不同配比依托咪酯-丙泊酚混合液在无痛胃镜中的应用比较

目的比较不同配比依托咪酯与丙泊酚(EP)混合液在无痛胃镜检查中的麻醉效果、安全性和不良反应。方法选择拟行无痛胃镜检查患者200例,男95例,女105例,年龄18~65岁,BMI 18.5~27.0 kg/m2,ASAⅠ或Ⅱ级,随机分为两组。A组予以依托咪酯20 mg配比1%丙泊酚100 mg,容量比1∶1;B组予以依托咪酯20 mg配比1%丙泊酚200 mg,容量比1∶2,每组100例。所有患者在胃镜检查前2 min予以舒芬太尼0.1μg/kg缓慢静注,EP混合液首次剂量予以0.15~0.2ml/kg缓慢静注,根据患者镇静深度单次予以1~2 ml追加。所有患者入室后持续监测HR、SBP、DBP和Sp O2,记录依托咪酯用量和丙泊酚用量。记录两组药物起效时间、操作时间、苏醒时间和离室时间。记录两组低血压、心动过缓、低氧血症、注射痛、肌颤、恶心呕吐等不良反应。结果 A组术中依托咪酯用量明显多于B组(P0.01),丙泊酚用量明显少于B组(P0.05);两组的药物起效时间、操作时间、苏醒时间、离室时间差异均无统计学意义。A组术中肌颤发生率明显高于B组(P0.01);A组恶心呕吐发生率明显高于B组(P0.05)。两组低血压、低氧血症和注射痛等不良反应发生率差异无统计学意义。结论与1∶1的EP混合液比较,1∶2的EP混合液肌颤和恶心呕吐发生率较低,更适合于胃镜检查。     

国产依托咪酯乳剂用于全身麻醉诱导的多中心研究

目的观察和比较依托咪酯乳剂与丙泊酚应用于健康成人全麻诱导时血流动力学的改变和不良反应的情况。方法选择来自五个研究中心的健康成年患者共489例,随机分为丙泊酚(P)组(n=246)和依托咪酯(E)组(n=243),两组患者全麻诱导均用咪唑安定0.03mg/kg、芬太尼2μg/kg、维库溴铵0.1mg/kg,在此基础上P组用丙泊酚2.0mg/kg,E组用依托咪酯乳剂0.3~0.4mg/kg完成诱导。记录患者在基础状态(T0)、插管前1min(T1)、插管即刻(T2)及插管后1min(T3)、2、3、4、5min(T4)、10min(T5)、15min(T6)的SBP、DBP、MAP、SpO2和HR。术后回访观察肌颤、注射痛、恶心、呕吐和浅表性静脉炎等不良反应的发生情况。结果与T0比较,两组患者在T1、T2时SBP、DBP、MAP有明显的波动(P<0.05或P<0.01),但E组变化幅度显著低于P组(P<0.05)。E组患者注射痛的发生率显著低于P组(P<0.01)。结论依托咪酯乳剂可安全地用于健康成人的麻醉诱导;与丙泊酚相比,依托咪酯乳剂对血流动力学的影响轻且不良反应少。     

依托咪酯和丙泊酚单一制剂在胃镜操作全麻方案的比较研究

目的 比较依托咪酯和丙泊酚单一制剂在全麻胃镜操作中的应用特点.方法 择期行胃镜检查术100例,用随机数字表法随机分为依托咪酯(E)组和丙泊酚(P)组,双盲法给药.E组静注依托咪酯0.3 mg/kg,术中胃镜置入时追加0.1 mg/kg.P组静注丙泊酚2.5 mg/kg,术中胃镜置入时追加1 mg/kg.Ramsay分级...     

依托咪酯与丙泊酚对电休克治疗脑癫痫波发作的影响

目的 比较依托咪酯与丙泊酚对改良电休克治疗(MECT)患者脑癫痫波发作的影响.方法 42例患者随机均分为依托咪酯组(E组)和丙泊酚组(P组).E组用依托咪酯0.3 mg./kg静脉麻醉;P组用丙泊酚2 mg/kg静脉麻醉.两组全麻诱导后均静注琥珀胆碱1 mg/kg,待肌肉松弛后行MECT 治疗.记录初始阈值电量、最终阈值电量、治疗总电量、平均癫痫发作时间、发作不良次数.结果 两组患者HR和MAP峰值较基础值明显升高(Pd0.01);E组HR和MAP谷值与基础值比较差异无统计学意义,P组则明显下降(P＜0.01);两组患者HR和MAP的峰值和谷值P组明显低于E组(P＜0.05或P＜0.01).两组初始阈值电量、癫痫发作时间、发作不良次数差异无统计学意义,但P组最终阈值电量和治疗总电量[(180.4±52.7)mC和(1742.7±661.5)mC)]明显高于E组[(146.O±28.9)mC和(1255.2±405.3)mC](P＜0.05或P＜0.01).结论 2 mg/kg丙泊酚对脑癫痫波发作的抑制作用强于0.3 mg/kg依托咪酯.     

国产依托咪酯在全麻诱导和维持中的应用

目的 探讨依托咪酯在全麻诱导和维持中的应用.方法 选择ASA Ⅰ或Ⅱ级,年龄20～70岁,需要全身麻醉行腹部手术、开胸手术或开颅手术的患者95例.随机分为依托咪酯组(E组,n=45)和丙泊酚组(P组,n=50).麻醉诱导:提前5 min静脉注射咪唑安定0.075 mg/kg,预注维库溴铵总量(0.1 mg/kg)的1/4,静脉注射芬太尼3μg/kg、依托咪酯0.4 mg/kg(E组)或丙泊酚2 mg/kg(P组)、再注射维库溴铵总量的3/4.麻醉维持:雷米芬太尼0.05～0.1μg·kg-1·min-1,依托咪酯0.6～1.2 mg·kg-1·h-1(E组)或丙泊酚4～10 mg/kg(P组),维库溴铵酌情追加.记录入室、插管前、插管即刻、插管后1、3、5、10 min及切皮时的SBP、DBP、HR、SpO2,诱导期BP和HR的最高和最低值、麻醉时间、手术时间、患者清醒时间、拔管时间.麻醉前、插管后和术后24 h分别经桡动脉抽血2 ml,采用放免法测定血浆皮质醇浓度.观察有无肌颤、注射痛、恶心、呕吐、血栓性静脉炎等不良反应.结果 (1)两组患者的麻醉时间、手术时间、手术完毕后的清醒时间以及拔管时间等比较差异均无统计学意义;(2)与入室时比较,插管前两组SBP、DBP均明显降低(P<0.05或P<0.01),尤其P组降低更为明显;插管后3、5、10 min P组SBP、DBP明显降低(P<0.05或P<0.01);插管后1、3 min E组HR明显增快(P<0.05或P<0.01),而P组在插管后1 min HR也明显增快(P<0.05),插管后3、5、10 min时减慢(P<0.05);(3)诱导期间两组患者最高SBP、HR和最低SBP、HR的比较差异均无统计学意义;(4)与麻醉前比较,两组患者在插管后血浆皮质醇浓度升高(P(0.05或P(0.01),而P组升高更为显著;(5)两组均有注射痛发生,但E组(11%)发生率较P组(44%)低(P<0.01),两组均未出现肌颤、恶心呕吐、静脉炎等其他不良反应.结论 使用临床剂量的依托咪酯作为麻醉诱导和术中维持的静脉全麻药是安全可行的,诱导前预注射小剂量咪唑安定和肌肉松弛药可有效预防肌颤的发生.     

BIS指导靶控输注依托咪酯复合瑞芬太尼用于非心脏手术麻醉的效果:前瞻性、随机、单盲、多中心、临床对比研究

目的 评价脑电双频谱指数(BIS)指导靶控输注(TCI)依托咪酯复合瑞芬太尼用于非心脏手术麻醉的效果.方法 择期非心脏手术患者244例,性别不限,年龄20～60岁,体重54～76 kg,身高151～176 cm,ASA分级Ⅰ或Ⅱ级,预计手术时间＜3h.采用随机数字表法,将患者随机分为2组:丙泊酚TCI复合麻醉组(P组,n=121)和依托咪酯TCI复合麻醉组(E组,n=123).麻醉诱导:2组静脉注射舒芬太尼0.3～0.4 μg/kg;E组TCI依托咪酯,效应室靶浓度(Ce)0.5～1.0 μg/ml,P组TCI丙泊酚,Ce3～4μg/ml,静脉注射罗库溴铵0.9 mg/kg,气管插管后机械通气,维持PET CO2 35～ 40 mm Hg.麻醉维持:E组TCI依托咪酯,Ce 0.3～0.8 μg/ml;P组TCI丙泊酚,Ce 3 ～4 μg/ml,静脉输注瑞芬太尼0.1～1.0μg·kg-1·min-1,间断静脉注射罗库溴铵10 ～ 20 mg,维持BIS值40～60.记录意识消失时、麻醉维持和苏醒时依托咪酯的Ce,记录麻醉诱导时药物注射痛发生情况及术中血管活性药物使用情况、瑞芬太尼用量、苏醒时间、拔除气管导管时间、麻醉恢复期恶心呕吐及躁动的发生情况.结果 意识消失和苏醒时依托咪酯Ce分别为(0.50±0.22)、(0.16±0.09)μg/ml,麻醉维持时Ce 0.22～0.39μg/ml.与P组比较,E组注射痛发生率与血管活性药物使用率降低,瑞芬太尼用量增加,躁动及恶心呕吐发生率升高(P＜0.05或0.01),苏醒时间和拔除气管导管时间差异无统计学意义(P＞0.05).结论 与丙泊酚TCI复合瑞芬太尼麻醉比较,BIS指导依托咪酯TCI复合瑞芬太尼用于3h内非心脏手术麻醉时,血液动力学更平稳,无明显注射痛,而麻醉恢复期躁动及恶心呕吐的发生机率升高.     

依托咪酯和丙泊酚用于气管食管双通喉罩麻醉诱导时的比较

目的比较依托咪酯和丙泊酚在插入气管食管双通喉罩(PLMA)麻醉诱导时的优缺点。方法28例行择期手术的患者随机分为依托咪酯组(n=13)和丙泊酚组(n=15)。所有患者麻醉诱导前均静脉注射咪唑安定0.02mg/kg。依托咪酯组麻醉诱导用药依次为利多卡因1.5mg/kg、依托咪酯0.3mg/kg、芬太尼50μg;丙泊酚组为利多卡因1.5mg/kg、丙泊酚2mg/kg、芬太尼50μg。插入PLMA,观察注药至睫毛反射消失时间、注药至下颌松弛时间、注药至成功插入PLMA时间、PLMA成功插入的次数、是否发生呼吸抑制等。观察PLMA插入后患者是否出现咳嗽、呃逆、喉痉挛、体动等不良反应。记录患者HR、SBP、DBP在麻醉诱导前后的变化。结果两组睫毛反射消失时间、下颌松弛时间和成功插入PLMA时间差异无显著意义。依托咪酯组的呼吸抑制发生率明显低于丙泊酚组(P<0.05),但体动反射的发生率明显高于丙泊酚组(P<0.05)。两组患者在PLMA插入前后HR差异均无显著意义,依托咪酯组患者SBP、DBP在PLMA插入前后差异无显著意义。丙泊酚组患者SBP、DBP在PLMA插入后3、5min时明显下降(P<0.05)。结论依托咪酯0.3mg/kg复合利多卡因和芬太尼能够为插入PLMA提供良好的条件,并能保持血液动力学的稳定,但体动反应的发生率较丙泊酚高。     

等辐射分析法研究全身麻醉诱导丙泊酚、依托咪酯催眠相互作用

目的以等辐射分析法研究全身麻醉诱导时丙泊酚、依托咪酯催眠效应相互作用。方法75例择期上腹部手术病人随机分成三组:丙泊酚(P)组、依托咪酯(E)组、丙泊酚复合依托咪酯(C)组,每组25例。再各分成5个亚组(P1~P5,E1~E5,C1~C5)。麻醉诱导前各亚组给予不同剂量的丙泊酚及依托咪酯。监测给药前、给药后1、2、3、5min的SBP、DBP、HR、SpO2等指标。病人对口令失去反应即进入催眠状态。给药2min后,开始评估。以等辐射分析法分析两者之间催眠相互作用。结果在催眠末点:P组ED50值为1.15mg/kg(95%可信限0.95~1.40);E组ED50值为0.11mg/kg(95%可信限0.09~0.13);C组ED50值分别为0.38/0.05mg/kg(95%可信限0.33/0.05~0.44/0.06)。在催眠末点,C组ED50偏离相加线有显著性差异(P<0.05)。C组的SBP、DBP在给药前后无显著性差异(P>0.05)。结论点斜法测定依托咪酯ED50值为0.11mg/kg;经等辐射分析法分析后判定丙泊酚、依托咪酯(剂量比7/1)在催眠效应上呈现协同作用,复合用药血液动力学稳定。     

依托咪酯联合丙泊酚诱导麻醉用于老年患者无抽搐电休克治疗的临床观察

目的 探讨依托咪酯联合丙泊酚诱导麻醉用于老年患者无抽搐电休克治疗(MECT)的安全性及疗效.方法 2009年8月至2010年10月收治的需行MECT的老年患者60例,男42例,女18例,年龄60～85岁.按随机化顺序均分为依托咪酯与丙泊酚联合组(A组)、依托咪酯组(B组)和丙泊酚组(C组).A组静注依托咪酯0.15 mg/kg、丙泊酚1mg/kg;B组静注依托咪酯0.3mg/kg;C组静注丙泊酚2 mg/kg.测定三组患者麻醉前、麻醉诱导后和MECT后5、10 min的SBP、DBP、HR、SpO2以及麻醉前、MECT 10 min后的血糖.记录治疗过程中每组患者的脑电癫痫波发作时间及不良反应.结果 B组MECT后5、10 min SBP、DBP明显高于、HR明显快于A、C组,B组MECT后10 min血糖明显高于麻醉前和A、C组(P＜0.05).A、B组脑电癫痫波发作时间明显长于C组(P＜0.01);A组不良反应发生率明显低于B组(P＜0.05).结论 依托咪酯联合丙泊酚诱导麻醉用于老年患者MECT安全有效,对血流动力学影响轻微,同时能明显延长脑癫痫波发作时间,减少不良反应的发生.     

丙泊酚靶控输注用于重症心脏瓣膜病患者全麻诱导

目的探讨丙泊酚滴定法靶控输注用于重症心脏瓣膜病患者全麻诱导的安全性和有效性。方法重症心脏瓣膜病患者47例,随机分成丙泊酚组(P组,n=24)和依托咪酯组(E组,n=23)。P组以丙泊酚靶控输注,初始血浆靶浓度1.0μg/ml,采用改良警觉/镇静(MOAA/S)评分行镇静评分,每2分钟递增靶浓度0.2μg/ml,至患者MOAA/S评分≤1分时给予芬太尼5μg/kg、维库溴铵0.1mg/kg。E组使用依托咪酯0.25～0.30mg/kg和同剂量的芬太尼、维库溴铵并行气管插管。记录入室(T1)、MOAA/S评分≤1分(T2)、诱导期收缩压最低点(T3)、插管前(T4)、插管完毕(T5)、插管后5min(T6)时的SBP、DBP、HR、CVP;记录血管活性药物的使用情况。结果与T1时比较,P组T2～T6时SBP、DBP明显下降,HR明显减慢(P0.05或P0.01),E组T2～T4、T6时的SBP,T2～T6时的DBP明显下降,T2～T4时HR明显减慢(P0.05或P0.01),T3、T4时两组CVP明显降低(P0.05或P0.01)。与E组比较,P组T5时的SBP,T5、T6时的DBP明显降低,T5、T6时HR明显减慢(P0.05或P0.01)。P组患者在T2时的血浆靶浓度平均值为1.61μg/ml。结论丙泊酚滴定法靶控输注用于重症心脏瓣膜病患者全麻诱导的安全性与依托咪酯相似,并且能更好地抑制气管插管后的应激反应。     

A comparison of etomidate and thiopental anesthesia for cardioversion

Sixteen ASA class II or III male patients (aged, 52 to 66 years) undergoing elective cardioversion were randomly assigned to receive either thiopental or etomidate according to an observer-blinded, parallel study design. The appropriate drug was administered in 2-mL aliquots every 15 seconds until the patient no longer responded to verbal commands, at which time cardioversion was attempted. The total dose for induction was 0.22 +/- 0.2 mg/kg and 3.2 +/- 0.4 mg/kg for etomidate and thiopental, respectively. The cardiorespiratory data after induction were evaluated for maximal percent change from baseline. The baseline heart rate was 106 +/- 6 beats/min and 98 +/- 8 beats/min for the etomidate and thiopental groups, respectively (mean +/- SEM). The heart rate decreased 5% after induction with etomidate and increased 7% with thiopental (P less than 0.05). The baseline mean arterial pressure (MAP) was 96 +/- 3 mm Hg and 105 +/- 11 mm Hg for the etomidate and thiopental groups, respectively (mean +/- SEM). The MAP decreased 4% with etomidate and 3% with thiopental. Respiratory rate was significantly increased by 22% after etomidate compared with a 22% decrease in respiratory rate with thiopental (P less than 0.05). Seven of eight patients in the thiopental group required only one countershock, whereas four of eight patients in the etomidate group required only one shock. One patient in each group could not be successfully cardioverted. Recovery time and clinical side effects were similar between groups except for mild myoclonus in the etomidate group. Titration to effect of either etomidate or thiopental provided satisfactory anesthesia for elective cardioversion in hemodynamically stable patients.(ABSTRACT TRUNCATED AT 250 WORDS)     

依托咪酯和丙泊酚对罗库溴铵插管条件和起效时间的影响

目的 比较依托咪酯和丙泊酚对罗库溴铵插管条件和起效时间的影响。方法 60例ASA Ⅰ～Ⅱ级拟行择期上腹部手术的病人,随机均分为依托咪酯诱导组(E组)和丙泊酚诱导组(P组)。两组术前及其他术中用药相同,采用TOF-WATCH加速度仪监测肌松,并记录诱导前后的血压、心率。结果两组的插管条件无显著性差异(P>0.05)。E组的起效时间明显快于P组(P<0.05),P组诱导后的MAP明显低于E组(P<0.05)。结论 依托咪酯和丙泊酚均可提高罗库溴铵的插管条件。相对于丙泊酚,依托咪酯可缩短罗库溴铵的起效时间。     

咪唑安定和芬太尼对依托咪酯所致肌阵挛的影响

目的研究咪唑安定和芬太尼对依托咪酯所致肌阵挛的影响。方法全麻下行择期手术患者128例,根据麻醉诱导用药顺序和剂量的不同随机分为五组:Ⅰ组,咪唑安定0.05mg/kg、依托咪酯0.25mg/kg、芬太尼3μg/kg,22例;Ⅱ组,芬太尼3μg/kg、依托咪酯0.25mg/kg、咪唑安定0.05mg/kg,24例;Ⅲ组,咪唑安定0.05mg/kg、芬太尼3μg/kg、依托咪酯0.25mg/kg,32例;Ⅳ组,咪唑安定0.08mg/kg、依托咪酯0.25mg/kg、芬太尼3μg/kg,23例;Ⅴ组(对照组),依托咪酯0.25mg/kg、咪唑安定0.05mg/kg、芬太尼3μg/kg,27例。在静注依托咪酯后,观察并记录2min内肌阵挛阳性率及发生分级。结果五组肌阵挛阳性率分别为68.18%、41.67%、21.88%、21.74%、59.26%。与Ⅴ组比,Ⅲ、Ⅳ组肌阵挛阳性率及发生分级明显较低(P<0.05),Ⅰ、Ⅱ组肌阵挛阳性率及发生分级差异则无统计学意义。结论依次采用咪唑安定、芬太尼、依托咪酯诱导可减低依托咪酯引起的肌阵挛发生。     

The effects of speed of injection on induction with propofol A comparison with etomidate

One hundred and eighty female patients received either propofol 2.5 mg/kg or etomidate 0.3 mg/kg injected over 20, 40 or 80 seconds for induction of anaesthesia after premedication with temazepam 20 mg. The mean induction times for both etomidate and propofol were significantly reduced with increasing speed of injection. The mean induction times for etomidate were significantly less than propofol at the slower rates of injection. At each speed of injection, the decrease in systolic, mean and diastolic arterial blood pressures with etomidate were less than with propofol. The decrease in systolic blood pressure was not significantly affected by injection speed for either drug. Apnoea occurred significantly more frequently with propofol than with etomidate at each speed of injection and the incidence of apnoea greater than 60 seconds with propofol was significantly higher when injected over 20 seconds than 80 seconds. The incidence of pain on injection was unaffected by injection speed for either drug. The incidence of myoclonus and (or) hypertonus was significantly higher following etomidate.     

输注速度和刺激对全麻诱导时依托咪酯所致肌阵挛的影响

目的 通过观察不同给药速度以及在麻醉诱导过程中给予刺激对依托咪酯进行全麻诱导时发生肌阵挛的影响,分析肌阵挛的诱发因素.方法 200例ASA Ⅰ～Ⅱ级的患者随机分为四组：慢诱导组（S组）、慢诱导刺激组（S-s组）、快诱导组（F组）、快诱导刺激组（F-s组）,各50例.四组患者麻醉诱导均采用依托咪酯0.3 mg/kg.S组与S-s组输注时间均为1 min,F组与F-s组输注时间为10s.S组与F组待睫毛反射消失、呼吸变浅后开始行辅助通气,S-s组与F-s组待意识消失即刻开始行正压机械通气.记录四组患者麻醉前、依托咪酯注药后3 min内平均动脉压（MAP）、心率（HR）、脉搏血氧饱和度（SPO2）变化;观察静脉注射依托咪酯后肌阵挛的发生情况以及严重程度.结果 S组患者与F组患者肌阵挛发生率无明显差异,S-s组与S组相比以及F-s组与F组相比,其肌阵挛发生率均增高（P＜0.01）,但S-s组与F-s组相比肌阵挛发生率稍低（P＜0.01）.此外S-s组与F-s组注药后MAP及HR较基础值有所升高,SPO2则呈下降趋势（P＜0.01）,其余两组无明显变化.结论 全麻诱导时,加快输注速度并不会增加依托咪酯所致肌阵挛的发生率,但若在麻醉深度不够时给予了刺激则易诱发肌阵挛的发生.     

Predictors of hypotension after induction of general anesthesia

Hypotension after induction of general anesthesia is a common event. In the current investigation, we sought to identify the predictors of clinically significant hypotension after the induction of general anesthesia. Computerized anesthesia records of 4096 patients undergoing general anesthesia were queried for arterial blood pressure (BP), demographic information, preoperative drug history, and anesthetic induction regimen. The median BP was determined preinduction and for 0-5 and 5-10 min postinduction of anesthesia. Hypotension was defined as either: mean arterial blood pressure (MAP) decrease of >40% and MAP <70 mm Hg or MAP <60 mm Hg. Overall, 9% of patients experienced severe hypotension 0-10 min postinduction of general anesthesia. Hypotension was more prevalent in the second half of the 0-10 min interval after anesthetic induction (P < 0.001). In 2406 patients with retrievable outcome data, prolonged postoperative stay and/or death was more common in patients with versus those without postinduction hypotension (13.3% and 8.6%, respectively, multivariate P < 0.02). Statistically significant multivariate predictors of hypotension 0-10 min after anesthetic induction included: ASA III-V, baseline MAP <70 mm Hg, age > or =50 yr, the use of propofol for induction of anesthesia, and increasing induction dosage of fentanyl. Smaller doses of propofol, etomidate, and thiopental were not associated with less hypotension. To avoid severe hypotension, alternatives to propofol anesthetic induction (e.g., etomidate) should be considered in patients older than 50 yr of age with ASA physical status > or =3. We conclude that it is advisable to avoid propofol induction in patients who present with baseline MAP <70 mm Hg.     

Remifentanil pretreatment reduces myoclonus after etomidate

STUDY OBJECTIVE: The aim of the study was to compare the effect of pretreatment with remifentanil 1 microg/kg and the effect of gender on the incidence of myoclonus after anesthesia induction with etomidate. DESIGN: This was a randomized, double-blind study. SETTING: The study was conducted at a university hospital. PATIENTS: Sixty patients were pretreated in a randomized double-blinded fashion with remifentanil 1 microg/kg or placebo. Two minutes after remifentanil or placebo injection, etomidate 0.3 mg/kg was given. MEASUREMENTS: Myoclonus was recorded with a scale of 0 to 3. The grade of sedation (none, mild, moderate, severe), nausea, pruritis, and apnea were recorded after injection of both drugs. MAIN RESULTS: The incidence of myoclonus was significantly lower in the remifentanil group (6.7%) than in the placebo group (70%) (P < 0.001). None of the patients experienced sedation, apnea, nausea, or pruritis after injection of both drugs. In the placebo group, male patients were associated with significantly increased incidence of myoclonus after etomidate administration. CONCLUSION: Pretreatment with remifentanil 1 microg/kg reduced myoclonus after etomidate induction without side effects such as sedation, apnea, nausea, or pruritis. Men experience increased incidence of myoclonus than women after etomidate administration.     

Prevention of myoclonus after etomidate using a priming dose

OBJECTIVE: To investigate the influence of pretreatment with a low dose of etomidate (priming dose) on the incidence of etomidate-induced myoclonus. STUDY DESIGN: Prospective randomized double-blind study. METHODS: Forty six patients ASA physical status I - II, scheduled for abdominal elective surgery, were allocated randomly to receive either pre-treatment 0.03 mg/kg of etomidate (priming group) or placebo (control group). Sixty-seconds after the pre-treatment was injected, anesthesia was induced with etomidate 0.3 mg/kg and 60 seconds later induction was completed with fentanyl (3 microg/kg) and vecuronium (0.1 mg/kg). The occurrence and intensity of myoclonus were graded clinically by a blinded observer as: 0=no myoclonus, 1=mild myoclonus, 2=moderate myoclonus and 3=severe myoclonus. Statistical analysis: Fisher test exact for qualitative variable and Student t-test for quantitative variables. RESULTS: Demographic data and the average dose of etomidate used during the induction were similar in the 2 groups (0.29+/-0.032 mg/kg in the priming group and 0.30+/-0.029 mg/kg in the control group). Twenty patients (87%) in the control group experienced myoclonic movements whereas only 6 patients (26%) in the control group had such movements (P<0,001). CONCLUSION: Pretreatment with etomidate (0.03 mg/kg), given 60 seconds before induction of anesthesia, is effective at reducing etomidate-induced myoclonus, without related side-effect.     

肌肉注射不同剂量右美托咪定对芬太尼诱发咳嗽反射的影响

目的观察全麻诱导前肌肉注射不同剂量右美托咪定（dexmedetomidine,DEX）对芬太尼诱发咳嗽反射的影响。方法200例美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级择期手术患者,完全随机分为对照组（c组）和DEX组（D1组、D2组、D3组）4组,每组50例。诱导前D1组、D2组、D3组分别肌肉注射DEX1、1．5、2IAg／kg,C组肌肉注射等容量的生理盐水。15min后静脉注射芬太尼3μg／kg,过1min后静脉注射异丙酚2mg／kg、罗库溴铵0．6mg／kg行快速诱导气管插管。记录注射DEX前（R）、注射芬太尼前（T1）、插管前即刻（T2）、插管后即刻（T3）、插管后1min（T4）、插管后3min（T5）、插管后5min（T6）的收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、平均动脉压mean artery pressure,MAP）、心率（heart rate,HR）以及咳嗽反射情况。结果D1组、D2组、D3组咳嗽反射的发生率（分别为8％、6％、4％）明显低于c组（32％）（P〈0．01）;D。组、D：组、D3组之间咳嗽反射的发生率比较差异无统计学意义（P〉0．05）;各组T1时点MAP、HR[（89±10）、（91±11）、（94±9）、（90±9）mmHg（1mmHg=0．133kPa）,（68±9）、（70±10）、（68±8）、（70±12）次／min]与T0时点MAP、HR[（9±8）、（89±10）、（92±8）、（88±9）mmHg,（73±11）、（74±9）、（71±7）、（72±8）次／min]比较差异无统计学意义（P〉o．05）;与Tn时点MAP、HR[（91±8）、（89±10）、（92±8）、（88±9）mmHg,（73±11）、（74±9）、（71±7）、（72±8）次／rain]比较,各组T2时点MAP、HR[（80±8）、（78±10）、（71±9）、（69±9）mmHg,（64±9）、（65±10）、（58±7）、（56±8）次／min]明显降低（P〈0．05）;T2时点D2组、D3组MAP、HR[（71±9）、（69±9）mmHg,（58±7）、（56±8）次／min]低于C组、D1组[（80±8）、（78±10）mmHg,（64±9）、（65±10）次／min]（P〈0．05）;诱导后D,组有11例（22％）发生低血压,明显高于c组[2例（4％）]（P〈0．01）;D2、D3组分别有10例（20％）和12例（24％）发生心动过缓,明显高于C组[1例（2％）]（P〈0．01）;D,组、C组之间低血压和心动过缓的发生率比较差异无统计学意义（P〉0．05）。结论全麻诱导前预先肌肉注射小剂量（1μg／kg）DEX能显著减少芬太尼诱发咳嗽反射的发生率,且对诱导期间血流动力学无明显影响。