Intravenous or rectal administration of sedatives in outpatient oral surgery

A number of cross-over studies on sedation in outpatient oral surgery investigated the quality of sedation produced by intravenous or rectal administration of diazepam. The sedation methods were equally efficient with a mean dose of 0.24 mg/kg (range 0.1–0.4) for i.v. administration and 0.53 mg/kg (range 0.5–0.6) for rectal administration. Eighty-five percent of the patients preferred surgery under sedation and local anaesthesia to local anaesthesia alone. The patients preferred the session in which they experienced stronger sedation, regardless of the route of administration.     

靶控输注咪唑安定对靶控输注丙泊酚镇静催眠效应的影响

目的评价靶控输注咪唑安定对靶控输注丙泊酚镇静催眠效应的影响。方法ASAI～Ⅱ级择期手术患者40例，随机分为四组：A组为单纯丙泊酚组，B、C、D组为丙泊酚 咪唑安定组，咪唑安定靶浓度分别为10、20、30ng／mL。咪唑安定达到平衡后，血浆靶控输注丙泊酚。记录丙泊酚效应部位浓度为1、2、3、4、5μg／mL时BIS值和OAA／S评分，并记录OAA／S评分达到4、3、2、1时丙泊酚效应部位浓度和BIS值，记录BIS值为50时丙泊酚效应部位浓度。结果1．咪唑安定达到平衡后，C组和D组BIS值显著下降；D组中OAA／S评分也显著下降，并低于B组和C组；2．随丙泊酚浓度升高四组患者．BIS值和OAA／S评分逐渐下降；3．相同丙泊酚浓度时，BIS值和OAA／S评分随咪唑安定浓度增加呈降低趋势；4．B、C、D三组患者OAA／S评分达到3、2、1以及BIS值达到50时所需丙泊酚效应部位浓度均显著低于A组，达到相同OAA／S评分D组所需丙泊酚效应部位浓度显著低于B组和C组。结论效应部位浓度为10、20、30ng／mL的咪唑安定均能显著降低丙泊酚靶控浓度，以达到需要的镇静深度；随咪唑安定浓度加深，降低作用越明显。     

Pattern of renal dysfunction in analgesic nephropathy--comparison with glomerulonephritis.

Comprehensive renal function tests were performed in 84 patients with analgesic nephropathy, 33 glomerulonephritis patients matched for creatinine clearance, and 30 control subjects. A system of 1-day renal function tests including urine microscopy, creatinine clearance, phenolsulphonphthalein excretion, urine concentration and acidification, and electrolyte excretion, was used. Patients with analgesic nephropathy were found to have significant sterile pyuria and haematuria, even those with mild renal insufficiency, significantly reduced concentrating ability and a distal acidifying defect, and a tendency to impaired sodium conservation. These function defects are consistent with the primary lesion of renal papillary necrosis in analgesic nephropathy; the detection of these defects have implications in patient management.     

A randomized controlled trial of sedation in the critically ill

A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi-squared P <0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/distressed) was significantly greater in the midazolam group (Chi-squared P <0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.     

疏可眠胶囊镇静作用的实验研究

且的:观察疏可眠胶囊对小鼠的镇静作用。方法:采用旷野活动法观察疏可眠胶囊不同给药剂量、给药时间对小鼠自主活动的量效、时效作用;对士的宁诱发惊厥小鼠的作用。结果:连续给药7d,疏可眠低中剂量(1g·k~(-1)、2g·kg~(-1))均能显著减少小鼠的自主活动;疏可眠高剂量(3g·kg~(-1))给药后1h～2h自主活动显著减少;给药后2h,呈现量效关系,随着剂量增加小鼠自主活动减少。各剂量组均可延长士的宁诱发小鼠惊厥出现的时间及死亡时间。结论:疏可眠胶囊具有减少小鼠自主活动和抗惊厥作用。     

硬膜外阻滞的镇静作用及其可能机制

目的 通过监测脑电双频指数和心率变异功率谱,评价硬膜外麻醉后对异丙酚镇静催眠剂量的影响,并探讨其可能的机制。方法 50例行全子宫切除病人,随机分为硬膜外利多卡因组（GE,n=15）;硬膜外盐水-静脉利多卡因组（GI=15）;硬膜外盐水-静脉盐水组（GC=20）。硬膜外或静脉给利多卡因 20 min后,连续输注异丙酚至神志消失并记录异丙酚用量。所有病人同时监测脑电双频谱（BIS）、心率变异高频功率谱（HF）、低频功率谱（LF）、心电图和血压。输注异丙酚前抽取桡动脉血 2ml,测定血浆利多卡因浓度。结果 病人意识消失时异丙酚用量分别为GE组（1.22±0.25）mg/kg;GI组（1.62±0.22）mg/kg;GC组（1.85±0.41）mg/kg（GE与GI和GC比,P<0.05）。GE组和 GI组血浆利多卡因浓度分别为 3.04 μg/ml和 2.45 μg/ml,无统计学差异。三组病人意识消失时BIS平均值分别为54.4、57.1、55.3。结论 硬膜外利多卡因阻滞可降低异丙酚用量约35％。其作用机制与利多卡因自硬膜外吸收后的中枢镇静作用无明显关系,而可能与硬膜外阻滞后间接引起中枢兴奋阈值降低有关。     

乳舒胶囊镇痛、抗炎作用研究

目的：研究乳舒胶囊(RS)的镇痛、抗炎药效。方法：采用RS灌胃给药后，分别用甩尾法、热板法、扭体法研究RS对乳腺增生模型大鼠及小鼠的镇痛作用，分别用二甲苯法、琼脂法研究RS抑制小鼠耳廓炎症及大鼠慢性炎症性肉芽肿的作用。结果：乳舒胶囊能提高乳腺增生模型大鼠和小鼠的痛阈值、能减少醋酸致扭体疼痛小鼠的扭体次数、延长其发生扭体的潜伏期，有明显的镇痛作用；还可以抑制琼脂所致的大鼠肉芽肿和二甲苯致小鼠耳肿胀，有明显的抗炎作用。结论：乳舒胶囊镇痛、抗炎作用明显、疗效确切。     

Anaesthetic management during awake craniotomy in a 12-year-old boy

We present our approach to the preoperative preparation and anaesthetic management for awake craniotomy in a 12-year-old boy. Management included conscious sedation with a propofol infusion plus local anaesthetic infiltration of the scalp, periosteum, and dura. The complications which may be encountered during such procedures and their treatments are reviewed.     

End-tidal Carbon Dioxide Monitoring during Procedural Sedation

OBJECTIVE: To prospectively determine whether end-tidal carbon dioxide (ETCO2) monitors can detect respiratory depression (RD) and the level of sedation in emergency department (ED) patients undergoing procedural sedation (PS). METHODS: This was a prospective observational study conducted in an urban county hospital of adult patients undergoing PS. Patients were monitored for vital signs, depth of sedation per the physician by the Observer's Assessment of Alertness/Sedation scale (OAA/S), pulse oximetry, and nasal-sample ETCO2 during PS. Respiratory depression was defined as an oxygen saturation <90%, an ETCO2 >50 mm Hg, or an absent ETCO2 waveform at any time during the procedure. The physician also determined whether protective airway reflexes were lost during the procedure and assisted ventilation was required, or whether there were any other complications. Rates of RD were compared with the physician assessment of airway loss and between agents using chi-square statistics. Spearman's rho analysis was used to determine whether there was a correlation between ETCO2 and the OAA/S score. RESULTS: Seventy-four patients were enrolled in the study. Forty (54.1%) received methohexital, 21 (28.4%) received propofol, ten (13.5%) received fentanyl and midazolam, and three (4.1%) received etomidate. Respiratory depression was seen in 33 (44.6%) patients, including 47.5% of patients receiving methohexital, 19% receiving propofol (p = 0.008), 80% receiving fentanyl and midazolam, and 66.6% receiving etomidate. No correlation between OAA/S and ETCO2 was detected. Eleven (14.9%) patients required assisted ventilation at some point during the procedure, all of whom met the criteria for RD. Pulse oximetry detected 11 of the 33 patients with RD. Post-hoc analysis revealed that all patients with RD had an ETCO2 >50 mm Hg, an absent waveform, or an absolute change from baseline in ETCO2 >10 mm Hg. CONCLUSIONS: There was no correlation between ETCO2 and the OAA/S score. Using the criteria of an ETCO2 >50 mm Hg, an absolute change >10 mm Hg, or an absent waveform may detect subclinical RD not detected by pulse oximetry alone. The ETCO2 may add to the safety of PS by quickly detecting hypoventilation during PS in the ED.