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.

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.

Randomized Double-Blind Controlled Clinical Study of Ciprofol and Propofol in Patients with Painless Artificial Abortion

Background and Objectives: Propofol is a commonly used intravenous anesthetic for painless artificial abortion, but the injection pain and related adverse reactions such as those related to respiration and circulation it induces have also been criticized. We aimed to conduct a comparative study on the efficacy, safety and comfort of ciprofol and propofol applied in painless artificial abortion. Materials and Methods: A total of 140 early pregnant patients undergoing painless induced abortion were selected and randomly divided into the ciprofol combined with fentanyl group (Group C) and the propofol combined with fentanyl group (Group P), with 70 cases in each group. The anesthetic effect, depth of anesthesia sedation (NI), onset time, recovery time, recovery time of orientation, retention time in the anesthesia recovery room and total amount of intravenous anesthetic drug were recorded in both groups. The respiratory rate (RR), oxygen saturation (SpO2), mean arterial pressure (MAP), and heart rate (HR) at different time points were recorded. The occurrence of perioperative adverse events, injection pain, postoperative nausea and vomiting, and dizziness were compared. The pain score at 30 minutes after operation and the satisfaction of patients and surgeons with anesthesia were evaluated. Results: The success rate of anesthesia in both groups was 100%. There were no statistically significant differences in the NI value at each time point, intraoperative body movement, recovery time, recovery time of orientation, retention time in the anesthesia recovery room, and total dosage of sedative drugs (ml) between the two groups;the onset time in Group C was longer than that in Group P, with a statistically significant difference (P Conclusion: The efficacy of ciprofol in painless induced abortion is equivalent to that of propofol, and the incidence of adverse reactions is lower than that of propofol, with higher safety and comfort.

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.

Effects of propofol versus urapidil on perioperative hemodynamics and intraocular pressure during anesthesia and extubation in ophthalmic patients

AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n = 41) and urapidil groups (n = 41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P > 0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO(2) and intraocular pressure (TOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P < 0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P > 0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P < 0.05), and had significant difference compared with those in urapidil group (P < 0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P < 0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P < 0.05). The changes in these indicators between the two groups had no significant difference (P > 0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.

Prospective, Randomized Comparisons of Induction of Anesthesia with Ketamine, Propofol and Sevoflurane for Quality of Recovery from Short Sevoflurane Anesthesia in Pediatric Patients

Background: Emergence agitation (EA) after sevoflurane anesthesia is common in children. When rapid intravenous induction of general anesthesia is indicated in a brief procedure, the induction agent can reduce the incidence of EA after sevoflurane anesthesia. The aim of this study was to compare the efficacy of intravenous induction with ketamine and propofol for reducing EA in children after short sevoflurane anesthesia. Methods: Children aged 2 to 6 years who were scheduled to undergo inguinal hernia repair were randomly divided into 3 groups to receive 2 mg/kg ketamine iv, 3 mg/kg propofol iv, or inspired concentration of 8% sevoflurane for induction of anesthesia. After a laryngeal mask airway (LMA) insertion, a caudal block was performed in all children. Anesthesia was maintained with 1.5% sevoflurane and 65% nitrous oxide in oxygen with spontaneous ventilation. The recovery characteristics were recorded and EA were evaluated by using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Results: One hundred and twenty children were enrolled and randomized to treatment. Children who received ketamine induction had higher incidence of EA than those who received propofol (42% vs 16%, P < 0.05) and showed delayed recovery (32 ± 9 min) as compared with those who received propofol or sevoflurane (22 ± 8 min and 20 ± 7 min, respectively, P < 0.05). The mean peak PAED score was significantly lower in children who received propofol induction (6.8 ± 4.0, P < 0.05) than ketamine (11.8 ± 4.1) or sevoflurane (11.6 ± 3.8). Conclusions: Intravenous induction with ketamine does not prevent the incidence of EA and delays recovery. Induction with propofol improves the quality of recovery by reducing the incidence of EA and provides a safe and early recovery.

Study on the Clinical Effect of Dezocine and Remifentanil Combined with Propofol in Anesthesia for Painless Abortion

Objective:To investigate the anesthetic effect of dezocine and remifentanil combined with propofol in painless artificial abortion.Methods:90 cases in total of painlessinduced abortion 1n our hospital from May 2017to May 2020 were retrospectively analyzed,29cases of propofol anesthesia(group A),29cases of dezocine combined with propofol anesthesia(group B),and 32 cases of remifentanil combined with propofol anesthesia(group C)were compared the anesthesia situation.Resuits:Compared with the cases in group A,the incidence of pain,body movement and sPo,90oat the injection site were lower in group B and group C,the use of propofol was reduced,and the VAS scores were lower when the patients begin to awake,and the efficiency was higher than that in group A(P<0.05);there was no statistic difference in the changes of SBP,DBP and HR index data in the operation time,postoperative awake time,and preoperative,intraoperative and postoperative time points of the three groups(P<0.05).Conclusion:Dezocine and remifentamil combined with propofol for painless artificial abortion anesthesia has more significant effect than propofol anesthesia alone,which can relieve patients'pain and reduce the chance of respiratory depression.

Investigating the application value of propofol combined with sufentanil and dexmedetomidine in cosmetic anesthesia

Objective:To investigate the effects of propofol combined wit h s u f e n t a n i l a n d dexmedetomidine in cosmetic anesthesia.Methods:The clinical data of 40 plastic surgery patients admitted to the hospital from June to November 2019 were retrospectively analyzed.According to the different anesthesia methods during surgery,they were divided into control group(propofol combined with sufentanil and normal saline,20 cases)and was compared with the observation group(propofol combined with sufentanil and dexmedetomidine,20 cases).The anesthetic effect,total dosage of propofol,spontaneous breathing recovery time,and adverse reactions were compared between the two groups.Results:The total dosage of propofol in the observation group was less than that in the control group,and the spontaneous breathing recovery time was shorter than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in the anesthetic effect and adverse reaction rate between the two groups(P>0.05).Conclusion:The application of propofol in combination with sufentanil and dexmedetomidine in cosmetic anesthesia can reduce the dosage of propofol,speed up the anesthesia recovery,and have better anesthetic effect and safety.

Uncontrolled high blood pressure under total intravenous anesthesia with propofol and remifentanil:A case report

BACKGROUND Although propofol generally reduces blood pressure,rarely,it causes hypertension.However,the mechanism by which propofol increases blood pressure has not been established,and so far,there are only a few reported cases.CASE SUMMARY A 46-year-old woman,diagnosed with thyroid cancer,was administered general anesthesia with propofol and remifentanil for a thyroid lobectomy.An increase in the concentrations of intravenous anesthetics further increased her blood pressure.The blood pressure remained stable when anesthesia was maintained with sevoflurane and remifentanil after the interruption of propofol administration.CONCLUSION We concluded that propofol administration was the cause of increased blood pressure.

A COMPARISON OF THE EFFECTS OF THE PROPOFOL VERSUS MIDAZOLAM DURING TOTAL INTRAVENOUS ANESTHESIA FOR GYNECOLOGICAL SURGERY PROCEDURES

The effects of propofol and midazolam as an intravenous anesthetic were compared in 40 ASA Ⅰ-Ⅱ patients undergoing gynecological surgery during total intravenous anesthesia (TIVA). They were divided into propofol group (Pn= 20) and midazolam group (Mn= 20) randomly. The anesthesia was designed for each group respectively. Here, we discuss the experimental method and the results, which indicate that propofol is not only an effective anesthetic but also has more rapid and head-clear recovery properties than midazolam.

Improved Pittsburgh Sleep Quality Index scores on first postoperative night achieved by propofol anesthesia in patients undergoing ambulatory gynecologic surgery

BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.AIM To compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.METHODS We enrolled 61 American Society of Anesthesia(ASA) class Ⅰ-Ⅱ outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index(PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.RESULTS For the propofol group, the mean postoperative global PSQI score(3.3 ± 1.3) was lower than the mean preoperative global PSQI score(4.9 ± 2.3)(P < 0.001);for the sevoflurane group, the mean postoperative global PSQI score(6.5 ± 2.8) was higher than the mean preoperative global PSQI score(5.5 ± 3.2)(P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.CONCLUSION Sleep quality assessed by the PSQI is better improved in ASA class Ⅰ-Ⅱ female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.

Effects of Remifentanil combined with Propofol anesthesia on neurological function, inflammatory response and stress state in patients undergoing craniotomy

Objective:In this study, the effects of combined anesthesia with Remifentanil and Propofol on the hemodynamics and stress state indexes at different times in patients undergoing craniotomy were studied, and the effects of combined anesthesia with Remifentanil and Propofol on neurological function and inflammatory response in patients undergoing craniotomy were explored.Methods:A total of 92 patients who underwent craniotomy in our hospital from January 2017 to February 2019 were collected and divided into observation group and control group according to their anesthesia methods. 45 patients in the control group received propofol to maintain anesthesia. In the observation group, 47 cases were treated with remifentanil combined with propofol to maintain anesthesia. Changes in hemodynamics (HR, SpO2, MAP) of the two groups were monitored at different times throughout the operation. At the same time by ria method detection in patients with two groups of T0, T1, T2, T3, T4 in serum stress state index (AngⅡ, NE, ALD) changes. The changes of nerve function indexes (NSE, S100) and inflammatory factors (CRP, TNF-α) before and after surgery were compared between the two groups.Results:There were no significant differences in hemodynamics and stress state indicators of T0 between the two groups, and there were no significant differences in preoperative inflammatory reaction and neurological function indicators between the two groups. In the observation group, the changes of HR, SpO2 and MAP at each time point during the operation were less than those in the control group, and the hemodynamic state of the observation group was more stable than that of the control group. The level of AngⅡ, NE, ALD in Control patients in T1, T2, T3, T4 were higher than T0. The level of AngⅡ, NE, ALD of the two groups in T1, T2, T3, T4 are higher than T0. Observation group of patients with T1, T2, T3, T4 AngⅡ level obviously is higher than the control group with time. In the observation group, the levels of NE and ALD were higher at T2, T3 and T4 than at T0. The levels of NE and ALD in T3 and T4 were lower in the observation group than in the control group. Postoperative neurological function (NSE, S100) and inflammatory factors (CRP, TNF-α) were significantly higher in the two groups than in the control group.Conclusion: Combined anesthesia with Remifentanil and Propofol can stabilize the hemodynamic state of patients undergoing craniotomy, reduce cardiovascular stress response and inflammatory response, reduce nerve damage, and play a role in brain protection.

Effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation

Objective:To investigate the effects of dexmedetomidine + propofol intervention during general anesthesia induction on endotracheal intubation.Methods: A total of 218 patients receiving tracheal intubation general anesthesia in the hospital between January 2017 and December 2017 were divided into the control group (n=109) and the dexmedetomidine group (n=109) by random number table method. Control group underwent routine propofol anesthesia induction and dexmedetomidine group underwent dexmedetomidine anesthesia induction on the basis of propofol. The differences in the severity of inflammatory response and stress response were compared between the two groups of patients after general anesthesia induction (T0), 1 min after endotracheal intubation (T1), 5 min after endotracheal intubation (T2) and 10 min after endotracheal intubation (T3).Results:At T0, there was no statistically significant difference in serum levels of inflammatory factors and stress hormones between the two groups. At T1, T2 and T3, serum inflammatory factors CRP, IL-1, IL-6, IL-8 and TNF-α levels of dexmedetomidine group were lower than those of control group;serum stress hormones ACTH, Cor, NE, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion: Dexmedetomidine + propofol general anesthesia induction can effectively reduce the inflammatory stress response caused by endotracheal intubation.

Comparison of the Effect of Combined Cardiovascular Dexmedetomidine and Propofol in Minimally Invasive axillary Odor Surgery with Tumescent Anesthesia

Objective:The effects of combined dexmedetomidine hydrochloride and propofol in minimally invasive axillary odor surgery with tumescent anesthesia.Methods:A total of 46 patients underwent minimally invasive axillary odor surgery by tumescent anesthesia received in the hospital from May 2017 to January 2019 were divided into observation group(23 cases)and control group(23 cases)according to the random number table method.The control group used propofol,and the observation group underwent minimally invasive axillary odor combined with dexmedetomidine hydrochloride by tumescent anesthesia.The changes of arterial blood pressure(MAP),heart rate(HR)and postoperative complications before and after anesthesia were compared and analyzed between the two groups.Results:After anesthesia,MAP and HR in both groups were lower than before anesthesia,and the observation group was lower than the control group,the difference was statistically significant(P<0.05).Compared with the control group,the postoperative complications were less in the observation group,but the difference was not statistically significant(P>0.05).Conclusion:Compared with the use of propofol,the effect of dexmedetomidine hydrochloride combined with minimally invasive axillary odor surgery by tumescent anesthesia is more obvious,and the postoperative recovery is faster with fewer complications.

Effect of propofol intravenous anesthesia on hemorheology, hemodynamics and immune function in patients with colorectal cancer after radical operation

Objective:To investigate the effect of Propofol Intravenous Anesthesia on hemorheology, hemodynamics and immune function in patients with colorectal cancer after radical operation.Method: A total of 100 patients with colorectal cancer treated in our hospital from September 2015 to August 2017 were randomly divided into observation group and control group according to random number table. The control group was inhaled sevoflurane anesthesia, observation group propofol intravenous anesthesia. The changes of hemorheology, hemodynamics and immune function were compared between the two groups.Results: There was no significant difference in hemorheology index, hemodynamic index, T lymphocyte subsets CD45RA+, CD45RO+, CD45RA+/CD45RO+ levels between the two groups before anesthesia. Anesthesia 1.5 h after, the levels of LBV, HBV, PV, EAI and EDI in the two groups were significantly decreased, but there was no significant difference between the observation group and the control group. At 1.5 h after anesthesia induction, the HR and SBP levels of the observation group did not change significantly compared with anesthesia before, while the HR and SBP levels of the 1.5 h after anesthesia induction in the control group were significantly lower than those before anesthesia and significantly lower than the corresponding level HR level (86.43±13.25) times/min, SBP level (110.84±15.41) mmHg in the observation group. At the end of surgery, the levels of CD45RA+ and CD45RO+ in the observation group were significantly decreased, but increased at 72 h after operation.Conclusion: After operation, CD45RA+ and CD45RO+ levels in the control group were significantly decreased, and preoperatively, which can significantly improve the hemorheology and reduced hemodynamic effects, and contribute to the recovery of patients with immune function, is worth clinical promotion.

环泊酚、丙泊酚分别联合布托啡诺麻醉在老年无痛胃肠镜检查中的应用比较

目的:比较环泊酚、丙泊酚分别联合布托啡诺麻醉在老年无痛胃肠镜检查中的应用。方法:选取无痛胃肠镜检查的老年患者160例,使用随机信封法分为环泊酚组(80例)和丙泊酚组(80例)。环泊酚组采用环泊酚复合布托啡诺麻醉,丙泊酚组采用丙泊酚复合布托啡诺麻醉。比较两组麻醉诱导前(T_(0))、睫毛反射消失后(T_(1))和定向力恢复时(T_(2))的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO_(2))。比较两组苏醒时间和术后简易精神状态量表(MMSE)评分。比较两组离开麻醉监测治疗室(PACU)即刻(T_(3))、离开PACU后1 h(T_(4))和离开PACU后2 h时(T_(5))的视觉模拟量表(VAS)评分。比较两组注射痛、心律失常等不良反应发生情况。结果:环泊酚组T_(1)时间点MAP、HR和SpO_(2)高于丙泊酚组(均P<0.05)。环泊酚组苏醒时间及各时间点MMSE评分与丙泊酚组比较无统计学差异(均P>0.05)。两组各时间点VAS评分比较无统计学差异(均P>0.05)。环泊酚组注射痛发生率低于丙泊酚组(P<0.05)。环泊酚组心律失常发生率、血压异常率、呼吸抑制率、恶心呕吐率与丙泊酚组比较无统计学差异(均P>0.05)。结论:老年患者无痛胃肠镜检查中使用环泊酚复合布托啡诺麻醉能取得满意的麻醉效果,患者苏醒迅速,且有助于维持循环呼吸稳定,减少不良反应。

瑞马唑仑联合阿芬太尼与丙泊酚联合阿芬太尼全凭静脉麻醉在宫腔镜电切手术麻醉中的应用比较

目的:探究在进行宫腔镜电切手术时,麻醉方案采用瑞马唑仑联合阿芬太尼、丙泊酚联合阿芬太尼两种全凭静脉麻醉方案的应用效果。方法:研究时间为2023年1月至2023年6月,纳入研究对象为107例宫腔镜电切手术患者,根据随机数字表法分为对照组、观察组。对照组53例采用丙泊酚联合阿芬太尼全凭静脉麻醉,观察组54例采用瑞马唑仑联合阿芬太尼全凭静脉麻醉。比较两组患者的疼痛情况(使用VAS评分评估)、镇静情况(采用Ramsay镇静评分评估)、生命体征情况、改良警觉/镇静评分,记录不良反应情况。结果:与对照组相比,观察组在术后2h及术后12h的VAS评分降低(P<0.05),术后2h时的Ramsay镇静评分升高(P<0.05)。两组在手术前的HR、SBP、DBP、SPO_(2)差异无统计学意义(P>0.05),与对照组患者相比较,观察组患者手术开始后5min及术后2h的HR、SBP、DBP、SPO_(2)水平均升高(P<0.05)。两组的VAS评分、Ramsay镇静评分、生命体征指标均具有显著的组间效应、时间效应及交互效应(P<0.05)。观察组患者手术结束后1min、3min、5min时MOAA/S评分比对照组高(P<0.05)。组间不良反应发生率差异无统计学意义(P>0.05)。结论:瑞马唑仑联合阿芬太尼应用于宫腔镜电切手术麻醉在术后早期具有更好的疼痛控制和镇静效果,且患者恢复清醒状态更快,生命体征水平维持更稳定。

全身麻醉下胸横肌平面-胸神经阻滞在乳腺癌手术患者中的价值

目的:评价胸横肌平面-胸神经(transversus thoracic muscle plane-pectoral nerves,TTP-PECS)阻滞用于减阿片类药物全麻下乳腺癌改良根治术中的安全性与可行性。方法:选择择期行乳腺癌改良根治术的患者60例,随机分为TTP-PECS阻滞联合减阿片药物全麻组(TO组)和常规全身麻醉组(GA组),每组30例。观察并记录两组患者各时点收缩压、舒张压、心率;麻醉诱导前(T0)、插管前即刻(T1)、切皮时(T2)、切除乳腺标本时(T3)、手术结束时(T4)各时点安静及运动状态下的疼痛视觉模拟评分量表(visual analogue scale,VAS);术后24 h 40项恢复质量评分量表(quality of recovery-40,QoR-40)评分;围术期不良反应的发生率。结果:与T0比较,两组患者T1~T4时点收缩压、舒张压、心率均显著降低(P <0.05),但两组之间各时点收缩压、舒张压、心率比较差异无统计学意义(P> 0.05);TO组术后2 h、6 h、12 h安静及运动状态下VAS评分均显著低于GA组(P <0.05);TO组术后24 h QoR-40量表总评分及情绪状态、身体舒适度、心理支持、疼痛各项评分均显著高于GA组(P <0.05);TO组患者诱导期咳嗽反射及术后恶心呕吐的发生率显著低于GA组(P <0.05)。结论:TTP-PECS阻滞联合羟考酮-丙泊酚减阿片药物全身麻醉可安全用于乳腺癌改良根治术中,术后镇痛效果确切,降低术后恶心呕吐发生率,并能提高患者早期恢复质量。

不同剂量丙泊酚靶控输注麻醉对内镜逆行性胰胆管造影联合内镜括约肌切开术下胆总管结石患者血流动力学镇痛及安全性的影响

目的探讨不同剂量丙泊酚靶控输注麻醉在内镜逆行性胰胆管造影(ERCP)联合内镜下括约肌切开术治疗胆总管结石的临床观察。方法2019年12月至2023年1月选取浙江省丽水市人民医院就诊的300例胆总管结石并行ERCP联合内镜下括约肌切开术的患者,按剂量将其分为低剂量丙泊酚(LP)组,中剂量丙泊酚(MP)组和高剂量丙泊酚(HP)组,每组100例,LP组、MP组、HP组均进行丙泊酚靶控输注,剂量分别为1μg/ml、3μg/ml、5μg/ml,观察并分析3组临床相关指标。结果T0、T1、T2、T3、T4、T5时LP组的平均动脉压(MAP)分别为(88±6)mmHg、(77±5)mmHg、(71±5)mmHg、(70±5)mmHg、(75±5)mmHg、(84±7)mmHg;MP组分别为(87±6)mmHg、(78±5)mmHg、(70±5)mmHg、(70±5)mmHg、(76±6)mmHg、(83±6)mmHg;HP组分别为(88±6)mmHg、(77±5)mmHg、(71±5)mmHg、(71±5)mmHg、(75±5)mmHg、(83±6)mmHg。T0、T1、T2、T3、T4、T5时LP组的心率分别为(78±6)次/min、(73±5)次/min、(67±5)次/min、(68±5)次/min、(71±6)次/min、(80±6)次/min;MP组分别为(78±6)次/min、(72±5)次/min、(68±5)次/min、(67±5)次/min、(71±6)次/min、(80±6)次/min;HP组分别为(78±6)次/min、(73±5)次/min、(67±5)次/min、(67±5)次/min、(72±6)次/min、(79±6)次/min。在T0时,3组MAP、心率水平、视觉模拟评分(VAS)对比差异无统计学意义(P>0.05),在T1、T2时,3组的MAP、心率均降低(P<0.05),但3组MAP、心率水平对比差异无统计学意义(P>0.05),T2与T3时3组MAP、心率水平对比差异无统计学意义(P>0.05),而在T4、T5时,3组MAP、心率水平均升高,但3组MAP、心率水平对比差异无统计学意义(P>0.05),组间与时间不存在相互作用(F=0.249,P=0.991)。T0、T1、T2、T3、T4、T5时LP组的VAS评分分别为(4.25±0.22)分、(2.34±0.15)分、(2.41±0.16)分、(2.38±0.14)分、(4.33±0.23)分、(5.21±0.26)分;MP组分别为(4.35±0.24)分、(1.85±0.14)分、(1.82±0.13)分、(1.84±0.12)分、(3.65±0.14)分、(4.78±0.21)分;HP组分别为(4.30±0.23)分、(1.36±0.11)分、(1.33±0.11)分、(1.37±0.12)分、(2.96±0.13)分、(3.55±0.18)分。T1、T2、T3时3组VAS评分降低(P<0.05),且与LP组相比,MP组降低(P<0.05),与MP组相比,HP组降低(P<0.05),T4、T5时3组VAS评分均升高,且LP组比MP组、HP组升高明显(P<0.05),组间与时间存在相互作用。与LP组相比,MP组手术时间、术中出血量、住院时间比较差异无统计学意义(P>0.05),与MP组对比,HP组手术时间、术中出血量、住院时间比较差异无统计学意义(P>0.05);与LP组相比,MP组呼吸恢复时间、苏醒时间、拔管时间比较差异无统计学意义(P>0.05),与MP组相比HP组呼吸恢复时间、苏醒时间、拔管时间比较差异无统计学意义(P>0.05)LP组、MP组、HP组恶心呕吐、呼吸抑制、高血压、心动过缓、谵妄不良反应发生率分别为21.0%、25.0%、30.0%,组间相比差异无统计学意义(χ^(2)=2.150,P>0.05)。结论低中高剂量丙泊酚既不会改变血流动力学,也不会延长苏醒时间,且高剂量丙泊酚镇痛效果更好,提示丙泊酚靶控输注麻醉在ERCP联合内镜下括约肌切开术治疗胆总管结石中具有满意效果,且安全性较高。

右美托咪定联合丙泊酚静脉麻醉在儿童肿瘤患者放射治疗中的安全性研究

目的评价右美托咪定联合丙泊酚在儿童肿瘤静脉麻醉放射治疗中的安全性。方法选取2016年10月~2022年5月在郑州市第三人民医院行静脉麻醉下放疗的82例儿童肿瘤患者,非插管静脉麻醉共1256次,采用随机数字表法分为丙泊酚麻醉组(P组)41例,静脉麻醉628次;右美托咪定联合丙泊酚麻醉组(D+P组)41例,静脉麻醉628次。观察比较两组患儿在不同麻醉方式下放疗前(麻醉前)、放疗后(麻醉后)呼吸频率、心率、氧饱和度的变化,计算丙泊酚给药次数、丙泊酚用量,计算患儿麻醉后入睡至放疗结束后清醒的时间间隔,并统计两组不良反应发生情况。结果P组与D+P组患儿放疗前后的心率、呼吸频率、氧饱和度差异无统计学意义(均P>0.05);两组患儿放疗前后心率和呼吸频率差异均无统计学意义(均P>0.05),两组患儿放疗前后氧饱和度差异有统计学意义(P<0.05)。两组麻醉苏醒时间差异无统计学意义(P>0.05),D+P组丙泊酚给药次数减少、用药剂量减少。P组不良反应发生率为63.41%,D+P组不良反应发生率为12.19%,两组比较差异有统计学意义(P<0.05)。结论丙泊酚及右美托咪定联合丙泊酚在儿童肿瘤静脉麻醉放疗过程中,安全性均较好,其中右美托咪定联合丙泊酚组麻醉苏醒时间未见明显延长,丙泊酚给药次数减少,用药剂量减少,不良反应小,值得临床推广应用。