异丙酚静脉麻醉在小儿胃镜检查中的临床应用

2004年1月至2006年11月我们开展了异丙酚麻醉在小儿胃镜检查治疗中的应用，取得了良好效果，但也出现了一些并发症，现报道如下。[第一段]     

小剂量氯胺酮并异丙酚胃镜检查心血管反应的影响

目的：观察小剂量氯胺酮并异丙酚胃镜检查的效果及其对心血管反应的影响。方法：112例患，依次静推氯胺酮0．1～0．3mg．kg^-1、异丙酚1～2mg．kg^-1后实行无痛胃镜与传统胃镜检查，记录无痛胃镜组与传统胃镜组的各项反应以及HR、SBP、MAP、SPO2的变化。结果：小剂量氯胺酮并异丙酚使患对胃镜检查过程无知晓、无痛，且HR、SBP、MAP、反应低于传统胃镜组。结论：小剂量氯胺酮复合异丙酚应用于胃镜检查效果好。     

胃镜检查并发两侧气胸及纵隔气肿一例

患者女,48岁。于4 h前行常规胃镜检查,结束后突发 颈部皮下气肿,伴进行性胸闷、气促,当即行急诊胸部CT检 查,示两侧气胸,纵隔气肿,食管X线造影口服碘剂未见外 漏,急诊在局麻下行两侧胸腔闭式引流术,术后胸闷、气促症 状减轻,为进一步诊治收住入院。患者既往无肺部疾病史。 入院查体:体温37.5℃,心率108次／min,呼吸20次／min, 血压130／75 mmHg,神清,急性病容,颜面及颈部皮下气肿, 浅表淋巴结未及。两侧胸部皮下气肿,两肺呼吸动度基本对 称,两肺语颤减低,叩呈鼓音,两肺呼吸音减低,未闻及干湿 罗音。心律齐,未闻及杂音。腹平软,剑下轻压痛,肝脾肋下 未触及。入院后予口服美蓝溶液未见胸腔引流液颜色改变, 故不考虑食管穿孔。经两侧胸腔闭式引流及抗炎补液治疗     

异丙酚静脉麻醉在胃镜检查中应用的研究

目的分析探讨异丙酚应用于胃镜检查中的适应人群、最佳剂量、安全性和顺应性。方法术前了解受检查者身体基本状况、双腔鼻导管持续吸氧、静注利多卡因、异丙酚。术中监护心率、血压、氧饱和度变化。术后了解病人遗忘度和满意度。结果，异丙酚起效时问为15～20秒。持续时问为8～10min。用药前后对照，心率下降10％、血压下降10％～20％、氧饱和度基本不变。术后遗忘度100％。满意度100％。结论异丙酚静脉麻醉下胃镜检查可消除病人的恐惧感和痛苦感，显著改善病人的耐受性．也具有较好的安全性和顺应性．是值得推广应用的内镜检杏方法之一．     

异丙酚、芬太尼静脉麻醉在胃镜检查中的效果观察

胃镜检查是目前上消化道疾病诊断最常见和最直观的检查方法，但因检查有一定的痛苦，患者会有紧张、焦虑、恐惧、恶心、呕吐、呛咳等各种痛苦不适，部分患者难以接受及惧怕再次检查，影响了患者病情的诊断和治疗，我院采用异丙酚、芬太尼联合应用于部分内镜检查患者，并与对照组进行对比观察，以探讨镇静效果和安全性。     

胃镜检查中应用异丙酚的临床观察

胃镜检查时患者因有明显的咽部不适、屏气、呛咳、恶心、呕吐等,往往难以配合,给胃镜检查带来困难,甚至造成机械性创伤。为此,我们应用异丙酚进行镇静镇痛,效果良好,现报告如下。 一、资料和方法 1 临床资料:将胃镜检查患者（行镜下治疗者除外）共1357例,分成常规检查组（A组）和异丙酚镇静组（B组）。A组672例,男 401例,女 271例,年龄为（48.68±17.52）岁,体重（60.81±9.31）kg。B组685例,男418例,女267例,年龄为（46.97±18.40）岁,体重（61.62±7.82）kg。两组患者的男女比例、年龄结构和体重情况无差异（性别X2=0.25,年龄t=1.76,体重t=1.72,P均>0.05）。     

异丙酚镇静麻醉胃镜检查并发症的预防和治疗

目的探讨异丙酚镇静麻醉胃镜检查并发症的预防和治疗。方法对1358例患者应用单纯异丙酚静脉麻醉后进行胃镜检查，并观察和治疗出现的并发症。结果静注异丙酚后全组血压、心率、呼吸频率均有不同程度的下降，绝大多数的下降在正常范围内，不须处理。有2例(0．15％)发生低血压，经静注麻黄碱后血压回升；3例(0．22％)发生心动过缓，经静注阿托品后心率恢复正常；318例(23．42％)出现咳嗽，经增加首剂用药量和避免胃镜碰撞会厌软骨和喉头后咳嗽病例明显减少；16例(1．18％)发生严重呛咳伴血氧饱和度降低，经抽吸咽喉分泌物、抬高下颌和加大氧流量后，呛咳明显减轻，血氧饱和度恢复正常；吹干胃镜、插镜经过会厌部时禁止打气打水、检查前咽部禁止用药能有效地预防呛咳；46例(3．39％)诉注射部位疼痛，选择较粗的静脉注射和减慢注药速度可减轻疼痛；43例(3．17％)出现恶心，2例(0．15％)发生膈肌痉挛，轻柔的操作和增加首剂用药量可减轻这些副反应；39例(2．87％)检查后出现眩晕，卧床和延迟唤醒患者可防治此并发症。结论异丙酚镇静麻醉胃镜检查是一种安全有效的检查方法，科学的防治措施是成功检查和减少并发症的关键。     

咪唑安定与异丙酚镇静行胃镜检查的临床观察

我院自 2 0 0 2年 9月以来 ,对胃镜检查病人辅以咪唑安定、异丙酚镇静 ,取得很好效果。报道如下。1　资料与方法1.1　一般资料　将门诊、住院病人 92例随机分为观察组与对照组。观察组 4 6例 ,男 30例 ,女 16例 ,平均年龄 4 5 .5 3岁 ,其中高血压 2例 ,ST改变心肌缺血 2例。对照组 4 6例 ,男 32例 ,女 14例 ,平均年龄 4 3.4 6岁。两组一般资料无统计学差异 (P >0 .0 5 )。1.2　方法　观察组检查前用 2 %利多卡因液行咽喉部充分喷雾麻醉 2～ 3次 ,输氧 ,同时监测并记录血压、心率、脉搏血氧饱和度。 5 %葡萄糖作溶酶 ,将异丙酚 (西安力邦制…     

异丙酚和咪唑安定在胃镜检查中的应用研究

目的研究联合应用异丙酚和咪唑安定在胃镜检查中的镇静效果和安全性.方法胃镜检查患者1 915例给予异丙酚和咪唑安定镇静,640例予常规操作(不给任何镇静药),比较2组胃镜检查中患者反应和感受、操作时间,观察其清醒时间及检查前、中、后血压,心率和血氧饱和度变化.结果镇静组患者99.2%无不适,而对照组为35.0%(P<0.01).镇静组患者咳嗽、躁动、恶心呕吐和咽喉不适的发生率分别为1.1%、0.8%、0.5%与0%,明显低于对照组(分别为5.0%、5.3%、45.0%与37.5%,P<0.01),镇静组胃镜操作时间为(4.5±1.5)min,短于对照组(5.6±1.8)min,(P<0.01).镇静组患者清醒时间为(1.4±1.3)min,检查中有血压下降,但检查结束后迅速恢复至检查前水平.结论胃镜检查时适量应用异丙酚和咪唑安定静脉镇静,是一种安全、有效的方法.     

胸腔镜下肺癌手术时单肺通气的临床麻醉分析

目的 探讨胸腔镜下行肺癌手术时单肺通气的临床麻醉情况.方法 分析218例胸腔镜下行肺癌手术患者,均采用静脉快速诱导插入双腔支气管导管,运用纤维支气管镜进行定位后进行间歇性正压通气（IPPV）,而单肺通气则采用IPPV或加呼气末正压呼吸和萎缩肺持续正压通气,对呼吸参数进行调整.结果 MAP、HR和SaO2在麻醉前、双肺IPPV和单肺的IPPV30 min、IPPV60 min、IPPV 90 min、IPPV 120 min和双肺IPPV15 min比较无明显差异性（P〉0.05）,而PaCO2和PETCO2则有明显的差异性（P〈0.05）;其中双肺IPPV和单肺IPPV在FiO2和TV方面比较也有差异性（P〈0.05）.结论 单肺通气可使胸腔镜下治疗肺癌手术时患侧肺萎缩满意,可顺利度过手术期.     

Outcome of manipulation under anesthesia with or without intra-articular steroid injection for treating frozen shoulder: A retrospective cohort study

Manipulation under anesthesia (MUA) combined with intra-articular steroid injection (ISI) is preferred in management of the refractory frozen shoulder (FS). This study aimed to evaluate the effect of MUA with ISI or not on pain severity and function of the shoulder.Data on 141 patients receiving MUA with primary FS refractory to conservative treatments for at least 1 month were retrospectively obtained from medical records. We performed propensity score matching analysis between patients receiving MUA only and those receiving MUA plus ISI, and then conducted logistic regression analysis to identify the risk factors for the need to other treatments during 6-month follow-up.More improvement in terms of the SPADI pain scores and passive ROM at 2 weeks after first intervention remained in patients receiving MUA plus ISI after matching. The need to other treatments during 6-month follow-up occurred in 10.6% patients (n = 141). Logistic regression analysis revealed that a repeat MUA 1 week after first intervention was a protective factor (OR 0.042; 95% CI 0.011–0.162; P = .000) and duration of disease was the only one risk factor (OR 1.080; 95% CI 1.020–1.144; P = .008) for the need to other treatments during follow-up.ISI immediately following MUA provided additional benefits in rapid relief of pain and disability for patients with refractory FS. Pain and disability of the shoulder may be rapidly alleviated by an earlier MUA from the onset of the symptoms and a repeat MUA 1 week after first intervention.     

Comparison of 2 effect-site concentrations of remifentanil with midazolam during percutaneous transluminal balloon angioplasty under monitored anesthesia care: A randomized controlled study

Background:Until now, target-controlled infusion of remifentanil with midazolam in percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas has not been described. Here, we investigate 2 effect-site concentrations of remifentanil with intermittent bolus midazolam for percutaneous transluminal balloon angioplasty under monitored anesthesia care.Methods:A prospective, randomized controlled trial including patients who received a percutaneous transluminal balloon angioplasty between March 2019 and March 2021 was conducted. Group 1 and Group 2 were, respectively, administered an initial effect-site concentration of remifentanil of 1.0 and 2.0 ng/mL by a target-controlled infusion pump with Minto model. In both groups, maintenance of the effect-site concentration of remifentanil was adjusted upward and downward by 0.5 ng/mL with intermittent bolus midazolam to keep the Observer''s Assessment of Alertness/Sedation scale between 2 and 4, mean arterial pressure and heart rate at baseline levels ± 30%, and patient comfort (remaining moveless). The primary outcome was to determine the appropriate effect-site concentration of remifentanil for the procedure in terms of patient comfort (remaining moveless), hemodynamic conditions, and adverse events. Secondary endpoints included the total dosage of anesthetics and total times of target-controlled infusion pump adjustments.Results:A total of 40 patients in Group 1 and 40 patients in Group 2 were eligible for analysis. Most parameters were insignificantly different between 2 groups, except Group 1 having higher peripheral oxygen saturation, while local anesthetic injection compared with Group 2. In addition, Group 1 patients had less apnea with desaturation (peripheral oxygen saturation < 90%; 0 vs 6, P = .034), less remifentanil consumption (189.65 ± 69.7 vs 243.8 ± 76.1 μg, P = .001), but more intraoperative movements affecting the procedure (14 vs 4; P = .016), total times of target-controlled infusion pump adjustment [2 (1-4) vs 1 (1–2), P < .001] compared with Group 2.Conclusion:In percutaneous transluminal balloon angioplasty for dysfunctional hemodialysis fistulas, target-controlled infusion with remifentanil Minto model target 2.0 ng/mL with 3 to 4 mg midazolam use provided appropriate hemodynamic conditions, sufficient sedation and analgesia, and acceptable apnea with desaturation.     

Arterial oxygen saturation during Nd:YAG laser photoresection of endobronchial tumors under local anesthesia. Use of intermittent supplemental oxygen with pulse oximetry guidance

Although Nd:YAG laser photoresection of endobronchial lung tumor can result in significant arterial oxygen desaturation, oxygen supplementation during procedures is often limited due to fear of intrabronchial combustion. We gave intermittent pulse supplemental oxygen to ten patients during 26 laser procedures performed under local anesthesia using SaO2 measured by a pulse oximeter as a guide. In four procedures (15.4 percent), severe oxygen desaturation contraindicated performing or completing laser phototherapy. In the remaining 22 procedures (84.6 percent), laser photoresection was safely and successfully performed without incident. Thus, pulse oximetry is a valuable tool and intermittent oxygen supplementation with pulse oximeter guidance an effective technique for maintaining adequate oxygenation during laser photoresection.     

Different control of the adrenocorticotropin-corticosterone response and of prolactin secretion during cold stress, anesthesia, surgery, and nicotine injection in the rat: involvement of capsaicin-sensitive sensory neurons

The release of ACTH, corticosterone, and PRL was compared in capsaicin-pretreated rats, which lack afferent C-fibers, and their controls under somatosensory (cold, surgery) and central (restraint) forms of stress. Cold stress induced the release of ACTH and consequently that of corticosterone in the controls, but not in the capsaicin-pretreated rats. Intravenous injection of ACTH1-24 was equally effective in releasing corticosterone in both groups. Whereas PRL was not released in response to cold stress, restraint stress did induce the release of both ACTH and PRL, in the capsaicin-pretreated as well as in the control group. Pentobarbital anesthesia alone elicited PRL, but no ACTH release. ACTH release was evoked by surgery under pentobarbital anesthesia but was abolished by capsaicin pretreatment. PRL levels were not further increased by surgery. Nicotine in a small dose (5 micrograms intra-arterially) evoked stimulation of afferent C-fibers as observed on a depressor reflex. Intraperitoneal injection of nicotine (250 micrograms/kg) caused a marked rise in plasma ACTH both in the capsaicin-pretreated conscious rats and in their controls, probably resulting from central stimulation as this effect was shown to be inhibited during pentobarbital anesthesia. A moderate rise of PRL by nicotine was seen in conscious rats. The stimuli used, regarded as experimental models of stress, show essential differences in their ability to evoke the release of ACTH, corticosterone, and PRL. Those stimuli which cause the release of ACTH and corticosterone via afferent C-fiber stimulation do not release PRL, whereas emotional and cognitive stress causes the release of both ACTH and PRL.     

The effects of perioperative oral management on perioperative serum albumin levels in patients treated surgically under general anesthesia: A multicenter retrospective analysis in Japan

The purpose of the present study was to investigate the efficacy of perioperative oral managements (POMs) on perioperative nutritional conditions in patients undergoing surgery with general anesthesia. Medical records were retrospectively reviewed and the effects of POMs were investigated based on a large number of cases using a multicenter analysis. The profile of serum albumin levels was assessed and compared between patients with and without POMs using the multivariate analysis. Seventeen Eleven thousand and one hundred sixty patients (4,873 males and 6,287 females) were reviewed. Of these, 2710 patients (24.3%) had undergone POMs. The results of a multivariate analysis revealed the significant positive effect of POMs on perioperative serum albumin level (change between at admission and discharge, (Estimate: 0.022, standard error: 0.012, P < .0001). Patient gender, age, surgical site, performance status, the American Society of Anesthesiologists (ASA) physical status classification, operation time, amount of blood loss, and serum albumin level at admission were also significant predictors. Adjusted multivariate analysis of the effects of POMs on perioperative change of serum albumin level in all subjects reveled the significance of POMs intervention (estimate: 0.022, standard error: 0.012, P < .0001). These results suggest that POMs exerts significant positive effects on perioperative serum albumin levels in patients underwent surgery under general anesthesia.     

Blood samples collected under venous oxygen pressure from patients with sickle cell disease contain a significant number of a new type of reversibly sickled cells: constancy of the percentage of sickled cells in individual patients during steady state

We found various levels of a new type of reversibly sickled cell (RSC) with blunt edges in 44 blood samples obtained from 32 steady-state patients with sickle cell disease (SCD) without exposure to air (UnExp-blood). Because these RSCs could be generated in vitro by partial oxygenation of once-deoxygenated SS cells to venous oxygen pressure, we named them "partially oxygenated sickled cells" (POSCs). These RSCs were classified into elongated and non-elongated RSCs, depending on the ratio of the short axis to long axis. The presence of these cells was previously unknown because the standard blood collection method oxygenates most of the POSCs to discocytes due to oxygen in the air space in the needle, syringe, and blood collection tube (Exp-blood). Although the shape of elongated POSCs is similar to that of irreversibly sickled cells (ISCs), POSCs revert to discocytes upon exposure to air. We found the following: (1) the percentage of total sickled cells (total POSCs + ISCs) in UnExp-blood (29.0 +/- 14.5%) was significantly higher than the percentage of sickled cells (mainly ISCs) in Exp-blood (7.3 +/- 5.7%); (2) the percentage of sickled cells in UnExp-blood was specific to individual patients during steady state, while it decreased at the onset of a vaso-occlusive event; and (3) the percentage of sickled cells in UnExp-blood varied widely among steady-state patients (4-56%). This new type of RSC may be used as an internal biomarker to evaluate the disease state of individual patients.