瑞芬太尼复合七氟烷用于老年股骨颈骨折全髋关节置换术患者的效果

目的 评价瑞芬太尼复合七氟烷用于老年股骨颈骨折(FNF)全髋关节置换术(THA)患者的效果。方法 择期拟行THA术的老年FNF患者85例,年龄60～77岁,性别不限,ASA分级Ⅰ～Ⅲ级。采用随机数字表法分为瑞芬太尼组(R组,43例)和瑞芬太尼复合七氟烷组(R+S组,42例)。比较2组患者麻醉前(T₀)、手术开始45 min(T₁)、术毕30 min(T₂)的心率(HR)、收缩压(SBP)、舒张压(DBP)、氧饱和度(SpO₂)。统计2组患者的意识消失时间、苏醒时间、拔管时间,以及术后不良反应。结果 2组患者T₁、T₂时的HR、DBP、SBP、SpO₂均低于T₀时,但R+S组患者的HR、DBP、SBP、SpO₂均高于S组,差异均有统计学意义(P<0.05)。R+S组患者的意识消失时间、清醒时间,以及拔管时间均短于R组,差异有统计学意义(P<0.05)。2组不良反应总发生率差异无统计...     

右美托咪定联合罗哌卡因硬膜外麻醉用于良性前列腺增生手术的效果

目的 评价右美托咪定联合罗哌卡因硬膜外麻醉用于良性前列腺增生(BPH)手术的效果。方法 择期硬膜外麻醉下行经尿道前列腺电切术(TURP)的BPH患者94例,ASA分级Ⅱ～Ⅲ级。采用随机数字表法分为罗哌卡因组(R组)和右美托咪定+罗哌卡因组(D+R组),各47例。比较给药前5 min(T₀)、手术开始前5 min(T₁)、手术开始10 min(T₂)2组患者的心率(HR)、舒张压(DBP)、收缩压(SBP)血流动力学指标;采用视觉模拟评分法(VAS)评估2组患者术后6 h、12 h、24 h的疼痛程度;统计不良反应发生率。结果 T₀时2组患者的HR、DBP、SBP差异无统计学意义(P>0.05)。2组患者T₁时的HR、DBP、SBP均较T₀时下降,但D+R组下降的幅度小于R组,差异均有统计学意义(P<0.05)。2组患者T₂时的HR、DBP、SBP均较T₁时升高,但D+R组升高的幅度小于R组,差异有统计...     

舒芬太尼联合瑞芬太尼麻醉诱导用于内镜黏膜下剥离术的效果

目的 评价舒芬太尼联合瑞芬太尼麻醉诱导用于内镜黏膜下剥离术(ESD)的效果。方法 择期行ESD术的患者70例,按随机数字表法分为舒芬太尼麻醉诱导组(S组)和舒芬太尼联合瑞芬太尼麻醉诱导组(S+R组),各35例。比较2组患者麻醉诱导前(T₀)、气管插管前(T₁)、气管插管后1 min(T₂)、拔管时(T₃)的平均动脉压(MAP)、心率(HR),以及术后拔管时间、苏醒时间、恢复室留观时间。结果 T₀时2组患者的MAP、HR水平差异无统计学意义(P>0.05)。T₁、T₂、T₃时,S+R组患者的HR水平低于S组,T₁、T₃时的MAP水平较高于S组,T₂时的MAP水平低于S组。差异均有统计学意义(P<0.05)。S+R组患者的拔管时间、苏醒时间,以及恢复室留观时间均较短于S组,差异有统计学意义(P<0.05)。结论 与舒芬太尼比较,采用舒...     

喉罩麻醉中靶控输注异丙酚复合瑞芬太尼效果观察

目的观察靶控输注异丙酚复合瑞芬太尼实施喉罩麻醉的效果。方法随机将86例接受喉罩麻醉的患者分为2组,各43例。对照组给予异丙酚靶控输注。观察组应用异丙酚复合瑞芬太尼靶控输注。比较2组患者(1)麻醉前(T_0)、喉罩置入前(T_1)、喉罩置入后1 min(T_2)、停药时(T_3)的SBP、DBP、HR。(2)术中不良反应例数、患者苏醒时间及异丙酚用量。结果 T_0、T_3时2组SBP、DBP及HR差异无统计学意义(P0.05)。T_1、T_2时点观察组SBP、DBP及HR的波动幅度优于对照组,术中不良反应、苏醒时间及异丙酚的用量少于对照组,差异均有统计学意义(P0.05)。结论与单纯应用异丙酚比较,靶控输注异丙酚复合瑞芬太尼实施喉罩麻醉,对患者血液动力学影响较小,不良反应发生率低,苏醒快及异丙酚的用量少,效果满意。     

不同麻醉方式对老年妇科腹腔镜手术患者麻醉效果及术后认知功能的影响

目的 评价不同麻醉方式对老年妇科腹腔镜手术患者麻醉效果及术后认知功能的影响。方法 选取西平县妇幼保健院2019-03—2021-06行妇科腹腔镜手术的老年患者,年龄≥60岁,ASA分级I～Ⅱ级。根据麻醉方式分为静吸复合组和静脉麻醉组。比较2组麻醉效果及患者术后的认知功能。结果 2组患者的基线资料及诱导前(T₀)、拔管时(T₃)时的SBP、 DBP、HR差异均无统计学意义(P>0.05)。插管时(T₁)、建立人工气腹后5 min(T₂)时2组患者的SBP、 DBP、HR较T₀、T₃时均有所降低,差异有统计学意义(P<0.05);但2组间差异无统计学意义(P>0.05)。2组麻醉效果起效时间差异无统计学意义(P>0.05)。静吸复合组患者术后苏醒时间、拔管时间均短于静脉麻醉组,术后24 h和72 h时的简易精神状态检查量表(MMSE)评分和认知功能障碍(POCD)发生率均低于静脉麻醉组,差异均有统计学意义(P<0.05)。2组患者...     

喉罩通气全身麻醉在腹腔镜小儿腹股沟斜疝手术中的应用效果

目的探讨喉罩通气全身麻醉在腹腔镜小儿腹股沟斜疝手术中的应用效果。方法选取行腹腔镜手术治疗84例腹股沟斜疝患儿,根据麻醉方式分为2组,各42例。对照组行气管插管全麻;观察组行喉罩通气全麻。对比2组麻醉诱导前(T_0)、喉罩通气/插入气管通气即刻(T_1)、拔管后即刻(T_2)的心率(HR)、收缩压(SBP)、舒张压(DBP)变化情况。统计2组拔管时间、复苏时间及并发症发生率。结果 2组T_0时段HR、SBP、DBP水平比较差异均无统计学意义(P0.05),T_1、T_2时段观察组HR、SBP、DBP水平优于对照组,且观察组拔管时间、复苏时间均少于对照组,并发症发生率低于对照组,差异均有统计学意义(P0.05)。结论喉罩通气全身麻醉用于腹腔镜小儿腹股沟斜疝手术,对患儿循环系统影响小,术后苏醒时间短,安全性高。     

瑞芬太尼复合小剂量咪达唑仑用于ERCP监护性麻醉的研究

目的观察瑞芬太尼复合小剂量咪达唑仑用于内镜逆行胰胆管造影术（ERCP）监护性麻醉的效果和安全性。方法选择66例ASAⅠ～Ⅲ级、年龄35～79岁拟在监护性麻醉下行ERCP的患者,随机均分为单纯瑞芬太尼组（R组）和瑞芬太尼复合小剂量咪达唑仑组（RM组）。R组首先持续输注瑞芬太尼0.2μg·kg^-1·min^-15min,随后减为0.15μg·kg^-1·min^-1,RM组在手术开始前静注咪达唑仑0.02mg/kg,其余用药同R组。观察两组患者麻醉前（T₀）、手术开始时（T₁）、手术开始后 min（T₂）、10min（T₃）和术毕（T₄）时MAP、HR、RR、SpO₂、脑电双频指数（BIS）以及术后改良Aldrete镇静评分、操作者对麻醉效果的满意度评分和不良反应发生情况,并记录手术操作时间和麻醉时间。结果与T₀时比较,T₁、T₂时R组MAP均明显升高（P<0.05）;T₂～T₄时两组HR均明显加快,T₁时R组HR明显快于T₀时和RM组。T₁～T₄时两组BIS均明显低于T₀时,且T₁～T₃时RM组BIS明显低于R组（P<0.05）。术后RM组遗忘评分明显高于R组（P<0.05）。R组手术操作者满意度评分明显高于RM组（P<0.05）;术毕时R组的改良Aldrete评分明显高于RM组（P<0.05）。结论瑞芬太尼0.2 μg·kg^-1·min^-1用于ERCP实施监护性麻醉可获得满意的麻醉效果,且安全性佳。     

亚麻醉剂量艾司氯胺酮复合丙泊酚-瑞芬太尼在老年患者纤维支气管镜检查术中的应用

目的 探讨亚麻醉剂量艾司氯胺酮复合丙泊酚-瑞芬太尼在老年患者纤维支气管镜检查术中的应用效果。方法 选择择期行纤维支气管镜检查术老年患者114例,年龄65～80岁,BMI 18～25 kg/m²,ASAⅡ或Ⅲ级。采用随机数字表法将患者分为两组：艾司氯胺酮组(E组)和对照组(C组),每组57例。麻醉诱导前E组静脉注射艾司氯胺酮0.2 mg/kg, C组给予等容量生理盐水,两组均在Marsh模式下靶控输注(TCI)丙泊酚效应室浓度3μg/ml, Minto模型TCI瑞芬太尼效应室浓度4 ng/ml,入镜后调整丙泊酚和瑞芬太尼效应室浓度分别为1.5～3μg/ml和2～4 ng/ml。记录入室后安静10 min(T₀)、睫毛反射消失时(T₁)、至声门时(T₂)、至隆突时(T₃)、术毕时(T₄)、拔除喉罩时(T₅)的HR、MAP、SpO₂和Narcotrend指数(NI)。记录术中丙泊酚和瑞芬太尼用量。记录呛咳、支气管痉挛、...     

右美托咪定和瑞芬太尼持续静脉输注在纤维支气管镜清醒插管中的应用

目的比较右美托咪定和瑞芬太尼在纤维支气管镜（FOB）清醒插管中应用的效果。方法选择困难气道FOB清醒插管患者60例,ASAⅠ或Ⅱ级,年龄18～59岁,体重46～80 kg,随机均分为右美托咪定组（D组）和瑞芬太尼组（R组）。气管内表面麻醉后,D组给予右美托咪定1μg/kg后以0.5μg·kg^-1·h^-1持续静脉输注;R组给予瑞芬太尼1μg/kg后以0.1μg·kg^-1·min^-1持续静脉输注。记录入室后（基础值,T₀）、插管前即刻（T₁）、气管导管进入声门即刻（T₂）、插管后2min（T₃）、5 min（T₄）、10 min（T₅）时的HR、SBP、DBP,并于各时点采静脉血检测肾上腺素（E）、去甲肾上腺素（NE）浓度。结果与T₀时比较,T₂～T₄时两组SBP、DBP明显增高,HR明显增快,且R组显著高于、快于D组（P<0.05）;T₃～T₅时,两组NE均明显升高,且R组明显高于D组,R组E明显升高,且高于D组（P<0.05）。结论气管表面麻醉后持续静注右美托咪定较瑞芬太尼能更好地完成困难气道FOB清醒气管插管,血流动力学变化更小,不良反应少。     

“新肾合剂”对冠状动脉旁路移植术患者丙泊酚麻醉诱导期血流动力学的影响

目的观察去氧肾上腺素和肾上腺素混合液（新肾合剂,每毫升含去氧肾上腺素80μg、肾上腺素2μg）对冠状动脉旁路移植术（CABG）患者丙泊酚麻醉诱导期血流动力学的影响。方法择期行CABG的冠心病患者24例,随机均分为"新肾合剂"组（PE组）和去氧肾上腺素组（P组）。麻醉诱导过程中在开始输注丙泊酚的同时PE组和P组分别给予"新肾合剂"和去氧肾上腺素（100μg/ml）1 ml。记录麻醉诱导前（T₀）、诱导后1 min（T₁）、2 min（T₂）、3 min（T₃）、插管前（T₄）、插管后即刻（T₅）、插管后2 min（T₆）、5 min（T₇）、10 min（T₈）时的HR、SBP、DBP、心脏指数（CI）、每搏量指数（SVI）和HR、BP的乘积（RPP）。结果 T₀～T₈时两组HR、SBP、DBP和RPP差异均无统计学意义。T₄、T₅时P组CI、SVI显著低于T₀时和PE组（P<0.05）。结论 "新肾合剂"在CABG丙泊酚诱导过程中能更好地维持冠心病患者心脏收缩功能。     

联合椎管内麻醉时硬膜外注药升高阻滞平面的机制研究

探讨联合椎管内麻醉时硬膜外注药升高阻滞平面的机制。方法：３０例下肢矫形手术患者均采用蛛网膜下隙与硬膜外联合穿刺针行Ｌ２－３穿刺,蛛网膜下隙注入等比重的０．７５％布比卡因１．５ｍｌ后硬膜外置管。患者随机分成三组,每组１０例：硬膜外不给药（Ａ组）,蛛网膜下腔注射药后１５、２０、２５分钟经硬膜外导管给予２％利多卡因各３ｍｌ（Ｂ组）或生理盐水各３ｍｌ（Ｃ组）。结果     

Regional versus general anesthesia in high-risk surgical patients: The need for a clinical trial

Regional anesthesia is often preferred over general anesthesia for patients with cardiovascular disease because of presumed decreased risk of perioperative myocardial ischemia. However, few studies have addressed this issue directly. To determine whether the type of anesthesia is independently associated with myocardial ischemia, records of 134 patients undergoing peripheral vascular grafting under general or regional anesthesia were examined. There were no significant differences preoperatively between groups in ASA class, age, sex, or prevalence of angina, diabetes, or hypertension. Twelve patients developed myocardial ischemia or infarction within 7 days of operation; 11 of these 12 patients had received regional anesthesia (p < 0.015). The association between anesthetic approach and perioperative myocardial ischemia or infarction remained after adjustment for preoperative factors associated with ischemia or with type of anesthesia. General anesthesia does not appear to be associated with increased risk of myocardial ischemia, and stringent recommendations to avoid it in this population may be unfounded. A clinical trial is needed to define more clearly the risks and benefits of different types of anesthesia in high-risk patients.     

Finland's first anaesthesia revealed by newspapers

Background: According to the literature on the history of anaesthesia, Finland's first anaesthesia was given on March 8, 1847 for a ligature of an aneurysm of the subclavian artery. It has, however, not been possible to verify the date with certainty. We therefore wanted to find out whether newspapers might give additional information and how this exceptionally important medical invention had been received by the Finnish newspapers.
Methods: Microfilms of the 10 newspapers which appeared in Finland in 1847 were studied at the Helsinki University library.
Results: The first report which made reference to English newspapers was published on February 10 by "Borgå Tidning". On March 6, "Helsingfors Tidningar" wrote that two anaesthesias had already been given in Helsinki; the first of them for a difficult varicose veins operation and the second for an exarticulation of a shoulder. But there was no information regarding the dates of the operations. Fortunately, both operations had been recorded in the patient diary of the clinic, although without any information about the anaesthesia. According to the diary, Johan August Örn was operated for varicose veins on February 16 and Anders Gustaf Henrikson had his right arm exarticulated on March 3. Both patients recovered. In total, only six pieces of news on anaesthesia were found.
Conclusions: Finland's first anaesthesia was given on February 16, 1847, which is three weeks earlier than had been previously assumed.     

不同麻醉方式对血液流变学的影响

麻醉对外科手术患者术中及术后早期血液流变学产生一定的影响,这可能与围手术期血栓形成等因素有一定的关联.而不同麻醉方式对血液流变学的影响不同,现就此进行综述,为临床麻醉方式的选择提供一定的参考.     

Musculoskeletal Sonopathology and Ultrasound-Guided Regional Anesthesia

The use of real-time ultrasound guidance has revolutionized the practice of regional anesthesia. Ultrasound is rapidly becoming the technique of choice for nerve blockade due to increased success rates, faster onset, and potentially improved safety. In the course of ultrasound-guided regional anesthesia, unexpected pathology may be encountered. Such anomalous or pathological findings may alter the choice of nerve block and occasionally affect surgical management. This case series presents a variety of musculoskeletal conditions that may be encountered during ultrasound-guided regional anesthesia practice.     

Comparison of Acceptance,Preference, and Efficacy Between Jet Injection INJEX and Local Infiltration Anesthesia in 6 to 11 Year Old Dental Patients

Needleless devices have been developed to provide anesthesia without injections. Little controlled research has examined the acceptability of needleless devices in pediatric patients. The aims of the study were to compare children’s acceptance and preference for one type of needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia. Eighty-seven nonfearful children with no previous experience of dental anesthesia were studied using a split-mouth design. The first dental procedure was performed with the classical infiltration anesthesia. The same amount of anesthetic was administered using the INJEX needleless device in a second session 1 week later, during which a second dental procedure was performed. Patients rated their acceptance and preference for the 2 methods, and the dentist recorded data about the need for additional anesthesia. More negative experiences were reported for the INJEX method. Most (73.6%) of the children preferred the traditional method. Among the 87 treatment procedures attempted following the use of INJEX, 80.5% required additional anesthesia, compared with 2.3% of those attempted following traditional infiltration. Traditional infiltration was more effective, acceptable, and preferred, compared with the needleless INJEX.     

Comparação entre anestesia intravenosa e inalatória na náusea e vômito pós‐operatórios em laparotomia: estudo clínico randomizado

BackgroundPostoperative Nausea and Vomiting (PONV) is a multifactorial surgical complication with an unclear underlying cause. Anesthetic methods, patients’ characteristics and the type of surgery are considered as factors affecting PONV. This study was designed to compare the effect of inhalational and intravenous anesthesia in abdominal surgery on the incidence and severity of PONV.MethodsA single‐blinded prospective randomized clinical trial on 105 patients aged 18 − 65 years was carried out. Patients were divided in two groups of Total Intravenous Anesthesia (TIVA) and Inhalational anesthesia. The incidence and severity of PONV were examined at 0, 2, 6, 12, and 24 hours after the surgery. The use of a rescue antiemetic was also evaluated.ResultsFifty point nine percent of the patients in the inhalation group and 17.3% of the patients in the intravenous group developed PONV (p < 0.001). The incidence of vomiting was reported in 11.3% of the Inhalational group and 3.8% of the TIVA group (p = 0.15), and 24.5% of patients in the Inhalation group and 9.6% of patients in the intravenous group needed an antiemetic medication (p = 0.043).ConclusionThe incidence of postoperative nausea and vomiting and the need for administration of an antiemetic rescue drug, and the severity of nausea in patients were significantly lower in the TIVA group.     

Semi-automated,slow subcutaneous infusion anesthesia (SIA) with diluted mixtures of prilocaine and ropivacaine

In recent years it has been found that local anesthesia, which often suffices for surgery of the skin and superficial structures, can be adequately administered using large amounts of highly diluted anesthetic solutions combined with epinephrine. This has considerably increased application of local anesthesia in plastic surgery. Using one or more conventional infusion pumps for slow subcutaneous infusion anesthesia (SIA), we injected mixed anesthetic solutions painlessly and automatically into the subcutaneous layer. The local anesthetics used were equivalent mixtures of prilocaine and ropivacaine (Xylonest and Naropin); these were diluted with original Ringers solution containing epinephrine (1:1,000,000) in 500-ml bottles. The concentrations of the mixtures varied between 0.3% and 0.06% depending on the requirements of surgery. Routinely available 18- to 30-gauge needles were used. The speed of injection varied between 30 ml and 1500 ml per hour depending on the location, the requirements of surgery, and the needle size. Volumes usually ranged from 2 ml to 1000 ml depending on the concentrations. The maximum dose was approximately 4 mg of prilocaine and 2 mg/kg of ropivacaine, which is the maximum tolerated dose. Regardless of secondary disorders, all patients scheduled for skin and lymph node operations under local anesthesia underwent surgery using this kind of anesthesia, including those for the nose and ear region. No suprarenin was added for nerve blocks of the fingers and penis. This technique was used in 20,310 major and minor skin operations in 11,810 patients ranging in age from 0.5 years (510 children under 14 years) to 95 years (mean age 55 years; 49% females, 51% males), including all types of local flaps and grafts. There were no complications whatsoever from local anesthesia. The technique proved safe and comfortable even for children and very sensitive patients. The median duration of postoperative anesthesia was 4.3 h (maximum 23 h). We found that experience is required for correct selection of the needle position, the flow rate, and the volume.