腰硬联合麻醉下复合丙泊酚镇静的临床研究

目的 探讨腰硬联合麻醉复合丙泊酚恒速输注清醒镇静的可行性、理想的药物剂量、术中知晓情况以及麻醉质量和效果.方法 收集2009年3-12月480例美国麻醉医师协会(ASA)Ⅰ～Ⅲ级拟在腰硬联合麻醉下行下腹部、会阴部、下肢手术的患者480例,随机分为咪达唑仑组(M组)、丙泊酚Ⅰ组(PA组)、丙泊酚Ⅱ组(PB组)、丙泊酚Ⅲ组...     

Evaluation of propofol and remifentanil for intravenous sedation for reducing shoulder dislocations in the emergency department

Objectives

To assess the combination of propofol and remifentanil for sedation to reduce shoulder dislocations in an ED.

Methods

Eleven patients with anterior glenohumeral dislocation were given propofol 0.5 mg/kg and remifentanil 0.5 μg/kg iv over 90 seconds and then further doses of 0.25 mg/kg and 0.25μg/kg, respectively, if needed. Another practitioner attempted reduction using the Milch technique.

Results

Reduction was achieved in all patients within four minutes of giving sedation (range 0.3–4; mean 1.6). Seven required one attempt at shoulder reduction, three required two attempts, and one required three attempts. Mean time to recovery of alert status was three minutes (range 1–6). The mean pain score during the reduction was 1.7 out of 10 (range 0–5). Nine patients had full recall, one had partial recall, and one had no recall at all. Eight patients were “very satisfied” with the sedation and three were “satisfied”. There were no respiratory or haemodynamic complications that required treatment.

Conclusions

Propofol and remifentanil provide excellent sedation and analgesia for the reduction of anterior glenohumeral dislocation, enabling rapid recovery.     

Optimization of propofol dose shortens procedural sedation time, prevents resedation and removes the requirement for post-procedure physiologic monitoring

Objective: To examine the effect of propofol dosing (total dose and number of doses) on patient sedation time and likelihood of resedation. Methods: This was a prospective, observational patient series in an urban district hospital ED with 42 000 attendances per annum. Patients undergoing an emergent procedure requiring procedural sedation were included. Titrated intravenous propofol was administered according to departmental procedure. Standardized consent and data collection forms were used. Time taken for the patient to become conversational after first administration was recorded and any resedation documented. Results: Four hundred patients, undergoing 404 procedures, were enrolled for the period commencing August 2004 until March 2006. The mean initial propofol bolus was 0.8 mg/kg (SD 0.6), and mean total propofol dose was 1.8 mg/kg (SD 1.0), comprising a mean of 2.3 (SD 2.1) doses of 15.8 mg (SD 11.4). Mean sedation time was 11.8 min (SD 6.9), and increased sedation times were associated with higher total propofol dose and number of boluses (P < 0.0001). Resedation occurred in two patients (0.5%, 95% CI 0–1.6%). Conclusion: Shorter sedation times are seen with lower doses of propofol. Patients do not need prolonged post‐procedure monitoring because the occurrence of spontaneous resedation associated with propofol use is a rare event. This has implications for patient flow and staff resource allocation in a busy ED.     

The use of propofol sedation in a paediatric intensive care unit

Background: The aim of this study was to prospectively evaluate and report the experience of the use of continuous intravenous propofol sedation in a paediatric intensive care unit (PICU). Methods: All children younger than 16 years who were admitted to the PICU at a University Hospital for slightly more than a year and received propofol infusion were included prospectively and data were recorded before and within 6 h after completion of the propofol infusion. Results: A total of 174 out of 955 children (18·2%) received propofol infusion for sedation. The median age was 2 years 10 months (range: 2 months to 16 years), duration of propofol infusion 13 h (range: 1·6–179 h) and dose of propofol 2·9 mg/kg/h (range: 0·3–6·5 mg/kg/h). No one developed signs of the propofol infusion syndrome (PRIS). Neither dose >3 mg/kg/h, duration of infusion >48 h nor both were found to be related to adverse metabolic derangements or circulatory failure. Eight children increased their lactate concentration ≥1·8 mmol/L during propofol infusion. All had a favourable outcome. One child who had received propofol infusion for 10 h died, but this occurred 14 h after the infusion ceased and was without doubt attributed to a multiple organ failure not related to the propofol infusion. Conclusion: Propofol infusion was used in this population at low risk of PRIS with no metabolic or circulatory adverse effects. These findings indicate that the occurrence of adverse effects may not be directly related to dose or duration of infusion, but emphasizes the risk that sporadic factors may be involved, such as genetic mutations. Guidelines are presented.     

Safety of nonanesthetist sedation with propofol for outpatient colonoscopy and esophagogastroduodenoscopy

BACKGROUND AND STUDY AIMS: In our endoscopy service, nonanesthetists administered propofol sedation has been used in more than 8000 procedures during the past 3 years. This study prospectively assessed the safety of propofol sedation in outpatient colonoscopy and esophagogastroduodenoscopy (EGD). PATIENTS AND METHODS: A total of 300 consecutive outpatients (mean age 53, range 14-94) were enrolled in the study (139 colonoscopies, 161 EGDs). After an initial dose of 0.5 mg/kg (ASA I-II and age III or age >70 years), propofol was titrated in 10 mg boluses to a steady state of sedation by the endoscopy nurse under the endoscopist's supervision. Colonoscopy patients also received 25 mg pethidine (meperidine) and 20 mg butylscopolamine, whereas EGDs were performed with propofol sedation alone, without topical pharyngeal anesthesia. In addition to standard monitoring with pulse oximetry and automated sphygmomanometry, patients were also observed with sidestream capnography or measurement of electrocardiographic impedance changes, providing real-time graphic assessment of respiratory activity. All patients were given oxygen 2 L/min by nasal cannula during the entire procedure. RESULTS: Mean dosages of 157 mg (range 70-340) and 180 mg (60-400) propofol were administered for colonoscopy and EGD procedures, respectively. No episodes of apnea occurred. The oxygen saturation fell below 90 % for short periods of time in 11 patients (3.7 %). Three patients required a temporary increase in oxygen delivery. No assisted ventilation was necessary. In 22 patients (7.3 %), the mean blood pressure temporarily decreased below 50 mmHg. Two patients received a 500-ml infusion of normal saline. CONCLUSIONS: Propofol can be safely administered for sedation during colonoscopy and esophagogastroduodenoscopy by nonanesthetists who are familiar with the pharmacological properties and use of this drug.     

Propofol for procedural sedation in the pediatric emergency department

This retrospective case series reports our experience using propofol for procedural sedation in the Emergency Department over an 18-month period with 52 pediatric patients. Propofol sedation was performed successfully in all children (mean age, 10.2 years; range 0.7-17.4 years). Indications for sedation included orthopedic manipulation, incision and drainage of abscess, sexual assault examination, laceration repair, and non-invasive imaging studies. The mean dose administered with the intermittent bolus and continuous infusion methods of delivery was 4.25 mg/kg (+/- 1.86) and 8.3 mg/kg/h, respectively. The mean recovery time was 27.1 min (+/- 15.84). No patient required assisted ventilation or developed clinically significant hypotension. Respiratory depression requiring airway repositioning or supplemental oxygen was noted in 5.8% (3/52) patients. Propofol is a reasonable alternative to facilitate sedation for a range of procedures performed in a busy Pediatric Emergency Department.     

Improved sedation in diagnostic and therapeutic ERCP: propofol is an alternative to midazolam

BACKGROUND AND STUDY AIMS: Adequate sedation of the patient is required for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The anesthetic propofol, with its shorter half-life, affording better control, offers an alternative to the benzodiazepine midazolam. The aim of this randomized, controlled, unblinded study was to compare prospectively the quality of sedation under propofol and midazolam in patients undergoing ERCP. PATIENTS AND METHODS: A total of 80 patients were randomized to sedation with propofol alone (n = 40) or midazolam alone (n = 40). Blood pressure, pulse, and oxygen saturation were measured. Midazolam was given by the endoscopist and titrated to the patients' response during ERCP, to a maximum dose of 15 mg per patient. In the propofol group an anesthetist was present to administer the propofol and to observe the patient. Standardized testing procedures (Steward score, Trieger test) were used to determine the length of postendoscopy recovery time. Efficacy of sedation was assessed by investigators and patients, using scoring systems. RESULTS: Complete ERCP and adequate sedation was possible in 80% of patients (32 out of 40) with midazolam, and in 97.5% of patients (39 out of 40) with propofol (P<0.01). The average propofol induction dose was 1.24 mg/kg body weight, with maintenance requiring a mean dose of 9 mg/kg body weight per hour, or the equivalent of 354 mg in total. The average dose of midazolam administered was 0.12 mg/kg body weight; the total dose averaged 8 mg. Recovery time in the propofol patients was significantly shorter (P<0.01). The investigators (P<0.01) and the patients (P<0.05) both judged the quality of sedation to be better in the propofol group. There were no differences in blood pressure, pulse, or oxygen saturation between the two groups. One patient in the propofol group (79 years old) suffered a protracted apneic phase accompanied by hypotension that was managed by manual ventilation and drug therapy, and led to no complications. CONCLUSIONS: Propofol proves to be an excellent sedative for ERCP and shows a shorter recovery time than midazolam. Because of the narrow therapeutic window, we recommend close patient monitoring.     

Propofol Versus Propofol/Ketamine for Brief Painful Procedures in the Emergency Department: Clinical and Bispectral Index Scale Comparison

ABSTRACT

The ideal procedural sedation drug for emergency department (ED) use would be easily titrated, rapid in onset, brief in duration, and provide sedation and analgesia without respiratory or hemodynamic compromise. Although many agents have been tried, no single drug fits this profile. The authors evaluated the comparative effectiveness and safety of propofol versus propofol/ketamine combination for procedural sedation using bispectral index monitoring for measuring depth of sedation. A prospective, randomized case series of patients undergoing procedural sedation for fracture manipulation was studied in a Level 1 trauma center emergency department. Patients were randomized to a propofol (P) group with a target dose of 0.5 to 1.5 mg/kg or a propofol/ketamine (P/K) group with a target dose of both ketamine and propofol of 0.75 mg/kg. Procedural success, bispectral index (BIS) score, adverse effects, recovery time, and vital signs were measured. Twenty-eight patients were enrolled. The P/K group experienced a smaller decline in systolic blood pressure (1.6% versus 12.5%) and BIS score at goal sedation (77 versus 61), a smaller difference between baseline and goal sedation BIS score (18.78 ± 10 versus 34.64 ± 11) and a lower mean propofol dose (92.5 ± 58 versus 177.27 ± 11 mg). No patient in either group experienced respiratory depression or required any intervention. The combination of propofol and ketamine provides an attractive combination for procedural sedation in the emergency department. Compared to propofol alone, “ketofol” results in less hypotension, better sedation, and enhanced patient comfort and safety.     

Propofol versus propofol/ketamine for brief painful procedures in the emergency department: clinical and bispectral index scale comparison

The ideal procedural sedation drug for emergency department (ED) use would be easily titrated, rapid in onset, brief in duration, and provide sedation and analgesia without respiratory or hemodynamic compromise. Although many agents have been tried, no single drug fits this profile. The authors evaluated the comparative effectiveness and safety of propofol versus propofol/ketamine combination for procedural sedation using bispectral index monitoring for measuring depth of sedation. A prospective, randomized case series of patients undergoing procedural sedation for fracture manipulation was studied in a Level 1 trauma center emergency department. Patients were randomized to a propofol (P) group with a target dose of 0.5 to 1.5 mg/kg or a propofol/ketamine (P/K) group with a target dose of both ketamine and propofol of 0.75 mg/kg. Procedural success, bispectral index (BIS) score, adverse effects, recovery time, and vital signs were measured. Twenty-eight patients were enrolled. The P/K group experienced a smaller decline in systolic blood pressure (1.6% versus 12.5%) and BIS score at goal sedation (77 versus 61), a smaller difference between baseline and goal sedation BIS score (18.78 ± 10 versus 34.64 ± 11) and a lower mean propofol dose (92.5 ± 58 versus 177.27 ± 11 mg). No patient in either group experienced respiratory depression or required any intervention. The combination of propofol and ketamine provides an attractive combination for procedural sedation in the emergency department. Compared to propofol alone, "ketofol" results in less hypotension, better sedation, and enhanced patient comfort and safety.     

Palliative sedation in advanced cancer patients followed at home: a retrospective analysis

ContextData regarding palliative sedation at home in dying patients are lacking.ObjectivesTo describe the frequency, indication, and modality of palliative sedation (PS) in patients followed at home.MethodsA retrospective analysis of home care cancer patients was performed. Patients who received PS before dying were selected and information about epidemiologic characteristics, indications, duration, drugs, and outcomes was collected.ResultsOf 370 medical charts of patients who died at home, 49 patients received PS before dying. PS was proposed by the team, relatives, or both in 63.3%, 4.1%, and 32.6% of cases, respectively. Delirium alone or in combination with other symptoms was the most frequent indication to begin PS. Midazolam was the most frequently used drug to initiate PS (98%), at a mean dose of 28.1 mg/day, in combination with parenteral morphine (84.7%) at a mean dose of 25.4 mg/day. At the time of death, midazolam was administered in 98% of patients (mean dose 22.3 mg/day), combined with parenteral morphine in 87.8% of patients (mean dose 28.1 mg/day). Satisfaction for physicians and principal caregivers after PS was good in 46 and 48 cases, respectively.ConclusionPS at home seems to be a feasible treatment option among selected patients and makes a potentially important contribution to improving care for those who choose to die at home.     

老年患者自控镇静与全静脉镇静进行肠镜检查比较

目的:比较老年患者自控镇静和全静脉镇静施行结肠镜检查的安全性、有效性和患者可接受性。方法:100例行结肠镜检查65岁以上患者随机分两组:(1)患者自控镇静组异丙酚和阿芬太尼的混合制剂通过自控镇静的方式给予,每次给药为异丙酚4.8mg和阿芬太尼12μg,无负荷剂量,锁定时间为0min。(2)全静脉组按照0.5mg/kg和0.1mg/kg的剂量给予哌替啶和安定的混合液,如需要可以根据麻醉医师的观察适当追加。观察指标包括心肺并发症、疼痛评分、满意程度评分和恢复时间等。结果:自控镇静组应用的异丙酚平均剂量为0.89±0.56mg/kg,阿芬太尼的剂量2.90±1.4μg/kg;全静脉镇静组患者的安定和哌替啶剂量分别为5.6±1.4mg和30.0±7.8mg;低血压的发生率在患者自控镇静组为6%(3例),而在全静脉麻醉组为30%(15例)(P<0.01);低氧饱和度在全静脉发生率为8%(4例),患者自控镇静组为0%(0例);患者自控镇静组和全静脉麻醉组患者的平均恢复时间分别为1min和5min,前者明显较后者短(P<0.01)。关于镇痛评分和满意度评分两组之间无显著差异。结论:在同样有效性和可接受程度情况下,老年患者进行结肠镜检查自控镇静较全静脉镇静更加安全。     

An audit of propofol administration in the intensive care unit: Infusion pump–recorded versus electronically documented amounts

BackgroundAlthough propofol is widely used for sedation in intensive care units around Australia, evaluation of bedside nursing practices of the administration of propofol have been limited. We investigated whether there was a discrepancy between the amount of propofol delivered by the infusion pump and that recorded electronically and consequently patient exposure to avoidable harms.AimsThe aim of this research was to compare the total amount of propofol administered to intensive care patients via a programmable infusion pump with that documented in the electronic medical record (EMR). Secondary objectives were to ascertain the percentage of 1) patients exposed to a propofol dose greater than recommended and 2) daily energy requirements administered as propofol infusion.MethodsThis was a prospective, observational study of total propofol delivered to 50 patients in a 14-bed metropolitan, Australian intensive care unit. Infusion pump data and entries from the EMR were collated.ResultsPropofol sedation was administered for a median 18 (interquartile range: 14–47) hours with median total propofol 3025 mg (interquartile range: 1840–7755 mg) by pump and 3250 mg (interquartile range: 1915–6960 mg) by EMR, i.e. 1.9 (interquartile range: 1.3–2.3) mg/kg/hour by pump (correlation coefficient = 0.99). The total bolus propofol documented in the EMR was a median 330 mg (interquartile range: −838 to −124) less than the pump amount. Nineteen (38%) patients had no EMR-documented propofol boluses yet had received at least one bolus via the pump. In two of 50 (4%) patients, the pump propofol infusion dose was above the recommended maximum safe dose of 4 mg/kg/h.ConclusionIn this cohort of patients, the bolus administration of propofol was frequently not documented, potentially placing some patients at risk of drug-related toxicity. Further research to develop and implement strategies to improve the documentation of propofol administration is indicated.     

Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? A prospective randomized controlled trial

BACKGROUND AND STUDY AIMS: We previously demonstrated that audio distraction using relaxation music could lead to a decrease in the dose of sedative medication required and improve patient satisfaction during colonoscopy. This prospective randomized controlled trial was designed to test the hypotheses that visual distraction may also decrease the requirement for sedatives and that audio and visual distraction may have additive beneficial effects when used in combination. PATIENTS AND METHODS: 165 consecutive patients who underwent elective colonoscopy were randomly allocated into three groups to receive different modes of sedation: group 1 received visual distraction and patient-controlled sedation (PCS); group 2 received audiovisual distraction and PCS; group 3 received PCS alone. A mixture of propofol and alfentanil, delivered by a Graseby 3300 PCA pump, was used for PCS in these groups. Each bolus of PCS delivered 4.8 mg propofol and 12 micro g alfentanil. Measured outcomes included the dose of PCS used, complications, recovery time, pain score, satisfaction score, and willingness to use the same mode of sedation if the procedure were to be repeated. RESULTS: Eight patients were excluded after randomization. The mean+/-SD dose of propofol used in group 2 (0.81 mg/kg +/- 0.49) was significantly less than the dose used in group 1 (1.17 mg/kg +/- 0.81) and that used in group 3 (1.18 mg/kg +/- 0.60) ( P < 0.01, one-way analysis of variance). The mean +/- SD pain score was also lower in group 2 (5.1 +/- 2.5), compared with the pain scores in group 1 (6.2 +/- 2.2) and group 3 (7.0 +/- 2.4) ( P < 0.01, one-way analysis of variance). The mean +/- SD satisfaction score was higher in groups 1 (8.2 +/- 2.4)) and 2 (8.4 +/- 2.4), compared with the score in group 3 (6.1 +/- 2.9) ( P < 0.01, one-way analysis of variance). A majority of patients in groups 1 (73 %) and 2 (85 %) said that they would be willing to use the same mode of sedation again, compared with only 53 % in group 3 ( P < 0.01, chi-squared test). CONCLUSIONS: Visual distraction alone did not decrease the dose of sedative medication required for colonoscopy. When audio distraction was added, both the dose of sedative medication required and the pain score decreased significantly. Both visual and audiovisual distraction might improve patients' acceptance of colonoscopy.     

Deepening of sedation with propofol has limited effect on intra-abdominal pressure – An interventional study in mechanically ventilated adult patients with intra-abdominal hypertension

PurposeTo evaluate the effect of deepening of sedation on intra-abdominal pressure (IAP).Methods37 adult mechanically ventilated ICU patients with intra-abdominal hypertension received a bolus dose and subsequent infusion of propofol (bolus: 1 mg/kg, infusion: 3 mg/kg/h). IAP, mean arterial pressure (MAP), abdominal perfusion pressure (APP), depth of sedation according to Richmond Agitation-Sedation Scale (RASS), respiratory parameters, and vasopressor dose were assessed after bolus and at 15, 30 and 60 min of infusion of propofol.ResultsMedian IAP at baseline was 15 (13–16) mm Hg. During the intervention, median IAP decreased by 1 mm Hg at all time points. In 24% of patients IAP decreased by ≥3 mm Hg. Compared to baseline, MAP and APP were reduced at all time points. Deepening of sedation per RASS was achieved in 70% of patients at all time points. No changes in respiratory tidal volumes nor plateau pressures were observed. Vasopressor therapy with noradrenaline was started or increased in 43% of patients, whereas the increase in patients already receiving noradrenaline prior to the intervention was not significant.ConclusionsDeepening of sedation with propofol results in a small decrease in IAP and greater simultaneous decrease in MAP and APP, requiring increased vasopressor support in some cases.     

吗啡-咪达唑仑与普鲁泊福、咪达唑仑在机械通气患者镇静中的成本-效果分析

目的 评价吗啡-咪达唑仑与普鲁泊福、咪达唑仑在机械通气患者镇静中的疗效及成本-效果.方法 93例需要机械通气患者随机分为3组:普鲁泊福组:首剂1 mg/kg,维持剂量1 mg/(kg·h).吗啡-咪达唑仑组:吗啡首剂0.05 mg/kg,维持剂量0.05 ms/(kg·h);咪达唑仑首剂0.15 mg/kg,维持剂量0.05 mg/(kg·h).咪达唑仑组:首剂0.15 mg/kg,维持剂量0.05 mg/(kg·h).根据Ramsay镇静评分逐渐增加镇静药物剂量.记录镇静时间、停药至拔管时间、镇静费用及低血压发生率.结果 咪达唑仑组停镇静药至拔管时间为(6.0±2.4)h,长于普鲁泊福组的(4.6±1.7)h(P<0.01).吗啡-咪达唑仑停镇静药至拔管时间(5.6±2.7)h与普鲁泊福组(4.6±1.7)h差异无统计学意义(P>0.05).吗啡-咪达唑仑组镇静费用(101.7±20.4)元低于咪达唑仑组(127.7±21.3)元(P<0.05)及普鲁泊福组(199.7±65.9)元(P<0.01),咪达唑仑组及吗啡-咪达唑仑组低血压发生率低于普鲁泊福组[分别为3.2%(1/31)、9.7%(3/31)、35.4%(11/31),P<0.05,P<0.01].结论 吗啡-咪达唑仑在机械通气患者镇静中较普鲁泊福及咪达唑仑更安全、经济,值得临床推广使用.     

Age-related Differences in Propofol Dosing for Procedural Sedation in the Emergency Department

Background

Propofol dose requirements may differ in the elderly due to age-related changes in pharmacokinetic or pharmacodynamic variables.

Objective

The objective of this study was to determine the effect of patient age on propofol dose required for procedural sedation in the Emergency Department (ED).

Methods

This was a retrospective cohort study conducted in a tertiary hospital ED. Adult patients who underwent procedural sedation in the ED using propofol were grouped a priori by age into three categories: 18–40 years, 41–64 years, and ≥65 years. The median induction dose and total dose of propofol required for the procedure was compared between the three age group categories. Multivariate linear regression analyses were used to adjust for confounders.

Results

A total of 170 patients were included in the final analyses: 18–40 years (n = 66), 41–64 years (n = 59), and ≥65 years (n = 45). The median induction dose was 1.4, 1, and 0.9 mg/kg, respectively; and the median total propofol dose was 2, 1.7, and 1.2 mg/kg, respectively. The ≥65 year-old group required significantly less propofol (mg/kg) for induction (compared to the 18–40-year-old group) and for the entire procedure (compared to all other groups) (p < 0.001). In the multivariate linear regression analyses, patient age was negatively predictive of induction dose (coefficient −0.011, 95% confidence interval [CI] −0.017 to −0.005) and total dose (coefficient −0.014, 95% CI −0.022–0.007) after adjusting for confounders.

Conclusion

Elderly patients may require lower doses of propofol for procedural sedation in the ED, compared to younger adults.     

地佐辛复合丙泊酚对无痛小肠镜检查患者血流动力学及麻醉深度的影响

目的探讨地佐辛复合低剂量丙泊酚用于无痛小肠镜检查对患者血流动力学及麻醉深度的影响。方法行无痛小肠镜检查患者70例随机分成观察组和对照组各35例,观察组依次缓慢静脉注射地佐辛50μg／kg、丙泊酚1mg／kg,对照组静脉注射丙泊酚2mg／kg,检查中如有体动反应则追加丙泊酚0．2～0．5mg／kg。观察2组给药前（T0）、给药后5min（T1）、给药后10min（T2）、给药后30min（T3）、给药后60min（T4）、检查结束出镜时（T5）心率、平均动脉压（meanarterypressure,MAP）、血氧饱和度（pulseoxygensaturation,SpO2）和麻醉深度指数（Narcotrend,NTI）以及丙泊酚用量、苏醒时间及不良反应发生情况。结果2组T1～T5时间点MAP均低于T0时（P〈0．05）,对照组T1时SpO2低于观察组（P〈0．05）;观察组丙泊酚用量和苏醒时间低于对照组（P〈0．05）,T1～T5时间点NTI均高于对照组和T0时（P〈0．05）,心动过速、呼吸抑制、Ⅲ级体动反应和术后腹痛、腹胀发生率低于对照组（（P〈0．05）。结论无痛小肠镜检查中应用地佐辛复合丙泊酚较单独应用丙泊酚镇痛效果好,血流动力学稳定,并可减少丙泊酚用量。     

The use of midazolam versus propofol for short-term sedation following coronary artery bypass grafting

Midazolam and propofol were compared in an open randomized study for postoperative sedation during 12 h of mechanical ventilation in 40 patients following coronary artery bypass grafting. After an intravenous loading dose of midazolam (50 micrograms.kg-1) or propofol (500 micrograms.kg-1), a titrated continuous infusion was administered of midazolam (mean dose 38.1 micrograms.kg-1.h-1 (SEM 2.6)) or propofol (mean dose 909 micrograms.kg-1.h-1 (SEM 100)) together with a narcotic analgesic infusion. During mechanical ventilation midazolam and propofol produced a similar quality of sedation, but recovery (midazolam 66 min (SEM 16); propofol 24 min (SEM 7)) and weaning from the ventilator (midazolam 243 min (SEM 44); propofol 154 min (SEM 33)) where faster with propofol. In the 2 groups administration of an intravenous loading dose caused a significant decrease in mean arterial pressure but hemodynamic tolerance during maintenance infusion was good.     

A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit

OBJECTIVE: To evaluate dexmedetomidine for sedation of patients in the medical ICU. DESIGN AND SETTING: Prospective observational study in an intensive care unit of a university hospital. PATIENTS. Twelve ventilated patients with median APACHE II score 23 (range 10-26). INTERVENTIONS: Patients received a loading dexmedetomidine infusion of 1 microg x kg(-1) over 10 min followed by a maintenance infusion rate of 0.2-0.7 microg x kg(-1) x h(-1) for up to 7 days. After experience with the first four patients this maintenance rate of infusion was increased to a maximum of 2.5 microg kg(-1) x h(-1). If required, propofol and morphine provided rescue sedation and analgesia, respectively. RESULTS: The first four patients with dexmedetomidine infusion at 0.7 microg x kg(-1) x h(-1)all required rescue sedation with a propofol infusion. A protocol amendment allowed the next eight patients to receive higher dexmedetomidine infusions (mean 1.0+/- microg x kg(-1) x h(-1)). Five of the next eight patients did not required propofol, and two patients only required minimal propofol infusions (20-40 mg x h(-1)). A further patient, with hepatic encephalopathy, required a propofol at 50-100 mg x h(-1). Only modest falls in arterial pressure, heart rate and cardiac output were seen, and no rebound sequelae occurred on discontinuation of dexmedetomidine. Adverse cardiovascular events were nearly all confined to the initial loading dose period of dexmedetomidine. CONCLUSIONS: Sedation with dexmedetomidine is efficacious in critically ill medical patients requiring mechanical ventilation in the intensive care unit. A reduction in loading infusion is advised, but higher maintenance infusions may be required to that seen previously in the postoperative ICU patient.