Effect of remimazolam vs. propofol on hemodynamics during general anesthesia induction in elderly patients: Single-center, randomized controlled trial

The current study aimed to compare the effects between remimazolam and propofol on hemodynamic stability during the induction of general anesthesia in elderly patients.We used propofol at a rate of 60 mg/(kg·h)in the propofol group(group P)or remimazolam at a rate of 6 mg/(kg·h)in the remimazolam group(group R)for the induction.A processed electroencephalogram was used to determine whether the induction was successful and when to stop the infusion of the study drug.We measured when patients entered the operating room(T_(0)),when the induction was successful(T_(1)),and when before(T_(2))and 5 min after successful endotracheal intubation(T_(3)).We found that mean arterial pressure(MAP)was lower at T_(1–3),compared with T_(0) in both groups,but higher at T_(2) in the group R,whileΔMAP_(T0–T2) andΔMAP_(max) were smaller in the group R(ΔMAP_(T0–T2):the difference between MAP at time point T_(0) and T_(2),ΔMAP_(max):the difference between MAP at time point T_(0) and the lowest value from T_(0) to T_(3)).Cardiac index and stroke volume index did not differ between groups,whereas systemic vascular resistance index was higher at T_(1–3) in the group R.These findings show that remimazolam,compared with propofol,better maintains hemodynamic stability during the induction,which may be attributed to its ability to better maintain systemic vascular resistance levels.

Safety and efficacy comparison of remimazolam and propofol for intravenous anesthesia during gastroenteroscopic surgery of older patients:A meta-analysis

BACKGROUND Remimazolam is characterized by rapid action and inactive metabolites.It is used as the general anesthetic for many clinical surgeries.In this study,we performed a meta-analysis to evaluate whether remimazolam is superior to propofol for gastroenteroscopy in older patients.AIM To compare the adverse events and efficacy of remimazolam and propofol during gastroenteroscopy in older adults.METHODS The PubMed,Web of Science,the Cochrane Library databases were queried for the relevant key words"remimazolam,""and propofol,""and gastrointestinal endoscopy or gastroscopy."The search scope was"Title and Abstract,"and the search was limited to human studies and publications in English.Seven studies wherein remimazolam and propofol were compared were included for the metaanalysis.RESULTS We selected seven randomized controlled trials involving 1445 cases for the analysis.Remimazolam reduced the hypotension(relative risk,RR=0.44,95%CI:0.29-0.66,P=0.000),respiratory depression(RR=0.46,95%CI:0.30-0.70,P=0.000),injection pain(RR=0.12,95%CI:0.05-0.25,P=0.000),bradycardia(RR=0.37,95%CI:0.24-0.58,P=0.000),and time to discharge[weighted mean difference(WMD)=-0.58,95%CI:-0.97 to-0.18,P=0.005],compared to those after propofol administration.No obvious differences were observed for postoperative nausea and vomiting(RR=1.09,95%CI:0.97-1.24,P=0.151),dizziness(RR=0.77,95%CI:0.43-1.36,P=0.361),successful sedation rate(RR=0.96,95%CI:0.93-1.00,P=0.083),or the time to become fully alert(WMD=0.00,95%CI:-1.08-1.08,P=0.998).CONCLUSION Remimazolam appears to be safer than propofol for gastroenteroscopy in older adults.However,further studies are required to confirm these findings.

Impact of propofol and sevoflurane anesthesia on cognition and emotion in gastric cancer patients undergoing radical resection

BACKGROUND Propofol and sevoflurane are commonly used anesthetic agents for maintenance anesthesia during radical resection of gastric cancer.However,there is a debate concerning their differential effects on cognitive function,anxiety,and depression in patients undergoing this procedure.AIM To compare the effects of propofol and sevoflurane anesthesia on postoperative cognitive function,anxiety,depression,and organ function in patients undergoing radical resection of gastric cancer.METHODS A total of 80 patients were involved in this research.The subjects were divided into two groups:Propofol group and sevoflurane group.The evaluation scale for cognitive function was the Loewenstein occupational therapy cognitive assessment(LOTCA),and anxiety and depression were assessed with the aid of the self-rating anxiety scale(SAS)and self-rating depression scale(SDS).Hemodynamic indicators,oxidative stress levels,and pulmonary function were also measured.RESULTS The LOTCA score at 1 d after surgery was significantly lower in the propofol group than in the sevoflurane group.Additionally,the SAS and SDS scores of the sevoflurane group were significantly lower than those of the propofol group.The sevoflurane group showed greater stability in heart rate as well as the mean arterial pressure compared to the propofol group.Moreover,the sevoflurane group displayed better pulmonary function and less lung injury than the propofol group.CONCLUSION Both propofol and sevoflurane could be utilized as maintenance anesthesia during radical resection of gastric cancer.Propofol anesthesia has a minimal effect on patients'pulmonary function,consequently enhancing their postoperative recovery.Sevoflurane anesthesia causes less impairment on patients'cognitive function and mitigates negative emotions,leading to an improved postoperative mental state.Therefore,the selection of anesthetic agents should be based on the individual patient's specific circumstances.

Brain protective effect of dexmedetomidine vs propofol for sedation during prolonged mechanical ventilation in non-brain injured patients

BACKGROUND Dexmedetomidine and propofol are two sedatives used for long-term sedation.It remains unclear whether dexmedetomidine provides superior cerebral protection for patients undergoing long-term mechanical ventilation.AIM To compare the neuroprotective effects of dexmedetomidine and propofol for sedation during prolonged mechanical ventilation in patients without brain injury.METHODS Patients who underwent mechanical ventilation for>72 h were randomly assigned to receive sedation with dexmedetomidine or propofol.The Richmond Agitation and Sedation Scale(RASS)was used to evaluate sedation effects,with a target range of-3 to 0.The primary outcomes were serum levels of S100-βand neuron-specific enolase(NSE)every 24 h.The secondary outcomes were remifentanil dosage,the proportion of patients requiring rescue sedation,and the time and frequency of RASS scores within the target range.RESULTS A total of 52 and 63 patients were allocated to the dexmedetomidine group and propofol group,respectively.Baseline data were comparable between groups.No significant differences were identified between groups within the median duration of study drug infusion[52.0(IQR:36.0-73.5)h vs 53.0(IQR:37.0-72.0)h,P=0.958],the median dose of remifentanil[4.5(IQR:4.0-5.0)μg/kg/h vs 4.6(IQR:4.0-5.0)μg/kg/h,P=0.395],the median percentage of time in the target RASS range without rescue sedation[85.6%(IQR:65.8%-96.6%)vs 86.7%(IQR:72.3%-95.3),P=0.592],and the median frequency within the target RASS range without rescue sedation[72.2%(60.8%-91.7%)vs 73.3%(60.0%-100.0%),P=0.880].The proportion of patients in the dexmedetomidine group who required rescue sedation was higher than in the propofol group with statistical significance(69.2%vs 50.8%,P=0.045).Serum S100-βand NSE levels in the propofol group were higher than in the dexmedetomidine group with statistical significance during the first six and five days of mechanical ventilation,respectively(all P<0.05).CONCLUSION Dexmedetomidine demonstrated stronger protective effects on the brain compared to propofol for long-term mechanical ventilation in patients without brain injury.

Propofol sedation in routine endoscopy:A case series comparing target controlled infusion vs manually controlled bolus concept

BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.

A Study to Observe Pulse Pressure Variation after Induction with Propofol for General Anesthesia

Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring helps the physician in deciding whether to volume resuscitate or use interventions in patients undergoing surgery. Propofol is an intravenous induction agent which lowers blood pressure. There are multiple causes such as depression in cardiac output, and peripheral vasodilatation for hypotension. We undertook this study to observe the utility of PPV as a guide to fluid therapy after propofol induction. Primary outcome of our study was to monitor PPV as a marker of fluid responsiveness for the hypotension caused by propofol induction. Secondary outcome included the correlation of PPV with other hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP);after induction with propofol at regular interval of time. Methods: A total number of 90 patients were recruited. Either of the radial artery was then cannulated under local anaesthesia with 20G VygonLeadercath arterial cannula and invasive monitoring transduced. A baseline recording of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and PPV was then recorded. Patients were then induced with predetermined doses of propofol (2 mg/kg) and recordings of HR, SBP, DBP, and PPV were taken at 5, 10 and 15 minutes. Results: Intraoperatively, PPV was significantly higher at 5 minutes and significantly lower at 15 minutes after induction. It was observed that there were no statistically significant correlations between PPV and SBP or DBP. PPV was strongly and directly associated with HR. Conclusion: We were able to establish that PPV predicts fluid responsiveness in hypotension caused by propofol induction;and can be used to administer fluid therapy in managing such hypotension. However, PPV was not directly correlated with hypotension subsequent to propofol administration.

Propofol with Varied Functions: A Potential Therapeutic Opportunity for Postoperative Nausea, Vomiting and Pruritus—A Narrative Review

Background: Despite the advances in anesthetics and non-pharmacological techniques, the prevalence of postoperative nausea and vomiting in all patients remains high. It is one of the most common distressing symptoms that cause dissatisfaction among patients after anesthesia and surgery. A sub-hypnotic dose of propofol has been shown to reduce morphine-induced postoperative nausea, vomiting, and pruritus. This review article will provide sufficient knowledge on the role of propofol in minimizing opioid-induced postoperative nausea, vomiting, and pruritus by providing detailed information on propofol antiemetic and antipruritic effects, as well as discussions based on empirically available data. Method: We conducted a narrative review of the literature published between 1990 and 2023 from a range of databases;PubMed, BioMed Central, Biosis Previews, Nature, International Pharmaceutical Abstracts, Springer-Link, and Elsevier. Discussion and Conclusion: The literatures reviewed in this study have demonstrated that propofol may have diverse therapeutic effects including antiemetic and antipruritic. The antiemetic effect of propofol may be an effective therapeutic approach for the prevention of postoperative nausea and vomiting. The literature also demonstrated that the use of propofol for sedation during surgery may as well ameliorates opioids induced postoperative pruritus, which may be beneficial to surgical patients. Also, it was demonstrated that prophylactic use of propofol may be an effective way of preventing nausea and vomiting and pruritus during opioid use.

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.

Efficacy and safety of propofol target-controlled infusion combined with butorphanol for sedated colonoscopy

BACKGROUND Propofol is a short-acting,rapid-recovering anesthetic widely used in sedated colonoscopy for the early detection,diagnosis and treatment of colon diseases.However,the use of propofol alone may require high doses to achieve the induction of anesthesia in sedated colonoscopy,which has been associated with anesthesia-related adverse events(AEs),including hypoxemia,sinus bradycardia,and hypotension.Therefore,propofol co-administrated with other anesthetics has been proposed to reduce the required dose of propofol,enhance the efficacy,and improve the satisfaction of patients receiving colonoscopy under sedation.AIM To evaluate the efficacy and safety of propofol target-controlled infusion(TCI)in combination with butorphanol for sedation during colonoscopy.METHODS In this controlled clinical trial,a total of 106 patients,who were scheduled for sedated colonoscopy,were prospectively recruited and assigned into three groups to receive different doses of butorphanol before propofol TCI:Low-dose butorphanol group(5μg/kg,group B1),high-dose butorphanol group(10μg/kg,group B2),and control group(normal saline,group C).Anesthesia was achieved by propofol TCI.The primary outcome was the median effective concentration(EC50)of propofol TCI,which was measured using the up-and-down sequential method.The secondary outcomes included AEs in perianesthesia and recovery characteristics.RESULTS The EC50 of propofol for TCI was 3.03μg/mL[95%confidence interval(CI):2.83-3.23μg/mL]in group B2,3.41μg/mL(95%CI:3.20-3.62μg/mL)in group B1,and 4.05μg/mL(95%CI:3.78-4.34μg/mL)in group C.The amount of propofol necessary for anesthesia was 132 mg[interquartile range(IQR),125-144.75 mg]in group B2 and 142 mg(IQR,135-154 mg)in group B1.Furthermore,the awakening concentration was 1.1μg/mL(IQR,0.9-1.2μg/mL)in group B2 and 1.2μg/mL(IQR,1.025-1.5μg/mL)in group B1.Notably,the propofol TCI plus butorphanol groups(groups B1 and B2)had a lower incidence of anesthesia AEs,when compared to group C.Furthermore,no significant differences were observed in the rates of AEs in perianesthesia,including hypoxemia,sinus bradycardia,hypotension,nausea and vomiting,and vertigo,among group C,group B1 and group B2.CONCLUSION The combined use with butorphanol reduces the EC50 of propofol TCI for anesthesia.The decrease in propofol might contribute to the reduced anesthesia-related AEs in patients undergoing sedated colonoscopy.

Efficacy and safety of remimazolam-based sedation for intensive care unit patients undergoing upper gastrointestinal endoscopy:a cohort study

BACKGROUND:Remimazolam is a novel ultra-short-acting sedative,but its safety and adverse events(AEs)in high-risk patients in the intensive care unit(ICU)setting remain unknown.METHODS:This was a single-center,retrospective study that compared remimazolam to propofol and midazolam in patients undergoing upper gastrointestinal endoscopy.The primary outcome was the incidence of treatment-related AEs.The secondary outcomes were the time to extubation,the length of ICU stay,and the average cost of sedative per case.RESULTS:Of the 88 patients analyzed,47 were treated with remimazolam(mean dose,7.90±4.84mg),and 41 were treated with propofol(21.19±17.98 mg)or midazolam(3.08±2.17 mg).There was no statistically significant difference in the average duration of the endoscopic procedure(35.89±13.37 min vs.44.51±21.68 min,P=0.133)or the time to extubation(15.00±9.75 h vs.20.59±18.71 h,P=0.211)in the remimazolam group(group I)compared to the propofol or midazolam group(group II).ICU stays(5.40±2.93 d vs.4.63±3.31 d,P=0.072)and treatment-related AEs(48.61%vs.51.38%,P=0.056)were similar between groups.The average cost of sedative per case was significantly lower in the group I than in the group II(RMB 16.07±10.58 yuan vs.RMB 24.37±15.46 yuan,P=0.016).CONCLUSION:Remimazolam-based sedation was noninferior to the classic sedatives and had lower average cost per case,indicating that it may be used as a promising sedative for high-risk patients during endoscopic procedures in the ICU setting.

Effects of Sevoflurane and Propofol on Neurological Recovery of Traumatic Brain Injury Patients in the Early Postoperative Stage: A Retrospective Cohort Study

Objective To investigate the effects of propofol and sevoflurane on neurological recovery of traumatic brain injury(TBI)patients in the early postoperative stage.Methods We retrospectively analyzed the clinical data of TBI patients who underwent craniotomy or decompressive craniectomy.Generalized additive mixed model(GAMM)was used to analyze effects of propofol and sevoflurane on Glasgow Coma Scale(GCS)on postoperative days 1,3,and 7.Multivariate regression analysis was used to analyze effects of the two anesthetics on Glasgow Outcome Scale(GOS)at discharge.Results A total of 340 TBI patients were enrolled in this study.There were 110 TBI patients who underwent craniotomy including 75 in the propofol group and 35 in the sevoflurane group,and 134 patients who underwent decompressive craniectomy including 63 in the propofol group and 71 in the sevoflurane group.It showed no significant difference in GCS at admission between the propofol and the sevoflurane groups among craniotomy patients(β=0.75,95%CI:-0.55 to 2.05,P=0.260).However,elevation in GCS from baseline was 1.73 points(95%CI:-2.81 to-0.66,P=0.002)less in the sevoflurane group than that in the propofol group on postoperative day 1,2.03 points(95%CI:-3.14 to-0.91,P 0.001)less on day 3,and 1.31 points(95%CI:-2.43 to-0.19,P=0.022)less on day 7.The risk of unfavorable GOS(GOS 1,2,and 3)at discharge was higher in the sevoflurane group(OR=4.93,95%CI:1.05 to 23.03,P=0.043).No significant difference was observed among two-group decompressive craniectomy patients in GCS and GOS.Conclusions Compared to propofol,sevoflurane was associated with worse neurological recovery during the hospital stay in TBI patients undergoing craniotomy.This difference was not detected in TBI patients undergoing decompressive craniectomy.

Effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing resection of rectal carcinoma

BACKGROUND Rectal carcinoma(RC)treatment primarily involves laparoscopic surgery,which may induce significant hemodynamic changes and weaken immune function.Certain anesthetic approaches using opioid drugs(including remifentanil and sufentanil)pose risks,such as hypotension.AIM To determine the effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing RC resection.METHODS A total of 211 patients one hundred and four patients with RC treated at the First Affiliated Hospital of Dalian Medical University between November 2018 and November 2022 were retrospectively analyzed.Among them,the remifentanil group included 45 patients receiving remifentanil with propofol anesthesia and the sufentanil group included 59 patients receiving sufentanil with propofol anesthesia.Changes in the hemodynamic index,oxidative stress index,general data,consumption of remifentanil,and use of vasoactive drugs were compared.The incidences of adverse reactions were calculated.RESULTS The two groups did not significantly differ in terms of operation,anesthesia,and extubation times(P>0.05).At 1 min after intubation,the sufentanil group showed a notably higher heart rate,systolic blood pressure(SBP),diastolic blood pressure,and mean arterial pressure(MAP)compared with the remifentanil group(P<0.05),whereas the sufentanil group showed a notably higher SBP and MAP compared with the remifentanil group at 5 min after pneumoperitoneum(P<0.05).Thirty minutes after surgery,the remifentanil group showed significantly lower plasma cortisol,noradrenaline,and glucose levels than the sufentanil group(P<0.001).The remifentanil group consumed significantly less remifentanil than the sufentanil group(P<0.05),and the adoption frequency of ephedrine was lower in the remifentanil group than that in the sufentanil group(P<0.05).The incidence of hypotension was notably higher in the sufentanil group than that in the remifentanil group(P<0.05).CONCLUSION Remifentanil combined with propofol can improve hemodynamics and relieve oxidative stress in patients undergoing RC resection.

Protective effect of sevoflurane on lung function of elderly chronic obstructive pulmonary disease patients undergoing total hip arthroplasty

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a common respiratory disorder that affects the elderly population and increases the risk of postoperative pulmonary complications(PPCs)after major surgeries.Sevoflurane is a volatile anesthetic that has been shown to have anti-inflammatory and antioxidant properties and attenuate lung injury in animal models.AIM To evaluate the protective effect of sevoflurane on the lung function of elderly COPD patients undergoing total hip arthroplasty(THA).METHODS In this randomized controlled trial,we randomly assigned 120 elderly patients with COPD,who were scheduled for THA,to receive either sevoflurane(sevoflurane group)or propofol(propofol group)as the maintenance anesthetic.The primary outcome was the incidence of PPCs within seven days after surgery.The secondary outcomes were changes in the lung function parameters,inflammatory markers,oxidative stress markers,and postoperative pain scores.RESULTS The results showed that the incidence of PPCs was significantly lower in the sevoflurane group than in the propofol group(10%vs 25%,P=0.02).Furthermore,the decline in the forced expiratory volume in 1 s,forced vital capacity,and peak expiratory flow was significantly lesser in the sevoflurane group than in the propofol group at 24 h and 48 h after surgery(P<0.05).The interleukin-6,tumor necrosis factor-alpha,malondialdehyde,and 8-hydroxy-2α-deoxyguanosine levels were significantly lower in the sevoflurane group than in the propofol group at 24 h after surgery(P<0.05).The sevoflurane group showed significantly lower postoperative pain scores than the propofol group at 6 h,12 h,and 24 h after surgery(P<0.05).CONCLUSION Sevoflurane protects the lung function of elderly COPD patients undergoing THA under general anesthesia by reducing the incidence of PPCs,attenuating inflammatory and oxidative stress responses,and alleviating postoperative pain.

作用于GABA-R的静脉麻醉药(异丙酚与咪唑安定)之间相互作用的研究进展

目前普遍认为位于突触后膜的配体门控型离子通道可能是全麻药的分子作用位点。其中γ-氨基丁酸型受体(GABAa受体)及其门控Cl^-通道复合物尤显重要。本文扼要概述了异丙酚与苯二氮(艹卓)类在该通道复合物水平的相互作用及其可能机制。

丙泊酚血浆浓度的增加不影响神经外科手术病人在不同温度下的颈静脉氧饱和度

近期有研究表明，与吸入全麻药相比丙泊酚能破坏大脑氧供需平衡。但是不同剂量的丙泊酚对脑氧供的影响仍没有明确的研究。Iwata等（Iwata M，Kawaguchi M，Inoues，et al．Effects of increasing concentrations of propofol on jugular venous bulb oxygen saturation in neurosurgical patients under normothermic and mildly hypothermic conditions．Anesthesiology 2006；104：33—8）观察了增加丙泊酚用量对神经外科病人术中在正常体温和中低温状态下颈静脉氧饱和度（SjO2）的影响。他们选择了30例行开颅手术的病人，

Clinical study of anesthetization by dezocine combined with propofol for indolent colonoscopy

AIM: To assess the use of dezocine combined with propofol for the anesthetization of patients undergoing indolent colonoscopy.METHODS: A cross-sectional survey of patients undergoing indolent colonoscopy in the Xinjiang people's Hospital was conducted from April 1 to April 30, 2015. The survey collected patient general information and anesthesia data, including overall medical experience and pain management. Thirty minutes after colonoscopy surgery, samples of venous blood were collected and the biochemical indicators of gastrointestinal function were analyzed. RESULTS: There were 98 female and 62 male respondents. Indolent colonoscopy was found to be more suitable for mid to older-aged patients. The necessary conditions for the diagnosis of digestive diseases were required in 65 of the 73 inpatients. Adverse reactions to the intraoperative process included two cases of body movement and two cases of respiratory depression. Gastrin and vasoactive intestinal peptide levels were slightly increased. However, somatostatin and endothelin levels were slightly decreased. CONCLUSION: This study revealed that dezocine combined with propofol can be successfully used for the anesthetization of indolent colonoscopy patients without pain and should be widely used.

Combination of propofol and dezocine to improve safety and efficacy of anesthesia for gastroscopy and colonoscopy in adults: A randomized, double-blind, controlled trial

BACKGROUND Gastroscopy and colonoscopy are important and common endoscopic methods for the diagnosis and treatment of gastrointestinal and colorectal diseases.However,endoscopy is usually associated with adverse reactions such as nervousness,nausea,vomiting,choking cough,and pain.Severe discomfort,such as vomiting,coughing,or body movement,may lead to aggravation of a preexisting condition or even interruption of examination or treatment,especially in some critically ill patients with physiological dysfunction(e.g.,cardiovascular or respiratory disease).The optimal methods for inducing analgesia and sedation in endoscopy are areas of ongoing debate;nevertheless,determining an appropriate regimen of sedation and analgesia is important.AIM To evaluate the effects of propofol combined with dezocine,sufentanil,or fentanyl in painless gastroscopy and colonoscopy.METHODS Four hundred patients were randomly assigned to one of four groups for anesthesia:intravenous dezocine,sufentanil,fentanyl,or saline.Propofol was administered intravenously for induction and maintenance of anesthesia.RESULTS The dosage of propofol in the dezocine group was significantly lower than those in other groups(P<0.01).Bispectral index and Steward score(0-6 points,an unresponsive,immobile patient whose airway requires maintenance to a fully recovered patient)after eye opening in the dezocine group were significantly higher than those in other groups(P<0.01).Awakening time and postoperative pain score(0-10 points,no pain to unbearable pain)in the dezocine group were significantly lower than those in other groups(P<0.01).Mean arterial pressure and pulse oxygen saturation in the dezocine group were significantly more stable at various time points(before dosing,disappearance of eyelash reflex,and wakeup)than those in other groups(P<0.01).The rates of hypopnea,jaw thrust,body movements,and usage of vasoactive drugs in the dezocine group were significantly lower than those in other groups(P<0.01).Additionally,the rates of reflex coughing,nausea,and vomiting were not statistically different between the four groups(P>0.05).CONCLUSION The combination of propofol and dezocine can decrease propofol dosage,reduce the risk for the development of inhibitory effects on the respiratory and cardiovascular systems,increase analgesic effect,decrease body movement,shorten awakening time,and improve awakening quality.

Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

Compared to standard endoscopy,endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic ultrasound(EUS)are often lengthier and more complex,thus requiring higher doses of sedatives for patient comfort and compliance.The aim of this review is to provide the reader with information regarding the use,safety profile,and merits of propofol for sedation in advanced endoscopic procedures like ERCP and EUS,based on the current literature.

Remimazolam benzenesulfonate anesthesia effectiveness in cardiac surgery patients under general anesthesia

BACKGROUND Sedation with propofol injections is associated with a risk of addiction,but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism.Compared to remimazolam,remimazolam benzenesulfonate has a faster effect,is more quickly metabolized,produces inactive metabolites and has weak drug interactions.Thus,remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation.AIM To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.METHODS A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study.Using a random number table,patients were divided into two anesthesia induction groups of 40 patients each:remimazolam(0.3 mg/kg remimazolam benzenesulfonate)and propofol(1.5 mg/kg propofol).Hemodynamic parameters,inflammatory stress response indices,respiratory function indices,perioperative indices and adverse reactions in the two groups were monitored over time for comparison.RESULTS At pre-anesthesia induction,the remimazolam and propofol groups did not differ regarding heart rate,mean arterial pressure,cardiac index or volume per wave index.After endotracheal intubation and when the sternum was cut off,mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group(P<0.05).After endotracheal intubation,the oxygenation index and the respiratory index did not differ between the groups.After endotracheal intubation and when the sternum was cut off,the oxygenation index values were significantly higher in the remimazolam group than in the propofol group(P<0.05).Serum interleukin-6 and tumor necrosis factor-αlevels 12 h after surgery were significantly higher than before surgery in both groups(P<0.05).The observation indices were re-examined 2 h after surgery,and the epinephrine,cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group(P<0.05).The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group(P<0.05);there were significantly fewer adverse reactions in the remimazolam group(10.00%)than in the propofol group(30.00%;P<0.05).CONCLUSION Compared with propofol,remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations.Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function,thereby reducing anesthesia-related adverse reactions.