咪唑安定和异丙酚联合用于老年人单侧下肢手术联合镇静麻醉的效果观察

目的:探讨咪唑安定联合异丙酚在老年人单侧下肢手术中的镇静麻醉效果。方法:选取80例老年人单侧下肢手术患者资料进行分析,采用随机对照方法将患者分为对照组和实验组,对照组单纯采用异丙酚镇静麻醉,实验组在对照基础上联合咪唑安定麻醉,比较两组镇静麻醉效果。结果:实验组感觉阻滞起效时间,显著短于对照组(P?0.05);实验组感觉阻滞持续时间显著长于对照组(P?0.05);对照组各时间点HR和MAP变化差异无统计学意义(P>0.05)。实验组T1时HR与MAP,与T0比较(P<0.05);实验组T1时HR和MAP,显著低于对照组比较(P<0.01);实验组不良反应发生率为7.5%,显著低于对照组(不良反应发生率为17.5%)(P<0.01)。结论:老年人单侧下肢手术过程中在异丙酚镇静麻醉基础上联合咪唑安定效果理想,该方案镇静起效快,恢复清醒快,且不良反应发生率低,值得应用。

Superiority of split dose midazolam as conscious sedation for outpatient colonoscopy

AIM: To elucidate the efficacy and safety of a split dose of midazolam in combination with meperidine for colonoscopy. METHODS: Eighty subjects undergoing outpatient colonoscopy were randomly assigned to group A or B. Group A (n = 40) received a split dose of midazolam in combination with meperidine. Group B (n = 40) received a single dose of midazolam in combination with meperidine. Outcome measurements were level of sedation, duration of sedation and recovery, degree of pain and satisfaction, procedure-related memory, controllability, and adverse events. RESULTS: Group A had a lower frequency of significant hypoxemia (P = 0.043) and a higher sedation score on withdrawal of the endoscope from the descending colon than group B (P = 0.043). Group B recovered from sedation slightly sooner than group A (P < 0.002). Scores for pain and memory, except insertion-related memory, were lower in group A one week after colonoscopic examination (P = 0.018 and P < 0.030, respectively). Poor patient controllability was noted by the endoscopist and nurse in group B (P = 0.038 and P = 0.032, respectively). CONCLUSION: Split dose midazolam in combination with meperidine resulted in a safer, more equable sedation status during colonoscopic examination and a reduction in procedure-related pain and memory, but resulted in longer recovery time.

Ketamine and midazolam sedation for pediatric gastrointestinal endoscopy in the Arab world

AIM:To evaluate the safety and effectiveness of intravenous ketamine-midazolam sedation during pediatric endoscopy in the Arab world.METHODS:A retrospective cohort study of all pediatric endoscopic procedures performed between 2002-2008 at the shared endoscopy suite of King Abdullah University Hospital,Jordan University of Science & Technology,Jordan was conducted.All children were > 1 year old and weighed > 10 kg with American Society of Anesthesiologists class 1 or 2.Analysis was performed in terms of sedation-related complications(desaturation,respiratory distress,apnea,bradycar-dia,cardiac arrest,emergence reactions),adequacy of sedation,need for sedation reversal,or failure to complete the procedure.RESULTS:A total of 301 patients(including 160 males) with a mean age of 9.26 years(range,1-18 years) were included.All were premedicated with atropine;and 79.4%(239/301) had effective and uneventful sedation.And 248(82.4%) of the 301 patients received a mean dose of 0.16 mg/kg(range,0.07-0.39) midazolam and 1.06 mg/kg(range,0.31-2.67) ketamine,respectively within the recommended dosage guidelines.Recommended maximum midazolam dose was exceeded in 17.6% patients [34 female(F):19 male(M),P = 0.003] and ketamine in 2.7%(3 M:5 F).Maximum midazolam dose was more likely to be exceeded than ketamine(P < 0.001).Desaturation occurred in 37(12.3%) patients,and was reversible by supplemental oxygen in all except 4 who continue to have desaturation despite supplemental oxygen.Four(1.3%) patients had respiratory distress and 6(2%) were difficult to sedate and required a 3rd sedative;12(4%) required reversal and 7(2.3%) failed to complete the procedure.None developed apnea,bradycardia,arrest,or emergence reactions.CONCLUSION:Ketamine-midazolam sedation appears safe and effective for diagnostic pediatric gastrointestinal endoscopy in the Arab world for children aged > 1 year and weighing > 10 kg without co-morbidities.

Propofol vs midazolam plus fentanyl for upper gastrointestinal endomicroscopy:A randomized trial

AIM:To compare the endomicroscopic image quality of integrated confocal laser endomicroscopy(iCLE)and sedation efficacy of propofolvs midazolam plus fentanyl(M/F).METHODS:Consecutive outpatients undergoing iCLE were prospectively recruited and randomized to the propofol group(P group)or M/F group.The patient,performing endoscopist and endoscopic assistant were blinded to the randomization.The quality of endomicro-scopic images and anesthetic efficacy outcomes were blindly evaluated after iCLE examination.RESULTS:There were significantly more good quality endomicroscopic images in the propofol group than in the M/F group(72.75%vs 52.89%,P<0.001).The diagnostic accuracy for upper gastrointestinal mucosal lesions using confocal laser endomicroscopy favors the P group,although this did not reach statistical significance.Adverse events and patient assessment were not significantly different for M/F vs propofol except for more frequent intraprocedural recall with M/F.Procedure duration and sedation times were significantly longer in the M/F group,while the scores of endoscopist,anesthetist and assistant assessment were all significantly better in the P group.CONCLUSION:Sedation with propofol might increase the proportion of good quality endomicroscopic images,and may result in improved procedural efficacy and diagnostic accuracy during iCLE examination.