罗哌卡因复合舒芬太尼腰-硬联合麻醉在剖宫产术中的应用效果

目的比较剖宫产术中应用罗哌卡因腰-硬联合麻醉和罗哌卡因复合舒芬太尼腰-硬联合麻醉的临床效果。方法回顾性分析2018年9月至2019年7月92例接受剖宫产术产妇的临床资料,按照麻醉方法不同将其分为罗哌卡因组和罗哌卡因+舒芬太尼组,每组46例。罗哌卡因组给予罗哌卡因腰-硬联合麻醉,罗哌卡因+舒芬太尼组给予罗哌卡因复合舒芬太尼腰-硬联合麻醉。观察两组麻醉前、手术开始时的收缩压(SBP)、舒张压(DBP)、呼吸频率、心率(HR)、药物起效时间、痛觉恢复时间、术后24 h不良反应发生情况、麻醉后肌肉松弛优良率。结果手术开始时,两组SBP、DBP、呼吸频率、HR均明显下降,但罗哌卡因+舒芬太尼组下降程度明显低于罗哌卡因组(P<0.05)。罗哌卡因+舒芬太尼组药物起效时间明显短于罗哌卡因组,痛觉恢复时间明显长于罗哌卡因组(P<0.05)。罗哌卡因+舒芬太尼组术后24 h不良反应总发生率明显低于罗哌卡因组(P<0.05)。罗哌卡因+舒芬太尼组麻醉后肌肉松弛优良率明显高于罗哌卡因组(P<0.05)。结论罗哌卡因复合舒芬太尼腰-硬联合麻醉应用于剖宫产术中的临床效果显著,可广泛推广。     

不同剂量罗哌卡因复合芬太尼对妊娠期高血压剖宫产手术产妇的血流动力学和应激反应的影响

目的分析探讨不同剂量罗哌卡因复合芬太尼对妊娠期高血压剖宫产手术产妇的血流动力学和应激反应的影响。方法选取2012年9月~2017年5月我院收治的200例妊娠期高血压剖宫产手术产妇,根据患者健康条件和自主意愿分为小剂量组(n=100)和常规剂量组(n=100)。小剂量组产妇采用1.0ml1%罗哌卡因联合10μg芬太尼麻醉,常规剂量组采用1.5ml 1%罗哌卡因联合10μg芬太尼麻醉。分析比较两组患者在麻醉前、麻醉后15min、胎儿分娩后、手术完成时的血流动力学指标(HR、DBP、SBP)和应激反应(Cor、ET、SOD、MDA)。结果 (1)麻醉15min后,观察组患者的DBP、SBP水平高于对照组(P0.05);胎儿娩出后,对照组患者的HR水平高于观察组,DBP水平低于观察组(P0.05);(2)麻醉15min后,观察组患者的Cor、SOD水平小于对照组(P0.05);胎儿娩出后,观察组患者的Cor、ET小于对照组,MDA大于对照组(P0.05);手术结束后观察组患者的SOD水平小于对照组(P0.05)。结论小剂量罗哌卡因复合芬太尼用于妊娠期高血压剖宫产产妇,能有效稳定产妇的血流动力学,并改善其应激反应。     

罗哌卡因联合芬太尼腰硬联合麻醉在剖宫产术中的临床观察

观察罗哌卡因联合芬太尼腰硬联合麻醉在剖宫产术中的有效性和安全性。择期行剖宫产术产妇60例,随机双盲分为两组:罗哌卡因组(R组)和罗哌卡因联合芬太尼组(RF组)(n=30),R组腰麻药物为14mg罗哌卡因,RF组腰麻药物为12mg罗哌卡因联合10g芬太尼。记录产妇手术期间麻醉效果、麻醉并发症和新生儿1、5min Apgar评分。与R组比较,RF组产妇低血压、恶心呕吐麻醉并发症的发生率明显降低(P0.05),两组患者麻醉效果和新生儿1、5min Apgar评分比较差异无统计学意义(P0.05)。罗哌卡因联合芬太尼腰硬联合麻醉用于剖宫产术麻醉效果好,麻醉并发症少。     

罗哌卡因腰-硬联合麻醉在妊娠高血压综合征孕妇剖宫产术中的应用

观察罗哌卡因腰-硬联合麻醉(CSEA)在妊娠高血压综合征孕妇剖宫产术中的应用效果。选择收治的70例妊娠高血压综合征产妇为研究对象,按随机数表法分为对照组和观察组各35例。两组均在常规治疗基础上接受CSEA下剖宫产术,对照组给予布比卡因,观察组给予罗哌卡因,对比两组血压水平、新生儿Apgar评分及胎儿娩出时间。观察组不同时间点血压水平均优于对照组,差异有统计学意义(P<0.05);两组胎儿娩出时间及出生后1min、5min Apgar评分对比,差异无统计学意义(P>0.05)。妊娠高血压综合征剖宫产孕妇接受罗哌卡因腰硬联合麻醉时血压水平平稳,临床麻醉效果较好。     

小剂量盐酸罗哌卡因腰硬联合麻醉应用于剖宫产产妇的效果及对血流动力学的影响

目的分析剖宫产产妇应用小剂量盐酸罗哌卡因腰硬联合麻醉的临床效果及血流动力学的变化。方法采用随机数字表法将89例剖宫产产妇分为两组,对照组44例采用大剂量(15 mg)盐酸罗哌卡因腰硬联合麻醉,观察组45例给予小剂量(10 mg)盐酸罗哌卡因腰硬联合麻醉,对比两组产妇的麻醉效果、血流动力学指标水平变化及并发症发生率。结果观察组产妇麻醉后麻醉起效时间及肌松满意度评分均高于对照组,麻醉持续时间及苏醒时间短于对照组,差异均有统计学意义(P均0.05);观察组产妇手术前后心率、血氧饱和度及平均动脉压无明显变化(P0.05),对照组产妇变化明显(P0.05),观察组产妇术后心率低于对照组,血氧饱和度高于对照组,并发症发生率(4.44%)低于对照组(20.45%),差异均有统计学意义(P均0.05)。结论小剂量盐酸罗哌卡因能够显著降低对剖宫产产妇血流动力学的影响,麻醉效果确切,安全性高。     

罗哌卡因与布比卡因及氯普鲁卡因在剖宫产手术腰-硬联合麻醉中的比较

目的比较罗哌卡因、布比卡因和氯普鲁卡因在剖宫产手术腰-硬联合麻醉(CSEA)中的应用效果。方法择期行剖宫产手术产妇120例,随机均分成三组:罗哌卡因组(A)组、布比卡因组(B组)和氯普鲁卡因组(C组),蛛网膜下腔分别给予0.5%罗哌卡因、0.5%布比卡因和1.5%氯普鲁卡因各2 ml。记录患者感觉阻滞起效时间、平面固定时间、阻滞平面、腰麻持续时间和运动阻滞效果;VAS评分评估产妇疼痛程度、术者评定腹壁松驰度、记录其后不良反应。结果 A组产妇感觉阻滞起效时间明显短于B、C组(P<0.05),麻醉持续时间长于B、C组(P<0.05),最高阻滞平面高于B组、低于C组;三组镇痛效果满意,腹壁松驰度"很松"者分别占95%、94%、80%。麻醉后不良反应少。结论与0.5%布比卡因和1.5%氯普鲁卡因比较,0.5%罗哌卡因具有起效快、阻滞完善,能达到满意的肌松效果,适用于剖宫产手术的CSEA中的脊麻。     

0.5%罗哌卡因腰硬联合麻醉时不同注药速度的麻醉效果观察

探讨不同速度注射0.5%罗哌卡因腰硬联合麻醉的效果及差异性。选取我院接受剖宫产手术并采取腰硬联合麻醉的患者120例作为研究对象。随机分为A、B、C组,每组40例,三组均选择0.5%罗哌卡因作为麻醉用药,其中A组注射速度为1ml/5s,B组注射速度1ml/10s,C组注射速度为1ml/15s,比较三组麻醉效果及不良反应发生情况。A组患者在阻滞平面达到T10以及消退至T8的时间明显短于B组与C组,P0.05;但B、C组不良反应发生率明显低于A组,P0.05;A组患者术中肌松满意度明显高于B、C组,P0.05,但三组患者术中追加利多卡因例数比较无显著差异,P0.05。在腰硬联合麻醉中不同罗哌卡因注药速度麻醉效果存在显著差异,应以1ml/10s速度推注0.5%罗哌卡因可获得满意的麻醉效果以及可靠的安全性,具有应用及推广价值。     

腰-硬联合麻醉在老年人粗隆间骨折中的应用60例分析

目的观察腰-硬联合麻醉在老年人粗隆间骨折中应用的安全性。方法对60例老年人粗隆间骨折的患者在L2～3和L3～4腰椎间隙穿刺,见脑脊液后注入0.5%盐酸罗哌卡因重比重液1.5～2.0ml,硬膜外向上置管4cm记录给药后5min(T1)、10min(T2)、15min(T3)、30min(T4)时的BP、HR和SpO2值。结果腰-硬联合麻醉时T1、T2、T3、T4等4个时间点的SBP、DBP、HR、SpO2与术前基础值比较,DBP、HR无明显变化(P>0.05),SBP明显下降(P<0.05),但未超过基础值的20%。结论小剂量0.5%罗哌卡因重比重液腰-硬联合麻醉在老年人粗隆间术中应用,效果确切,安全可靠,对心肺功能影响小。     

腰-硬联合麻醉剖宫产手术中联合应用芬太尼对罗哌卡因半数有效剂量的影响

目的采用序贯法分析剖宫产病人腰-硬联合麻醉中联合应用芬太尼对罗哌卡因半数有效剂量(ED50)的影响。方法选择大邑县人民医院择期拟行剖宫产术的足月单胎初产妇100例作为研究对象,采用抽签法法将产妇随机分为0.5%罗哌卡因组(R组,n=50)和0.5%罗哌卡因联合10μg芬太尼组(RF组,n=50)。R组和RF组0.5%罗哌卡因的初始剂量分别为15 mg和8 mg,根据阻滞效果按照Dixon序贯法确定下一例产妇的剂量,剂量调整间隔为0.5 mg。采用Probit概率单位回归法计算两组产妇ED50及其95%置信区间(95%CI)。结果 RF组ED50为6.370 mg(95%CI:5.892~11.477 mg),R组ED50为14.088 mg(95%CI:13.412~20.893 mg),与R组比较,RF组产妇的0.5%罗哌卡因半数有效剂量更低,感觉阻滞起效早,运动阻滞程度低,差异有统计学意义(P0.05)。结论剖宫产患者腰-硬联合麻醉中联合应用芬太尼可以有效降低罗哌卡因半数有效剂量(ED50),可以保证满意的麻醉效果前提下减少罗哌卡因的用药,缩短麻醉的起效时间,降低麻醉并发症的发生风险,值得在临床推广应用。     

舒芬太尼复合罗哌卡因腰硬联合麻醉在无痛分娩中的麻醉效果分析

目的探讨舒芬太尼复合罗哌卡因腰硬联合麻醉在无痛分娩中的麻醉效果,分析对疼痛程度及分娩结局的影响。方法回顾性分析2017年8月～2019年8月于我院产科接受无痛分娩的产妇80例的临床资料,根据麻醉用药的不同进行对照组和观察组各40例。对照组采用罗哌卡因腰硬联合麻醉,观察组予罗哌卡因复合舒芬太尼腰硬联合麻醉。比较两组不同时间疼痛程度及分娩结局。结果观察组活跃期给药后、第二产程以及第三产程VAS评分均低于对照组,差异均有统计学意义(P<0.05);观察组剖宫产及产钳助产率低于对照组,顺产率高于对照组,差异均有统计学意义(P<0.05)。结论舒芬太尼复合罗哌卡因腰硬联合麻醉应用于无痛分娩效果显著,可减轻产妇疼痛程度,优化分娩结局。     

Principles of office anesthesia: part II. Topical anesthesia

The development of topical anesthetics has provided the family physician with multiple options in anesthetizing open and intact skin. The combination of tetracaine, adrenaline (epinephrine), and cocaine, better known as TAC, was the first topical agent available for analgesia of lacerations to the face and scalp. Cocaine has been replaced with lidocaine in a newer formulation called LET (lidocaine, epinephrine, and tetracaine). For analgesia to nonintact skin, LET gel is generally preferred over TAC because of its superior safety record and cost-effectiveness. EMLA (eutectic mixture of local anesthetics) is perhaps the most well-known topical anesthetic for use on intact skin. EMLA can be used to anesthetize the skin before intramuscular injections, venipuncture, and simple skin procedures such as curettage or biopsy. To be fully effective, EMLA should be applied at least 90 minutes before the procedure. ELA-Max is a new, rapidly acting topical agent for intact skin that works by way of a liposomal delivery system and is available over the counter. Other delivery vehicles for topical anesthesia currently in development, including iontophoresis and anesthetic patches, may one day give patients and physicians even more flexibility.     

Principles of office anesthesia: part I. Infiltrative anesthesia

The use of effective analgesia is vital for any office procedure in which pain may be inflicted. The ideal anesthetic achieves 100 percent analgesia in a short period of time, works on intact or nonintact skin without systemic side effects, and invokes neither pain nor toxicity. Because no single agent meets all of these criteria, the physician must choose from the available armamentarium based on the anesthetic properties that are most desired. Infiltrative anesthetics are frequently chosen because of their proven safety record, low cost, ease of storage, widespread availability, and rapid onset of action. Allergy to local injectable anesthetics is rare, and when it occurs it is often secondary to the preservative in multidose vials. Anesthesia can be prolonged with the addition of epinephrine or the use of longer-acting agents. Buffering the local anesthetic with bicarbonate, warming the solution, and injecting slowly can minimize the pain of anesthetic injection. Complications are rare but include central nervous system and cardiovascular toxicity, or extreme vasoconstriction in an end organ, if epinephrine is used.     

Awareness under anesthesia.

Awareness under anesthesia, also known as unintentional intraoperative awareness, occurs when a patient unintentionally becomes aware while under general anesthesia. Although unintentional intraoperative awareness occurs rarely, patients who experience this may develop anxiety disorders of varying severity, including posttraumatic stress disorder. Perianesthesia nurses can play an important role in the prevention and management of unintentional intraoperative awareness in patients.     

Legal aspects of anesthesia charting.

To the anesthesia practitioner, the possibility of malpractice claims constitutes a very real and ever-present problem for it lies within the risks inherent in the administration of anesthesia. Since the areas of anesthesia which may be subject to suit are legion, the problem of malpractice becomes too complex to afford easy answers. Clearly, though, it is a problem all too serious to ignore. This article examines one aspect of the problem: the importance of good documentation in anesthesia.