咪达唑仑和右美托咪定对七氟醚麻醉苏醒期躁动的对比分析

分析咪达唑仑和右美托咪定对七氟醚麻醉苏醒期躁动的影响分析。对从2016年1月~10月在我院普外科就诊的118例全麻患者按照数字随机表法将患者随机的分为对照组和试验组两组,各59例;两组患者均采用七氟醚进行面罩全身麻醉,对照组患者在手术前15min静脉注射50ug/mg的咪达唑仑,试验组患者在手术结束前15 min静脉注射1ug/mg的右美托咪定;对比分析两组患者手术、麻醉、苏醒和恢复室时间,躁动评分和舒适(BCS)评分。结果:(1)两组患者在手术时间、麻醉时间、苏醒时间、恢复室时间上均不存在着显著性差异(P>0.05)。(2)对照组中,15例患者为3级,7例为4级,躁动发生率为37.29%;试验组中,有7例患者为3级,4例为4级,躁动发生率为18.64%;试验组患者的躁动发生率显著的低于对照组(P<0.05)。(3)对照组2分患者有31例(52.54%),显著的高于试验组的11例(18.64%)(P<0.05);两组患者3分指标上不存在着显著性差异(P>0.05);试验组4分患者有30例(50.85%),显著的高于对照组的12例(20.34%)(P<0.05)。与咪达唑仑相比,右美托咪定能够更加有效的降低七氟醚麻醉苏醒期躁动发生率,在临床中具有推广和应用价值。     

右旋美托咪定不同给药方式对小儿七氟醚麻醉后苏醒期躁动的影响

目的:探讨右旋美托咪定不同给药方式对小儿七氟醚麻醉后苏醒期躁动的影响。方法:选择2014年1月—11月在昆明市儿童医院行择期腭裂修补术的患儿90例,年龄2~7岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级,采用随机数字表法将患儿分为3组,每组各30例,其中D1组经静脉单次注射右旋美托咪定1μg/kg(10 min)负荷量,D2组静脉持续泵注右旋美托咪定1μg/(kg·h)至术毕,C组静脉持续泵注与D2组等容积0.9%氯化钠液作为对照;对比分析3组患儿镇静躁动评分及躁动发生率。结果:与C组比较,D1组、D2组镇静躁动评分、躁动发生率均降低(P0.05);D1组、D2组镇静躁动评分、躁动发生率比较差异均无统计学意义(P0.05)。结论:右旋美托咪定单次负荷量静脉注射与静脉持续泵注均可有效降低小儿七氟醚麻醉后苏醒期躁动的发生,且二者效果类似。     

比较可乐定和咪达唑仑对儿童术后躁动的影响

术后躁动是全麻术后常见的并发症,尤其对儿童,应用七氟烷麻醉出现躁动是一个普遍的术后现象.产生躁动的原因目前尚不清楚,认为疼痛是个促进因素.但单纯应用七氟烷麻醉而不进行外科手术,麻醉结束后也会出现躁动[1].麻醉诱导后静脉注射可乐定能减少七氟烷麻醉后早期躁动的发生率[2],但术前口服可乐定有否有作用未见有报道.本研究在镇痛完全的情况下术前口服可乐定,观察对七氟烷麻醉后早期躁动的影响.     

小儿氯胺酮复合咪达唑仑麻醉术后清醒期的护理

总结了30例患儿术中应用氯胺酮、咪达唑仑两种药物麻醉后清醒期的护理。认为术后防止呼吸道分泌物过多及呼吸抑制,监控患儿体温,加强安全护理,防止意外伤害;掌握正确输液、输血速度,调适患儿情绪,做好心理护理,加强转出麻醉清醒室时的呼吸管理,保持呼吸道通畅,是保证手术质量和手术安全性,预防术后并发症的有效措施。     

右美托咪定与芬太尼抑制七氟醚麻醉苏醒期躁动的对比观察

依据纳入/排除标准共选取55例甲状腺乳腺手术患者并随机分组;两组患者均于麻醉诱导成功之后给予七氟醚、阿曲库铵行麻醉维持;于手术结束前10min,观察组给予右美托咪定,对照组给予芬太尼,比较两组术后躁动发生情况、自主呼吸恢复时间等。结果观察组躁动率为10.7%,较对照组(18.5%)显著降低,差异有统计学意义(P﹤0.05);两组自主呼吸恢复时间比较无统计学差异(P>0.05);观察组术后苏醒时间、离开麻醉后监测治疗室时间值分别为21.0±4.2、31.8±6.2min,均显著低于对照组(P<0.05)。右美托咪定抑制七氟醚麻醉苏醒期躁动的临床效果优于芬太尼,值得临床推广应用。     

丙泊酚在消除小儿斜视手术七氟烷麻醉苏醒期躁动的临床观察

目的观察丙泊酚对消除小儿斜视手术七氟烷麻醉苏醒期躁动的影响。方法选择小儿斜视消除术病例110例,随机分为丙泊酚（P组）和生理盐水对照组（N组）,分别给予丙泊酚1.5mg/kg及生理盐水静点。分别记录PACU停留时间、术后躁动情况及恶心呕吐等不良反应情况,术后躁动采用5分躁动分级法评分。结果 PACU停留时间两组无显著性差异（P〉0.05）,苏醒躁动情况P组明显弱于N组（P〈0.05）,N组出现1例恶心、呕吐现象并有1例患儿发生静脉留置针脱落。结论小儿斜视手术麻醉中停用七氟烷后给予单次剂量1.5mg/kg的丙泊酚能明显降低术后躁动的发生,使麻醉更趋平稳,而并不会延长患儿麻醉苏醒时间和PACU停留时间。     

小儿氯胺酮复合咪哒唑仑麻醉术后苏醒期护理

近年来,我们为30例患儿进行体表小手术时实施氯胺酮复合咪哒唑仑静脉麻醉,经精心护理,效果满意.现将麻醉术后苏醒期护理体会报告如下. 1 临床资料 本组共有30例患儿,年龄8个月～12岁,其中8个月1例,1～3岁13例,4～12岁16例;行头面部手术6例,四肢手术8例,泌尿系统手术11例,躯干表浅手术5例.     

咪达唑仑应用于小儿术前镇静的研究进展

咪达唑仑是一种苯二氮类药物,具有抗焦虑、镇静、催眠、中枢性肌肉松弛及顺行性遗忘作用。由于其起效快,安全性好,被广泛地应用于小儿术前镇静。通过概括咪达唑仑药物代谢动力学特点以及有关镇静-躁动双向反应,镇静成功率,与术后烦躁、术后认知功能改变的关系等,旨在了解咪达唑仑在小儿术前镇静中的应用进展及药物特性,为临床用药提供参考。     

Prophylactic Midazolam and Clonidine for Emergence from Agitation in Children After Emergence From Sevoflurane Anesthesia: A Meta-analysis

Background

Emergence agitation (EA) after emergence from sevoflurane anesthesia is a common phenomenon in children. The efficacy of prophylactic midazolam or clonidine in preventing EA is controversial.

Objective

We performed a meta-analysis of clinical trials of the 2 drugs to evaluate their ability to prevent EA in pediatric patients after emergence from sevoflurane anesthesia.

Methods

A comprehensive literature search was conducted to identify clinical trials that observed the effect of midazolam and clonidine on preventing EA in children after their emergence from sevoflurane anesthesia. All data were examined using the Mantel-Haenszel model to calculate the pooled odds ratio (OR) and 95% CI. I² was used to assess heterogeneity. Subgroup analysis was used to assess the effects of preoperative analgesics, routes of administration, and dose, and funnel plots were used to check publication bias.

Results

After a comprehensive literature search, we found 12 papers that met the criteria for inclusion in this analysis, with a total of 447 children in the midazolam group and 767 children in the clonidine group. We found that both midazolam and clonidine decreased the incidence of EA (OR = 0.45 [95% CI, 0.29–0.70], P = 0.0004, I² = 46%; and OR = 0.24 [95% CI, 0.13–0.43], P < 0.00001, I² = 48%, respectively). Subgroup analysis indicated that preoperative analgesia may decrease the effect of midazolam against EA, whereas for clonidine, neither the route of administration (intravenous or caudal) nor the dose affected the results. Funnel plots did not detect publication bias in the midazolam group, but a bias was detected in the clonidine group.

Conclusions

This meta-analysis suggests that prophylactic administration of midazolam or clonidine could significantly decrease the incidence of sevoflurane-induced EA in pediatric patients.     

全麻苏醒期患儿躁动危险因素探讨

目的探讨全麻苏醒期患儿躁动的发病情况及其危险因素。方法回顾分析366例经全麻手术患几苏醒期躁动的发生情况,采用Logistic多元回归分析方法探讨影响患儿躁动发生的因素。结果本组患儿发生全麻苏醒期躁动46例,发病率12．6％,Logistic多元回归分析表明年龄、麻醉方式、手术时间、手术类别是患儿发生躁动影响因素（P〈0．05）,性别、ASA分级、手术部位则对患儿躁动的发生无明显影响（P〉0．05）。结论儿童全麻苏醒期躁动发生率较成人高,低龄、静脉全麻、长时间手术和急诊手术是全麻苏醒期患儿躁动发生的危险因素。护理人员应针对躁动发生的危险因素进行护理,预防全麻苏醒期躁动发生。     

Management of Acute Undifferentiated Agitation in the Emergency Department: A Randomized Double-Blind Trial of Droperidol, Ziprasidone, and Midazolam

Objectives: To compare the efficacy of sedation, need for rescue sedation, rates of respiratory depression, and complications of droperidol, ziprasidone, and midazolam when used for the treatment of emergency department (ED) patients requiring sedation for acute undifferentiated agitation. Methods: A prospective, randomized, double-blind trial of agitated ED patients requiring emergent sedation was performed. Patients were randomized to receive droperidol 5 mg, ziprasidone 20 mg, or midazolam 5 mg intramuscularly. Interval measurements were made at 0, 15, 30, 45, 60, and 120 minutes and included Altered Mental Status Scale (AMS) scores, oxygen saturations, and end-tidal carbon dioxide levels. Results: A total of 144 patients were enrolled; 50 patients received droperidol, 46 received ziprasidone, and 48 received midazolam. Adequate sedation (mean AMS score <0) was achieved at 15 minutes in patients receiving midazolam (mean AMS score, −0.81) and 30 minutes for patients receiving droperidol (mean AMS score, −1.3) and ziprasidone (mean AMS score, −0.74). Rescue medication for sedation was necessary in 38 of 144 patients (droperidol, 5 of 50; ziprasidone, 9 of 46; midazolam, 24 of 48; p < 0.05). No cardiac dysrhythmias were identified in any treatment group. Respiratory depression that clinically required treatment with supplemental oxygen occurred in 21 of 144 patients (droperidol, 4 of 50; ziprasidone, 7 of 46; midazolam, 10 of 48; p = 0.20). No patients required endotracheal intubation. Conclusions: Acutely agitated ED patients sedated with droperidol or ziprasidone required rescue medications to achieve adequate sedation less frequently than those sedated with midazolam. The onset of adequate sedation is delayed with ziprasidone, relative to the other agents.     

Comparison of Haloperidol Alone and in Combination with Midazolam for the Treatment of Acute Agitation in an Inpatient Palliative Care Service

Agitation is a very distressing problem that must be controlled as quickly as possible, but using a safe method. The authors conducted a comparison of two protocols: a combination of haloperidol and midazolam and haloperidol alone. The combination drug protocol controlled 101 out of 121 (84%) episodes of agitation with only the first dose, whereas the haloperidol alone protocol controlled 47 out of 74 (64%) episodes. This difference is statistically significant (P =.002), with a post hoc analyzed power of 0.88. The median time from the first dose to the control of agitation was 15 minutes (range: 5–210) with the combination and 60 minutes (range: 10–430) with the other protocol, P <.001. There were no complications other than some transient somnolence, mainly with the combination protocol. The authors conclude that the combination of haloperidol and midazolam is effective and safe for the control of agitation in palliative care and it is more effective than haloperidol alone. Therefore, the combination should be adopted as the preferred protocol. It would be helpful if the usefulness of this protocol is confirmed by others.     

不同剂量右美托咪定复合七氟烷麻醉对妇科腔镜手术患者苏醒期躁动的影响

目的观察不同剂量右美托咪定复合七氟烷麻醉对妇科腔镜手术患者苏醒期躁动的影响。方法将90例行腹腔镜下全子宫切除术的患者随机分为N组、D1组和D2组,各30例。D1、D2组于全麻诱导后分别泵注0.5、0.8μg/(kg·h)右美托咪定至术毕前30 min,N组给予泵注生理盐水10 mL/h。术中吸入3%七氟烷复合麻醉维持。记录三组的苏醒时间、拔管时间、PACU期间最高Ramsay评分、Ricker镇静-躁动评分(SAS评分)、MAP、HR及术中麻药用量。结果 D1组的苏醒时间、拔管时间短于N组和D2组(P<0.05);D2组的PACU期间最高Ramsay评分高于N组和D1组(P<0.05);D1、D2组的术中SAS评分低于N组(P<0.05)。T_1时,D1、D2组的MAP和HR均低于N组,D2组的HR低于D1组(P<0.05);T_2时,D1和D2组的MAP、HR均低于N组(P<0.05);T_3时,D1组的MAP低于N组、D2组,D1和D2组的HR均低于N组(P<0.05)。D1、D2组术中瑞芬太尼及七氟烷的用量均少于N组,D2组少于D1组(P<0.05)。结论全麻诱导后以0.5μg/(kg·h)静脉泵注右美托咪定,可缩短妇科腔镜手术患者苏醒时间和拔管时间,且可维持围术期血流动力学的平稳,减少麻醉药物用量。     

麻醉深度对小儿斜视术后躁动发生的影响

目的:探讨行斜视手术的患儿术中麻醉深度对术后躁动(emergence agitation,EA)发生的影响。方法:选择2~7岁且美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级的择期行斜视手术的患儿123例。术中应用七氟烷进行麻醉诱导及维持,并采用脑电双频指数(bispectral index,BIS)监测麻醉深度。术后于苏醒室(postanesthesia care unit,PACU)内采用小儿麻醉苏醒期躁动评分量表(pediatric anesthesia emergence delirium scale,PAED)对患儿进行躁动评分。比较躁动与非躁动患儿的各项临床指标。根据BIS值将患儿分为2组:HBIS组(术中BIS均值≥40)及LBIS组(术中BIS均值40),比较2组患儿躁动的发生率。结果:躁动与非躁动患儿术中BIS值分别为42.77±8.96与46.67±9.01,差异有统计学意义(P0.05),躁动与非躁动患儿其他临床指标差异均无统计学意义。HBIS组与LBIS组患儿的躁动发生率分别为21.59%和40.00%,差异有统计学意义(P0.05)。Logistic回归分析显示,HBIS组与LBIS组比较,OR=0.435(95%CI=0.184~1.027),P0.1,差异有统计学意义。结论:术中麻醉深度会影响术后躁动发生率,术中麻醉深度过深(BIS均值40)可能会导致小儿术后躁动发生率上升。     

环包式胸腹约束固定法在全麻后苏醒期躁动患儿中的应用

目的探讨环包式胸腹约束固定法在全麻后苏醒期躁动患儿中的应用效果。方法选择需择期手术的患儿300例,按随机数字表法分观察组和对照组各150例。观察组术后患儿采取侧卧位,胸腹部位于环包式胸腹约束带上方,经腋下做适当约束,反方向交叉固定,松紧适宜。对照组术后患儿同样取侧卧位,将约束带固定于患儿上肢的手腕与下肢的脚腕上,腹部上方横档1条约束腹带,保持患儿上、下肢体处于舒适的体位后固定约束带。比较两组患儿术后躁动发生时间、术后苏醒时间、恢复室停留时间、术后躁动评分、术后躁动发生率及不良反应发生情况。结果两组患儿术后躁动发生时间差异无统计学意义(P0.05),观察组患儿术后苏醒时间、恢复室停留时间、术后躁动评分、术后躁动发生率与对照组比较,差异有统计学意义(P0.05),对照组7例患儿发生不良反应,观察组1例患儿发生不良反应。结论环包式胸腹约束固定方法能有效保护全麻后苏醒期躁动患儿,该方法操作简单,增加患儿的安全感与舒适度,更适用于苏醒期躁动患儿的保护及应用。