丙泊酚用于无痛胃镜检查术中纳布啡最佳剂量的选择

目的探讨在无痛胃镜检查术中使用纳布啡复合丙泊酚静脉麻醉时,纳布啡的最佳剂量。方法无痛胃镜检查病人250例,随机分成3组,N1组78例,纳布啡0.10 mg/kg;N2组89例,纳布啡0.15 mg/kg;N3组83例,纳布啡0.20 mg/kg)。记录各组患者麻醉前(T0)、置入胃镜时(T1)、退出胃镜时(T2)时收缩压(systolic pressure,SBP)、心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO_2),并记录术中丙泊酚用量、胃镜检查时间,停药后苏醒时间、术中麻醉效果、术中辅助呼吸例数、术后恶心呕吐、离院时间、离院时眩晕例数等。结果 N2组、N3组麻醉效果优良率分别为93.3%和94.0%,N1组为82.1%,N2组、N3组优于N1组。N3组病人离院时眩晕人数多于N1、N2组,差异有统计学意义(P0.05);3组病人术中辅助呼吸、术后恶心呕吐例数比较差异均无统计学意义(P0.05)。N2、N3组病人丙泊酚用量较N1组减少,苏醒时间也较N1组缩短,同时N3组病人离院时间较N1组、N2组延长,差异有统计学意义(P0.05)。结论以0.15 mg/kg纳布啡复合适当剂量的丙泊酚,能有效地保证麻醉效果,同时尽量减少麻醉的不良反应。     

纳布啡复合丙泊酚用于无痛人工流产术麻醉及术后镇痛效果观察

目的探讨纳布啡联合丙泊酚用于无痛人工流产术的麻醉及术后镇痛效果。方法选择2017-04—06间在郑州大学第二附属医院接受无痛人工流产术的68例早孕者,随机分为2组,各34例。F组应用芬太尼0.001 mg/kg+丙泊酚2 mg/kg,N组应用纳布啡0.15 mg/kg+丙泊酚2 mg/kg。观察麻醉前(T_1)、意识消失时(T_2)及清醒时(T_3)三个时点早孕者的MAP、HR及SpO_2的变化。记录其苏醒时间及T_3、苏醒后30 min(T_4)、苏醒后90 min(T_5)的疼痛VAS评分。比较2组早孕者的满意度(NRS)评分和不良事件发生例数。结果 N组T_3时的MAP及SpO_2明显优于F组(P0.05),丙泊酚用量及苏醒时间少于F组(P0.05),T_4及T_5时VAS评分明显低于F组(P0.05),对麻醉满意度明显高于F组(P0.05),呼吸抑制发生率明显低于F组(P0.05)。差异均有统计学意义。结论纳布啡联合丙泊酚用于无痛人工流产术的麻醉及术后镇痛,安全有效且不良反应少。     

丙泊酚复合纳布啡应用于膀胱镜拔除双J管日间手术中的效果观察

目的 观察丙泊酚复合纳布啡应用于膀胱镜拔除双J管日间手术中的效果.方法 选择2018年1月至2018年12月本院择期拟行无痛膀胱镜拔除双J管的日间手术患者40例,ASA分级Ⅰ-Ⅱ级,年龄18-60岁,采用随机数字表法分为丙泊酚复合盐酸纳布啡(A)组和丙泊酚复合舒芬太尼(B)组,每组20例.A组:先用0.15 mg/kg...     

比较舒芬太尼和纳布啡复合丙泊酚静脉全麻用于无痛肠镜检查的效果

目的比较舒芬太尼和纳布啡复合丙泊酚静脉全麻用于无痛肠镜检查的效果。方法依据不同静脉全麻用药,将行无痛肠镜检查的96例患者分为2组,各48例。观察组采用纳布啡复合丙泊酚静脉全麻,对照组采用舒芬太尼复合丙泊酚静脉全麻。回顾性分析患者的麻醉资料。结果2组患者的麻醉诱导用时、肠镜检查用时、检查中的不良反应,以及检查后的苏醒时间、恢复时间比较,差异均无统计学意义(P>0.05)。麻醉苏醒后60 min内,观察组患者的恶心、呕吐等不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论对接受无痛肠镜检查的患者,纳布啡和舒芬太尼复合丙泊酚静脉麻醉均有良好的镇静、镇痛效果,但纳布啡复合丙泊酚静脉全麻患者苏醒后的不良反应少。     

纳布啡用于术后病人自控硬膜外镇痛效应的观察

已证明硬膜外给予阿片类药的镇痛作用确切,目前临床常用阿片类药物有:吗啡、芬太尼和丁丙诺啡等,均为μ受体激动剂,多伴有呼吸抑制、恶心呕吐和排尿困难等一些不良反应[1]。为此,我们选用阿片受体的激动拮抗药纳布啡(Nalbuphine)进行术后病人自控硬膜外镇痛(PCEA),观察其镇痛效应与不良反应,并和吗啡进行对照。资料与方法1.临床资料　46例ASA～级妇科手术病人,年龄(41±9.25)岁,体重(54±3.96)kg,均为下腹部手术,经L2～3穿刺置管,术毕保留硬膜外导管行PCEA。全部采用双盲法给药观察效应及不良反应。吗啡组(M组)26例,纳布啡组(N组)20例…     

丙泊酚联合瑞芬太尼在小儿肝穿刺活检中的应用

目的探讨丙泊酚联合瑞芬太尼静脉麻醉在小儿行门诊肝穿刺活检中的应用效果及安全性。方法择期在门诊治疗室行B超引导下肝穿刺活检的患儿40例,分为两组:单纯丙泊酚组(A组,n=20)及丙泊酚联合瑞芬太尼组(B组,n=20)。A组在皮肤消毒前予以2.5～3.5mg/kg丙泊酚缓慢静推,B组则予1.5～2.5 mg/kg丙泊酚+0.5μg/kg瑞芬太尼缓慢静推;穿刺过程中若患儿出现躁动则立即追加10～30 mg丙泊酚加深麻醉。记录麻醉前(T_0)、麻醉后1 min(T_1)、术毕时(T_2)及返回病房时(T_3)的平均动脉压(MAP)、心率(HR)及血氧饱和度(SpO_2);比较两组丙泊酚用量、呼吸抑制率、术中躁动发生率及术后初醒时间(t)。结果两组患儿的年龄、性别、体重、ASA分级等一般情况无统计学差异(P0.05);A组T_1、T_2时刻MAP较麻醉前(T_0)下降(P0.05),而同时刻点两组HR、SpO_2无显著改变(P0.05);丙泊酚用量、躁动发生率和初醒时间A组皆大于B组(P0.05),呼吸抑制率两组无明显差异(P0.05)。结论在小儿肝穿刺活检的门诊手术中,单纯推注丙泊酚和丙泊酚联合瑞芬太尼两种方案都安全可行。在吸氧状态下,丙泊酚联合瑞芬太尼静脉麻醉方案相对优于单纯丙泊酚镇静。     

直肠黏膜下肿瘤患者行ESD术纳布啡结合丙泊酚麻醉效果观察

探讨纳布啡结合丙泊酚泵注对行内镜黏膜下剥离术(ESD)的直肠黏膜下肿瘤患者(SMT)镇痛效果.2017年4月-2019年4月,行肠道ESD术的178例SMT患者随机分为对照组和观察组各89例,在丙泊酚泵注麻醉基础上,对照组加用舒芬太尼麻醉,观察组加用纳布啡麻醉,记录两组患者麻醉时间、苏醒时间和丙泊酚用量,比较两组麻醉诱...     

丙泊酚复合纳布啡对无痛肠镜检查患者膈肌运动的影响

目的探讨超声监测下丙泊酚复合纳布啡对肠镜检查患者膈肌运动的影响。方法选择择期行无痛肠镜检查患者40例,男21例,女19例,年龄18～65岁,BMI 18～25kg/m2,ASAⅠ或Ⅱ级,采用随机数字表法将患者均分为两组(n=20)∶丙泊酚组(P组)和丙泊酚复合纳布啡组(F组)。F组患者在丙泊酚输注前1min静脉推注纳布啡0.1mg/kg,P组给予等容量的生理盐水。两组患者TCI模式给予丙泊酚,初始血浆靶浓度为2μg/ml,逐渐调整靶浓度,直至Ramsay镇静评分为5分,开始肠镜检查。肠镜检查中根据Ramsay评分调整丙泊酚靶浓度。超声监测患者右侧膈肌运动情况。记录患者入室平静呼吸时(T0)、丙泊酚输注后Ramsay评分5分时(T1)以及肠镜检查结束后Ramsay评分2分时(T2)的SpO2、MAP、HR、PETCO2、RR、膈肌运动幅度(DM)、吸气末膈肌厚度(TEI)、呼气末膈肌厚度(TEE),计算膈肌厚度变化率(DTF)=(TEI-TEE)/TEI。记录心动过缓、低血压、体动、呼吸抑制等不良反应。结果与T0时比较,两组T1时MAP和SpO2明显降低,HR和RR明显减慢,PETCO2明显升高(P 0.05);P组丙泊酚用量明显多于F组(P 0.05);T1、T2时F组DM明显长于,T1时DTF明显高于P组(P 0.05)。P组2例发生体动反应,F组1例出现窦性心动过缓。两组均未发生低血压、呼吸抑制和反流误吸等不良反应。结论与单用丙泊酚比较,丙泊酚复合纳布啡一定程度上可以减轻对无痛肠镜检查患者膈肌运动的抑制程度。     

超声引导下深静脉穿刺置管技术在围术期小儿患者中的应用

目的：探讨超声引导下深静脉穿刺置管技术在围术期小儿患者中的应用效果。方法选取我院接收的80例择期拟行手术患儿作为本次的研究对象,对其临床资料进行回顾分析。结果观察组患儿的穿刺置管时间、穿刺总成功率、一次穿刺成功率、失败率及并发症发生率与对照组比较均有统计学差异（P ＜0.05）。结论给予择期手术患儿超声引导下深静脉穿刺置管术治疗可提高成功率,减少并发症,具有较高的应用价值,可推广应用。     

小剂量纳布啡复合罗哌卡因腰麻用于剖宫产术效果观察

目的探讨小剂量纳布啡复合罗哌卡因腰麻用于剖宫产手术的效果。方法随机将择期行剖宫产手术的80例患者分为2组,每组40例。罗哌卡因组(R组)蛛网膜下腔注射1%罗哌卡因1.5 mL+0.5 mL生理盐水,罗哌卡因+纳布啡组(R+N组)蛛网膜下腔注射1%罗哌卡因1.5 mL+0.5 mL纳布啡5 mg。蛛网膜下腔穿刺成功后,注射混合液,速率为0.1 mL/s。记录感觉神经最高阻滞平面、运动神经阻滞评分,感觉、运动神经的起效及恢复时间。了解术中麻醉效果满意度。记录术中出现低血压、心动过缓、恶心、呕吐、瘙痒、呼吸抑制、宫缩痛等不良反应及处理措施。结果 2组患者的感觉神经阻滞起效时间及恢复时间、运动神经阻滞改良评分比较差异明显(P0.05)。2组患者麻醉效果满意度差异显著(P0.05)。心动过缓和宫缩痛例数及发生率分别为2∶4(5%∶10%)和3∶1(7.5%∶2.5%),差异均有统计学意义(P0.05)。结论 5 mg纳布啡复合罗哌卡因腰麻用于剖宫产术,麻醉镇痛效果更好,特别是对宫缩痛效果显著,不良反应少,可以安全用于剖宫产手术。     

Comparison of propofol versus propofol‐ketamine combination for sedation during spinal anesthesia in children: randomized clinical trial of efficacy and safety

Objectives: This study was designed to compare the efficacy and safety of propofol vs propofol‐ketamine combination for sedation during pediatric spinal anesthesia. Methods: Forty children, aged 3–8 undergoing spinal anesthesia for lower abdominal surgeries were included. Participants were randomly assigned into two groups. Group 1 received propofol bolus of 2 mg·kg^?1 followed by an infusion of 4 mg·kg^?1·h^?1. Group 2 received a combination of 1.6 mg·kg^?1 propofol and 0.4 mg·kg^?1 ketamine followed by an infusion of 3.2 mg·kg^?1·h^?1 and 0.8 mg·kg^?1·h^?1, respectively. The infusion rate was titrated to keep the child sedated at University of Michigan Sedation Score of 3. The heart rate, blood pressure, respiratory rate and oxygen saturation were recorded every 5 min. The episodes of spontaneous body movements and requirement of supplemental sedation were recorded. The postoperative recovery was assessed by modified Aldrette score. Results: Seventeen patients in group 1 and four patients in group 2 (P < 0.001) required extra boluses of study drug to prevent movements during lumbar puncture. Four patients experienced respiratory depression and three airway obstruction in group 1 when compared to one patient each in group 2 (P < 0.05). The recovery time was similar in both groups. None of the patient had postoperative nausea/vomiting or psychomimetic reactions. Conclusions: Propofol‐ketamine combination provided better quality of sedation with lesser complications than propofol alone and thus can be a good option for sedation during spinal anesthesia in children.     

Effect of propofol on emergence behavior in children after sevoflurane general anesthesia

BACKGROUND: Emergence agitation (EA) is a postoperative behavior that may occur in children undergoing general anesthesia with inhaled agents. OBJECTIVES: The aim of the present study was to assess the effect of propofol administered at the end of sevoflurane anesthesia on the incidence and severity of EA in children undergoing magnetic resonance imaging (MRI). METHODS: Eighty-four children, 2-7 years old, undergoing MRI were enrolled in this randomized double-blind study. No sedative premedication was administered prior to anesthesia induction. Anesthesia was induced and maintained with sevoflurane in N(2)O/O(2). Group P received propofol 1 mg.kg(-1) and group S received saline. Pediatric Anesthesia Emergence Delirium scale (PAEDs) was used to evaluate recovery characteristics upon awakening and during the first 30 min after emergence from anesthesia. Children with PAEDs >16 were considered agitated. EA was analyzed using the Mann-Whitney U-test. Demographic data and other side effects were analyzed using the Student's t-test. RESULTS: Eighty-three children completed the study. There were 42 children in group P. EA was diagnosed in two children in the propofol group (4.8%) and in 11 children in the placebo group (26.8%, P < 0.05). Time to achieving postanesthesia care unit discharge criteria was not different between the two groups. CONCLUSIONS: The addition of propofol 1 mg.kg(-1) can significantly decrease the incidence of EA after sevoflurane general anesthesia in children undergoing nonpainful procedures.     

The effect of a target controlled infusion of propofol on predictability of recovery from anesthesia in children

Background: Emergence following termination of a general anesthetic depends on the effect site concentration (C_e) of the drug declining to an awakening value (C_e‐awake). C_e‐awake has been described in adults, but is unknown in children. Objectives: To determine C_e‐awake in children following a target‐controlled infusion (TCI) of propofol and to assess a C_e‐driven TCI system’s ability to predict times to emergence from anesthesia. Methods: Subjects undergoing elective surgery, aged 3 months to <10 years were recruited into three age‐stratified groups. A target C_e of 3–4 μg·ml^?1 was selected for induction and subsequently titrated to patient response and surgical stimulus. Preoperative acetaminophen, a remifentanil infusion and regional anesthesia were permitted for supplemental analgesia. State Entropy (SE) was monitored from induction to emergence. Emergence was defined as the time of first purposeful spontaneous movement (PSM). Time zero was defined as the end of propofol infusion. Based on a pilot study, a C_e‐awake of 1.9 μg·ml^?1 was chosen as the wake‐up threshold used by the software to predict emergence times. Results: Data was collected for 90 of 104 recruited patients. PSM occurred at a mean (sd ) C_e of 2.0 (0.5) μg·ml^?1 and an SE of 79 (11). There were no differences between age groups. A wide variation in emergence time was observed, with a mean (sd ) of 16.9 (7) min, and a trend to more rapid emergence in older subjects. Conclusion: A predicted C_e‐awake of 2.0 μg·ml^?1 in children aged 3 months to <10 years was identified with the selected model. For expert users of propofol in children, during shorter surgical procedures, TCI predicted emergence times do not offer significant clinical advantages.     

Propofol-ketamine mixture for anesthesia in pediatric patients undergoing cardiac catheterization

OBJECTIVE: To evaluate the safety of a propofol-ketamine mixture to induce and maintain anesthesia in spontaneously breathing pediatric patents during cardiac catheterization. DESIGN: Prospective clinical study. SETTING: Departments of Cardiothoracic Surgery, Anesthesiology, and Pediatric Anesthesiology in a university hospital. PARTICIPANTS: Forty-five children aged 6 months to 16 years with ASA grade II to III undergoing cardiac catheterization. INTERVENTIONS: Continuous intravenous infusion of a mixture of propofol (4 mg/mL) and ketamine (2 mg/mL) with spontaneous ventilation. The infusion rate was changed and additional boluses of propofol or/and ketamine were given as needed. Hemodynamic, respiratory, and other variables were recorded during the procedure and recovery. RESULTS: Mean dose of ketamine was 26 +/- 8.3 microg/kg/min and of propofol, 68.3 +/- 21.7 microg/kg/min. Changes in heart rate and mean arterial pressure of more than 20% from baseline were observed in 4 and 5 patients, respectively. A transient reduction in oxygen saturation because of hypoventilation was observed in 3 patients and responded to oxygen administration and manual assisted ventilation. No other complications were observed. CONCLUSIONS: The propofol-ketamine mixture is a safe, practical alternative for general anesthesia in pediatric patients undergoing cardiac catheterization.     

Anaesthesia for computerised tomography of the brain in children: a comparison of propofol and thiopentone

Propofol (2,6-di-isopropylphenol) 1.5-2.0 mg/kg i.v. was compared with thiopentone 3.0-4.0 mg/kg i.v. as an induction agent in anaesthesia for computerised tomography (CT) of the brain in children. Both induction agents were combined with diazepam 0.2 mg/kg i.v. Thirty children (ASA physical status I-II) aged 3 to 10 years and scheduled for elective examination were included in the randomized study. The haemodynamic response to propofol and thiopentone did not differ between the groups. Spontaneous respiration was retained in all patients and no ventilatory support was required during anaesthesia. The incidence of side-effects did not differ between the groups. Pain on injection with propofol was rare (n = 1) after mixing 1 ml lignocaine (1%) with propofol prior to induction. The recovery times were significantly shorter in the propofol than in the thiopentone group. Propofol appears to be a promising alternative for use in short day-case anaesthesia for CT scanning in children.     

Injection pain, cardiovascular changes and recovery following induction of anaesthesia with propofol in combination with alfentanil or lignocaine in children

The effect of pretreatment with alfentanil 10 (Alf10), 15 (Alf15) or 20 (Alf20) micrograms.kg-1 on reducing injection pain caused by propofol was compared with lignocaine 10 mg mixed with propofol (Lign). This double-blind, double-dummy and randomized study included 100 children with a mean age of 4.3 +/- 0.6 years, 25 children in each group, undergoing minor otolaryngological surgery. The children were premedicated orally with midazolam 0.5 mg.kg-1 and atropine 0.03 mg.kg-1. Injection pain occurred in 4% in the Lign group. The corresponding figures were 40, 16 and 20% in the Alf10, Alf15 and Alf20 groups, respectively. Both 1% lignocaine 10 mg and alfentanil 15 micrograms.kg-1 reduced injection pain significantly compared with alfentanil 10 micrograms.kg-1. Pretreatment with alfentanil significantly diminished haemodynamic responses to tracheal intubation. Furthermore, the concomitant use of alfentanil and propofol caused transient severe bradycardia and a significant decrease in heart rate after laryngoscopy.     

Haemodynamic effects of propofol in children

The haemodynamic effects of induction of anaesthesia with propofol in children were studied. Two hundred and sixteen children (ASA 1) were randomly allocated to receive one of six different doses of propofol, from 1.6 mg/kg to 2.6 mg/kg, in 0.2 mg/kg increments. Noninvasive measurement of blood pressure showed that mean arterial pressure was reduced by approximately 15% after 1 minute, and by 30% after 5 minutes. The reduction in pulse rate over a 5-minute period was approximately 17%. These changes were similar in each group, regardless of the dose administered. The propofol was mixed with lignocaine, 0.5 mg/ml, and the incidence of pain on injection into a vein on the dorsum of the hand was 24%. We conclude that, within the dose range of our study, the haemodynamic disturbance after induction of anaesthesia with propofol in children is not dose related.     

The influence of cold on pain during intravenous induction of anaesthesia with propofol in children

Pain on injection and quality of induction were compared in 74 children (5–12 years) randomly assigned to receive either 5 mg·kg^?1 of cold propofol (group A), 5 mg·kg^?1 of cold propofol mixed with lignocaine 1% (group B) or 5 mg·kg^?1 of propofol at room temperature (22–23°C) mixed with lignocaine 1% (group C). The group receiving cold propofol had to be stopped due to a very high incidence of pain (70%). The incidence of pain on injection was 3% in group B and 17% in group C (not significant). Quality of induction and side-effects were similar in the two groups.