利多卡因和异丙酚预先给药对哮喘大鼠肺组织NO和内皮素水平的影响

目的通过观察预先给予利多卡因和异丙酚对哮喘大鼠内皮素（ET）和一氧化氮（NO）的影响,探讨其对哮喘作用的机制。方法Wistar大鼠32只,随机分为4组（n=8）：对照组（Ⅰ组）、哮喘组（Ⅱ组）、异丙酚组（Ⅲ组）和利多卡因组（Ⅳ组）。Ⅱ组、Ⅲ组、Ⅳ组大鼠用卵清蛋白辅以氢氧化铝注射致敏及雾化吸入诱发哮喘。Ⅲ组、Ⅳ组在诱发前30 min分别从股静脉输注异丙酚50 mg·kg^-1·h^-1或利多卡因12 mg·kg^-1·h^-1。哮喘发作后10 min,采集动脉血行动脉循环内皮细胞（CEC）计数,处死大鼠后,测定支气管肺泡灌洗液（BALF）中ET、NO浓度,计算NO/ET比值;取肺组织,计算肺湿干重比（W/D）、观察肺组织病理学结果。结果与Ⅰ组相比,Ⅱ组、Ⅲ组、Ⅳ组CEC计数及W/D增加,Ⅱ组BALF中ET、NO浓度增高,NO/ET比值下降（P＜0．05）;与Ⅱ组相比,Ⅲ组、Ⅳ组CEC计数及W/D降低, BALF中ET、NO浓度下降,NO/ET比值升高（P＜0．05）。Ⅱ组肺组织呈支气管壁增厚、炎性细胞浸润表现,Ⅲ组、Ⅳ组病理损伤程度减轻。结论利多卡因和异丙酚预先给药可通过降低肺组织ET、NO的水平、调节NO/ET的平衡,减轻了大鼠哮喘的发作程度。     

人工流产术中不同镇痛药物复合靶控输注异丙酚麻醉的效果多中心研究

目的比较人工流产术患者瑞芬太尼、芬太尼及舒芬太尼复合靶控输注异丙酚麻醉的安全性和有效性。方法采用前瞻性、多中心、开放、随机分组、对照研究的方法。4个研究中心共选择390例行人工流产手术患者,随机分为3组：芬太尼单次静脉注射组（F组,n=134）、瑞芬太尼血浆靶控输注组（R组,n=120）和舒芬太尼单次静脉注射组（S组,n=136）,分别复合异丙酚血浆靶控输注行全身麻醉,记录起效时间、恢复时间、准确定向时间、术中体动（程度和次数）、镇痛效果、呼吸抑制评分和HR、MAP、SpO2及术后并发症的发生情况等。结果3组间麻醉起效时间和准确定向力时间差异无统计学意义（P＞0．05）,R组麻醉恢复时间长于F组和S组（P＜0．01）,R组异丙酚总用量、术中最低SpO2、术中体动次数及术后恶心呕吐、嗜睡的例数均低于F组和S组（P＜0．05或0．01）,R组呼吸抑制评分高于F组和S组（P＜0．01）。结论与芬太尼和舒芬太尼相比,瑞芬太尼复合异丙酚靶控输注麻醉用于人工流产手术镇痛效果更好,但其呼吸抑制作用较明显。     

Middle-ear pressure variations during total intravenous anesthesia with propofol, fentanyl, and ketamine

Purpose As the middle-ear cavity is one of the noncompliant gas-filled cavities, an increase in middle-ear pressure (MEP) instead of volume expansion is observed with inhalation of nitrous oxide (N₂O). Changes in MEP cause many complications, such as ear pain, temporary hearing impairment, and postoperative emesis. Therefore, we investigated changes in MEP during total intravenous anesthesia (TIVA) with propofol, fentanyl, and ketamine (PFK) and inhalation of N₂O. Methods Twelve patients were anesthetized with PFK until 60 min after the induction of anesthesia, and then N₂O (60%) inhalation was started. MEP was measured by impedance audiometry (ranging from −300 daPa to +200 daPa) at 10-min intervals during PFK, and at 2-min intervals after the inhalation of N₂O. Results MEP gradually but significantly increased from the preanesthetic value of 16±8 to 34±12 (SEM) daPa 50 min after the induction of PFK. However, MEP did not exceed the normal limit. The values of MEP in all patients were more than 200 daPa within 36 min after the start of inhalation of N₂O in oxygen. Conclusion PFK had a minimal effect on MEP, whereas addition of N₂O to PFK increased MEP dramatically. Therefore, TIVA, or at least PFK, would be a better choice for patients with middle-ear or upper-airway diseases.     

异丙酚麻醉不同阶段对卵细胞受精和对早期胚胎质量的影响

目的探讨异丙酚静脉麻醉下取卵手术中卵泡抽吸液中异丙酚的浓度变化及各阶段对卵细胞受精和早期胚胎质量的影响.方法 17例实施超促排卵下体外受精-胚胎移植术的妇女预测卵泡至少有15个,按取卵的先后分3组(早、中、晚)分别培养.记录从静脉给异丙酚到每个卵泡取出时间.检测卵泡抽取液中异丙酚的浓度及观察卵细胞的受精率及卵裂率等.结果取出第G一个卵泡的平均时间是200秒,取出卵泡的平均速率是17.6s/ 个.所有患者的最后一个卵泡抽吸液中异丙酚的浓度明显高于第一个卵泡抽吸液中异丙酚的浓度(P<0.01).除未成熟的卵细胞占总卵泡百分比在3组间有明显的区别外,受精率和卵裂率无明显区别.结论随着麻醉的进展,卵泡抽吸液中异丙酚的浓度逐渐增加,但与所给剂量或持续的时间之间无必然的关联.我们不能显示卵泡抽吸液中升高的异丙酚浓度对卵细胞质量的不利影响.     

Power spectral analysis of the electroencephalographic and hemodynamic correlates of propofol anesthesia in the rat: Intravenous infusion

Based on the tail-flick response to noxious thermal stimuli, we determined in the present study that effective antinociception could be achieved in adult male Sprague-Dawley rats 15 min after intravenous infusion of propofol at 60 mg/kg/h. Simultaneous power spectral analysis of the electroencephalographic (EEG) and systemic arterial pressure signals further revealed a concomitant depression of the activity of all EEG frequency bands (δ, θ, , β), alongside hypotension, negative inotropic and chronotropic actions, and attenuated baroreceptor reflex and vasomotor activity. These effects were congruent with a plasma concentration of propofol in the arterial blood of 1.70 ± 0.13 μg/ml, as determined by high-performance liquid chromatography.     

Dexmedetomidine versus propofol for prolonged sedation in critically ill trauma and surgical patients

Backgroundand Purpose: Currently, dexmedetomidine versus propofol has primarily been studied in medical and cardiac surgery patients with outcomes indicating safe and effective sedation. The purpose of this study was to assess the efficacy of dexmedetomidine versus propofol for prolonged sedation in trauma and surgical patients.MethodsThis was a single-center prospective study conducted in the Trauma/Surgical Intensive Care Unit (ICU) at a Level I academic trauma center. It included patients 18 years of age or older requiring mechanical ventilation who were randomly assigned based on unit bed location to receive either dexmedetomidine or propofol. The primary outcome was duration of mechanical ventilation. Secondary outcomes included mortality; proportion of time in target sedation; incidence of delirium, hypotension, and bradycardia; and ICU and hospital length of stay (LOS).ResultsA total of 57 patients were included. Baseline characteristics were similar between groups. There was no significant difference in duration of mechanical ventilation (median [IQR]) between the dexmedetomidine (78.5[125] hours) and propofol (105[130] hours; p = 0.15) groups. There was no difference between groups in ICU mortality, ICU and hospital LOS, or incidence of delirium. Safety outcomes were also similar. Patients in the dexmedetomidine group spent a significantly greater percentage of time in target sedation (98[8] %) compared to propofol group (92[10] %; p = 0.02).ConclusionsOur results suggest that, similar to medical and cardiac surgery patients, dexmedetomidine and propofol are safe and effective sedation agents in critically ill trauma and surgical patients; however, dexmedetomidine achieves target sedation better than propofol for this specific population.     

Plasma histamine levels during induction of anesthesia with propofol in dogs

We examined a property of emulsion formation of propofol (ICI 35868) to release histamine into circulating plasma in dogs. Plasma histamine was measured with radioimmunoassay before (baseline), and 1, 5 and 10min after the administration of 15mg·kg^–1 propofol. There were no significant differences between the plasma histamine levels at 1, 5 and 10min after the administration of propofol and the baseline level. We conclude that the emulsion formation of propofol of 15mg·kg^–1 does not release histamine during induction of anesthesia in dogs.(Mitsuhata H, Shimizu R: Plasma histamine levels during induction of anesthesia with propofol in dogs. J Anesth 7: 206–209, 1993)     

异丙酚复合芬太尼维持麻醉对脑代谢的影响

观察异丙酚复合芬太尼维持麻醉对脑代谢的影响。方法： 择期手术病人８ 例, 芬太尼、硫贲妥钠、维库溴铵诱导插管, 静脉联接Ｇｒａｓｅｂｙ 微泵异丙酚８ ｍｇ／ （ｋｇ·ｈ） , 芬太尼１ μｇ／ （ｋｇ·ｈ）维持麻醉。连续监测ＭＡＰ、心电图、脉搏氧饱和度和呼气末二氧化碳分压, 同步采集动脉血和颈内静脉血作血气分析, 计算动－ 静脉氧含量差（Ｄａ － ｖＯ２） 和脑氧摄取率（ＥＲＯ２） 。结果： 异丙酚麻醉维持平稳, Ｄａ － ｖＯ２ 和ＥＲＯ２ 在给药３０ ｍｉｎ 、６０ ｍｉｎ 较气管插管后５ ｍｉｎ 无明显改变, 有平均动脉压下降和心动过缓。结论： 异丙酚复合芬太尼维持麻醉可保持脑氧供需平衡稳定。     

In vitro effects of propofol on blood coagulability and fibrinolysis by the use of thromboelastograph technique

BACKGROUND: To investigate the in vitro effects of propofol on blood coagulability and fibrinolysis by the use of thromboelastograph (TEG) technique. METHODS: The blood samples, obtained from 14 healthy volunteers, were divided into two groups: propofol (n = 7) and intralipid (n = 7), and 360 microliters volumes of whole blood were incubated with 2 microliters of 1% propofol and with its solvent intralipid, respectively. The incubated sample was then used for TEG measurements. RESULTS: The maximum amplitude (MA), which reflects coagulability, in the intralipid group significantly increased by about 7% and 16% compared to the control and propofol groups, respectively (P < 0.05), whereas the MA in the propofol group did not change. The fibrinolytic rate (FR) in the propofol group significantly increased by about 170% and 210% compared to the control and intralipid groups, respectively (P < 0.05), whereas the FR in the intralipid group did not change. CONCLUSIONS: Propofol, per se, has at the concentration of 55.6 micrograms.ml-1 an in vitro accelerative effect on blood fibrinolysis detected by TEG.