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.

Propofol Target-Controlled Infusion Modeling in Rabbits:Pharmacokinetic and Pharmacodynamic Analysis

This study aimed to establish a new propofol target-controlled infusion（TCI） model in animals so as to study the general anesthetic mechanism at multi-levels in vivo. Twenty Japanese white rabbits were enrolled and propofol（10 mg/kg） was administrated intravenously. Artery blood samples were collected at various time points after injection, and plasma concentrations of propofol were measured. Pharmacokinetic modeling was performed using Win Nonlin software. Propofol TCI within the acquired parameters integrated was conducted to achieve different anesthetic depths in rabbits, monitored by narcotrend. The pharmacodynamics was analyzed using a sigmoidal inhibitory maximal effect model for narcotrend index（NI） versus effect-site concentration. The results showed the pharmacokinetics of propofol in Japanese white rabbits was best described by a two-compartment model. The target plasma concentrations of propofol required at light anesthetic depth was 9.77±0.23 μg/m L, while 12.52±0.69 μg/m L at deep anesthetic depth. NI was 76.17±4.25 at light anesthetic depth, while 27.41±5.77 at deep anesthetic depth. The effect-site elimination rate constant（ke0） was 0.263/min, and the propofol dose required to achieve a 50% decrease in the NI value from baseline was 11.19 μg/m L（95% CI, 10.25–13.67）. Our results established a new propofol TCI animal model and proved the model controlled the anesthetic depth accurately and stably in rabbits. The study provides a powerful method for exploring general anesthetic mechanisms at different anesthetic depths in vivo.

Pharmacokinetics of sufentanil administered by target-controlled infusion in Chinese surgical patients

Background Target-controlled infusion （TCI） has been recently developed and successfully implemented in clinical practice. This study was conducted to determine the pharmacokinetics of TCI administered sufentanil in Chinese surgical patients. Methods The pharmacokinetics of sufentanil was investigated in 12 adult patients, aged 23-76 years, scheduled for prolonged surgery under general anesthesia. Anesthetic induction was carried out with propofol, rocuronium and TCI administered sufentanil aiming for target effect-site concentration of sufentanil 4 or 6 ng/ml. Sufentanil TCI lasted for 30 minutes. Frequent arterial blood samples （1.5 ml） were drawn during and up to 24 hours after sufentanil TCI. Plasma sufentanil concentrations were measured by liquid chromatography-tandem mass spectrometry; limit of sensitivity of mass spectrometry was 5 pg/ml. The data were analyzed with the nonlinear mixed-effect model program. Results The pharmacokinetics of TCI administered sufentanil were optimally described by a three-compartment model with the following parameters： the central volume of distribution （V1） = 5.4 L, the volume of distribution at steady-state （Vdss） = 195.4 L, systemic clearance （CI1） = 1.10 L/min, and elimination half-life （t1/2 Y） = 271.8 minutes. Both age and gender affected the pharmacokinetic parameters. The rapid distribution clearance （012） was negatively correlated with patient age, and the volume of slowly equilibrating compartment （V3） was positively correlated with age. The Cl2 and the volume of rapidly equilibrating compartment （V2） were influenced by gender with male patients showing higher values of Cl2 and V2 than female patients. There was no relationship of body weight, lean body mass, plasma albumin, or target effect-site concentration of sufentanil with any of the pharmacokinetic parameters studied. Conclusions The pharmacokinetics of TCI administered sufentanil in Chinese patients can be adequately described by a three-compartment model. Pharmacokinetics adjusted to the individual patient should improve the accuracy of TCI systems.

Relationship between depth of anesthesia and effect-site concentration of propofol during induction with the target-controlled infusion technique in elderly patients

Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients （60-80 years） with an American Society of Anesthesiologists （ASA） physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 （30 patients in each group）. The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer＇s Assessment of Alertness/Sedation （OANS） score of 1 was achieved, remifentanil （effect-site concentration （Ce） of 4.0 ng/ml） and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure （BP）, heart rate （HR）, and bispectral index （BIS） were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were （1.7±0.4） pg/ml, （1.9±0.3） pg/ml, （1.9±0.4） pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was （2.8±0.2） pg/ml, （2.8±0.3） pg/ml, （2.7±0.3） pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found （r=-0.580, P 〈0.01）. Systolic blood pressure （SBP） before intubation was significantly lower in Group S1 than in Groups S2 and S3. SBP and HR after intubation in the three groups were significantly increased when compared with pre-intubation values, but they did not exceed baseline values Conclusions During the TCI induction, Ce of propofol with （1.9±0.3） pg/ml may make the elderly patients unconscious. When remifentanil with a Ce of 4.0 ng/ml is added a Ce of propofol with （2.8±0.3） pg/ml is suitable for intubation. The Ce of propofol has a close correlation with the BIS values. Also, a two-step TCI technique seems to be a more suitable method of anesthesia induction in elderly patients compared with the no-stepwise TCI technique and three-step TCI technique.

Two-stage analysis of pharmacokinetics of sufentanil administered by target-controlled infusion in Chinese patients

Background Sufentanil is a suitable choice for target-controlled infusion （TCI） because of its shorter context-sensitive half-time. The current study was to estimate the pharmacokinetics of sufentanil TCI in Chinese patients using the two-stage analysis. Methods Twelve adult patients with American Society of Anesthesiologists （ASA） physical status I or II undergoing elective surgery under general anesthesia were included. Anesthesia was induced with propofol, rocuronium and sufentanil administered by TCI lasting for 30 minutes, with target effect-site concentration of sufentanil 4 or 6 ng/ml. Frequent arterial blood samples （1.5 ml） were taken during and up to 24 hours after sufentanil TCI. Before the end of surgery, another arterial blood sample （1.0 ml） was drawn for the blood-gas analysis. Plasma sufentanil concentrations were determined by liquid chromatography-tandem mass spectrometry （limit of quantitation was 5 pg/ml）. The data were analyzed with the two-stage approach, linear regression and correlation analysis. Results The pharmacokinetics of sufentanil TCI were adequately described by a three-compartment model. The variables were derived as follows： the volume of central compartment （V1） was 5.4 L, volume of distribution at steady-state （Vdss） was 222.6 L, metabolic clearance （CI1） was 0.84 L/min and elimination half-life （t~/2y） was 389 minutes. Patients＇ age, gender and PaCO2 correlated significantly with the pharmacokinetic parameters. The Vdss, volume of slowly equilibrating compartment （V3） and t1/2 y increased, and rapid distribution clearance （012） decreased with increasing patient age. Male patients had larger values of Vdss, volume of rapidly equilibrating compartment （V2） and V3 than female patients. The Vdss and V3 increased with higher PaCO2 values. There were no significant correlations between the pharmacokinetic variables and body weight, height, lean body mass, plasma albumin, sufentanil dose, duration of surgery, pH or base excess of blood （BE-B）. Conclusions The pharmacokinetics of sufentanil TCI in Chinese patients can be optimally described by a three-compartment model. The pharmacokinetic analysis technique may affect the pharmacokinetic parameters and correlations.

Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients

Background：In this prospective randomized study,we compared the predicted blood and effect-site C50 for propofol and remifentanil target-controlled infusion （TCI） and the bispectral index （BIS） values at loss of consciousness （LOC） and response to a standard noxious painful stimulus （LOS） in elderly and young patients,respectively.We hypothesized that the elderly patients will require lower target concentration of both propofol and remifentanil at above two clinical end-points.Methods：There were 80 American Society of Anesthesiologists （ASA） physical status Ⅰ Ⅱ unpremedicated patients enrolled in this study,they were divided into elderly group （age ≥65 years,n =40） and young group （aged 18-54 years,n =40）.Propofol was initially given to a predicted blood concentration of 1.2 μg/ml and thereafter increased by 0.3 μg/ml every 30 s until Observer＇s Assessment of Alertness and Sedation score was 1.The propofol level was kept constant,and remifentanil was given to provide a predict blood concentration of 2.0 ng/ml,and then increased by 0.3 ng/ml every 30 s until loss of response to a tetanic stimulus.BIS （version 3.22,BIS Quattro sensor） was also recorded.Results：In elderly group,the propofol effect-site C50 at LOC of was 1.5 （1.4-1.6） μg/ml,was significantly lower than that of young group,which was 2.2 （2.1-2.3） μg/ml,the remifentanil effect-site C50 at LOS was 3.5 （3.3-3.7） ng/ml in elderly patients,was similar with 3.7 （3.6-3.8） ng/ml in young patients.Fifty percent of patients lost consciousness at a BIS value of 57.3 （56.4-58.1）,was similar with that of young group,which was 55.2 （54.0-56.3）.Conclusion：In elderly patients,the predicted blood and effect-site concentrations of propofol at LOC were lower than that of young patients.At same sedation status,predicted blood and effect-site concentrations of remifentanil required at LOS were similar in elderly and young patients.BIS were not affected by age.Low-propofol/high-opioid may be optional TCI strategy for elderly patients.

Concentrations of propofol in cerebral spinal fluid: target-controlled infusion

Background Although the performance of target-controlled infusion (TCI) have been studied extensively, the accuracy and safety of a TCI system that targets the effect site remains to be demonstrated. This study was to investigate the relations of TCI of propofol to its concentrations in cerebral spinal fluid (CSF), the effect-site concentrations and bispectral index (BIS).Methods Twelve mongrel dogs were used for investigations. The target effect-site concentration was set at 3μg/ml and the infusion was lasted for 15 minutes. CSF and blood samples were then collected and propofol concentrations were determined by using high performance liquid chromatography with fluorescence detection. BIS and hemodynamic data were monitored continuously.Results The predicted plasma concentrations were generally overestimated. Median performance error (MDPE) and absolute median performance error (MDAPE) were -10.0% and 29.9% respectively. Propofol CSF concentrations were much lower than its effect-site concentrations. Changes in BIS were consistent with propofol concentrations in CSF, both of which changed direction at 5 minutes while the effect-site concentrations relatively lagged behind. Better correlation ( r2 = 0. 9195) was found between BIS and CSF concentrations, when compared with that between BIS and effect-site concentrations (r2=0. 554).Conclusion With 1% enflurane inhaled, the inconsistency of drug effect to the effect-site concentrations may result from inaccuracy of pharmacokinetic parameters. CSF may show effect-site concentrations more accurately than plasma when using target effect-site concentration infusion.

BIS反馈闭环路靶控输注右美托咪定可减少丙泊酚用量

目的比较在静脉麻醉中脑电双频指数(BIS)反馈闭环靶控输注(CL-TCI)调控下,右美托咪定(Dex)对丙泊酚用量及对血流动力学的影响。方法需要60例全麻患者参考随机数字表法随机分为D组(n=30)和C组(n=30),D组患者在术前及术中均泵注Dex直至手术结束;C组患者按照同样的方案泵注等量的生理盐水。检测负荷剂量前(T0),负荷剂量后(T1),插管即刻(T2),切皮(T3),手术开始后30 min(T4),缝皮(T5),拔管即刻(T6)的收缩压(SBP)、舒张压(DBP)、心率(HR);BIS值的变化;诱导期及维持期间的丙泊酚的用量。术中及术后出现的血流动力学不良事件。结果在BIS反馈闭环靶控输注调控下,Dex可有效减少麻醉诱导时间,诱导期及维持期丙泊酚的用量,差异具有统计学意义(P<0.05)。在拔管即刻,D组的HR,SBP及DBP均较C组减低,差异具有统计学意义(P<0.05)。负荷剂量前后D组与C组的BIS值及血流动力学不良反应的发生率差异均无统计学意义(P>0.05)。结论 BIS反馈闭环调控下定量证实Dex可减少丙泊酚的用量,同时可减少血流动力学不良反应的发生,不增加麻醉过深的发生率,是较为理想的麻醉辅助药物及镇静药物。

NarcoTrend反馈调控丙泊酚靶控输注联合舒芬太尼靶控输注静脉麻醉的临床效果

目的：探讨Narcotrend反馈调控丙泊酚靶控输注静脉麻醉联合舒芬太尼靶控输注在妇科腹腔镜手术中应用的临床效果。方法：择期腹腔镜下子宫次全切除术的患者100例,ASAⅠ-Ⅱ级,随机分为4组（n=25）：Narcotrend反馈丙泊酚麻醉联合舒芬太尼靶控组（NS组）;舒芬太尼靶控组（S组）;Narcotrend反馈丙泊酚麻醉组（N组）;对照组（C组）。Narcotrend反馈控制变量定在35。丙泊酚效应室靶浓度设定为3μg/ml,舒芬太尼效应室靶浓度设定为0.4 ng/ml,麻醉期维持靶浓度不变。记录诱导前患者清醒状态下（T0）、MOAA/S评分≤1时（T1）、气管插管后（T2）、切皮时（T3）、切皮后5 min（T4）、术毕停药（T5）、拔管时（T6）各时间点的HR、MAP;记录丙泊酚的使用剂量、计算丙泊酚单位标准化剂量、患者苏醒时间及定向力恢复时间。结果：Narcotrend反馈调控丙泊酚麻醉与舒芬太尼靶控可产生协同作用,可使MAP更稳定（P=0.028 6）;降低丙泊酚总量（P=0.037 9）和丙泊酚单位标准化量（P=0.025 0）;缩短苏醒时间（P=0.012 2）与定向力恢复时间（P=0.018 3）;但对HR不存在交互效应（P=0.5703）。结论：Narcotrend作为丙泊酚靶控反馈调控变量应用于妇科腹腔镜手术全身麻醉是可行的,与舒芬太尼靶控输注可使术中血压更平稳,减少丙泊酚使用量,苏醒快,提高麻醉复苏质量。

运用病人信息反馈改进门诊输液区护理管理效果观察

目的 探讨运用病人信息反馈改进门诊输液区护理管理的效果.方法 以600例门诊输液区病人为研究对象,采用问卷调查法进行护理服务需求调查,一周后电话回访,并将反馈结果汇总,制定改进方案：对护士进行语言规范培训,按不同需求增加服务项目、加大健康教育力度,建立巡视岗位制度、改善输液环境等.结果 每季度各项护理质量如组织管理、环境管理、业务管理、安全管理、物品管理全部达标;每季度病人满意率由原来的86%提高到94%;护士遭到投诉次数、护患纠纷次数由原来的6～8件/年下降到2～3件/年、护士无明显差错事故发生.结论 及时反馈门诊输液病人对护理的需求并采取针对措施,对提高护理质量,提高病人满意度有着重要的意义.

异丙酚闭环与开环靶控输注用于硬膜外麻醉病人清醒镇静的比较

目的:评价BIS作为异丙酚靶控输注的反馈控制变量用于硬膜外麻醉病人清醒镇静的可行性。方法:60例择期在硬膜外麻醉下行下腹部或下肢手术的病人,随机均分为两组:靶控输注组和反馈靶控输注组。异丙酚的血浆靶控浓度均设定为1.8μg/mL,靶控输注组整个手术期维持不变,反馈靶控输注组BIS作为控制变量设定在75。记录并比较两组间BIS值、OAA/S评分、平均动脉压(MAP)和心率(HR)的最高值和最低值、异丙酚的单位标准化剂量、定向力恢复时间、术中的遗忘程度和满意度。结果:两组间BIS值、OAA/S评分、平均动脉压的最高值和最低值及定向力恢复时间均有统计学差异(P<0.05);反馈靶控组异丙酚总剂量低于靶控输注组(P<0.01),单位标准化剂量亦较低(P<0.01);两组病人术中的遗忘程度和满意度的比较无显著性差异。结论:BIS作为异丙酚反馈控制变量是可行的,此输注系统为硬膜外麻醉病人提供了适宜的镇静深度,且异丙酚用量少,定向力恢复快,术中血流动力学稳定。

Cure Mate SM-2100输液泵的工作原理及检修方法

SM—2100输液泵是韩国JONGSANG公司产品 ,它打破了传统的吊瓶输液方式 ,是一种集光、机、电于一身化的智能化的自动输液装置 ,可以满足不同的输液要求。同时 ,还具有多项报警功能。是降低工作强度 ,提高治疗精度的理想设备。本文介绍了SM—2100输液泵的工作原理 ,并针对实际操作中常见的故障现象进行了较为全面的叙述。

硬膜外阻滞期间反馈靶控输注异丙酚清醒镇静的临床研究

目的评价脑电双频谱指数(BIS)作为反馈靶控输注异丙酚在硬膜外阻滞期间清醒镇静的可行性。方法将50例在硬膜外阻滞下完成择期手术的病人,随机分为靶控输注组(TCI组),反馈靶控输注组(FTCI组),每组25例。以1.0μg/kg为初始靶控浓度开始输注,在效应室异丙酚浓度达到平衡后3min,将靶控浓度增加至1.8μg/ml。TCI组整个手术过程中维持此浓度不变。FTCI组5min后开启BIS反馈系统,当BIS>75时,持续进行TCI,BIS<75停止TCI。整个调控由脑电监测仪器控制输注泵自动完成。记录两组病人麻醉前(T1)、开启BIS反馈系统前(T2)、切皮时(T3)、腹腔探查时(T4)、手术60min时(T5)、术毕停异丙酚输注时(T6)、病人清醒时(T7)等各时点BIS、MAP、HR、SPO2的参数及OAA/S评分,并记录两组病人麻醉时间、异丙酚总用量、平均给药速度、意识恢复时间,计算术中OAA/S、BIS、MAP、评分的最大值和最小值之差,分别表示为△OAA/S、△BIS、△MAP。随访有否术中知晓。结果与T1比较,两组患者在T2时BIS、MAP、HR均下降(P<0.05),T4时MAP、HR升高(P<0.05)。与FTCI组比较,TCI组患者在T4时BIS、MAP、HR升高,而在T6时上述几项指标均下降(P<0.05),术中△OAA/S、△BIS、△MAP升高(P<0.05)。FTCI组病人异丙酚总用量犤(410±33)mg犦显著低于TCI组犤(528±59)mg犦(P<0.01)。结论应用BIS值反馈靶控输注异丙酚在硬膜外阻滞期间的清醒镇静,可更加合理地评估镇静的深度,防止术中知晓,减少异丙酚用量,加快病人清醒,安全有效,较TCI更适用于临床。

Clinical evaluation of target controlled infusion system for sufentanil administration

Background Sufentanil target controlled infusion （TCI） provides stable analgesia, better hemodynamic control than a bolus injection of intravenous anesthetics, anticipated recovery and improved quality of anesthesia during perioperative period. This study evaluated the accuracy and feasibility of TCI system for sufentanil at high concentrations in Chinese surgical patients. Methods Twelve low risk adult patients undergoing elective surgery under general anesthesia were included in this study. Sufentanil was administered with a specific TCI system incorporating the population pharmacokinetic data of sufentanil previously reported, using a target effect-site concentration of sufentanil 4 or 6 ng/ml. Sufentanil TCI duration was 30 minutes. Frequent arterial blood samples were taken during and up to 24 hours after sufentanil TCI for determination of plasma sufentanil concentrations by liquid chromatography-mass spectrometry/mass spectrometry. The changes of circulatory system function during the procedure, recovery profile and adverse effects were recorded. Measured plasma sufentanil concentrations were compared with the values predicted by the TCI system. The bias （median performance error, MDPE）, precision （median absolute performance error, MDAPE） and wobble （variability of performance error） of the sufentanil TCI system were determined. Results All patients had stable cardiovascular variables during induction and maintenance of anesthesia. Time to eye opening and extubation were （5.6±1.7） minutes when TCI set to 4 ng/ml and （7.2±2.3） minutes when set to 6 ng/ml. There was no episode of agitation, muscle rigidity or intraoperative awareness. The bias （MDPE）, precision （MDAPE） and wobble of the sufentanil TCI system were -3.7%, 18.9% and 19.6% respectively during TCI, and the MDPE, MDAPE and wobble were -29.1%, 31.7% and 15.0% respectively after TCI （up to 8 hours）. Conclusions The TCI system programmed for sufentanil at 4 or 6 ng/ml was considered acceptable for clinical use in low risk Chinese surgical patients. But the relatively larger MDPE and MDAPE after TCI suggest improvements of the Dharmacokinetic model are needed.

Effect of subarachnoid anesthesia combined with propofol targetcontrolled infusion on blood loss and transfusion for posterior total hip arthroplasty in elderly patients

Background:Intravertebral and general anesthesia(GA)are two main anesthesia approaches but both have defects.This study was aimed to evaluate the effect of subarachnoid anesthesia combined with propofol target-controlled infusion(TCI)on blood loss and transfusion for total hip arthroplasty(THA)in elderly patients in comparison with combined spinal-epidural anesthesia(CSEA)or GA.Methods:Totally,240 patients(aged>65 years,American Society of Anesthesiologists[ASA]I-III)scheduled for posterior THA were enrolled from September 1st,2017 to March 1st,2018.All cases were randomly divided into three groups to receive CSEA(group C,w=80),GA(group G,n=80),or subarachnoid anesthesia and propofol TCI(group T,w=80),respectively.Primary outcomes measured were intra-operative blood loss,autologous and allogeneic blood transfusion,mean arterial pressure at different time points,length of stay in post-anesthesia care unit(PACU),length of hospital stay,and patient satisfaction degree.Furthermore,post-operative pain scores and complications were also observed.The difference of quantitative index between groups were analyzed by one-way analysis of variance,repeated measurement generalized linear model,Student-Newman-Keuls test or rank-sum test,while ratio index was analyzed by Chi-square test or Fisher exact test.Results:Basic characteristics were comparable among the three groups.Intra-operative blood loss in group T(331.53±64.33 mL)and group G(308.03±64.90 mL)were significantly less than group C(455.40±120.48 mL,F=65.80,P<0.001).Similarly,the autologous transfusion of group T(130.99±30.36 mL)and group G(124.09±24.34 mL)were also markedly less than group C(178.31±48.68 mL,F=52.99,P<0.001).The allogenetic blood transfusion of group C(0[0,100.00])was also significantly larger than group T(0)and group G(0)(Z=2.47,P=0.047).Except for the baseline,there were significant differences in mean arterial blood pressures before operation(F=496.84,P<0.001),10-min after the beginning of operation(F=351.43,P<0.001),30-min after the beginning of operation(F=559.89,P<0.001),50-min after the beginning of operation(F=374.74,P<0.001),and at the end of operation(F=26.14,P<0.001)among the three groups.Length of stay in PACU of group T(9.41±1.19 min)was comparable with group C(8.83±1.26 min),and both were significantly shorter than group G(16.55±3.10 min,F=352.50,P<0.001).There were no significant differences among the three groups in terms of length of hospitalization and post-operative visual analog scale scores.Patient satisfaction degree of group T(77/80)was significantly higher than group C(66/80,%=7.96,P=0.004)and G(69/80,/2=5.01,P=0.025).One patient complained of post-dural puncture headache and two complained of low back pain in group C,while none in group T.Incidence of post-operative nausea and vomiting in group G(10/80)was significantly higher than group T(3/80,/2=4.10,P=0.043)and group C(2/80,x2=5.76,P=0.016).No deep vein thrombosis or delayed post-operative functional exercise was detected.Conclusions:Single subarachnoid anesthesia combined with propofol TCI seems to perform better than CSEA and GA for posterior THA in elderly patients,with less blood loss and peri-operative transfusion,higher patient satisfaction degree and fewer complications.Trial registration:chictr.org.cn:ChiCTR-IPR-17013461;http://www.chictr.org.cn/showproj.aspx?proj=23024.

A New Pharmacokinetic Model of Propofol for Japanese Patients

Target-controlled infusion (TCI) of propofol is used for general anesthesia. However, the only pharmacokinetic parameter commercially used for Japanese patients is weight, and pharmacokinetic models are based on European physical attributes. Drug metabolism also differs in races. This study aimed to identify optimal continuous doses of propofol for Japanese patients and to create a simulated pharmacokinetic (PK) model. Thirty Japanese patients were enrolled. Patients received a constant infusion of 9 mg/kg/h of propofol. Arterial blood samples were collected and the time course of plasma propofol concentrations was modeled using the nonlinear mixed effects model (NONMEM) three-compartmental PK model. We validated the model by intravenously injecting 10 patients with a TCI driver system programmed with the NONMEM model. Our model’s performance was evaluated using the median prediction error (MDPE), median absolute prediction error (MDAPE), and Wobble. We analyzed 320 blood samples for model building and 160 samples for validating our new model. The calculated parameters for the three-compartmental PK model were volume [V1, 3.58;V2, 13.0 + 0.49 × (Age—64);and V3, 186] and elimination clearance [CL1, 0.77 + (WT—54) × 0.04 + (HT—158) × 0.03;CL2, 0.89 + 0.12 × (Age—64);and CL3, 0.98 × exp ((Age—64)/10)]. The new model improved MDPE, MDAPE, and Wobble values (11.5% ± 43.8%, 14.3% ± 33.0%, and 25.0% ± 21.3%, respectively). We created a new pharmacokinetic model for Japanese patients, which is more accurate than the three existing models applied to Japanese populations. Electronic document is a “live” template. The various components of your paper [title, text, heads, etc.] are already defined on the style sheet, as illustrated by the portions given in this document.

不同靶浓度的瑞芬太尼用于七氟醚吸入诱导的对比观察

目的在脑电双频指数(BIS)的监测下,比较不同血浆靶浓度的瑞芬太尼复合七氟醚麻醉诱导对血流动力学的影响,探讨瑞芬太尼合适的麻醉诱导剂量。方法择期全麻手术患者60例,按瑞芬太尼靶浓度不同随机分为3组:3 ng/ml(D1组)、4 ng/ml(D2组)和5 ng/ml(D3组),每组20例。3组均采用七氟醚吸入麻醉诱导。当BIS值达60时静注顺式阿曲库铵辅助插管。分别记录诱导前(T1)、插管前(T2)、插管即刻(T3)、插管后3 min(T4)的平均动脉压(MAP)和心率(HR),以及各组患者意识消失的时间。结果与T1相比,T2各组MAP和HR均有下降,但D3下降更明显(P<0.05);T3时D1组MAP和HR显著快于T1、T2(P<0.05)。3组患者意识消失的时间相比差异无统计学意义。结论靶控输注4ng/ml的瑞芬太尼复合七氟醚诱导血流动力学更平稳,此剂量的瑞芬太尼为合适的诱导剂量。

丙泊酚闭环靶控输注全凭静脉麻醉在颅脑手术的应用

目的以脑电双频指数(BIS)为反馈控制变量,探讨丙泊酚闭环靶控输注复合舒芬太尼全凭静脉麻醉应用于颅脑手术的可行性。方法44例择期行大脑半球肿瘤切除患者,随机分为闭环靶控输注组和靶控输注组,各22例。闭环组设定反馈值为BIS=50,两组丙泊酚血浆靶控浓度设定为2．0μg/mL,舒芬太尼恒速持续静脉输注。记录两组在麻醉前、插管即时、插管后3min、切皮、锯颅骨、切开脑皮质、切肿瘤1h、缝皮等时间点的MAP、CVP、HR、HRV、BIS变化及丙泊酚的用量。结果靶控组在插管后3min、切开脑皮质、切肿瘤1h等时间点MAP下降较闭环组明显(P＜0．05),HRV变化幅度也大于闭环组(P＜0．05)。闭环组丙泊酚用量少于靶控组(P＜0．01)。结论以BIS为反馈值,丙泊酚闭环靶控输注复合舒芬太尼全凭静脉麻醉用于颅脑手术,术中患者麻醉深度易于维持,血流动力学稳定,并明显减少丙泊酚用量。

脑电双频谱指数反馈调控异丙酚靶控输注静脉麻醉

目的 评价BIS作为异丙酚靶控输注的反馈控制变量在腹腔镜胆囊切除术麻醉中的可行性。方法 40例行择期腹腔镜手术的病人随机分为两组,反馈靶控输注组和靶控输注组,每组20人。BIS作为反馈控制变量设定在50。诱导前3min一次性静注芬太尼3μg,异丙酚的血浆靶浓度设定为3μg/ml,诱导及维持期间保持不变。记录并比较两组间的实时BIS值、术中收缩压和舒张压的最高值和最低值、附加药物剂量、呼唤睁眼反应恢复和定向力恢复时间、术中知晓情况和异丙酚的单位标准化使用剂量。结果 反馈组的异丙酚总剂量低于靶控组（P<0.01）,单位标准化剂量亦较低（P<0.01）,血液动力学相对稳定,所用升压药少（P<0.01）,停药后呼唤反应恢复时间较短（P<0.05）,但定向力恢复时间两组间无统计学差异（P>0.05）。术中BIS的最高值、最低值及清醒值、定向力恢复时的数值,两组间无统计学差异（P>0.05）。芬太尼均可以使反馈输注组BIS值和靶控输注组BIS值显著下降（P<0.01）。结论BIS作为异丙酚靶控输注麻醉的反馈控制变量是可行的,具有这种特性的输注系统能够满足腹腔镜胆囊切除手术的麻醉要求,具有异丙酚用药量少、苏醒快、术中血压比较稳定的优点,使得麻醉深度的调控更加精确。由于不同药物对BIS的影响不同,BIS作为麻醉深度监测指标?

心肌特异性脂肪酸结合蛋白在不停跳冠状动脉搭桥术中的变化

Objective To appraise the sensitivity of hFABP for myocardial ischemia in patients undergoing off-pump coronary artery bypass grafting among cardiac markers. Methods Thirty-eight consecutive patients undergoing OPCABG were included in a randomized study using standardized operative procedures and myocardial protection. Serial blood samples were taken preoperatively, during anastomoses, at the end of operation, 6 h, 18 h and 36 h postoperatively and tested for hFABP、Troponin I (cTnI)、sCD40L、creatine kinase isoenzyme (CK-MB). Results Six cases (16.7%) were found myocardial injury during the OPCABG by ECG or PAP. Their serial serum hFABP,cTnI,sCD40L,CK-MB were higher than those without myocardial injury. The peak serum level of hFABP was higher and occurred earlier than those of cTnI,sCD40L,CK-MB. Conclusion These results suggest that serum hFABP is an early and sensitive biochemical marker for the diagnosis of myocardial injury in patients undergoing OPCABG.