Comparison of remifentanil with fentanyl for deep sedation in oral surgery.

PURPOSE: The aim of this study was to compare recovery for oral surgery patients given a deep sedation regimen of midazolam, propofol, and remifentanil with a standard control of fentanyl in place of remifentanil. MATERIALS AND METHODS: This investigation was designed as a randomized, prospective, single-blinded controlled study. Group 1, the control, received midazolam 0.03 mg/kg, fentanyl 1 microg/kg, and propofol initially at 140 microg/kg/min. Group 2 received midazolam 0.03 mg/kg, remifentanil: propofol (1:500) given at an initial propofol infusion rate of 40 microg/kg/min. Outcome measures included time to response to verbal command, Aldrete score = 9, Postanesthesia Discharge Scoring System = 7, and assessment by the Digit Symbol Substitution Test. RESULTS: Forty-seven subjects were entered in the study. Baseline findings were homogenous between the 2 groups. Subjects in group 2 recovered earlier (P < .005) and required less propofol for both the induction (0.8 +/- 0.4 versus 1.2 +/- 0.6 mg/kg; mean +/- SD, P < .01) and maintenance of deep sedation (46 +/- 9 versus 131 +/- 17 microg/kg/min; P < .005). There were minor differences in vital signs. CONCLUSIONS: This study demonstrated that this remifentanil regimen provided significantly more rapid recovery and used significantly less propofol compared with the fentanyl regimen.     

Complications of sevoflurane–fentanyl versus midazolam–fentanyl anesthesia in pediatric cleft lip and palate surgery: a randomized comparison study

Careful choice of anesthetic agents in pediatric patients reduces the frequency of anesthesia-related complications. The frequency and type of intraoperative and postoperative complications of sevoflurane–fentanyl versus midazolam–fentanyl anesthesia were compared in 140 consecutive children (aged 3 months to 10 years) undergoing cleft lip and palate repair. Midazolam–fentanyl anesthesia was induced with midazolam (0.05 mg/kg), fentanyl (0.005 mg/kg) and vecuronium (0.1 mg/kg), and maintained with the same agents according to the defined parametars. Sevoflurane–fentanyl anesthesia was induced and maintained with sevoflurane (5–8 vol% and 0.8–1 vol%, respectively) in an oxygen/air mixture and supplemented with fentanyl (0.005 mg/kg). Both groups were comparable in basic demographic data, hemodynamic and respiratory parameters. Difficult intubation occurred in 6 of 76 children (midazolam–fentanyl group) and 4 of 64 children (sevoflurane–fentanyl group) (P = 0.754). Ventricular extrasystole and bronchospasm occurred in one patient each in the sevoflurane–fentanyl group. Postoperatively, emergence agitation was observed in the sevoflurane–fentanyl group (17 cases; P < 0.001); postoperative nausea and vomiting occurred in 2 children (midazolam–fentanyl group) and 3 children (sevoflurane–fentanyl group) (P = 0.660). Midazolam-based anesthesia in children is safer than sevoflurane-based anesthesia regarding occurrence of emergence agitation.     

Duration of amnesia associated with midazolam/fentanyl intravenous sedation

The purpose of this study was to determine the duration of amnesia associated with the intravenous usage of midazolam and fentanyl. The midazolam was administered in three different dosages based on the patient's weight in kilograms. Patients were shown a series of pen-and-ink drawings at various times throughout the procedure and tested the next day for memory of the drawings using both free recall and match-to-sample paradigms. The results indicate that the low-dosage group (0.07 mg/kg) had insufficient amnesia, whereas the medium (0.10 mg/kg) and high (0.13 mg/kg) groups displayed adequate amnesia in the intraoperative period.     

Moderate intravenous sedation for office-based full face laser resurfacing using a continuous infusion propofol pump.

PURPOSE: The purpose of this study was to compare the anesthetic requirements and hemodynamic and oxygenation variables involved between the bolus midazolam/fentanyl intravenous sedation-analgesia technique, and the same technique combined with continuous-infusion propofol. PATIENTS AND METHODS: This was a retrospective chart analysis of 41 consecutive patients undergoing full-face carbon dioxide laser resurfacing with either bolus midazolam/fentanyl (n = 15) or midazolam/fentanyl with continuous propofol infusion anesthesia (n = 26) techniques. Data recorded were noninvasive baseline and intraoperative hemodynamic measurements at 5-minute intervals for systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), pulse pressure (PP), pulse (P), and rate-pressure product (RPP), respiratory rate (RR), and oxygen saturation (SpO2). Data collected were reported as mean values with standard deviation. Statistical analyses were performed with the Student's t test and found statistically significant for P < .05. RESULTS: Statistically significant decreases in averages were seen in SBP (P < .001), DBP (P = .02), MAP (P = .004), P (P < .00l), RPP (P < .00l), and RR (P < .001), but not PP (P = .4) and SpO2 (P = .08) in the midazolam/fentanyl/continuous propofol infusion group compared with the midazolam/fentanyl only group. Changes from baseline were statistically significant only for MAP (P = .04), but statistically insignificant for all other measurements, SBP (P = .7), DBP (P = .4), P (P = .95), PP (P = .97), RPP (P = .6), RR (P = .6), and SpO2 (P = .4). Statistically significant smaller amounts of midazolam (P = .01) and fentanyl (P < .001) were used in the midazolam/fentanyl/continuous propofol infusion pump group. Length of procedure was statistically insignificant between groups (P = .4). Conclusion The addition of a continuous propofol pump maintained hemodynamic and oxygenation values close to baseline, while decreasing the amount of respiratory depressing opiates administered and without affecting the length of the procedure.     

Monitored anesthesia care for dental implant surgery: analysis of effectiveness and complications

The optimal method of providing safe and effective sedation for outpatients undergoing lengthy dental operations is unclear. We provided monitored anesthesia care (conscious sedation) for 102 consecutive dental implant procedures, using intravenous midazolam and fentanyl as primary pharmacologic agents. Midazolam was administered by multiple, intermittent injection or via continuous infusion. The dose of midazolam required for the induction of sedation ranged from 3.4 +/- 1.6 mg to 4.0 +/- 2.0 mg. Maintenance of adequate sedation required a mean midazolam administration rate of 4.0 +/- 2.1 mg/h to 5.1 +/- 2.1 mg/h, and a mean fentanyl administration rate of 54 +/- 29 mcg/h to 60 +/- 27 mcg/h. Continuous monitoring allowed for rapid detection and treatment of 40 separate hemodynamic and respiratory problems. There was no evidence of patient injury, and all patients returned home on the day of surgery. A post-operative telephone survey revealed that 65% of patients had complete amnesia for operative events, 96% were satisfied with monitored anesthesia care, and 94% would desire a similar anesthetic technique for future procedures.     

咪唑安定、芬太尼、氨氟醚静吸复合全麻在腭裂整复术中的应用

目的：探讨咪唑安定,芬太尼,氨氟醚静吸复合全麻用于腭裂整复手术的效果。方法：１２８例腭裂患儿采用咪唑安定０．２－０．３ｍｇ．ｋｇ＾－１,芬太尼３－５μｇ．ｋｇ＾－１,司可林１－２ｍｇ．ｋｇ＾－１诱导插管,术中氨氟醚和芬太尼维持麻醉的方法,行腭裂整复术。     

Comparitive Evaluation of Propofol and Midazolam as Conscious Sedatives in Minor Oral Surgery

Objective

The objective of the study was to assess the efficacy of propofol and midazolam as an intravenous sedative agent in minor oral surgical procedures in terms of: (a) the onset of action, (b) heart rate, (c) oxygen saturation, (d) systolic and diastolic blood pressure, (e) respiratory rate, (f) pain during the injection of sedative agent, (g) recovery period, (h) side effects, (i) patient’s cooperation during the surgery.

Methodology

This was a double blind randomized study in which one group of 20 patients received propofol with the induction dose of 0.5 mg/kg and 50 μg/kg/min which was administered by syringe infusion pump as a maintenance dose and the other group received midazolam in a single dose of 75 μg/kg and no maintenance dose was given, instead 5 % dextrose was administered by syringe infusion pump at the rate of 50 μg/kg/min. Since propofol was milky white in colour, a green cloth was covered over the infusion pump in all cases. The surgeon, assistants and observers were blind about the medications which would be given to the patient for sedation. After the administration of the sedative, local anesthesia was achieved with 2 % lignocaine hydrochloride.

Results

The onset of action in propofol group was significant as onset of action was faster. The maximum increase in heart rate in propofol group was at 10 min intraoperatively (Mean ± 80.40 ± 12.73) and that in midazolam group was at 15 min intraoperatively (Mean 79.25 ± 13.44). Post operatively the heart rate decreased near to the baseline value in both the groups. The average oxygen saturation before induction in propofol group was 99.7 ± 0.73 % and that of midazolam group was 99.15 ± 01.31 P = 0.314. None of the patients in this study developed apnea. The systolic blood pressure (Mean ± SD) before induction in both the groups decreased from the baseline value after the administration of sedatives. The diastolic blood pressure (Mean ± SD) before induction in both the groups decreased from the baseline value after the administration of sedatives and the decreased diastolic blood pressure was maintained throughout the procedure. The respiratory rate (Mean ± SD) before induction in both the groups decreased from the baseline value after the administration of sedatives. The decreased respiratory rate remained throughout the surgical procedure. Pain during the injection of the sedatives was reported by nine patients (45 %) in the propofol group whereas none of the patients in midazolam group complained of pain during the injection. This is statistically significant (P = 0.001). The recovery time (Mean ± SD) in propofol group was 22.50 ± 3.04 (range 15–25 min) and that in midazolam group was 33.75 ± 3.93 (range 30–40 min), which was statistically significant (P < 0.001). Patients in the propofol group were significantly less co-operative than midazolam group at both 10 and 25 min intra operatively.

Conclusion

The design of the present study permitted qualitative assessment of propofol and midazolam as sedative agents in minor oral surgical procedures. The ideal anesthetic agent should provide rapid onset of action, profound intra operative amnesia while ensuring rapid recovery without much complications. There were no significant differences in either patient demographics or surgical characteristics between the two groups. The propofol group was less co-operative than midazolam group. Pain during the injection of sedative was a significant adverse effect in the propofol group. Cardiovascular parameters remained stable throughout the procedure in both study groups and no intervention was required. However recovery and onset of action was faster in the propofol group as compared with the midazolam group.     

咪唑安定与异丙酚用于颌面外科老年人麻醉

:目的　寻找一种适合于老年人颌面外科手术的麻醉诱导方法。方法　 6 0例颌面外科老年病人 ,随机分为三组 ,分别选用不同的麻醉诱导药物。 A组采用咪唑安定 0 .2 m g/ kg,B组用咪唑安定 0 .1mg/ kg和异丙酚 1.0 m g/ kg配伍 ,C组采用异丙酚 2 .0 mg/ kg。注药均在 1m in内完成。注药后 5 min,给予芬太尼 2 μg/ kg和维库溴铵 0 .5 m g/ kg,完成气管插管。观察比较三组病人的麻醉诱导效果和诱导插管期间循环和呼吸的变化。结果　 (1) B组麻醉诱导时间明显少于 A组 (P<0 .0 5 ) ,而与 C组相似 (P<0 .0 5 )。 (2 )与注药前比较 ,A组在插管即刻和插管后1m in平均动脉压 (MAP)和心率 (HR)明显上升 (P<0 .0 5 )。 C组在注药后 3m in MAP明显下降 ,在注药后 1min和3m in HR明显减慢 (P<0 .0 5 )。B组在诱导插管期间循环变化轻微 (P>0 .0 5 )。 (3) C组呼吸停顿 (呼吸暂停时间 >30 s)的发生率 6 0 % ,明显高于其它两组 (P<0 .0 5 )。三组注药后均有呼吸减慢 (呼吸次数 <10次 / m in) ,发生率为70 %～ 85 % ,面罩供氧下血氧饱和度 (Sp O2 )保持在 97%～ 10 0 %之间。结论　咪唑安定与异丙酚配伍使用是适合于老年人的麻醉诱导方法之一。     

Outcomes of moderate sedation in paediatric dental patients

Background: The aim of this study was to evaluate the outcomes of moderate sedation with nitrous oxide/oxygen (N₂O/O₂) alone or combined with different dosages and administration routes of midazolam in uncooperative paediatric dental patients using the Bispectral Index System (BIS). Methods: This one‐year clinical study examined first‐visit moderate sedation performed in 240 healthy children aged 4–6 years. Subjects were randomly divided into four groups according to drug, route and dosage, as follows: Group 1 – 0.20 mg/kg midazolam (40 mg/ml) delivered intranasally; Group 2 – 0.75 mg/kg midazolam (15 mg/3 ml) delivered orally; Group 3 – 0.50 mg/kg midazolam (15 mg/3 ml) delivered orally. All children in these three groups also received inhalation sedation with 50%–50% N₂O/O₂, whereas children in Group 4 received inhalation sedation with 50%–50% N₂O/O₂ only. The outcome of sedation was evaluated as either ‘successful’, ‘failed’ or ‘not accepted’. Results: The highest success rate was found in Group 1 (0.20 mg/kg intranasally, 87%), followed by Group 2 (0.75 mg/kg orally, 79%). The overall mean success rate for all groups was 73%. Conclusions: Moderate sedation can be successfully used in the clinical management of paediatric dental patients, with both intranasal and oral sedation using midazolam in conjunction with nitrous oxide found to be effective methods.     

Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy

We studied the effects of low-dose midazolam with propofol for patient control sedation (PCS) in 30 healthy (ASA grade I) patients who were randomly allocated into two equal groups (n = 15 in each). They were given a propofol infusion of 2mg/kg/h after a bolus dose of 0.7 mg/kg. The second group was given the 2mg/kg/h propofol infusion after a dose of midazolam 0.03 mg/kg and a bolus dose of propofol 0.7 mg/kg. The standard dose for PCS was propofol 0.2mg/kg in both groups. Clinical data were taken and haemodynamic variables, and oxygen saturation were recorded before and on the 5th, 10th, 20th, and 30th minutes during the operations. The level of sedation, amnesia and conditions of each patient were evaluated during the study. Patients' satisfaction was recorded using a modified visual analogue scale (VAS). All results were evaluated statistically. We conclude that low-dose midazolam with propofol during PCS neither reduced oxygen saturation nor prolonged the time of discharge. Low-dose midazolam with propofol also improved the acceptability and comfort for patients and made the operation easier, which makes it preferable to propofol alone.     

Comparison of a bolus of fentanyl with an infusion of alfentanil during target-controlled propofol infusion in third molar extraction under conscious sedation.

PURPOSE: This study was designed to compare hemodynamic changes, respiratory depression, and patient satisfaction between a bolus of fentanyl and an infusion of alfentanil during target-controlled propofol infusion in third molar extraction under conscious sedation. PATIENTS AND METHODS: Forty patients were randomly assigned to receive either a bolus of fentanyl (n = 24) or an infusion of alfentanil (n = 16) in combination with target-controlled propofol infusion. Hemodynamic changes, respiratory depression, sedation, and cooperation scores were recorded during surgery and patient satisfaction scores were assessed after surgery. RESULTS: Changes in mean blood pressure, heart rate, or oxygen saturation within and between the groups were not significant throughout the procedure. There were no significant differences in sedation, cooperation, and patient satisfaction scores between the 2 groups. CONCLUSION: Because there was no difference in hemodynamic variables and patient satisfaction scores between a bolus of fentanyl and an infusion of alfentanil during target-controlled propofol infusion, both combinations are suitable for conscious sedation in third molar extraction.     

BIS monitoring during midazolam and midazolam-ketamine conscious intravenous sedation for oral surgery

OBJECTIVE: The purpose of this study was to determine whether the bispectral index scale (BIS) would provide added benefit to established methods of monitoring conscious sedation with midazolam (M group) or midazolam supplemented with ketamine (MK group). STUDY DESIGN: BIS was prospectively and blindly examined in 22 patients receiving outpatient oral surgery with conscious sedation supplemented with local anesthesia. RESULTS: The average midazolam dose in the midazolam group over the treatment period was 0.01 mg/kg/h, and the average midazolam plus ketamine dose was 0.01 and 0.05 mg/kg/h, respectively. Mean BIS values throughout the sedation study period were 90 for the midazolam group and 94 for the midazolam plus ketamine group. The addition of ketamine did not lower BIS. BIS values did not alter significantly over time except for an expected transient drop after the midazolam bolus induction. CONCLUSION: BIS levels remained close to baseline levels, suggesting that BIS would not provided any additional benefit to currently established methods of monitoring patient consciousness during conscious sedation for oral surgery.     

Paradoxical reactions to rectal midazolam as premedication in children

Eighty healthy children, between the ages of 2 and 7 years, who were to undergo oral surgical procedures under general anaesthesia, were allocated randomly to 4 groups. Three groups received rectal midazolam, and the other group a placebo (saline) as premedication 30 min prior to induction of anaesthesia. Group A children received midazolam 0.25 mg/kg, Group B 0.35 mg/kg and Group C 0.45 mg/kg. No statistically significant difference was found between the treatment groups as to the effect on systolic- (p = 0.6920) and diastolic (p = 0.8701) blood pressures, respiration (p = 0.0505) and pulse (p = 0.6192) rates at either pre- or post-sedation levels. However, the results indicate that levels of anxiolysis and sedation were significantly associated with midazolam dosage (p less than 0.0001).     

静脉泵入咪达唑仑清醒镇静技术控制牙科恐惧症的临床效果评价

目的评价静脉泵入咪达唑仑控制牙科恐惧症的临床效果。方法选择31例对牙科治疗极度恐惧但能与医师良好沟通的患者,将其两侧需行根管治疗的2颗患牙分别纳入试验组和对照组,对照组为常规牙科治疗,试验组加用咪达唑仑静脉泵入清醒镇静技术,控制患者治疗过程中的恐惧。评价两组患者的治疗依从性和行为治疗效果,并观察试验组患者生命体征的变化及副作用的发生率。结果试验组、对照组的Houpt行为治疗效果评分和Frankl治疗依从性评分均存在显著性差异（z=- 4.846,P=0.000;z=- 4.907,P=0.000）。试验组患者采用镇静措施后血压、心率均有轻度降低,并有轻度的呼吸抑制,但不影响治疗完成。结论单纯咪达唑仑静脉镇静对于能够良好沟通、主观愿意配合的极度牙科恐惧患者具有较好的疗效。     

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。     

Hypotensive anesthesia and recovery of cognitive function in long-term craniofacial surgery

The aim of our study was to compare three different anesthesiological techniques with regard to hemodynamics, recovery, and postoperative morbidity, for craniofacial surgery. One hundred twenty patients with American Society of Anesthesiologists (ASA) classification of I or II patients, 18 to 32 years old, and undergoing maxillary and mandibular osteotomies were randomly assigned to receive anesthesia with propofol-remifentanil (group P), desflurane-remifentanil (group D), or sevoflurane-remifentanil (group S). All patients were given premedication: midazolam 0.03 mg/kg, atropine 0.007 mg/kg, desametasone 0.1 mg/kg, NaCl 0.9% 100 mL + 2 mg/kg ketoprofene + 1.5 mg/kg ranitidine + 1 microg/kg clonidine. Anesthesia was induced by O2/air (FiO2 0.5), remifentanil 0.5 microg/kg/min, propofol 2 mg/kg, rocuronium 0.6 mg/kg. Maintenance group P received O2/air (FiO2 0.5), remifentanil 0.25 to 1.5 microg/kg/min, propofol 6 to 10 mg/kg/h; groups D and S received O2/air (FiO2 0.5), remifentanil 0.25 to 1.5 microg/kg/min, and respectively, sevoflurane or desflurane 0.5 minimum alveolar anesthetic concentration. The dosage of propofol, desflurane, and sevoflurane, obtained with a value of bispectral index (BIS) 40, was kept unchanged throughout the course, and remifentanil was titrated to maintain controlled hypotension: systolic arterial blood pressure 70 to 90 mmHg and mean arterial blood pressure 50 to 65 mmHg. A 24-hour elastomeric infusion system (ketoprofene 320 mg) was started 60 minutes before induction and cloridrat ondansetron 0.1 mg/kg was administered 30 minutes before the end of surgery. Hypotension was successfully obtained in all three groups with a bloodless surgical field, and there was no need for additional use of a potent hypotensive agent. Early and late recovery were faster and more complete in the D group; P < 0.05. Postoperative morbidity (nausea, vomiting, shivering, pain, and edema) was slight and did not significantly differ among the groups.     

右美托咪定和咪唑安定复合芬太尼用于清醒经鼻盲探气管插管的比较

目的 比较右美托咪定和咪唑安定复合芬太尼在清醒经鼻盲探气管插管中的麻醉效果,以及对呼吸和循环的影响。方法 选择口腔颌面外科择期手术患者40例,美国麻醉医师协会分级为Ⅰ～Ⅱ级,预测插管困难,全身麻醉诱导选择清醒经鼻盲探气管插管。随机分为实验组和对照组。实验组静脉输注右美托咪啶;对照组静脉一次性给予咪唑安定和芬太尼。记录各组在用药前的基础值（T1）、插管开始前即刻（T2）、插管开始后10 min（T3）、插管开始后20 min（T4）、插管完成后即刻（T5）时的Ramsay镇静评分值、平均动脉压（MAP）、心率（HR）、心电图（ECG）、呼吸频率（RR）和脉搏血氧饱和度（SpO2）。观测插管成功率、插管尝试次数、插管时间和并发症的发生情况。气管插管完成后对诱导效果进行评级。结果 实验组插管成功率显著高于对照组（P<0.05）。实验组插管尝试次数明显低于对照组（P<0.05）。对照组中发生严重的恶心、呕吐、呛咳及术后咽喉不适的比例明显更高。对照组患者在T2时点RR较T1时点明显下降,插管中和插管后RR又显著增快;实验组患者RR和SpO2都无明显变化。与T1时点比较,对照组患者在T3、T4、T5时点MAP和HR明显增高（P<0.05）。实验组患者各时点MAP和HR无明显变化（P>0.05）。实验组Ramsay镇静评分值在插管过程中明显高于对照组（P<0.05）。结论 合理剂量右美托咪定比咪唑安定复合芬太尼能更安全、更有效地应用于清醒盲探气管插管。     

Comparison of three conscious sedation regimens for pediatric dental patients

The aim of this study was to compare the clinical success of three conscious sedation regimens for pediatric dental patients. A clinical trial was performed wherein dental treatment was administered to pediatric patients ASA I and II under conscious sedation.. Fifty-four children were divided into three groups of 18 patients each, randomly assigned Group A received hydroxyzine (2 mg/kg 2 h before treatment and a subsequent dose of 1 mg/kg 20 min before treatment) orally; group B received 0.50 mg/kg midazolam mixed with 1.5 mg/kg hydroxyzine 20 min before treatment orally; group C received chloral hydrate, 50 mg/kg mixed with 1.5 mg/kg hydroxyzine 20 min before treatment orally. The Ohio State Behavioral Rating Scale (OSBRS) showed statistically significant differences between groups B and C with respect to group A. The regimens of midazolam or chloral hydrate mixed with hydroxyzine represent excellent choices for conscious sedation regimens for pediatric dental patients.     

布洛芬超前镇痛对婴幼儿腭裂术后苏醒质量的影响

目的: 评价布洛芬注射液对婴幼儿腭裂手术后麻醉苏醒质量的影响。方法: 将46例拟行腭裂修补术治疗的患儿,按照是否接受布洛芬注射液随机分为试验组（A组）和对照组（B组）,每组23例。采用8%七氟醚合并8 L/min氧气吸入麻醉诱导,待患儿意识消失后开放静脉,静脉注射阿托品0.01 mg/kg、芬太尼2 μg/kg、异丙酚2 mg/kg、罗库溴铵0.6 mg/kg,肌松效果满意后插入气管导管。调节七氟醚浓度,维持麻醉深度在1~2 MAC值。麻醉诱导后,A组立即静脉泵注布洛芬10 mg/kg,B组泵注等容量生理盐水,2组静脉泵注时间均设置为10 min。术毕停用七氟醚,符合拔管指征后拔出气管内导管,转运至麻醉复苏室(PACU)。记录患儿手术时间、停药至自主呼吸恢复时间与拔管时间。记录患儿入PACU即刻(T0)、10 min(T1)、20 min(T2)、30 min(T3)的FLACC疼痛评分和PAED躁动评分,对重度疼痛患儿或严重躁动持续5 min的患儿,采用芬太尼1 μg/kg缓慢注射治疗,记录围术期不良事件。采用SAS 9.1软件包进行统计学分析。结果: 2组患儿一般资料、手术时间、术毕自主呼吸恢复时间与拔管时间无显著差异（P>0.05）,2组FLACC疼痛评分在T0、T1及T2时间点差异显著(P<0.05);2组PAED躁动评分在各时间点均有显著差异（P<0.05）;A组4例患儿接受芬太尼治疗（18%）,B组9例（43%）患儿接受芬太尼治疗,差异显著（P<0.05）;B组1例患儿使用芬太尼治疗后出现SpO₂<93%,持续吸氧后情况改善,未延长PACU留观时间。结论: 麻醉诱导后使用布洛芬注射液,不影响婴幼儿术毕自主呼吸恢复与拔管,可降低其PACU内疼痛与躁动水平,改善麻醉苏醒期质量。     

Comparing efficacy and safety of four intravenous sedation regimens in dental outpatients.

BACKGROUND: Management of patients' fear and anxiety during dental treatment is a primary concern of dental practitioners. Pharmacological strategies used in outpatient dental settings must be both safe and effective. Regimens of intravenously administered sedative drugs were evaluated in a collaborative, multicenter study of outpatients undergoing removal of impacted third molars. METHODS: A total of 997 patients randomly received one of five treatments: placebo; midazolam administered to a clinical endpoint of conscious sedation (mean dose, 8.6 milligrams); midazolam plus additional midazolam as needed during the procedure (mean total dose, 12.2 mg); fentanyl (1.4 micrograms/kilogram) plus midazolam to achieve the same endpoint of conscious sedation (mean dose, 5.7 mg); or fentanyl (1.4 (micrograms/kg), midazolam (mean dose, 5.8 mg) and methohexital as needed during the procedure (mean dose, 61.0 mg). RESULTS: Each drug regimen reduced anxiety during surgery in comparison with placebo, with the combination of midazolam, fentanyl and methohexital resulting in significantly less anxiety in comparison with the other treatment groups. Pain reports by patients during surgery also were reduced significantly by the combination of fentanyl, midazolam and methohexital. Patients' global evaluations of the efficacy of sedation ranked midazolam with supplemental midazolam and the combination of fentanyl, midazolam and methohexital as significantly more efficacious than the other two drug regiments. The authors noted transient respiratory depression in patients in the two opioid-treated groups, but no other physiological changes were detected. CONCLUSIONS: These data provide evidence that the drugs and doses evaluated resulted in therapeutic benefit to dental outpatients, with minimal incidence of potentially serious adverse effects. CLINICAL IMPLICATIONS: The results of this large-scale study provide assurance to both the public and the dental profession of the safety of parenteral sedation with these drugs and combinations of these drugs when titrated slowly in the recommended doses by appropriately trained dentists.