用氯胺酮抑制颌面外科手术瑞芬太尼麻醉后痛觉过敏的临床研究

目的评价应用小剂量氯胺酮缓解颌面部手术瑞芬太尼麻醉后痛觉过敏的有效性和安全性。方法择期全麻下颌面部手术患者80例,随机分为氯胺酮组（n=40）和对照组（n=40）,均采用静吸复合全身麻醉。静脉注射咪唑安定、丙泊酚、芬太尼和罗库溴铵麻醉诱导后,气管插管行机械通气。麻醉维持采用瑞芬太尼0.1-0.2ug/kg/min泵注,吸入七氟醚2%~3%,间断给予罗库溴铵维持麻醉。分别于缝皮时静脉给予0.5mg/kg氯胺酮（氯胺酮组）和相同剂量的生理盐水（对照组）。记录两组患者拔管时间、苏醒时间及再次要求镇痛的患者例数、曲马多用量和不良事件的发生情况。分别于苏醒后15min（T1）、30min（T2）、60min（T3）、120min（T4）进行VAS、Ramsay评分。结果两组患者拔管时间、苏醒时间比较差异无统计学意义（P〉0.05）。氯胺酮组要求镇痛人数（17/40）和曲马多用量（40.5mg）均低于对照组（25/40,70.6mg）（P〈0.05）。患者苏醒后15min Ramsay评分氯胺酮组显著大于对照组（P〈0.01）,30min VAS评分对照组显著高于氯胺酮组（P〈0.05）。两组患者不良反应无显著差异。结论颌面部手术瑞芬太尼麻醉后使用小剂量氯胺酮,可以有效缓解瑞芬太尼所致的痛觉过敏,无不良反应,临床应用安全可靠。     

瑞芬太尼用于小儿先天性腭裂修补术的临床观察

目的:观察瑞芬太尼对先天性腭裂修补术患儿血流动力学和血管紧张素Ⅱ的影响。方法:选择ASA(美国麻醉医师协会分级法)Ⅰ~Ⅱ级先天性腭裂修补手术患儿50例,患者年龄3.5~13岁。随机分为瑞芬太尼组(R组)和芬太尼组(F组),各25例。入手术室后均肌注氯胺酮4~10mg/kg。麻醉诱导:试验组用瑞芬太尼2μg/kg,异丙酚1~2mg/kg;对照组用芬太尼2.5μg/kg,异丙酚1~2mg/kg,2组肌松剂均用维库溴铵0.1mg/kg,经鼻气管插管。麻醉维持:试验组用瑞芬太尼、异丙酚持续泵注,对照组用芬太尼、异丙酚持续泵注。2组均间断静脉注射维库溴铵维持肌松。术中连续监测ECG,HR,BP,SpO2.;分别于手术前1d(T1),气管插管时(T2),手术开始后10min(T3),气管拔管后5min(T4)自静脉采血,检测血浆血管紧张素Ⅱ(AgⅡ)水平;记录麻醉时间,苏醒时间和拔管时间。结果:与T1比较2组T2、T3时HR,SBP,DBP和AgⅡ水平均降低(P<0.05);2组间T2、T3时HR、SBP、DBP、SpO2,血管紧张素Ⅱ水平均无显著差异;麻醉时间R组长于F组,术后苏醒和拔管时间R组显著短于F组(P<0.01)。结论:瑞芬太尼比芬太尼镇痛作用强,能更有效抑制先天性腭裂患儿手术中的应激反应,维持术中血流动力学稳定,并且术后苏醒快,拔管时间短。     

七氟烷复合瑞芬太尼用于小儿腭裂手术麻醉的临床观察

目的：观察七氟烷复合瑞芬太尼用于小儿腭裂手术麻醉的临床效果。方法：40例ASAⅠ～Ⅱ级择期行腭裂手术患儿，年龄1～3岁，随机分为2组。K组：给予氯胺酮6-8mg／kg＋丙泊酚2mg／kg诱导插管，术中丙泊酚4-10mg，（kg·h）麻醉维持。S组：给予七氟烷8％面罩吸入＋瑞芬太尼0.5μg／kg缓慢静注诱导，术中瑞芬太尼0．10～0．25μg（kg·min），七氟烷1～1．5MAC（2％～5％）维持。根据术中血流动力学状况和手术刺激程度，适当调控麻醉深度。采用SPSS11．0软件包进行统计。结果：2组诱导插管均顺利。K组诱导后患儿心率显著增快（P〈0．01）、血压下降（P〈0．05），插管及分离腭瓣时仍保持较快心率（P〈0．01），与S组比较有显著差异（P〈0．01）。S组在诱导后患儿心率、血压有所下降（P〈0．01），但插管和分离腭瓣时心率血压基本保持平稳。术后S组患儿自主睁眼和拔管的时间显著早于K组（P〈0．01），而发生躁动病例多于K组。结论：七氟烷复合瑞芬太尼麻醉能较舒适、平稳地满足小儿腭裂手术要求。     

小剂量舒芬太尼复合丙帕他莫对口腔颌面外科手术术后苏醒期应激反应的影响

目的:观察小剂量舒芬太尼复合丙帕他莫对口腔颌面外科手术患者术后苏醒期拔管时应激反应的效果。方法:选取60例ASAⅠ～Ⅱ级择期在全身麻醉下行口腔颌面外科手术的患者,随机分为舒芬太尼组(S组)、舒芬太尼复合丙帕他莫组(S+P组)和生理盐水对照组(C组),每组各20例。S组于手术结束时静脉推注舒芬太尼0.2μg/kg,S+P组于手术结束时静脉推注舒芬太尼0.1μg/kg+静脉输注20g/L丙帕他莫50mL,C组于手术结束时静脉输注生理盐水50mL。分别记录患者手术结束时(T0)、拔管后1min(T1)、3min(T2)、5min(T3)时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),并于以上各时点抽取动脉血测定血糖,记录清醒和拔管时间以及其他不良反应。采用SPSS12.0软件包进行统计学处理。结果:T1-T3时,S组及S+P组的MAP、HR均低于C组;T1-T3时,C组血糖高于T0时,同时也高于S组及S+P组。拔管时,C组躁动发生率显著高于S组及S+P组,S组的清醒时间较S+P组及C组显著延长。结论:口腔颌面外科手术患者拔管前给予小剂量舒芬太尼复合丙帕他莫,可以减轻苏醒期拔管时的应激反应。     

异丙酚、氯胺酮对腭裂患儿全麻手术中心率变异性的影响

目的:研究异丙酚与氯胺酮麻醉对小儿自主神经功能的影响。方法:35例ASAⅠ~Ⅱ级腭裂手术患儿,随机分为2组:插管后Ⅰ组(氯胺酮组,n=17)静注氯胺酮(1~2mg/kg),Ⅱ组(异丙酚组,n=18)异丙酚4~8mg/(kg·h)微量泵输注。监测麻醉前(T0)、插管后5min(T1)、切皮(T2)、手术开始后1h(T3)、术毕(T4)及拔管后(T5)低频(LF)、高频(HF)、低频高频比(LF/HF)和总功率(LF HF)及MAP、HR、SpO2各值。结果:T1~T4各时点LF、HF、LF/HF及LF HF显著降低(P<0.05)。拔管后HRV各值基本恢复至术前水平(P>0.05)。2组比较,T2~T5各时点Ⅱ组HRV各值明显低于I组(P<0.05)。T2~T5HR、MAPⅡ组明显低于I组(P<0.05)。T5时点SpO22组明显低于T0~T4(P<0.05)。Ⅰ组拔管时间、清醒时间明显较Ⅱ组长(P<0.05),且躁动哭闹及术后恶心呕吐发生率明显高于Ⅱ组(P<0.05)。结论:异丙酚在麻醉中降低血压、心率和抑制自主神经功能的作用强于氯胺酮,术后拔管时间、苏醒时间、恶心呕吐及躁动哭闹的发生明显优于氯胺酮。     

瑞芬太尼对七氟烷诱导小儿口腔颌面部术后烦躁的影响

目的：探讨瑞芬太尼对口腔颌面部手术患儿七氟烷诱导术后苏醒烦躁的影响。方法：择期口腔颌面部手术患儿30例,ASAⅠ级,3～8岁,体质量15～26kg。实验随机分为2组,每组15例,A组为实验组,B组为对照组。2组患儿入手术室前根据改良耶鲁术前焦虑分级表评分,肌内注射盐酸氯胺酮后入室诱导,调节七氟烷浓度,静脉注射罗库溴铵后行气管插管。术中瑞芬太尼血浆靶浓度4～6ng/ml,调节七氟烷浓度维持BIS于40～60,2组术毕前10min调节瑞芬太尼至1ng/mL,七氟烷浓度0.8%（结束时关闭）。对照组手术结束时停用瑞芬太尼,实验组入苏醒室5min后停用。根据小儿麻醉苏醒烦躁量表及改良CHEOPS表,对小儿烦躁及疼痛情况评分。采用SPSS12.0软件包对数据进行统计学分析。结果：2组小儿术前焦虑及术后疼痛评分差异无统计学意义（P〉0.05）,实验组小儿术后烦躁评分显著低于对照组（P〈0.05）。结论：瑞芬太尼能有效减少小儿七氟醚诱导口腔颌面部手术术后烦躁。     

鼻导管通气下静脉麻醉在腮腺手术中的应用

目的:观察鼻导管通气下丙泊酚复合瑞芬太尼靶控输注(TCI)行腮腺手术的麻醉效果。方法:选择60例择期行腮腺手术的患者,ASA I～II级,年龄18～65岁,体重50～90 kg。随机分成气管插管组(A,n=30)和鼻导管通气组(B,n=30),2组均采用丙泊酚复合瑞芬太尼诱导,A组诱导后行气管内插管,B组诱导后置入鼻导管吸氧,术中调整丙泊酚的浓度以维持麻醉深度,并记录患者基础值(T0)、插管即刻(T1)、插管后1 min(T2)、3 min(T3)、5 min(T4)时的心率(HR)、血压(BP)、血氧饱和度(SpO2)、脑电双频指数(BIS)。比较2组血流动力学、血气分析和麻醉后恢复的情况。结果:2组T1时BP、BIS均较T0值降低(P<0.01);与T1比较,2组T2时BP均升高(P<0.01),而在T3、T4时变化无差异(P>0.05);A组HR在T3、T4时低于T0(P<0.05或P<0.01);组间比较,B组BP、HR在T2、T3时均低于A组(P<0.01)。2组苏醒时间、拔管时间、术中动脉血气pH值和PCO2差异无统计学意义(P>0.05)。结论:鼻导管通气下行丙泊酚复合瑞芬太尼靶控输注在腮腺手术中能获得较满意的麻醉效果,血流动力学较气管插管组稳定。     

瑞马唑仑和丙泊酚用于儿童日间全麻多生牙拔除术的效果比较

目的 比较瑞马唑仑与丙泊酚用于儿童日间多生牙拔除术的有效性及安全性。方法 选取江苏省口腔医院2022年10月—2023年4月于日间门诊全麻拔牙的患儿80例,采取随机数字表法分成丙泊酚组(P组)和瑞马唑仑组(R组),每组40例。丙泊酚组麻醉诱导丙泊酚2 mg/kg,麻醉维持丙泊酚6～12 mg/(kg·h),瑞芬太尼10μg/(kg·h)。瑞马唑仑组麻醉诱导瑞马唑仑0.3 mg/kg,麻醉维持瑞马唑仑0.8～1.5 mg/(kg·h),瑞芬太尼10μg/(kg·h)。记录两组患儿麻醉诱导前(T0)、插管前(T1)、插管后即刻(T2)、手术开始时(T3),手术结束时(T4),拔管即刻(T5),拔管后5 min(T6)的平均动脉压(mean arterial pressure, MAP)、心率(heart rate, HR)。记录组儿童手术时长、意识消失时间、拔管时间、镇静失败率等指标。结果 R组T1-T4时刻MAP、HR高于P组(P<0.05)。R组意识消失时间长于P组(P<0.05),但拔管时间短于P组(P<0.05)。两组患儿的镇静成功率均为100%,但R组的补救镇静...     

不同右美托咪定给药时机在全麻儿童龋齿治疗中的效果比较

目的 探讨不同右美托咪定给药时机在全麻儿童龋齿治疗中的效果。方法 将120例择期行全麻龋齿治疗的患儿随机分为D1组、D2组、D3组,每组40例。所有患儿术中均使用七氟烷1.5 MAC维持麻醉,D1组术中不给予右美托咪定;D2组于麻醉诱导插管后给予0.5 μg/(kg·h)右美托咪定,持续泵注10 min;D3组于手术结束前泵注0.5 μg/(kg·h) 右美托咪定10 min。记录3组患儿入室时(T0)、手术开始时(T1)、手术1 h时(T2)、术毕时(T3) 的心率及平均动脉压; 从七氟烷关闭至拔管时间及苏醒时间;入麻醉后监测治疗室(PACU) 的麻醉苏醒躁动评分（PAED）和疼痛评分（FLACC）。采用SPSS 21.0软件包对数据进行统计学分析。结果 与同组T0时相比,3组T1、T2和T3时心率、平均动脉压显著降低(P<0.05);与D1组相比,D2组T1、T2和T3时心率和平均动脉压显著降低(P<0.05),D3组T3时心率和平均动脉压显著降低(P<0.05)。与D1组相比,D2组D3组PAED和FLACC评分显著低于D1组(P<0.05)。结论 麻醉诱导插管后泵入 0.5 μg/(kg·h) 右美托咪定10 min,可使术中血流动力学稳定,减少麻醉苏醒躁动,同时不会影响麻醉苏醒及拔管时间,是较为合理的临床用药时机。     

清醒镇静镇痛麻醉应用于全牙弓种植手术的疗效研究

目的:观察清醒镇静镇痛麻醉配合局部麻醉下行全牙弓种植手术的临床效果及患者术后恢复情况。方法:选取24例需行全牙列种植固定咬合重建治疗的患者,按照随机数字表法分成实验组及对照组,每组12例,全牙列种植手术过程中,实验组采用清醒镇静镇痛麻醉配合局部麻醉,对照组采用单纯局部麻醉,记录两组麻醉前(T0)、局部浸润麻醉(T1)、翻粘骨膜瓣(T2)、钻洞(T3)、缝合(T4)时的平均动脉压(MAP)、心率(HR)、指氧饱和度(SpO₂),记录两组T1～T4时的镇静评分(RSS),离院前进行术中疼痛评分,术后前3 d进行术后疼痛评分。结果:实验组T1～T4各时点MAP及HR均显著低于对照组(P<0.05);对照组MAP及HR随时点变化为升高趋势,实验组MAP及HR随时点变化为下降趋势;两组各时点SpO₂均无显著差异(P>0.05);实验组T1～T4各时点RSS评分均显著优于对照组(P<0.05),实验组术中及术后第1、2、3天疼痛评分均明显低于对照组(P<0.05);两组不良反应发生率无统计学差异(P>0.05)。结论:清醒镇...     

酒石酸布托啡诺和曲马多用于舌癌术后静脉自控镇痛比较

目的:比较酒石酸布托啡诺和曲马多对舌癌术后静脉自控镇痛(PCIA)的效果。方法:81例ASAⅠ-Ⅲ择期在全身麻醉下行舌癌根治性手术患者,术后使用PCIA镇痛,并被随机分为2组使用不同镇痛药物,酒石酸布托啡诺组36例,曲马多组45例。采用视觉模拟评分法(VAS)评价两组患者术后即刻和术后6、24、48 h的镇痛、镇静程度,恶心呕吐等不良反应发生率,以及患者对术后镇痛的满意度等情况。结果:患者术毕即刻VAS评分,两组间差别没有统计学意义(P>0.05);术后6、24、48 h的VAS评分,曲马多组高于布托啡诺组,差异有统计学意义(P<0.05);术后48 h的不良反应发生率,曲马多组高于布托啡诺组(P<0.05);患者满意度方面,布托啡诺组不满意率较曲马多组低(P<0.05)。结论:酒石酸布托啡诺组对舌癌术后镇痛效果优于曲马多组,患者满意度高,可安全、有效的应用于舌癌术后镇痛。     

Diclofenac Transdermal Patch: A Potential Ingress to Maxillofacial Surgery

Purpose

To evaluate the analgesic efficacy of a diclofenac transdermal patch with diclofenac intra muscular injection in the immediate postoperative period in patients undergoing major oral surgical procedures.

Materials and Methods

Subjects who underwent bijaw surgeries for surgical correction of various dentofacial deformities were included. Sixty such patients who belonged to the above entity were randomly categorized into two groups from Jan 2012–Aug 2015. Group A (study group) received a single dose of 100 mg transdermal diclofenac patch, Group B (control group) received 75 mg intramuscular diclofenac and tramadol HCl 2 mg/kg body wt was used as rescue analgesic in the immediate post operative phase. The analgesic efficacy of the drugs are evaluated on periodic patient’s perception of pain in the immediate postoperative phase of 2nd, 6th, 12th, 24th and 48 hours.

Results

The mean VAS score in Group A was 2, mean duration of analgesia was 16 h 9 min, and in Group B the mean VAS score was 4, duration of analgesia was 8 h and 4 min. Tramadol HCl was given as rescue analgesia in 22 % (6) of patients belonging to Group A. None of the patients from both the groups reported local complications.

Conclusion

A noninvasive application of a single dose of 100 mg transdermal diclofenac patch is more effective than intramuscular diclofenac (75 mg) in the immediate post operative phase, without any significant side-effects is a novel ingress into the field of oral and maxillofacial surgery for post operative pain management.

     

区域神经阻滞在口腔颌面肿瘤股前外侧皮瓣修复术后镇痛中的临床应用

目的:探讨区域神经阻滞联合阿片类药物多模式镇痛用于口腔颌面肿瘤根治及股前外侧皮瓣修复术后患者镇痛的有效性和安全性。方法:将择期行口腔颌面肿瘤根治股前外侧皮瓣修复患者60例随机分为实验组和对照组,每组各30例。实验组在术毕前30 min,于B超引导下行术侧股神经联合股外侧皮神经阻滞,分别注入0.25%左旋布比卡因15 mL,同时接PCIA泵（舒芬太尼1.5 μg/kg+地佐辛0.1 mg/kg+雷琼0.4 mg/0.9%NS 100 mL）。对照组于术毕前30 min接PCIA泵（舒芬太尼2 μg/kg+地佐辛0.2 mg/kg+雷琼0.6 mg/0.9%NS 100 mL）。分别记录2组患者的一般情况,观察术后6 h（T1）、12 h（T2）、24 h（T3）、48 h（T4）时的镇静镇痛评分,比较2组不良反应的发生率。采用SPSS19.0软件包进行数据分析。结果:在T1、T3、T4时,2组患者VAS和Ramsay评分无统计学差异（P>0.05）;在T2时,实验组的VAS 评分大于对照组,差异有统计学意义（P<0.05）;实验组的不良反应率为10.0%,显著低于对照组的36.6%（P<0.05）。结论:区域神经阻滞联合阿片类药物静脉镇痛用于口腔颌面肿瘤根治及股前外侧皮瓣修复术后镇痛的效果确切,且可减少阿片类药物不良反应的发生率。     

右美托咪定用于口腔颌面肿瘤术后患者镇静及镇痛的临床观察

目的:探讨右美托咪定(DEX)对口腔颌面肿瘤术后保留气管套管患者镇静及镇痛的作用。方法:将口腔颌面肿瘤术后保留气管套管的60例患者按照随机原则分为右美托咪定Ⅰ组(D1组,20例)、右美托咪定Ⅱ组(D2组,20例)和生理盐水组(C组,20例)。D1组经静脉泵入负荷剂量的右美托咪定0.5μg/kg,10 min输注完毕,然后以0.2μg/(kg.h)维持;D2组经静脉泵入负荷剂量的右美托咪定0.5μg/kg,10 min内输注完毕,然后以0.4μg/(kg.h)维持;C组给予同等剂量的0.9%氯化钠输注。比较3组患者的Ramsay评分、疼痛情况、心率、血压、呼吸等变化。采用SPSS11.0软件包对数据进行统计学处理。结果:在各时点,3组的呼气末二氧化碳分压(ETCO2)无显著差异(P>0.05);在T2～T4时,D1组、D2组的Ramsay评分显著高于C组(P<0.05),D2组的Ramsay评分也显著高于D1组(P<0.05);在T4时,D1组、D2组的VAS评分显著高于C组(P<0.05),D2组的VAS评分也显著高于D1组(P<0.05)。结论:静脉输注右美托咪定用于口腔颌面肿瘤术保留气管套管患者镇静安全、镇痛有效,且无明显不良反应,推荐剂量为负荷剂量0.5μg/kg后,以0.4μg/(kg.h)维持输注。     

音乐疗法在90例正颌术后带管患者镇静镇痛中的效果评价

目的:探讨音乐疗法在正颌术后带管患者镇静镇痛中的有效性和安全性.方法:将择期行正颌手术的90例患者随机分为3组,每组各30例.A、B组分别给予0.4、0.8μg/(kg·h)右美托咪定镇静镇痛,C组则给予右美托咪定0.4μg/(kg·h)+音乐疗法.分别记录3组患者的一般情况,观察术毕入监护室后3 h(T1)、6 h(...     

Pre-emptive analgesia with the combination of tramadol plus meloxicam for third molar surgery: a pilot study

The aim of this pilot study was to evaluate pre-emptive analgesia using the combination tramadol plus meloxicam compared with each individual drug alone for the reduction of pain after extraction of third molars. Fifty-one patients were randomised into three groups (n=17 in each), using a series of random numbers: the first group was given tramadol 25mg and meloxicam 7.5mg; the second tramadol 50mg, and the third meloxicam 15mg, all intramuscularly. Treatments were prepared in identical syringes by an independent investigator and were given immediately. The teeth were removed 50min after the analgesics had been given. Intensity of pain, consumption of analgesics, and adverse effects were evaluated. The intensity of pain was evaluated using a visual analogue scale (VAS) and the area under the curve of the VAS showed significant differences amongst the groups. In conclusion, the study showed that the combination of tramadol 25mg and meloxicam 7.5mg had an analgesic effect similar to that of meloxicam 15mg, but both were better than tramadol 50mg for relief of pain after the extraction of mandibular third molars.     

Analgesic efficacy of tramadol and butorphanol in mandibular third molar surgery: a comparative study

Background: Butorphanol tartrate, a mixed synthetic agonistantagonist opioid analgesic has been used for management of postoperative pain in minor and major surgical procedures.(14,20) Tramadol hydrochloride is a centrally acting opioid which is effectively used in postoperative pain in various minor and major surgeries. Materials and methods: Twenty subjects selected randomly received butorphanol tartrate 1 mg intramuscular and 20 subjects received tramadol hydrochloride 50 mg intramuscular after the removal of mandibular third molars. Time of injection, amount of anesthetic injected, duration of surgery, adverse effects were recorded.(21) Results: The mean amount of LA administered in butorphanol group was 2.6450 ml and in tramadol group was 2.640 ml respectively, the mean duration for surgery was 56.75 and 53.5 minutes for butorphanol and tramadol groups respectively which was statistically not significant. Pain assessment was done with VAS which showed mean of 19.2 and 15.5 mm (p = 0.001) which was significant for butorphanol and tramadol respectively after 12 hours. The mean time for rescue medication requirement was 5.9 hours (for tramadol) and 8.4 hours (for butorphanol). Effective analgesic activity was seen by butorphanol 1 mg intramuscular then tramadol 50 mg. Conclusion: Butorphanol 1 mg was more effective than tramadol 50 mg in respect to postoperative analgesia. Keywords: Butorphanol, Tramadol, Third molar surgery, VAS, Pain, Analgasia. How to cite this article: Hassan SS, Ahmed A, Rai M, Kalappa TM. Analgesic Efficacy of Tramadol and Butorphanol in Mandibular Third Molar Surgery: A Comparative Study. J Contemp Dent Pract 2012;13(3):364-370. Source of support: Nil Conflict of interest: None declared.     

Analgesic efficacy and clinical acceptability of adjunct pre-emptive intravenous tramadol in midazolam sedation for third molar surgery

Introduction

This study aims to compare two routine procedures of sedation, with and without intravenous adjunct analgesia, in third molar surgery regarding postoperative pain and consumption of analgesics.

Material and methods

In a randomized, controlled, single-blinded procedure, 87 men and women aged 18–44 years were divided into two treatment groups, midazolam?+?tramadol (M?+?T) and midazolam?+?saline (M?+?S), and one control group (C), with no additional medication. After removal of a third lower molar, patients recorded postoperative pain on a visual analog scale (VAS) and consumption of analgesics during the first day after surgery.

Results

Time from the end of operation until first rescue pill (400 mg Ibuprofen tablet) differed significantly between the M?+?S group (193 min) and the C group (110 min) (p?=?0.001) as well as the M?+?T group (157 min) and the C group (p?=?0.049). The study did not show any significant reduction of postoperative pain, VAS, after third molar surgery in patients who received adjunct pre-emptive intravenous administration of 1 mg/kg tramadol under midazolam sedation.

Discussion and conclusion

The lack of significant difference between the study and placebo groups indicates that tramadol at 1 mg/kg might be an insufficient dose, though the suitability for tramadol in oral and maxillofacial surgery has already been settled in other studies.     

七氟醚和氯胺酮用于婴儿唇裂术后拆线的临床比较

目的:探讨七氟醚吸入麻醉在婴儿唇裂术后拆线的可行性。方法:选择年龄小于1岁唇裂术后拆线患儿60例,随机分为氯胺酮肌注组(K),七氟醚吸入组(S)和七氟醚复合笑气吸入组(SN)。K组给予肌注氯胺酮5mg/kg,咪唑安定0.05mg/kg,阿托品0.01mg/kg;S组以8%七氟醚,氧流量6L/min面罩吸入诱导;SN组以8%七氟醚,复合笑气4L/min,氧气2L/min吸入诱导,患儿入睡后改为4%七氟醚,氧流量3L/min维持,吸入2min后开始拆线。术中常规监测患儿HR,SpO2。记录患儿诱导时间、苏醒时间、术中发生体动情况及术中呼吸抑制、分泌物增多等并发症情况。结果:S组和SN组的诱导时间、苏醒时间短于K组,2组间差异无统计学意义。S组和SN组患儿术中体动的发生率小于K组。3组均有患儿发生舌后坠和分泌物增多,但差异无统计学意义。结论:七氟醚吸入诱导和苏醒时间均比肌注氯胺酮麻醉迅速,能够更加安全有效地用于唇裂婴儿术后拆线;复合笑气吸入不能缩短七氟醚吸入麻醉的诱导和苏醒时间。