微量泵持续输注丙泊酚-瑞芬太尼在门诊整形美容手术中的应用

目的:比较丙泊酚复合瑞芬太尼与丙泊酚复合氯胺酮在门诊整形美容手术中的临床观察.方法:40例整形美容手术患者随机分为两组,每组20例.观察组(A组)采用微量泵静脉持续输注丙泊酚-瑞芬太尼,对照组(B组),微量泵静脉持续输注丙泊酚-氯胺酮.A组,麻醉诱导用,静脉注射丙泊酚2-2.5mg/kg/h,麻醉维持用丙泊酚4-12mg/kg/h,B组,麻醉诱导是静脉注射丙泊酚2-2.5mg/kg,氯胺酮1mg/kg,麻醉维持丙泊酚4-12mg/kg/h+氯胺酮1mg/kg/h,重点观察麻醉效果、定向恢复时间及不良反应.结果:观察组于对照组相比有显著的差异(P<0.05).结论:丙泊酚复合瑞芬太尼麻醉效果可靠,安全可行,但要注意静脉注射瑞芬太尼的速度.     

丙泊酚、咪唑安定对ICU老年患者术后精神障碍治疗的观察

目的:观察丙泊酚和咪唑安定对ICU老年患者术后精神障碍治疗的镇静效果和作用机制.方法:选择40例老年术后精神障碍患者,年龄71～88岁,随机分为两组:丙泊酚组(B组)和咪唑安定组(M组),分别用微量注射泵持续注射丙泊酚0.5mg/kg/h和咪唑安定0.04mg/kg/h治疗8h,比较两组Ramsay镇静评分和治疗有效率,同时记录药物起效时闹和停药后清醒时间.结果:B组达到5分镇静程度的例数(15例)明显多于M组(6例).精神症状改善者B组19例,M组15例.平均起效时间和平均清醒时间B组明显短于M组.结论:丙泊酚和咪唑安定都能达到镇静要求,丙泊酚可提高睡眠质量,改善精神症状更具有疗效好而副作用小的优点.     

丙泊酚复合瑞芬太尼全凭静脉麻醉用于股骨颈骨折闭合复位空心钉内固定术的总结

目的观察丙泊酚复合瑞芬太尼静脉麻醉用于股骨颈闭合复位内固定术的可行性。方法 55例老年股骨颈骨折空心钉内固定术患者持续微量泵泵注丙泊酚3～6 mg/(kg.h),复合瑞芬太尼0.025～0.1μg/(kg.min)静脉麻醉。结果 55例患者麻醉效优、苏醒迅速、安全送回病房。讨论丙泊酚复合瑞芬太尼静脉全麻可安全用于老年股骨颈骨折闭合复位固定术。     

瑞芬太尼对骨折患儿术后躁动和应激反应的影响

目的探讨瑞芬太尼对骨折患儿术后躁动和应激反应的影响。方法将46例患儿随机分为研究组和对照组,每组23例。研究组麻醉维持给予丙泊酚8～10 mg/(kg·h)联合瑞芬太尼0. 1～0. 3μg/(kg·min)持续静脉泵入;对照组给予丙泊酚8～10 mg/(kg·h)联合芬太尼0. 05μg/(kg·min)持续静脉泵入。比较两组患儿术后恢复情况、躁动发生、镇静情况及应激反应水平。结果与对照组比较,研究组患儿术后自主呼吸恢复早(P 0. 001),苏醒快(P 0. 001),拔管所需时间短(P 0. 001),术后躁动发生率低(P 0. 05)。手术结束时、脱机拔管时的血清皮质醇浓度研究组均明显低于对照组(P 0. 05)。术后5、15、30 min的Ramsay镇静评分研究组均明显低于对照组(P 0. 05)。两组不良反应发生率比较差异无统计学意义(P 0. 05)。结论瑞芬太尼在骨折患儿手术中麻醉效果好,术后躁动发生率及应激反应水平低。     

依托咪酯乳剂与丙泊酚在全身麻醉维持中的应用效果观察

目的观察依托咪酯乳剂与丙泊酚在全身麻醉维持中的临床应用效果。方法将52例ASAⅠ~Ⅱ级择期行手术治疗患者随机分为观察组和对照组2组,各26例。观察组应用依托咪酯乳剂1.0 mg/(kg·h),瑞芬太尼15μg/(kg·h)。对照组应用丙泊酚3 mg/(kg·h),瑞芬太尼15μg/(kg·h)。均采用静脉泵注方法予以维持。观察记录2组手术麻醉前后血压、脉搏、心率、血氧饱和度及术后苏醒时间。结果对照组手术麻醉前后血压、脉搏下降明显,比较差异有统计学意义(P0.05)血压、观察组手术麻醉前后血压、心率波动较小,比较差异无统计学意义(P0.05)。2组手术麻醉血氧饱和度比较,差异无统计学意义(P0.05);术后苏醒时间对照组长于观察组,2组比较差异有统计学意义(P0.05)。结论与丙泊酚比较,依托咪酯乳剂在全麻诱导时血液动力学稳定性好,术后恢复快。     

硬膜外泵入布托啡诺复合小剂量氯胺酮用于妇科患者术后镇痛

目的 观察术后硬膜外持续泵人布托啡诺复合小剂量氯胺酮用于妇科患者术后的镇痛效果.方法 60例ASA Ⅰ或Ⅱ级在腰-硬联合麻醉下行腹式子宫切除的妇科患者术后随机均分为两组,A组为观察组,用布托啡诺0.1 mg/kg 氯胺酮1 mg/kg 生理盐水至100 ml持续泵人;B组为对照组,用布托啡诺0.1 mg/kg 生理盐水至100 ml持续泵入.观察患者术后各时间段的视觉模拟镇痛评分(VAS)、Ramsay镇静评分及对术后镇痛的满意度进行评估,并观察不良反应情况.结果 A组在给药后4 h的VAS低于B组(P<0.05);B组在给药后4、8和12 h的Ramsay镇静评分高于A组(P<0.05),但是两组的评分均在镇静满意的范围.结论 硬膜外持续泵入布托啡诺0.1mg/kg对于妇科术后患者能提供安全有效的镇痛,同时复合小剂量的氯胺酮能增强其镇痛效果,不增加其不良反应的发生.     

丙泊酚复合瑞芬太尼用于肝癌射频消融术的麻醉

目的:探讨丙泊酚复合瑞芬太尼用于经皮射频消融治疗肝癌术的麻醉安全性。方法:将100例患者随机分为丙泊酚复合瑞芬太尼组(R组)与丙泊酚组(P组),各50例。R组采用微量泵输注瑞芬太尼1～1.5μg(/kg·h)及丙泊酚2～4mg(/kg·h),P组微量泵输注丙泊酚2～4mg(/kg·h)。结果:R组患者的治疗时间短(10.46±0.01)min,镇痛效果好(P0.01),恶心呕吐发生率低,苏醒时间短(4.37±0.68)min。但R组较P组呼吸抑制明显,血氧饱和度明显降低(P0.01)。结论:肝癌射频消融术中应用丙泊酚复合瑞芬太尼的麻醉效果确切、安全,但需要加强对呼吸循环监护与管理。     

瑞芬太尼复合丙泊酚麻醉应用于腹腔镜下腹股沟疝修补术的麻醉效果

目的观察瑞芬太尼复合丙泊酚应用与腹腔镜下腹股沟疝修补术麻醉的优越性和安全性。方法将2015-04—2015-10接受芬太尼和瑞芬太尼复合丙泊酚全凭静脉麻醉实施腹腔镜下腹股沟疝修补术的患者作为观察对象。根据不同麻醉用药分为2组,各34例。对照组依次给予咪唑安定0.04 mg/kg,芬太尼1.5~2μg/kg,罗库溴铵0.6 mg/kg,丙泊酚1.5~2 mg/kg诱导。术中间断静注芬太尼和泵注丙泊酚维持麻醉。观察组给予咪唑安定0.04 mg/kg,瑞芬太尼1.0~1.5μg/kg,罗库溴铵0.6 mg/kg,丙泊酚1.5~2 mg/kg诱导。插管成功后以0.2μg/(kg·min)持续泵注瑞芬太尼,4.2 mg/(kg·min)泵注丙泊酚维持麻醉。比较2组患者在诱导前、诱导后、切皮时、气腹后5 min和拔管后各时间点的血压、心率变化及术毕麻醉恢复过程中的呼叫睁眼、呼吸恢复、吞咽反射等指标变化。结果观察组患者各时间点的血压、心率变化明显小于对照组,且患者苏醒时间和拔管时间明显短于对照组。2组比较,差异均有统计学意义(P0.05)。结论瑞芬太尼复合丙泊酚麻醉在腹腔镜下腹股沟疝修补术中循环更稳定,具有起效快、操作简单、苏醒时间短等优越性和安全性。     

右美托咪定复合舒芬太尼在脑出血患者开颅手术中的应用

目的探讨右美托咪定复合舒芬太尼用于脑出血患者开颅血肿清除手术的I临床效果。方法脑出血病人60例．ASAII或Ⅲ级,GCS评分在9～12分。随机分为研究组（D组）和对照组（c组）,每组30例。研究组麻醉诱导前静脉微量泵入右美托咪啶负荷量（1μg／kg）,继以维持0．2～0．7μg／（kg·h）;对照组则微量泵人相同剂量的生理盐水。两组麻醉诱导选用丙泊酚、舒芬太尼和维库溴铵。以丙泊酚和舒芬太尼持续泵注维持麻醉,分别记录两组患者诱导前、插管后及术后10分钟心率（HR）和平均动脉压（MAP）,观察两组患者患者麻醉药泵注速度及术后自主呼吸恢复时间及镇静躁动评分（SAS评分）0—3分为镇静。结果右美托咪定组麻醉药泵注速度低于对照组（P〈0．05）．术后自主呼吸恢复时间两组无明显差异（P〉0．05）SAS评分低于对照组。结论右美托咪啶复合舒芬太尼用于脑出血患者开颅血肿清除术可明显减少麻醉用药量,减轻麻醉苏醒期心血管反应,具有良好的临床效果。     

右美托咪定复合舒芬太尼在非插管全麻下行输尿管镜钬激光碎石手术中的应用

目的探讨右美托咪定复合舒芬太尼在非插管全麻下行输尿管镜钬激光碎石手术中的应用效果,为临床提供参考。方法2019年1月~2020年5月,将在我院行输尿管镜检钬激光碎石术治疗的120例患者,按照随机数字分组法分成对照组与观察组,每组60例。观察组接受右美托咪定复合舒芬太尼非气管插管麻醉:舒芬太尼和右美托咪定分别用生理盐水配成50 ml溶液,即舒芬太尼浓度1μg/ml,右美托咪定浓度4μg/ml。于术前10 min开始静脉泵注,速度均为1.2 ml/(kg·h),10 min后将泵注速度调整为0.3 ml/(kg·h),持续泵注维持,另在开始进输尿镜前可予丙泊酚2~3 ml静注,待患者入睡,手术开始。术中保留自主呼吸,碎石完成放输尿管支架前停药。对照组患者接受气管插管全麻。结果观察组患者苏醒时间、住院时间、住院费用、首次进食时间和下床时间少于对照组(P<0.05)。术中观察组生命体征较对照组平稳。观察组患者术后2 h、12 h、24 h VAS评分低于对照组(P<0.05)。观察组患者不良反应总发生率低于对照组(P<0.05)。结论右美托咪定复合舒芬太尼非插管全麻既能提升镇痛、镇静效果,减少手术疼痛、住院时间、住院费用,又能稳定患者心率、呼吸,为手术提供一个稳定的机体环境。同时非插管全麻还可减少麻醉不良反应,提升麻醉满意度,推荐有条件的医院尝试。     

Muscle relaxation with an infusion of vecuronium

Vecuronium was administered by a continuous intravenous infusion following a bolus dose of 0.1 mg kg-1 in 10 patients. Following recovery of twitch height to 10% of control, steady state dose requirement for maintaining a 90% block was attained in an average of 15.4 min. The average dose required was 0.083 mg kg-1 h-1 or 3.27 mg m-2 h-1. Large individual variations were observed but each patient required an approximately constant dose over periods up to 4.5 h. Recovery was prompt following cessation of infusion.     

Propofol infusion syndrome--report of an adult fatality

This report describes a fatal case of the propofol infusion syndrome in an adult patient being sedated for a closed head injury using high doses of propofol. The features of circulatory collapse, metabolic acidosis, mild rhabdomyolysis and renal impairment are consistent with the syndrome and not readily attributable to alternative aetiologies. Potential mechanisms for the syndrome may relate to antagonism of beta-receptors, impaired myocardial oxygen utilization and a specific disruption to fatty-acid oxidation. This is the first published Australian case of the propofol infusion syndrome in an adult and should serve as an additional case report to the existing literature highlighting this potentially fatal syndrome in adults.     

Continuous infusion of baclofen and an antibiotic for treating meningitis related to refilling of an intrathecal infusion pump reservoir

Baclofen via intrathecal infusion pump is a widely used treatment severe spasticity. Complications are rare and usually mild, though they can also be serious. The sudden discontinuation of intrathecal baclofen may have significant adverse effects. We report the case of a 59-year-old man with chronic spasticity and torsion dystonia who developed meningitis due to Staphylococcus epidermidis due to contamination of the intrathecal, infusion pump reservoir during refilling. It was decided to treat the patient by administering vancomycin through the pump, together with the baclofen. We believe that changing the intrathecal perfusion pump is not necessary as the first measure to take in these cases. Combined infusion of baclofen and an antibiotic through the pump makes it possible to maintain antispastic treatment, sterilize the pump reservoir and tubes, and effectively treat infections that develop during use of these systems.     

The use of an infusion pump in arthroscopy

The use of an infusion pump is an effective method of irrigating the joint in arthroscopy. A Sarns roller blood pump is used to pump fluid into the joint through the arthroscope with outflow by gravity drainage through a plastic cannula. Flow and pressure can be adjusted independently. Measurements were made of calf, knee, and thigh swelling after arthroscopy in 42 patients; the average swelling of each was less than 1 cm. In 45 patients, the average rate of flow through the joint was 45 mm/min, with a measured outflow of 40 mm/min. Intraarticular pressure greater than 200 mm Hg can be obtained with the pump, compared with maximum pressures only slightly greater than 100 mm Hg with gravity inflow alone. The operator must carefully monitor the system; retention of excessive fluid can lead to postoperative swelling and morbidity.     

Hypoglycemia caused by siphoning of an insulin infusion

STUDY OBJECTIVE: To determine--through reconstruction of a clinical situation in which a syringe filled with insulin was removed from the syringe pump, placed above the patient, then emptied into the patient--the different physical forces at work, and to examine the height of the syringe (and thus the hydrostatic force) necessary to move the plunger. DESIGN: Prospective study. SETTING: Research laboratory of a university. MEASUREMENTS: The clinical situation was simulated using eight 50-mL and eight 20-mL syringes. A pressure transducer, placed between the syringe and the extension tubing, measured the pressure difference over the extension tubing. The Poiseuille equation of the viscous resistance was used to calculate flow. MAIN RESULTS: The mean height needed for initiation of flow in the 50-mL syringes was 76 cm (range, 60-90 cm). In the 20-mL syringes, no flow could be generated up to heights of 200 cm. There was a large variability in the height and time required to generate flow in apparently identical syringes, probably due to differences in the static sticking of the plunger to the barrel. CONCLUSIONS: Studies testing the effect of siphoning using one syringe cannot be interpreted reliably. Smaller syringes are safer to avoid siphoning.     

Repeated subarachnoid catheter displacement as a complication of spinal infusion using an internal infusion pump

OBJECTIVE: To present and analyze the case of a woman receiving chronic spinal opioid therapy using an implanted infusion pump who experienced repeated displacement of the subarachnoid catheter despite the use of standard techniques for anchoring the catheter. The solution devised to avoid the problem is described. CASE REPORT: A 53-year-old woman was diagnosed with transverse myelitis 10 years earlier and she developed T7-T10 spinal cord atrophy, and pain below the T7 segment. After unsuccessful noninvasive pharmacological treatment, a spinal opioid infusion protocol was begun. On 3 occasions during the course of therapy, despite the use of standard measures for anchoring the system, catheter displacement into the subcutaneous pouch of the pump occurred. After the last such episode, a specially designed technique was used, anchoring the catheter by means of a silicone piece, and the injection of 2.5 mL of fibrin glue in the epidural space. CONCLUSIONS: The application of fibrin glue (Tissucol; Immuno AG, Vienna, Austria) may be considered as an adjuvant for the fixation of subarachnoid catheters used for intraspinal infusions.     

Propofol infusion syndrome associated with short-term large-dose infusion during surgical anesthesia in an adult

In this case report we describe a case of propofol infusion syndrome in an adult after a short-term infusion of large-dose propofol during a neurosurgical procedure. Large-dose propofol (9 mg.kg(-1).h(-1)) was given for only 3 h during surgery and was followed by a small-dose infusion (2.3 mg.kg(-1).h(-1)) for 20 h postoperatively. The patient had also received large doses of methylprednisolone. He developed a marked lactic acidosis with mild biological signs of renal impairment and rhabdomyolysis but no cardiocirculatory failure. There were no other evident causes of lactic acidosis as documented by laboratory data. We believe this is the first report of reversible lactic acidosis associated with a short duration of large-dose propofol anesthesia.