含漱利多卡因复合小剂量咪达唑仑在肥胖患者无痛胃镜中的应用

目的 观察含漱利多卡因复合小剂量咪达唑仑用于肥胖患者无痛胃镜检查的麻醉效果。方法 选取2020年8月-2021年10月该院行无痛胃镜检查的肥胖患者120例作为研究对象,按照随机数表法分为常规组、对照组和观察组,每组40例。常规组采用舒芬太尼和丙泊酚静脉麻醉,对照组采用咪达唑仑、舒芬太尼和丙泊酚静脉麻醉,观察组采用含漱2%利多卡因复合咪达唑仑、舒芬太尼和丙泊酚静脉麻醉。比较3组患者麻醉给药前(T₀)、开始检查时(T₁)、胃镜过咽喉部时(T₂)、检查结束时(T₃)和苏醒时(T₄)的心率(HR)、平均动脉压(MAP)、经皮动脉血氧饱和度(SpO₂)和呼吸频率(RR)变化情况,同时记录3组患者丙泊酚总用量、苏醒时间、麻醉效果及不良反应的发生情况。结果 观察组在胃镜检查过程中各时点的HR、MAP和SpO₂变化均优于常规组和对照组,且与常规组和对照组相比,观察组丙泊酚总用量少,苏醒时间短,麻醉效果好,不良反应发生率低,差异均有统计学意义(P &l...     

羟考酮与舒芬太尼复合依托咪酯用于老年患者胃镜检查的麻醉效果

目的:比较羟考酮与舒芬太尼复合依托咪酯用于老年患者胃镜检查的麻醉效果。方法:选择2017年2月至6月保定市第一中心医院于全身麻醉下行无痛胃镜检查的老年患者60例,男女不限,年龄65～77岁,体重46～63 kg,经美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅱ级,患者随机被分为两组(n=30):羟考酮组(O组)和舒芬太尼组(S组)。O组静脉注射羟考酮0.05mg/kg,S组静脉注射舒芬太尼0.05μg/kg,2min后静脉注射依托咪酯0.2mg/kg。术中出现呛咳或体动反应时,静脉追加依托咪酯0.05～0.1 mg/kg。记录诱导前(T0)、诱导后2min(T1)、进镜后1 min(T2)、进镜后3min(T3)各时间点的生命体征;记录整个胃镜检查过程中依托咪酯用量及发生注射痛、呛咳、体动、呼吸抑制的情况;记录苏醒时间及苏醒后头晕、恶心、呕吐的情况。结果:与S组比较,O组苏醒时间及依托咪酯用量减少,呛咳、体动发生率降低(P0.05),T2时点平均动脉压降低(P0.05),T2,T3时点心率降低恶心、呕吐的发生率降低,差异均有统计学意义(P0.05)。两组注射痛、头晕及呼吸抑制的发生率差异无统计学意义(P0.05)。结论:羟考酮(0.05 mg/kg)复合依托咪酯可安全、有效地用于老年患者无痛胃镜检查,且效果优于舒芬太尼。     

舒芬太尼复合咪达唑仑在稳定性心绞痛患者胃镜检查中的应用

目的评估舒芬太尼复合咪达唑仑用于稳定性心绞痛病人胃镜检查的安全性和有效性。方法 30例合并稳定性心绞痛拟行胃镜检查的患者,舒芬太尼复合咪达唑仑行静脉麻醉。观察并记录麻醉前(T0)、手术开始前(T1)、胃镜至会厌水平时(T2)、检查结束时(T3)时的Ramsay评分、心率(HR)、平均动脉压(MAP)和脉搏血氧饱和度(Sp O2)。记录术中心动过缓、呼吸抑制、呛咳的发生例数。结果 30例患者均获得满意的麻醉效果,各时间点间的MAP、HR及Sp O2比较差异无统计学意义(P0.05)。结论稳定性心绞痛病人采取舒芬太尼复合咪达唑仑麻醉进行胃镜检查,麻醉效果确切,镇静深度合理,麻醉过程中血流动力学平稳。     

依托咪酯复合麻醉用于老年患者无痛膀胱镜检查的临床效果比较

目的探讨依托咪酯复合麻醉用于老年患者无痛膀胱镜检查的可行性及安全性。方法选取择期行无痛膀胱镜检查的老年患者120例进行前瞻性研究,按照随机数字表法随机分为三组:依托咪酯组(E组)、丙泊酚组(P组)和依托咪酯复合舒芬太尼及咪达唑仑组(ESM组),每组40例。E组静脉注射依托咪酯0.3 mg/kg,P组静脉注射丙泊酚2 mg/kg,ESM组静脉注射舒芬太尼0.1μg/kg和咪达唑仑0.02 mg/kg,3 min后静脉注射依托咪酯0.2 mg/kg。记录三组麻醉诱导前(T0)、诱导后BIS达60时(T1)、手术开始时(T2)、手术结束时(T3)的平均动脉压(MAP)、心率(HR)和血氧饱和度(SPO2)变化;观察注射痛、呼吸抑制、体动、肌颤、术后恶心呕吐的发生率。结果 P组的MAP和HR明显低于E组和ESM组(P0.05)。与P组相比,E组和ESM组注射痛,呼吸抑制,低血压和心动过缓的发生例数均减少(P0.05)。而E组体动,肌颤,术后恶心呕吐的发生率较高(P0.05)。ESM组血流动力学波动较小,且不良反应较少。结论依托咪酯复合小剂量舒芬太尼和咪达唑仑麻醉在老年无痛膀胱镜检查中的效果良好,安全性较高,不良反应少。     

右美托咪定联合丙泊酚在无痛纤维结肠镜检查中的应用

目的探讨小剂量右美托咪定(DEX)联合丙泊酚麻醉在无痛纤维结肠镜检查中的应用效果及安全性。方法选择2013年6月—2014年2月在中国医科大学附属第一医院行无痛纤维结肠镜检查患者110例,随机分为DEX联合丙泊酚组(观察组)和舒芬太尼联合丙泊酚组(对照组),每组55例。观察组予0.5μg/kg DEX 10 ml联合1~1.5 mg/kg丙泊酚麻醉,对照组予0.5μg/kg舒芬太尼10 ml联合丙泊酚1~1.5 mg/kg麻醉。检查过程患者如有体动反应影响操作,则追加丙泊酚0.2~0.5 mg/kg静脉注射。观察两组丙泊酚总用量、检查时间、苏醒时间、检查后30 min视觉模拟评分(VAS),检查前(T0)、给丙泊酚后5 min(T1)、过脾曲(T2)、过肝曲(T3)、检查结束(T4)时的平均动脉压(MAP)、心率(HR)及血氧饱和度(Sp O2)以及不良反应发生情况。结果观察组丙泊酚总用量(110.5±15.7)mg明显低于对照组(150.3±19.5)mg(P0.05),检查时间、苏醒时间及VAS评分比较差异均无统计学意义(P0.05);与对照组比较,T1~T3时间点观察组MAP、Sp O2显著升高(P0.05),T1~T4时间点HR显著降低(P0.05);观察组呼吸抑制、低血压、不良体动及肠绞痛的发生率明显低于对照组(P0.05或P0.01)。结论小剂量DEX联合丙泊酚用于无痛纤维结肠镜检查较舒芬太尼联合丙泊酚麻醉效果更佳,能够减少麻醉药用量,避免呼吸抑制和低血压的发生。     

盐酸羟考酮与舒芬太尼应用于无痛人流术中的镇痛效果对比

目的:探讨盐酸羟考酮与舒芬太尼应用于无痛人流术中的镇痛效果。方法:选取我院2017年2月~2018年2月妇科门诊进行无痛人流术的180例患者为研究对象,随机分为对照组和观察组各90例。对照组给予舒芬太尼+丙泊酚麻醉,观察组给予盐酸羟考酮+丙泊酚麻醉。比较两组患者麻醉不同时点的生命体征变化、丙泊酚用量、苏醒时间、疼痛程度、术中体动发生率及不良反应发生情况。结果:两组患者麻醉前、麻醉后5 min、苏醒时的HR、Sp O2、SBP、DBP均有变化,但组间比较无显著性差异(P0.05);两组麻醉后5 min的HR、SBP、DBP均较麻醉前出现不用程度的下降,组内比较差异显著(P0.05);观察组丙泊酚用量、苏醒时间及术中体动发生率均明显低于对照组(P0.05);观察组术后疼痛评分明显低于对照组(P0.05);两组患者术后均未出现明显不良反应(P0.05)。结论:盐酸羟考酮应用于无痛人流术中,对患者生命体征影响较小,可减少丙泊酚用药总量,提高镇痛效果,利于患者术后快速苏醒,降低不良反应,具有较高的临床应用价值。     

ICU呼吸衰竭采用咪达唑仑联合舒芬太尼镇静、镇痛的效果

目的:评价ICU呼吸衰竭患者采用咪达唑仑联合舒芬太尼镇静、镇痛的效果。方法:选取我院ICU于2016年11月～2018年10月收治的85例呼吸衰竭患者为研究对象,随机分为对照组42例和观察组43例,对照组接受咪达唑仑镇静、镇痛方案,观察组接受咪达唑仑联合舒芬太尼镇静、镇痛方案。观察两组镇静、镇痛效果。结果:观察组停药后苏醒时间、机械通气时间、ICU住院时间以及Ramsay镇静评分3～4分时间均短于对照组(P0.05);观察组人机顺应性满意度高于对照组(P0.05);观察组谵妄、呼吸抑制、血压下降发生率均低于对照组(P0.05)。结论:咪达唑仑联合舒芬太尼在ICU呼吸衰竭患者镇痛、镇静治疗中是有效、安全、可行的。     

盐酸羟考酮用于无痛结肠镜检查的随机、双盲、对照研究

目的比较丙泊酚分别复合羟考酮、芬太尼、舒芬太尼、地佐辛在结肠镜下息肉电切术中的麻醉效果及副作用。方法选择无痛肠镜检查患者400例,随机分为4组:羟考酮组(O组)、芬太尼组(F组)、舒芬太尼组(S组)、地佐辛组(D组),每组100例。患者行检查前由护士随机给予4种实验药物的一种,体积均为0.1 ml/kg,5 min后给予丙泊酚2 mg/kg缓慢静脉推注。记录麻醉诱导时(T_0)、肠镜进入肛门时(T_1)、肠镜经过肝曲时(T_2)、肠镜到达回盲部时(T_3)、息肉电切时(T_4)的脉搏血氧饱和度(SpO_2)、心率(HR)和平均动脉压(MAP);记录患者术中的体动例数、苏醒时间、恶心呕吐、头晕头痛和腹痛等不良反应的发生例数以及苏醒后视觉模拟评分(VAS)。结果 MAP比较:T_1时所有患者较T_0时均明显下降(P0.05);T_2、T_3、T_4时O组、F组、S组较T_1时无明显变化(P0.05),D组较T_1时明显升高(P0.05)。HR比较:T_1时所有患者较T_0时均明显下降(P0.05);T_2时O组、F组、S组较T_1时无明显变化(P0.05),D组较T_1时明显升高(P0.05);T_3时F组、S组、D组较T_1时明显降低(P0.05);T_4时O组、F组、S组较T_1时无明显变化(P0.05),D组较T_1时明显升高(P0.05)。SpO_2比较:所有患者各时间点组内比较差异无统计学意义。患者体动例数,D组较其他组明显升高,O组分别与F组和S组比较差异无统计学意义;呼吸抑制例数,F组、S组较其他组均有明显升高;苏醒时间,4组患者比较差异无统计学意义;术后恶心呕吐例数,O组明显低于其他3组;VAS评分,O组、F组、S组比较差异无统计学意义,D组明显高于其他组。结论羟考酮、芬太尼、舒芬太尼、地佐辛分别复合丙泊酚应用于无痛肠镜检查均安全有效;羟考酮的呼吸抑制作用明显弱于芬太尼和舒芬太尼;应用羟考酮术后恶心呕吐发生率明显低于其他3组。     

咪达唑仑复合舒芬太尼用于腰硬联合麻醉镇静的效果观察

选取2013年1月~2015年1月于笔者所在医院接受ASAⅠ~Ⅱ妇科手术患者88例。随机分为观察组和对照组,各44例。观察组患者给予咪达唑仑复合舒芬太尼镇静,B患者给予咪达唑仑镇静,对比两组患者给药10 min、30 min、60 min、90 min的OAA/S评分和遗忘程度。观察组OAA/S评分和遗忘率均优于对照组,两组数据具有显著差异,具有统计学意义P0.05。体动反应发生率和不良反应发生率两组对比均无明显差异(P0.05),对临床手术患者采取咪达唑仑复合舒芬太尼具有良好的麻醉效果,麻醉效果优于单用咪达唑仑,但是在使用时要注意患者血氧饱和度等指标的变化。     

舒芬太尼联合咪达唑仑用于股骨上段骨折椎管内麻醉前镇痛效果观察

目的探讨舒芬太尼与咪达唑仑联用于股骨上段骨折椎管内麻醉前疼痛缓解效果。方法选取收治的股骨上段骨折患者90例,采用随机数字表法分为对照组和观察组各45例;对照组于椎管内麻醉前给予咪达唑仑;观察组在对照组基础上间隔加用舒芬太尼;比较两组椎管内麻醉前疼痛视觉模拟(VAS)评分及给药前后生命体征相关指标等。结果观察组椎管内麻醉前VAS评分明显优于对照组(P0.05);观察组患者给药后心率、呼吸频率均明显优于对照组(P0.05)。结论舒芬太尼与咪达唑仑联用于股骨上段骨折椎管内麻醉前疼痛缓解效果确切,可有效减轻麻醉及创伤应激反应。     

Comparison of meperidine plus midazolam and fentanyl plus midazolam in procedural sedation: A double-blind,randomized controlled trial

This double-blind, randomized, prospective study was conducted to compare the analgesic and sedative efficacy of fentanyl and meperidine in orthopedic closed reduction of fractures and dislocations undertaken in the emergency department. Seventy consecutive adult patients with fractures or dislocations suitable for reduction were randomized to receive fentanyl (1 mcg/kg; n=36) or meperidine (0.5 mg/kg; n=34) in combination with midazolam (0.02 mg/kg). Vital signs and alertness scale scores of the patients were monitored. The Visual Analog Scale (VAS) was used to determine the degree of pain. There was no statistically significant difference between the VAS mean scores of the fentanyl and meperidine groups (t test,P=.772). The need for additional analgesic drugs was significantly more frequent in patients receiving meperidine (P=.018). No adverse events, such as hypotension or respiratory depression, were noted. Euphoria occurred in one patient in the fentanyl group. Although dose requirements differ, fentanyl and meperidine provide effective and reliable analgesia in closed reduction of fractures and dislocations.     

Intravenous ketamine plus midazolam is superior to intranasal midazolam for emergency paediatric procedural sedation

Objectives—This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department.

Method—A single blinded randomised clinical trial was conducted in the emergency department of a major urban paediatric hospital. Subjects requiring sedation for minor procedures were randomised to receive either INM (0.4 mg/kg) or intravenous ketamine (1 mg/kg) plus intravenous midazolam (0.1 mg/kg). Physiological variables and two independent measures of sedation (Sedation Score and Visual Analogue Sedation Scale) were recorded before sedation and at regular intervals during the procedure and recovery period. Times to adequate level of sedation and to discharge were compared.

Results—Fifty three patients were enrolled over a 10 month period. Sedation was sufficient to complete the procedures in all children receiving IVKM and in 24 of the 26 receiving INM. Onset of sedation was an average of 5.3 minutes quicker with IVKM than with INM (95%CI 3.2, 7.4 minutes, p<0.001). Children given INM were discharged an average of 19 minutes earlier than those given IVKM (95%CI 4, 33 minutes, p=0.02). Mean Sedation Scores and Visual Analogue Sedation Scale scores for the 30 minutes after drug administration were significantly better in children given IVKM compared with INM (2.4 and 1.8 versus 3.5 and 3.8, respectively). Both doctors and parents were more satisfied with sedation by intravenous ketamine and midazolam.

Conclusions—Intravenous ketamine plus midazolam used in an appropriate setting by experienced personnel provides an excellent means of achieving sedation suitable for most non-painful minor procedures for children in the emergency department. This combination is superior to INM in terms of speed of onset and consistency of effect. INM delivered via aerosol spray has a more variable effect but may still be adequate for the completion of many of these procedures.

     

咪达唑仑复合芬太尼对子宫肌瘤剔除术患者舒适度和满意度的影响

目的:通过复合应用咪达唑仑和芬太尼于子宫肌瘤剔除术患者使Ramsay镇静评分Ⅲ级～Ⅳ级,探讨其对患者麻醉舒适度和满意程度的影响.方法:106例择期行子宫肌瘤剔除术患者,ASAⅠ～Ⅱ,分成两组,对照组(C组 n=53)和镇静组(S组 n=53),镇静组在麻醉平面达到T8左右后静脉注射咪达唑仑0.04 mg/kg和芬太尼1 μg/kg,根据需要可追加咪达唑仑0.02 mg/kg或芬太尼1 μg/kg,使患者Ramsay镇静评分Ⅲ级～Ⅳ级,对照组不做干预.分别记录两组患者麻醉前、手术开始、手术结束和术后6、24 h的心率、血压和血氧饱和度,观察患者术中舒适程度(痛苦表情、牵拉反应、寒战反应),术后6、24 h询问患者的麻醉满意程度(满意、比较满意、不满意).结果:术中C组出现痛苦表情、牵拉反应、寒战反应明显多于S组,差异有统计学意义(P<0.01),C组和S组术后6 h满意度分别为67.9%和92.4%,术后24 h满意度分别为73.6%和94.3%,差异有统计学意义(P<0.05),两组心率、血压和血氧饱和度变化无差异.结论:复合应用咪达唑仑和芬太尼于子宫肌瘤剔除术患者使Ramsay镇静评分Ⅲ级～Ⅳ级,可以减少患者术中痛苦表情、牵拉反应、寒战反应,提高患者麻醉舒适度和满意度.     

When midazolam fails

Significant distress is experienced by patients, families, and caregivers when a symptom or disorder, such as an agitated delirium, becomes an intractable, or a catastrophic event, such as irreversible stridor. When palliative sedation is indicated for these patients, midazolam is usually the preferred drug. In some cases, however, midazolam fails to provide adequate sedation. Two cases are presented to illustrate this phenomenon and explore the possible mechanisms underlying this lack of response. These mechanisms appear to be multifaceted. The heterogeneity of the GABA(A) receptor complex and the alterations that this complex can undergo functionally can explain, to some degree, the diversity of the physiological and pharmacological outcomes. Other factors responsible for the diversity in response may include concomitant medications, age, concurrent disease, overall health status, alcohol use, liver disease, renal disease, smoking and hormonal status. Evidence-based guidelines on alternative treatment options should midazolam fail are required. In the interim, a lower threshold for adding an alternative drug, such as phenobarbital, or substituting midazolam with another drug, such as propofol, should be considered in these circumstances.     

Neurotoxicity of midazolam in the rabbit

Safe and efficient use of spinal drugs requires neurotoxicologic animal studies before ethical application. We have evaluated the neurotoxicologic interruptions of intrathecal administration of midazolam in rabbits. Eighteen white New Zealand rabbits were randomly assigned into three groups consisting of six rabbits each. In conscious animals, 0.3 ml 0.9% normal saline solution, 0.3 ml 0.1% midazolam (Roche, Dormicum) or 0.3 ml preservative free midazolam were intrathecally administered. Light and fluorescence microscopy evaluations were performed on transverse spinal cord sections by a neurohistopathologist in a blind fashion. Midazolam and preservative free midazolam treated rabbits showed significant histologic changes in light and fluorescence microscopy. The histologic and vascular lesions with the use of midazolam and preservative free midazolam suggested neurotoxic effects; thus chronic intrathecal administration of midazolam should be avoided in humans.