Quantification of exhaled propofol is not feasible during single-lung ventilation using double-lumen tubes: A multicenter prospective observational trial

Background

Volatile propofol can be measured in exhaled air and correlates to plasma concentrations with a time delay. However, the effect of single-lung ventilation on exhaled propofol is unclear. Therefore, our goal was to evaluate exhaled propofol concentrations during single-lung compared to double-lung ventilation using double-lumen tubes.

Methods

In a first step, we quantified adhesion of volatile propofol to the inner surface of double-lumen tubes during double- and single-lumen ventilation in vitro. In a second step, we enrolled 30 patients scheduled for lung surgery in two study centers. Anesthesia was provided with propofol and remifentanil. We utilized left-sided double-lumen tubes to separately ventilate each lung. Exhaled propofol concentrations were measured at 1-min intervals and plasma for propofol analyses was sampled every 20 min. To eliminate the influence of dosing on volatile propofol concentration, exhalation rate was normalized to plasma concentration.

Results

In-vitro ventilation of double-lumen tubes resulted in increasing propofol concentrations at the distal end of the tube over time. In vitro clamping the bronchial lumen led to an even more pronounced increase (Δ AUC +62%) in propofol gas concentration over time. Normalized propofol exhalation during lung surgery was 31% higher during single-lung compared to double-lung ventilation.

Conclusion

During single-lung ventilation, propofol concentration in exhaled air, in contrast to our expectations, increased by approximately one third. However, this observation might not be affected by change in perfusion-ventilation during single-lung ventilation but rather arises from reduced propofol absorption on the inner surface area of the double-lumen tube. Thus, it is only possible to utilize exhaled propofol concentration to a limited extent during single-lung ventilation.

Registration of Clinical Trial

DRKS-ID DRKS00014788 ( www.drks.de ).     

脑出血继发损伤中沉默信息调节因子2的表达和炎症反应*

目的：探讨脑出血对酵母沉默信息调节因子2（Sirt2）和炎症的影响。方法：将胶原酶Ⅳ注入SD大鼠右侧 纹状体中建立脑出血模型，通过免疫印迹和ELISA 等方法测定大鼠脑出血后48 h 的Sirt2 的表达及炎症变化。利 用Hemin 诱导PC12 细胞损伤模拟体外脑出血模型，并检测Sirt2 及炎症变化；采用短发夹RNA（shRNA）-Sirt2 沉 默Sirt2 在PC12 细胞中的表达及对炎症的影响。结果：手术后48 h 脑出血行为学评分最低。脑出血组Sirt2 的表达 显著高于假手术组。脑出血组IL-6、IL-1β 表达显著升高。结论：脑出血可以促进Sirt2 的表达和炎症反应，降低 Sirt2 的表达可减缓炎症反应。 关键词 脑出血；沉默信息调节     

超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用

目的:研究超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用价值。方法:选取90例择期进行腹腔镜结直肠癌根治术患者作为研究对象，随机分为观察组和对照组，各45例。对照组采用传统腰麻联合丙泊酚麻醉，观察组采用超声引导下腰方肌阻滞联合丙泊酚麻醉，比较两组患者术中（麻醉后5、15、30、60 min）收缩压（SBP）、舒张压（DBP）、心率（HR）和术后不同时间段的疼痛评分（VAS评分），以及加用镇痛药情况和肠道恢复排气时间和术后48 h内不良反应发生情况。结果:两组患者SBP、DBP、HR组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组麻醉后上述指标波动较对照组小（P<0.05）；麻醉前，两组患者皮质醇、肾上腺素水平无显著差异（P>0.05），麻醉后各时间点观察组患者上述指标水平均显著低于对照组（P<0.05）；两组患者VAS评分组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组术后各时间点VAS评分均显著低于对照组（P<0.05）；观察组不良反应发生率显著低于对照组（8.89% vs 24.44%, P<0.05）；观察组患者加用镇痛药的人数、剂量和肠道恢复排气时间均显著少于对照组（P<0.05）。结论:超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌手术中具有良好、稳定的麻醉效果，可有效缓解患者疼痛，减少术后不良反应发生。     

加深麻醉对改善 MECT 后谵妄的作用

目的: 将不同麻醉深度下进行无抽搐电休克治疗( MECT) 后的谵妄发生率进行对比研究，探讨加深 麻醉对改善 MECT 后谵妄的作用。方法: 将 2017－09～ 2018－12 期间，在内蒙古精神卫生中心接受 MECT 治疗并 符合入组标准的 116 例精神分裂症病人随机分为 A、B 两组，在治疗中分别给予1．2mg /kg 和1．6mg /kg 的丙泊酚 进行麻醉，对治疗后谵妄发生率进行对比分析。结果: B 组谵妄发生率明显低于 A 组( P＜0．05) 。结论: 适当增 加麻醉深度在同等条件下可以有效降低 MECT 治疗后谵妄的发生。     

Patient Satisfaction of Propofol Versus Midazolam and Fentanyl Sedation During Colonoscopy in Inflammatory Bowel Disease

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丙泊酚麻醉对老龄大鼠认知功能和海马神经元γ-氨基丁酸A受体表达的影响

目的观察丙泊酚麻醉对老龄大鼠认知功能及海马神经元γ-氨基丁酸A(GABA)受体表达的影响。方法50只SD老年大鼠随机分为丙泊酚组和对照组,每组25只。丙泊酚组大鼠腹腔注射1%丙泊酚中/长链脂肪乳注射液6 mL/kg,对照组腹腔注射等体积的生理盐水。麻醉后1 d进行Morris水迷宫实验,分别采用HE染色和尼氏体染色观察海马区神经细胞及尼氏体(Nissl体)形态学变化,Western Blot检测GABA蛋白量表达。结果麻醉后,2组大鼠肛温、心率、呼吸频率、血氧饱和度比较,差异均无统计学意义(P>0.05)。随着实验时间的延长,2组大鼠逃逸潜伏期、总里程数逐渐减小,丙泊酚组大鼠各时间点逃逸潜伏期、总里程均高于对照组,差异有统计学意义(P<0.05)。丙泊酚组大鼠穿越平台区域次数、时间小于、短于对照组,差异有统计学意义(P<0.05)。对照组海马区Nissl体存在于细胞浆及树突,染色较深,神经细胞排列整齐,形态规则;丙泊酚组Nissl体消失,神经细胞数量减少,细胞核破裂、丢失。丙泊酚组大鼠海马GABA蛋白表达量低于对照组,差异有统计学意义(P<0.05)。结论丙泊酚对大鼠认知功能有影响,并与海马区GABA的表达相关。     

固相微萃取-HPLC测定生物样品中异丙酚含量

目的 采用固相微萃取（solid phase microextraction,SPME）-HPLC联用技术测定生物样品中异丙酚的含量。方法 采用Oasis HLB固相微萃取小柱对样品进行前处理,Shim-pack VP-ODS色谱柱（250 mm×4.6 mm,5 μm）,乙腈-水（1%三氟乙酸调pH值至4.00）（70：30）为流动相,流速1.0 mL·min^-1,激发波长276 nm,发射波长301 nm,柱温40℃。结果 异丙酚和卡马西平分离度良好。异丙酚在1.2~21.0 mg·L^-1内线性关系良好（r=0.999 7）,平均方法回收率为98%~104%,RSD<5%;日内、日间精密度RSD均<5%。结论 该方法简便、专属性好,能有效消除部分内源性物质的干扰,适用于异丙酚的血药浓度监测和临床药动学研究。     

Safety and efficacy of propofol anesthesia for pediatric target-controlled infusion in children below 3 years of age: a retrospective observational study

Background: Although the requirement of propofol in children is increasing, propofol for induction and maintenance of anesthesia below 3 years old has not been approved in Korea. This study can provide a clinical evidence to increase the range of approval.

Research design and methods: We reviewed the medical records of patients below 3 years of age who underwent surgery between September 2013 and December 2016. Safety was evaluated on the basis of vital signs, and laboratory findings and efficacy were evaluated on the basis of the bispectral index (BIS). Adverse events were examined.

Results: A total of 109 patients anesthetized with propofol (propofol group) were compared with 109 patients with volatile anesthetics (volatile group) after propensity score matching. There was a difference in the proportion of patients showing decreased systolic pressure (P < 0.001) and heart rate (P = 0.03), but there was no difference in diastolic pressure (P = 0.238), mean arterial pressure (P = 0.175) during surgery. After surgery, there was no difference in all vital signs and the proportion patients who experienced adverse events of two groups.

Conclusions: Propofol anesthesia by target-controlled infusion was effective and didn’t show serious propofol-related perioperative adverse events.     

麻醉镇静药在胃镜检查中的应用

目的通过对在内镜检查前应用异丙酚等麻醉镇静药的研究,对这种新的胃镜检查方法进行评价.方法在胃镜检查前根据情况给予病人静脉推注阿托品或芬太尼,然后缓慢静脉推注异丙酚.检查过程中记录病人反应、血压、心率、遗忘程度和血氧变化.结果检查后舒适满意220例(100%),对检查过程遗忘220例(100%).血压下降163例(74.1%);血压上升44例(20%);血压基本没变13例(5.9%);脉氧下降24例(10.9%),检查结束后患者苏醒时间0～9 min,平均(4.8±2.10)min.结论在胃镜检查中适量应用麻醉镇静药物是安全的,能使病人无痛苦、安全、顺利地完成检查.