咪达唑仑-丙泊酚序贯镇静在术后机械通气中的应用研究

目的为临床医生选择合理的镇静镇痛方案提供参考。方法采用前瞻性对照研究,选术后出现呼吸衰竭需机械通气的122例患者,均给予芬太尼持续静脉泵入镇痛,根据镇静方法不同随机分为A组(丙泊酚组)、B组(咪达唑仑组)、C组(咪达唑仑+丙泊酚组)、D组(咪达唑仑-丙泊酚序贯组),比较4组患者的起效时间、停药至拔除气管插管的时间、平均动脉压及心率的变化。结果 A组镇静起效时间最短(P0.05);B、D组起效时间较长(P0.05)。A组停药至拔管时间显著短于D、B、C组(P0.05)。用药30 min后,A、C组平均动脉压、心率显著低于用药前(P0.05),D组著高于A组(P0.05)。D组低血压发生率显著低于A、B、C组(P0.05)。结论咪达唑仑-丙泊酚序贯镇静效果最好。     

颅内动脉瘤栓塞术中依托咪酯乳剂的麻醉效果观察

目的观察颅内动脉瘤栓塞术依托咪酯乳剂的麻醉效果。方法将42例颅内动脉瘤患者随机分为A、B组,各21例,均行颅内动脉瘤栓塞手术。麻醉诱导：A组静注咪达唑仑0.1 mg/kg、芬太尼2μg/kg、依托咪酯乳剂0.15～0.3 mg/kg（30～60 s）、维库溴铵0.1 mg/kg,B组静注咪达唑仑0.1 mg/kg、芬太尼2μg/kg、丙泊酚1～2 mg/kg（30～60 s）、维库溴铵0.1 mg/kg。麻醉维持：A组静脉泵入依托咪酯乳剂0.8～1 mg/（kg.h）,B组静脉泵入丙泊酚4～6 mg/（kg.h）。结果两组手术时间、自主呼吸恢复时间、苏醒时间相比,P均〉0.05。A组麻醉后各时点BP、HR、PETCO2、MAP、NBP、ABP与术前比较,P均〉0.05;B组在麻醉诱导后、插管前、插管后5 min与术前及A组比较,BP显著降低（P均〈0.05）。结论依托咪酯乳剂用于颅内动脉瘤栓塞术麻醉安全、有效。     

丙泊酚瑞芬太尼静脉全麻与七氟烷芬太尼静吸复合全麻在老年患者骨关节置换术中麻醉效果对比

目的比较丙泊酚瑞芬太尼静脉全麻与七氟烷芬太尼静吸复合全麻在老年患者骨关节置换术中效果。方法择期行骨关节置换术美国麻醉师协会(ASA)Ⅱ^Ⅲ级的老年患者(65Ⅲ级的老年患者(65⁸5岁)60例,随机分为丙泊酚瑞芬太尼静脉全麻组(A组)与七氟烷芬太尼静吸复合组(B组),A组应用丙泊酚及瑞芬太尼持续泵注来进行麻醉维持,B组应用七氟烷吸入加芬太尼静脉注射来实现麻醉维持,两组均同时应用Narcotrend监测仪监测麻醉深度。比较两组血流动力学相关指标的变化、术中血管活性药物的使用情况及术后苏醒情况。结果 A组收缩压(SBP)、心率(HR)变化均大于B组(P<0.05)。A组吞咽反射恢复时间、术后清醒时间、拔除气管导管时间及出麻醉恢复室(PACU)时间均比B组延长(P<0.05)。结论七氟烷芬太尼静吸复合全麻组麻醉维持更平稳,血管活性药物使用率更少,术后患者苏醒更迅速,该全麻方式可以更好地应用于行骨关节置换术的老年患者。     

咪达唑仑用于无痛纤支镜的临床研究

目的探讨在无痛纤支镜术前麻醉诱导过程中使用咪达唑仑的利弊。方法将288例行无痛纤支镜检查的患者随机分为2组,采用不同的麻醉诱导方法,第1组（A组）静注异丙酚、芬太尼联合咪达唑仑,第2组（B组）静注异丙酚和芬太尼,从安全性、舒适性和便捷性三方面选择指标进行比较。结果 B组对呼吸、循环的影响小于A组,整个麻醉过程中患者经皮血氧饱和度和心率的变量比较差异有统计学意义;术后感受A组优于B组,A组对操作过程有记忆的患者少于B组（P=0.004）,A组术后呕吐的发生率与B组无显著性差异（P=0.211）;A组的麻醉诱导时间（T1）比B组短,但麻醉苏醒时间（T2）比B组长,总的药物相关时间（T=T1＋T2）A组长于B组（P=0.000）。结论静注异丙酚、芬太尼的麻醉诱导方式安全性更好,效率更高,静注异丙酚、芬太尼联合咪达唑仑术后记忆较少,相比而言,前者更值得临床推广。     

咪达唑仑清醒镇静在支气管镜检查中的作用及其对肺功能的影响

目的 探讨在支气管镜检查中应用静脉注射咪达唑仑清醒镇静的作用及其对肺功能的影响.方法 40例患者分为A、B两组,各20例,分别采用丁卡因、利多卡因局部麻醉和局部麻醉加咪达唑仑静脉注射镇静;对比患者术中麻醉效果,观察其各时点的生命体征和肺功能指标.结果B组在麻醉效果四个方面均优于A组;两组肺功能指标FVC、FEV1.0及PEF在术后10 min均比术前下降,其中B组FVC下降程度较A组更显著(P<0.05);两组术后4h的肺功能可回到基线水平;A组生命体征指标在术中及术后均较麻醉前有明显波动;B组内仅术中HR、MAP较麻醉前有差异,且A组进声门时HR的升高程度大于B组.结论 静脉应用咪达唑仑清醒镇静安全、有效、便捷,对患者术后4 h肺功能没有影响.     

小剂量芬太尼-咪达唑仑在支气管镜检查中的应用

目的探讨小剂量芬太尼-咪达唑仑静脉麻醉,联合进镜时局部喷利多卡因麻醉,在支气管镜检查中的应用。方法将62例患者随机分成两组(A、B两组),每组31人,治疗组(A组)在行支气管镜检查前5 min给予静推小剂量咪达唑仑及芬太尼,待患者进入浅睡眠状态且可唤醒时开始操作,进支气管镜时局部喷利多卡因,对照组(B组)在行支气管镜检查时仅给予局部喷利多卡因。观察其麻醉前、麻醉后及术前、术后的生命体征指标(心率、呼吸频率、血氧饱和度、平均动脉压)及不良反应。结果 A组患者能在无知觉和无痛苦中接受检查,且出现呛咳、憋气及胸闷等不良反应很少;生命特征监测均在正常范围内,较前无明显变化;B组上述不良反应多,程度重,与A组比较有显著差异。结论小剂量芬太尼-咪达唑仑静脉推注合并局部喷利多卡因,用于支气管镜检查,镇静镇痛作用效果好,而且对循环和呼吸影响较小,并发症极少。     

咪达唑仑清醒镇静无痛内镜检查的临床应用

背景：目前国内多采用单独或联合使用丙泊酚或芬太尼等药物产生深度镇静或基础麻醉的方法进行无痛内镜检查,实施时必须有麻醉科医师配合,且费用昂贵。目的：总结单独应用咪达唑仑行清醒镇静无痛内镜检查的合理用量、效果、安全性和临床应用价值。方法：纳入佛山市第二人民医院1997年8月～2008年2月单独应用咪达唑仑行清醒镇静无痛内镜检查的患者,对其一般情况、药物用量、成功率等行回顾性分析。结果：共28600例患者单独应用咪达唑仑行清醒镇静无痛内镜检查,其中清醒镇静胃镜检查22100例,平均用量为3.0mg;清醒镇静结肠镜检查6500例,平均用量为4.0mg。清醒镇静内镜检查的成功率为100%,98%的患者对检查过程完全遗忘,很满意和满意的比例为95%,行走恢复时间平均为（13±5）min,无一例患者发生严重并发症。结论：单独应用咪达唑仑行清醒镇静无痛内镜检查具有无痛效果显著、恢复迅速、安全、费用低廉的优点,适用于广大基层医院。     

右美托咪啶联合咪达唑仑在颅脑创伤中的镇静效果及对患者神经内分泌的影响

目的研究右美托咪啶与咪达唑仑联合应用于颅脑创伤患者中的镇静效果及对其神经内分泌产生的影响。方法选取2017年12月—2018年12月期间,于荆州市第三人民医院接受治疗的颅脑创伤患者90例,将给予丙泊酚与右美托咪啶镇静治疗的45例设为A组,将采用右美托咪啶与咪达唑仑联合进行镇静治疗的45例设为B组,对A、B两组患者的临床结果进行对比分析。结果治疗后,两组患者在镇静效果方面比较,差异无统计学意义(P0.05);但是药物使用后B组患者的平均动脉压(MAP)、心率(HR)以及呼吸频率(RR)三项指标均明显优于A组(P0.05);两组患者的血氧饱和度(SpO2)与中心静脉压(CVP)水平比较,差异无统计学意义(P0.05);但B组患者的血清皮质醇、β-内啡肽水平均明显高于A组(P0.05)。结论右美托咪啶与咪达唑仑联合应用于颅脑创伤患者临床治疗中镇静效果良好,可有效降低患者颅脑创伤之后产生的应激反应,缓解其神经内分泌系统紊乱症状,值得在临床上积极推广应用。     

右美托咪定、咪达唑仑对腹腔镜胆囊切除术全麻患者气管插管拔管期心血管应激反应的影响

目的 观察右美托咪定与咪达唑仑对腹腔镜胆囊术全麻患者气管插管拔管期心血管应激反应的影响.方法 100例合并高血压行腹腔镜胆囊切除患者随机分为两组,两组患者均采用相同全麻诱导和维持,右美托咪定组诱导前10 min内静脉泵注1μg/kg右美托咪定,咪达唑仑组同速度同容量静射0.05 mg/kg咪达唑仑.观察两组诱导前、拔管时及拔管后1、5、10 min时的SBP、DBP、HR、心率和收缩压的乘积(RPP).结果 与咪达唑仑组比较,右美托咪定组拔管时、拔管后1 min的SBP、DBP、HR、RPP降低,拔管后5 min的RPP亦降低(P均＜0.05);与同组诱导前比较,咪达唑仑组拔管时、拔管后1 min的SBP、DBP、HR、RPP升高,拔管后5 min的RPP亦升高(P均＜0.05).结论 相对于咪达唑仑,右美托咪定能有效减轻腹腔镜胆囊切术全麻患者气管插管拔管期心血管应激反应,增加拔管时的安全性.     

右美托咪定、咪达唑仑对急性左心衰竭机械通气患者的镇静作用

目的 比较右美托咪定与咪达唑仑对急性左心衰竭行机械通气患者的镇静效果.方法 将急性左心衰竭需行机械通气的40例患者随机分成A、B两组各20例,分别予以右美托咪定和咪达唑仑镇静.观察两组药物起效时间、停药后清醒时间及治疗期间发生低血压的例数;记录两组镇静前,镇静后1、2、4h的心率、平均动脉压、动脉血氧饱和度和动脉氧分压;于患者人院时及治疗第1、4天分别检测血清心肌酶.结果 A组停药后清醒时间与B组比较有统计学差异（P＜0.05）,其中A组发生低血压4例.治疗后1、2、4h两组血流动力学及血气指标均较治疗前显著改善（P均＜0.05）.与B组比较,A组治疗后1、2h血流动力学及血气指标改善较明显（P均＜0.05）.治疗后第1、4天,两组血清心肌酶均下降,A组较B组下降更明显（P＜0.05）.结论 急性左心衰竭行机械通气患者使用右美托咪定可以较快改善血流动力学状况,对心肌有保护作用.     

异丙芬分别复合芬太尼和米唑安定行无痛胃镜检查的研究

目的 比较异丙芬复合芬太尼或米唑安定用于无痛胃镜检查的有效性和安全性.方法 将180例需要无痛胃镜检查的患者分为A、B、C三组,每组各60例.A组单独静脉注射异丙芬1.5mg/kg,B组先注射芬太尼0.5mg后再注射异丙芬1.5mg/kg,C组先注射米唑安定0.02～0.03 mg/kg后再注射异丙芬1.5 mg/kg.至患者睫毛反射消失后开始插镜检查,如有呛咳、体动等表现时追加异丙芬30～40 mg.记录患者用药前、插镜前、检查结束后各时间点的呼吸、血氧饱和度、血压、心率以及不良反应.结果 B组和C组的异丙芬用量明显少于A组(P＜0.01).B组苏醒最快,没有注射部位疼痛,呛咳、体动等发生率明显低于A组(P＜0.05).结论 异丙芬联合芬太尼组具有麻醉镇痛效果好、副反应少、苏醒快等优点,更适合于无痛胃镜检查.     

Target-controlled infusion during monitored anesthesia care in patients undergoing EUS: Propofol alone versus midazolam plus propofol: A prospective double-blind randomised controlled trial

BACKGROUND: It has been speculated that midazolam may be effective in reducing the required dose of propofol during sedation. AIM: To evaluate the sparing effect of midazolam during target-controlled propofol infusion. METHODS: Two hundred-seventy patients undergoing upper endoscopic ultrasound were randomised to receive sedation with propofol plus placebo (group A) or plus midazolam (group B). Outcome parameters were the procedure duration, the discharge time and the satisfaction of patients, operator and nurse about the quality of sedation. RESULTS: The mean propofol dose administered was 364+/-207 mg in group A and 394+/-204 mg in group B. Mean procedure duration (group A: 32+/-17 min, group B: 35+/-22 min) and discharge time (group A: 39+/-30 min, group B: 38+/-24 min) were similar in both groups. No severe complications were observed. The quality of sedation was judged satisfactory for all patients by both the endoscopist and the nurse assistant without any difference between the two groups. No patient remembered the procedure or reported it as unpleasant. CONCLUSIONS: Target-controlled propofol infusion provides safe and effective sedation; premedication with low dose of midazolam does not reduce the total amount of propofol administered. Further studies are needed to compare propofol alone with propofol co-administered with opioid.     

Nurse-administered propofol versus midazolam and meperidine for upper endoscopy in cirrhotic patients

OBJECTIVES: Upper GI endoscopy is often performed in patients with chronic liver disease to screen for esophageal and gastric varices. Propofol is currently under evaluation as an alternative to the combination of midazolam and meperidine for sedation during endoscopic procedures. The purpose of this study was to compare nurse-administered propofol to midazolam and meperidine for sedation in patients with chronic liver disease undergoing diagnostic upper GI endoscopy. METHODS: Twenty outpatients who had known chronic liver disease (Child-Pugh class A or B) and were undergoing variceal screening were randomized to receive propofol or midazolam plus meperidine for sedation. Administration of sedation was performed by a registered nurse and supervised by the endoscopist. Outcome measures studied were induction and recovery times, efficacy and safety of sedation, patient satisfaction, and return to baseline function. RESULTS: The mean dose of propofol and meperidine/midazolam administered was 203 mg (SD 43.7, range 150-280) and 71.3 mg (SD 17.7, range 50-100)/5.3 mg (SD 0.9, range 3.0-6.0), respectively. The mean time to achieve adequate sedation was 3.6 min (SD 1.2) for the propofol group in comparison to 7.3 min (SD 2.8) for the meperidine/midazolam group (p<0.05). Procedure times between the groups were similar: propofol, 3.9 min (SD 1.9); midazolam/meperidine, 2.7 min (SD 0.8) (p=0.11). The level of sedation achieved by the propofol group was greater (p=0.0001). Time to full recovery was faster in the propofol group: 34.9 min (SD 10.3) versus 51.6 min (SD 18.4) (p<0.05). The mean time to reach a maximal level of alertness on the Observer's Assessment of Alertness and Sedation Scale for the propofol group was 15 min (SD 3.6) versus 29 min (SD 10.5) (p=0.001). Although both groups recorded a high level of satisfaction, patients receiving propofol expressed greater overall mean satisfaction with the quality of their sedation at the time of discharge (p<0.05), and reported a return to baseline function sooner in the majority of cases. Propofol achieved comparable levels of efficacy and safety to meperidine/midazolam in our study group. Both were well tolerated with minimal complications. CONCLUSIONS: Propofol sedation administered by registered nurses in the setting of adequate patient monitoring is efficacious and well tolerated in patients with liver disease who are undergoing variceal screening by upper endoscopy. Patients were more satisfied with the quality of sedation, and return to baseline function was usually sooner compared to results achieved with midazolam/meperidine. Propofol offers advantages over meperidine/midazolam in cirrhotic patients.     

Sedation with propofol for routine ERCP in high-risk octogenarians: a randomized, controlled study

OBJECTIVES: Adequate patient sedation is mandatory for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In this respect it is known that the short-acting anesthetic propofol offers certain potential advantages for sedation during ERCP, but there are no controlled studies concerning the feasibility and safety of propofol sedation in elderly, high-risk patients. METHODS: One hundred and fifty consecutive patients aged >or=80 yr with high comorbidity (ASA score >or=III: 91 %), randomly received midazolam plus meperidine (n = 75) or propofol alone (n = 75) for sedation during ERCP. Vital signs were continuously monitored and procedure-related parameters, recovery time, and quality as well as patients' cooperation and tolerance of the procedure were assessed. RESULTS: Clinically relevant changes in vital signs were observed at comparable frequencies with a temporary oxygen desaturation (<90%) occurring in eight patients in the propofol-group and seven patients receiving midazolam/meperidine (n.s.). Hypotension was documented in two patients in the propofol group and one patient receiving midazolam/meperidine. Propofol provided a significantly better patient cooperation than midazolam/meperidine (p < 0.01), but the procedure tolerability was rated nearly the same by both groups. Mean recovery time was significantly shorter in the propofol group (22 +/- 7 min vs 31 +/- 8 min for midazolam/meperidine (p < 0.01)) while the recovery score was significantly higher under propofol (8.3 +/- 1.2 vs 6.1 +/- 1.1(p < 0.01)). During recovery a significant lower number of desaturation events (<90%) were observed in the propofol group (12%) than in the midazolam/meperidine group (26%, p < 0.01). CONCLUSION: Under careful monitoring the use of propofol for sedation during ERCP is superior to midazolam/meperidine even in high-risk octogenarians.     

Technical performance of colonoscopy in patients sedated with nurse-administered propofol

OBJECTIVES: Nurse-administered propofol has gained attention as a safe and effective means of sedation for patients undergoing endoscopic procedures. However, little is known about the effect of propofol on the technical performance of colonoscopy. METHODS: Three separate studies were conducted. In the first study, we reviewed procedure notes from consecutive colonoscopies performed by a single experienced endoscopist at our hospital endoscopy unit on patients sedated with either nurse-administered propofol (n = 162) or midazolam/narcotic (n = 164). In the second study, 100 eligible colonoscopy outpatients were randomized to receive either nurse-administered propofol (n = 50) or midazolam/fentanyl (n = 50). In both studies, the measured parameters included visualization of the cecum, time required to reach the cecum, repositioning of the patient, and the application of abdominal counterpressure. In a third study, we reviewed the rate of cecal intubation and colonic perforation in the first 2357 patients in our unit receiving nurse-administered propofol. RESULTS: In the retrospective comparative study, there was no difference in the cecal intubation rate in those receiving propofol (99.4%) compared to those receiving midazolam/narcotic (97%; p= 0.1), and three of five failed cecal intubations in the latter group resulted from obstructing masses. Patients sedated with propofol were repositioned less frequently compared to those receiving midazolam/narcotic (3.7%vs 26.2%) (p < 0.0001). Abdominal pressure was employed in 9.9% of patients sedated with propofol compared to 19.5% (p= 0.01) of those given midazolam/narcotic. The mean time to reach the cecum was lower in the propofol group than in the midazolam/narcotic group (4.6 min vs 6.0 min, p= 0.002). In the prospective randomized study, the endoscopist intubated the cecum in all 100 patients. Patients in the propofol group were repositioned less frequently than those in the midazolam/fentanyl group (2%vs 24%, respectively, p= 0.001). The number of cases requiring abdominal counterpressure was not significantly different between the propofol and midazolam/fentanyl groups (12%vs 24%, respectively, p= 0.1). The mean time to reach the cecum in the propofol group (3.2 min) was similar to that in the midazolam/fentanyl group (3.8 min, p= 0.08). Among the first 2357 patients in our unit undergoing colonoscopy with nurse-administered propofol, the rate of complete colonoscopy was 99.2% and there were no perforations. CONCLUSION: Nurse-administered propofol sedation is safe and simplifies the technical performance of colonoscopy compared to midazolam/narcotic sedation.     

Synergistic sedation with midazolam and propofol versus midazolam and pethidine in colonoscopies: a prospective,randomized study

OBJECTIVE: The aim of our study was to compare the safety and efficacy of the synergistic sedation with a low dose of midazolam combined with propofol versus the standard regimen of midazolam and pethidine for conscious sedation in colonoscopy in a group of patients that included a sufficient number of elderly patients with several comorbidities. METHODS: A total of 120 consecutive patients undergoing colonoscopy in a prospective study were randomly assigned to one of two medication regimens (55 patients were over 65 yr). Patients in group A (n = 64) received i.v. 2 mg (<70 kg b.w.) or 3 mg (>70 kg b.w.) of midazolam and a median dose of 80 mg of propofol (range 40-150). Patients in group B (n = 56) received i.v. a median dose of 5 mg of midazolam (range 3-7) and 75 mg of pethidine (range 50-125). The patient's comfort level was assessed by a 4-point scale 24 h after the procedure. The time to recover from sedation was assessed at 5, 10, and 30 min after the procedure by using the Aldrete score. RESULTS: Multivariate stepwise logistic regression analysis revealed that among sex, age, duration of the test, American Society of Anesthesiologists' Physical Status Classification grade, and the sort of sedation, the synergistic sedation with midazolam and propofol was the only factor associated with a higher level of patient comfort (chi2 = 5.5, p < 0.05). Additional multivariate stepwise logistic regression analysis revealed that among sex, age, duration of the test, American Society of Anesthesiologists' Physical Status Classification grade, and the sort of sedation, the synergistic sedation with midazolam and propofol was the only factor associated with a quicker patient recovery time (chi2 = 24.5, p < 0.01; chi2 = 51.7, p < 0.01; chi2 = 148.4, p < 0.01 for Aldrete in 10 min, 20 min, and 30 min, respectively). The endoscopist's evaluation of patient sedation and cardiorespiratory parameters were similar in both groups and in all age groups. CONCLUSIONS: Our data suggest that the synergistic sedation with a low dose of midazolam combined with propofol was superior to a standard combination of midazolam and the opioid pethidine for colonoscopies as far as the patient comfort and recovery times are concerned.     

Carbon dioxide accumulation during analgosedated colonoscopy: Comparison of propofol and midazolam

AIM: To characterize the profiles of alveolar hypoventilation during colonoscopies performed under sedoanalgesia with a combination of alfentanil and either midazolam or propofol. METHODS: Consecutive patients undergoing routine colonoscopy were randomly assigned to sedation with either propofol or midazolam in an open-labeled design using a titration scheme. All patients received 4 μg/kg per body weight alfentanil for analgesia and 3 L of supplemental oxygen. Oxygen saturation (SpO 2 ) was measured by pulse oximetry (POX), and capnography (PcCO 2 ) was continuously measured using a combined dedicated sensor at the ear lobe. Instances of apnea resulting in measures such as stimulation of the patient, a chin lift, a mask maneuver, or withholding of sedation were recorded. PcCO 2 values (as a parameter of sedation-induced hypoventilation) were compared between groups at the following distinct time points: baseline, maximal rise, termination of the procedure and 5 min after termination of the procedure. The number of patients in both study groups who regained baseline PcCO 2 values (± 1.5 mmHg) five minutes after the procedure was determined.RESULTS: A total of 97 patients entered this study. The data from 14 patients were subsequently excluded for clinical procedure-related reasons or for technical problems. Therefore, 83 patients (mean age 62 ± 13 years) were successfully randomized to receive propofol (n = 42) or midazolam (n = 41) for sedation. Most of the patients were classified as American Society of Anesthesiologists (ASA) Ⅱ [16 (38%) in the midazolam group and 15 (32%) in the propofol group] and ASA Ⅲ [14 (33%) and 13 (32%) in the midazolam and propofol groups, respectively]. A mean dose of 5 (4-7) mg of Ⅳ midazolam and 131 (70-260) mg of Ⅳ propofol was used during the procedure in the corresponding study arms. The mean SpO 2 at baseline (%) was 99 ± 1 for the midazolam group and 99 ± 1 for the propofol group. No cases of hypoxemia (SpO 2 85%) or apnea were recorded. However, an increase in PcCO 2 that indicated alveolar hypoventilation occurred in both groups after administration of the first drug and was not detected with pulse oximetry alone. The mean interval between the initiation of sedation and the time when the PcCO 2 value increased to more than 2 mmHg was 2.8 ± 1.3 min for midazolam and 2.8 ± 1.1 min for propofol. The mean maximal rise was similar for both drugs: 8.6 ± 3.7 mmHg for midazolam and 7.4 ± 3.2 mmHg for propofol. Five minutes after the end of the procedure, the mean difference from the baseline values was significantly lower for the propofol treatment compared with midazolam (0.9 ± 3.0 mmHg vs 4.3 ± 3.7 mmHg, P = 0.0000169), and significantly more patients in the propofol group had regained their baseline value ± 1.5 mmHg (32 of 41vs 12 of 42,P = 0.0004). CONCLUSION: A significantly higher number of patients sedated with propofol had normalized PcCO 2 values five minutes after sedation when compared with patients sedated with midazolam.     

Analysis of gene expression profiles for distinct stages of intestinal-type gastric cancer using suppression subtractive hybridization and cDNA microarray

Objective. Midazolam sedation for upper gastrointestinal (GI) endoscopy exacerbates minimal hepatic encephalopathy (HE) in patients with liver cirrhosis, therefore an alternative drug regimen for these patients is warranted. The aim of this randomized, controlled study was to assess whether the use of the short-acting propofol as a sedative for GI endoscopy could prevent the exacerbation of minimal HE in patients with liver cirrhosis. Material and methods. The study comprised patients with liver cirrhosis without clinical HE who had undergone upper GI endoscopy for therapeutic purposes (intended variceal band ligation). Sixty patients were randomly assigned into two groups to receive propofol (n=40) or midazolam (n=20) for upper GI endoscopy. The study groups were matched for age, gender and Child-Pugh score. All patients completed number connecting tests (NCTs), as well as a porto-systemic encephalopathy (PSE) syndrome test before and at 2 h after completion of the endoscopic procedure. Time needed to fulfill the tests was documented. Baseline results of the psychomotor test batteries were compared with the post-interventional evaluations. Data were also compared with the results of a healthy control group (n=20) that did not undergo endoscopic sedation. Recovery time and quality (score system) were evaluated. Results. The differences in the NCT times before and after sedation (median delta NCT, midazolam group, 11 s (95% CI, ?1.2 to 16.1 s) versus the propofol group, ?9.5 s (95% CI, ?15.7 to ?4.6 s), p=0.002) and in the PSE scores (median delta PSE, midazolam group, ?1 (95% CI, ?1.5 to 0.2) versus the propofol group, 1 (95% CI, 0.5 to 1.5), p=0.0009) differed significantly between the two groups. In addition, the recovery time and quality in patients receiving propofol were significantly improved compared with in the midazolam group (7.8±2.9 min versus 18.4±6.7 min, 6.1±1.1 versus 8.2±1.3, both p<0.001). Conclusions. The study demonstrates that propofol sedation for upper GI endoscopy does not cause acute deterioration of minimal hepatic encephalopathy and is associated with improved recovery in patients with liver cirrhosis. Propofol should be recommended for these patients as an alternative to midazolam.     

The effects of target-controlled infusion of lidocaine undergoing vocal cord polypectomy: A randomized controlled trial (CONSORT compliant)

Background:The present study aimed to assess the efficacy and safety of general anesthesia-assisted target-controlled plasma infusion of lidocaine in patients with vocal cord polypectomy using a supporting laryngoscope.Methods:In total, 80 patients undergoing vocal cord polypectomy using a supporting laryngoscope were randomly divided into an intervention group and a control group; each group contained 40 subjects: both groups received general anesthesia; subjects in the intervention also received an additional 3 mg/L of lidocaine by target-controlled plasma infusion during induction and maintenance of anesthesia; heart rate (HR) mean arterial pressure (MAP), propofol and urapidil consumption (Uradil, which is a blood pressure drug that blocks alpha-1, is called Urapidi Hydrochloride Injection. It is produced by Germany, the enterprise name is Nycomed Deutschland GmbH, the import drug registration number is H20090715, and it is widely used in China), recovery time, and cough score (measured by Minogue et al''s 5-grade scoring method) during extubation, and throat pain score (measured by visual analogue scale,[VAS]) after extubation and adverse events were recorded.Results:Significant differences were observed in HR (P < .05) and MAP (P < .05) immediately after intubation (T2), immediately after the operation starting to support laryngoscope exposure (T3), immediately after operation field adrenergic tampon hemostasis (T4), and 5 minutes after hemostasis (T5) between the 2 groups, and significant differences were also observed in HR (P < .05) before intubation (T1). Moreover, significant differences were observed in propofol consumption (P < .05), urapidil consumption (P < .05), cough score during extubation (P < .05), and throat pain score after extubation (P < .05). However, no significant difference was observed in the recovery time (P > .05). Furthermore, no adverse events were detected in either group.Conclusion:The results of this study showed that target-controlled plasma infusion of lidocaine can reduce propofol consumption in patients undergoing vocal cord polypectomy by supporting laryngoscopy, and the hemodynamics are more stable and reduce the coughing reaction in the wake period and throat pain after extubation without adverse events.