Kognitive Störungen in der frühen postoperativen Phase nach Remifentanil/Propofol- und Sevofluran/Fentanylanästhesie

OBJECTIVE: In ambulatory anaesthesia the time required to recover from cognitive impairment should be as short as possible. The aim of this study was to compare the early cognitive recovery after remifentanil/propofol (R/P) and sevoflurane/fentanyl (S/F) anaesthesia. METHODS: Sixty patients scheduled for elective gynaecological laparoscopy and 24 female volunteers tested for the assessment of learning effects were investigated. After praemedication with midazolam anaesthesia was induced with propofol, atracurium and either 1 microgram/kg fentanyl or 1 microgram/kg remifentanil. For maintenance 0.25 microgram/kg/min remifentanil and 0.6 mg/kg/min propofol (R/P) or 1.7 vol% sevoflurane (S/F) were given. Both groups were ventilated with 30% oxygen in air and received metamizol for postoperative analgesia. Verbal Learning Test, Stroop Colour and Word Interference Test, Digit Symbol Substitution Test and Four Boxes Test were performed the day before surgery and 30 min, 1 h, 2 h and 4 h after termination of anaesthesia. RESULTS: For remifentanil/propofol cognitive function was still impaired 2 h (Verbal Learning) and 4 h (Stroop, Digit Symbol Substitution and Four Boxes Test) after termination of anaesthesia. After sevoflurane/fentanyl anaesthesia cognitive impairment lasted the same duration in Four Boxes Test, but shorter in Stroop and Digit Symbol Substitution and could not be found in Verbal Learning Test. CONCLUSION: The duration of cognitive impairment in the early postoperative period differed by the test procedures and the anaesthetic procedures used in this investigation. Recovery appeared to be faster after sevoflurane/fentanyl than after remifentanil/propofol at least in aspects of cognitive function.     

A comparison of anaesthesia using remifentanil combined with either isoflurane, enflurane or propofol in patients undergoing gynaecological laparoscopy, varicose vein or arthroscopic surgery

BACKGROUND: Anaesthesia comprising remifentanil plus isoflurane, enflurane or propofol was randomly evaluated in 285, 285 and 284 patients, respectively, undergoing short-procedure surgery. METHODS: Anaesthesia was induced with propofol (0.5 mg x kg(-1) and 10 mg x 10 s(-1)), and a remifentanil bolus (1 microg x kg(-1)) and infusion at 0.5 microg x g(-1) x min(-1). Five minutes after intubation, remifentanil infusion was halved and 0.5 MAC of isoflurane or enflurane, or propofol at 100 microg x kg(-1) x min(-1) were started and titrated for maintenance. RESULTS: Patient demography and anaesthesia duration were similar between the groups. Surgery was performed as daycases (52%) or inpatients (48%). The median times (5-7 min) to extubation and postoperative recovery were similar between the groups. Responses to tracheal intubation (15% vs 8%) and skin incision (13% vs 7%) were significantly greater in the total intravenous anaesthesia (TIVA) group (P<0.05). Fewer patients given remifentanil and isoflurane (21%) or enflurane (19%) experienced > or =1 intraoperative stress response compared to the TIVA group (28%) (P<0.05). Median times to qualification for and actual recovery room discharge were 0.5-0.6 h and 1.1-1.2 h, respectively. The most common remifentanil-related symptoms were muscle rigidity (6-7%) at induction, hypotension (3-5%) and bradycardia (1-4%) intraoperatively and, shivering (6-7%), nausea and vomiting postoperatively. Nausea (7%) and vomiting (3%) were significantly lower with TIVA compared with inhaled anaesthetic groups (14-15% and 6-8%, respectively; P<0.05). CONCLUSION: Anaesthesia combining remifentanil with volatile hypnotics or TIVA with propofol was effective and well tolerated. Times of extubation, postanaesthesia recovery and recovery room discharge were rapid, consistent and similar for all three regimens.     

Effects of propofol on desipramine-sensitive [3H]-noradrenaline uptake kinetics in rat femoral artery

BACKGROUND: The intravenous anaesthetic propofol inhibits the neuronal uptake of noradrenaline (uptake1) from the vascular sympathetic neuromuscular junction, resulting in an enhancement of the sympathetic neurotransmission. This could be important for maintenance of blood pressure during propofol anaesthesia. The aim of the present study was to determine how propofol influences the kinetics of uptake1. METHODS: Isolated segments of rat femoral arteries were incubated with [3H]-noradrenaline in the presence or absence of propofol and the radioactivity taken up was measured in a scintillation counter. The uptake1 inhibitor, desipramine, was used to delineate the specific neuronal uptake. RESULTS: Desipramine and 10 microM propofol significantly reduced the uptake in segments incubated with 0.1 microM [3H]-noradrenaline. Propofol at 1 microM and 100 microM did not affect the uptake. Non-linear regression analysis of specific uptake yielded Km 0.50 microM, Vmax 1.6 pmol mg(-1) 15 min(-1) and Hill coefficient 1.1. Propofol (1-10 microM) increased the Km value and propofol (10-100 microM) increased the Vmax value concentration-dependently, while the Hill coefficient was not affected. CONCLUSION: Propofol seems to have a biphasic effect on the uptake of noradrenaline in the vascular sympathetic neuromuscular junction. At lower propofol concentrations there is a decrease in the affinity of the noradrenaline transporters. The resulting uptake inhibition is counteracted at higher propofol concentrations by an increase in the efficacy of the uptake.     

Severe neuroexcitatory symptoms after anaesthesia--with focus on propofol anaesthesia

Delayed neuroexcitatory symptoms after an uneventful anaesthesia are uncommon, although described in many reports. We want to report on two cases. The first patient developed muscle hypertonicity, jerky movements and unconsciousness after an uneventful anaesthesia with propofol, and later the same thing happened after anaesthesia with thiopentone. The second patient developed similar symptoms after an uneventful anaesthesia with propofol, but she never recovered completely after this and is now severely disabled. A search of the literature and the Swedish adverse drug reactions register revealed many similar cases. In both our patients the causal relationship between propofol and the neuroexcitatory symptoms remains uncertain, but we want to alert readers about this possible adverse reaction.     

毛细管胶束电泳法测定血浆异丙酚方法的研究

目的　采用毛细管胶束电泳法测定血浆中异丙酚血药浓度。　方法　探讨样品预处理方法、缓冲液种类、波长、SDS浓度、pH值、工作电压、柱温对分离的影响 ,筛选后的最佳方案为 5 0mmol/L硼砂 -2 0mmol/L硼酸 -2 5mmol /LSDS -3 %甲醇 (pH =9.3 ) ,分离电压 2 0KV ,柱温 2 0℃ ,检测波长 2 72nm ,压力进样 2 0 psi× 10S。　 结果　异丙酚、百里酚能得到令人满意的分离。　结论　本方法可使异丙酚血药浓度的测定时间缩短 ,方法简便、快速、灵敏、干扰少 ,是测定异丙酚血药浓度的理想方法之一。     

曲马多用于人工流产术后疼痛治疗的临床观察

目的　调查人工流产术后疼痛情况 ,观察曲马多治疗疼痛的效果。方法　行人工流产的孕妇 4 84例 ,随机分为四组。A组 ,局麻下手术 ;B组 ,异丙酚静脉麻醉下完成手术 ;C组 ,局麻下手术 ,曲马多片术后镇痛 ;D组 ,异丙酚静脉麻醉下完成手术 ,曲马多片术后镇痛。记录病人术后 6h、12h、2 4h、4 8h、72h的疼痛强度评分、生活质量评分 ,对手术治疗满意度进行评价 ,记录手术或药物副作用。结果　疼痛评分 ,A、B、C、D组间疼痛持续时间和程度依次降低 ,差别均有显著性 (P <0 0 1或P <0 0 5 )。生活影响评分 ,A组高于其它三组 ,B组高于C、D组 (P <0 0 1) ,术后 6h、12h ,C组高于D组 (P <0 0 5 )。满意度评分 ,各组间比较差别均有显著性 (P <0 0 1)。副作用发生率 (人 /次 )比较差异无显著性 (P >0 0 5 )。结论　人工流产术后存在轻、中度疼痛 ,使用曲马多片术后镇痛效果良好。     

三种镇痛药辅助异丙酚静脉全麻用于人工流产术的效果比较

目的　观察比较泰勒宁、芬太尼或氯诺昔康辅助异丙酚静脉全麻用于人工流产术的麻醉效果。方法　选择自愿接受全麻下人工流产孕妇 4 0 0例 ,随机分为对照组 (C)、芬太尼组 (F)、泰勒宁组 (T)和氯诺昔康组 (L)四组 ,每组 10 0例。C组不给任何辅助性镇痛药、T组术前 1h口服泰勒宁 1片、L组先静注 0 14mg/kg的氯诺昔康、F组将 1μg/kg的芬大尼加入异丙酚中。各组均按 2 2mg/kg的异丙酚剂量于 6 0s内静脉注射完毕 ,待睫毛反射消失后即行人流操作。观察SBP、DBP、HR、R及SpO2 ;术毕记录不适反应。结果　四组受术者在异丙酚麻醉后 2min ,SBP、DBP、R、SpO2 与麻醉前比较 ,有显著性差异 ,HR则无明显变化 ;术毕诉注射部位疼痛和下腹痛 (宫缩痛 )者 ,T、F、L组与C组比较有显著性差异 ,但其VAS评分均为 3～ 6 ,属轻、中度疼痛。结论　泰勒宁、氯诺昔康、芬太尼辅肋异丙酚静脉全麻用于人工流产镇痛时具有镇痛效果确切、术中呼吸循环功能基本稳定、术毕宫缩痛发生率低、清醒程度高、并发症少等优点。     

异丙酚复合氯胺酮静脉麻醉在人工流产术中的应用

目的:探讨异丙酚复合氯胺酮在人工流产术中的应用。方法:选择自愿接受无痛人流术的早孕妇女120例,ASAⅠ-Ⅱ级。经静脉缓慢注入氯胺酮0.2 mg／kg,异丙酚2 mg／kg,视手术时间,追加异丙酚20-50 mg。术中监测ECG、SBP、DBP、HR、SpO2,观察用药过程中的不良反应及麻醉效果。结果:诱导后血压、心率与诱导前比较有明显差异,P<0.05,但仍在正常范围。120例中显效97.5％,有效2.5％,麻醉效果优良率达100％。结论:异丙酚复合小剂量氯胺酮静脉麻醉应用于人工流产术.其效果满意,且安全易掌握,是一种可行的麻醉方法。     

丙泊酚及氯胺酮持续泵注静脉麻醉的效果

目的观察丙泊酚复合氯胺酮静脉泵注应用于静脉全麻的效果。方法20例ASAⅠ～Ⅱ级静脉全麻手术患者随机为Ⅰ、Ⅱ组,每组10例。Ⅰ组为丙泊酚及氯胺酮分次静脉注射组,Ⅱ组为丙泊酚及氯胺酮持续静脉泵泵注组。两组术前3min静脉注射丙泊酚0.6mg/kg,氯胺酮1mg/kg。Ⅰ组术中当麻醉转浅时静脉注射丙泊酚(0.6mg/kg)和(或)氯胺酮(1mg/kg);Ⅱ组术中以微泵泵注丙泊酚眼1～3mg/(kg·h)演,氯胺酮眼2～4mg/(kg·h)演。记录麻醉前至手术进行1h每隔5min测得的平均动脉压(MAP)、心率(HR)、呼吸(R)及脉搏氧饱和度(SpO2);整个手术过程中麻醉药用量,术后苏醒时间。结果麻醉期间Ⅰ组MAP、HR、R波动大,Ⅱ组较平稳;Ⅰ组有4例SpO2下降至88%～94%;Ⅱ组所有患者SpO2为98%～100%。Ⅱ组人均氯胺酮及丙泊酚用量明显多于Ⅰ组,两组患者术后苏醒时间无显著性差异。结论氯胺酮及丙泊酚微泵泵注给药麻醉效果好,术中BP、HR和R平稳,安全性好。     

异丙酚在人工流产术中的临床效果观察

目的:观察异丙酚在人工流产术中麻醉效果、宫颈松弛程度、阴道出血量、人工流产综合征及术中不良反应。方法:选择对象200例,分观察组、对照组各100例,观察组术前静脉注射异丙酚,对照组术前未给予任何药物,手术方法两组相同。结果:观察组镇痛率为:100％,无人工流产综合征发生;宫颈口松弛程度和术中不良反应,两组有显著性差异(P<0.01);两组术中出血量比较无统计学意义(P>O.05)。结论:异丙酚用于人工流产术镇痛效果较好,可避免人工流产综合征的发生,减少术中不良反应,缩短手术时间,对子宫收缩无影响,可以广泛应用于无痛人工流产术。