全麻苏醒期代谢改变

目的　探讨麻醉苏醒期的代谢改变。方法　 2 0例颅脑和胸腹部手术的全麻病人在分别于诱导前、插管后 1 5分钟、切皮时、拔管前即刻和拔管后 1 5分钟测定呼吸频率 (RR)、潮气量(VT)、吸入气氧分数 (FIO2 )、呼出气氧分数 (FEO2 )、吸入气CO2 分数 (FICO2 )和呼出气CO2 分数(FECO2 ) ,同时测定血压、心率和SpO2 。结果　大部分病人在苏醒过程中有躁动、挣扎、不耐受导管和痛苦等表现。在拔管前即刻心率、收缩压乘积显著增加 (1 968 44± 31 0 33) ,拔管后 1 5分仍高于基础水平。拔管前即刻RR和MV明显增加。拔管前即刻 VO2 和 VCO2 均显著增加 ,同时产热量也增加。拔管后 1 5分钟这三种参数仍未恢复至基础值。结论　苏醒期存在明显应激反应和代谢改变 ,因素是多方面的 ,应采取综合性措施加以防治     

全麻苏醒期患者躁动的研究进展

全麻苏醒期躁动(emergence agitation,EA)为麻醉苏醒期的一种不恰当行为,表现为并存的兴奋、躁动和定向障碍.患者出现一些不适当行为,如肢体的无意识动作、挣扎、语无伦次、无理性言语、哭喊或呻吟、妄想思维等.EA是我们临床上较常碰到的麻烦问题,其可能导致患者出现许多并发症,造成意外伤害,甚至影响手术成败.所以了解其发病原因与机制并积极预防处理,对患者安全和手术成功具有重要的意义.本文重点就近年来有关EA的发生原因及防治的研究进展归纳综述如下.     

术前医学心理治疗对全麻病人苏醒的影响

全麻病人苏醒期因恐惧和焦虑的心理状态,多有躁动发生;而且气管拔管可刺激交感神经使病人血压急剧升高,易导致心脑血管意外。为了防止上述情况的发生,临床上多使用镇静催眠药和镇痛药及降压药物如乌拉地尔等治疗[1-3],这样不仅延长麻醉恢复期,还会增加病人的治疗费用。本研究旨在评价术前医学心理治疗对全麻病人苏醒期     

术前压力管理对全麻苏醒期躁动的影响

目的观察术前压力管理对全身麻醉患者苏醒期躁动发生率的影响。方法选择80例成年全身麻醉下行择期腹腔镜胆囊切除或子宫切除患者,无精神病、麻醉和手术史。随机分为压力管理组(P组)和对照组(C组),各40例。P组利用术前访视掌握患者心理情况,施行压力管理,向患者提供全身麻醉的客观存在和主观感受信息,帮助患者建立正确的心理防御机制。C组仅做常规访视。记录诱导前(T0)、术毕(T1)、拔管时(T2)、拔管后5 min(T3)、拔管后l0 min(T4)各时段HR、MAP、Sp O2,躁动评分,Ramsay镇静评分及苏醒时躁动发生率及程度。结果 2组术后清醒时间、拔管时间和Sp O2均无差异。麻醉苏醒期患者的HR、MAP升高幅度P组比C组低(P0.05)。P组躁动发生率低于C组,醒期躁动评分低于C组,2组相比有差异有统计学意义(P0.05)。结论手术前施行压力管理有助于降低全身麻醉患者苏醒期躁动的发生率。     

预注地佐辛抑制全麻苏醒期患者躁动效果观察

目的探讨预注地佐辛抑制全麻苏醒期患者躁动的效果。方法将84例全麻手术的患者随机分为2组,每组42例。对照组在手术结束前15 min前静推生理盐水2 mL,观察组则静推地佐辛0.25 mg/kg。比较2组患者:(1)苏醒期躁动评分。(2)拔管前、拔管时、拔管后5 min、10 min及15 min的MAP、SpO_2、HR。(3)苏醒时间及不良反应发生率。结果 2组患者苏醒期不良反应发生率、苏醒时间及各时点SpO_2的差异均无统计学意义(P0.05)。观察组患者的躁动评分优于对照组,各时点的MAP、HR波动幅度小于对照组,差异均有统计学意义(P0.05)。结论对全麻手术患者,在手术结束前预注地佐辛,可有效改善苏醒期患者的躁动评分,并保持患者血流动力学稳定。     

局部脑氧饱和度用于评估全身麻醉苏醒期患者意识恢复的研究

目的:检验脑氧饱和度对于全身麻醉苏醒期患者意识恢复的评估效能。方法:选择110例全身麻醉下行择期手术的成年患者,应用近红外光谱法（near infrared spectroscopy, NIRS）监测局部脑氧饱和度（regional cerebral oxygen saturation, rSO 2）的变化...     

全麻术后苏醒期患者早期饮水的研究进展

综述全麻术后苏醒期患者早期饮水的必要性与可行性,重点分析早期饮水的实施要素,主要包括饮水的对象评估、种类及方式、饮水量及间隔时间和安全性,以期为我国全麻术后苏醒期患者开展早期饮水临床实践提供参考.     

Narcotrend麻醉深度监测仪用于全麻苏醒期患者意识恢复预测的评价

目的观察Narcotrend(NT)麻醉深度监测仪对于全麻苏醒期患者意识恢复的预测效能。方法选择34例ASAⅠ或Ⅱ级在全身麻醉下择期行腹部手术的患者,手术期间通过异氟醚吸入维持麻醉。术毕入麻醉苏醒室,采用NT监测麻醉深度,在对刺激无反应、呼之睁眼、定向力恢复时记录NT分级(NTS)和NT指数(NTI)、MAP和HR,计算比较这些参数对应意识变化的预测概率(Pk)。结果NTS、NTI与患者苏醒期意识水平的变化显著相关(P<0.01)。NTS、NTI预测患者睁眼时Pk值分别为0.693和0.692,预测患者恢复定向力时Pk值分别为0.837和0.824,均显著高于0.5(P<0.01),也高于MAP和HR对应的Pk数值(P<0.01)。结论NT麻醉深度监测指标能够及时有效反映全麻苏醒期患者意识水平的变化。     

不同年龄病人全麻苏醒期中潜伏期听觉诱发电位的变化

<正> 全麻深度调控一直是麻醉学研究的课题。近年来一些文献报道中潜伏期听觉诱发电位与麻醉深度有良好的相关性。我院利用Aline麻醉深度监测仪对不同年龄的90例病人进行临床观察,现总结如下。 1 资料与方法 1.1 一般资料:选择ASAⅠ～Ⅱ级的择期手术90例,无精神病史,心肺功能正常,听力正常的上腹部及胸科病人。按     

预见性麻醉苏醒护理减少腹部手术患者全麻苏醒期躁动中的效果

目的 探讨预见性麻醉苏醒护理在降低腹部手术患者全麻苏醒期躁动发生率中的应用效果.方法 选取2019-11—2020-10在濮阳市第五人民医院手术室进行全麻后复苏的68例腹部手术后患者.依据护理方法分为预见性麻醉苏醒护理组(预见组)和苏醒期常规护理组(对照组),各34例.比较2组患者的基线资料和收缩压(SBP)、舒张压(...     

Rapid opioid detoxification during general anesthesia: a review of 20 patients

BACKGROUND: Opioid addiction therapy includes successful detoxification, rehabilitation, and sometimes methadone maintenance. However, the patient may have physical, mental, and emotional pain while trying to achieve abstinence. A new detoxification technique that incorporates general anesthesia uses a high-dose opioid antagonist to compress detoxification to within 6 h while avoiding the withdrawal. METHODS: After Institutional Review Board approval and detailed informed consent, 20 patients, American Society of Anesthesiologists status I-II, addicted to various opioids underwent anesthesia-assisted rapid opioid detoxification. After baseline hemodynamics and withdrawal scores were obtained, anesthesia was induced. After testing with 0.4 mg intravenous naloxone, 4 mg nalmefene, was infused over 2 to 3 h. After emergence, severity of withdrawal was scored before and after administration of 0.4 mg intravenous naloxone. After 24 h, patients began outpatient follow-up treatment while taking oral naltrexone. RESULTS: All 20 patients were successfully detoxified with no adverse anesthetic events. After the first post-treatment test dose of 0.4 mg naloxone, 13 of 20 patients had no signs of withdrawal and hemodynamic changes were minimal. Withdrawal scores were always very low and similar before and after detoxification. Three of 17 patients (18%) available for follow-up have remained abstinent from opioids since treatment (< or = 18 months). Four other patients are clean after brief relapses. CONCLUSIONS: Anesthesia-assisted opioid detoxification is an alternative to conventional detoxification.     

Fentanyl-induced rigidity during emergence from general anesthesia potentiated by venlafexine

PURPOSE: To present and discuss a case of opioid-induced rigidity with low-dose fentanyl during recovery from anesthesia. CLINICAL FEATURES: A 41-yr-old woman underwent laparotomy for total abdominal hysterectomy and bilateral salpingo- oophorectomy under general anesthesia. She received a total of 500 micro g of fentanyl by iv intermittent boluses during the three-hour anesthetic. During emergence from anesthesia, while intubated, the patient presented with rigidity. No changes in ventilatory parameters were measured during the episode. The only notable predisposing factor was treatment with venlafexine, an antidepressant that modifies serotonin and norepinephrine levels. She was successfully treated with iv naloxone 20 micro g. The rest of the postoperative period was uneventful. CONCLUSION: We observed an atypical case of opioid-induced rigidity in contrast to the classical syndrome, which presents at induction with high-dose opioids. This syndrome has many clinical presentations with neurologic and ventilatory signs of varying intensity. Early recognition of the syndrome and adequate treatment is crucial. If treated adequately, opioid-induced rigidity is self-limited with few complications.     

Abdominal relaxation during emergence from general anesthesia with propofol and remifentanil

Study ObjectiveTo characterize respiratory dynamics during emergence from propofol-remifentanil anesthesia using noninvasive respiratory inductance plethysmography (RIP).DesignObservational pilot study.SettingOperating room in a university-affiliated teaching hospital.Patients50 ASA physical status 1, 2, and 3 patients scheduled for microdirect laryngoscopy or bronchoscopy using total intravenous anesthesia (TIVA) with high-frequency jet ventilation.InterventionsPatients were fitted with plethysmography bands around the chest and abdomen prior to induction. Following completion of surgery in patients undergoing brief airway procedures using propofol-remifentanil general anesthesia, the anesthetic infusions were stopped and ventilation suspended until resumption of spontaneous ventilation or desaturation below 90%. During this period of apnea, abdominal and thoracic girth was assessed with noninvasive RIP.MeasurementsCross-sectional area of the thorax and abdomen during emergence were measured.Main ResultsUseful data were obtained from 41 patients, with stable apnea lasting 404 ± 193.1 seconds; of these, 34 exhibited a slow and significant decrease in abdominal girth over a period of 267.8 ± 128.5 seconds. Resumption of spontaneous ventilation generally coincided with the end of this abdominal relaxation.ConclusionSlow expiration is the initial step in the resumption of spontaneous ventilation during apnea induced with TIVA using propofol-remifentanil.     

全麻复苏期患者的护理流程

目的 探讨规范全麻手术后复苏期护理内容、落实方法及流程对护理工作的价值.方法 从回病室、复苏中、复苏后3个阶段分别制定了全麻复苏期护理内容及落实流程,对1 200例患者实施护理.结果 科室自查患者满意度由实施前的96.0％上升至实施后的99.0％,基础护理满意率由90.0％上升至100％.结论 规范全麻复苏期护理内容与...     

Suppression of cough during emergence from general anesthesia: laryngotracheal lidocaine through a modified endotracheal tube

STUDY OBJECTIVE: To ascertain if coughing during emergence from general anesthesia can be suppressed with a modified endotracheal tube. DESIGN: Randomized, double-blind, controlled study. SETTING: Operating rooms at a university hospital. PATIENTS: 46 adult ASA physical status I, II, and III patients requiring elective surgery. INTERVENTIONS: Patients underwent general anesthesia with the laryngotracheal instillation of topical anesthesia (LITA) endotracheal tube (ETT). Thirty minutes before anticipated extubation, one investigator administered, via the LITA tube injection port onto the laryngotracheal mucosa, one of the following according to randomized preselection: 2 mg/kg with 4% lidocaine (Group I; n = 15); 4 mL with saline (Group 2;n = 16); and nothing (Control; n = 15). At the completion of surgery, with the patient adequately anesthetized, the oropharynx was gently suctioned, and the isoflurane was then turned off. When the isoflurane end-tidal concentration was < or =0.2%, the neuromuscular block was reversed and the inspiratory oxygen concentration was increased to 100% while awaiting the return of spontaneous ventilation. MEASUREMENTS: An observer who was blinded to the study drug regimens judged the presence or absence of cough upon emergence, over a 1-minute period. The observer noted the responses to the following verbal commands, in this order: 1) "open your eyes", 2) "grip my hand", and 3) "lift your head". Coughing was defined as any evidence of irritation from having a tube in the trachea. Blood samples for plasma lidocaine levels were taken at the time of extubation from patients who received lidocaine (Group 1). MAIN RESULTS: Seventy-five percent of patients were found to have complete cough suppression upon emergence, while Group 2 (saline) had 14% and Group 3 (the control) only had 13% suppression. CONCLUSIONS: The technique of laryngotracheal topical lidocaine administered by the LITA tube can, in most cases, provide a smooth emergence from general anesthesia without coughing.