不同浓度七氟醚吸入对患者镇静程度和麻醉深度的影响

目的研究吸入不同浓度七氟醚全麻诱导对患者镇静程度和麻醉深度的影响。方法选择本院60例择期行妇科腹腔镜手术的患者(ASAⅠ-Ⅱ级),采用随机双盲对照方法,研究比较3组患者吸入七氟醚4%(A组)、6%(B组)和8%(C组)浓度的诱导时间、诱导质量、镇静程度和麻醉深度的差异。并记录睫毛反射消失时间、患者入睡时间、不良事件发生率,同时记录患者的平均动脉压(MAP)、心率(HR)、脑电双频谱指数(B IS)、听觉诱发电位指数(AAI)和警觉与镇静评分(OAA/S评分)。结果C组睫毛反射消失时间为(45.5±4.4)s要明显短于A组(78.1±8.3)s和B组(55.2±6.9)s(P<0.05),患者入睡时间C组(93.0±10.7)s也明显快于A组(148.4±13.8)s和B组(102.0±8.9)s(P<0.05)。OAA/S评分为3分时,C组的B IS值为(74.1±3.8),AAI值为(37.2±4.2);C组诱导前后MAP下降和HR增快,且部分患者波动较大(P<0.05)。C组呼吸暂停发生率(30%)要高于A组和B组(P<0.05)。结论单纯吸入七氟醚诱导患者入睡快,临床推荐吸入浓度为6%,其可提供良好的麻醉质量,且血流动力学平稳,不良反应小。     

七氟醚与异氟醚分别复合氧化亚氮全程吸入麻醉的临床应用

目的观察七氟醚与异氟醚分别复合氧化亚氮在紧闭式静吸复合全麻中的临床应用。方法选择60例ASAⅠ-Ⅱ级择期手术患者,随机分为S、I两组,每组患者均于诱导前静注咪唑安定004mg／kg＋太尼2ug／kg,1分钟后S组吸入5％七氟醚＋50％氧化亚氮,Ⅰ组吸入3％异氟醚＋50％氧化亚氮,待患者入睡后静注罗库溴铵06mg／kg,气管插管后S组继续吸入1．0-30％七氟醚＋50％氧化亚氮,I组吸入0．6～18％异氟醚＋50％氧化亚氮至术毕,同时观察各时点MAP、HR、SPO2、。BIS及吸入麻醉药浓度,手术结束观察病人苏醒及拔管时间,术后随访术中知晓、恶心、呕吐及有无其它不良反应。结果七氟醚与异氟醚分别复合氧化亚氮全程吸入麻醉,结合BIS监测指导术中用药,使诱导、苏醒迅速,麻醉过程平稳,麻醉深度易控制,对患者血流动力学影响小。结论七氟醚与畀氟醚分别复合氧化亚氮全程吸入麻醉是一种安全有效的麻醉方法,可作为临床麻醉用药的另一种选择。     

七氟醚吸入麻醉在全胃切除手术中的应用

目的 探讨七氟醚吸入麻醉在全胃切除手术中的临床应用价值.方法 回顾性分析我院2010年3月至2012年3月76例行全胃切除术患者的临床资料,按不同麻醉方法分成2组,每组38例.对照组给予靶控输注丙泊酚复合舒芬太尼麻醉,实验组给予吸入七氟醚复合舒芬太尼麻醉.观察比较2组患者的麻醉恢复情况、脑电双频指数(BIS)和血流动力学变化情况、术后疼痛评分及不良反应发生情况.结果 实验组患者的定力恢复时间、随意运动恢复时间均明显少于对照组(P＜0.05);2组患者麻醉后(T1 ～T5时段)的BIS、收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)指标水平与麻醉前(T0时段)相比均明显降低(P＜0.05),实验组患者T1 ～T5时段的心率指标水平较对照组稳定(P＜0.05);实验组患者的术后疼痛评分和不良反应总发生率明显低于对照组(P＜0.05).结论 全胃切除手术中采用吸入七氟醚复合舒芬太尼麻醉的临床效果良好.     

七氟醚麻醉的脑电影响

七氟醚是近年来应用临床的新型麻醉剂,麻醉监测非常重要,定量脑电图ｑＥＥＧ是近年来临床应用较理想的麻醉深度监测仪器,脑电信号通过计算机分析,提供直观的量化指标,现将七氟醚麻醉的脑电监测作一综述。１　七氟醚麻醉的ＥＥＧ一般监测Ｔｓｕｓｈｉｍａ等〔１〕报道,分别给３０只猫（每组１０只）七氟醚、异氟醚、氟烷麻醉。结果在相同ＭＡＣ下,七氟醚和异氟醚的脑电抑制较氟烷大（Ｐ＜０．０５）,七氟醚对外周神经刺激反应抑制较弱。ＫｕｒａｔａＪ等〔２〕报道,给猫七氟醚、氨氟醚、异氟醚麻醉３～４ｈ后,连续观察５～７ｄＥＥ…     

全凭吸入七氟醚麻醉在小儿腭裂修补术中的应用

目的：探讨全凭吸入七氟醚麻醉用于小儿腭裂修补术的效果及安全性。方法：40例择期腭裂修补术患儿随机均分为七氟醚组（S组）和安氟醚组（E组），每组20例。E组安氟醚浓度由1％逐渐升至4％，S组七氟醚浓度由1％逐渐升至8％。维持阶段，挥发性麻醉药浓度维持在1．3～1．5MAC。连续监测血压、心率等指标，观察并比较两组诱导、维持及恢复过程。结果：麻醉期间两组血压、心率比较无显著差异（P〉0．05），诱导及恢复过程拒吸、呛咳、躁动等各项指标S组明显好于E组（P〈0．05或P〈0．01）。结论：全凭吸入七氟醚麻醉是小儿腭裂修补术较理想的麻醉方法。     

七氟醚吸入麻醉在小儿短小手术的应用

小儿短小手术通常在门诊进行,如何使麻醉既安全又便捷,且能减少并发症的发生,是值得临床研究的课题.为此,我院尝试在小儿短小手术中应用七氟醚吸入麻醉,取得了较为满意的效果,现介绍如下.     

全麻气管插管后七氟醚和异氟醚吸入对吸烟患者呼吸力学的影响

目的 比较观察全麻气管插管后七氟醚和异氟醚吸入对吸烟和非吸烟患者气道阻力、肺顺应性和气道峰压的影响.方法 选择既往有和无吸烟史择期手术的普通外科患者80例[美国麻醉医师协会(ASA)Ⅰ～Ⅱ级,既往有或无吸烟史患者各40例],随机分为4组(n=20):有吸烟史患者吸入七氟醚全麻组(SS组)和吸入异氟醚全麻组(SI组),无吸烟史患者吸入七氟醚全麻组(NS组)和吸入异氟醚全麻组(NI组).使用多功能麻醉气体监护仪监测患者吸入麻醉剂浓度达到肺泡最低有效浓度(1MAC)后4、8、12、16min的气道峰压、肺顺应性,同时用无创心功能测定仪监测气道阻力,记录各组患者在吸入麻醉剂期间各项指标的变化情况.结果 与吸入前相比,所有接受全麻气管插管的患者在使用七氟醚和异氟醚吸入维持4、8、12、16 min后均出现气道阻力和气道峰压的明显下降(均P＜0.05),其中SS组和NS组8min后下降趋于稳定[气道阻力:SS组(10.38±1.12)cmH2O·L-1·s-1,NS组(9.65±1.04)cm H2O·L-1·s-1;气道峰压:SS组(13.52±1.01)cm H2O,NS组(12.86±0.94)cm H2O,1 cm H2O=0.098kPa],SI组和NI组则于12 min后下降趋于稳定[气道阻力:SI组(10.30±0.98)cm H2O·L-1·s-1,NI组(11.00±0.73)cm H2O·L-1·s-1;气道峰压:SI组(13.47±0.88)cm H2O,NI组(12.85±0.65)cm H2O],同时间点的非吸烟组下降幅度高于吸烟组(均P＜0.05).4组患者在使用七氟醚和异氟醚吸入维持后其肺顺应性较吸入前均无明显变化(均P＞0.05),同时间点的非吸烟组与吸烟组相比肺顺应性差异也没有统计学意义(均P＞0.05).结论 全麻气管插管后七氟醚和异氟醚吸入使患者的气道阻力和气道峰压出现明显下降,吸烟者比非吸烟者下降程度低.     

七氟醚和异氟醚低流量麻醉用于腹腔镜手术的比较

目的：在腹腔镜手术中采取七氟醚低流量麻醉和异氟醚低流量麻醉,观察两组应用效果。方法选取我院收治的行腹腔镜手术患者56例,按照分层随机法,随机分为I组合II组,I组采取七氟醚低流量麻醉,II组采取异氟醚低流量麻醉,比较两组应用效果。结果 I 组患者气腹前SBP、DBP及HR在T2、T3、T4时与I组比较,差异有统计学意义(P<0.05)。I 组苏醒时间及拔管时间均长于I组,有显著性差异(P<0.05)。结论七氟醚血流动学更平稳,是一种安全可靠的麻醉方法。     

七氟醚吸入诱导插管在小儿心脏手术中的应用

本文总结在吸入高浓度七氟醚在小儿先心病麻醉诱导插管中的应用。1临床资料先天性心脏病患儿47例(其中有紫绀型6例,肺动脉高压17例)心功能Ⅰ～Ⅱ级,年龄从18个月到16岁,体重从9.5kg到55kg,术前常规给予哌替啶1mg/kg,阿托品0.01mg/kg,面罩吸入氧5～6L/min 8%七氟醚诱导。待疼痛反射消失     

七氟醚在小儿麻醉诱导中的临床应用

目的通过研究七氟醚在对小儿麻醉中的相关诱导作用,总结临床经验。方法对我院2011年5月~2012年5月收治的全麻下行手术患儿进行观察研究,将患儿分为对照组和观察组,对照组患儿采用氯胺酮进行静脉麻醉,而观察组采用七氟醚吸入麻醉,对患儿的呼吸和心率进行观察总结,并记录停药之后患儿的疼痛持续时长等项目。结果在进行对比后发现,对照组患儿的分泌物增加、术后呕吐等数量远远高于观察组患儿,差异具有显著性（P＜0.05）。结论采用七氟醚对患儿进行麻醉,效果较好、麻醉速度快、没有刺激性味道,不太影响患儿的循环呼吸且术后苏醒快,是应该推广使用的临床方法。     

Clinical effects of sevoflurane anesthesia induction with a portable inhalational anesthetic circuit in pediatric patients

Introduction

Pediatric anesthesia induction with sevoflurane usually needs a special vaporizer and gas source, which limits its use to the operating room (OR). Many children feel anxious and cry when entering the OR because of being separated from their parents, which impairs anesthesia safety and their physical and mental health. In this study, we used a portable circuit to perform sevoflurane anesthesia induction outside the OR, assessed its effects and compared them with those of ketamine anesthesia in pediatric patients.

Material and methods

One hundred children had anesthesia induced with either sevoflurane (sevoflurane group) through the portable inhalational anesthetic circuit, or ketamine by intramuscular injection (ketamine group), then were transferred to the OR. Peak inspired concentration (Cp) and steady state concentration (Cs) of sevoflurane were measured. Heart rate (HR) and saturation of peripheral oxygen (SpO₂) were monitored. Time for anesthesia induction, awakening, leaving the OR and duration of the operation were recorded. The patients’ reaction during anesthesia was also analyzed.

Results

The Cp and Cs of sevoflurane were correlated with bodyweight. Compared with the ketamine group, the sevoflurane group showed shorter time for anesthesia induction (28 ±7 s vs. 195 ±34 s, p < 0.0001), awakening (11.2 ±3.6 s vs. 63.5 ±6.7 s, p < 0.0001) and leaving the OR (20.5 ±5.6 s vs. 43.4 ±10.6, p < 0.0001), less noncooperation during anesthesia induction (10% vs. 80%, p < 0.0001), lower HR (130 ±16 beats/min vs. 143 ±19 beats/min, p = 0.0004) and higher SpO₂ (98.9 ±0.9% vs. 96.1 ±2.5%, p < 0.0001) on arrival at the OR.

Conclusions

Pediatric anesthesia induction by sevoflurane with the portable inhalational anesthetic circuit is convenient, safe and effective outside the OR.     

Sofnolime with different water content causes different effects in two sevoflurane inhalational induction techniques with respect to the output of compound-a

Objective: During sevoflurane anesthesia with Sofnolime for CO2 absorption, the factors affecting the production of compound A (a chemical is nepherotoxic) are still not clear. This study is designed to investigate the effects of different fresh gas flow during induction, the vital capacity induction (VCI) vs. the tidal volume breath induction (TBI) on the compound-A production with a fresh Sofnolime or a dehydrated Sofnolime using a simulated lung model.Method: The experiments were randomly divided into four groups: group one, VCIf, vital capacity fresh gas inflow with fresh Sofnolime; group two, TBIf, tidal volume breath fresh gas inflow with fresh Sofnolime; group three, VCId, vital capacity fresh gas inflow with dehydrated Sofnolime, and group four, TBId, tidal volume breath fresh gas inflow with dehydrated Sofnolime. The inspired sevoflurane was maintained at 8%, the concentrations of compound-A were assayed using Gas-spectrum technique, and Sofnolime temperatures were monitored at 1-min intervals throughout the experiment.Results: The mean and maximum concentrations of compound A were significantly higher in the vital capacity group than the tidal volume breath group (P<0.01). At the beginning of anesthesia maintenance, the compound-A concentration in group VCIf was 36.28±6.13 ppm, which was significantly higher than the 27.32±4.21 ppm observed in group TBIf (P<0.01). However, these values decreased to approximately 2 ppm in the dehydrated Sofnolime groups. Sofnolime temperatures increased rapidly in the dehydrated Sofnolime groups but slowly in the fresh Sofnolime groups.Conclusion: With fresh Sofnolime, vital capacity induction increased compound-A production in the circuit system compared with tidal volume breath induction. However, with dehydrated Sofnolime, the effects of the two inhalation induction techniques on compound-A output were not significantly different.     

Changes in electroencephalographic power and bicoherence spectra according to depth of dexmedetomidine sedation in patients undergoing spinal anesthesia

Background: Assessment the depth of dexmedetomidine sedation using electroencephalographic (EEG) features can improve the quality of procedural sedation. Previous volunteer studies of dexmedetomidine-induced EEG changes need to be validated, and changes in bicoherence spectra during dexmedetomidine sedation has not been revealed yet. We aimed to investigate the dexmedetomidine-induced EEG change using power spectral and bicoherence analyses in the clinical setting.Patients and Methods: Thirty-six patients undergoing orthopedic surgery under spinal anesthesia were enrolled in this study. Dexmedetomidine sedation was conducted by the stepwise increase in target effect site concentration (Ce) while assessing sedation levels. Bispectral index (BIS) and frontal electroencephalography were recorded continuously, and the performance of BIS and changes in power and bicoherence spectra were analyzed with the data from the F3 electrode.Results: The prediction probability values for detecting different sedation levels were 0.847, 0.841, and 0.844 in BIS, 95% spectral edge frequency, and dexmedetomidine Ce, respectively. As the depth of sedation increased, δ power increased, but high β and γ power decreased significantly (P <0.001). α and spindle power increased significantly under light and moderate sedation (P <0.001 in light vs baseline and deep sedation; P = 0.002 and P <0.001 in moderate sedation vs baseline and deep sedation, respectively). The bicoherence peaks of the δ and α-spindle regions along the diagonal line of the bicoherence matrix emerged during moderate and deep sedation. Peak bicoherence in the δ area showed sedation-dependent increases (29.93%±7.38%, 36.72%±9.70%, 44.88%±12.90%; light, moderate, and deep sedation; P = 0.008 and P <0.001 in light sedation vs moderate and deep sedation, respectively; P = 0.007 in moderate sedation vs deep sedation), whereas peak bicoherence in the α-spindle area did not change (22.92%±4.90%, 24.72%±4.96%, and 26.96%±8.42%, respectively; P=0.053).Conclusions: The increase of δ power and the decrease of high-frequency power were associated with the gradual deepening of dexmedetomidine sedation. The δ bicoherence peak increased with increasing sedation level and can serve as an indicator reflecting dexmedetomidine sedation levels.     

不同麻醉深度对结直肠癌腹腔镜手术患者肠道免疫及肠功能恢复的影响

目的探讨不同麻醉深度对结直肠癌腹腔镜手术患者肠道免疫以及肠功能恢复的影响。方法选择拟行全身麻醉下腹腔镜结直肠癌根治手术患者80例,随机分为2组。对照组(40例)术中脑电双频指数(BIS)维持在50~59,观察组(40例)BIS维持在40~49。比较2组患者术前(T0)、术后12 h(T1)、术后24 h(T2)、术后72 h(T3)肠道免疫指标,包括Treg/Th17、白细胞介素-6(IL-6)、白细胞介素-17(IL-17)、白细胞介素-10(IL-10)、转化生长因子-β1(TGF-β1)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、CD3+、CD4+、CD8+,以及肠道功能恢复情况。结果2组患者围术期不同时间肠道免疫指标变化差异有统计学意义(P<0.05);血清IL-6、IL-17均于T1时升高,T2时达高峰,T3时回落,Treg/Th17、TGF-β1、IL-10、CD3+、CD4+、CD8+、IgA、IgG则于T1时降低,T2时达低峰,T3时回升。观察组患者T1、T2、T3时血清IL-6、IL-17低于对照组(P<0.05),Treg/Th17、TGF-β1、IL-10、CD3+、CD4+、CD8+、IgA、IgG高于对照组(P<0.05)。观察组患者术后肠鸣音恢复时间、首次肛门排气时间、首次肛门排便时间、进食恢复时间均短于对照组(P<0.05)。结论全身麻醉时BIS维持在40~49,可保护结直肠癌腹腔镜手术患者肠道免疫功能,促进肠道功能恢复。     

七氟烷和丙泊酚麻醉对肺癌患者围术期细胞因子平衡的影响

目的:探讨七氟烷单纯吸入麻醉和丙泊酚全凭静脉麻醉对肺癌患者围术期细胞因子平衡的影响.方法:选择90例择期开胸行单纯性肺叶切除术的肺癌患者,随机分为两组:A组采用七氟烷单纯吸入麻醉;B组采用丙泊酚全凭静脉麻醉,每组45例.分别于麻醉诱导前即刻(T0)、单肺通气开始前即刻(T1)、单肺通气结束前即刻(T2)、手术关胸后即刻...     

基于脑电非线性特征和AdaBoost算法的诱导期麻醉深度检测

提出一种结合自适应增强学习AdaBoost算法和脑电非线性特征的麻醉深度评估方法,通过提取脑电信号中的4种非线性特征（KC复杂度、小波熵、排序熵、模糊熵）作为输入,以双谱指数作为参考输出,将诱导期麻醉深度分为清醒、轻度麻醉、中度麻醉。使用9例全麻患者的诱导期脑电信号对该方法进行评估,3种不同麻醉状态分类准确度为86.69%,Kappa系数为0.837,表明该方法可以较好地区分诱导期3种不同麻醉水平,为麻醉深度监测提供新思路。     

Histamine release during the induction of anesthesia with propofol in allergic patients: A comparison with the induction of anesthesia using midazolam-ketamine

OBJECTIVE: A prospective randomized controlled study was performed for patients with a history of allergy to evaluate the effect of the induction of anesthesia with propofol against histamine release, skin reactions, hemodynamic changes and other clinical symptoms, while also comparing these parameters during the induction of anesthesia with midazolam-ketamine for patients with a history of allergy. SUBJECTS: We examined 40 patients undergoing oral surgery, who had a history of allergy and/or the percentage of eosinophils in the leukocytes was more than 3%. METHODS: Forty patients were randomly allocated into two groups and thus received either midazolam-ketamine (M-K group, n = 20) or fentanyl-propofol (propofol group, n = 20) for the induction of anesthesia. Venous blood samples (4 ml each) were obtained before induction as a control and at 0.5, 1, 3, 5 minutes after the administration of each induction agent, and then furthermore at 0.5, 1, 3, 5 minutes after tracheal intubation in order to measure the plasma histamine level by using the HPLC post-label system. In addition, the blood pressure and heart rate were also simultaneously recorded. Skin reactions were also evaluated by two anesthesiologists. RESULTS: The incidence of 50% histamine release during the induction of anesthesia with propofol occurred in 15% of the patients with a history of allergy. Sixteen patients out of 20 (80%) showed a decrease in the systolic blood pressure after the administration of propofol without any evidence of histamine release. The incidence of 50% histamine release, skin reactions and an increase in the heart rate between the two groups were not statistically significant after the administration of each anesthetic agent. Moreover, some patients also demonstrated histamine release after tracheal intubation. Hemodynamic changes after tracheal intubation showed a similar tendency in both groups. No significant difference was observed regarding the incidence of histamine release, skin reactions and hemodynamic changes between both groups after tracheal intubation. CONCLUSIONS: Propofol was found to show a similar incidence of histamine release during the induction of anesthesia using midazolam-ketamine, and thus was also found to be a useful induction agent against histamine release for patients with a history of allergy when hydroxizine was used as a premedication.     

The effects of a single bolus of remifentanil on corrected QT interval change during sevoflurane induction

Purpose

Opioids may affect changes in the corrected QT interval (QTc) during anesthetic induction. This study examine whether a single bolus of remifentanil would prolong QTc after laryngeal mask airway (LMA) insertion during sevoflurane induction.

Materials and Methods

Forty women of American Society of Anesthesiologists physical status 1 (ASA PS1) undergoing gynecological surgery were studied. All patients were induced using three vital capacity inhalation inductions with 5% sevoflurane. Two minutes after induction, the inspiratory concentration of sevoflurane was reduced to 2%. Using double-blinded randomization, patients were allocated into one of two groups, receiving either saline (placebo group, n = 20) or 0.25 µg.kg^-1 remifentanil (remifentanil group, n = 20) over a period of thirty seconds. Sixty seconds later, LMA insertion was performed. Recordings were taken with a 12-lead electrocardiogram at baseline, 2 min after induction and 1 and 3 min after LMA insertion. QTc was calculated by Bazett''s formula. The mean arterial pressure (MAP) and heart rate (HR) were also measured at each time point.

Results

The QTc interval was significantly prolonged in the placebo group as compared to the remifentanil group at 1 min after LMA insertion (467.8 ± 16.5 vs. 442.7 ± 21.3 ms, p < 0.001). However, there was no significant difference in QTc at 3 min after LMA insertion between the two groups. MAP and HR were significantly higher in the placebo group (p < 0.001).

Conclusion

A single bolus of remifentanil is safe method to attenuate prolonged QTc associated with insertion of LMA.     

七氟醚麻醉对食管癌手术患者脑氧代谢及认知功能的影响

目的:探讨七氟醚麻醉对食管癌手术患者脑氧代谢及认知功能的影响.方法:回顾性分析2018年4月至2019年4月我院收治的79例食管癌手术患者临床资料,按照麻醉方案不同进行分组,其中采用丙泊酚麻醉的38例为对照组,采用七氟醚麻醉的41例为观察组.观察术后两组恢复指标(呼吸恢复时间、气管拔管时间及定向力恢复时间)及麻醉前(T...