Extubation after transsternal thymectomy for myasthenia gravis: a prospective analysis.

Recommendations concerning postoperative extubation after thymectomy for myasthenia gravis are presently based upon retrospective chart reviews. We present the results of a prospective investigation of time to extubation after thymectomy for 14 patients over a 12-month period based upon a protocol that included preoperative immunologic therapy, combined epidural and general anesthesia, postoperative epidural narcotic analgesia, and a standardized approach to discontinuation of ventilatory support. After a neurologist took measures to optimize preoperative neuromuscular function, all 14 patients received agents to produce lumbar epidural anesthesia and light general anesthesia. Muscle relaxants were avoided in all but one patient. Postoperative analgesia was initially maintained with epidural hydromorphone, then therapy was switched to patient-controlled intravenous morphine sulfate. Criteria for weaning from mechanical ventilation, first measured at the end of anesthesia, were partial pressure of oxygen (arterial) greater than or equal to 90 mm Hg (fraction of inspired oxygen = 0.40), partial pressure of carbon dioxide (arterial) less than or equal to 50 mm Hg, pH greater than or equal to 7.30, and respiratory rate less than or equal to 30 breaths/min. If these criteria were not met, ventilatory support was continued postoperatively with intermittent mandatory ventilation, and the patient was weaned gradually from this support. Criteria for extubation included meeting the criteria for weaning, vital capacity greater than or equal to 10 mL/kg, and inspiratory pressure better than -30 cm H2O. Criteria for reintubation included tachypnea (respiratory rate greater than 40 breaths/min), respiratory acidosis not due to narcotics, or vital capacity less than or equal to 8 mL/kg. The mean time to extubation was 9 hours (range, 0.75 to 25 hours). Mean preoperative vital capacity was 2.59 +/- 0.64 L (range, 1.90 to 4.20), which decreased approximately 50% to 1.19 +/- 0.39 L (range, 0.70 to 2.0) at the time of extubation. No patient required reintubation. Half of the patients required postoperative anticholinesterase therapy based upon serial neurologic examinations; there were no instances of cholinergic crisis. Thirteen patients returned to the ward on the first postoperative day, and one on the second day. Thirteen patients preferred epidural analgesia to patient-controlled analgesia. The time to extubation and average length of stay in an intensive care setting were markedly reduced compared to those reported in previous retrospective studies. We conclude that a multidisciplinary approach that optimizes neuromuscular function and decreases poststernotomy pulmonary insult will shorten the time to extubation and decrease the length of stay in the intensive care or recovery room after thymectomy.     

Effect of preoperative oral sustained-release morphine sulfate on postoperative morphine requirements in elective spine surgery

Sustained-release morphine sulfate (SRMS) is a painkiller used in oncology. The purpose of our study was to assess its efficacy on postoperative morphine requirements in elective spine surgery. This was a placebo-controlled, randomized, double-blind study. Adults scheduled for spine surgery under general anesthesia were orally administered SRMS (30 mg) or a placebo 2 h before surgery. Primary endpoint was postoperative cumulated morphine consumption through patient-controlled analgesia (PCA) during the 12 h following extubation. Statistical analysis was performed using a sequential method, the triangular test. The study was stopped after the sixth analysis (51 patients had been included; placebo: 26, SRMS: 25). Age, weight, sex ratio, type of surgery, intra-operative sufentanil consumption, anesthesia duration and time to extubation were similar in the two groups. Morphine consumption through PCA during the 12 h following extubation was significantly lower in the SRMS group (mean +/- SD: 10.5 +/- 7.6 mg) compared with placebo group (15.6 +/- 6.0 mg, P = 0.016, sequential analysis). Corresponding unbiased median estimates were 10.6 and 15.8 mg in SRMS and placebo groups, respectively. Morphine consumption through PCA during the 24 h following extubation was also significantly lower in the SRMS group (15.9 +/- 12.7 mg) compared with the placebo group (23.8 +/- 10.9 mg, P = 0.032). Vigilance, nausea and respiratory rate 3 and 6 h after extubation were similar in the two groups. A preoperative oral administration of SRMS (30 mg) induces a 33% reduction of postoperative morphine requirements in patients scheduled for spine surgery without inducing side effects.     

Rocuronium: automatic infusion versus manual administration with TOF monitorisation

TOF (train-of-four) monitoring provides objective data in application of neuromuscular blocking agent. Thus, applicator-based differences are eliminated and optimum muscle relaxation is maintained during operation. In the present study, we aimed to compare the effects of target-controlled infusion system and standard TOF monitoring, on use of rocuronium. ASA I–II patients, who were aged between 18 and 75 years and scheduled for elective abdominal surgery at Haydarpa?a Numune Training and Research Hospital, were enrolled in the study. In order to evaluate neuromuscular blockade, the patients in Group 1 were connected to the acceleromyography device of the target-controlled infusion pump (Veryark-CLMRIS-I-China) while the ones in Group 2 were connected to the routinely used acceleromyography device (TOF Watch SX). There was no significant difference between groups regarding patient characteristics, the durations of anaesthesia and surgery, quality of intubation, time to extubation and time to recovery (TOF ratio of 0.9). Intubation time was significantly longer in Group 1 (Automated group) as compared to Group 2 (Control group) (p < 0.05). The total rocuronium amount used in Group 1 was found to be significantly higher than the amount used in Group 2 (p < 0.05). There was no clinical evidence of residual neuromuscular blockage or reoccurrence of neuromuscular blockage in any patient in either group. Both methods can be used for administration of neuromuscular blocker agent during moderate time anesthesia. No advantage was noted when rocuronium was administered via automatical infusion pump during anaesthesia.     

Liver blood flow during cardiac surgery

OBJECTIVE: Impairment of liver blood flow and, therefore, potentially liver function, has important short-term consequences because of the liver's key metabolic importance and role in drug metabolism. The objective of this study was to quantify the effect of cardiac surgery on liver blood flow from before the induction of anaesthesia to 24 hours postoperatively. METHOD: Ten patients with no history of liver impairment, moderate or good left ventricular function, and undergoing routine hypothermic coronary artery bypass graft surgery, were entered into the study. Liver blood flow was determined by the clearance of indocyanine green (ICG), expressed as a percentage disappearance rate (PDR). RESULTS: The mean baseline percentage disappearence rate (PDR) of indocyanine green (ICG) was 19.84 +/- 4.47%/min. This increased marginally to 20.42 +/- 6.67%/min following the induction of anaesthesia, but after 15 min of cardiopulmonary bypass, the PDR fell to 13.51 +/- 3.69%/min; this was significantly lower than all other PDRs measured throughout the study. Prior to extubation, the PDR increased again to 20.01 +/- 3.72%/ min, and this level was maintained at 12 hours (PDR 20.32 +/- 3.53%min) and 24 hours (PDR 20.51 +/- 2.27%/min). CONCLUSION: The induction of anaesthesia and positive pressure ventilation do not affect liver blood flow. Cardiopulmonary bypass at 30 degrees C is associated with a significant reduction in liver blood flow, which returns to normal within 4-6 hours of surgery and remains normal for up to 24 hours after surgery.     

Rocuronium (esmerone) in anesthesia during surgery under extracorporeal circulation

The study was undertaken to examine the myoplegic, hemodynamic, and histamine-releasing effects of the new aminosteroidal myorelaxant Rocuronium (esmerone, Organon firm) used to maintain anesthesia in cardiac surgical patients by orienting to early tracheal extubation. Twenty two patients aged 50 +/- 3 years operated on under extracorporeal circulation were examined. At the initial stage of maintenance, the agent in a dose of 0.6 mg/kg failed to affect cardiac pump function and to elevate plasma histamine levels. A moderate vagolytic effect was shown in 45% of cases. The incidence of myoplegia reduced in patients with significant circulatory insufficiency. In the preperfusion period, Rocuronium in a dose of 10.2 +/- 0.9 micrograms/kg/min blocked neuromuscular conduction (NMC) at a level of 5.1 +/- 1.8 to 19.2 +/- 3.5%. During hypothermic extracorporeal circulation and postperfusion period, the dosage of the myorelaxant substantially decreased. After termination of Rocuronium infusion, the time of up to 95%-recovery of NMC was 63 +/- 6 min. Early tracheal extubation was conducted in 68% of the patients 69 +/- 7.6 min after the end of the operation. Residual myoplegia was absent. The predictable recovery of NMC following the use of Rocuronium creates conditions for early activation of patients operated on under extracorporeal circulation.     

两种不同麻醉方法用于颅内动脉瘤介入术的临床观察

目的通过比较两种不同的麻醉方法用于颅内动脉瘤介入术,探求颅内动脉瘤介入术最佳的麻醉方法。方法选择ASAⅠ～Ⅲ级颅内动脉瘤介入术患者40例,随机分为两组,每组各20例,两组麻醉诱导相同,气管插管后,I组持续输注瑞芬太尼0．2—0．4μg／（kg·min）,异丙酚4—6mg／（kg·h）维持;Ⅱ组吸入2．0％～2．5％七氟醚维持麻醉,术中根据临床征象如血压、心率、ETCO2、体动等,随时调整输注速度及吸入麻醉药的浓度,必要时间断加入罗库溴胺10mg,记录术毕至清醒时间及术毕至拔管时间,观察患者苏醒期躁动情况,随访术后恶心、呕吐和术中知晓。结果清醒时间Ⅰ组为（6．9±2．1）min,Ⅱ组（9．8±3．0min）（P〈0．05）,拔管时间Ⅰ组为（9．0±2．7）min,Ⅱ组为（12．6±3．8）min（P〈0．05）,苏醒期躁动发生率Ⅰ组为0,Ⅱ组为30％（6／20）,术后恶心、呕吐发生率差异无统计学意义,两组均无术中知晓。结论瑞芬太尼复合异丙酚持续输注用于颅内动脉瘤介入术优于七氟醚吸入麻醉。     

乌拉地尔复合舒芬太尼在高血压患者全麻拔管期的应用

目的评价乌拉地尔复合舒芬太尼对高血压患者全麻气管拔管时心血管反应的影响.方法选择全麻择期腹部手术合并有高血压的患者80例,ASAⅠ~Ⅱ级,随机分为A组和B组,每组40例.两组均在手术结束前20min静脉注射舒芬太尼0.1μg/kg,当达到拔管指征时,B组静脉注射乌拉地尔0.2~0.3mg/kg,A组不给予.观测比较拔管前、拔管即刻、拔管后2min和5min时的收缩压(SBP)、平均动脉压(MAP)和心率(HR).结果 B组拔管前后各时点各项指标值无明显波动(P>0.05),且拔管后2min已恢复至拔管前水平,A组拔管即刻及拔管后各时点各项指标值与拔管前比较,以及与B组同时点各项指标值比较均明显升高(P<0.05).结论乌拉地尔复合舒芬太尼可预防高血压患者全麻气管拔管时的心血管反应,有助于提高高血压患者全麻拔管期的安全性.     

More reliable oximetry reduces the frequency of arterial blood gas analyses and hastens oxygen weaning after cardiac surgery: a prospective,randomized trial of the clinical impact of a new technology

OBJECTIVE: Evaluation of the impact on clinical care of improved, innovative oximetry technology. DESIGN: Randomized, prospective trial. SETTING: Postcardiac surgery intensive care unit in a major teaching hospital. PATIENTS: A total of 86 patients after undergoing coronary artery bypass surgery. INTERVENTIONS: All patients were monitored with two oximeters, one employing conventional oximetry (conventional pulse oximeter, CPO) and one using an improved innovative technology (innovative pulse oximeter, IPO), on different fingers of the same hand. The outputs from both devices were collected continuously by computer, but only one device was randomly selected and displayed for clinicians. MEASUREMENTS AND MAIN RESULTS: The amount and percentage of nonfunctional monitoring time was collected and found to be much greater for the CPO than the IPO (8.7% +/- 16.4% for CPO vs. 1.2% +/- 3.3% for IPO, p =.000256). Time to extubation was not different between the two groups (634 +/- 328 mins for IPO vs. 706 +/- 459 mins for CPO). Clinicians managing patients with the more reliable IPO weaned patients faster to an FIO2 of 0.40 (176 +/- 111 mins for IPO vs. 348 +/- 425 mins for CPO, p =.0125), obtained fewer arterial blood gas measurements (2.7 +/- 1.2 for IPO vs. 4.1 +/- 1.6 for CPO, p =.000015), and made the same number of ventilator changes during this weaning process (2.9 +/- 1.2 for IPO vs. 2.9 +/- 1.7 for CPO). CONCLUSIONS: Provision of more reliable oximetry allows caregivers to act in a more efficient and cost-effective manner in regard to oxygen weaning and use of arterial blood gas measurements. Investigating the effect of a monitor on the process of care, rather than simply its accuracy and precision, is a useful, relevant paradigm for evaluating the value and impact of a new technology.     

Anesthesiological aspects of early activation of patients after aortocoronary bypass surgery

The specific features of the course of anesthesia and the time of extubation were studied in 142 patients suffering from coronary heart disease who had undergone myocardial revascularization. All the patients were divided into 3 groups in accordance with the type of anesthesia. Group 1 patients (n = 48) received routine anesthesia with ketamine, benzodiazepines, and large-dose fentanyl. Group 2 (n = 45) had combined anesthesia with inhalational and intravenous anesthetics having their better pharmacodynamics (such as isoflurane, diprivan, tracrium). In Group 3 (n = 49), the authors employed another developed modality of anesthesia using high thoracic (TII-TIV) epidural anesthesia as a basic component of anesthesiological maintenance. The two developed modalities of anesthesia almost halved the use of total dose opioids, which promoted patients' early postoperative recovery of consciousness and respiration. The time before extubation was 9.9 +/- 2.1, 4.5 +/- 1.1, and 1.5 +/- 1.2 hours in Groups 1, 2, and 3, respectively (p < 0.05). The developed anesthesia procedure using isoflurane, midazolam, propofol, and small-dose fentanyl ensures safe and early (up to 6-hour) extubation in 73% of the patients undergone aortocoronary bypass surgery. The developed anesthesiological protocol based on thoracic epidural anesthesia enables extubation to be carried out on the operating table within an hour in 75% of patients after aortocoronary bypass surgery. A comparative intraoperative analysis of hemodynamics, the incidence of myocardial ischemia, arrhythmias, glucose levels has indicated that the anesthesia techniques aimed at a patient's early activation are not inferior in the degree of protection to routine anesthesia using large doses of opioids, ketamine, and diazepam. When used in combination with thoracic epidural block, the methods are superior to the latter.     

新生儿七氟醚麻醉下无肌松剂行腹腔镜手术的临床观察

目的 探讨七氟醚维持麻醉下新生儿无肌松剂行腹腔镜手术的可行性.方法 选择我院择期在七氟醚麻醉下行腹腔镜腹部手术的新生儿80例,随机分为无肌松组和肌松组,对两组术中呼吸、循环及拔管情况进行监测.结果 术中七氟醚浓度无肌松组为（2.2±0.6）％,肌松组为（1.9±0.5）％,差异有统计学意义（P＜0.05）;气腹后5 min时血压无肌松组为（40.6 ±4.7） mmHg,肌松组为（44.3±5.6） mmHg,差异有统计学意义（P＜0.05）.肌松组的气管导管拔除时间长于无肌松组,但差异无统计学意义（P＞0.05）.结论 新生儿在无肌松剂的条件下使用七氟醚诱导插管可行,但对于七氟醚合并芬太尼麻醉维持下行长时间腹腔镜手术的患者仍应合理使用肌松剂.     

Posttetanic Count Revisited: Are Measurements More Reliable Using the TOF-Watch Accelerographic Peripheral Nerve Stimulator?

OBJECTIVE: Measurement of profound neuromuscular block using posttetanic count is among the most subjective measurements made in clinical anesthesia. The TOF-Watch accelerographic peripheral nerve stimulator provides objective measurements of neuromuscular block that may improve our ability to quantitate intense blockade. METHODS: The TOF-Watch and Digi Stim III peripheral nerve stimulators were used to monitor onset and early recovery of neuromuscular response induced by rocuronium 0.6 mg/kg i.v. in 30 patients anesthetized with general anesthesia. After induction, train-of-four count (when present) was measured at one-min intervals. Subsequently, posttetanic count was measured at three-min intervals until the first response to train-of-four stimulation reappeared. RESULTS: Posttetanic count and train-of-four count measurements were determined to be consistently unreliable throughout the study in seven (23%) patients with the TOF-Watch stimulator and three (10%) patients with the Digi Stim III stimulator (p = NS). Among stimulators yielding reliable measurements, decreases in train-of-four count to 0/4 were noted earlier with the Digi Stim III monitor (median = 2 min) as compared with the TOF-Watch device (median = 4 min) (p < 0.05). Also, posttetanic count decreased to zero in only 35% of patients with the TOF-Watch stimulator versus 67% of patients with the Digi Stim III stimulator (p < 0.05). CONCLUSIONS: Both monitors were similar in their ability to predict return to TOFC = 1 as a function of PTC measurements. The TOF-Watch monitor is easy to apply even in inexperienced hands. However, the device yielded erroneous data in 23% of patients.     

双管喉管与双管喉罩用于全身麻醉患儿通气效果的比较

目的 比较双管喉管与双管喉罩用于全身麻醉患儿的通气效果.方法 拟行全身麻醉的患儿40例,ASAⅠ～Ⅱ级,随机分为双管喉管组(L组)和双管喉罩组(P组),每组20例.采用咪唑达伦0.05 mg/kg、丙泊酚1～2 mg/kg、芬太尼2～4 μg/kg和阿曲库胺0.5 mg/kg进行麻醉诱导,待肌松完全后插入适宜型号的双管喉管或双管喉罩.记录插入时间和一次插入成功率;术中持续监测的脉搏氧饱和度(SpO2)、心率(HR)、气道峰压(Ppeak)和呼气末二氧化碳分压(PETCO2),间隔3分钟测量并记录一次无创血压;记录手术时间、清醒时间、拔除时间和术后24 h内咽部不良反应的发生情况.结果两组插入时间和一次插入成功率比较差异均无统计学意义(P＞0.05);两组血流动力学平稳,SpO2、Ppeak和PETCO2 均在正常范围内,且差异均无统计学意义(P＞0.05);两组手术时间、清醒时间、拔除时间和术后24 h内咽部不良反应发生率比较差异无统计学意义(P＞0.05).结论双管喉管可以安全而有效地用于全身麻醉患儿,且通气效果与双管喉罩相似.     

右美托咪定对高血压患者全身麻醉后气管拔管期的影响

目的：探讨右美托咪定对高血压患者全身麻醉后气管拔管期的影响.方法：将80例拟行气管插管全身麻醉的择期手术且伴原发性高血压的患者随机分为观察组和对照组,每组40例.停用全身麻醉药后观察组患者静脉泵注右美托咪定0.5μg/kg,对照组静脉注射等剂量的0.9％氯化钠液.观察2组患者麻醉前（T0）、拔管时（T1）、拔管后2 min（T2）、拔管后5 min（T3）时的平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SpO2）,及术后躁动发生率等情况.结果：观察组T1～T3时间点MAP及HR均显著低于对照组（P＜0.01）,SpO2与对照组比较差异无统计学意义（P＞0.05）.观察组患者术后躁动发生率明显低于对照组（P＜0.05）.结论：右美托咪定能有效减轻高血压患者全身麻醉气管拔管期的心血管反应,并降低躁动发生率.     

右美托咪定对腹腔镜下全子宫切除术患者全麻气管拔管期心血管反应的影响

目的:观察右美托咪定(dexmedetomidine,DEX)对腹腔镜下全子宫切除术患者全麻气管拔管期心血管应激反应及苏醒的影响。方法:将60例择期行腹腔镜下全子宫切除术患者(ASAⅠ~Ⅱ级)随机分为DEX组和对照组,每组30例。气管拔管前10 min,DEX组静脉滴注DEX0.3μg/kg;对照组静脉滴注0.9%氯化钠液10 mL。观察麻醉前、气管拔管前(1 min)、气管拔管时、气管拔管后(1 min、5 min、10 min)的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR);比较2组患者自主呼吸恢复时间、苏醒时间、气管拔管时间以及气管拔管期不良反应。结果:对照组MAP和HR在气管拔管前、气管拔管时均升高,且明显高于同期DEX组(P0.05);DEX组MAP和HR在气管拔管后5 min、10 min时均下降,且明显低于同期对照组(P0.05)。DEX组MAP和HR在气管拔管前、气管拔管时及气管拔管后1 min与麻醉前比较,差异无统计学意义(P0.05)。两组患者呼吸恢复时间、苏醒时间、气管拔管时间差异无统计学意义(P0.05);DEX组气管拔管期不良反应率明显低于对照组(P0.05)。结论:DEX能有效抑制腹腔镜下全子宫切除术患者气管拔管期的心血管应激反应,而且对患者的苏醒和气管拔管时间影响甚少。     

Bioz无创监测系统评价氢吗啡酮对老年高血压患者全麻术后血流动力学的影响

目的探讨Bioz无创血流动力学监测系统评价氢吗啡酮对老年高血压患者全麻术后血流动力学的影响。方法60例行择期全麻腹部手术的老年高血压患者为氢吗啡酮组(HM组)和生理盐水组(SP组)。手术结束前15 min,HM组皮下注射氢吗啡酮,SP组皮下注射生理盐水。观察2组患者在麻醉诱导前(T1)、拔管时(T2)、拔管后10 min(T3)的心率(HR)、平均动脉压(MAP)、心输出量(CO)、心脏指数(CI)、外周血管阻力(SVR)。记录2组患者自主呼吸恢复时间、唤醒时间、拔管时间和转出PACU时间。记录患者进入PACU后5 min(H1)、15 min(H2)、30 min(H3)的视觉模拟评分(VAS)评分、Ramsay镇静评分。结果与HM组相比,SP组患者HR、MAP、SVR、VAS评分、Ramsay评分显著增高(P0.05);与T1时相比,2组T2时HR、MAP、SVR显著升高,CO、CI显著降低(P0.05);2组T3时SVR较T2降低,但显著高于T1(P0.05)。HM组H2、H3时刻VAS评分、Ramsay评分显著升高(P0.05)。2组患者自主呼吸恢复时间、唤醒时间、清醒拔管时间无显著差异(P0.05)。结论 Bioz无创血流动力学监测系统能够提供全面有效的血流动力学信息,术毕前皮下注射氢吗啡酮1 mg可有效维持老年高血压患者全麻恢复期血流动力学的稳定。     

右美托咪定对老年高血压患者围术期心肌的保护作用

目的观察右美托咪定对老年高血压患者围术期心肌的保护作用。方法择期行全髋置换手术的老年高血压患者30例,年龄〉65岁,高血压Ⅱ级,随机分为右美托咪定（D组）和对照组（c组）,每组15例。两组均采用静吸复合全身麻醉,诱导方式相同,D组在麻醉诱导前给予负荷剂量右美托咪定1μg／kg,注射泵缓慢静脉注射,输注时间超过10min,维持剂量以0．7μg／（kg·h）持续静脉注射。记录麻醉前、诱导后、气管插管后、拔管后即刻患者的血流动力学变化,同时在麻醉前、气管插管后、拔除气管导管后即刻三个时点记录患者心电图ST段水平。结果两组患者麻醉诱导后心率、血压均明显下降（P〈0．05或P〈0．01）;气管插管后、拔除气管导管后即刻,心率、收缩压、舒张压D组明显低于C组（P〈0．05）;气管插管后、拔除气管导管后即刻,ST段出现心肌缺血性改变,C组5例明显多于D组1例（P〈0．05）。结论静脉注射右美托咪定,能减轻老年高血压患者围术期心肌损伤,对心肌有一定保护作用。     

右美托咪定对功能性鼻内窥镜手术患者苏醒期质量的影响?

【目的】研究术中输注右美托咪定对功能性鼻内窥镜手术(FESS)患者苏醒期质量的影响。【方法】选取40例年龄为30~60岁择期全身麻醉下行 FESS 的患者。将入选患者随机分为两组(每组20例)：对照组(C组)和右美托咪定组(D组)。常规麻醉诱导气管插管后,D组给予1μg/kg 右美托咪定10 min内静脉输注完毕,随后以0.2μg/(kg·h)速率输注至手术结束前30 min。C 组以同样方式输注等量生理盐水。两组麻醉维持均采用静脉持续输注异丙酚,七氟醚吸入,适时静注顺式阿曲库铵。当患者平均动脉压(MAP)和心率(HR)较基础值增加超过15%时单次追加芬太尼1.5μg/kg。比较两组患者麻醉前、手术结束时、拔管时、离开麻醉恢复室(PACU)时的 HR、MAP;入 PACU 后的 Riker 躁动评分、VAS 疼痛视觉模拟评分;拔管时间、滞留PACU时间以及术后不良反应情况。【结果】与麻醉前比较,C 组患者拔管时 HR 明显增快(P <0.05)。入PACU后D组 Riker躁动评分和 VAS疼痛视觉模拟评分均低于 C组(P <0.05)。两组拔管时间、滞留PACU时间的差异均无显著性(均P >0.05)。D组术后寒战发生率低于 C 组(P <0.05)。【结论】术中输注右美托咪定可明显改善 FESS患者苏醒期质量。     

不同剂量右美托咪啶对拔管期心血管反应的影响

目的：观察手术结束前单次静脉输注不同剂量右美托咪啶对全麻苏醒拔管期患者心血管反应的影响,探讨右美托咪啶在拔管期应用的最佳剂量。方法：美国麻醉师协会（AmericanSocietyofAnesthesiologists,AsA）评分I或Ⅱ级择期行腹腔镜胆囊切除术的患者80例,将其随机均分为A、B、C、D4组,每组20例。手术结束前10min各组分别静脉输注如下药物：A组0,9％氯化钠液10mL,B组右美托咪啶0．3μg／kg,C组右关托咪啶0．5μg／kg,D组右美托咪啶0．7μg／kg。记录手术前、拔管前1min、拔管时、拔管后1min、5min、10min、20min、30min的平均动脉压（MAP）和心率（HR）;观察患者呼吸恢复时间、苏醒时间、拔管时间及围拔管期不良反应发生情况。结果：与手术前比较,拔管前1min、拔管时、拔管后1minA组的MAP、HR及B组的MAP均显著升高（P〈0．05）,而C、D两组MAP、HR变化不明显。拔管后5min、10min、20min、30min时C、D组MAP和HR与手术前比较显著降低（P〉0．05）。D组有4例发生低血压和5例发生心动过缓,显著高于其余3组;D组患者自主呼吸恢复时间、拔管时间及苏醒时间与A、B、C3组比较,显著延长（P〉0．05）;拔管期间C、D组的呛咳和躁动发生率显著低于A、B两组（P〉0．05）。结论：0．5μg／kg右美托咪啶可以有效抑制全麻苏醒拔管期的心血管反应并减轻拔管期躁动、喻咳等不良反应窟生．同时不影响今廉拔管及苏醒时间．     

右美托咪啶对全身麻醉拔管期应激反应的影响

目的评估术中持续静脉输注右美托咪啶对全身麻醉拔管期应激反应的影响.方法60例全麻下择期行腹部手术患者随机分为右美托咪啶组(D组)和对照组(C组),各30例.全麻诱导开始,D组患者接受持续静脉输注浓度4μg/ml右美托咪啶0.3~0.7μg/(kg·h),C组患者接受持续静脉输注等量生理盐水,持续输注至手术结束前30min.观察拔管前(T0)、拔管即刻(T1)、拔管后3min(T2)、10min(T3)平均动脉压(MAP)、心率(HR)、动脉血氧饱和度(SpO2).用放射免疫法检测各时点血浆中肾上腺素(E)、去甲肾上腺素(NE)和促肾上腺皮质激素(ACTH)含量.结果右美托咪啶组在拔管期间血液动力学平稳,与对照组相比,MAP和HR在拔管即刻以及拔管后3、10min无明显升高;与基础值相比,对照组吸痰拔管时及拔管后3、10min时MAP、HR均明显升高,尤以拔管时明显;D组T1、T2、T3三个时点血浆E、NE和ACTH含量明显低于C组(P均<0.05).结论术中持续静脉输注右美托咪啶可减少麻醉拔管应激引起的神经内分泌反应,稳定血流动力学,减轻全麻患者气管拔管引起的心血管反应,可以安全地应用于全麻患者气管拔管.     

BIS监测下异丙酚靶控输注和持续输注对术中血流动力学的影响

目的 通过全麻患者在脑电双频指数（Bispectral Index,BIS）监测下维持一定的麻醉深度,对血流动力学、苏醒与拔管时间、定向力恢复时间以及术后并发症有关指标进行检测和观察,比较术中异丙酚靶控输注（TCI）和持续输注（CI）二种不同方式对全麻患者的影响.方法 随机选择80例ASA Ⅰ-Ⅱ级,拟择期在全身麻醉下行关节置换术的患者.随机分为异丙酚TCI组和CI组.通过调整异丙酚的输注,将麻醉深度控制在一定范围（BIS值45～55）,记录术中各组血流动力学变化并进行比较,同时比较两组术后苏醒时间、拔管时间和定向力回复时间以及异丙酚用量.结果 TCI组和CI组两组患者血流动力学各指标相比,前者血流动力学更稳定（P＜0.05）,且异丙酚用量明显多于CI组（P＜0.05）;两组患者术后苏醒时间、拔管时间和定向力恢复时间无统计学差异（P＞0.05）.结论 无论靶控输注或者持续输注丙泊酚均能很好地维持全身麻醉的深度和血流动力学的稳定性,但前者具有更好的可控性和安全性.