异丙酚和异氟醚对颅脑手术病人围术期细胞因子平衡的影响

目的探讨异丙酚和异氟醚对颅脑手术病人同术期细胞因子IL-10、IL-6及TNF-α的影响及异丙酚用于颅脑手术麻醉的优越性。方法30例择期行颅内肿瘤切除术的病人，随机分为两组：异氟醚组（Ⅰ组），异丙酚组（P组），每组15例。两组患者分别在麻醉前（T1）、手术开始切皮后2h（T2）、术后2h（T3）、术后48h（T4）四个时间点采取静脉血测血清中细胞因子1L-6、IL-10及TNF-α浓度。结果①两组血清IL-10浓度切皮后2h明显上升，与术前水平相比有显著差异（P〈0．01）。组间比较，P组切皮后IL-10浓度明显高于Ⅰ组（P〈0．01）。术后2h两组间的差异减小，但仍有统计学意义（P〈0．05）。②两组血清IL-6浓度切皮后2h明显上升，与术前水平相比均有显著差异（P〈0．01）。至术后48h仍维持在一个较高的水平，与术前相比仍右显著统计学差异（P〈0．01）。组间比较，P组切皮后2h IL-6浓度低于Ⅰ组（P〈0．05）。③两组血清TNF-α浓度在组内及组间比较均无统计学差异（P〉0．05）。结论在颅脑手术中，手术麻醉可引起血清细胞因子IL-10及IL-6的显著升高，但对TNF-α无明显影响；异丙酚可在一定程度上抑制IL-6的产生并促进IL—10的产生，从而有利于围术期细胞因子平衡的维持。可作为颅脑手术麻醉的首选用药。     

腔镜甲状腺术后患者血清和创腔引流液中IL-6及TNF-α的表达变化

目的探讨腔镜甲状腺手术对机体的创伤。方法20例腔镜甲状腺手术患者为观察组（LT）,20例开放甲状腺手术患者为对照组（OT）,术前及术后6、24、72 h检测并比较两组患者血清和创腔引流液中的IL-6及TNF-α。结果术后6 h观察组血清及创腔引流液中IL-6、TNF-α明显低于对照组（P均〈0.05）;对照组术后72 h血清IL-6、TNF-α浓度仍高于术前（P均〈0.05）;两组创腔引流液中IL-6、TNF-α均高于血清（P均〈0.05）。结论腔镜甲状腺手术对机体的创伤明显小于开放甲状腺手术,细胞因子形成的部位应为创腔。     

两种麻醉方法对宫颈癌手术患者外周血TC细胞亚群及细胞因子水平的影响

目的 探讨不同麻醉方法对宫颈癌手术患者细胞免疫功能的影响。方法将90例行宫颈癌手术患者随机分为全麻组和硬外麻组各45例，分别采用全麻及硬膜外麻醉，手术方法相同。两组分别于麻醉前、麻醉后及术后1h、1d、3d检测外周血T淋巴细胞亚群及IL-6、TNF-α水平。结果两组麻醉后及术后CD3^＋、CD4^＋、CD8^＋及CD4^＋／CD8^＋均较麻醉前下降（P〈0.05），术后3d全麻组各项指标低于麻醉前及硬外麻组（P〈0．0．5）；全麻组IL-6术后1h有一过性升高（P〈0．05），全麻组术后1h、1dTNF-α及硬外麻组术后1h TNF-α均降低（P〈0．05）。结论全麻及硬膜外麻醉对手术应激反应抑制程度不同。硬膜外麻醉对宫颈癌患者围术期细胞免疫功能抑制较轻．     

连续性肾脏替代治疗多脏器功能障碍综合征患者血清细胞因子的变化及意义

目的探讨多脏器功能障碍综合征（MODS）患者应用连续性肾脏替代治疗（CRRT）血清细胞因子的变化及预后价值。方法选择MODS患者34例,常规治疗后行CRRT。根据随访患者28 d结局分为存活组19例、死亡组15例。分别在CRRT治疗前,治疗后6、12、18、24、48、72 h检测两组IL-1β、IL-1Rα、IL-6、TNF-α、IL-10、可溶性肿瘤坏死因子受体1（sTNFR1）,同时各时点进行动态急性生理和慢性健康评分（APACHEⅡ评分）。结果①与治疗前比较,存活组CRRT治疗后不同时间血清IL-1β、IL-6、TNF-α、sTNFR1、IL-10水平显著下降（P〈0.05或〈0.01）,血清sTNFR1/TNF-α明显升高（P〈0.01）;死亡组IL-1Rα在12 h明显升高（P〈0.01）,TNF-α在6 h明显下降（P〈0.05）。存活组与死亡组比较,TNF-α水平在72 h差异有统计学意义（P〈0.05）。②存活组中APACHEⅡ评分在48、72 h与治疗前相比明显下降（P〈0.05或〈0.01）。存活组与死亡组比较,能明显降低APACHEⅡ评分,在48、72 h有统计学意义（P均〈0.01）。③血清IL-6、TNF-α、IL-10水平以及sTNFR1/TNF-α与APACHEⅡ评分呈正相关（r分别为0.893、0.747、0.864、0.752,P〈0.05或〈0.01）。结论 MODS患者应用CRRT后血清IL-1β、IL-6、TNF-α、sTNFR1、IL-10水平降低,血清sTNFR1/TNF-α升高,这些细胞因子可预测MODS患者的预后。     

氯胺酮对食管癌根治术患者的肺保护作用

目的 探讨氯胺酮对行食管癌根治术患者肺的保护作用.方法 拟行食管癌根治术患者32例,ASAⅠ～Ⅱ级;随机分为对照组(C组)和氯胺酮组(K组),每组16例.麻醉诱导后K组缓慢静脉注射氯胺酮1 mg/kg,C组给予等量生理盐水.分别于麻醉诱导后(T1)、单肺通气45 min(T2)、90 min(T3)及术后2 h(T4)采取外周静脉血,测定血清肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6、IL-8和IL-10浓度.结果 两组患者的TNF-α、IL-6、IL-8 和IL-10浓度于T2时相均明显上升(P<0.05);与C组相比,K组T3、T4时相TNF-α、IL-6、IL-8浓度降低,IL-10浓度升高(P<0.05).结论 氯胺酮对食管癌根治术患者肺有一定的保护作用,其机制可能与减轻全身炎性反应有关.     

氨溴索、乌司他丁对体外循环心脏手术患者肺功能的保护作用及机制

目的观察氨溴索、乌司他丁对体外循环（CPB）心脏手术患者肺功能的保护作用,并探讨其机制。方法40例CPB下行瓣膜置换手术患者,随机分为氨溴索组（A组）、乌司他丁组（U组）、联合组（AU组）和对照组（C组）,每组10例。A组麻醉诱导后静脉滴注氨溴索0.5 mg/kg,U组在CPB过程中予1万U/kg乌司他丁,AU组联合应用上述两种药物;C组均未应用氨溴索及乌司他丁。分别在CPB前（T1）、CPB停止（T2）、CPB结束后2 h（T3）、CPB结束后4 h（T4）及CPB结束后18 h（T5）采集桡动脉血,测定血清白介素-6（IL-6）、白介素-8（IL-8）、白介素-10（IL-10）、肿瘤坏死因子-α（TNF-α）,并通过血气分析计算呼吸指数（RI）和肺氧合指数（OI）。结果四组患者CPB后RI和OI较CPB前均有不同程度升高（P均〈0.05）;CPB后各时点A、U、AU组患者RI、OI均明显低于C组,AU组RI、OI明显低于其他3组（P均〈0.05）。四组患者血清中IL-6、IL-8、IL-10、TNF-α水平在T2开始升高并很快达到峰值,后逐渐下降,IL-6、IL-8和TNF-α直到术后18 h仍未降至术前水平（P均〈0.05）。与C组相比,CPB结束后各时点U组、AU组患者血清中IL-6、IL-8、IL-10、TNF-α水平明显减低（P均〈0.05）,AU组降低更加明显（P均〈0.05）。结论氨溴索、乌司他丁均可对CPB心脏瓣膜置换手术患者围术期肺功能起到保护作用。乌司他丁的肺保护作用与其抑制炎症因子的释放有关,从而减轻肺功能损伤,保护并改善术后肺功能。     

乌司他丁对胆石症并重症胆管炎手术患者血清TN-α、IL-6、IL-8水平的影响

将40例胆石症并急性重症胆管炎手术患者随机分为两组。观察组麻醉前静脉输入含5000 U／kg乌司他丁的生理盐水溶液100ml，对照组仅输入生理盐水100ml。于术前、插管后、给药后1h、术毕0．5h采用双核夹心法测定血清TNF-a、IL-6、IL-8水平。结果两组给药后1h及术毕0．5h上述指标均较术前升高，但观察组明显低于对照组（P〈0．05）。证实乌司他丁能有效抑制胆石症重症胆管炎手术患者麻醉中TNF-α、IL-6、IL-8的释放。     

超声引导下胸椎旁神经阻滞复合全身麻醉在乳腺癌手术中的应用效果观察

目的 观察超声引导下胸椎旁神经阻滞复合全身麻醉对乳腺癌手术患者术后炎症、应激反应及认知功能障碍、疼痛等方面的影响。方法 选取拟行乳腺癌根治术的患者100例,随机分为观察组和对照组,每组50例;观察组采用超声引导下胸椎旁神经阻滞复合全身麻醉,对照组采用全凭静脉复合麻醉。比较两组术前及术后3 d时的血清炎症相关指标[白细胞介素6(IL-6)、白细胞介素10(IL-10)、肿瘤坏死因子α(TNF-α)、超敏C反应蛋白（hsCRP）]、应激反应相关指标[皮质醇（Cor）、血糖（Glu）及促肾上腺皮质激素（ACTH）]、认知功能[简易认知精神状态检查量表（MMSE）评分],术后6、12、24、48 h的疼痛程度[视觉模拟评分（VAS）],术后48 h麻醉相关并发症的发生情况[尿潴留、恶心呕吐、嗜睡、乳腺术后疼痛综合征（PMPS）]。结果 与术前比较,两组术后3 d血清IL-6、IL-10、TNF-α、hs-CRP、Cor、Glu及ACTH水平均升高,MMSE评分均降低,但对照组变化更明显（P均<0.05）。观察组术后6、12、24、48 h的VAS均低于对照组（P均<0.05）。观察...     

米力农雾化吸入、静脉泵入对体外循环肺损伤的预防效果及机制探讨

目的观察并比较磷酸二酯酶抑制剂米力农雾化吸入、静脉泵入预防体外循环肺损伤的效果,并探讨其机制。方法 45例风湿性瓣膜病患者,随机分为3组,每组15例。雾化组（M组）于术前48 h以生理盐水5 ml加米力农注射液5 mg缓慢雾化吸入,1次/8 h;静脉组（V组）于术前48 h每24 h静脉泵入米力农注射液15 mg,生理盐水稀释成50 ml,2 ml/h持续静脉泵入;对照组（C组）术前不做药物处理。于切皮前（T0）、主动脉开放后30 min（T1）、术毕（T2）、术后24 h（T3）、72 h（T4）及术后7 d（T5）测定两组患者肺血管阻力、氧合指数,同时检测静脉血与动脉血白细胞计数比值（V/A）、血浆丙二醛（MDA）、人髓过氧化物酶（MPO）、肿瘤坏死因子（TNF-α）、白介素-6（IL-6）及超敏C反应蛋白（HSCRP）水平。结果三组患者术后肺血管阻力不同程度升高,氧合指数不同程度降低（P均〈0.05）。M组两指标的变化幅度较C组小,且较早恢复（P均〈0.05）。三组TNF-α、IL-6、HSCRP、MDA、MPO活性在体外循环后均不同程度升高（P均〈0.05）。M组的TNF-α在T2、T4、T5低于C组;在T1～T4,C组的IL-6、MDA高于M组;两组HSCRP均在手术后逐渐升高,并于术后24 h达到高峰,随后缓慢下降,M组升高幅度显著低于对照组;C组的MPO在T2、T3、T5显著高于M组;M组的V/A白细胞比值在T1～T3显著低于C组（P均〈0.05）。与C组比较,V组TNF-α在术后各时点水平均较低,且其IL-6在T1～T3亦低于C组（P均〈0.05）;但V组各时点HSCRP、MDA、MPO活性及V/A白细胞比值与C组相比较并无显著差异（P均〉0.05）;体外循环后M组MDA、MPO活性及V/A白细胞比值均显著低于V组（P均〈0.05）。结论雾化吸入及静脉泵入米力农均可预防体外循环所致肺损伤,其机制可能与米力农抑制炎症介质的释放有关。雾化吸入效果相对较好,原因可能是雾化吸入米力农可以减少局部白细胞的聚集和氧自由基产生。     

不同麻醉方法对腹腔镜手术婴幼儿炎性细胞因子的影响

目的观察单纯全身麻醉和全身麻醉复合骶管麻醉对腹腔镜手术婴幼儿炎性细胞因子的影响。方法将40例行腹腔镜手术的患儿随机分为单纯全身麻醉组（Ⅰ组）和全身麻醉复合骶管麻醉组（Ⅱ组）各20例。分别于麻醉前（T0）、气腹30 min（T1）、气腹结束后10 min（T2）和气腹结束后12 h（T3）各时间点检测TNF-α、IL-6、IL-10和IL-1受体拮抗剂（IL-1ra）水平,并记录平均动脉压（MAP）和心率（HR）。采用ELISA技术测定细胞因子TNF-α、IL-6、IL-10和IL-1ra水平。结果两组T1～T3各时点TNF-α、IL-6、IL-10和IL-1ra水平较T0明显增高（P〈0.05）;腹腔镜手术气腹后及手术结束后Ⅱ组TNF-α、IL-6和IL-10升高的水平较Ⅰ组明显低（P〉0.05）。Ⅰ组气腹后MAP和HR显著升高（P〈0.05）,气腹结束后又回到气腹前的水平;Ⅱ组MAP和HR较气腹前无统计学差异（P〉0.05）。结论腹腔镜手术婴幼儿可引起促炎细胞因子和抗炎细胞因子的表达增强,全身麻醉复合骶管麻醉能够更好地调节促炎因子和抗炎因子之间的平衡,对机体具有一定的保护作用。     

小剂量氯胺酮围术期持续静注对食管癌开胸术后急性及慢性疼痛的影响研究

目的观察小剂量氯胺酮围术期持续静脉输注对食管癌开胸术后急性及慢性疼痛的影响。方法拟在全身麻醉联合硬膜外阻滞下行开胸食管癌根治术病人75例,ASAⅠ-Ⅱ。按数字表法随机将患者分为3组（n=25）：A组切皮前先缓慢静脉注射氯胺酮0.5mg/kg（0.9%氯化钠溶液稀释至5m l）然后接输注泵静脉持续输注氯胺酮0.05mg.kg-1.h-1至术后48h;B组切皮前缓慢静脉注射氯胺酮0.5mg/kg（0.9%氯化钠溶液稀释至5m l）和C组切皮前缓慢静脉注射0.9%氯化钠溶液5m。l全麻开始经T6~7硬膜外阻滞并检测阻滞平面。采用静脉注射异丙酚-舒芬太尼-维库溴铵诱导和维持麻醉。术后均采用0.125%布比卡因和舒芬太尼0.5μgom l行PCEA,维持VAS≤3。于术后6、12、24、48h时进行BCS舒适度评分,记录术后48h内舒芬太尼用量、不良反应情况,并追踪随访术后1、3、6个月的慢性疼痛持续情况。结果与C组比较,A组和B组术后48h内舒芬太尼的用量明显减少（P〈0.05）,术后48h内各时点BCS舒适度评分升高（P〈0.05）。术后1、3、6个月A组各时段VAS显著降低（P〈0.05）。3组镇静评分和不良反应发生率比较差异无统计学意义（P〉0.05）。结论小剂量氯胺酮围术期持续静脉输注减少食管癌开胸手术病人术后阿片类镇痛药用量,并且能够有效缓解开胸术后急慢性疼痛。     

Evaluation of propofol-ketamine anesthesia for children undergoing cardiac catheterization procedures

The aim of this study was to assess the safety and efficacy of the continuous intravenous administration of a combination of propofol and ketamine for children undergoing cardiac catheterization procedures (CCP). Thirty-two children scheduled for CCP in a university teaching hospital were included in this prospective randomized study. Patients in group 1 (n = 15) were given a combination of propofol (25 microg/kg per minute) and ketamine (25 microg/kg per minute), whereas patients in group 2 (n = 17) received a combination of propofol (25 microg/kg per minute) and ketamine (12.5 microg/kg per minute) for the maintenance of anesthesia. There were no statistically significant differences with age, weight, duration of the procedure, and the number of diagnostic and interventional procedures between the two groups. There was no hemodynamic instability, airway compromise, excessive salivation, or arterial desaturation in either of the two groups. There was more incidence of movements in patients who received less dose of ketamine; however, it did not reach to statistically significant level. The total dose of ketamine used in group 1 was 309.25 +/- 90.97 microg/min, whereas in group 2, it was 148.06 +/- 34.05 microg/min. The time to awakening was significantly less in group 2 (P < 0.05). We conclude that a combination of propofol (25 microg/kg per minute) and two different doses of ketamine (25 and 12.5 microg/kg per minute, respectively) are safe and efficacious for CCP in children. Although the time to awaken was more in patients receiving 25 microg/kg per minute of ketamine compared to those receiving 12.5 microg/kg per minute of ketamine, it was well within acceptable limits.     

缩窄性心包炎手术麻醉分析

目的回顾总结分析缩窄性心包炎患者手术的麻醉体会.方法96例患者分为3组.A组:采用异丙酚/硫喷妥钠、司可林诱导麻醉;B组:采用氯胺酮、芬太尼、司可林诱导麻醉;C组:采用依托咪酯、芬太尼、维库溴胺/潘库溴胺诱导麻醉.3组维持麻醉方法相同.常规监测心电图、血压及尿量,C组还监测中心静脉压(CVP)及桡动脉压.观察麻醉前、后循环变化及术后低心排与死亡的发生率.结果A组术中血压较术前明显下降(P＜0.05),而B、C组术中血压维持平稳;A组和B组术后低心排发生率及病死率均明显高于C组(P＜0.05,P＜0.01),A组病死率又明显高于B组(P＜0.05).结论缩窄性心包炎手术麻醉宜采用依托咪酯、氯胺酮等对心肌功能抑制作用弱的药物,而需慎用异丙酚、硫喷妥钠;上腔静脉及桡动脉插管监测CVP及动脉内压作为麻醉管理的重要手段,不仅能减少术后低心排的发生,同时也能提供快速输血通道以利于术中大出血患者的抢救.     

Evaluation of efficacy of intranasal midazolam, ketamine and their mixture as premedication and its relation with bispectral index in children with tetralogy of fallot undergoing intracardiac repair

We compared the efficacy of intranasal midazolam, ketamine and their mixture as premedication in children with tetralogy of Fallot (TOF) using bispectral index (BIS), sedation score and separation score at the time of separation from parent. Sedation score at the time of intravenous cannulation was also measured. Children with TOF physiology were randomly divided into three equal groups of 20 each. Group-A received intranasal ketamine (10 mg/Kg), Group-B received intranasal midazolam (0.2 mg/Kg), while Group-C received a mixture of ketamine (7.5 mg/Kg) and midazolam (0.1 mg/Kg) intranasally. After 30 minutes of premedication, sedation and separation score were noted. BIS values were recorded at 5 minutes intervals. A 4-point scale for sedation, separation and acceptance of intravenous cannulation was used. Sedation was good in midazolam group (group B-3.25 +/- 0.44), but the separation and acceptance of intravenous catheter was poor (2.9 +/- 0.31 and 2.85 +/- 0.37 respectively). Sedation scores in group A and C were excellent (3.75 +/- 0.44 and 3.80 +/- 0.41 respectively). Separation from parent was excellent in group A (ketamine) and group C (mixture) (group A- 3.90 +/- 0.28 and group C- 3.83 +/- 0.35 respectively). Children of both these groups allowed easy placement of intravenous cannula. At BIS values < 90, the sedation achieved was good. BIS values decreased with increase in sedation scores in groups who received intranasal midazolam and mixture containing ketamine and midazolam (group B and C respectively), while it remained high in children who received ketamine. We conclude that intranasal ketamine is better than intranasal midazolam. The combination of two is better than midazolam alone but provides no benefit as compared with ketamine alone.     

Intramuscular Ketamine for Pediatric Sedation in the Emergency Department: Safety Profile in 1,022 Cases

Study objective: To determine the safety of intramuscular ketamine when administered by emergency physicians for pediatric procedures in accordance with a defined protocol. Methods: We assembled a consecutive case series of children aged 15 years or younger who were given ketamine in the emergency departments of a university medical center and an affiliated county hospital over a 9-year period. A protocol for ketamine use (4 mg/kg, intramuscularly) was followed. Treating physicians were instructed to complete data forms recording complications and adequacy of sedation concurrent with patient care. Subsequent chart review was used to determine indications, adjunctive drugs, time to discharge, and adverse reactions for all patients. Results: Intramuscular ketamine was administered 1,022 times, mainly for laceration repair and fracture reduction. Physicians completed data forms for 431 of treated children (42%). Transient airway complications occurred in 1.4%: airway malalignment (n=7), laryngospasm (n=4), apnea (n=2), and respiratory depression (n=1). All were quickly identified and treated without intubation or sequelae. Emesis occurred in 6.7%, without evidence of aspiration. Mild recovery agitation occurred in 17.6%, moderate to severe agitation in 1.6%. No child required hospitalization for complications caused by ketamine. Ketamine produced acceptable sedation in 98% of patients. The median time from injection to emergency department discharge was 110 minutes for children given a single dose of ketamine. Conclusion: Intramuscular ketamine may be administered safely by emergency physicians to facilitate pediatric procedures in accordance with a defined protocol and with appropriate monitoring. Ketamine is highly effective, has a wide margin of safety, does not require intravenous access, and uniquely preserves protective airway reflexes. [Green SM, Rothrock SG, Lynch EL, Ho M, Harris T, Hestdalen R, Hopkins GA, Garrett W, Westcott K: Intramuscular ketamine for pediatric sedation in the emergency department: Safety profile in 1,022 cases. Ann Emerg Med June 1998;31:688-697.]     

Effect of sedation using Ketamine for primary closure of pediatric facial laceration

Pediatric lacerations are frequently encountered by plastic surgeons in the emergency room. Since pediatric patients cannot cooperate due to the anxiety and pain occurring during the suture procedure, sedation is induced. Since commonly used drugs inducing shallow sedation such as chloral hydrates are insufficient to perform procedures, the need or deep sedation has been increased. In our experience, inducing sedation with ketamine is safe and allows for accurate procedures.A total of 106 pediatric patients aged between 3 months to 5 years who visited the emergency room between August 2020 and January 2021 were included in this study. Of the 106 patients, 54 were sedated using ketamine, and the remaining 52 patients who did not cooperate were operated under local anesthesia, and these were set as the control group. The patients were intravenously injected with ketamine 1.5–2.0 mg/kg ketamine while monitoring the blood oxygen saturation, end-tidal CO₂, and other vital signs. The patients were discharged as a complete awakening was confirmed by physicians.The number of patients who received sedation induced by ketamine was 54 and the number of patients who underwent the procedure without sedation was 52. The mean induction time of a single injection was 35.3 ± 11.3 minutes, and that of additional injection was 253.5 ± 54.1 minute. The total procedure time of the ketamine group was 20.3 ± 11.85 minutes, and that of the nonketamine group was 19.31 ± 10.50 minutes (P = .454). No statistically significant differences were found between the 2 groups.The need for sedation during the suture procedure in an emergenc9y room has been arising not only for reducing pain and anxiety, but also for safe and accurate procedures and scar minimization.Based on the parental satisfaction and the safety of the procedure, using ketamine is more effective than other drugs and should be used more actively.     

Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial

STUDY OBJECTIVE: This study was conducted to investigate the frequency and severity of adverse effects, specifically emergence phenomena, experienced by patients receiving intravenous ketamine with or without midazolam for sedation in a pediatric emergency department. METHODS: Patients aged 4.5 months to 16 years receiving ketamine sedation were prospectively enrolled in a double-blind, randomized, controlled study at a university-affiliated children's hospital-pediatric ED. All patients received ketamine (1 mg/kg) and glycopyrrolate (5 microgram/kg) intravenously. Patients were randomly assigned to receive midazolam (0.1 mg/kg) intravenously or no midazolam. Total time of sedation, sedation efficacy, and adverse effects were recorded. Adverse effects were compared between patients receiving ketamine versus those who received ketamine and midazolam. Additional comparisons were made based on age and number of ketamine doses administered. RESULTS: Two hundred sixty-six patients were studied; 129 received ketamine and 137 patients received ketamine and midazolam. Time of sedation and efficacy of sedation were equivalent between groups. Overall, adverse effects with ketamine sedation included respiratory events (12 [4.5%]), vomiting (50 [18.7%]), emergence phenomena in the pediatric ED (71 [26.7%]), and emergence phenomena at home (60 [22.4%]). Significant emergence phenomena in the pediatric ED (ie, nightmares, hallucinations, and severe agitation) occurred in 7.1% of the ketamine group and in 6.2% of the ketamine-midazolam group, a rate difference of 0.8 (95% confidence interval [CI] -5.3 to 7.0). The addition of midazolam led to an increased incidence of oxygen desaturation events (ketamine 1.6% versus ketamine-midazolam 7.3%; rate difference -5.7, 95% CI -10.6 to -0.9) but a decreased incidence of vomiting (ketamine 19.4%, ketamine-midazolam 9.6%, rate difference 9.8, 95% CI 1.4 to 18.2). The incidence of emergence phenomena and significant emergence phenomena was not affected by the addition of midazolam. However, the addition of midazolam was associated with more agitation in the pediatric ED in children 10 years or older (ketamine 5.7% versus ketamine-midazolam 35.7%; rate difference -30.0, 95% CI -10.7 to -49.3). Age breakdown further showed 6.3% (95% CI 0.9 to 11.6) more episodes of oxygen desaturation in the ketamine-midazolam group in children younger than 10 years, and 12.1% (95% CI 1.5 to 22.6) more vomiting episodes in the ketamine group in children younger than 10 years. CONCLUSION: Ketamine and combined ketamine and midazolam provided equally effective sedation. The addition of midazolam did not alter the incidence of emergence phenomena. Vomiting occurred more frequently in the ketamine only group, whereas oxygen desaturation occurred more frequently in the ketamine-midazolam group. These findings were more pronounced in patients younger than 10 years. Parental and physician satisfaction remained high for all patients receiving intravenous ketamine sedation.     

Low-Dose Ketamine Pretreatment Reduces the Incidence and Severity of Myoclonus Induced by Etomidate: A Randomized,Double-Blinded,Controlled Clinical Trial

Myoclonic movement induced by etomidate is a common but undesirable problem during general anesthesia induction. To investigate the influence of pretreatment with low-dose ketamine on the incidence and severity of myoclonus induced by etomidate, 104 patients were randomized allocated to 1 of 2 equally sized groups (n = 52) to receive either intravenous low-dose ketamine 0.5 mg/kg (group K) or an equal volume of normal saline (group S) 1 minute before induction of anesthesia with 0.3-mg/kg etomidate. The incidence and severity of myoclonus were assessed for 2 minutes after administration of etomidate. Here, we found that the incidence and intensity of myoclonus were both significantly reduced in low-dose ketamine-treated group compared with saline-treated group. The incidence of adverse effects was low and similar between groups. These results demonstrate that intravenous infusion of low-dose ketamine 0.5 mg/kg 1 minute prior to etomidate administration is effective in relieving etomidate-induced myoclonic movements during general anesthesia induction.     

Ketamine Hypertension and the Renin-Angiotensin System

Renin and angiotensin II have been measured before and 10 minutes after anaesthesia, in 23 patients undergoing minor gynaecological surgery. Twelve were anaesthetised with ketamine 2 mg/kg i.v. and the remainder with thiopentone 5-10 mg/kg i.v. Arterial blood pressure was monitored automatically throughout.

The arterial blood pressure rose significantly in the group given ketamine and plasma All concentration fell. In the group given thiopentone there was no significant overall change in blood pressure but an increase in All.

Plasma renin concentration and activity showed significant increases following the administration of ketamine but were unchanged following thiopentone.

Overall, there was a significant inverse relationship between the change in blood pressure and the change in All. This is compatible with a negative feedback being exerted on the renin-angiotensin system by the raised blood pressure, which has itself been evoked by some quite different factor or factors. We conclude that the renin-angiotensin system is not concerned in the pressor response to ketamine.     

不同穴位按摩对老年患者腹腔镜胆囊切除术后胃肠功能影响

目的 观察老年患者腹腔镜胆囊切除术后单穴与多穴位按摩对改善胃肠功能的效果.方法 选择2014年12月-2017年2月在上海市中医医院住院行腹腔镜胆囊切除术及胆囊切除加胆管探查术的老年患者72例,采用随机数字分组法分为3组,单穴位按摩为A组、多穴位按摩为B组、常规护理为C组,每组24例.3组患者均采用腹腔镜胆囊手术常规治...