Several methods have been suggested to decrease bleeding during surgery, one of which is the usage of hypotensive anesthetic agents. Endoscopic Sinus Surgery (ESS) is one of the surgeries which need a clear field and ...Several methods have been suggested to decrease bleeding during surgery, one of which is the usage of hypotensive anesthetic agents. Endoscopic Sinus Surgery (ESS) is one of the surgeries which need a clear field and the amount of bleeding profoundly impacts the ability of surgeons. Current study was designed to evaluate the effect of remifentanil combined with propofol versus Isoflurane on blood loss during ESS and its possible interaction with Depth of Anesthesia. Fifty one patients comprising 15 females and 36 males undergoing ESS were chosen for this study. One group received propofol and remifentanil to induce and maintain anesthesia and the second group received Isoflurane. Mean Arterial Blood Pressure (MAP), Depth of Anesthesia and total blood loss were recorded for the patients of both group. Data were analyzed using t-test, Repeated Measures ANOVA and Pearson’s correlation. P 0.05 was considered statistically significant. Both agents induced hypotension during surgery. No significant difference was observed in total blood loss between two groups. DA was decreased in both groups, but no significant correlation was found between DA and MAP or DA and blood loss. There is no significant difference between remifentanil combined with propofol and Isoflurane in decreasing blood loss during ESS, thus we suggest usage of hypotensive anesthetic agent regardless of its type is ESS.展开更多
目的探讨静脉输注右美托咪定(Dex)联合靶控输注瑞芬太尼在老年患者经内镜逆行胰胆管造影术(ERCP)麻醉中的安全性及可行性。方法选择2021年1月至8月择期监测麻醉(MAC)下行ERCP的老年患者(年龄≥65岁)98例,随机分为丙泊酚-瑞芬太尼(TRP)组...目的探讨静脉输注右美托咪定(Dex)联合靶控输注瑞芬太尼在老年患者经内镜逆行胰胆管造影术(ERCP)麻醉中的安全性及可行性。方法选择2021年1月至8月择期监测麻醉(MAC)下行ERCP的老年患者(年龄≥65岁)98例,随机分为丙泊酚-瑞芬太尼(TRP)组和Dex-瑞芬太尼(TRD)组。TRP组患者麻醉采用靶控输注丙泊酚-瑞芬太尼,TRD组患者麻醉采用静脉输注Dex联合靶控输注瑞芬太尼,2组均采用非气管插管的MAC麻醉。观察并记录患者在麻醉诱导前(T0)、麻醉诱导后即刻(T_(1))、进镜时(T_(2))、十二指肠乳头插管时(T_(3))、退镜时(T_(4))、留置鼻胆管结束时(T_(5))平均动脉压(MAP)、心率(HR)、脉博氧饱和度(SpO_(2))、呼吸频率(RR)、脑电双频指数(BIS)。于不同时点(术前、麻醉诱导后每隔15 min和苏醒即刻)采动脉血行血气分析,记录动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、瑞芬太尼靶控输注浓度、手术时间、苏醒时间(停止输注瑞芬太尼至意识恢复时间)、麻醉恢复时间(意识恢复至离开手术室时间)、术中体动、离室Aldrete评分、术后60 min VAS评分、术后不良反应,以及麻醉医生、内镜医生和患者的满意度。结果2组患者的年龄、性别、BMI、ASA分级等一般资料均无统计学差异(P>0.05)。与TRP组比较,TRD组MAP在T_(1)和T_(3)时点增高(P<0.05),HR在T_(1)、T_(2)、T_(3)、T_(4)时点降低,SpO_(2)、RR在T_(1)、T_(2)、T_(3)、T_(4)时点增高,BIS在T_(2)、T_(3)、T_(4)、T_(5)时点增高,托下颌次数和低氧血症发生率降低,离室Aldrete评分增高,术后60 min VAS评分降低,麻醉医生、内镜医生及患者满意度增高,差异均有统计学意义(均P<0.05)。2组患者各时点PaO_(2)、PaCO_(2)、靶控输注瑞芬太尼浓度、手术时间、苏醒时间、麻醉恢复时间、术后不良反应发生率无统计学差异。结论与靶控输注丙泊酚-瑞芬太尼相比,静脉输注Dex联合靶控输注瑞芬太尼可降低老年患者在ERCP手术中低氧血症的发生率,麻醉方案能够满足ERCP手术的麻醉需求,安全可行。展开更多
文摘Several methods have been suggested to decrease bleeding during surgery, one of which is the usage of hypotensive anesthetic agents. Endoscopic Sinus Surgery (ESS) is one of the surgeries which need a clear field and the amount of bleeding profoundly impacts the ability of surgeons. Current study was designed to evaluate the effect of remifentanil combined with propofol versus Isoflurane on blood loss during ESS and its possible interaction with Depth of Anesthesia. Fifty one patients comprising 15 females and 36 males undergoing ESS were chosen for this study. One group received propofol and remifentanil to induce and maintain anesthesia and the second group received Isoflurane. Mean Arterial Blood Pressure (MAP), Depth of Anesthesia and total blood loss were recorded for the patients of both group. Data were analyzed using t-test, Repeated Measures ANOVA and Pearson’s correlation. P 0.05 was considered statistically significant. Both agents induced hypotension during surgery. No significant difference was observed in total blood loss between two groups. DA was decreased in both groups, but no significant correlation was found between DA and MAP or DA and blood loss. There is no significant difference between remifentanil combined with propofol and Isoflurane in decreasing blood loss during ESS, thus we suggest usage of hypotensive anesthetic agent regardless of its type is ESS.
文摘目的探讨静脉输注右美托咪定(Dex)联合靶控输注瑞芬太尼在老年患者经内镜逆行胰胆管造影术(ERCP)麻醉中的安全性及可行性。方法选择2021年1月至8月择期监测麻醉(MAC)下行ERCP的老年患者(年龄≥65岁)98例,随机分为丙泊酚-瑞芬太尼(TRP)组和Dex-瑞芬太尼(TRD)组。TRP组患者麻醉采用靶控输注丙泊酚-瑞芬太尼,TRD组患者麻醉采用静脉输注Dex联合靶控输注瑞芬太尼,2组均采用非气管插管的MAC麻醉。观察并记录患者在麻醉诱导前(T0)、麻醉诱导后即刻(T_(1))、进镜时(T_(2))、十二指肠乳头插管时(T_(3))、退镜时(T_(4))、留置鼻胆管结束时(T_(5))平均动脉压(MAP)、心率(HR)、脉博氧饱和度(SpO_(2))、呼吸频率(RR)、脑电双频指数(BIS)。于不同时点(术前、麻醉诱导后每隔15 min和苏醒即刻)采动脉血行血气分析,记录动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、瑞芬太尼靶控输注浓度、手术时间、苏醒时间(停止输注瑞芬太尼至意识恢复时间)、麻醉恢复时间(意识恢复至离开手术室时间)、术中体动、离室Aldrete评分、术后60 min VAS评分、术后不良反应,以及麻醉医生、内镜医生和患者的满意度。结果2组患者的年龄、性别、BMI、ASA分级等一般资料均无统计学差异(P>0.05)。与TRP组比较,TRD组MAP在T_(1)和T_(3)时点增高(P<0.05),HR在T_(1)、T_(2)、T_(3)、T_(4)时点降低,SpO_(2)、RR在T_(1)、T_(2)、T_(3)、T_(4)时点增高,BIS在T_(2)、T_(3)、T_(4)、T_(5)时点增高,托下颌次数和低氧血症发生率降低,离室Aldrete评分增高,术后60 min VAS评分降低,麻醉医生、内镜医生及患者满意度增高,差异均有统计学意义(均P<0.05)。2组患者各时点PaO_(2)、PaCO_(2)、靶控输注瑞芬太尼浓度、手术时间、苏醒时间、麻醉恢复时间、术后不良反应发生率无统计学差异。结论与靶控输注丙泊酚-瑞芬太尼相比,静脉输注Dex联合靶控输注瑞芬太尼可降低老年患者在ERCP手术中低氧血症的发生率,麻醉方案能够满足ERCP手术的麻醉需求,安全可行。
