艾司洛尔对丙泊酚麻醉诱导过程中脑电双频指数的影响

目的观察艾司洛尔用于丙泊酚麻醉诱导插管时脑电双频指数(BIS)的变化。方法30例ASAⅠ或Ⅱ级患者随机分为两组,对照组静注生理盐水10ml负荷量后静滴生理盐水,用药组艾司洛尔1mg/kg稀释于生理盐水10ml静注后以250μg.kg-1.min-1微量泵输入,然后静注丙泊酚2mg/kg,当两组BIS降至40~50时静注芬太尼2μg/kg、阿曲库铵0.5mg/kg行经口明视气管插管。监测给药前、诱导前、插管前、插管后1、3、5minBIS、MAP及HR,并观察插管后各时点与插管前BIS、MAP、HR的变化差值△BIS、△MAP及△HR。结果插管前对照组及用药组BIS变化差异无显著意义。插管后1、3、5min对照组BIS较插管前显著升高,用药组BIS与插管前比较差异无显著意义,两组间比较差异有显著意义(P<0.05)。插管后对照组△BIS变化最大百分比为40%,与用药组的6.8%相比差异有极显著意义(P<0.01)。插管后1、3min对照组MAP、HR显著高于插管前,两组比较差异无显著意义;插管后对照组△MAP及△HR变化最大百分比为55%及40%,明显高于用药组的29%及15%。结论艾司洛尔用于丙泊酚麻醉诱导插管时,对插管前BIS无影响,插管后可抑制BIS的增加。     

Brain tumors may alter the relationship between bispectral index values and propofol concentrations during induction of anesthesia

STUDY OBJECTIVE: To compare propofol-predicted effect-site concentrations (PropCe) and bispectral index (BIS) of the electroencephalogram during induction of anesthesia in patients with small brain tumors and to analyze BIS and PropCe at loss of consciousness (LOC). DESIGN: Prospective investigation. SETTING: Operating theater of a university hospital. PATIENTS: 26 ASA physical status I and II patients, 13 of whom were scheduled for nontumor spinal surgeries, and the other 13, for brain surgery for small brain tumor removal. INTERVENTIONS: Anesthesia was induced with a propofol 1% constant infusion rate of 200 mL/h until LOC. MEASUREMENTS: BIS, PropCe, heart rate, and mean arterial pressure were analyzed at the beginning of the propofol infusion and every 30 seconds during induction. MAIN RESULTS: The BIS values were significantly higher in patients with brain tumors in the period from 150 to 210 seconds, with PropCe similar to patients without brain tumors. Loss of consciousness occurred 3.6 +/- 0.8 minutes in patients without brain tumors and 3.9 +/- 0.7 minutes in patients with brain tumors. No differences were observed between groups in the time to LOC (3.6 +/- 0.8 in group 1 vs 3.9 +/- 0.7 in group 2) or in BIS at LOC (48.7 +/- 11.4 in group 1 vs 58.6 +/- 21.7 in group 2). CONCLUSIONS: For similar propofol concentrations, patients with small brain tumors show higher BIS values on induction of anesthesia with propofol.     

Efficacy of 1% ropivacaine at sacral segments in lumbar epidural anesthesia

BACKGROUND AND OBJECTIVES: It is suggested that the potency of 1% ropivacaine is comparable to that of 0.75% bupivacaine and higher than that of 2% lidocaine. Alkalinized lidocaine reportedly enhances the block of sacral segments during lumbar epidural anesthesia. We hypothesized that 1% ropivacaine might also block at the lumbosacral segments adequately during lumbar epidural anesthesia. METHODS: Forty-two patients undergoing lumbar epidural anesthesia at L4-5 or L5-S1 were randomly divided into 3 groups and received either 14 mL 2% lidocaine (lidocaine group), 2% lidocaine with epinephrine 1:200,000 and bicarbonate (lidocaine-epinephrine-bicarbonate group), or 1% ropivacaine (ropivacaine group). Pain threshold after repeated electrical stimulation was used to assess sensory block at the L2, S1, and S3 segments while motor block was evaluated using the modified Bromage Scale. RESULTS: Demographic data were comparable between the groups. Significant differences in the pH of each local anesthetic solution were found between the 3 groups. Pain thresholds at the S1 and S3 segments in the lidocaine-epinephrine-bicarbonate group were significantly higher and sensory block onset faster than in the other groups. However, no significant differences were found in either the pain threshold or the onset of sensory block of the L2 segment between the groups. No significant differences in the pain threshold, onset of sensory block, or Bromage Scale were found between the lidocaine and ropivacaine groups. CONCLUSIONS: We conclude that 1% ropivacaine does not improve block of sacral segments within 20 minutes following epidural ropivacaine administration.     

Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy

We evaluated in this prospective study the effectiveness of continuous thoracic epidural anesthesia (TEA) and postoperative analgesia with ropivacaine and compared it with general anesthesia (GA) and opioids for pain relief, side effects, postanesthesia recovery, and hospital discharge after modified radical mastectomy. Sixty ASA physical status II and III patients undergoing mastectomy were randomly assigned to two study groups of 30 patients each. In the TEA group, an epidural catheter was inserted at T6-7, and 5--10 mL of 0.2% ropivacaine was injected to maintain anesthesia and to continuously administer adequate analgesia for 48 h. GA was induced with IV 1--2 mg of midazolam or 50--100 microg/mL of fentanyl followed by 50--150 mg of propofol and was maintained with sevoflurane and 50% N(2)O in oxygen. The Aldrete score system was used to evaluate postanesthesia recovery, a verbal rating scale was used for assessment of pain intensity, and a postanesthesia discharge scoring system was used for discharge home. The demographic data and side effects (except for nausea and vomiting) (GA 43%, TEA 10%, P = 0.0074) and discharge home were similar in both groups. However, the number of patients ready for discharge from the recovery room during the first postanesthesia hour (Aldrete score of 10) was significantly larger after TEA (80%) than after GA (33%) (P = 0.0006). GA patients experienced significantly more (P < 0.001) substantial pain than TEA patients on Day 0 (70%), Day 1 (53%), and Day 2 (27%) after the surgery. Patient satisfaction was greater with TEA (70%) than with GA (30%) (P < 0.001). We conclude that TEA with ropivacaine provides better postoperative pain relief and less nausea and vomiting, facilitates postanesthesia recovery, and gives greater patient satisfaction than GA.     

Comparison of bupivacaine 0.2% and ropivacaine 0.2% combined with fentanyl for epidural analgesia during labour

BACKGROUND AND OBJECTIVE: Recent clinical studies comparing ropivacaine 0.25% with bupivacaine 0.25% reported not only comparable analgesia, but also comparable motor block for epidural analgesia during labour. An opioid can be combined with local anaesthetic to reduce the incidence of side-effects and to improve analgesia for the relief of labour pain. The purpose of the study was to evaluate the effects of epidural bupivacaine 0.2% compared with ropivacaine 0.2% combined with fentanyl for the initiation and maintenance of analgesia during labour and delivery. METHODS: Sixty labouring nulliparous women were randomly allocated to receive either bupivacaine 0.2% with fentanyl 2 microg mL(-1) (B/F), or ropivacaine 0.2% with fentanyl 2 microg mL(-1) (R/F). For the initiation of epidural analgesia, 8 mL of the study solution was administered. Supplemental analgesia was obtained with 4 mL of the study solution according to parturients' needs when their pain was > or = 4 on a visual analogue scale. Analgesia, hourly local anaesthetic use, motor block, patient satisfaction and side-effects between groups were evaluated during labour and at delivery. RESULTS: Sixty patients were enrolled and 53 completed the study. No differences in verbal pain scores, hourly local anaesthetic use or patient satisfaction between groups were observed. However, motor block was observed in 10 patients in the B/F group whereas only two patients had motor block in the R/F group (P < 0.05). The incidence of instrumental delivery was also higher in the B/F group than in the R/F group (P < 0.05). CONCLUSIONS: The results suggest that epidural bupivacaine 0.2% and ropivacaine 0.2% combined with fentanyl produced equivalent analgesia for pain relief during labour and delivery. It is concluded that ropivacaine 0.2% combined with fentanyl 2 microg mL(-1) provided effective analgesia with significantly less motor block and need for an instrumental delivery than a bupivacaine/fentanyl combination at the same concentrations during labour and delivery.     

肌松药对异丙酚诱导期脑电熵和脑电双频指数的影响

目的：探讨维库溴铵、琥珀胆碱对异丙酚诱导期脑电熵和脑电双频指数（bispectral index,BIS）的影响。方法：靶控输注异丙酚进行诱导,当患者OAA/S评分≤1分时置入喉罩,机械通气。调节异丙酚靶控浓度,使效应室浓度（effect-site concentration,Ce）维持在2.0μg/mL或3.0μg/mL,稳定5min。维库溴铵2.0组（V2.0组）和维库溴铵3.0组（V3.0组）分别在异丙酚Ce稳定在2.0μg/mL或3.0μg/mL时静脉推注维库溴铵0.1mg/kg,琥珀胆碱2.0组（S2.0组）和琥珀胆碱3.0组（S3.0组）则静脉推注琥珀胆碱1mg/kg,两组对照组（C2.0组,C3.0组）给予等容量的生理盐水。记录麻醉诱导前、肌松药静脉推注前（基础值）及静脉给药后第1～5分钟的BIS、反应熵（respect entropy,RE）、状态熵（state entropy,SE）。结果：与基础值比较,V2.0组、S2.0组和C2.0组静脉给药后BIS、RE、SE下降（P〈0.05）,V3.0组和S3.0组各指标变化差异无统计学意义（P〉0.05）。S2.0组和S3.0组在给予琥珀胆碱后第2分钟时点RE、SE升高（P〈0.05）,但BIS变化差异无统计学意义（P〉0.05）。V2.0组、V3.0组、S2.0组和S3.0组分别与相同异丙酚Ce对照组比较,静脉推注肌松药前后SE、BIS差异均无统计学意义（P〉0.05）,仅RE在给予琥珀胆碱后第2分钟时点升高（P〈0.05）。结论：肌松药对脑电熵和BIS的影响与镇静深度有关,在较浅的镇静状态下,肌松药可引起BIS、RE、SE数值下降;肌松药对脑电熵和BIS的影响与肌松药的种类无关。     

咪唑安定与丙泊酚对脑电双频指数的影响

目的测定和比较咪唑安定与丙泊酚诱导时半数病人入睡时的脑电双频指数（BIS50）和半数有效量（ED50）。方法选择60例无服用精神药物和镇静催眠药物史、无术前用药的门诊手术病人（ASAⅠ～Ⅱ级），随机均分为咪唑安定组（M组）和丙泊酚组（P组），以半数效量序贯法分别进行咪唑安定与丙泊酚诱导的睡眠观察，以对语言指令和睫毛反射消失为入睡指标，同时记录BIS的变化。对取得的数据以直线回归的方法和加权均数法分别求得咪唑安定、丙泊酚的BIS50和ED50。结果咪唑安定诱导后，术峤病人与入睡病人的BIS值均较用药前的基础值明显下降，但下降幅度在两类病人之间差异无统计学意义，BISso和EDso分别为：77．02（95％可信区间为：71．08～85．86）和0．1237mg／kg（95％可信区间为：0．0990-0．1540mg／kg）。丙泊酚诱导时未睡病人的BIS值下降不明显，而入睡病人的BIS值显著下降，两者之间差异有统计学意义（P〈0．05）。丙泊酚的BIS50和ED50分别是79．17（95％可信区间为：72．08～88．55）和1．0192mg／kg（95％可信区间为：0．9400～1．1480mg／kg）。结论咪唑安定和丙泊酚对BIS的影响有较大的差异。与丙泊酚比较，BIS值与咪唑安定催眠效果的相关性小于丙泊酚。     

Changes of bispectral index during recovery from general anesthesia with 2% propofol and remifentanil in children

BACKGROUND: The bispectral (BIS) index is a pharmacodynamic measure of the effect of anesthesia on the central nervous system. The aim of this study was to investigate the relationship between BIS index and predicted plasma concentration of propofol delivered by target controlled infusion (TCI) during emergence in children. METHODS: With approval of IRB, 30 patients (2-7 years) were included in this study. Anesthesia was with TCI propofol 3-5 microg.ml(-1) and remifentanil 7.5 ng.ml(-1) to maintain BIS 40-60 and the propofol concentration was fixed at 3 microg.ml(-1) Remifentanil infusion was stopped 10 min before the end of surgery. BIS values were recorded after reducing propofol in decrement of 0.2 microg.ml(-1). BIS values were checked when spontaneous respiration occurred and children were able to obey a command (eye opening or hand grasping). RESULTS: Spearman's correlation analysis showed negative correlation between BIS and propofol plasma concentration (r = -0.559, P < 0.001). When respiration returned, mean BIS was 77.2 +/- 5.3 and propofol plasma concentration 1.6 +/- 0.3 microg.ml(-1) and when a verbal command was obeyed, BIS was 82.4 +/- 5.6 and propofol plasma concentration 1.5 +/- 0.3 microg.ml(-1). CONCLUSIONS: In preschool children, BIS moderately correlated with the predicted plasma concentration of propofol.     

Ability of the bispectral index, autoregressive modelling with exogenous input-derived auditory evoked potentials, and predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifentanil

BACKGROUND: This study was conducted to compare the performance accuracy of the independent variables Bispectral Index (BIS), A-Line ARX index (AAI), and predicted propofol effect-site concentration (CePROP) to measure the dependent variables of loss of responses to different stimulation defined as loss of response to verbal command (LORverbal), eyelash reflex (LORlash), and noxious stimulus (LORnoxious) during stepwise increased levels of propofol infusion with and without remifentanil. METHODS: Forty-five patients were randomly allocated to one of three groups (0, 2, and 4 ng/ml remifentanil) to receive graded CePROP and predicted effect compartment controlled remifentanil (CeREMI). At every step, the ability to respond to verbal command using the Observer's Assessment of Alertness/Sedation Scale (OAA/S), eyelash reflex, and electrical tetanic noxious stimulus were compared against BIS, AAI, and CePROP. Prediction probability and sensitivity/specificity were calculated. RESULTS: Increasing CeREMI increased BIS and AAI values at LORverbal and LORlash and decreased CePROP. Similar findings were found for LORnoxious. The overall prediction probability to measure the hypnotic component of anesthesia remained accurate in the three groups for BIS, AAI, and CePROP. Combined information from CePROP, CeREMI, and BIS or AAI increased the overall prediction probability for predicting the OAA/S scale and LORlash. Less accuracy to LORnoxious was found in all independent variables. CONCLUSIONS: Although BIS, AAI, and CePROP were influenced by remifentanil during propofol administration, their ability to detect OAA/S and LORlash remained accurate. Improved performance is obtained when BIS and AAI are measured in conjunction with drug targeted effect-site concentrations. Remifentanil decreases the ability of these independent variables to detect LORnoxious.     

Comparison of ropivacaine 0.2% and 0.25% with lidocaine 0.5% for intravenous regional anesthesia

Study ObjectiveTo compare the anesthetic effects of two different concentrations and doses of ropivacaine (0.2% and 0.25%) with those of a conventional dose of lidocaine 0.5%.DesignProspective, randomized, double-blinded, clinical investigation.SettingLarge metropolitan university hospital.Patients66 adult ASA physical status I and II patients undergoing forearm and hand surgery.InterventionsPatients were randomly allocated to three groups to receive intravenous regional anesthesia (IVRA). Study groups were: ropivacaine 0.2% (Group I, n = 22), ropivacaine 0.25% (Group II, n = 22), and lidocaine 0.5% (Group III, n = 22).MeasurementsTourniquet tolerance times and regression of sensory analgesia were noted. Verbal numerical pain scores (VNS), cumulative analgesic consumption, and side effects were recorded during surgery and postanesthesia care unit (PACU). Time to first pain medication intake and number of patients receiving analgesics in the PACU were recorded.Main ResultsAdditional tolerance times for the distal tourniquet were significantly higher in the ropivacaine 0.25% group than the other two groups. Regression of sensory anesthesia was fastest in the lidocaine group. During the PACU stay, VNSs were significantly lower in the first 20 minutes in the ropivacaine groups than the lidocaine group. Time to first intake of pain medication in the PACU was soonest in the lidocaine group. The number of patients given analgesics in the PACU was highest in the lidocaine group. The number of patients taking > two tablets of tramadol was significantly lowest in the ropivacaine 0.25% group. No serious side effects were observed in any study group.ConclusionLonger tolerance times for the distal tourniquet, prolonged analgesia after tourniquet release, and lower analgesic requirements postoperatively make ropivacaine 0.2% and 0.25% an alternative to lidocaine for IVRA.     

丙泊酚靶控输注全麻诱导时BIS值与机体应激反应的关系

目的观察丙泊酚靶控输注(TCI)用于全麻诱导时,脑电双频指数(BIS)值与应激反应的关系。方法30例气管插管全麻下手术患者随机分为三组,每组10例。Ⅰ组BIS值维持在36~45,Ⅱ组46~55,Ⅲ组56~65,分别于麻醉诱导前(T0)、插管即刻(T1)以及插管后1min(T2)、3min(T3)、5min(T4)和10min(T5)记录HR和MAP,同期抽取桡动脉血测定血糖和皮质醇。结果Ⅰ组MAP、HR于T3、T4时持续下降(P<0.05),且T3、T4时MAP低于Ⅲ组(P<0.05);Ⅱ组T4时MAP低于T0时(P<0.05);Ⅲ组血糖和皮质醇水平T2、T3时高于T0时(P<0.05或P<0.01),血糖T2~T4时较Ⅰ组升高(P<0.05或P<0.01),T3、T4时较Ⅱ组升高(P<0.05),T2、T3时皮质醇水平明显高于Ⅰ组和Ⅱ组(P<0.05或P<0.01)。结论丙泊酚TCI用于全麻诱导时,将BIS值控制在46~55,在有效减轻应激反应的同时,能维持血流动力学的相对稳定。     

Ephedrine,but not phenylephrine,increases bispectral index values during combined general and epidural anesthesia

Ephedrine and phenylephrine are used to treat hypotension during combined general and epidural anesthesia, and they may change anesthetic depth. In the current study, we evaluated the effects of ephedrine versus phenylephrine on bispectral index (BIS) during combined general and epidural anesthesia. After injection of ropivacaine through the epidural catheter, general anesthesia was induced with propofol and vecuronium, and was maintained with 0.75% sevoflurane. Approximately 10 min after the intubation, BIS was recorded as a baseline value. Patients with decreases in arterial blood pressure <30% of the preanesthetic values were defined as control group (n = 9). Patients who had to be treated for larger decreases in arterial blood pressure were randomly assigned to receive ephedrine 0.1 mg/kg (n = 17) or phenylephrine 2 micro g/kg (n = 17). BIS values were recorded at 1-min intervals for 10 min. BIS in the ephedrine group was significantly larger from 7 to 10 min than that in the control and phenylephrine groups (P < 0.05). Seven patients in the ephedrine group had BIS >60, whereas no patient in the control and phenylephrine groups had BIS >60 (P < 0.005). Ephedrine, but not phenylephrine, increased BIS during general anesthesia combined with epidural anesthesia.     

Toxic effects of epidural analgesia with ropivacaine 0.2% in a diabetic patient.

A 51-year-old ASA physical status II, non-insulin-dependent diabetic male patient manifested lower limb nerve injury after receiving postoperative epidural analgesia with ropivacaine 0.2%. The case is presented, including a discussion of the relation between local anesthetic toxicity and diabetic neuropathy.     

The effect of lidocaine on the bispectral index during anesthesia induction with propofol]

We investigated the effect of premixing lidocaine with propofol on a bispectral index (BIS) during propofol infusion. We studied 40 adult patients given mixture of 1% propofol 20 ml with 2 ml of normal saline (control group) or 2% lidocaine (lidocaine group) infused at 2 ml.kg-1.hr-1 for 10 minutes. Heart rate, mean arterial pressure, and BIS were measured every minute. The addition of lidocaine to propofol reduced the incidence of injection pain from 85% to 10% but did not change the induction time. Propofol significantly decreased mean arterial pressure and BIS but there was no difference between the groups. In conclusion, premixing lidocaine with propofol reduces injection pain without affecting the hypnotic effect.     

Relationship between clinical endpoints for induction of anesthesia and bispectral index and effect-site concentration values

STUDY OBJECTIVE: To assess the relationship between clinical endpoints for induction of anesthesia and the electroencephalographic (EEG) bispectral index (BIS) and effect-site concentration (C(E)) values when using a target-controlled infusion (TCI) of either thiopental sodium or propofol, by hypothesizing that yawning may be a useful alternative to other commonly used clinical signs for determining loss of consciousness. DESIGN: Randomized observational clinical study. SETTING: Operating room of a university-based hospital.PATIENTS: 60 healthy adult patients (aged 20-50 yrs) scheduled for elective surgery with general anesthesia. INTERVENTIONS: During a TCI of propofol (n = 30) or thiopental (n = 30), clinical endpoints for loss of verbal responsiveness (LOV), loss-of-eyelash reflex (LOE), occurrence of yawning, and apnea were assessed at 15-second intervals. In addition, BIS and C(E) values were recorded at each of the endpoints. MEASUREMENTS AND MAIN RESULTS: In both anesthetic groups, the sequence of occurrence of the clinical endpoints was similar, namely LOV, LOE, yawning, and, lastly, apnea. Compared with LOV and LOE, yawning was associated with lower BIS and higher C(E) values with both anesthetics. The frequency of yawning was higher with thiopental than propofol (83% vs. 63%, respectively). However, the frequency of apnea was higher with propofol than thiopental (77% vs. 53%, respectively). CONCLUSION: The correlation of the clinical endpoints with BIS and C(E) values was highest for LOV. Yawning was as unreliable as LOE for determining the onset of unconsciousness during induction of anesthesia. This clinical sign failed to be observed in 17% and 37% of patients induced with thiopental and propofol, respectively.     

State entropy and bispectral index: correlation with end tidal sevoflurane concentrations

AIM: Aim of this study was to evaluate the difference between the correlations of state entropy (SE) and bispectral index (BIS) with different end tidal concentrations (Et) of sevoflurane. METHODS: A total of 40 ASA I/II patients submitted to abdominal surgery were enrolled in the study. After premedication with fentanyl, anesthesia was induced with propofol and atracurium and maintained with sevoflurane in oxygen and air. The values of Et sevoflurane, SE and BIS were recorded during the operating room stay. The mean Et sevoflurane was calculated and the correlations of SE and BIS with Et sevoflurane were determined with Pearson test separately at values of Et sevoflurane below and higher the mean Et sevoflurane. Student's t-test was used to verify if the difference between the correlations was significant (P<0.05). RESULTS: The mean Et sevoflurane was 1.5%. During anesthesia the correlation with Et sevoflurane was -0.75 for SE and -0.70 for BIS. At Et sevoflurane higher than 1.5% the correlation with Et sevoflurane was -0.41 for SE and -0.14 for BIS. At Et sevoflurane below 1.5% the correlation with Et sevoflurane was -0.65 for SE, and -0.8 for BIS. The difference between the correlations of Et sevoflurane with SE and BIS resulted statistically significant. CONCLUSION: During sevoflurane anesthesia SE shows a better correlation than BIS with Et sevoflurane. Although at low Et sevoflurane the correlation is better with BIS, at high Et sevoflurane the correlation is better with SE.     

Bispectral index values at sevoflurane concentrations of 1% and 1.5% in lower segment cesarean delivery

Inadequate hypnosis in the absence of opioid analgesia may account for the increased incidence of awareness in cesarean delivery. An end-tidal concentration of 0.5 MAC isoflurane in 50% nitrous oxide (N(2)O) during cesarean delivery resulted in bispectral index (BIS) values >60, the threshold below which consciousness is unlikely. Our aim was to determine the BIS values achieved with the equivalent end-tidal concentration of sevoflurane and to determine if a larger concentration would consistently maintain BIS values <60. Twenty ASA physical status I-II parturients were randomized to receive an end-tidal concentration of either 1% sevoflurane or 1.5% sevoflurane delivered in 50% N(2)O throughout surgery. Thiopental 4 mg/kg was used for anesthetic induction. Morphine 0.1-0.15 mg/kg was administered only after delivery. Mean BIS values in the period between skin incision and neonatal delivery were 61 (95% confidence interval, 57-64) in the 1% sevoflurane group, versus 42 (95% confidence interval, 37-47) in the 1.5% sevoflurane group. BIS values were significantly different between groups at skin incision, uterine incision, delivery, and 10 min after delivery, but not thereafter. Indices of maternal and neonatal outcome were similar between groups. IMPLICATIONS: Bispectral index (BIS) values <60 are consistent with a high probability of unconsciousness. An end-tidal concentration of 1.5% sevoflurane maintained BIS values <60 during cesarean delivery, whereas 1% did not. Adverse effects were not seen with the use of larger concentrations of sevoflurane.     

0.2%左旋布比卡因与罗哌卡因持续硬膜外泵注镇痛效应的比较

目的 研究0.2％左旋布比卡因(LBUP)硬膜外持续泵注的镇痛效应,并与0.2％罗哌卡因(ROP)比较。方法 60例妇科下腹部择期手术ASA Ⅰ-Ⅱ级病人随机分为两组,LBUP组(L组)和ROP组(R组),每组30例。术毕采用双泵法镇痛,一泵持续泵注0.2％ LBUP或0.2％ ROP 4ml/h;另一泵病人硬膜外自控镇痛(PCA)0.01％吗啡2ml/次,锁定时间为10min。结果 两组的镇痛效果均满意,术后24h VAS评分L组略低、BCS及Ramsey镇静评分两组基本相似,L组和R组分别有7例(23％)和5例(17％)未按压PCA泵,两组24h吗啡需求量分别为(0.6±0.4)mg、(0.7±0.6)mg。下肢运动完全恢复时间L组(7.8±2.8)h长于R组(5.9±2.5)h,P<0.05,术后4h时Bromage评分分别为1.3±0.9和1.1±1.0。结论 硬膜外0.2％LBUP 4ml/h 吗啡硬膜外PCA术后镇痛效果满意,同等浓度的LBUP阻滞效果比ROP强。