异丙酚静脉复合麻醉在老年人胃肠镜联合检查中的应用

目的 评价异丙酚合并芬太尼静脉麻醉在老年患者胃肠镜联合检查中的效果及安全性.方法 回顾分析326例采用静脉麻醉下胃肠镜联合检查(联合检查组)老年患者的临床资料,与同期接受静脉麻醉下胃镜(胃镜组)或结肠镜检查(结肠镜组)的老年患者进行对照,比较各组血压、心率、血氧饱和度(SpO2)变化情况以及不良反应发生情况.结果 异丙酚平均用量分别为联合检查组(100.4±38.5)mg、胃镜组(130.4±50.5)mg、结肠镜组(170.3±60.3)mg,所有患者均能达到胃肠镜检查的满意镇静程度,无因麻醉并发症终止胃肠镜检查者;心率、血压变化及心血管事件发生率各组间比较,差异无统计学意义(P＞0.05);呼吸事件发生率分别为9例(3.1％)、6例(2.3％)和13例(4.0％),差异亦无统计学意义(P＞0.05).结论 在严格控制适应证、术中严密监测的条件下,应用异丙酚静脉复合麻醉对于老年患者胃肠镜联合检查是安全、有效的.     

胃镜检查时静脉麻醉对高血压肥胖者血氧饱和度的影响

目的研究胃镜检查时丙泊酚联用芬太尼静脉麻醉下对高血压病肥胖患者血氧饱和度的影响。方法收集我院两年来190例高血压病肥胖患者静脉麻醉下胃镜检查的临床资料,另取同期体重、血压均正常的胃镜检查者200例为对照组,比较在相同检查方式下两组患者血氧饱和度（SpO2）的最低值和SpO2最低时的血压、心率变化。结果所有检查者均顺利完成检查;高血压病肥胖组SpO2最低值为（91．8±7．8）％,对照组SpO2最低值为（96．7±1．6）％,高血压病肥胖组SpO2下降程度明显低于对照组（P〈0．05）;SpO2最低时两组血压、心率均相应下降,但变化程度不大,组内前后两观察时点比较差异均无显著性（P〉0．05）。结论高血压病肥胖患者行胃镜检查时,丙泊酚联用芬太尼麻醉可引起血氧饱和度下降,检查前应予充分吸氧,以避免缺氧导致不良后果。     

地佐辛联合异丙酚在无痛胃肠镜检查术的应用

目的评价地佐辛联合异丙酚对无痛胃肠镜术的麻醉效果及安全性。方法收集接受无痛胃肠镜检查的患者共232例（胃肠镜136例,肠镜96例）,随机分为观察组与对照组,后者单用异丙酚麻醉,观察组在异丙酚的基础上加用地佐辛。比较两组患者的生命体征、苏醒时间、异丙酚用量以及术后恶心感评分（VAS）等方面的差异。结果与对照组比较,术中观察组患者血压及心率显著低于对照组,而血氧饱和度高于对照组（P〈0．05）;观察组的异丙酚用量为（83．39±7．92）mg,显著少于对照组的（121．83±17．74）mg（t=-6．992,P=0．000）;观察组患者VAS评分明显低于对照组（f=1．782,P=0．036）,但两组间的苏醒时间无统计学差异（P〉0．05）。结论地佐辛联合异丙酚应用于无痛胃肠镜的麻醉效果及血液动力学安全性优于单用异丙酚。     

老年冠心病患者麻醉胃镜安全性的评估

目的 研究异丙酚和芬太尼联合静脉麻醉运用于老年冠心病患者胃镜检查中的安全性。方法 选择胃镜检查中自愿接受麻醉的老年冠心病患者24例为麻醉胃镜组(A组)，另30例常规胃镜检查的老年冠心病患者为非麻醉胃镜对照组(B组)，A组于镜检前静脉推注异丙酚和芬太尼，检测两组患者在检查前、检查中、检查后的心率、心律、血压、氧饱和度和心电图表现等。结果 麻醉组的各项生理指标较对照组稳定，引起心脏意外的风险明显减少，安全可行。结论 异丙酚和芬太尼联合静脉麻醉运用于老年冠心病患者是安全可行的，但应在有经验的麻醉医师实施和监控下及有抢救条件的胃镜室进行。     

异丙酚静脉全凭麻醉在老年无痛消化内镜检查中的临床应用

目的探讨异丙酚静脉全凭麻醉在老年无痛消化内镜诊疗中的有效性和安全性。方法选择在我院门诊同期行消化内镜检查的≥60岁老年患者分为2组,行无痛内镜的患者入A组,行常规内镜的患者入B组,每组60例。A组患者给予异丙酚2.0mg/kg,20s内缓慢注入,以睫毛反射消失进行诊疗,后视手术时间长短和患者的反应,可每次酌情追加20～30mg,诊疗结束后停药。B组患者行普通内镜检查,记录2组患者术前、术中、术毕和清醒时的收缩压（SBP）、舒张压（DBP）、心率（HR）、血氧饱和度（SpO2）的变化,以及并发症和医生患者满意度。结果 A组术中SBP、DBP、HR与术前相比有所降低（P〈0.05）,而B组术中SBP、DBP、HR与术前相比有所增高,2组间术中比较差异有显著性（P〈0.05）;2组SpO2在术中均下降,B组较A组下降明显（P〈0.05）。A组并发症发生率较B组明显减少,且A组患者满意度及医生操作满意度明显高于B组（P〈0.05）。结论异丙酚全凭静脉麻醉对老年内镜诊疗患者的循环、呼吸抑制小,快速诱导与清醒,在老年消化内镜诊疗麻醉中安全有效。     

静脉麻醉下联合胃肠镜检查顺序对肠道清洁度的影响

目的探讨静脉麻醉下联合胃肠镜检查中,先做胃镜对肠道清洁度有无不利影响,为合理检查顺序提供参考。方法单中心随机盲法观察性研究。65例患者随机分成A组（先做胃镜后做结肠镜）和B组（先做肠镜后做胃镜组）,根据改良波士顿肠道准备评分标准评估2组肠道清洁度,并比较2组丙泊酚用量、肠镜达盲时间、在操作室总时间、麻醉诱导和恢复时间以及不良事件发生情况。结果2组全结肠清洁度差异无统计学意义（6．724±0．34比6．89±1．50;t=-0．473,P=0．638）,而回盲部清洁度差异有统计学意义（1．21±0．54比1．55±0．73;t=-2．158,P=0．035）。2组间操作时间、丙泊酚用量和不良事件发生率等差异无统计学意义。结论静脉麻醉下联合胃肠镜检查时先肠镜后胃镜组回盲部清洁度优于先胃镜后肠镜组,而全结肠清洁度组间差异无统计学意义。对怀疑回盲部病变的患者,若行联合胃肠镜检查,可考虑优先行肠镜检查。     

静脉麻醉辅助大肠镜检查的效果

目的在大肠镜检查中以良好的止痛及镇静作用,增加患者接受检查的依从性,提高检查的成功率。方法将６１９例患者随机分为观察组（３１９例,给予异丙酚及芬太尼静脉麻醉）与对照组（３００例,常规操作）,对２组患者的操作时间、检查成功率、检查反应以及检查前、中、后三阶段的血氧饱和度、心率进行观察。结果观察组操作时间、检查成功率、检查反应等方面明显优于对照组（Ｐ＜０．０１）,检查前后血氧饱和度和心率的变化与对照组比较差异无显著意义（Ｐ＞０．０５）。结论辅以异丙酚及芬太尼静脉麻醉进行大肠镜检查是安全有效的,为无痛苦大肠镜检查开辟了广阔前景。     

胃镜检查中应用异丙酚的临床观察

胃镜检查时患者因有明显的咽部不适、屏气、呛咳、恶心、呕吐等,往往难以配合,给胃镜检查带来困难,甚至造成机械性创伤。为此,我们应用异丙酚进行镇静镇痛,效果良好,现报告如下。 一、资料和方法 1 临床资料:将胃镜检查患者（行镜下治疗者除外）共1357例,分成常规检查组（A组）和异丙酚镇静组（B组）。A组672例,男 401例,女 271例,年龄为（48.68±17.52）岁,体重（60.81±9.31）kg。B组685例,男418例,女267例,年龄为（46.97±18.40）岁,体重（61.62±7.82）kg。两组患者的男女比例、年龄结构和体重情况无差异（性别X2=0.25,年龄t=1.76,体重t=1.72,P均>0.05）。     

瑞芬太尼、异丙酚和阿托品联合应用对老年人胃镜检查时心肺功能的影响

目的观察瑞芬太尼、异丙酚联合阿托品对老年人胃镜检查中呼吸、循环功能的影响。方法接受胃镜检查的240例老年患者随机分为4组，瑞芬组经静脉缓慢注入阿托品、瑞芬太尼和异丙酚，达到镇静3～4级后行胃镜检查，设老年常规胃镜检查为对照Ⅰ组，单纯异丙酚为对照Ⅱ组，异丙酚＋芬太尼为对照Ⅲ组。记录各组基础值及检查中、检查后的HR，SpO2，NBP；观察检查中患者反应及检查后的不良反应。结果全组操作顺利完成，无严重并发症出现，效果满意。瑞芬组虽有一过性氧饱和度降低（P〈0.05），但可自动恢复。与基础值相比，检查中、检查后的SBP，DBP无明显改变（P〉0.05）。结论瑞芬太尼、异丙酚联合阿托品用于老年人胃镜检查，具有安全无痛、无不良记忆、利于检查操作等优点，对病人呼吸、循环功能无明显抑制作用。     

异丙酚及其联合芬太尼应用于老年无痛胃镜30例

目的:观察老年人应用异丙酚、芬太尼联合异丙酚两种不同静脉麻醉方法行无痛胃镜检查的优劣性.方法:选取2008-05/2011-02于我院就诊的行胃镜检查的老年患者60例为研究对象,随机分为A、B两组,各30例,分别应用异丙酚、芬太尼联合异丙酚浅静脉麻醉,采用警觉与镇静评分(OAA/S)标准评分<2分为无痛胃镜检查的界值,未达到界值者酌情应用异丙酚10-30mg追加使用.比较分析两组达到无痛检查界值的时间、苏醒时间及定向力恢复时间.以麻醉前20min检查结果为基点,比较分析两组患者检查中5min时心率(heart rate,HR)、血压(blood pressure,BP)、呼吸(respiratory rate RR)、动脉血氧分压(partial pressure of oxygen in arterial blood,SPO2)波动情况.结果:本组60例均安静入睡,完成胃镜诊疗,其中于诊疗结束1-5min内苏醒46例,15min内完全清醒14例;A组患者达到无痛检查界值时间19.5min±2.6min及苏醒时间17.5min±2.2min均显著低于B组患者14.9min±3.1min、11.1min±1.7min(P<0.01),两组患者定向力恢复时间差异无统计学意义(P>0.05);两组患者检查中5min时HR、BP、RR、SPO2均有所下降,其中A组HR下降幅度-9.9次/min±5.1次/min高于B组-13.2次/min±4.7次/min(P<0.05),但收缩压下降幅度显著低于B组(P<0.01);两组RR、SPO2、下降幅度差异无统计学意义(P>0.05).结论:芬太尼联合异丙酚静脉麻醉对老年人有减轻咽反射刺激的作用,对呼吸、循环系统影响小,是一种安全有效的麻醉方法.     

Intermittent manually controlled versus continuous infusion of propofol for deep sedation during interventional endoscopy: A prospective randomized trial

Abstract Introduction. Beside the traditional, intermittent bolus application of propofol, continuous propofol infusion via infusion pump is an alternative procedure for deep sedation during long-lasting interventional endoscopy. However, up to now, there are no randomized comparisons for gastrointestinal endoscopy. Methods. One hundred patients (ERCP: n = 60, EUS: n = 40) were randomly assigned to receive intermittent bolus application ("bolus group") or continuous infusion ("perfusor group") of propofol sedation after induction with 3 mg midazolam for deep sedation. Patients in the bolus group received an initial propofol dose according to body weight (bw <70 kg: 40 mg; bw ≥70 kg 60 mg). In the perfusor group, bw-adapted, continuous propofol infusion (6 mg/kg) via the Injectomat 2000 MC (Fresenius-Kabi) was administered after an initial bolus of 1 mg/kg. Vital signs, dose of propofol, patient cooperation (VAS 1-10), sedation depth, and the recovery time as well as the quality of recovery were evaluated. Results. Total propofol dose in the bolus group 305 ± 155 mg (100-570 mg) and in the perfusor group 343 ± 123 mg (126-590 mg, p = 0.5) were comparable. Oxygen saturation below 90% was seen in four patients of each group, with no need for assisted ventilation. Arterial blood pressure <90 mmHg was documented in two patients in the bolus group and seven patients in the perfusor group (p = 0.16). Patients' cooperation was rated as good in both groups (bolus group, 9.1 ± 0.9; perfusor group, 8.9 ± 1; p = 0.17). Recovery time was significantly shorter in the bolus group compared with the perfusor group (19 ± 5 versus 23 ± 6 min, p < 0.001) whereas the quality of recovery was nearly identical in both groups. Conclusion. Both sedation regimens allow nearly identical good controllability of propofol sedation. However, recovery time was significantly slower and hypotension was tended to occur more often in the perfusor group.     

Propofol versus midazolam and meperidine for conscious sedation in GI endoscopy

OBJECTIVE: Propofol (2,6-diisopropyl phenol) is a relatively new intravenous sedative hypnotic with an ideal pharmacokinetic profile for conscious sedation. In this study, we compared the safety and efficacy of propofol versus the conventional regimen of midazolam and meperidine for conscious sedation in GI endoscopy. METHODS: In this prospective study, 274 patients that included many elderly patients with multiple comorbid conditions underwent GI endoscopic procedures at our hospital. A total of 150 patients received propofol (20-120 mg) and fentanyl (0.25-1.5 mg). The control group of 124 patients was given midazolam (2-6 mg) and meperidine (25-75 mg). The dose of medication was titrated according to patient need and the duration of the procedure. A "comfort score" on a scale of 1-4 assessed the efficacy of the drugs based on pain or discomfort to the patient and ease of endoscopy. A "sedation score" was used to assess the degree of sedation on a scale of 1-5. The Aldrete score was used to measure recovery from anesthesia at 5 and 10 min after the procedure. RESULTS: After controlling for age, American Society of Anesthesiologists' Physical Status Classification (ASA grade), and type and duration of procedure, logistic regression analysis determined that propofol resulted in 2.04 times better patient comfort (p = 0.033, 95% CI = 1.058-3.923). Propofol was 1.84 times more likely to produce deeper sedation than the regimen of midazolam and meperidine (p = 0.027, 95% CI = 1.071-3.083). The recovery from sedation was faster in patients receiving propofol, although this did not reach statistical significance. The safety parameters between the two groups were comparable. CONCLUSION: Propofol was associated with a statistically significant improvement in comfort and sedation score when compared to midazolam and meperidine.     

Which should go first during same‐day bidirectional endosocopy with propofol sedation?

Background and Aim: Same‐day bidirectional endoscopy, including esophagogastroduodenoscopy (EGD) and colonoscopy, is frequently performed to screen for cancer and gastrointestinal bleeding. However, the optimal sequence for the procedures is unclear thus far. The aim of this study was to evaluate the optimal sequence for same‐day bidirectional endoscopy. Methods: Consecutive patients undergoing same‐day bidirectional endoscopy under propofol sedation were randomized to either the colonoscopy‐first group (colonoscopy followed by EGD, n = 87) or the EGD‐first group (EGD followed by colonoscopy, n = 89). We evaluated the propofol dose, procedure duration, patient tolerance and recovery, adverse events, and endoscopic findings. The patient tolerance was assessed with a 0–10 visual analog scale. Results: Total procedure times, patients' tolerance and recovery, adverse events, and endoscopic findings were similar between the two groups. The total propofol dose was significantly higher for the colonoscopy‐first group than for the EGD‐first group (mean 95% credibility limit: 135.7 [70–201.4] mg vs 124.7 [64.1–185.3] mg, respectively, P = 0.024). Patients in the colonoscopy‐first group moved significantly more during colonoscopy than those in the EGD‐first group: 1.1 (0–3.8) versus 0.6 (0–2.9) scores, respectively (P = 0.024). Conclusion: The optimal sequence for same‐day bidirectional endoscopy is EGD followed by colonoscopy. In this order, the procedure is better tolerated, and patients require a lower overall dose of propofol.     

Synergistic sedation with midazolam and propofol versus midazolam and pethidine in colonoscopies: a prospective,randomized study

OBJECTIVE: The aim of our study was to compare the safety and efficacy of the synergistic sedation with a low dose of midazolam combined with propofol versus the standard regimen of midazolam and pethidine for conscious sedation in colonoscopy in a group of patients that included a sufficient number of elderly patients with several comorbidities. METHODS: A total of 120 consecutive patients undergoing colonoscopy in a prospective study were randomly assigned to one of two medication regimens (55 patients were over 65 yr). Patients in group A (n = 64) received i.v. 2 mg (<70 kg b.w.) or 3 mg (>70 kg b.w.) of midazolam and a median dose of 80 mg of propofol (range 40-150). Patients in group B (n = 56) received i.v. a median dose of 5 mg of midazolam (range 3-7) and 75 mg of pethidine (range 50-125). The patient's comfort level was assessed by a 4-point scale 24 h after the procedure. The time to recover from sedation was assessed at 5, 10, and 30 min after the procedure by using the Aldrete score. RESULTS: Multivariate stepwise logistic regression analysis revealed that among sex, age, duration of the test, American Society of Anesthesiologists' Physical Status Classification grade, and the sort of sedation, the synergistic sedation with midazolam and propofol was the only factor associated with a higher level of patient comfort (chi2 = 5.5, p < 0.05). Additional multivariate stepwise logistic regression analysis revealed that among sex, age, duration of the test, American Society of Anesthesiologists' Physical Status Classification grade, and the sort of sedation, the synergistic sedation with midazolam and propofol was the only factor associated with a quicker patient recovery time (chi2 = 24.5, p < 0.01; chi2 = 51.7, p < 0.01; chi2 = 148.4, p < 0.01 for Aldrete in 10 min, 20 min, and 30 min, respectively). The endoscopist's evaluation of patient sedation and cardiorespiratory parameters were similar in both groups and in all age groups. CONCLUSIONS: Our data suggest that the synergistic sedation with a low dose of midazolam combined with propofol was superior to a standard combination of midazolam and the opioid pethidine for colonoscopies as far as the patient comfort and recovery times are concerned.     

丙泊酚复合不同阿片类药物在老年人结肠镜检查中的镇静效果

目的 探讨丙泊酚复合不同阿片类药物应用于老年人结肠镜检查镇静的效果.方法 60例老年结肠镜受检者随机分为3组,均采用靶控输注方法给予丙泊酚,其中20例单次推注芬太尼(芬太尼组),靶控输注舒芬太尼(舒芬太尼组)、瑞芬太尼(瑞芬太尼组)各20例.记录患者血流动力学改变、镇静深度和不良事件.结果 3组受检患者一般情况、血流动力学改变、镇静深度和不良事件比较差异无统计学意义(均P＞0.05).检查后恢复时间芬太尼组[(21.3±4.6)min]长于舒芬太尼组[(19.9±3.3)min]和瑞芬太尼组[(15.9±1.8)min],且与瑞芬太尼组比较差异有统计学意义(均P＜0.05).结论 丙泊酚复合3种阿片类药物均可安全有效地用于老年人结肠镜检查,但使用瑞芬太尼受检者恢复更为迅速.

Abstract：

Objective To explore the feasibility and safety of fentanyl, sufentanil or remifentanil combined with target-controlled infusion (TCI) of propofol for sedation in the elderly undergoing colonoscopy. Methods In this prospective randomized study, 60 patients undergoing colonoscopy and propofol TCI were randomly assigned to group F (fentanyl), group S (sufentanil) and group R (remifentanil)(each n=20). Patients in group F received a single bolus of fentanyl, while those in group S and group R received TCI sufentanil and remifentanil separately. The blood pressure, heart rate, blood oxygen content and Bispectral index (BIS) were monitored, and all the complications were recorded. Results All patients were adequately sedated. There were no significant differences in general conditions, hemodynamics changes, sedation depth and adverse event among the three groups (all P＞0.05). Time for recovery was longer in group F [(21.3±4.6) min] than in group S [(19.9±3.3) min] and group R [(15.9±1.8) min, P＜0.05]. Conclusions For the elderly undergoing colonoscopy, sedation with fentanyl, sufentanil or remifentanil combined with propofol TCI is feasible and safe. It is more excellent for the remifentanil group at shorter discharge time.     

Patient-controlled sedation versus intravenous sedation for colonoscopy in elderly patients: a prospective randomized controlled trial

BACKGROUND: A prospective randomized trial was conducted to compare the safety, effectiveness, and patient acceptance of patient-controlled sedation and intravenous sedation for colonoscopy in a group of elderly patients undergoing outpatient colonoscopy. METHODS: One hundred patients over 65 years of age were recruited and randomized to patient-controlled sedation (n = 50) or intravenous sedation (n = 50) groups by means of computer-generated numbers. In the patient-controlled sedation group, a mixture of propofol and alfentanil was delivered by means of a patient-controlled pump; each bolus delivered 4.8 mg propofol and 12 microg alfentanil. No loading dose was used and the lockout time was set at zero. In the intravenous sedation group, fixed doses of diazemuls (0.1 mg/kg) and meperidine (0.5 mg/kg) were given with further increases in dosages administered at the discretion of the endoscopist. Outcome measures assessed included cardiopulmonary complications, recovery time, pain score, and satisfaction score. RESULTS: The mean (SD) age of patients in the patient-controlled sedation and intravenous sedation groups were, respectively, 72.4 years (5.3) and 73.5 years (6.1). The mean dose of propofol consumed in the patient-controlled sedation group was 0.79 (0.46) mg/kg. The mean doses of diazemuls and meperidine consumed in intravenous sedation group were, respectively, 5.8 (1.3) mg and 30.1 (6.8) mg. Hypotension occurred in 2 (4%) patients in the patient-controlled sedation group and 14 (28%) in the intravenous sedation group (p < 0.01). Oxygen desaturation was recorded for 4 patients (8%) in the intravenous sedation group. The median (interquartile range [IQR]) recovery time was significantly shorter in the patient-controlled sedation group compared with the intravenous sedation group (respectively, 0 minutes [IQR 0-5] vs. 5 minutes [IQR 5-10]; p < 0.01). There were no statistically significant differences between groups for pain and satisfaction scores. CONCLUSIONS: Patient-controlled sedation appears to be safer than intravenous sedation, with comparable effectiveness and acceptance, in elderly patients undergoing elective outpatient colonoscopy.     

Oxygen desaturation and changes in breathing pattern in patients undergoing colonoscopy and gastroscopy

The respiratory effect of diagnostic colonoscopy and upper endoscopy were studied in 32 elderly patients. Twenty-two underwent colonoscopy and 10 upper endoscopy. In the group undergoing upper endoscopy, 4 of 10 patients experienced a decrease in oxygen desaturation greater than or equal to 4% during the medication period; an additional 2 patients desaturated during the procedure. In the group undergoing colonoscopy, 12 of 22 patients experienced oxygen desaturation during the medication period; 3 other patients desaturated during the procedure. Mean SaO2 for each group was lowest (p less than 0.05) during the medication period. Central apneas occurred in 13 of the patients undergoing colonoscopy during the medication period; however, only 8 of these patients with apneas experienced desaturation greater than or equal to 4% and the periods of desaturation did not correlate with the periods of apneas. Oxygen desaturation greater than or equal to 4% occurs frequently during both upper endoscopy and colonoscopy in this elderly population. This is related to the effects of sedation; the procedure itself worsened the desaturation in only 16% of the patients. Furthermore, the desaturation did not correlate with changes in the breathing patterns of the patients. Low-flow oxygen and/or close monitoring of patients during and subsequent to administration of medication is advised.     

笑气清醒镇静镇痛与丙泊酚静脉麻醉用于胃镜检查的临床价值比较研究

目的研究笑气化状态的诱导过程并比较笑气清醒镇静镇痛与丙泊酚静脉麻醉用于胃镜检查的安全性及有效性。方法选择2013年4月至2013年10月行胃镜检查患者400例,随机分为笑气组200例和丙泊酚组200例,记录笑气组达到笑气化状态的时间及浓度,2组患者检查前、中、后的收缩压、舒张压、心率、血氧饱和度,及药物起效时间、胃镜操作时间、镇静效果、恢复时间、留院时间、不良反应。检查结束后医生与患者填写调查问卷。结果笑气组达到笑气化状态的平均时间为（3．16±0．65）min,男性与女性无明显差异[（3．16±0．71）比（3．16±0．58）min,t=0．006,P〉0．05）;达到笑气化状态的平均笑气浓度为（43．68±5．05）％,男性明显高于女性[（45．30±4．99）％比（41．46±4．30）％,t=3．042,P〈0．05]。与检查前比较,丙泊酚组检查中的收缩压、舒张压、心率、血氧饱和度均明显降低（P〈0．05）,而笑气组检查中的收缩压、舒张压、心率均明显升高（P〈0．05）。丙泊酚组的起效时间及操作时间比笑气组短（P〈0．05）,镇静效果比笑气组更深（P〈0．05）,但笑气组的恢复时间、留院时间均比丙泊酚组明显减少（P〈0．05）。检查中丙泊酚组部分患者出现低氧血症、低血压、心率过缓等不良反应,而笑气组主要不良反应为恶心、干呕等咽部刺激反应。调查问卷结果显示：笑气组的医师满意度、患者满意度、患者愿意再次接受检查的比例均低于丙泊酚组（86±3．7比96±2．6,87±2．8比98±1．2,87％比99％,P〈0．05）。结论笑气清醒镇静镇痛及丙泊酚静脉麻醉用于胃镜检查均是有效的,但前者对心肺功能影响更小更安全。准确识别笑气化状态是笑气清醒镇静镇痛成功实施的关键。重视影响笑气清醒镇静镇痛技术安全性及有效性的9个因素,对于优?     

Significance of patient-controlled sedation during colonoscopy. Results from a prospective randomized controlled study

BACKGROUND: In France, general anesthesia is given to more than 90% of patients undergoing colonoscopy although in several countries sedation is limited to intolerant patients. This study was carried out to determine whether Patient-Controlled Sedation (PCS) could provide a lighter sedation than general anesthesia adapted to the patient's individual requirement. METHODS: Patients aged from 18 to 80 scheduled for elective colonoscopy were prospectively randomized to receive either standard sedation (control group) or patient-controlled-sedation (PCS). In the control group, patients received a continuous infusion of propofol. Patients in the PCS group were connected to an infusion pump containing propofol and self-administered 20-mg boluses as often as they required. An anesthetist was present throughout the procedure. Patient satisfaction measured on a visual analog scale four hours after colonoscopy was the main outcome criterion. RESULTS: From December 2002 to September 2003, 402 patients underwent elective colonoscopy, 173 of them were eligible and were asked to participate in the study. Seventy-two gave their informed consent and were prospectively randomized. The patients' mean satisfaction scores were not statistically different between the two groups: 84.7 mm (PCS group) vs. 91.5 mm (control group); P = 0.24. Mean doses of propofol (60 mg vs. 248 mg; P <0.001), depth of sedation and time before discharge (1.75 hours vs. 4.45 hours) were significantly lower for patients in the PCS group; nine of them (25.7%) did not use the pump and had total colonoscopy without sedation. There were no statistically significant differences between the two groups regarding total duration of colonoscopy (19.4 min (PCS) vs. 18 min (control)) difficulty and therapeutic procedures (biopsy or polypectomy). Two weeks after the procedure, 96.5% of patients in the PCS group were willing to repeat the examination under the same conditions vs. 72.5% of patients in the control group (P = 0.03). CONCLUSIONS: Our results demonstrate that need of sedation is widely overestimated in France. A subset of our patients is willing to consider colonoscopy without general anesthesia. For them, PCS with propofol is an effective and very well accepted form of sedation.     

Conscious analgesia/sedation with remifentanil and propofol versus total intravenous anesthesia with fentanyl,midazolam, and propofol for outpatient colonoscopy

BACKGROUND: This study tested the hypothesis that, for colonoscopy, analgesia/sedation with remifentanil and propofol might be more effective compared with anesthesia by intravenous administration of midazolam, fentanyl, and propofol. METHODS: In a prospective, randomized trial, 100 adult patients received either conscious analgesia/sedation (Sedation group) or total intravenous anesthesia (TIVA group). Analgesia/sedation was achieved by infusion of remifentanil (0.20 to 0.25 microg/kg/min) and propofol in titrated doses. TIVA was induced by intravenous administration of fentanyl (2 microg/kg), midazolam (0.05 mg/kg) and propofol (dosage titrated). Cardiorespiratory parameters and bispectral index were monitored and recorded. The quality of the analgesia was assessed with a Numerical Pain Rating Scale (NRS); recovery level and return of psychomotor efficiency were evaluated with, respectively, the Aldrete scale and a Modified Post Anesthesia Discharge Scoring (MPADS) system. RESULTS: Both groups of 50 patients were comparable with respect to demographic data, initial parameters, and duration of colonoscopy. All patients in the TIVA group found the colonoscopy painless (NRS score 0). In the Sedation group, the average pain intensity score was 0.4 (0.8). There was a marked difference between the Sedation and TIVA groups with respect to the time from the end of the procedure until the maximum MPADS score was reached: respectively, -6.9 (4.0) versus 25.7 (8.4) minutes (p < 0.001). In the TIVA group, changes in mean arterial pressure and heart rate and signs of respiratory depression were significant (p < 0.05). CONCLUSIONS: Combined administration of remifentanil and propofol for colonoscopy provides sufficient analgesia, satisfactory hemodynamic stability, minor respiratory depression, and rapid recovery, and allows patients to be discharged approximately 15 minutes after the procedure.