盐酸氯普鲁卡因注射液静脉复合全身麻醉的临床观察

目的　观察盐酸氯普鲁卡因注射液静脉复合全身麻醉的临床效果。方法　将 4 0例患者随机分为 A组 (盐酸氯普鲁卡因组 ) 2 0例 ,B组 (盐酸普鲁卡因组 ) 2 0例。结果　两组麻醉效果相似 ,术中及术后均无不良反应。而盐酸氯普鲁卡因组苏醒时间明显短于盐酸普鲁卡因组。结论　盐酸氯普鲁卡因用于静脉复合全身麻醉 ,麻醉平稳 ,苏醒快。     

氯普鲁卡因与利多卡因在剖宫产硬膜外麻醉中应用比较

目的分析盐酸氯普鲁卡因与盐酸利多卡因硬膜外麻醉在剖宫手术中的临床效果。方法回顾性分析2009年1月至2010年1月期间56例在我院接受L1～2间隙硬膜外麻醉行剖宫产手术的患者的临床资料。56例足月单胎孕妇随机分为3%氯普鲁卡因组和2%利多卡因组各28例。观察两组患者麻醉前后血压、心率变化及硬膜外麻醉的临床效果。结果两组患者麻醉后5min、30min收缩压、舒张压较麻醉前无明显变化（P〉0.05）,3%盐酸氯普鲁卡因麻醉起效时间及疼痛消失时间较2%盐酸利多卡因短,麻醉维持时间3%盐酸氯普鲁卡因较2%盐酸利多卡因长。肌松效果：3%盐酸氯普鲁卡因较2%盐酸利多卡因满意率高。结论在硬膜外麻醉行剖宫产手术中,盐酸氯普鲁卡因临床效果优于2%利多卡因。     

氯普鲁卡因联合罗哌卡因硬膜外阻滞用于剖宫产术中的临床观察

目的氯普鲁卡因联合罗哌卡因硬膜外阻滞用于剖宫产术中的效果观察。方法RR组注入2.5%氯普鲁卡因混合0.5%罗哌卡因混合液4mL,R组注入3%氯普鲁卡因4mL,观察5min,无不良反应后再分次注入同种局麻药12mL。结果两组麻醉越效时间、痛觉消失时间、运动阻滞最大程度比较差异无统计意义。结论本麻醉方法能更好地抑制术中牵拉痛,提高麻醉效果。     

盐酸氯普鲁卡因注射液静脉复合全身麻醉40例临床观察

为观察盐酸氯普鲁卡因注射液静脉复合全身麻醉的临床效果,我们将40例患者随机分为A组(盐酸氯普鲁卡因组20例),B组(盐酸普鲁卡因组20例)。观察到两组麻醉效果相似,术中及术后均无不良反应。而盐酸氯普鲁卡因组苏醒时间明显短于盐酸普鲁卡因组,故认为盐酸氯普鲁卡因用于静脉复合全身麻醉,麻醉平稳,苏醒快。     

1.5%氯普鲁卡因用于小儿骶管阻滞的效果探讨

目的 观察1.5%氯普鲁卡因用于小儿骶管阻滞麻醉的临床效果.方法 66例需行下肢或会阴部位手术的患儿,根据骶管阻滞方法不同随机分为2组：氯普鲁卡因组和利多卡因组,每组33例.观察并记录患儿的生命体征、骶管阻滞起效时间、感觉阻滞平面上界及阻滞持续时间等.结果 氯普鲁卡因组起效时间短于利多卡因组,差异有统计学意义（P〈0.05）.2组麻醉平面固定时间和维持时间比较差异无统计学意义 （P〉0.05）.用药后HR、BP、RR和SpO2变化,2组比较差异无统计学意义（P〉0.05）.结论 1.5%氯普鲁卡因用于小儿术中骶管阻滞,能保持呼吸与循环功能基本稳定,起效快、安全、麻醉效果好,无明显不良反应.     

剖宫产手术的氯普鲁卡因硬膜外麻醉效果

国产氯普鲁卡因的临床应用日渐增多。笔者为观察氯普鲁卡因用于剖宫产手术硬膜外阻滞的麻醉效果，并与盐酸利多卡因进行了比较。     

氯普鲁卡因硬膜外麻醉效果的临床观察

目的：观察盐酸氯普鲁卡因用于腰段硬膜外麻醉的临床效果。方法：将60例拟行下腹部、下肢择期手术患者,随机分为氯普鲁卡因组和利多卡因组,每组各30例。行硬膜外（L2～3）穿刺置管,分别推注3%氯普鲁卡因5ml或2%利多卡因5ml。5min后,如无全脊麻反应,分别追加局麻药10ml。观察麻醉起效时间、痛觉消失时间、持续时间和心率、呼吸、血压、SpO2以及中枢神经系统反应。结果：试验组麻醉起效时间、痛觉消失时间均快于对照组（P均〈0.05）,麻醉持续时间相似（P〉0.05）,两组呼吸、循环变化一致,均未出现明显不良反应。结论：氯普鲁卡因用于硬膜外麻醉起效较利多卡因快,痛觉完全消失快,在持续时间上两者无明显差异,可安全用于临床。     

盐酸氯普鲁卡因用于剖宫产硬膜外麻醉的临床价值分析

目的探究盐酸氯普鲁卡因用于剖宫产硬膜外麻醉的临床价值。方法抽取我院于2015年1月至2016年2月期间收治的70例行剖宫产的孕妇,将其纳入此研究中,根据麻醉药物的差异性划分为观察组和对照组,分别采用盐酸氯普鲁卡因和利多卡因,分析其临床价值。结果观察组和对照组产妇麻醉后,SBP、DBP、HR、麻醉起效用时、痛觉消失用时、痛觉恢复用时以及运动恢复用时数据之间经对比统计学意义产生,P<0.05。结论盐酸氯普鲁卡因在剖宫产硬膜外麻醉中具有显著的起效效果,对产妇手术后的功能恢复具有促进作用。     

氯普鲁卡因硬膜外麻醉用于经尿道前列腺汽化电切术的观察

<正>盐酸氯普鲁卡因是一种新型的酯类短效局麻药,因其麻醉效果好,可控性好,已广泛用于硬膜外麻醉行产科或下腹部手术的麻醉。笔者将2%盐酸氯普鲁卡因应用于经尿道前列腺汽化电切术的硬膜外麻醉,以评价其临床效果和安全性,现报道如下。     

盐酸氯普鲁卡因硬膜外麻醉用于下腹部手术40例观察

下腹部手术普遍采用硬膜外麻醉。盐酸氯普鲁卡因为盐酸普鲁卡因的氯化类局部麻醉药,其在体内的代谢、麻醉效能与盐酸普鲁卡因相似,由于其起效快、毒性小,较高浓度时痛觉神经与运动神经阻滞完全,可应用于硬膜外麻醉。本文分析国产盐酸氯普鲁卡因硬膜外麻醉的效果,并与盐酸利多卡因进行比较。     

氯普鲁卡因在阴部神经阻滞和会阴浸润麻醉中的应用

目的 :评价国产氯普鲁卡因在阴部神经阻滞和会阴浸润麻醉中的临床效应。方法 :足月产妇80人 ,随机分为试验组和对照组 ,每组 4 0例。均行会阴侧切术 ,分别采用氯普鲁卡因注射液和普鲁卡因注射液行阴部神经阻滞麻醉 (10mL)和会阴皮下浸润麻醉 (10mL)。观察麻醉起效时间、痛觉消失和持续时间以及麻醉前 10min、麻醉后 30 ,6 0min的HR ,BP和ECG。并随时记录与药物相关的不良反应。结果 :试验组麻醉起效时间、痛觉消失时间和持续时间分别为 (1.1±s 0 .4 ) ,(2 .3± 0 .8) ,(4 8±16 )min ;对照组为 (1.4± 0 .7) ,(2 .9± 1.4 ) ,(36±13)min ,P <0 .0 5或P <0 .0 1。 2组HR ,BP与注射局麻药前相比无显著差异 ,2组间比较也无显著差异 ,P >0 .0 5。 2组均未出现局麻药毒性反应和过敏反应。结论 :国产氯普鲁卡因是产科病人局部浸润麻醉的合适选择之一。     

盐酸氯普鲁卡因用于经尿道前列腺电切术后硬膜外镇痛的临床研究

目的观察国产盐酸氯普鲁卡因用于老年人经尿道前列腺电切术后硬膜外镇痛的临床效果。方法选择60-75岁行经尿道前列腺电切术患者80例,随机双盲分为A、B、C、D 4组（n=20）。术中均行L3-4 3%盐酸氯普鲁卡因硬膜外麻醉,术后予硬膜外持续镇痛,剂量分别为A组生理盐水100 mL,B、C、D 3组分别予1%,1.2%和1.5%盐酸氯普鲁卡因各100 mL,持续镇痛3 d,连续监测患者视觉模糊评分（VAS评分）、改良Bromage评分、膀胱痉挛次数、患者镇痛满意程度、呼吸循环变化和中枢神经系统反应等。结果A组VAS评分及膀胱痉挛次数于安返病房6 h后均较B、C、D 3组明显为高,具有统计学差异（P〈0.01）;B组VAS评分及膀胱痉挛次数均较C、D 2组为高,但无统计学差异;C、D 2组VAS评分无差异,但D组膀胱痉挛次数略低于C组。4组术后6 h Bromage评分均为0级。A组有11位患者对镇痛满意度低,表示不能耐受;B组除有3位患者满意度稍低外,其余表示满意;C、D 2组患者均对镇痛效果满意,除D组有2例患者诉恶心、腹胀外,其余均无呼吸循环变化、中枢神经系统反应和其他不良反应。结论盐酸氯普鲁卡因用于老年人经尿道前列腺电切术后硬膜外镇痛,1.2%即可满足患者镇痛需要,降低膀胱痉挛次数,又无不良反应的发生,其术后镇痛效果令人满意。     

3%氯普鲁卡因用于低位硬膜外麻醉的临床观察

目的比较3%氯普鲁卡因和2%利多卡因低位硬膜外麻醉的临床效果。方法 40例行下腹部手术患者,随机分成2组,每组20例。对照组:2%利多卡因;试验组:3%氯普鲁卡因。行连续低位(L1～2)硬膜外麻醉。观察感觉阻滞起效时间、感觉阻滞平面上界、运动阻滞起效时间、运动阻滞程度及麻醉质量。结果试验组感觉阻滞起效时间明显快于对照组(P<0.05)。感觉阻滞平面上界2组差异无统计学意义(P>0.05)。运动阻滞起效时间试验组明显快于对照组(P<0.05),但2组Bromage评分在1分以上之和的差异无统计学意义(P>0.05)。对照组和试验组麻醉质量0加1分所占例数的百分比分别为80%和85%(P>0.05)。对照组和试验组患者收缩压在感觉阻滞平面达上界及运动阻滞起效时均明显降低(P<0.05),在整个手术过程中HR和DBP无明显改变(P>0.05)。2组患者术前、术后24h血生化指标差异无统计学意义(P>0.05)。结论 3%盐酸氯普鲁卡因用于低位硬膜外麻醉感觉、运动阻滞起效快于2%利多卡因,但两种局麻药整体麻醉效能相似。     

Benefit and risks of local anesthetics in infants and children

Regional anesthesia has become a routine part of the practice of anesthesiology in infants and children. Local anesthetic toxicity is extremely rare in infants and children; however, seizures, dysrhythmias, cardiovascular collapse, and transient neuropathic symptoms have been reported. Infants and children may be at increased risk from local anesthetics compared with adults. Larger volumes of local anesthetics are used for epidural anesthesia in infants and children than in adults. Metabolism and elimination of local anesthetics can be delayed in neonates, who also have decreased plasma concentrations of alpha(1)-acid glycoprotein, leading to increased concentrations of unbound bupivacaine. Most regional anesthetic procedures in infants and children are performed with the patient heavily sedated or anesthetized; because of this, and because a test dose is not a particularly sensitive marker of intravenous injection in the anesthetized patient, detection of intravascular local anesthetic injection is extremely difficult. The same local anesthetics used in adult anesthetic practice are also used in infants and children. Because of its extremely short duration of action, chloroprocaine has been used primarily for continuous epidural techniques in infants and children. The use of tetracaine has generally been limited to spinal and topical anesthesia. Lidocaine (lignocaine) has been used extensively in infants and children for topical, regional, plexus, epidural and spinal anesthesia. The association between prilocaine and methemoglobinemia has generally restricted prilocaine use in infants and children to the eutectic mixture of local anesthetics (EMLA). Because of its greater degree of motor block compared with other long-acting local anesthetics, etidocaine has generally been limited to plexus blocks in infants and children. Mepivacaine has been used for both plexus and epidural anesthesia in infants and children. Because postoperative analgesia is often the primary justification for regional anesthesia in infants and children, bupivacaine, a long-acting local anesthetic, is the most commonly reported local anesthetic for pediatric regional anesthesia. Given the lower toxic threshold of bupivacaine compared with other local anesthetics, the risk-benefit ratio of bupivacaine may be greater than that of other local anesthetics. Two new enantiomerically pure local anesthetics, ropivacaine and levobupivacaine, offer clinical profiles comparable to that of bupivacaine but without its lower toxic threshold. The extreme rarity of major toxicity from local anesthetics suggests that widespread replacement of bupivacaine with ropivacaine or levobupivacaine is probably not necessary. However, there are clinical situations, including prolonged local anesthetic infusions, use in neonates, impaired hepatic metabolic function, and anesthetic techniques requiring a large mass of local anesthetic, where replacement of bupivacaine with ropivacaine, levobupivacaine or (for continuous techniques) chloroprocaine appears prudent.     

An in vivo method for the quantitative evaluation of local anesthetics

We describe a mouse model for evaluation of skin anesthesia after infiltration of local anesthetic. The method involves subcutaneous injection of the anesthetic over the abdomen, and monitoring the vocalization response to electrical stimulus as a measure of analgesia. Prior to drug injection, the vocalization threshold was determined. Mice that vocalized at < or = 8 mA were included in the study. The model was tested using representative agents of the two classes of local anesthetics, bupivacaine, an amide, and chloroprocaine, an ester. The time course and dose response were assessed after injection. The median analgesic time was 15, 40, and 55 min for 0.015%, 0.0625%, and 0.25% bupivacaine and 30, 50, and 55 min for 0.125%, 0.25%, and 2.0% chloroprocaine, respectively. Statistical analysis of the data showed that this method is sufficiently sensitive to detect differences between the dose and duration of local anesthesia (p<0.05, by log rank test of the survival curves). To further validate the model, we compared the duration of anesthesia between the 0.5% bupivacaine and a new long-acting liposomal formulation of 2% bupivacaine. The results showed that the new formulation significantly prolonged the duration of anesthesia (p<0.05). This simple and reliable method may facilitate research on the pharmacology of infiltration anesthesia and the development of new local anesthetics and/or formulations.     

The importance of myorelaxants in anesthesia

Neuromuscular blocking drugs were introduced into clinical practice in 1942. Although these drugs made new surgical techniques possible, they also led to morbidity and mortality owing to respiratory muscle paralysis and paralysis in the face of inadequate anesthesia. Newer competitive antagonists at the neuromuscular junction have been developed that have a more rapid onset of action, including rocuronium and mivacurium, making them suitable for use at the onset of anesthesia. Rapid titratable offset of action has been more difficult to achieve, but has been attempted with the inclusion of ester bonds (mivacurium) and binding agents that are in clinical trials. These novel approaches to pharmaceuticals, along with improved understanding of the physiology of the neuromuscular junction in health and disease, have made surgical treatment possible in a wide breadth of clinical situations.     

A critical review of the topical local anesthetic amethocaine (Ametop) for pediatric pain

A topical formulation of the ester-type local anesthetic amethocaine (tetracaine) [Ametop ] is currently available for reducing pain from cutaneous procedures such as venipuncture. The Ametop mark preparation contains 40 mg of amethocaine base (4% w/w) and produces anesthesia within 30-45 minutes of application; duration of action ranges from 4 to 6 hours. Clinical studies have demonstrated the superiority of the 4% amethocaine preparation over placebo in pediatric populations for indications such as intravenous cannulation, vaccination, and venipuncture. Amethocaine has been shown to produce anesthesia comparable to that of 5% lidocaine-prilocaine for procedures such as venipuncture and accessing centrally placed devices; in general, anesthesia was achieved more rapidly with amethocaine than lidocaine-prilocaine. In the neonatal population amethocaine was found to be ineffective at reducing the pain of heel prick and peripherally inserted central catheters. Depending on the type of procedure, amethocaine application times between 30 and 60 minutes have produced clinically acceptable anesthesia; application times <30 minutes have not been associated with reliable anesthesia. The 4% amethocaine preparation is well tolerated; the most commonly reported local skin reaction is transient local erythema while local edema and itching have been reported more rarely. There have been no accounts of systemic toxicity with topical use of the preparation. Several cases of sensitization have been described in adults upon repeated exposure to topical amethocaine. In summary, the novel preparation of 4% amethocaine gel has been shown to be clinically effective for managing pain associated with minor cutaneous procedures while maintaining a good tolerability profile. Amethocaine has also demonstrated similar efficacy to lidocaine-prilocaine when appropriate application times are used; the more rapid onset of action and extended duration of action of amethocaine may make it more useful than lidocaine-prilocaine in busy clinical settings.     

Clinical uses of fentanyl, sufentanil, and alfentanil.

The pharmacokinetics, pharmacodynamics, and clinical uses of fentanyl, sufentanil, and alfentanil are reviewed. The fentanyl derivatives have reduced or eliminated many of the disadvantages of opioid anesthetics, such as incomplete amnesia and undesirable hemodynamic responses to surgery. Fentanyl is 50-100 times as potent as morphine and was the first of the three to be marketed. Sufentanil is even more potent than fentanyl. Alfentanil has the fastest onset of action, followed by sufentanil and then fentanyl. Alfentanil also has the shortest duration of action of the group. Most studies of these agents have been done to assess their role as anesthetics in cardiac surgery. All three provide cardiovascular stability when administered before noxious surgical stimuli, except when given as a single bolus during the induction of anesthesia. All seem to produce adequate anesthesia, particularly when used in combination with nitrous oxide. Because of its short duration of action, alfentanil is preferred for brief procedures or when rapid changes in the level of consciousness are desired. All three agents have also been used for analgesia; epidural administration provides adequate relief of pain. Fentanyl has been formulated as a transdermal patch that seems to provide the same degree of analgesia as a continuous i.v. infusion. Fentanyl has also been formulated as an investigational lozenge that has shown advantages as a preoperative sedative in children. As more is learned about these agents, their perioperative uses for anesthesia, analgesia, and sedation will continue to be refined.     

Remimazolam, a short-acting GABA(A) receptor agonist for intravenous sedation and/or anesthesia in day-case surgical and non-surgical procedures

Remimazolam (CNS-7056) is a short-acting GABA(A) receptor agonist, under development by PAION, in collaboration with Japanese licensee Ono Pharmaceutical, as an intravenous sedative agent for potential use in day-case procedures, and the induction and maintenance of anesthesia. A member of the benzodiazapene class of drugs, the structure of remimazolam was modified to produce a drug that displays organ-independent metabolism. The incorporation of a carboxylic ester moiety into the benzodiazapene core of remimazolam renders it susceptible to non-specific tissue esterases and it is rapidly metabolized into its pharmacologically inactive metabolite CNS-7054. Preclinical studies in sheep demonstrated that remimazolam produced a more rapid onset of action, and a shorter duration of action, compared with midazolam. In a phase IIa clinical trial evaluating remimazolam as a procedural sedative for upper gastrointestinal endoscopy in patients, the time to recovery from sedation was shorter and more consistent with remimazolam, relative to midazolam. Because of its organ-independent metabolism and rapid and predictable onset and recovery, remimazolam appears to have potential advantages over other currently available short-acting sedatives.