右美托咪啶复合丙泊酚靶控输注对喉罩置入条件的影响

目的：比较右美托咪啶（Dex）复合丙泊酚不同血浆靶浓度靶控输注（TCI）诱导时喉罩置入条件,探讨喉罩置入时右美托咪啶复合丙泊酚靶控输注的合适靶浓度。方法：择期行短小手术患者75例,年龄20～60岁,ASAI-II级,随机分为三组（n=25）,I、II、III组丙泊酚靶浓度分别为2.0、2.5、3.0μg/mL。右美托咪啶0.6μg/kg负荷量10min泵完,当丙泊酚效应室浓度（Ce）达预设靶浓度3min后置入喉罩,观察喉罩置入条件：下颌活动度、呛咳、体动及喉痉挛。记录患者术前（T0）、喉罩置入前（T1）、置入后1min（T2）、3min（T3）时收缩压（SBP）、平均动脉压（MAP）、心率（HR）及脑电双频谱指数（BIS）。计算T0和T1时SBP、MAP、HR的变化幅度。记录各组呼吸抑制例数、时间。记录各组麻黄素和阿托品使用情况。结果：各组T1～T3SBP、MAP、HR均低于T0（P〈0.05）,与I、II组相比,III组下降幅度更明显（P〈0.05）。与T1比较,三组T2时的SBP、MAP和HR没有出现明显的变化（P〉0.05）。三组BIS差异无统计学意义（P〉0.05）。喉罩置入条件I组有3例张口度差,5例发生呛咳或体动,与II、III组比较差异有统计学意义（P〈0.05）,II、III组间差异无统计学意义（P〉0.05）。与I、II组相比,III组呼吸抑制例数增加和抑制时间延长（P〈0.05）,而且III组有更多患者需要使用麻黄素、阿托品（P〈0.05）。结论：右美托咪啶0.6μg/kg复合丙泊酚靶浓度2.5μg/mL能够提供足够的麻醉深度和良好的喉罩置入条件,不会产生明显的呼吸和循环抑制作用。

Laryngeal mask insertion conditions at different target plasma concentrations of propofol combined with dexmedetomidine

AIM： To compare the laryngeal mask insertion conditions at different plasma target concentrations （Cp） during the induction of anesthesia with target-controlled infusion （TCI） of propofol combined with dexmedetomi- dine. METHODS： Seventy-five ASA I-II pa- tients of both sexes aged 20-60 years, weighing 50-80 kg, in which the use of laryngeal mask was indicated were randomly divided into 3 groups （n：25） according to Cp of propofol set during induction of anesthesia： 2.0, 2.5 and 3.0 μg/mL. Dexmedetomidine 0.6 μg/kg was in- fused over 10 minitues. Then,TCI propofol was given by Diprifusor （Graseby 3500 infusion pump）. Laryngeal mask was inserted when the effect-site concentration （ Ce ） of propofol reached the settled Cp. Laryngeal mask insertion conditions （jaw mobility, coughing, head and limb movement, laryngeal spasm） were as- sessed. SBP, MAP, HR and BIS value were re- corded at four time points=baseline before induc- tion （T0）, instant before laryngeal mask insert- ed （T,）, 1 min （T2） and 3 min （Ta） after inser- tion of laryngeal mask. Changes of SBP, MAP and HR between T1 and To were calculated. The number of patients with apnea and apnea times were recorded. The administration of atropine and ephedrine was also recorded. RESULTS：The levels of SBP, MAP and HR were decreased with increasing depth of anesthesia in the 3 groups. The decline rates of SBP, MAP and HR after induction had significantly differences in group III than those in group I and II （P 〈 0.05）. BIS value was similar in all groups. The insertion conditions were significantly better in group II and III than that in group I. More pa- tients developed apnoea and their apnoea times were longer in group III than the other two groups （P~0.05）. More patients were adminis- trated with atropine and ephedrine in group III compared with the other two groups （P〈0. 05）. CONCLUSION： Induction of anesthesia with dexmedetomidine 0.6 μg/kg combined with TCI of propofol with Cp set at 2.5μg/mL is satisfac- tory for laryngeal mask insertion in terms of car- diovascular stability and insertion conditions.