不同剂量氯胺酮复合丙泊酚诱导在全麻剖宫产中的应用

目的 观察不同剂量氯胺酮复合丙泊酚诱导对产妇血流动力学及新生儿Apgar伴分的影响.方法 择期剖宫产足月初产妇60例,ASA Ⅰ或Ⅱ级,随机均分为0.5 mg/kg氯胺酮复合丙泊酚2 mg/kg组(A组)和1.0mg/kg氯胺酮复合丙泊酚2mg/kg组(B组).观察围术期产妇心率、血压变化及不良反应,新生儿1 min和5min的Apgar评分,以及新生儿行为神经评分(NBNA).结果 与诱导前比较,两组产妇插管后1 min的SBP、DBP明显升高,HR增快(P＜0.01),且A组的SBP和HR明显高于和快于B组(P＜0.05).两产妇组均无术中知晓.两组新生儿Apgar评分及NBNA评分差异无统计学意义.结论 2mg/kg丙泊酚复合1.0 mg/kg氯胺酮诱导产妇心率、血压变化较小,同时不增加新生儿呼吸抑制风险.     

瑞芬太尼复合丙泊酚全身麻醉对剖宫产新生儿的影响

目的探讨瑞芬太尼复合丙泊酚全身麻醉对子宫下段剖宫产新生儿的影响。方法将择期行子宫下段剖宫产的足月产妇60例采用随机数字表法分为瑞芬太尼复合丙泊酚全身麻醉组(G组)和腰麻组(L组),各30例。G组采用瑞芬太尼0.5μg/kg缓慢静滴,复合血浆靶浓度为3~3.5μg/mL的丙泊酚靶控输注的方法全身麻醉诱导。L组采用L2-3间隙蛛网膜下腔阻滞,蛛网膜下腔注入0.5%布比卡因3 mL,并预防性应用甲氧明1~2 mg预防低血压的发生。2组胎儿娩出后进行新生儿Apgar评分,并于娩出30 min后抽取新生儿脐动脉血进行血气分析(PH值、血氧饱和度及红细胞压积)。结果产妇均顺利完成子宫下段剖宫产手术,G组和L组新生儿Apgar评分比较,差异无统计学意义(P0.05)。两组新生儿的脐动脉血血气分析指标均符合正常标准,两组PH值、血氧饱和度及红细胞压积比较,差异无统计学意义(P0.05)。结论瑞芬太尼复合丙泊酚全身麻醉对子宫下段剖宫产分娩的新生儿无明显影响,具有一定的临床应用价值。     

丙泊酚瑞芬太尼靶控输注全麻在输尿管镜钬激光碎石术中的应用

目的研究丙泊酚复合瑞芬太尼靶控输注全麻在经尿道输尿管镜钬激光碎石术中应用的安全性和有效性。方法将80例在全麻下行输尿管镜钬激光碎石手术的患者随机分为两组,丙泊酚复合瑞芬太尼靶控输注组(R组)和丙泊酚复合芬太尼组(F组),每组40例。记录麻醉前、麻醉后5 min、10 min和停药后10 min的DBP、SBP、HR、SpO2。记录患者手术时间、苏醒时间、离室时间。结果两组均顺利完成手术,无严重不良反应发生。两组患者在麻醉后5 min、10 min的SBP和DBP较术前下降明显(P0.05)。R组患者苏醒时间和离开手术室时间较F组短(P0.01)。结论丙泊酚复合瑞芬太尼靶控输注全麻应用于输尿管镜钬激光碎石术手术,苏醒迅速,安全有效。     

舒芬太尼复合丙泊酚对小儿麻醉诱导期血流动力学及脑电双频指数的影响

目的 研究舒芬太尼复合丙泊酚对小儿全麻诱导期血流动力学及脑电双频指数(BIS)的影响.方法 45例择期全麻手术患儿随机均分为三组,每组15例.舒芬太尼剂量分别为0.1μg/kg(S1组)、0.2μg/kg(S2组)和0.3μg/kg(S3组).3 min后三组均静注丙泊酚2.5 mg/kg和维库溴铵0.1 mg/kg麻醉诱导.经口行气管插管.记录诱导前(T1)、静注舒芬太尼后(T2)、静注丙泊酚后(T3)、插管即刻(T4)、插管后2 min(T5)、5 min(T6)时的BP、HR和BIS.结果 S1、S2组在T4时SBP、DBP、MAP明显高于T1时(P＜0.05);而S3组变化不明显,但与S1组同一时点比较,SBP、DBP、MAP明显低于S1组、HR慢于S1组(P＜0.05).三组间各时点的BIS差异无统计学意义.结论 应用舒芬太尼0.3 μg/kg复合丙泊酚诱导能较好地抑制气管插管时的心血管应激反应.     

剖宫产术患者瑞芬太尼辅助用药对新生儿的影响及其胎盘转移

目的 探讨剖宫产术患者瑞芬太尼辅助用药对新生儿的影响及其胎盘转移情况.方法 择期足月剖宫产术患者40例,初产,ASA Ⅰ级,年龄26～32岁,体重70～90 kg,随机分为2组(n=20),对照组(C组)和瑞芬太尼组(R组).于L3-4间隙穿刺行脊椎-硬膜外联合阻滞,控制阻滞平面上界T6-T8.R组靶控输注瑞芬太尼,血浆靶浓度1.5 ng/ml,C组按瑞芬太尼的血浆靶控模式和靶浓度输注生理盐水,血样采集完毕时停止输注.于入室平静5 min(T0)、切皮(T1)、胎儿娩出(T2)、子宫修补(T3)和关腹(T4)时记录MAP、HR、分钟通气量(MV)、呼吸频率(RR>、警觉,镇静评分(OAA/S评分);记录T0时和消毒前胎心率(FHR)、子宫切开到胎儿娩出时间(分娩时间)、新生儿体重、新生儿1、5 minApgar评分、1、24 h新生儿神经行为评分(NBNA)和患者不良反应发生情况.胎儿娩出后3 min内分别取脐动脉血(UA)、脐静脉血(UV)各2 ml,于足背动脉取母体动脉血(MA)2 ml,行血气分析,测定瑞芬太尼血浆浓度.结果 与C组和T0时比较,R组T1,2时OAMS评分降低(P<0.05).两组间MAP、HR、MV、RR、分娩时间、FHR、血气分析指标、新生儿体重、Apgar评分和NBNA评分的比较差异无统计学意义(P>0.05),且均在正常范围内.胎儿娩出时MA、UV及UA中瑞芬太尼血浆浓度分别为(0.85±0.31)、(0.57±0.12)、(0.22±0.09) ng/ml,CUV/CMA为0.67±0.41,CUA/CUV为0.39±0.08.结论 靶控输注瑞芬太尼(血浆靶浓度1.5 ng/ml)时,尽管瑞芬太尼可迅速进行胎盘转移,但进入胎儿体内后,可迅速被代谢或重分布,因而对新生儿无不良影响.     

丙泊酚复合瑞芬太尼靶控输注在腹腔镜胆囊切除术中的应用

目的:观察丙泊酚复合瑞芬太尼靶控输注全凭静脉麻醉对腹腔镜胆囊切除术血流动力学及术后苏醒时间的影响。方法:50例择期行腹腔镜胆囊切除术的患者均采用丙泊酚复合瑞芬太尼靶控输注全凭静脉麻醉。设定诱导时静注咪达唑仑2mg,先血浆靶控输注瑞芬太尼4ng/ml,1min后血浆靶控输注丙泊酚3μg/ml或3.5μg/ml,患者意识消失后静注维库溴铵0.1mg/kg,3min后气管内插管,插管后丙泊酚靶浓度调至2μg/ml,术中维持根据需要调整丙泊酚靶浓度,以0.2μg/ml递增或递减,瑞芬太尼维持不变。记录诱导前、诱导后2min、插管即刻、插管后5min、气腹时、气腹后5min的收缩压(systolic bloodpressure,SBP)、舒张压(diastolic blood pressure,DBP)、心率(heart rate,HR)及术后呼吸恢复时间、呼之睁眼时间。结果:诱导后2min的SBP、DBP、HR与诱导前差异均有统计学意义(P0.05),气腹时SBP、DBP、HR有所升高,但差异无统计学意义,其他时点经适当调整丙泊酚靶浓度处理后逐渐平稳,术后呼吸恢复时间为(6.5±2.2)min,呼之睁眼时间(8.9±3.1)min。结论:丙泊酚复合瑞芬太尼靶控输注用于腹腔镜胆囊切除术安全,术中血流动力学平稳,术后苏醒快。     

瑞芬太尼复合丙泊酚靶控输注喉罩静脉麻醉用于颈部手术效果观察

目的观察瑞芬太尼复合丙泊酚靶控输注喉罩静脉麻醉应用于颈部手术的效果。方法随机将68例接受颈部手术的患者分为观察组和对照组,各34例。2组均实施喉罩静脉麻醉,观察组采用瑞芬太尼复合丙泊酚靶控输注,对照组患者采用丙泊酚靶控输注。比较2组患者在各时的SBP、DBP、HR变化及丙泊酚的用量。结果 2组患者麻醉前和停药时点的SBP、DBP、HR差异无统计学意义(P0.05);在喉罩置入前、后1 min时SBP、DBP、HR的差异有统计学意义;观察组丙泊酚使用量少于对照组,2组差异有统计学意义。结论颈部手术应用瑞芬太尼复合丙泊酚靶控输注喉罩静脉麻醉,对患者血液动力学影响较小,且可减少丙泊酚用量,效果满意。     

舒芬太尼或芬太尼复合丙泊酚对喉显微手术血流动力学和应激反应的影响

目的 比较芬太尼复合丙泊酚与舒芬太尼复合丙泊酚用于喉显微手术患者的血流动力学和应激激素变化.方法 200例患者行支撑喉镜下声带手术,患者随机均分为芬太尼复合丙泊酚组(F组)和舒芬太尼复合丙泊酚组(S组).F组、S组分别静脉注射芬太尼3.0μg/kg或舒芬太尼0.3μg/kg、丙泊酚2.0mg/kg、琥珀胆碱1.5mg/kg实施麻醉诱导.记录和测定两组诱导前(T0)、插管即刻(T1)、插管后1min(T2)、置支撑喉镜后1min(T3)及拔管后1min(T6)的SBP、DBP、HR、去甲肾上腺素(NE)、皮质醇(Cor)、血糖(Glu)的变化和丙泊酚用量、麻醉恢复情况及不良反应.结果 F组T1、T2、T3时SBP、DBP高于、HR快于T0和S组(P<0.05).F组T1～T3时NE、Cor、Glu分别显著高于T0和S组(P<0.05).术中丙泊酚追加量和总用药量F组显著高于S组(P<0.05),麻醉恢复时间S组稍长于F组,但差异无统计学意义.结论 舒芬太尼复合丙泊酚麻醉对血流动力学和应激反应影响小,是喉显微手术中比较理想的麻醉配伍组合.     

七氟醚复合瑞芬太尼在烧伤患者手术中的临床应用

目的评价七氟醚复合瑞芬太尼在烧伤患者手术中的临床应用效果。方法选择本院2016年6月至2017年6月择期行烧伤整形植皮手术的患者,性别不限,年龄19~53岁,ASA分级Ⅰ~Ⅱ级。采用随机数字表将患者分为七氟醚+瑞芬太尼组(T组)和丙泊酚+瑞芬太尼组(C组),每组各100例。T组患者吸入6%七氟醚联合顺阿曲库铵0.1mg/kg进行麻醉诱导。采用0.75~1.25MAC七氟醚联合瑞芬太尼0.05~0.15μg/kg/min、间断注射顺阿曲库铵进行麻醉维持。C组患者采用咪达唑仑0.05mg/kg、丙泊酚1~2mg/kg、顺阿曲库铵0.15mg/kg、瑞芬太尼1μg/kg进行麻醉诱导,以丙泊酚4~12mg/kg/h、瑞芬太尼0.05~0.15μg/kg/min、间断注射顺阿曲库铵进行麻醉维持。记录两组患者麻醉诱导前(T_0)、气管插管时(T_1)、手术开始即刻(T_2)、手术开始后30分钟(T_3)、术毕即刻(T_4)的收缩压(SBP)、舒张压(DBP)及心率(HR)。记录两组患者睁眼时间、拔管时间、术中低血压、PONV、寒战、苏醒期躁动发生情况。结果在T_2、T_3、T_4时点,C组患者SBP、DBP、HR均显著低于T组患者,差异有统计学意义(P0.05)。两组患者睁眼时间、拔管时间差异无统计学意义(P0.05)。C组患者术中低血压发生率显著低于T组,差异有统计学意义(P0.05)。但两组患者PONV、术后寒战、苏醒期躁动发生率差异无统计学意义(P0.05)。结论与丙泊酚复合瑞芬太尼相比,七氟醚复合瑞芬太尼能够有效维持术中血流动力学稳定,降低术中低血压的发生风险。     

瑞芬太尼联合丙泊酚在剖官产全麻中的应用

目的:应用瑞芬太尼和丙泊酚实行产科麻醉,观察其对新生儿和母体的影响.方法:行剖宫产术者40例,随机分成R组和K组,每组各20例,麻醉诱导插管R组:瑞芬太尼1～1.5ug/kg+丙泊酚1.5mg/kg+司可林1～2mg/kg;K组:丙泊酚1.5mg/kg+氯胺酮1mg/kg+司可林1～2mg/kg.吸入七氟醚维持麻醉,胎儿娩出后,静脉加入咪达唑仑2mg+芬太尼0.1mg+顺式苯磺酸阿曲库胺0.15mg/kg,比较两组麻醉效果.结果:R组诱导后插管前MAP、HR值明显低于K组(P＜0.05);R组插管后的MAP、HR值也明显低于K组(P＜0.05),K组术毕到拔管前时间较R组显著延长(P＜0.05).结论:剖宫产全麻使用瑞芬太尼和丙泊酚具有可行性,尤其是适合重度妊高症患者.     

不同剂量右美托咪定对丙泊酚诱导效应室靶浓度的影响

目的观察不同剂量右美托咪定在全麻患者气管插管时有效性和安全性及对丙泊酚效应室靶浓度(Ce)的影响。方法 60例全麻下行择期上腹部手术患者,随机均分为四组:D1、D2、D3、C组,分别在麻醉诱导前10min静脉泵注右美托咪定0.25μg/kg(D1组)、0.5μg/kg(D2组)和1.0μg/kg(D3组)及10ml生理盐水(C组)。麻醉诱导采用靶控输注丙泊酚,以BIS为靶控目标。丙泊酚初始Ce设为1.5μg/ml,递增梯度为0.5μg/ml,同时泵注瑞芬太尼0.2μg·kg-1·min-1。BIS≤60时推注罗库溴铵0.9mg/kg,BIS≤50并维持5s行气管插管。于输注右美托咪定前(T0)、诱导前(T1)、气管插管前(T2)、气管插管后1min(T3)、3min(T4)、5min(T5)、10min(T6)时记录SBP、DBP、HR、BIS、丙泊酚Ce。结果与T0时比较,T1时D2、D3组HR减慢、D3组SBP、DBP升高(P<0.05);与T1时比较,T2时D1组和C组SBP、DBP下降,HR减慢(P<0.05);与T2时比较,T3～T5时D1组和C组SBP、DBP升高,HR增快,T3时C组BIS升高(P<0.05)。T2～T6时丙泊酚CeD1、D2、D3组明显低于C组(P<0.05)。不同剂量右美托咪定各时点对丙泊酚Ce存在明显负相关关系。结论麻醉诱导前静脉输注不同剂量右美托咪定对丙泊酚诱导效应室浓度存在负相关关系。麻醉诱导前静脉输注右美托咪定0.5μg/kg心血管反应平稳并能显著减少诱导时所需丙泊酚Ce。     

Remifentanil versus propofol sedation for peribulbar anesthesia

The short onset and offset of remifentanil may allow for accurate dosing of sedative effect with few side-effects and rapid recovery. In this study, remifentanil is compared with propofol for sedation intraocular pressure hemodynamics and oxygen saturation, in patients undergoing cataract surgery with peribulbar block. After ethical committee approval, fifty patients scheduled for one eye cataract surgery were enrolled into the prospective study. Remifentanil infusion was initialized at a rate of 0.04 microg/kg/min, 10 min before peribulbar anesthesia in Remifentanil group (Group R). In Propofol Group (Group P), propofol infusion of 2 mg/kg/h was reduced to 1mg/kg/h. Intraocular pressures of the contralateral eye were measured before and after peribulbar anesthesia and at the end of the operation. Sedation scores (1-5), hemodynamic parameters and saturation were assessed at 5 minute intervals. Heart rate, intraocular pressure, saturation and sedation scores were similar between groups. Intraocular pressures decreased within time in both groups. There were significant changes in mean blood pressure after 5th min between groups (P < 0.05). The infusion of remifentanil or propofol for sedation provided adequate sedation, hemodynamic stability without increasing intraocular pressure during surgery in patients undergoing cataract surgery with peribulbar anesthesia.     

丙泊酚对肺癌患者围术期肿瘤微转移的影响

目的探讨丙泊酚对肺癌根治术患者围手术期微转移是否存在影响,为临床麻醉精准化用药提供参考依据。方法择期行胸腔镜肺癌根治术患者40例,男21例,女19例,年龄30~65岁,BMI 20~30 kg/m^2,ASAⅠ或Ⅱ级。随机分为丙泊酚静脉组(P组)和七氟醚吸入组(S组),每组20例。P组丙泊酚靶控浓度3~4μg/ml维持麻醉。S组持续吸入1.5%~2%七氟醚维持麻醉。两组均静脉泵注瑞芬太尼0.4 ng/ml,手术开始后行单肺通气,手术全程维持BIS在40~60。分别于麻醉诱导前5 min(T0)、手术开始1 h(T1)、术毕即刻(T2)、术后24 h(T3),术后48 h(T4)监测HR、SBP、DBP,记录T0-T2时BIS,并于T0-T4时点抽取中心静脉血5 ml,采用PCR技术检测细胞角蛋白19(CK19),肺特异性X蛋白(LUNX)阳性表达,记录CK19和LUNX阳性表达情况。结果与T0时比较,T1时P组HR明显减慢(P<0.05)。T1时P组HR明显慢于S组(P<0.05)。不同时点两组内组间SBP和DBP差异均无统计学意义。T0-T2时两组BIS组内组间比较差异均无统计学意义。T3-T4时P组CK19和LUNX阳性表达率明显低于S组(P<0.05)。T0-T2时两组CK19和LUNX阳性表达率差异无统计学意义。结论围术期应用丙泊酚有助于降低肿瘤微转移指标阳性表达,从而降低围术期肿瘤细胞进入循环系统形成微转移的风险,可以优先考虑用于肿瘤患者的围术期麻醉用药。     

妇科腹腔镜手术全凭静脉麻醉与异氟醚吸入麻醉的对比研究

目的观察瑞芬太尼靶控输注复合异丙酚全凭静脉麻醉与异氟醚吸入麻醉在妇科腹腔镜手术中的应用效果。方法随意选择2008年1～12月择期妇科腹腔镜手术60例,ASA分级Ⅰ～Ⅱ级,分为2组：靶控输注瑞芬太尼复合异丙酚全凭静脉麻醉组（T组,n=30）,采用咪唑安定0.05 mg/kg,瑞芬太尼1μg/kg,异丙酚2～2.5 mg/kg及维库溴铵0.1 mg/kg快速诱导后,经口明视气管插管,维持采用瑞芬太尼靶浓度4～8 ng/ml,异丙酚4～8 mg.kg-1.h-1;异氟醚组（I组,n=30）,采用芬太尼2μg/kg,异丙酚2～2.5 mg/kg,维库溴铵0.1 mg/kg诱导,经口明视插管后,维持采用1∶1的氧气和异氟醚（维持呼气末浓度0.8～1.2 MAC）吸入麻醉。术中监测收缩压（SBP）、舒张压（DBP）、心率（HR）等指标。结果在插管后1 min（T3）,I组病人DBP、HR与基础值（T1）比较明显升高（P〈0.05）,T组病人DBP、HR则基本恢复到T1水平,2组比较差异有显著性（t=-4.277,P=0.000;t=-3.286,P=0.002）。清醒拔管时（T6）与T1比较,I组SBP、DBP、HR明显升高（P〈0.05）,而T组SBP、DBP、HR则无明显变化（P〉0.05）,2组比较差异有显著性（t=-5.461,P=0.000;t=-2.287,P=0.000;t=-4.382,P=0.000）。T组病人诱导时间、苏醒时间、拔管时间均显著短于I组（t=-6.386,P=0.000;t=-4.876,P=0.000;t=-6.632,P=0.000）。结论瑞芬太尼靶控输注复合异丙酚全凭静脉麻醉在妇科腹腔镜手术中既满足了手术要求又提高了麻醉药的可控性。     

Remifentanil bolus for cesarean section in high-risk patients: study of 12 cases

OBJECTIVES: To evaluate the utility and safety of remifentanil for hemodynamic control during cesarean section in high-risk patients ineligible for spinal anesthesia. METHODS: One minute before induction we injected a bolus of 1 microg x kg(-1) of remifentanil, followed by propofol (2.5 mg x kg(-1)), succinylcholine (1 mg x kg(-1)), cisatracurium, sevoflurane in oxygen and nitrous oxide, and fentanyl (5 microg x kg(-1)) after clamping the umbilical cord. We recorded maternal hemodynamic variables, pulse oximetry, capnography, bispectral index, and presence of muscular rigidity. In the neonate we assessed fetal wellbeing, weight, and requirement for naloxone. Hemodynamic stability was defined as no more than 15% variation in arterial pressure with respect to baseline. RESULTS: Twelve patients undergoing surgery because of placenta abruptio, subarachnoid hemorrhage, HELLP syndrome, or preeclampsia were enrolled. Hemodynamic variables were consistently stable during surgery in all patients. No cases of neonatal rigidity were noted and there was no need for naloxone. The mean Apgar score was 6.42 (1.5) at 1 minute and 8.42 (0.9) at 5 minutes. CONCLUSION: Bolus injection of 1 microg x kg(-1) of remifentanil may be useful for maintaining maternal hemodynamic stability in high-risk obstetric cases. Given the risk of neonatal depression, this resource should be used selectively and the means for neonatal resuscitation should be available.     

Effects of propofol and remifentanil on phrenic nerve activity and nociceptive cardiovascular responses in rabbits.

BACKGROUND: The effects of propofol, remifentanil, and their combination on phrenic nerve activity (PNA), resting heart rate (HR), mean arterial pressure (MAP), and nociceptive cardiovascular responses were studied in rabbits. METHODS: Basal anesthesia and constant blood gas tensions were maintained with alpha-chloralose and mechanical ventilation. PNA, HR, MAP, and maximum changes in HR and MAP (deltaHR, deltaMAP) evoked by electrical nerve stimulation of tibial nerves were recorded. The comparative effects were observed for propofol at infusion rates from 0.05 to 3.2 mg x kg(-1) x min(-1) (group I) and remifentanil from 0.0125 to 12.8 microg x kg(-1) x min(-1) alone (group II), and during constant infusions of propofol at rates of 0.1 and 0.8 mg x kg(-1) x min(-1) (groups III and IV, respectively). Finally, the effect of remifentanil on propofol blood levels was observed (group V). RESULTS: The infusion rates for 50% depression (ED50) of PNA, deltaHR, and deltaMAP were 0.41, 1.32, and 1.58 mg x kg-(1) x min(-1) for propofol, and 0.115, 0.125, and 1.090 microg x kg(-1) x min(-1) for remifentanil, respectively. The ratios for the ED50 values of deltaHR and deltaMAP to PNA were 3.2 and 3.9 for propofol, and 1.1 and 9.5 for remifentanil, respectively. Analysis of the expected and observed responses and isobologrms showed that although their combined effects on PNA, resting HR, and MAP, and deltaMAP were synergistic for deltaHR, they were merely additive. Remifentanil had no effect on propofol blood levels. CONCLUSION: PNA was abolished by propofol and remifentanil, alone and in combination, before significant depression of nociceptive pressor responses occurred. Their combined effects on PNA, HR, MAP, and deltaMAP are greater than additive, ie., synergistic. Unlike propofol, remifentanil obtunded pressor responses more than the resting circulation.     

The continuous recording of blood pressure in patients undergoing carotid surgery under remifentanil versus sufentanil analgesia.

We compared the hemodynamic stability during carotid endarterectomy of remifentanil with that of sufentanil anesthesia. Fifty-six patients were randomly assigned into Remifentanil (n = 27) or Sufentanil (n = 29) groups. In the Remifentanil group, IV propacetamol (2 g) and morphine (0.1 mg/kg) were infused 30 min before skin closure. In the Sufentanil group, patients received 2 g propacetamol. Beat-to-beat recordings of systolic arterial blood pressure (SBP) and heart rate (HR) were stored on a computer. The maximum and minimum values of BP and HR after induction, at intubation, during the surgical procedure, and after the operation and the coefficients of variation of SBP and HR were used as indices of hemodynamic stability. The coefficients of variation of SBP and HR were similar in both groups during and after surgery. However, at intubation, maximal SBP was higher in the Sufentanil group (P < 0.05). Decreased propofol doses and isoflurane end-tidal concentrations were used in the Remifentanil group. At recovery, a similar profile of SBP and HR was found in both groups. We conclude that intra- and posthemodynamic stability was similar with remifentanil or sufentanil in patients undergoing carotid endarterectomy. However, remifentanil was more effective for blunting the increase in SBP at intubation without increasing the blood pressure-decreasing effect of induction. Intraoperative remifentanil use was associated with a decreased amount of hypnotic drug administered. IMPLICATIONS:Beat-to-beat recordings of heart rate and blood pressure in patients undergoing carotid surgery revealed that hemodynamic stability was similar with remifentanil or sufentanil anesthesia both during and after surgery. Remifentanil was more effective in limiting the increase in blood pressure associated with intubation without increasing the blood pressure-lowering effect of induction or the blood pressure response to recovery.     

Can intravenous atropine prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil?

This study was conducted to examine whether pretreatment with intravenous atropine could prevent bradycardia and hypotension during induction of total intravenous anesthesia with propofol and remifentanil in a prospective randomized placebo-controlled manner. Seventy patients, aged 24–78 years, were randomly divided into two groups, and received 0.5 mg atropine or placebo saline 1 min before induction of intravenous anesthesia with remifentanil at 0.4 μg/kg/min, propofol at a target blood concentration of 3 μg/ml, and vecuronium 1.5 mg/kg. Immediately after tracheal intubation, the infusion rate of remfentanil and the target concentration of propofol were reduced to and kept at 0.1 μg/kg/min and 2 μg/ml, respectively, for 10 min. Noninvasive blood pressure (BP) and heartrate (HR) were measured and recorded every minute. Intravenous atropine could prevent a fall in HR, but not a fall in BP, during induction of intravenous anesthesia with propofol and remifentanil of our dosing regimen. Our data suggested that a fall in HR induced by propofol–remifentanil anesthesia was mainly caused by centrally mediated sympatholytic and/or vagotonic actions of propofol and remifentanil, whereas a fall in BP was mainly the result of their direct vasodilating actions.