超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜在肥胖患者清醒气管插管中的应用效果

目的 探讨超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜在肥胖患者清醒气管插管中的应用效果。方法 选择2018年1月－2020年1月该院收治的120例拟行气管插管全身麻醉的肥胖患者作为研究对象,使用随机数表法将患者分为两组,每组各60例。观察组采用超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜气管插管,对照组采用超声引导下喉上神经阻滞联合传统光学喉镜气管插管。观察两组患者声门显露成功率、一次性气管插管成功率、总插管成功率、成功插管的平均插管时间、插管过程中呛咳发生率以及呛咳程度、血流动力学和插管相关并发症发生情况。结果 观察组声门显露成功率、一次性气管插管成功率高于对照组（P < 0.05）,成功插管的平均插管时间短于对照组（P < 0.05）,插管后1 min（T₁）和5 min（T₂）患者心率（HR）、无创收缩压（SBP）和无创舒张压（DBP）低于对照组（P < 0.05）,经皮动脉血氧饱和度（SpO₂）高于对照组（P < 0.05）,口腔出血、咽喉部损伤和气道损伤等并发症总发生率低于对照组（P < 0.05）。结论 超声引导下喉上神经阻滞联合ZX-KSHJ可视喉镜气管插管,可提高肥胖患者声门显露成功率和一次性插管成功率,缓解血流动力学波动,减少插管相关并发症发生风险。     

免充喉罩与气管内插管用于全身麻醉下经气管镜超声引导针吸活检的临床研究

目的 探讨免充喉罩与气管插管用于全身麻醉下经气管镜超声引导针吸活检（EBUS-TBNA）对患者围手术期血流动力学、气道峰压、麻醉恢复时间及围手术期不良反应的影响。方法 选择全身麻醉下行EBUS-TBNA的患者64例,随机分为喉罩组（L组,n = 32）和气管插管组（T组,n = 32）。观察两组患者麻醉诱导前（T₀）、诱导后插入喉罩/气管导管前（T₁）、诱导后插入喉罩/气管导管后即刻（T₂）、超声支气管镜置入即刻（T₃）、针吸活检时（T₄）、拔管即刻（T₅）和拔管后10 min（T₆）的血流动力力学变化;记录插入免充喉罩/气管插管后（P₁）、活检镜置入后（P₂）和拔出活检镜后（P₃）的气道峰压;记录两组患者呼吸恢复时间、清醒拔管时间、阿片类药物和顺式阿曲库铵使用量;比较两组患者围手术期不良反应发生率。结果 T组T₂和T₅时点收缩压（SBP）、舒张压（DBP）和心率（HR）均明显高于L组,差异有统计学意义（P < 0.05）;在P₂时点,T组气道峰压明显高于L组,差异有统计学意义（P < 0.05）;L组呼吸恢复时间与清醒拔管时间均短于T组,差异有统计学意义（P < 0.05）;T组瑞芬太尼使用量大于L组,差异有统计学意义（P < 0.05）;T组拔管躁动发生率高于L组,差异有统计学意义（P < 0.05）。结论 与气管插管相比,免充喉罩应用于全身麻醉下EBUS-TBNA,可维持血流动力学平稳,缩短麻醉恢复时间,是围手术期较为安全可行的麻醉管理方式。     

彩色多普勒超声观察异丙酚和依托咪酯麻醉诱导前后颈总动脉及椎动脉血流动力学改变

目的 探讨异丙酚和依托咪酯麻醉诱导前后颈总动脉及椎动脉血流动力学改变。方法 选择全麻手术患者60例,随机分为异丙酚组、依托咪酯组,每组30例。应用彩色多普勒超声检测颈总动脉及椎动脉,测量收缩期峰值流速(PSV)、舒张末期流速(EDV)、血流量(BF)、平均血流速度(Vm)、舒张期内径(Dd)、收缩期内径(Ds)等。结果 异丙酚诱导后血压、心率、颈总动脉及椎动脉Dd、Ds、BF降低(P<0.05),而PSV、EDV、Vm无明显变化(P>0.05)。依托咪酯诱导前后各指标除心率外均无明显变化(P>0.05)。结论 异丙酚较依托咪酯诱导前后颈总动脉及椎动脉BF明显降低、血流动力学改变显著。依托咪酯在稳定血流动力学方面更具优势。     

Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

BACKGROUNDSedation with propofol injections is associated with a risk of addiction, but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism. Compared to remimazolam, remimazolam benzenesulfonate has a faster effect, is more quickly metabolized, produces inactive metabolites and has weak drug interactions. Thus, remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation. AIMTo investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.METHODSA total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study. Using a random number table, patients were divided into two anesthesia induction groups of 40 patients each: remimazolam (0.3 mg/kg remimazolam benzenesulfonate) and propofol (1.5 mg/kg propofol). Hemodynamic parameters, inflammatory stress response indices, respiratory function indices, perioperative indices and adverse reactions in the two groups were monitored over time for comparison.RESULTSAt pre-anesthesia induction, the remimazolam and propofol groups did not differ regarding heart rate, mean arterial pressure, cardiac index or volume per wave index. After endotracheal intubation and when the sternum was cut off, mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group (P < 0.05). After endotracheal intubation, the oxygenation index and the respiratory index did not differ between the groups. After endotracheal intubation and when the sternum was cut off, the oxygenation index values were significantly higher in the remimazolam group than in the propofol group (P < 0.05). Serum interleukin-6 and tumor necrosis factor-α levels 12 h after surgery were significantly higher than before surgery in both groups (P < 0.05). The observation indices were re-examined 2 h after surgery, and the epinephrine, cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group (P < 0.05). The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group (P < 0.05); there were significantly fewer adverse reactions in the remimazolam group (10.00%) than in the propofol group (30.00%; P < 0.05). CONCLUSIONCompared with propofol, remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations. Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function, thereby reducing anesthesia-related adverse reactions.     

胃镜喉罩在无痛超声胃镜检查中的应用效果

目的 评价胃镜喉罩应用于无痛超声胃镜检查的可行性和安全性。方法 选取该院行无痛超声胃镜检查的患者50例,随机分为胃镜喉罩组和气管插管组。记录两组患者插管前(T₀)、插管后1 min (T₁)、拔管前1 min (T₂)和拔管后1 min (T₃)的平均动脉压(MAP)、心率(HR)、经皮动脉血氧饱和度(SpO₂)、T₁至T₂时点呼气末二氧化碳分压(PetCO₂)和气道峰压;同时记录麻醉药用量、手术时间、拔管时间和PACU监护时间;记录反流误吸及术后咽喉部并发症。结果 两组患者手术时间、T₁至T₂时点PetCO₂及气道峰压比较,差异均无统计学意义(P>0.05)。与T₀时点比较,气管插管组T₁至T₃时点MAP明显升高,HR明显增快,且相应时点均高于胃镜喉罩组(P <0.05...     

Etomidate for anesthesia induction: friends or foe in major cardiac surgery?

Use of etomidate for anesthesia induction is still debated. In the previous issue of Critical Care, Heinrich and colleagues reported that etomidate for anesthesia induction had similar outcome in comparison with other drugs, in a specific population of 3,054 patients ahead of major cardiac surgery. For the authors, the similar outcomes for mortality and length of hospital stay add to the hemodynamic stability and the improved intubation conditions to support keeping etomidate in the emergency drugs armamentarium for induction of anesthesia in patients at risk of hemodynamic failure. This commentary reviews the results and implications of their study.     

Influence of hypercapnia on cardiovascular responses to tracheal intubation

Background

Laryngoscopy and tracheal intubation are often associated with tachycardia, hypertension, and arrhythmias. There is a risk of hypercapnia in the case of difficult mask ventilation. The circulatory response to hypercapnia is increases in arterial pressure and heart rate. We evaluated the difference of cardiovascular responses to tracheal intubation between normocapnia and hypercapnia during mask ventilation before tracheal intubation.

Methods

We studied 40 ASA physical status I to II patients under general anesthesia. Induction of anesthesia was achieved with midazolam 0.05 mg/kg, propofol 1.5 mg/kg, alfentanil 10 μg/kg, and rocuronium 0.6 mg/kg IV. The lungs were mechanically ventilated with a tidal volume of 10 mL/kg and 6 to 10 bpm in the hypercapnia group (n = 20) or 12 to 15 bpm in the normocapnia group (n = 20) during the induction period. Intubation was performed 3 minutes after the induction, and anesthesia was maintained using 1.5% sevoflurane (inspired) and 75% N₂O in oxygen. Heart rate, systolic arterial pressure (SAP), and diastolic arterial pressure were recorded every minute throughout the study.

Results

The proportion of the patients whose increase of SAP between just before intubation and 1 minute after intubation was more than 30 mm Hg in the hypercapnia group (40%) was greater than that in the normocapnia group (9.5%) (P = .0325). There were no differences in heart rate and diastolic arterial pressure between hypercapnia and normocapnia groups. For the SAP of the patients, the trend of changes was increased (P = .024).

Conclusions

Hypercapnia during mask ventilation before tracheal intubation may exaggerate the increase of SAP during intubation compared to normocapnia. Ventilation was important in minimizing hemodynamic responses during induction regardless of using drugs.     

宫腔镜手术采用不同静脉全麻的效果比较

目的探讨宫腔镜手术中采用咪达唑仑复合芬太尼及丙泊酚不插管静脉全身麻醉与顺苯磺酸阿曲库铵复合咪达唑仑、芬太尼及丙泊酚气管内插管静脉全身麻醉的临床麻醉效果与安全性。方法选择妇科宫腔镜手术患者200例,按随机数字表法分为试验组和对照组各100例。试验组采用顺苯磺酸阿曲库铵复合咪达唑仑、芬太尼及丙泊酚气管内插管静脉全身麻醉,对照组采用咪达唑仑复合芬太尼及丙泊酚静脉全身麻醉。监测记录两组患者心率(HR)、平均血压(MAP)、血氧饱和度(SpO2)、术中体动、术者对麻醉满意度、手术时间、睁眼时间,术后24小时回访有无术中知晓及麻醉并发症。结果对照组术中SpO2<95%发生38例,术中体动发生8例,术者稍有不满意28例;试验组术中SpO2均维持在98%～100%,术中无体动,术者满意度100%。两组患者HR、MAP都有不同程度下降,手术时间、芬太尼及丙泊酚用量、术毕呼吸、睁眼时间、术后并发症比较差异均无统计学意义(P>0.05)。结论在宫腔镜手术中应用顺苯磺酸阿曲库铵复合咪达唑仑、芬太尼及丙泊酚气管内插管静脉全身麻醉能提供良好手术环境,便于术中呼吸管理,术后患者呼吸、意识恢复快速,是安全有效的。     

The Effectiveness of Intramuscular Dexmedetomidine on Hemodynamic Responses During Tracheal Intubation and Anesthesia Induction of Hypertensive Patients: A Randomized, Double-Blind, Placebo-Controlled Study

Background: Hypertensive patients are at risk for increased hemodynamic response to tracheal intubation. Sympatholytic drugs administered during the preinduction period may prevent adverse events.Objective: We assessed the effectiveness of a single preinduction IM bolus dose of dexmedetomidine (DMED) 2.5 μg/kg in attenuating hemodynamic responses to tracheal intubation and rapid-sequence anesthesia induction in hypertensive patients treated with angiotensin-converting enzyme inhibitors.Methods: Adult patients (American Society of Anesthesiologists classification II and III) with essential hypertension, scheduled for elective abdominal or gynecologic surgery, were enrolled in this randomized, double-blind, placebo-controlled study. Patients were assigned to i of 2 groups: the DMED group received IM DMED 2.5 μg/kg and the placebo group received IM saline 0.9% 45 to 60 minutes before induction of anesthesia. General anesthesia was induced with thiopental, fentanyl, and vecuronium and maintained with a sevoflurane-nitrous oxide-oxygen mixture. Hemodynamic values were recorded before (baseline) and after anesthesia induction, before endotracheal intubation, and 1, 3, and 5 minutes after intubation. The patients were monitored for hypotension (systolic arterial pressure [SAP] decreased ≥25% from baseline or to <90 mm Hg) or bradycardia (heart rate [HR] decreased ≥25% from baseline or to <50 beats/min).Results: Nine hundred sixty patients were assessed for enrollment during a 6-month period. Sixty patients (49 women, 11 men; mean [SD] age, 59.16 [8.39] years) were eligible for the study. There were no significant differences in baseline hemodynamic values between the groups. SAP and diastolic arterial pressure (DAP) before anesthesia induction, 1 and 3 minutes after intubation, and DAP 1 minute after intubation were significantly lower in the DMED group than in the placebo group (all, P < 0.05). There were no significant between-group differences in SAP or DAP 5 minutes after intubation. HR before anesthesia induction, before intubation, and 1, 3, and 5 minutes after intubation were lower in the DMED group than in the control group (all, P < 0.05). In the DMED group, SAP after intubation, DAP before intubation, 3 and 5 minutes after intubation, HR before induction, before intubation, and 3 and 5 minutes after intubation were significantly decreased compared with baseline values (all, P < 0.05). In the control group, SAP at all times, DAP before intubation, 1, 3, and 5 minutes after intubation, HR before intubation, and 3 and 5 minutes after intubation were significantly decreased compared with baseline values (all, P < 0.05). Hypotension and bradycardia were observed together in 3 patients, and hypotension alone was observed in 1 patient 3 minutes after intubation in the DMED group; hypotension was observed in 1 patient at 3 minutes after intubation in the control group.Conclusion: The results of this study suggest that IM DMED 2.5 μg/kg administered 45 to 60 minutes before anesthesia induction attenuated, but did not completely prevent, hemodynamic responses to tracheal intubation in these patients with essential hypertension.     

The effect of atropine on the bispectral index response to endotracheal intubation during propofol and remifentanil anesthesia

Atropine has been reported to increase the propofol requirements for the induction of anesthesia during continuous infusion of propofol. We investigated the influence of atropine on the bispectral index (BIS) response to endotracheal intubation during anesthetic induction with propofol and remifentanil target controlled infusion (TCI). Fifty-six patients aged 18–50 years undergoing general anesthesia, were enrolled. For induction of anesthesia, propofol TCI was set at a target effect-site concentration of 4.0 μg/ml. Two minutes later, remifentanil was started at an effect-site concentration of 4.0 ng/ml. Four minutes after the start of propofol TCI, patients received either atropine (10 μg/kg) or an equal volume of normal saline. Tracheal intubation was performed 10 min after anesthetic induction. Mean arterial pressure, HR, SpO₂, and BIS were recorded during the 15 min-anesthesia induction. From 2 to 5 min after tracheal intubation, BIS was significantly higher in the atropine group than in the control group (p = 0.043, 0.033, 0.049, and 0.001, respectively). When compared with baseline values (immediately before intubation), BIS showed a significant increase at 1 min after intubation in both groups, without intergroup differences, whereas it decreased significantly from 4 to 5 min after intubation only in the control group. This study demonstrated that atropine maintained BIS increases in response to endotracheal intubation during anesthetic induction with propofol and remifentanil TCI, although the maximal response did not differ between the groups.     

Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia

Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco ₂ of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco ₂ (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.     

不同剂量舒芬太尼对病人气管插管血流动力学的影响

目的比较不同剂量舒芬太尼复合异丙酚对病人气管插管血流动力学及脑电双频谱指数的影响,探讨舒芬太尼有效抑制气管插管应激反应的合适剂量。方法 60例择期全麻手术病人随机分为三组,每组20例,舒芬太尼剂量分别为0.2μg/kg（Ⅰ组）、0.3μg/kg（Ⅱ组）、0.4μg/kg（Ⅲ组）。3 min后三组均静脉注射异丙酚2 mg/kg和维库溴胺0.1 mg/kg麻醉诱导,经口气管内插管。记录麻醉诱导前（T0）、静脉注射舒芬太尼后（T1）、静脉注射异丙酚后（T2）、气管插管即刻（T3）、插管后3 min（T4）的收缩压（SBP）、舒张压（DBP）、心率（HR）、脑电双频谱指数（BIS）的变化。结果与T0比较,T1时三组SBP、DBP、BIS比较差异无统计学意义（P〉0.05）,T2时三组SBP、DBP、BIS明显下降（P（0.05或P（0.01）,T3时Ⅰ组SBP、DBP、BIS明显升高（P〈0.05）;与Ⅱ组比较,T3时Ⅰ组SBP、DBP、BIS明显升高（P〈0.05）;三组间各时点HR比较差异无统计学意义。结论应用舒芬太尼0.3μg/kg复合异丙酚2 mg/kg麻醉诱导能有效抑制气管插管应激反应,并维持插管期间血流动力学稳定,是临床使用的合理剂量。     

不同速度的恒速输注方式与靶控输注方式输注丙泊酚对老年患者全麻诱导插管过程中生命体征的影响

目的探讨不同速度的恒速输注方式与靶控输注方式输注丙泊酚对老年患者全麻诱导插管过程中生命体征的影响。方法选择60例老年择期行全麻手术患者,按入院顺序随机分为两组,每组30例,对照组患者使用靶控输注方式输注丙泊酚进行麻醉,研究组患者使用不同速度的恒速输注方式输注丙泊酚进行麻醉。比较两组患者血流动力学变化情况及诱导过程和插管过程血压变化情况。结果研究组患者血流动力学波动较对照组平稳,对照组插管前(T1)、插管即刻(T2),插管5 min后(T3)较麻醉诱导前及研究组变化明显,比较差异具有统计学意义(P0.05);对照组患者麻醉诱导及插管过程中血压改变过30%共21例,明显高于研究组5例,比较差异具有统计学意义(P0.05)。结论不同速度的恒速输注方式输注丙泊酚对老年患者进行全麻诱导时,对其心脑血管等抑制作用较小,操作简单易控制,值得临床推广应用。     

Efficacy and Tolerability of Sufentanil,Dexmedetomidine, or Ketamine Added to Propofol-based Sedation for Gastrointestinal Endoscopy in Elderly Patients: A Prospective,Randomized, Controlled Trial

PurposeTo investigate the optimal agent combined with propofol for sedation in elderly patients undergoing gastrointestinal endoscopy.MethodsA total of 120 elderly patients scheduled for gastrointestinal endoscopy under propofol-based sedation were randomly allocated to receive propofol + saline (control group), propofol + sufentanil 0.1 μg/kg, propofol + dexmedetomidine 0.4 μg/kg, or propofol + ketamine 0.4 mg/kg. Mean arterial pressure, heart rate, pulse oximetry, pressure of end-tidal carbon dioxide, respiratory rate, and Ramsay sedation scale score were recorded. Induction time, procedure time, recovery time, propofol dose, and adverse events were also recorded.FindingsDuring the sedation procedure, the AUC of HR was lowest in the propofol + dexmedetomidine group (all, P < 0.05), and the AUC of pulse oximetry was significantly higher in the propofol + dexmedetomidine and propofol + ketamine groups compared to the other 2 groups (both, P < 0.05). The propofol + dexmedetomidine group had the highest prevalences of hypotension and bradycardia, and the control group experienced the largest number of hypoxia episodes (all, P < 0.05). The control group consumed the highest dose of propofol, while the propofol + ketamine group needed the lowest dose (all, P < 0.05).ImplicationsThe combination of propofol + ketamine 0.4 mg/kg maintained hemodynamic and respiratory stability, as evidenced by less hypotension, bradycardia, and hypoxia events, in elderly patients undergoing gastrointestinal endoscopy. China clinical trial registration (chictr.org.cn) ID: ChiCTR-INR-17013710.     

全凭静脉麻醉下叠加式高频喷射通气在硬质气管镜诊疗中的应用

目的探讨全凭静脉麻醉下叠加式高频喷射通气(SHFJV)与高频喷射通气(HFJV)联合间断手控通气两种通气方式在硬质气管镜诊疗中的应用效果。方法回顾性分析2016年9月-2020年12月80例该院行硬质气管镜诊疗患者的临床资料,根据不同通气方式分为SHFJV与HFJV两组。比较两组患者入室时(T_1)、插管时(T_2)、机械通气10 min (T_3)、机械通气20 min (T_4)、术毕(T_5)的心率(HR)和平均动脉压(MAP)以及T_1、T_3、T_4、T_5时点的动脉血气分析结果 [酸碱度(pH)、氧合指数(PaO_2/FiO_2)、动脉血二氧化碳分压(PaCO_2)]和术中不良事件(血流动力学不稳事件、低氧血症、高碳酸血症、恶性心律失常、气道痉挛、是否中止手术)。结果硬质气管镜诊疗期间,两组患者T_2时点HR、MAP与T_1时点比较,差异无统计学意义(P 0.05),T_3、T_4和T_5时点MAP较T_1时点明显下降(P 0.05),T_3和T_4时点pH和PaO_2/FiO_2较T_1时点明显下降,PaCO_2较T_1时点明显上升(P 0.05);组间比较,SHFJV组T_3、T_4和T_5时点pH和PaO_2/FiO_2明显较高,PaCO_2明显较低(P 0.05),HFJV组术中血流动力学不稳事件及高碳酸血症发生率较高(P 0.05)。结论全凭静脉麻醉下SHFJV在硬质气管镜诊疗中的应用安全、可行,值得临床推广使用。     

依托咪酯静脉麻醉疗效观察

目的观察依托咪酯用于静脉维持麻醉的临床疗效。方法选择择期行2h之内手术病人100例,随机分为依托咪酯组（E组）和丙泊酚组（P组）,每组50例。2组病人麻醉诱导一致,E组采用依托咪酯维持剂量为7～15μg/（kg.min）,P组采用丙泊酚的维持剂量为60～160μg/（kg.min）。观察2组麻醉前、诱导后5、30、60min,拔管时心血管反应、苏醒的情况及术毕不良反应。结果P组病人诱导后30、60min平均动脉压（MAP）均低于麻醉前（P〈0.05）;E组血压较P组更为平稳（P〈0.05）;2组病人术毕苏醒时间及不良反应比较差异无统计学意义（P〉0.05）。结论依托咪酯用于静脉维持麻醉平稳,苏醒迅速。     

布托啡诺与舒芬太尼复合丙泊酚用于无痛肠镜中的效果研究

目的 探讨布托啡诺和舒芬太尼在无痛肠镜检查中的应用效果。方法 选择2021年1月-2022年1月该院收治的无痛肠镜检查患者200例，根据不同的麻醉方案分为舒芬太尼组(S组，100例)和布托啡诺组(B组，100例)。比较两组患者不同时点的生命体征参数、丙泊酚总用量、麻醉苏醒时间、麻醉诱导时间、术中术后不良反应发生率和术后清醒30 min的视觉模拟评分(VAS)。结果 两组患者在T₂和T₃时点平均动脉压(MAP)和心率(HR)均低于T₁时点，且呈现逐渐下降的趋势，B组高于S组，下降趋势相对缓慢(P<0.05)。T₄和T₅时点，两组患者的MAP和HR恢复至麻醉前水平，组间比较，差异均无统计学意义(P>0.05)。两组患者各时点组间和组内的经皮动脉血氧饱和度(Sp O)₂比较，差异均无统计学意义(P>0.05)。两组患者丙泊酚总用量、麻醉苏醒时间及麻醉诱导时间比较，差异均无统计学意义(P>0.05)。B组术中心动过缓、呛咳、术后恶心和呕吐发...     

利多卡因雾化吸入复合丙泊酚在小儿纤维支气管镜检查中的应用研究

目的 探讨利多卡因雾化吸入复合丙泊酚在小儿纤维支气管镜检查中的作用。方法 纳入80例行纤维支气管镜检查的小儿患者,采用随机数表法分为对照组和研究组。对照组予以丙泊酚静脉麻醉,研究组予以利多卡因雾化吸入复合丙泊酚静脉麻醉。对比两组患儿纤维支气管镜检查基础情况(包括检查时间、一次检查成功率和呛咳情况)和镇静满意率,记录纤维支气管镜检查前(T₁)、检查开始即刻(T₂)、检查开始后1 min (T₃)、检查开始后5 min (T₄)和检查结束即刻(T₅)的血流动力学指标[包括心率(HR)、平均动脉压(MAP)和经皮动脉血氧饱和度(Sp O₂)]和不良反应发生率。结果 研究组检查时间短于对照组[(15.14±2.03)和(18.26±2.65) min](P<0.05),呛咳评分低于对照组[(2.13±0.33)和(2.86±0.47)分](P<0.05);两组患儿一次检查成功率比较,差异无统计学意义(P>0.05);研究组镇静满意率为97.50%...     

瑞芬太尼与芬太尼用于气管插管及麻醉苏醒期血流动力学与拔管条件的比较

目的：研究瑞芬太尼与芬太尼对患者气管插管及苏醒期血流动力学变化与拔管条件的比较。方法：40例择期颅脑手术的患者麻醉诱导和麻醉维持分别用瑞芬太尼（R组）或芬太尼（F组）。观察气管插管及苏醒期血流动力学变化与拔管条件等情况。结果：麻醉诱导后气管插管1～5min内血流动力学变化幅度R组明显小于F组（P〈0．05）；术后苏醒恢复状况及拔管条件R组优于F组（P〈0．05）。结论：瑞芬太尼在气管插管和麻醉苏醒期的血流动力学更稳定，拔管条件优，并发症少。     

Right ventricular ejection fraction during orthotopic liver transplantation: Does anesthetic technique make a difference?

PurposeThe objective of this study is to evaluate the right ventricular ejection fraction (RVEF) during orthotopic liver transplantation (OLT) under 2 different anesthetic regimens: propofol vs isoflurane anesthesia.MethodsWe retrospectively analyzed the hemodynamic data of 25 (n = 25) patients who underwent OLT during the last year (2008). All patients were monitored with a modified pulmonary artery catheter, which continuously measured the RVEF. Anesthetic technique consisted of either isoflurane or total intravenous anesthesia with propofol. Surgical technique was similar between groups.ResultsTen (n = 10) patients comprised the isoflurane group (I), whereas 15 (n = 15) patients received propofol anesthesia (P). The RVEF was not significantly different between groups (I vs P, baseline: 41% ± 9% vs 40% ± 6%; anhepatic phase: 36% ± 8% vs 35% ± 6%; postreperfusion: 41% ± 6% vs 41% ± 8%; P = not significant).ConclusionsThe choice between propofol and isoflurane seems to have minimal influence on the RVEF during OLT, which followed similar trends regardless of the anesthetic technique.