Dexmedetomidine versus propofol for prolonged sedation in critically ill trauma and surgical patients

Backgroundand Purpose: Currently, dexmedetomidine versus propofol has primarily been studied in medical and cardiac surgery patients with outcomes indicating safe and effective sedation. The purpose of this study was to assess the efficacy of dexmedetomidine versus propofol for prolonged sedation in trauma and surgical patients.MethodsThis was a single-center prospective study conducted in the Trauma/Surgical Intensive Care Unit (ICU) at a Level I academic trauma center. It included patients 18 years of age or older requiring mechanical ventilation who were randomly assigned based on unit bed location to receive either dexmedetomidine or propofol. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality; proportion of time in target sedation; incidence of delirium, hypotension, and bradycardia; and ICU and hospital length of stay (LOS).ResultsA total of 57 patients were included. Baseline characteristics were similar between groups. There was no significant difference in duration of mechanical ventilation (median [IQR]) between the dexmedetomidine (78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There was no difference between groups in ICU mortality, ICU and hospital LOS, or incidence of delirium. Safety outcomes were also similar. Patients in the dexmedetomidine group spent a significantly greater percentage of time in target sedation (98[8] %) compared to propofol group (92[10] %; p = 0.02).ConclusionsOur results suggest that, similar to medical and cardiac surgery patients, dexmedetomidine and propofol are safe and effective sedation agents in critically ill trauma and surgical patients; however, dexmedetomidine achieves target sedation better than propofol for this specific population.     

Dexmedetomidine added to propofol for drug-induced sleep endoscopy in adult patients with obstructive sleep apnea: Randomized controlled trial

Background

The aim of this study was to evaluate if the addition of dexmedetomidine to propofol could improve the success and reduce the complications during drug induced sleep endoscopy in obstructive sleep apnea patients.

Flumazenil in the outpatient A study following midazolam as sedation for upper gastrointestinal endoscopy

Fifty outpatients who underwent upper gastrointestinal endoscopy under midazolam sedation were allocated randomly into two equal groups of 25 in this double-blind study. After the endoscopy, and 30 minutes after administration of the sedative, patients in one group received flumazenil 0.5 mg; those in the other group received a similar volume of vehicle only. Assessments of memory function, psychomotor performance and coordination were carried out and these were repeated 3.5 hours later. Flumazenil produced a significant improvement (p less than 0.001) immediately but no difference could be detected between flumazenil and placebo at 3.5 hours. However, patients in the flumazenil group reported, by means of linear analogue scales, a subjective feeling of alertness at the time of discharge, which was greater than that reported by those in the placebo group (p less than 0.005).     

右美托咪定与丙泊酚麻醉诱导时的协同作用

目的评价右美托咪定和丙泊酚麻醉诱导时镇静作用的相互影响。方法择期全麻手术患者75例,男36例,女39例,年龄18～65岁,BMI 20～25kg/m~2,ASAⅠ或Ⅱ级,采用随机数字表法均分为三组,每组25例:丙泊酚组(A组)、右美托咪定组(B组)、丙泊酚复合右美托咪定组(C组),每组再根据不同药物剂量分为5个亚组,相邻两组剂量等比为1.25,采用点斜法计算ED_(50)及其95%可信区间(CI)。结果A组丙泊酚诱导剂量ED_(50)为1.25 mg/kg(95%CI 0.90～1.45mg/kg),B组右美托咪定麻醉诱导剂量ED_(50)为1.35μg/kg(95%CI 0.95～1.50μg/kg),C组丙泊酚和右美托咪定诱导剂量ED_(50)分别为0.65mg/kg(95%CI 0.50～0.90mg/kg)和0.40μg/kg(95%CI 0.34～0.65μg/kg)。等辐射分析法判定丙泊酚和右美托咪定之间在镇静效应上呈现协同作用。结论右美托咪定复合丙泊酚可以产生明显的镇静效应协同作用。     

全麻诱导中右旋美托咪定的镇静效应及对丙泊酚用量的影响

目的研究全麻诱导中右旋美托咪定（Dex）的镇静效应及对丙泊酚用量的影响。方法选择30例择期全麻手术患者,ASAⅠ或Ⅱ级,随机分成Dex组（D组）和对照组（C组）,每组15例。D组以1μg/kgDex稀释成10ml、C组以生理盐水分别静脉泵注10min,给药后20min泵注丙泊酚0.4mg·kg-1.min-1,托下颌无体动时给予芬太尼1μg/kg和罗库溴铵0.6mg/kg,1.5min后进行气管内插管。记录用药前（T0）、用药后5min（T1）、10min（T2）、20min（T3）的反应指数（RE）、状态指数（SE）、Ramsay评分。记录睫毛反射消失时丙泊酚最小诱导量和丙泊酚诱导总用量。结果 T1～T3时D组SE、RE显著低于C组和T0时（P〈0.01）,Ramsay评分明显高于C组和T0时（P〈0.01）。D组丙泊酚最小诱导量和诱导总量明显低于C组（P〈0.01）。结论 Dex1μg/kg诱导可以产生明显的镇静效应,无呼吸抑制作用,可减少诱导时丙泊酚用量。     

Propofol-ketamine vs propofol-fentanyl for sedation during pediatric upper gastrointestinal endoscopy

BACKGROUND: The aim of this study was to compare the clinical efficacy and safety of propofol-ketamine with propofol-fentanyl in pediatric patients undergoing diagnostic upper gastrointestinal endoscopy (UGIE). METHODS: This was a prospective, randomized, double blinded comparison of propofol-ketamine with propofol-fentanyl for sedation in patients undergoing elective UGIE. Ninety ASA I-II, aged 1 to 16-year-old patients were included in the study. Heart rate (HR), systolic arterial pressure, peripheral oxygen saturation, respiratory rate (RR) and Ramsey sedation scores of all patients were recorded perioperatively. Patients were randomly assigned to receive either propofol-ketamine (PK; n = 46) or propofol-fentanyl (PF; n = 44). PK group received 1 mg x kg(-1) ketamine + 1.2 mg x kg(-1) propofol, and PF group received 1 microg x kg(-1) fentanyl + 1.2 mg x kg(-1) propofol for sedation induction. Additional propofol (0.5-1 mg x kg(-1)) was administered when a patient showed discomfort in either group. RESULTS: The number of patients who needed additional propofol in the first minute after sedation induction was eight in Group PK (17%), and 22 in Group PF (50%) (P < 0.01) and those who did not need additional propofol throughout the endoscopy were 14 in Group PK (30%) and three in Group PF (7%) (P < 0.01). HR and RR values after induction in Group PF were significantly lower than Group PK (P < 0.01). CONCLUSIONS: Both PK and PF combinations provided effective sedation in pediatric patients undergoing UGIE, but the PK combination resulted in stable hemodynamics and deeper sedation though more side effects.     

湿化高流量鼻导管氧疗在无痛消化内镜诊疗中的应用

目的 探讨湿化高流量鼻导管氧疗（HHFNC）用于无痛消化内镜诊疗的临床效果和安全性。方法 择期行无痛消化内镜诊疗的患者200例,男111例,女89例,年龄18~80岁,BMI 18~30 kg/m²,ASA Ⅰ—Ⅲ级,根据随机数字表将患者分为两组：普通鼻导管氧疗组（C组）和HHFNC组（H组）。C组通过鼻导管吸入氧气5 L/min。H组通过HHFNC系统（PT101AZ）吸入空氧混合气体50 L/min,FiO₂ 40％。记录术中最低SpO₂、经皮二氧化碳分压（PtcCO₂）、无创呼吸支持;丙泊酚用量、内镜时间和呼之睁眼时间;低氧血症、高血压、低血压、心动过速、心动过缓、恶心呕吐等不良反应情况。结果 与C组比较,H组术中最低SpO₂明显升高（P<0.05）,无创呼吸支持明显减少（P<0.05）,低氧血症发生率明显降低（P<0.05）,心动过缓发生率明显升高（P<0.05）。两组PtcCO₂、丙泊酚用量、内镜时间、呼之睁眼时间、高血压、低血压、心动过速、恶心呕吐差异均无统计学意义。结论 HHFNC用于无痛消化内镜可改善氧合和降低气道干预需求。     

右美托咪啶与异丙酚镇静下允许性高碳酸血症患者颅内压及脑氧代谢的比较

目的 比较右美托咪啶与异丙酚镇静下允许性高碳酸血症患者的颅内压及脑氧代谢情况.方法行允许性高碳酸血症通气、Ramsay评分≤2分的急性呼吸窘迫综合征患者24例,年龄28～64岁,APACHE-Ⅱ评分11～18分,采用随机数字表法,将患者随机分为2组(n=12):右美托咪啶组(D组)和异丙酚组(P组).调节右美托咪啶输注速率或异丙酚血浆靶浓度使D组和P组患者Ramsay评分逐步达到3、4、5分.于给药前(T0)、达各目标镇静水平后30 min(T1～3)时采用经颅多普勒超声测定大脑中动脉脑血流速率(CBFW)、搏动指数(PI)和阻力指数(RI),抽取桡动脉血样和颈内静脉球部血样行血气分析,计算脑氧代谢率(CNRO2)、动脉-颈内静脉氧含量差(Da-jvO2)、脑氧摄取率(CERO2).结果 与T0时比较,D组和P组T1～3时MAP、BIS值、CBFV、PI、RI和CMRO2降低(P＜0.05或0.01);两组各时点Da-jvO2、CERO2差异无统计学意义(P＞0.05);与P组比较,D组各时点BIS值和MAP差异无统计学意义(P＞0.05),CBF、PI和RI降低(P＜0.05).D组和P组CBFV与CMRO2均呈正相关(相关系数分别为0.80、0.76,P＜0.05).结论 在不同镇静水平,右美托咪啶较异丙酚可明显降低允许性高碳酸血症患者的颅内压,且可保持脑氧供需平衡.

Abstract：

Objective To compare the effects of sedation induced with dexmedetomidine and propofol on intracranial pressure and cerebral oxygen metabolism in patients with permissive hypercapnia. Methods Twentyfour patients with acute respiratory distress syndrome (ARDS) were randomly divided into 2 groups ( n = 12 each) :dexmedetomidine group (group D) and propofol group (group P) . Their APACHE Ⅱ scores were 11-18. The patients were mechanically ventilated (VT 5-7 ml/kg, RR 12-17 bpm, PEEP 6-10 cm H2O, FiO2 40-60%). PaCO2 was maintained at 50-65 mm Hg. Radial artery was cannulated for direct BP monitoring and blood sampling. Right internal jugular vein was cannulated and the catheter was advanced cephalad until jugular bulb. Continuous infusion of dexmedetomidine was started at 0.5 μg· kg-1· h-1 and TCI of propofol was started at target plasma concentration (Cp) of 0.4 μg/ml. The infusion of both drugs was gradually increased until Ramsay score (1= fully awake, 6 =asleep, unresponsive to loud verbal stimulus) reached 3,4,5. Transcranial Doppler monitoring was used to determine cerebral blood flow velocity (CBFV), pulsatility index (PI) and resistance index (RI) before administration of dexmedetomidine and propofol (T0 ) and at 30 min after the 3 levels of sedation were reached (T1-3) . Meanwhile blood samples were taken from radial artery and jugular bulb for blood gas analyses. Cerebral O2 metabolic rate (CMRO2), cerebral A-V O2 content differences (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated .ResultsCBFV, PI, RI and CMRO2 were significantly decreased at T1-3 as compared with the baseline values at T0 in both groups. CBFV was positively correlated with CMRO2 in both group D (r = 0.80) and group P ( r = 0.76) . CBFV, PI and RI were significantly lower at T1-3 in group D than in group P. There was no significant change in Da-jvO2 and CERO2 at T1-3 as compared with the baseline values at T0 in both groups. Conclusion At different sedation levels, dexmedetomidine results in lower intracranial pressure than propofol and maintains the balance between cerebral O2 supply and demand in patients with permissive hypercapnia.     

阿芬太尼或舒芬太尼复合咪达唑仑与丙泊酚在无痛胃肠镜检查的效果

目的 探讨阿芬太尼或舒芬太尼复合咪达唑仑和丙泊酚在无痛胃肠镜检查的效果。方法 选择行无痛胃肠镜检查患者150例,男62例,女88例,年龄30～60岁,体重45～90 kg, ASAⅠ或Ⅱ级。按照随机数字表法分为两组：阿芬太尼+咪达唑仑组(AM组)、舒芬太尼+咪达唑仑组(SM组),每组75例。AM组静脉注射咪达唑仑0.02 mg/kg、阿芬太尼6μg/kg, SM组静脉注射咪达唑仑0.02 mg/kg、舒芬太尼0.06μg/kg。静脉注射丙泊酚1～2 mg/kg至改良警觉/镇静(MOAA/S)评分为0分时停止注射丙泊酚,立即开始胃肠镜操作。记录丙泊酚首次剂量、总消耗量、追加次数。记录起效时间、操作时间、意识恢复时间和PACU停留时间。记录胃镜插入咽喉部(T₁)、结肠镜插入肛门(T₂)、过脾曲(T₃)、过肝曲(T₄)时改良非插管患者行为疼痛量表(BPS-NI)评分。记录患者和内镜医师满意率,低血压、低氧血症、心动过缓、心动过速、呛咳等不良反应发生情况。结果 与SM组比较,AM组丙泊酚首次剂量明显减少(P...     

A comparison of fentanyl with tramadol during propofol-based deep sedation for pediatric upper endoscopy

Aim: This study was conducted to compare the efficacy and safety of tramadol with those of fentanyl and to evaluate the impact of age in pediatric patients undergoing upper gastrointestinal endoscopy (UGIE). Methods: Eighty patients with ASA I‐II, aged 1–16 years, undergoing UGIE were included in this study. Baseline anesthesia was maintained with 1 mg·kg^?1 propofol, and then, the patients were randomly assigned to receive 2 μg·kg^?1 fentanyl (group F, n = 40) or 2 mg·kg^?1 tramadol (group T, n = 40). Additional propofol, 0.5–1 mg·kg^?1, was administered when needed. Heart rate, mean arterial pressure, oxygen saturation (SpO₂), and sedation scores were recorded at baseline, induction, and every 5 min. Endoscopy duration, recovery time, and adverse effects were recorded. The data were separated for subgroup analyses based on the age of 0–2, 2–12, and over 12 years. Results: Fentanyl significantly decreased the saturation at induction, 5th min and 10th min in patients of 0–2 years; at 5th and 10th min in 2–12 years; and at 5th min in >12 years. In all age subgroups, sedation scores at 10th, 15th, and 20th min, the overall frequency of adverse effects, and the recovery time were significantly lower in group T compared with group F. Conclusion: Tramadol in pediatric patients undergoing UGIE provided sedation as efficient as fentanyl with a better hemodynamic and respiratory stability and provided a superior safety and tolerance in younger children.     

右美托咪定同时靶控输注丙泊酚用于慢诱导纤维支气管镜引导经鼻气管内插管术的临床观察

目的 观察右美托咪定(dexmedetomidine,Dex)同时靶控输注(target controlled infusion,TCI)丙泊酚用于慢诱导纤维支气管镜(fiberoptic bronchoscopy,FOB)引导经鼻气管内插管术的可行性和安全性. 方法 拟行全身麻醉下颌面部肿瘤切除术的患者143例,年龄18～65岁,BMI 18～30 kg/m2,ASA分级Ⅰ、Ⅱ级,完全随机分为丙泊酚TCI组(P组,65例)和Dex组(D组,78例).入室后两组均静脉注射芬太尼1.5 μg/kg,TCI丙泊酚,丙泊酚初始血浆靶浓度(plasma concentration,Cp)为1.0 mg/L.D组同时负荷输注Dex(0.5μg/kg,10 min).根据BIS调整丙泊酚Cp.BIS值降至85时环甲膜穿刺注射2％丁卡因2.5 ml,1％丁卡因2ml行鼻腔黏膜表面麻醉.BIS值降至80～70时放置FOB.FOB进入声门后,两组均静脉注射丙泊酚1 mg/kg,放置气管导管并确定其位置,完成麻醉诱导.记录插管术中及术后情况,记录入室安静后(To)、BIS值降至85时(T1)、环甲膜穿刺后即刻(T2)、BIS值降至80～70时(T3)、FOB放置成功时(T4)和气管内插管成功时(T5)的HR、MAP、Sp02和BIS,记录T1和T3时丙泊酚效应室浓度(effect-site concentration,Ce). 结果 两组气管内插管难易度评分、气管内插管时间、呛咳或误吸率差异均无统计学意义(P＞0.05);与P组比较,D组气道阻塞评分升高(48/7/20/3/0比45/16/4/0/0)、舒适度升高(62/16/0/0/0比35/29/0/1/0)、插管记忆评分升高(60/18/0比62/3/0)、术后咽痛评分升高(22/55/1/0比41/20/4/0),D组血流动力学更稳定,差异有统计学意义(P＜0.05).两组患者T1时丙泊酚Ce差异无统计学意义(P＞0.05);与P组比较,D组T3时丙泊酚Ce降低[(1.00±0.20) mg/L比(1.10±0.30)mg/L](P＜0.05). 结论 负荷剂量Dex(0.5 μg/kg,10 min)辅助表面麻醉用于慢诱导FOB引导经鼻气管内插管可降低丙泊酚的Ce,舒适度更高,但应注意气道阻塞、插管知晓和术后咽痛等并发症.     

右美托咪定和舒芬太尼复合丙泊酚用于老年患者内镜逆行胰胆管造影术深度镇静的比较

目的 比较右美托咪定和舒芬太尼复合丙泊酚用于内镜逆行胰胆管造影术(ERCP)老年患者深度镇静的效果和安全性。方法 选择2022年7—10月择期行ERCP的老年患者60例,年龄65~90岁,BMI 15~33 kg/m²,ASAⅠ—Ⅲ级,心功能正常或NHYA分级Ⅰ或Ⅱ级。采用随机数表法将患者分为两组:右美托咪定组(D组)和舒芬太尼组(S组),每组30例。D组静脉泵注右美托咪定0.5μg/kg,持续10 min,之后缓慢静脉注射丙泊酚1 mg/kg进行麻醉诱导(给药时间>30 s);S组缓慢静脉注射舒芬太尼0.12μg/kg后,予丙泊酚1 mg/kg进行麻醉诱导(给药时间>30 s)。记录手术时间、丙泊酚用量、术中体动发生情况。记录术中最低SpO₂、气道干预例数、低氧血症发生情况。记录术中心动过速、心动过缓、高血压、低血压和心律失常等心血管不良事件发生情况。记录苏醒时间、入PACU后15 min静息时VAS疼痛评分、术后中重度疼痛(VAS疼痛评分≥4分)和PACU内恶心呕吐发生情况。结果 两组Ramsay评分均≥5分,镇静效果满意。与S组比较,D组术中最低SpO₂、心动过缓发生率明显升高(P<0.05),气道干预率、低氧血症、心动过速、低血压发生率明显降低(P<0.05),苏醒时间明显延长(P<0.05)。两组手术时间、丙泊酚用量、体动率和高血压发生率、入PACU后15 min静息时VAS疼痛评分、中重度疼痛以及PACU内恶心呕吐发生率差异均无统计学意义。结论 应用右美托咪定和舒芬太尼复合丙泊酚均能达到满意的深度镇静效果,右美托咪定复合丙泊酚时术中血流动力学更稳定,并且术中低氧血症和心血管不良事件发生率更低。     

Experience of intravenous sedation for pediatric gastrointestinal endoscopy in a large tertiary referral center in a developing country

Background: The aim of this study was to evaluate the clinical efficacy of intravenous sedation for pediatric gastrointestinal endoscopy (GIE) at a tertiary care teaching hospital in a developing country. Methods: We undertook a retrospective review of the sedation service records of pediatric patients who underwent GIE. All endoscopies were performed by a pediatric gastroenterologist. All of the sedation was administered by staff anesthesiologist or anesthetic personnel in the gastroenterology procedure room. Results: Sedation was provided for 222 procedures in 214 patients ranged in age from younger than 1 to 17 years and in weight from 2.7 to 80.0 kg. Intravenous sedation was provided in 176 patients (82.2%). Of these patients, 185 procedures were performed and reviewed, with 152 (82.2%) procedures were esophagogastroduodenoscopy (EGD) alone, 14 (7.6%) procedures were colonoscopy alone, 18 (9.7%) procedures were EGD and colonoscopy, and one procedure was endoscopic ultrasonography (EUS). Most common indications of the procedure were screening for esophageal varices (25.2%), abdominal pain (15.9%), history of upper gastrointestinal hemorrhage (13.6%), and unexplained anemia (10.3%). The majority of preanesthetic problems were hematologic disease, anemia (38.2%); liver disease, cirrhosis (13.5%); and electrolyte imbalance (13.5%). Propofol (94.0%), fentanyl (87.0%), and midazolam (67.8%) were frequently used. The mean dose of propofol was 7.8 ± 4.1 mg·kg^?1·h^?1, fentanyl 2.3 ± 1.1 mcg·kg^?1·h^?1, and midazolam 0.1 ± 0.1 mg·kg^?1·h^?1. Most of them were used in combination. The combination of propofol, fentanyl, and midazolam was commonly employed (46.4%). The mean sedation time of all procedures was 28.2 min and was different according to procedure type. Complications occurred infrequently (13.5%) and were medication or airway related. All complications were easily treated, with no adverse sequelae. Intravenous sedation was successful except for one patient who required general anesthesia. However, all procedures were completed successfully. Conclusions: In the setting of the developing country, intravenous sedation for pediatric GIE by trained anesthetic personnel with appropriate monitoring was safe and effective. Serious adverse events were rare in our population.     

Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy

PURPOSE: The aim of this study was to evaluate the safety and efficacy of a combination of propofol and remifentanil deep sedation in spontaneously breathing children less than 7 years of age undergoing upper and/or lower gastrointestinal endoscopy. METHODS: The effect of propofol and remifentanil sedation was prospectively studied in 42 unpremedicated children undergoing gastrointestinal endoscopy. Anesthesia was induced with a combination of sevoflurane, nitrous oxide and oxygen. Anesthesia was maintained with an infusion of propofol (50-80 microg x kg(-1) x min(-1)) and remifentanil (0.1 microg x kg(-1) x min(-1)). Demographic data, heart rate, blood pressure, respiratory rate, and oxygen saturation were recorded every 5 min for each child. In addition, recovery and discharge times were recorded. RESULTS: All 42 procedures were completed with no complications. The combination of propofol and remifentanil resulted in a decrease in heart rate, blood pressure, and respiratory rate. There was no respiratory depression or oxygen desaturation in any child. A bolus of propofol (1 mg x kg(-1)) was necessary in one child for excessive movement. No patient experienced any side effects in the recovery period. CONCLUSION: The combination of propofol and remifentanil for sedation in children undergoing gastrointestinal endoscopy can be considered safe, effective and acceptable.     

右美托咪定和丙泊酚用于硬膜外麻醉下妇科手术患者镇静的比较

目的 比较右美托咪定(Dex)和丙泊酚用于硬膜外麻醉下妇科手术患者的镇静效果.方法 硬膜外麻醉下择期行子宫或(和)卵巢切除患者100例,随机均分成Dex组(D组)和丙泊酚组(P组),应用Ramsay镇静评分和脑电双频指数(BIS)对两组患者术中镇静效果进行观察.记录给药前(T0)、切皮前即给药后15 min(T1)、手术开始后15 min(T2)、30 min(T3)、45 min(T4)、术毕(T5)及术后1 h(T6)患者HR、MAP、BIS、Ramsay镇静评分及呼吸抑制情况.结果 T1～T5时D组BIS,MAP明显低于T0时和P组,Ramsay镇静评分低于P组,HR慢于T0时和P组(P<0.05).低血压的发生率P组明显高于D组(P<0.05).结论 Dex用于硬膜外麻醉下妇科手术患者镇静是安全和可行的.     

Incidence of tumoral pathology according to study using capsule endoscopy for patients with obscure gastrointestinal bleeding

Background Capsule endoscopy has involved a significant advance in techniques for imaging of the small bowel. Its most frequent indication is for studying patients with obscure gastrointestinal bleeding (OGIB). Small bowel tumors are infrequent, representing only 1% to 3% of all malignant gastrointestinal tumors. This study aimed to assess retrospectively the occurrence and characteristics of tumoral pathology diagnosed by means of capsule endoscopy in patients with OGIB. Methods A retrospective review analyzed the first 320 patients submitted to capsule endoscopy because of OGIB (166 with obscure overt bleeding and 154 with obscure occult bleeding) at a single center. The patients with a tumor diagnosis were analyzed in terms of incidence, characteristics, and treatment of OGIB pathology. Results Tumor incidence was of 7.18% (23/320), with 65.2% of the cases supported with histologic confirmation (15/23). Obscure overt bleeding was the most frequent form of presentation, with the jejunum as the most frequent location (65.2%). For 16 patients, an intervention was conducted with a healing intent. Capsule endoscopy allowed the diagnosis of two cecal adenocarcinomas missed by colonoscopy. Conclusions Small bowel tumors are not an infrequent cause of OGIB. Capsule endoscopy, even if it does not allow determination of the benign or malignant nature or the histologic type of the tumor, is a useful tool for the diagnosis and early management of these tumors.     

右美托咪定在小儿患者的临床应用进展

背景 盐酸右美托咪定(dexmedetomidine hydrochloride,DH)是一种新型α2肾上腺素能受体激动剂,具有镇痛镇静和抗焦虑抑制交感神经的作用.它以起效迅速,清除率快且几乎对呼吸无影响的优点被国内外医学工作者广泛地应用于小儿患者.目的 了解DH在小儿患者的应用进展,可为临床用药提供参考.内容 概括DH的小儿药代学特点及对呼吸循环的影响,重点论述小儿临床常见领域如影像学检查,临床麻醉和重症监护室(ICU)的应用情况,它不仅在小儿非创伤性操作时的镇静具有独特的优势,而且对预防和治疗术后苏醒期激动和烦躁的患儿有肯定的疗效.趋向 DH在小儿临床麻醉辅助性应用和镇静镇痛抗焦虑等方面具有一定作用.     

Auditory evoked potentials index versus bispectral index during propofol sedation in spinal anesthesia

Purpose  It is still controversial whether an electroencephalogram could be a useful monitor of sedation levels. The present study was performed to compare the bispectral index (BIS) and the auditory evoked potentials index (AAI) during light sedation with propofol infusion in spinal anesthesia. Methods  Eighty patients, aged 20 to 70 years, scheduled for surgery of the lower extremities under spinal anesthesia were assigned to one of four groups (20 patients each). Patients in the AAI propofol and BIS propofol groups were sedated with propofol infusion at an initial rate of 2 mg·kg⁻¹·h⁻¹. Propofol infusion was controlled to try to keep the observer’s assessment of alertness/sedation (OAAS) scale at 3 or 4. Patients in the AAI control and BIS control groups did not receive propofol. Results  The OAAS scales and the AAI or BIS decreased significantly in all groups during surgery, while the decrease was larger in the AAI propofol and BIS propofol groups. The AAI was significantly lower along with lower OAAS scales. There was no overlap in the AAI between OAAS scale 3 and scale 5 in the AAI propofol group, while in the BIS propofol group, no difference was observed in the BIS among OAAS scales 2, 3, 4, and 5. Conclusion  The AAI, but not the BIS, could discriminate slight changes of consciousness during light sedation with propofol infusion in patients with spinal anesthesia. This work was done at the Department of Anesthesiology, Ofuna Chuo Hospital, Kanagawa, Japan.     

右美托咪定在宫腔镜手术静脉麻醉中的应用

目的探讨右美托咪定联合丙泊酚和瑞芬太尼用于宫腔镜手术的麻醉效果。方法 2012年4～8月选择ASAⅠ～Ⅱ级择期行宫腔镜下子宫肌瘤、子宫内膜息肉、子宫纵膈、宫腔粘连电切术80例,根据医生意愿分为2组（右美托咪定组和对照组）,每组40例。右美托咪定组术前给予右美托咪定0.125 ml/kg（1支右美托咪定200μg,用生理盐水稀释至50ml,终浓度为4μg/ml）,即小剂量0.5μg/kg,由微量注射泵10 min泵完,泵注完成后对患者行Ramsay镇静评分,然后由微量注射泵泵入瑞芬太尼1.0μg.kg-1.min-1,1 min后静脉推入丙泊酚,待病人睫毛反射消失后,手术开始。对照组术前给予生理盐水0.125 ml/kg,其余同右美托咪定组。2组病人术中根据情况随时静脉推入丙泊酚,手术结束时停止瑞芬太尼的输入。记录手术中收缩压、心率、呼吸频率和SPO2最低值;术中应用丙泊酚的总量;术前镇静评分;术后清醒时间及苏醒程度;术中呼吸抑制、术后恶心呕吐、头晕及苏醒期躁动等不良反应;术后宫缩痛的情况。结果右美托咪定组患者术中收缩压[（97.5±7.7）mm Hg vs.（84.0±5.5）mm Hg,t=9.023,P=0.000]、心率最低值[（66.0±6.5）次/min vs.（58.5±5.5）次/min,t=5.571,P=0.000]均显著高于对照组。右美托咪定组患者术前的Ramsay镇静评分明显优于对照组[（3.1±0.5）分vs.（1.2±0.4）分,t=18.767,P=0.000],苏醒时间明显长于对照组[（6.2±1.0）min vs.（5.7±0.7）min,t=2.591,P=0.011],清醒程度优于对照组[（5.0±0.2）分vs.（3.0±0.5）分,t=23.489,P=0.000],所需丙泊酚明显少于对照组[（110.2±6.2）mg vs.（180.4±6.7）mg,t=-48.637,P=0.000],右美托咪定患者术后恶心呕吐、兴奋躁动等不良反应明显优于对照组[6例（15%）vs.16例（40%）,χ2=6.270,P=0.012;4例（10%）vs.12例（30%）,χ2=5.000,P=0.025];术后宫缩痛程度明显低于对照组（Z=-4.137,P=0.000）。结论小剂量0.5μg/kg右美托咪定可安全应用于宫腔镜手术,并能明显减少丙泊酚的用量,降低术后不良反应的发生,缓解术后宫缩痛。