Supreme喉罩用于腹腔镜手术患者气道管理的效果

Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing laparoscopic surgery. Methods One hundred and twenty ASA I or Ⅱ patients of both sexes aged 35-60 yr weighing 48-85 kg undergoing elective laparoscopic surgery were randomized to 2 groups ( n = 60 each): LMA Supreme group (group S) and tracheal intubation group (group T). Mallampati test was performed before operation in both groups. The patients were classified as I - Ⅲ . In group S the LMA Supreme was inserted after induction of anesthesia with sufentanil 0.2 fig/kg, propofol 2-3 mg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA Supreme. In group T the patients were intubated under direct laryngoscopy. The success rate, LMA placement/intubation time, success rate of gastric tube placement, airway seal pressure, SpO2, PETCO2 , peak airway pressure and complications (hypoxemia, nausea and vomiting, choking hoarseness, sore throat and regurgitation of gastric contents) were recorded. The duration of surgery, anesthesia time, extubation time and emergence time were also recorded. Results There was no significant difference in the success rate between the two groups. The placement and removal time and recovery time were significantly shorter in group S than in group T. The airway seal pressure was (25 ±4) cm H2O in group S. SpO2, PETCO2 and peak pressure were within normal range in both groups. The incidence of postoperative hypoxemia, choking and sore throat were significantly lower in group S than in group T. Conclusion LMA Supreme can provide adequate ventilation during operation with less complications and can be used effectively for laparoscopic surgery.     

Supreme喉罩用于腹腔镜手术患者气道管理的效果

Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing laparoscopic surgery. Methods One hundred and twenty ASA I or Ⅱ patients of both sexes aged 35-60 yr weighing 48-85 kg undergoing elective laparoscopic surgery were randomized to 2 groups ( n = 60 each): LMA Supreme group (group S) and tracheal intubation group (group T). Mallampati test was performed before operation in both groups. The patients were classified as I - Ⅲ . In group S the LMA Supreme was inserted after induction of anesthesia with sufentanil 0.2 fig/kg, propofol 2-3 mg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA Supreme. In group T the patients were intubated under direct laryngoscopy. The success rate, LMA placement/intubation time, success rate of gastric tube placement, airway seal pressure, SpO2, PETCO2 , peak airway pressure and complications (hypoxemia, nausea and vomiting, choking hoarseness, sore throat and regurgitation of gastric contents) were recorded. The duration of surgery, anesthesia time, extubation time and emergence time were also recorded. Results There was no significant difference in the success rate between the two groups. The placement and removal time and recovery time were significantly shorter in group S than in group T. The airway seal pressure was (25 ±4) cm H2O in group S. SpO2, PETCO2 and peak pressure were within normal range in both groups. The incidence of postoperative hypoxemia, choking and sore throat were significantly lower in group S than in group T. Conclusion LMA Supreme can provide adequate ventilation during operation with less complications and can be used effectively for laparoscopic surgery.     

i-gel喉罩用于妇科腹腔镜手术患者气道管理的效果

Objective To assess the efficacy of laryngeal mask airway (LMA) i-gel used in patients undergoing laparoscopic gynecological surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 21-64 yr, weighing 4590 kg, undergoing elective laparoscopic gynecological surgery, were randomized into 2 groups ( n = 30 each):LMA i-gel group (group Ⅰ) and LMA Supreme group (group S) . Mallampatti test was performed before operation in both groups. Anesthesia was induced with target-controlled infusion of propofol (target plasma concentration 2.5-4.0 μg/ml) and remifentanil (target plasma concentration 3-6 ng/ml) . After the patients lost consciousness, rocuronium 0.6 mg/kg was given to facilitate the LMA insertion. LMA i-gel and LMA Supreme were inserted in I and S groups respectively. A gastric tube was inserted through the drain tube of the LMA. In group S the air was injected into the cuff to make intracuff pressure reach 60 cm H2O after successful LMA insertion. The LMA placement time, the number of attempts of LMA insertion, the number of attempts of gastric tube placement, the airway sealing pressure, the parameters of hemodynamics and ventilation, and complications (sore throat, odynopliagia,hoarseness) were recorded. The fiberoptic laryngoscopy scores were assessed after successful LMA placement. The anesthesia time and recovery time were also recorded. Results There was no significant difference in the anesthesia time, recovery time, LMA placement time, fiberoptic bronchoscopy scores and the parameters of hemodynamics and ventilation between the two group. The success rates of LMA and gastric tube placement were 100% in both groups. The airway sealing pressure was significantly higher, while the incidence of sore throat and odynopliagia was significantly lower in group I than in group S. Conclusion LMA i-gel provides adequate ventilation during operation with fewer complications and can be used effectively for gynecological laparoscopic surgery.     

i-gel喉罩用于妇科腹腔镜手术患者气道管理的效果

Objective To assess the efficacy of laryngeal mask airway (LMA) i-gel used in patients undergoing laparoscopic gynecological surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 21-64 yr, weighing 4590 kg, undergoing elective laparoscopic gynecological surgery, were randomized into 2 groups ( n = 30 each):LMA i-gel group (group Ⅰ) and LMA Supreme group (group S) . Mallampatti test was performed before operation in both groups. Anesthesia was induced with target-controlled infusion of propofol (target plasma concentration 2.5-4.0 μg/ml) and remifentanil (target plasma concentration 3-6 ng/ml) . After the patients lost consciousness, rocuronium 0.6 mg/kg was given to facilitate the LMA insertion. LMA i-gel and LMA Supreme were inserted in I and S groups respectively. A gastric tube was inserted through the drain tube of the LMA. In group S the air was injected into the cuff to make intracuff pressure reach 60 cm H2O after successful LMA insertion. The LMA placement time, the number of attempts of LMA insertion, the number of attempts of gastric tube placement, the airway sealing pressure, the parameters of hemodynamics and ventilation, and complications (sore throat, odynopliagia,hoarseness) were recorded. The fiberoptic laryngoscopy scores were assessed after successful LMA placement. The anesthesia time and recovery time were also recorded. Results There was no significant difference in the anesthesia time, recovery time, LMA placement time, fiberoptic bronchoscopy scores and the parameters of hemodynamics and ventilation between the two group. The success rates of LMA and gastric tube placement were 100% in both groups. The airway sealing pressure was significantly higher, while the incidence of sore throat and odynopliagia was significantly lower in group I than in group S. Conclusion LMA i-gel provides adequate ventilation during operation with fewer complications and can be used effectively for gynecological laparoscopic surgery.     

超声引导下肢神经阻滞联合喉罩下全麻用于全膝关节置换术的效果

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.     

超声引导下肢神经阻滞联合喉罩下全麻用于全膝关节置换术的效果

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.     

Coopdech封堵支气管导管联合加强型气管导管用于上纵隔肿瘤切除术患者气道管理的效果

目的 评价Coopdech封堵支气管导管联合加强型气管导管用于上纵隔肿瘤切除术患者气道管理的效果.方法 拟经前外侧开胸行上纵隔肿瘤切除术患者22例,年龄24～66岁,体重48～78 kg,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将患者随机分为双腔支气管导管组(Ⅰ组)和Coopdech封堵支气管导管联合加强型气管导管组(Ⅱ组),每组11例.Ⅰ组术中采用双腔支气管导管技术行单肺通气;Ⅱ组采用Coopdech封堵支气管导管联合加强型气管导管进行气道管理,需单肺通气时可应用Coopdech封堵支气管导管进行肺隔离.两组均应用纤维支气管镜辅助气管内导管定位.记录气管插管时间、定位时间、导管移位情况、纤维支气管镜检查次数、气道峰压增加情况、肺萎陷程度、术后咽痛声嘶的发生情况、呼吸机辅助通气情况.结果 与Ⅰ组比较,Ⅱ组气管插管时间缩短,导管移位的发生率、气道峰压增加率和术后咽痛声嘶发生率降低(P＜0.05或0.01),定位时间、纤维支气管镜检查次数、肺萎陷程度及术后呼吸机辅助通气发生率差异无统计学意义(P＞0.05).结论 Coopdech封堵支气管导管联合加强型气管导管用于前外侧开胸行上纵隔肿瘤切除术患者气道管理的效果优于双腔支气管导管.

Abstract：

Objective To evaluate the efficacy of Coopdech bronchial blocker combined with a strengthened single-lumen tube for airway management in patients undergoing upper mediastinal tumor resection. Methods Twenty-two ASA Ⅱ or Ⅲ patients, aged 24-66 yr, weighing 48-78 kg, scheduled for elective resection of upper mediastinal tumor, were randomly divided into 2 groups (n=11 each):double-lumen tube group(groupⅠ) and Coopdech bronchial blocker combined with a strengthened single-lumen tube group(group Ⅱ).One-lung ventilation was achieved with a double-lumen tube in groupⅠ. The Coopdech bronchial blocker combined with a strengthened single-lumen tube was used for airway management and the Coopdech bronchial blocker was used for lung isolation when one-lung ventilation was required in group Ⅱ. The fiberoptic bronchoscope was used to assist endotracheal tube positioning in both groups. The intubation time, positioning time, the number of patients required for tube displacement, the number of fiberoptic bronchoscopy, increase in airway peak pressure, degree of lung collapse, postoperative sore throat and hoarseness, and the number of patients needing ventilator-assisted ventilation were recorded. Results The intubation time was significantly shorter, the number of patients required for tube displacement was significantly smaller,and the rate of increase in airway peak pressure and incidences ofpostoperative sore throat and hoarseness were significantly lower in group Ⅱ than in group Ⅰ (P＜0.05 or0.01). Conclusion The efficacy of the Coopdech bronchial blocker combined with a strengthened single-lumen tube for airway management is better in patients undergoing upper mediastinal tumor resection than the double-lumen tube.     

i-gel喉罩用于妇科腹腔镜手术患者气道管理的效果

目的 评价i-gel喉罩用于妇科腹腔镜手术患者气道管理的效果.方法 择期全麻下拟行妇科腹腔镜手术患者60例,ASA分级Ⅰ或Ⅱ级,年龄21～64岁,体重45～90 kg,Mallampatti分级Ⅰ～Ⅲ级,采用随机数字表法,将其随机分为2组(n=30):i-gel喉罩组(I组)和Supreme喉罩组(S组).根据体重选择喉罩型号,麻醉诱导后置入喉罩,经引流管放置胃管,行机械通气.记录喉罩置入时间、置入次数、胃管置入次数、喉罩密封压、纤维支气管镜检查分级、术中血液动力学指标、通气指标、麻醉时间和苏醒时间,记录拔除喉罩后咽喉痛、吞咽痛和声音嘶哑的发生情况.结果 两组麻醉时间、苏醒时间、喉罩置入时间、纤维支气管镜检查分级、术中血液动力学指标和通气指标差异无统计学意义(P>0.05).两组喉罩和胃管置入成功率均为100%.与S组比较,I组喉罩密封压升高,咽喉痛和吞咽痛发生率降低(P<0.05或0.01).结论 i-gel喉罩气道密封性可靠,并发症少,可安全有效地应用于妇科腹腔镜手术患者的气道管理.

Abstract：

Objective To assess the efficacy of laryngeal mask airway (LMA) i-gel used in patients undergoing laparoscopic gynecological surgery. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 21-64 yr, weighing 4590 kg, undergoing elective laparoscopic gynecological surgery, were randomized into 2 groups ( n = 30 each):LMA i-gel group (group Ⅰ) and LMA Supreme group (group S) . Mallampatti test was performed before operation in both groups. Anesthesia was induced with target-controlled infusion of propofol (target plasma concentration 2.5-4.0 μg/ml) and remifentanil (target plasma concentration 3-6 ng/ml) . After the patients lost consciousness, rocuronium 0.6 mg/kg was given to facilitate the LMA insertion. LMA i-gel and LMA Supreme were inserted in I and S groups respectively. A gastric tube was inserted through the drain tube of the LMA. In group S the air was injected into the cuff to make intracuff pressure reach 60 cm H2O after successful LMA insertion. The LMA placement time, the number of attempts of LMA insertion, the number of attempts of gastric tube placement, the airway sealing pressure, the parameters of hemodynamics and ventilation, and complications (sore throat, odynopliagia,hoarseness) were recorded. The fiberoptic laryngoscopy scores were assessed after successful LMA placement. The anesthesia time and recovery time were also recorded. Results There was no significant difference in the anesthesia time, recovery time, LMA placement time, fiberoptic bronchoscopy scores and the parameters of hemodynamics and ventilation between the two group. The success rates of LMA and gastric tube placement were 100% in both groups. The airway sealing pressure was significantly higher, while the incidence of sore throat and odynopliagia was significantly lower in group I than in group S. Conclusion LMA i-gel provides adequate ventilation during operation with fewer complications and can be used effectively for gynecological laparoscopic surgery.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.     

困难气道患者上气道三维CT图像的改变

Objective To evaluate the changes in three-dimensional computer tomography (3DCT) images of upper airway in patients with difficult tracheal intubation and provide theoretical evidence for predicting the difficult tracheal intubation. Methods Seventeen ASA Ⅰ or Ⅱ male patients, 25-60 yr old, height 165-185 era, weight 55-110 kg, body mass index 19-33 kg/m2, scheduled for elective surgery under general anesthesia, were studied. The airway condition was evaluated with Mallampati classification and Willsan score system in all patients before the operation. The patients underwent 3DCT scanning under 2 different statuses: with or without tongue protruding while opening his mouth maximally. The volume of the oropharyngeal cavity (Va1, Va2) andtongue body (Vt1, Vt2), and area of the oropharyngeal cavity (Aa1, Aa2) and tongue body (At1, At2) in the coronal position were measured before and during tongue protruding. The midline sagittal images of the upper airway were made on computer to measure the direct laryngoscope angle and vertical distance between the mandible and hyoid (MHD). Awake blind tracheal intubation was performed in all patients. The exposure of the glottis was performed after anesthesia induction and evaluated with Cormack-Lehane classification. The patients were divided into non-difficult intubation group (group NDI, Cormack-Lehane grade Ⅰ or Ⅱ) and difficult intubation group (group DI, Cormack-Lehane grade Ⅲ or Ⅳ) according to Cormack-Lehane classification. Results There were 8 patients in group NDI, and 9 patients in group DI. There was no significant difference in the indices before tongue protruding between group DI and NDI (P>0.05). Va2, Va1 - Va1, Aa2, Aa1 - Aa2, and At1- At2 weresignificanfly smaller, MHD was significantly longer and Va1,/Vt1- Va2/Vt2was significantly larger in group DI than in group NDI (P < 0.05 or 0.01). Va2 and Aa2 were significantly smaller than Va1 and Aa1 in group DI respectively (P < 0.05). Conclusion The changes in 3DCT images of the upper airway in patients with difficult tracheal intubation are mainly presented as smaller volume and area of the oropharyngeal cavity, larger difference value of the ratio of cavity volume to tongue volume and prolonged MHD.     

大剂量磷酸肌酸钠预先给药对心脏瓣膜置换术患者心肌缺血再灌注损伤的影响

Objective To investigate the effect of high-dose creatine phosphate (CP) on myocardial ischemia-reperfusion (I/R) injury in patients undergoing cardiac valve replacement. Methods Two hundred and forty-six ASA Ⅱ or Ⅲ patients aged 42-71 yr weighing 45-80 kg undergoing mitral-aortic valve replacement were randomly assigned into 2 groups: control group ( n = 122) and CP group ( n = 124). CP 10 g in 100 ml normal saline (NS) was infused over 60 min starting from the beginning of operation in group CP. In control group NS 100 ml was infused instead of CP. Blood samples were collected before anesthesia and on 1st and 5th postoperative day for determination of serum CK, CK-MB and LDH activity and cTnI concentration. The number of patients receiving dopamine and adrenaline at the time of return of spontaneous heart beat and 12, 24 and 48 h after operation was recorded. The incidence of arrhythmia (auricular fibrillation, ventricular arrhythmia), myocardial infarct and left ventricular ejection fraction (LVEF) were also compared between the 2 groups. Results Serum CK, CK-MB and LDH activity and cTnI concentration on 1st and 5th postoperative day, the doses of dopamine and adrenalin, the incidence of arrhythmia and myocardial infarct were significantly lower in group CP than in control group. The postoperative LVEF and the incidence of spontaneous recovery of spontaneous heart-beat were significantly higher in group CP than in control group. Conclusion Pretreatment with high dose CP can protect myocardium against I/R injury in patients undergoing cardiac valve replacement under CPB.