,术前给予使用右美托咪啶可显著降低七氟醚麻醉后的躁动发生率或者躁动程度,对患儿血流动力学影响较小,可进行临床推广应用。     

咪达唑仑、右美托咪定对七氟醚麻醉术后躁动的作用

目的分析临床行七氟醚全身麻醉患者使用咪达唑仑、右美托咪定,其术后躁动发生情况。方法收治常熟市第一人民医院行全身麻醉手术的127例患者作为本次观察对象,按病床单双号分为两组,观察1组63例用右美托咪定,观察2组64例用咪达唑仑,对患者术后躁动发生及程度进行统计,观察不同药物患者苏醒、麻醉及恢复室时间,比较用药即刻、术后生命体征(血压、心率)水平差异。结果观察1组躁动发生率为11.1%。低于观察2组的28.1%,差异有统计学意义(P0.05);两组麻醉、苏醒、恢复室时间比较差异无统计学意义(P0.05)。结论临床对行七氟醚全麻者术中使用右美托咪定,不仅能有效预防术后躁动发生,且用药安全性高,不易引起血流动力学变化。     

七氟醚吸入复合局部浸润麻醉对小儿阑尾切除术后躁动的影响

目的观察七氟醚吸入复合局部浸润麻醉对小儿阑尾切除术后躁动的影响。方法研究60例择期阑尾切除术的小儿随机均分单纯七氟醚吸入麻醉组(S组)或七氟醚吸入复合局部浸润麻醉组(C组)对呼吸、循环及术后并发症的影响。结果两组均能较好的完成手术,但C组患儿在麻醉苏醒期躁动明显减少。结论七氟醚吸入复合局部浸润麻醉能显著降低患儿苏醒期的躁动发生率,在临床上是一种小儿行阑尾切除术较理想的麻醉方法。     

七氟醚吸入复合局部浸润麻醉对小儿包皮套扎术后躁动的影响

目的观察七氟醚吸入复合局部浸润麻醉对小儿包皮套扎术后躁动的影响。方法研究60例择期包皮套扎术的小儿随机均分单纯七氟醚吸入麻醉组(S组)或七氟醚吸入复合局部浸润麻醉组(C组)对呼吸、循环及术后并发症的影响。结果两组均能较好的完成手术,但C组患儿在麻醉苏醒期躁动明显减少。结论七氟醚吸入复合局部浸润麻醉能显著降低患儿苏醒期的躁动发生率,在临床上是一种小儿行包皮套扎术较理想的麻醉方法。     

帕瑞昔布钠预防儿童七氟醚全麻苏醒期躁动的临床研究

目的观察帕瑞昔布钠用于预防小儿七氟醚全麻苏醒期躁动的效果及安全性。方法择期下腹部手术患儿90例,随机分为三组。A组(手术开始前给予帕瑞昔布钠0.5 mg/kg)、B组(手术开始前给予曲马多2 mg/kg)和C组(手术开始前给予等容生理盐水)各30例,三组均以8%七氟烷、维库溴铵、舒芬太尼诱导,术中以2%～5%七氟烷维持。分别记录术毕患儿手术时间、停药至清醒时间、拔管时间、躁动评分和疼痛评分。观察患儿各种不良反应(如嗜睡、呼吸抑制、恶心、呕吐等),术后24 h随访。结果患儿苏醒期躁动发生率A组明显低于B组和C组,B组低于C组(p<0.01);拔管后15、30、45、60 min VAS评分A组显著低于B组和C组,B组低于C组(p<0.01)。术后24 h内三组患儿均无心律失常、呼吸抑制、凝血功能异常发生,恶心呕吐、头晕头痛、畏寒发热、心悸、嗜睡、倦怠等不良反应率差异无统计学意义(p>0.05)。结论帕瑞昔布钠预防小儿全麻苏醒期躁动的效果良好,起效快,作用时间长,无明显不良反应,可安全用于小儿七氟醚全麻术后躁动。     

咪达唑仑滴鼻与酮咯酸氨丁三醇超前镇痛对减少小儿麻醉苏醒期躁动的影响探讨

目的:研究咪达唑仑滴鼻与酮咯酸氨丁三醇超前镇痛对减少小儿麻醉苏醒期躁动的影响。方法:选择我院自2018年1月至2019年5月期间收治的行小儿麻醉的患儿52例,按照奇偶数分组发将其分为参照组与观察组,其中参照组在麻醉诱导前给予患儿生理盐水,观察组在麻醉诱导前给予患儿咪达唑仑滴鼻与酮咯酸氨丁三醇,观察并对比两组患儿麻醉苏醒期躁动情况。结果:观察组患儿在手术完毕后5分钟、10分钟、30分钟时间段的躁动评分明显低于参照组,差异显著,具有统计学意义(P0.05)结论:小儿麻醉应用咪达唑仑滴鼻联合酮咯酸氨丁三醇超前镇痛方式,能够有效改善患儿麻醉苏醒期躁动情况,有利于患儿治疗过程顺利进行,值得研究推广。     

对比分析喉罩麻醉和气管插管麻醉在小儿麻醉中的麻醉效果

目的:对比分析喉罩麻醉和气管插管麻醉在小儿麻醉中的麻醉效果。方法:选取2018年5月~2019年2月在本院行手术治疗的82例患儿为研究对象,按照随机双盲法将其分为两组,各41例。对照组给予气管插管麻醉,观察组给予喉罩麻醉。观察两组小儿不同时间点血流动力学指标及术后并发症。结果:较对照组相比,观察组T1、T3时平均动脉压及心率低,差异有统计学意义(P<0.05);较对照组相比,观察组术后并发症发生率低,差异有统计学意义(P<0.05)。结论:与气管插管麻醉相比,喉罩麻醉更利于小儿术中血流动力学的稳定,可降低术后并发症的风险。     

喉罩麻醉和气管插管麻醉在小儿麻醉中的对比研究

目的探讨喉罩麻醉和气管插管麻醉在小儿麻醉中的效果。方法选取2013年11月至2015年11月在我院接受手术治疗的患儿共84例,随机分为观察组和对照组,每组各42例。对照组采用气管插管麻醉,观察组采用喉罩麻醉。观察比较两组的麻醉效果、拔管时间、苏醒时间及拔管不良反应。结果观察组总有效率为97.6%,与对照组的92.9%比较,差异无统计学意义(P>0.05)。观察组拔管时间、苏醒时间均显著短于对照组;并发症发生率显著低于对照组(11.9%vs 59.5%),差异均有统计学意义(P<0.05)。结论在小儿麻醉中,采用喉罩麻醉能够维持患儿血流动力学的稳定性,降低术后并发症的发生率,保障麻醉的安全性,提高麻醉效果。     

Anesthesia systems

This Evaluation presents ECRI's detailed findings for three newly tested anesthesia systems and updated ratings for three previously evaluated ones. The study focuses on models intended for the full range of inpatient surgical applications. That is, we consider whether and how well the systems--three supplied by Datex-Ohmeda and three supplied by Draeger Medical--can meet the needs of patients covering a wide range of ages, sizes, and conditions. We also consider the adequacy of the systems' safety features, the comprehensiveness of their pre-use checks, and ease of use. We found that all the evaluated units generally perform well, displaying comparable accuracy and consistency of delivery when similarly equipped (e.g., with comparable ventilation modes). However, all the systems also have critical limitations associated with their pre-use check procedures. Several units also exhibit problems with the handling of important alarms under certain conditions. Our ratings will help guide healthcare facilities both when selecting a model and when determining which options to purchase. In several cases, models that are otherwise appropriate for use are rated Not Recommended for purchase if they are not equipped with certain options. And in one case, we rate a unit Unacceptable for purchase if it is not equipped with a safety feature that can help reduce the risk of surgical fires.     

Anesthesia systems

Anesthesia systems are used to induce general anesthesia during surgery. In addition, the systems track anesthetic agent and gas concentrations, as well as the patient's condition, using physiologic and multigas monitors. For this Update Evaluation, we present our findings for four newly evaluated models from two manufacturers and summarize our findings for the two previously evaluated models that are still on the market. (Our earlier Evaluations were published in the May-June 1996 and January 1998 issues of Health Devices.) As in the previous Evaluations, our ratings are based largely on the degree of system integration, the suitability of the systems for various types of procedures, and cost. When equipped with the appropriate monitors, all the systems can deliver anesthesia effectively and can meet the minimum monitoring requirements of general surgery. While no system met all our criteria, any limitations of the systems can easily be overcome by the purchaser. We rate two models Preferred. One provides performance and features similar to the other evaluated systems at a significantly lower cost. The second offers exceptional flexibility in meeting monitoring requirements. Three models are rated Acceptable, and the remaining model is rated Acceptable (with Conditions). It is Acceptable only if it is equipped to supply air as an inspired gas.     

气管插管麻醉与喉罩麻醉在婴儿麻醉中的应用效果比较

目的探讨气管插管麻醉与喉罩麻醉在婴儿麻醉中的应用效果。方法在医院2014年8月-2015年10月期间诊治的行手术治疗的婴幼儿中抽取88例作研究对象,遵循随机数字表法将其分为观察组和对照组各44例,观察组应用喉罩麻醉方式,对照组采取气管插管麻醉方式,比较两组麻醉效果以及不良反应发生率。结果观察组婴幼儿插管后的呼末二氧化碳分压、气道峰压分别是(39.2±0.7)mm Hg、(21.5±1.8)cm H2O,不良反应发生率是6.82%;对照组婴幼儿插管后的呼末二氧化碳分压、气道峰压分别是(36.3±2.1)mm Hg、(28.9±1.2)cm H2O,不良反应发生率是20.45%。两组婴幼儿插管后呼末二氧化碳分压、气道峰压以及不良反应发生率的组间比较有统计学差异(P<0.05)。结论与气管插管麻醉相比,喉罩麻醉在婴儿麻醉中的应用效果更佳,且患儿不良反应发生率较低,值得推广使用。     

全凭静脉麻醉

1静脉麻醉的特点 麻醉药经呼吸道吸入而产生全身麻醉,称为吸入麻醉.吸入麻醉药依赖于呼吸道进入体内和从体内消除,因此它的可控性较静脉麻醉药好.吸入麻醉药首先在麻醉环路中达到一定浓度,然后经过肺脏进入血液循环,再经循环系统到达中枢神经系统发挥其麻醉作用,排除体内的过程则按相反的方向进行.增加吸入麻醉药的浓度和潮气量及呼吸频率,就可以通过增加肺泡内吸入麻醉药的浓度,加快麻醉药的吸收从而增加麻醉的深度.麻醉苏醒时停止给予吸入麻醉药,增加潮气量及呼吸频率,就可以加快吸入麻醉药从体内的排除,从而加速病人从麻醉中苏醒.因此,吸入麻醉的深度易于调控.另外,在达到平衡后,呼气末麻醉药的浓度等同于肺泡气中麻醉药的浓度,又与血中和脑中麻醉药的浓度是一致的,这样只要测定呼气末麻醉药的浓度,就能知道麻醉药作用部位脑中麻醉药的浓度.     

IV Regional Anesthesia

Abstract

Background: There is a wide variation in reported accuracy of noninvasive stress myocardial imaging as a screening tool for coronary artery disease (CAD). This study was undertaken to determine its current accuracy in a wide spectrum of patients with chest pain syndromes using invasive coronary angiography as the gold standard. Methods: The patient population consisted of consecutive patients undergoing coronary angiography in whom noninvasive stress imaging, either nuclear or echocardiographic, was performed within 6 months prior to the angiogram. The specificity, sensitivity, positive and negative predictive values, and diagnostic accuracy for detecting ≥ 1 lesions with ≥ 50% diameter coronary stenosis were determined for each modality. Results: Of the 227 eligible patients, 141 were men and 86 were women; 70% had significant CAD. The diagnostic accuracy overall was 71% and was no different for nuclear or echocardiographic testing. The positive predictive value (86% vs 52%; P = 0.002) and diagnostic accuracy (83% vs 51%; P = 0.002) were better in men than in women. Interpretation: In this study, noninvasive stress imaging lacked the accuracy of a good screening test for significant CAD. This finding was particularly true for women, for whom it was not much better than a coin toss.