Effects of propofol and midazolam on lipids, glucose, and plasma osmolality during and in the early postoperative period following coronary artery bypass graft surgery: a randomized trial

It is not clear how levels of serum lipids and glucose and plasma osmolality change during propofol infusion in the pre- and postoperative period of coronary artery bypass graft surgery (CABG). This prospective, randomized, controlled trial evaluated changes in these parameters during propofol or midazolam infusion during and in the early postoperative period following surgery. Twenty patients undergoing CABG were randomized preoperatively into two groups: 10 patients received propofol (induction 1.5 mg/kg, maintenance 1.5 mg kg(-1) h(-1)) and 10 patients received midazolam (induction 0.5 mg/kg, maintenance 0.1 mg kg(-1) h(-1)). Both groups also received fentanyl (induction 20 mug/kg, maintenance 10 microg kg(-1)). Serum lipids, glucose, and plasma osmolality were measured preinduction, precardiopulmonary bypass, at the end of cardiopulmonary bypass, at the end of surgery, and 4 and 24 h postoperatively. In the propofol group, we observed a significant increase in triglycerides and very low-density lipoprotein levels 4 h postoperatively. In the midazolam group, we observed a significant decrease in low-density lipoprotein, cholesterol at the end of cardiopulmonary bypass, end of surgery, and 4 and 24 h postoperatively and significant increase in osmolality at the end of cardiovascular bypass. Changes in glucose levels did not differ significantly different between the two groups. In patients with normal serum lipids, glucose, and plasma osmolality undergoing CABG, propofol infusion for maintenance anesthesia is not associated with dangerous changes in serum lipids, glucose, and plasma osmolality compared with midazolam. A propofol infusion technique for maintenance of anesthesia for cardiac surgery where serum lipids and glucose may be of concern could be recommended as an alternative to midazolam.     

Influence of demographic factors, basic blood test parameters and opioid type on propofol pharmacokinetics and pharmacodynamics in ASA I-III patients

The aim of the study was to examine population pharmacokinetics (PK) and pharmacodynamics (PD) of propofol (CAS 2078-54-8) during total intravenous anesthesia monitored by spectral frequency index (SFx). Twenty-eight patients of ASA physical status I-III (ASA: American Society of Anesthesiologists) scheduled for laparoscopic cholecystectomy were included. In group I an anesthesia was induced with a bolus of propofol (2 mg/kg) and remifentanil (CAS 132875-61-7) (1.0 microg/kg), followed by a continuous infusion of remifentanil. In group II, an alfentanil (CAS 71195-58-9) (10 microg/kg) bolus dose was followed by a continuous infusion of alfentanil. The general anesthetic technique included propofol, opioid and muscle relaxant. During anesthesia, the propofol infusion rate (3-8 mg/kg/h) was adjusted to the SFx value. Venous blood samples were collected from the patients during 240 min after termination of the infusion. A two compartment model was used to describe propofol PK. A standard effect compartment model was used to describe the delay between the effect and the concentration of propofol. The SFx index was linked to the effect site concentrations through a sigmoidal Emax model. The influence of continuous (body weight, age, blood pressure, heart rate and blood oxygenation, serum protein, the erythrocyte count, hemoglobin and hematocrit, serum creatinine and creatinine clearance) and categorical (gender and the type of opioid) covariates on the pharmacokinetic and pharmacodynamic parameters was investigated. PK/PD analysis was performed using NONMEM. All the screened covariates did not influence propofol PK and PD, except of the opioid type. The central compartment volume of propofol was larger in the presence of remifentanil than in the presence of alfentanil.     

靶控输注异丙酚复合瑞芬太尼在老年人腹腔镜胆囊切除术中的应用

目的探讨异丙酚复合瑞芬太尼靶控输注（Target—controlled infusion,TCI）全凭静脉麻醉用于老年人腹腔镜胆囊切除术（Laparoscopic Cholecystectomy,LC）的可行性及安全性。方法择期LC手术老年患者56例,美国麻醉医师协会（American Society of Anesthesiologists,ASA）分级Ⅰ-Ⅱ级,心肺功能正常。随机等分为静吸麻醉组（I组）和静脉全麻组（T组）,两组均以咪选唑仑、异丙酚、芬太尼、雏库溴铵诱导后做气管插管。麻醉维持：静吸麻醉组（Ⅰ组,n=28例）采用3％异氟醚吸入诱导,1％-2．5％维持,间断辅以瑞芬太尼静注;全凭静脉组（T组,n=28例）将瑞芬太尼和异丙酚混合液持续恒速输入,诱导时设定瑞芬太尼血浆靶浓度为4—8ns／ml,异丙酚为3～5μg／ml,术中根据血压、心率调整靶浓度．术中监测心率（heart rate,HR）、收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、平均动脉压（mean arterial pressure,MAP）等指标及手术结束至自主呼吸、睁眼、拔除气管导管、恢复定向能力的时间等。结果两组间的拔管时间、清醒程度有显著差异。静吸麻醉组（Ⅰ组）在气腹后10min的HR、SBP、DBP及术毕明显高于术前基础值（P〈0．05或P〈0．01）,而全凭静脉组术中无明显变化,术后恶心呕吐发生率也明显低于静吸组。结论异丙酚复合瑞芬太尼靶控输注静脉麻醉用于老年人腹腔镜胆囊切除术可达满意的麻醉深度,具有苏醒快,围术期血压、心率变化幅度小,能降低术后恶心呕吐的发生,患者安全系数高等优点,且无吸入麻醉药的手术室空气污染,优于异氟醚吸人麻醉方法。     

右美托咪啶和曲马多预防宫腹腔镜联合手术患者术后寒颤效果比较

目的比较右美托咪啶和曲马多预防宫腹腔镜联合手术患者术后寒颤的效果。方法择期行宫腹腔镜联合手术患者120例,采用随机数字表法将其分为3组（n=40）：右美托咪啶组（D组）,曲马多组（T组）和生理盐水对照组（N组）。麻醉诱导：依次静注咪达唑仑0．1mg／kg、舒芬太尼0．25肛∥kg和顺式阿曲库铵0．15mg／kg,TCI丙泊酚血浆浓度3．0ng／ml。插入喉罩后行机械通气。麻醉维持：静脉泵注瑞芬太尼0．1μg/（kg·min）,TCI丙泊酚血浆浓度3．Ong/m1,间断静脉注射顺阿曲库铵0．1mg／kg,手术开始缝皮时三组分别静脉泵注右美托咪啶0．5μg/kg、曲马多2mg／kg和0．9％NaCl。结果与N组相比,D组和T组术后寒颤的发生率降低（P〈0．05）。与D组和N组相比,T组术后1h内不良事件发生率升高（P〈0．05）。结论右美托咪啶和曲马多可降低宫腹腔镜联合术后寒颤的发生率,对苏醒时间影响小,且右美托咪啶的不良反应发生率低于曲马多。     

丙泊酚或异氟醚对重度脑损伤患者Barthel指数的影响比较

目的 比较丙泊酚或异氟醚麻醉对硬膜外血肿重度脑损伤患者Baahel指数的影响.方法 行硬膜外血肿清除术重度脑损伤患者84例,随机分为A、B两组,每组42例;两组麻醉诱导方式相同,麻醉维持:A组靶控输注丙泊酚2.5～3.0μg/ml(血药浓度),B组吸入异氟醚1.5％～2.0％,两组均靶控输注瑞芬太尼4 ng/ml(效应室浓度);记录两组患者麻醉前(T0)、诱导后2 min(T1)、插管后10min(T2)、30 min(T3)心率(HR)、动脉血二氧化碳分压(PaCO2)、动脉血氧(CaO2)、血氧饱和度(SaO2)以及S100B蛋白浓度,评价术后1个月两组Barthel指数.结果 诱导后A组HR为(76.41±12.49)次/min、CaO2为(111.98± 15.64) ml/L,诱导后B组HR为(82.34±12.45)次/min,CaO2(109.41±17.12)ml/L,与A组比较,HR显著升高,CaO2显著降低(均P＜0.05);术后两组S100B蛋白浓度均有上升,但A组[(1.25±0.78)μg/L]显著低于B组[(1.61±0.42)μg/L],P＜0.05;A组术后Barthel指数优良率为57.14％,较B组的30.95％高(P＜0.05).结论 丙泊酚较异氟醚对重度颅脑损伤患者能降低脑氧代谢率,减少脑神经损伤,更具有脑保护作用.     

Cost-effectiveness of propofol anesthesia using target-controlled infusion compared with a standard regimen using desflurane.

The cost-effectiveness of propofol anesthesia using target-controlled infusion (TCI) versus a standard regimen using desflurane for anesthesia maintenance was analyzed. This observational study consisted of 100 inpatients 18 to 75 years old with an American Society of Anesthesiologists physical status of I or II who were scheduled for otological surgery lasting less than four hours. Patients received one of two treatments. The desflurane-maintenance group received propofol 2-4 mg/kg and sufentanil 0.15-0.30 microg (as the citrate)/kg. A constant fresh gas flow of 1 L/min was used during maintenance of anesthesia. The propofol-maintenance group received TCI propofol and an additional infusion of sufentanil. Anesthesia was induced with 0.15-0.30 microg/kg. One blinded evaluator assessed the postoperative recovery from anesthesia for all patients. The cost of drugs and medical devices used during the intraoperative and postoperative periods was calculated. Effectiveness was defined as the absence of postoperative nausea and vomiting (PONV), while the cost-effectiveness of each procedure was the cost per PONV-free episode. The efficiency of each procedure represented the production of effectiveness per dollar invested. Chi-square and t tests, sensitivity analysis, and logistic regression were also performed. The only intergroup difference detected was the frequency of PONV occurring in the early recovery phase (11 in the desflurane group versus 2 in the propofol group). Of those patients requiring antiemetic rescue, 9 were in the desflurane group and only 2 were in the propofol group (p < 0.05). The TCI propofol regimen was more expensive than the desflurane regimen ($45 versus $28 per patient, respectively) (p < 0.001). The differential cost-effectiveness ratio was $94.7 per PONV-free episode. PONV 24 hours after surgery and patient satisfaction were similar between groups. A standard regimen of desflurane was more cost-effective than TCI propofol for anesthesia maintenance in achieving PONV-free episodes.     

靶控输注异丙酚复合瑞芬太尼或舒芬太尼喉罩麻醉的效果研究

目的比较靶控输注瑞芬太尼或舒芬太尼对异丙酚喉罩麻醉作用的影响。方法60例择期手术患者,分别采用异丙酚（P组,n=20）、异丙酚瑞芬太尼（PR组,n=20）、异丙酚舒芬太尼（PS组,n=20）静脉靶控输注。瑞芬太尼麻醉诱导时靶浓度为4 ng/ml,术中维持靶浓度调节范围为2～6 ng/ml,舒芬太尼诱导时靶浓度为0.5 ng/ml,术中维持靶浓度调节范围为0.2～1 ng/ml,预期手术结束前30 min靶浓度设定为0.2 ng/ml,异丙酚初始靶浓度为2μg/ml,逐渐增加靶浓度值直至意识消失。术中调整异丙酚、瑞芬太尼、舒芬太尼靶浓度维持麻醉深度。观察喉罩置入前后血流动力学、以及麻醉药用量、麻醉后恢复情况。结果三组患者诱导后收缩压（SP）、舒张压（DP）明显降低（P值〈0.05）,PR组心率明显减慢（P值〈0.05）,PR、PS组喉罩置入前后SP、DP无明显改变,P组则明显升高（P值〈0.05）。PR组、PS组异丙酚麻醉维持用量分别较P组降低32.7%、35.5%（P值〈0.05）。PS组睁眼时患者自主呼吸的ET-CO2值明显高于P组和PR组（P值〈0.05）,停药至患者自主呼吸ET-CO2降至45mmHg以下的时间也明显长于P组和PR组（P值〈0.05）。结论瑞芬太尼、舒芬太尼均能明显减少全静脉喉罩麻醉时异丙酚用量,抑制喉罩置入的反应,但舒芬太尼会延迟麻醉苏醒期喉罩拔除时间。     

Influence of atropine on the dose requirements of propofol in humans

OBJECTIVE: The purpose of this study was to evaluate the effect of atropine on the dose requirement of propofol for induction of anesthesia and propofol concentrations during continuous infusion. METHODS: Study 1: Forty patients were randomly allocated to the control or atropine groups. Induction of anesthesia commenced 3 min following the administration of 0.9% saline or atropine (0.01 mg kg(-1)), using a Diprifuser set to achieve propofol concentration of 6.0 microg mL(-1). The primary end point was the propofol dose per kg at the moment of loss of response to a command. Study 2: Fifteen patients undergoing elective surgery were enrolled. Propofol was administered to all subjects via target-controlled infusion to achieve a propofol concentration at 2.0 microg mL(-1) after intubation. Before and after administration of atropine (0.01 mg kg(-1)), cardiac output (CO) was measured using indocyanine green as an indicator and blood propofol concentration was determined using high-performance liquid chromatography. RESULTS: Study 1: The propofol dose for each group was 2.22+/-0.21 mg kg(-1) for control group and 2.45+/-0.28 mg kg(-1) for atropine, respectively (p=0.014). Study 2: After the administration of atropine, CO was significantly increased from 4.28+/-0.83 to 5.76+/-1.55 l min(-1) (p<0.0001). Propofol concentration was significantly decreased from 2.12+/-0.28 to 1.69+/-0.27 microg mL(-1) (p<0.0001). CONCLUSIONS: Following the administration of atropine, the propofol requirements for the induction of anesthesia were increased and propofol concentrations were decreased during continuous infusion by the administration of atropine.     

七氟烷和丙泊酚麻醉对老年患者POCD的影响

目的研究应用七氟烷和丙泊酚麻醉对老年患者的影响。方法选择全麻下行择期非心脏手术且年龄≥60岁的老年患者30例,随机分为丙泊酚（P组）和七氟烷（I组）麻醉组和对照组,根据需要输血·麻醉诱导：两组患者静脉注射丙泊酚1．5～2．0ml／kg,芬太尼3-4μg／kg,维库溴铵0．1mg／kg行麻醉诱导。结果患者术后1h两组差异有显著性（P〈0．05）,术后4hP组MMSE评分较术前有所下降,但差异无显著性（P〉0．05）,术后4hP组差异无显著性（P〉0．05）,术后4h差异有显著性（P〈0．05）。术后24h及48h两组MMSE评分与术前比较差异无显著性（P〉0．05）。结论接受丙泊酚或七氟烷麻醉的老年患者非心脏手术POCD降低。     

Pharmacokinetics of nimodipine in patients with aneurysmal subarachnoid haemorrhage

Summary Patients with a ruptured supratentorial aneurysm undergoing early surgery after the subarachnoid haemorrhage were treated postoperatively with nimodipine to prevent delayed ischaemic dysfunction. It was given first as a continuous intravenous infusion 2 mg/h (mean dose 0.5 µg/kg/min) for at least 7 days, and then orally (45 mg × 6) for at least a further 7 days. During the i.v. infusion, the mean plasma concentration was 26.6±1.8 ng/ml. The plasma clearance ranged from 0.57 to 1.77 l/kg/h and was negatively correlated with the age of the patient. Immediately prior to successive oral doses, the mean plasma concentration was 13.2 ng/ml (range<3–38.8 ng/ml). The peak level was usually found after 1 h; it ranged from 7.0–96.0 ng/ml. Mean bioavailability was 15.9%. The nitropyridine metabolite was found in measurable concentrations only after oral treatment with nimodipine. In some cases, the concentration of metabolite exceeded that of the parent compound. The three patients investigated who developed delayed ischaemic dysfunction had plasma concentrations well within the range in patients who did not, so it seems unlikely that the therapeutic failure could be attributed to individual deviations in the pharmacokinetics of the drug.     

两种不同麻醉方法对胸科手术后持续硬膜外镇痛效果的影响

目的比较胸段硬膜外阻滞复合全身麻醉与静脉全身麻醉对胸科手术后持续硬膜外镇痛的效果。方法20例行食管癌根治术患者随机分为两组：胸段硬膜外阻滞复合全身麻醉组（GEA组）和静脉全身麻醉组（GA组）,每组10例。术毕均采用0．125％罗哌卡因和0．5μg/ml舒芬太尼硬膜外持续镇痛,观察术后6h、12h、24h和48h的静息和咳嗽疼痛视觉模拟评分（VAS）、生命体征、辅助药用量、有或无恶心、呕吐、皮肤瘙痒等副作用。结果GEA组在静止和活动状态下术后6h、12h、24h的VAS评分小于GA组,差异有显著意义（P〈0．05）;GEA组在术后12h和24h时MAP低于GA组,差异有显著意义（P〈0．05）,两组在各时点呼吸频率和脉搏氧饱和度的差异均无显著意义（P〉0．05）。结论胸段硬膜外阻滞复合全身麻醉比静脉全身麻醉开胸术后硬膜外镇痛效果更好。     

Intravenous voriconazole therapy in a preterm infant

A preterm infant younger than 3 months developed a disseminated fluconazole-resistant Candida albicans infection that was treated with liposomal amphotericin B for 52 days, followed by the combination of intravenous voriconazole and liposomal amphotericin B for an additional 19 days. The infant received concomitant phenobarbital throughout the hospital stay. The infection resolved after addition of voriconazole to the treatment regimen. Intravenous voriconazole was begun at a high dosage, 6 mg/kg every 12 hours, for anticipated developmental and drug-induced changes in volume of distribution and clearance. On day 4 of therapy, serum concentrations of voriconazole were 3.27 microg/ml immediately after infusion and 0.33 microg/ml 6 hours after infusion. These levels were significantly lower than those achieved in adult pharmacokinetic and safety studies. After the infant's dosage was increased to 6 mg/kg every 8 hours, serum concentrations were 5.33 microg/ml 30 minutes after infusion and 2.67 microg/ml 6 hours after infusion. These levels were similar to those observed in adults. Intravenous voriconazole 6 mg/kg every 8 hours was administered safely, with concomitant phenobarbital therapy, in this preterm infant with developmentally diminished renal function.     

BIS引导异丙酚镇静辅助椎管内麻醉在腹腔镜手术中的应用研究

目的探讨脑电双频指数（BIS）引导异丙酚靶控输注辅助椎管内麻醉行腹腔镜手术的可行性和优越性。方法选择腹腔镜手术患者60例,随机分为A、B组,每组30例。两组患者均行腰-硬联合麻醉并将麻醉平面控制在T6～T8水平,平面固定后先静脉注射芬太尼1μg/kg（10μg/ml）再以异丙酚镇静,A组在BIS监测下靶控输注异丙酚;B组异丙酚静脉注射负荷剂量后持续静脉泵注。观察两组麻醉前后生命体征的变化情况;比较两组异丙酚用量、手术时间、术后苏醒时间、输液量及不良反应发生情况。结果与B组比较,A组患者手术过程生命体征较稳定,无明显波动,不良反应少;异丙酚用量明显减少,术后苏醒较快（P〈0.05）。结论 BIS引导异丙酚靶控输注辅助椎管内麻醉行腹腔镜手术可精确调控麻醉深度并降低异丙酚用量,减少不良反应,是一种安全有效的麻醉方法。     

瑞芬太尼复合丙泊酚靶控输注在小儿脑瘫手术中的应用

目的 评价瑞芬太尼复合丙泊酚全凭(TCT)静脉麻醉用于小儿脑瘫的临床效果.方法 选择择期需全麻下行肌力肌张力调整术或者行颈动脉剥脱术手术的患儿50例,随机分成A组和B组各25例.A组麻醉诱导(咪达唑仑0.2 mg/kg、丙泊酚1.0 mg/kg、瑞芬太尼1.5 μg/kg、琥珀胆碱2 mg/kg).麻醉维持连续靶控输注丙泊酚2~4 mg/(kg·h)微量持续泵注瑞芬太尼0.1~0.25 μg/(kg·min)能用肌松剂的维库溴胺0.03 μg/(kg·min)B组麻醉实施中麻醉诱导中瑞芬太尼改用芬太尼0.5~1 μg/kg麻醉维持中微量泵持续泵入瑞芬太尼改为间断推注芬太尼0.1 μg/(kg·min)其余药物使用方法及剂量同A组.结果 丙泊酚联合瑞芬太尼比丙泊酚联合芬太尼更能有效的控制麻醉诱导和手术过程中血压和心率的上升 并且使用瑞芬太尼组的患儿苏醒时间及拔管时间较使用芬太尼组明显缩短,术中丙泊酚的用量也大大减少.结论 丙泊酚联合瑞芬太尼适用于脑瘫患儿手术,且效果优于丙泊酚联合芬太尼.     

Effect of dexmedetomidine on propofol requirements in healthy subjects

Dexmedetomidine-propofol pharmacodynamic interaction was evaluated in nine healthy subjects in a crossover design. Dexmedetomidine/placebo was infused using a computer-controlled infusion pump (CCIP) to maintain a pseudo-steady-state plasma concentration of 0.66 +/- 0.080 or 0 ng/mL, respectively. Forty-five minutes after the dexmedetomidine/placebo infusion was started, propofol was infused using a second CCIP to achieve a stepwise logarithmically ascending propofol concentration (1.00 to 13.8 microg/mL) profile. Each propofol step lasted 10 min. Blood was sampled for plasma concentration determination, and pharmacodynamic endpoint assessments were made during the study. Propofol and dexmedetomidine/placebo infusions were terminated when three endpoints (subjects were too sedated to hold a syringe, followed by loss of eyelash reflex, followed by loss of motor response to electrical stimulation) were achieved sequentially. The concentration of propofol associated with 50% probability of achieving a pharmacodynamic endpoint in the absence of dexmedetomidine (EC50; placebo treatment) was 6.63 microg/mL for motor response to electrical stimulation and ranged from 1.14 to 1.98 microg/mL for the ability to hold a syringe, eyelash reflex, and sedation scores. The apparent EC50 values of propofol (EC50APP; concentration of propofol at which the probability of achieving a pharmacodynamic endpoint is 50% in the presence of dexmedetomidine concentrations observed in the current study; dexmedetomidine treatment) were 0.273, 0.544-0.643, and 3.89 microg/mL for the ability to hold a syringe, sedation scores, and motor response, respectively. Dexmedetomidine reduced propofol concentrations required for sedation and suppression of motor response. Therefore, the propofol dose required for sedation and induction of anesthesia may have to be reduced in the presence of dexmedetomidine.     

Use of Target Controlled Infusion to Derive Age and Gender Covariates for Propofol Clearance

BACKGROUND AND OBJECTIVE: Attempts to describe the variability of propofol pharmacokinetics in adults and to derive population covariates have been sparse and limited mainly to experiments based on bolus doses or infusions in healthy volunteers. This study aimed to identify age and gender covariates for propofol when given as an infusion in anaesthetized patients. STUDY DESIGN AND SETTING: One hundred and thirteen patients (American Society of Anesthesiologists class I or II and aged 14-92 years) were anaesthetized for elective surgical procedures with propofol using a target controlled infusion (TCI) system and with alfentanil as a baseline analgesic infusion. Frequent venous blood samples were obtained for measurement of propofol plasma concentrations. PHARMACOKINETIC AND STATISTICAL ANALYSIS: Pharmacokinetic accuracy was determined by the percentage prediction error, bias and precision, as were wobble and divergence. The clearance of propofol from the central compartment was determined for each patient using the computerized record of the infusion profile delivered to each patient, together with relevant blood propofol concentration estimations. For each patient, the nonlinear mixed-effects modelling (NONMEM) objective function was employed to determine the goodness of fit. RESULTS: The population distribution of propofol clearance was subsequently found to have a Gaussian distribution only in the log domain (mean value equivalent to 26.1 mL/kg/min). The distribution in the normal domain was consequently asymmetric, with a slight predominance of patients with high values of clearance (5% and 95% confidence limits 17.7 and 42.1 mL/kg/min, respectively). Using regression analysis, gender and age covariates were derived that optimized the performance of the target controlled infusion system. The clearance (CL) of propofol in male patients changed little with age (CL [mL/kg/min]=26.88-0.029xAge; r2=0.006) whereas that in female patients had a higher initial value but decreased progressively with age (CL [mL/kg/min]=37.87-0.198xAge; r2=0.246). CONCLUSION: We achieved a relatively simple and practical covariate model in which the variability of pharmacokinetics within the study population could be ascribed principally to variability in clearance from the central compartment. Pharmacokinetic simulation predicted an improved performance of the TCI system when employing the derived covariates model, especially in elderly female patients.     

不同靶控浓度的舒芬太尼在老年患者麻醉诱导期的应用

目的比较不同靶控浓度舒芬太尼在老年患者麻醉诱导期对血流动力学和脑电双频谱指数（B IS）值的影响,寻求老年患者麻醉诱导期安全适宜的血浆靶控浓度。方法全麻下年龄65-80岁老年择期手术患者60例,按舒芬太尼血浆靶浓度随机分为三组：S1组,舒芬太尼血浆靶浓度为0.2ng/m l S2组,舒芬太尼血浆靶浓度为0.3ng/m l S3组,舒芬太尼血浆靶浓度为0.4ng/m l。先泵入舒芬太尼,待舒芬太尼血浆靶浓度达到预设靶浓度后泵入异丙酚（3μg/m l）,患者意识消失后静脉注射顺式阿曲库铵0.1mg/kg,待肌松满意时插管控制呼吸 记录基础值（T0）、插管前即刻（T1）、插管后即刻（T2）、气管插管后1m in（T3）、气管插管后2m in（T4）时平均动脉压（MAP）、心率（HR）及脑电双频谱指数（B IS）值、气管插管及不良反应发生率。结果血流动力学的影响：与T0比较,三组在T1时刻MAP、HR均下降（P〈0.05） 与T1比较,S2组T2、T3、T4时刻MAP、HR变化差异无统计学意义（P〉0.05）,S1组在T2、T3、T4时刻明显升高（P〈0.05）,S3组在T3、T4时刻明显降低（P〈0.05）。B IS值比较：与T0比较,三组在各时间点B IS值均降低（P〈0.05）,其中S2组在T1、T2、T3、T4时刻变化范围在45-55之间,S1、S3组在T1、T2、T3、T4时刻变化范围高于或低于45-55,显示麻醉过浅或过深。插管反应与不良反应比较：与S2比较,S1组出现插管反应较多（P〈0.05）,S3组出现不良反应较多＊P〈0.05,差异有统计学意义。结论舒芬太尼靶控输注用于老年患者全麻诱导期当异丙酚浓度为3.0μg/m l（TC I）时较为安全适宜的血浆靶浓度为0.3ng/m l。     

靶控输注丙泊酚-瑞芬太尼清醒镇静镇痛用于老年人结肠镜检查

目的研究靶控输注异丙酚-瑞芬太尼清醒镇静镇痛用于老年人结肠镜检查的有效性、安全性。方法70例美国麻醉医师协会(ASA)Ⅰ￣Ⅲ级行结肠镜检查的老年患者,随机分为麻醉组(T组)和对照组(C组),每组35例。T组:异丙酚血浆靶浓度0.4￣1.0μg/ml、瑞芬太尼血浆靶浓度0.4￣0.9ng/ml同时输注,待患者进入镇静分级评分(Ramsay)2级开始镜检,肠镜抵达回盲部停止给药。C组:未用药。结果Ramsay评分:T组2级86%,C组2级20%(P<0.01)。视觉模拟评分(VAS):T组明显小于C组(P<0.01)。T组入镜时间短于C组(P<0.05)。检查过程中:收缩压(SBP)、舒张压(DBP)、心率(HR)C组明显上升(P<0.05或0.01);脑电双频指数(BIS)T组明显降低(P<0.01);血糖C组升高(P<0.05)。T组检查成功率、操作者和患者的满意率均明显高于C组(P<0.01)。结论靶控输注异丙酚-瑞芬太尼用于老年人结肠镜检查能达到良好的清醒镇静镇痛麻醉效果,有效抑制应激反应,稳定血流动力学,缩短入镜时间,提高检查的成功率、患者的耐受性和依从性,是一种安全、有效、可行的麻醉方法。     

Postoperative sedation with propofol infusion: haemodynamics and pharmacokinetics

OBJECTIVE: This study was designed to investigate the haemodynamic response and pharmacokinetics of a low-dose propofol continuous infusion in providing sedation in patients who required mechanical ventilation after coronary artery bypass grafting surgery. PATIENTS: 22 male patients, aged between 45 and 65 years, were evaluated in an open, uncontrolled study. INTERVENTIONS: At the end of the surgical procedure, a low-dose (1 mg/kg/h) propofol infusion was started and adjusted to optimise sedation according to the Ramsay scale. The mean propofol infusion rate was 1.42 +/- 0.4 mg/kg/h. MAIN OUTCOME MEASURES: Electrocardiogram, systemic and pulmonary arterial pressure, and central venous pressure were monitored continuously. Left ventricular shortening fraction was calculated by transoesophageal echocardiography. Propofol plasma levels were calculated in 10 patients to evaluate the pharmacokinetics. RESULTS: Throughout the duration of the study all patients were haemodynamically stable. Sedation was maintained for 363 +/- 244 minutes and was adequate in all patients. The clinical recovery time (postsedation responsiveness) was 15.7 +/- 6.2 minutes, after infusion suspension. There was no correlation between propofol plasma levels or propofol infusion rate and the depth of sedation (respectively, r = 0.39 and r = 0.23), while there was a good correlation (r = 0.62) between propofol infusion rate and plasma levels. Open two-compartment model pharmacokinetics were demonstrated. CONCLUSION: Low-dose propofol infusion (1 to 2 mg/kg/h) proved to be well tolerated and effective in maintaining sedation after cardiac surgery. Sedation was quickly obtained without a propofol loading dose; steady-state plasma concentrations of 0.6 to 0.8 mg/L were rapidly achieved. Propofol pharmacokinetics ensure rapid clearance with rapid clinical recovery.     

依托咪酯复合瑞芬太尼麻醉用于老年患者的效果评价

目的探讨依托咪酯乳剂复合瑞芬太尼麻醉用于老年患者的效果、安全性和可行性。方法择期腹部全麻手术的老年患者4JD例,随机分为两组,即依托咪酯乳剂组（A组）和丙泊酚组（B组）。麻醉诱导：咪达唑仑0．04mg／kg,瑞芬太尼1．5μg/kg（时间〉60s）,阿曲库铵0．6mg／ks,A组依托咪酯乳剂0．2mg／kg（30～60s）,B组丙泊酚1．5mg／kg（30～60s）。麻醉维持：A组微量泵静脉持续泵入依托咪酯乳剂0．6～1．2mg·kg^-1·h^-1和瑞芬太尼12～15μg·kg^-1·h^-1,维持BIS值40～60;B组微量泵静脉持续泵人丙泊酚6—10mg·kg^-1·h^-1和瑞芬太尼12～15μg·kg^-1·h^-1,维持BIS值40—60。观察记录两种静脉复合麻醉用于老年患者麻醉前（T1）、气管插管前1min（T2）、气管插管后1min（L）、切皮后5min（T4）、探查后5min（T5）、病灶切下后5min（T6）、拔除气管导管后3min（T7）、术后30min（T8）的SBP、DBP、HR;同时记录两组患者停药后苏醒时间、拔管时间、恢复时间和术后随访术中知晓以及麻醉满意度。结果B组T2、T3、T4、T5的SBP、DBP和T6的DBP均明显低于A组（均P〈0．05）,B组T3和T7的HR均明显低于A组（均P〈0．05）;与麻醉前相比,B组T2、T3、T4、T5的SBP、DBP和T6的DBP均明显降低（均P〈0．05）,B组T2的HR下降明显（P〈0．05）,A组拔管后的HR明显加快（P〈0．05）。B组苏醒时间、拔管时间均明显低于A组（均P〈0．05）。两组术后满意度差异无统计学意义（P〉0．05）,均无术中知晓发生。结论依托咪酯复合瑞芬太尼麻醉对老年患者循环系统影响轻,血流动力学更平稳,比丙泊酚复合瑞芬太尼更适合用于老年患者。