目的研究靶控输注瑞芬太尼用于无痛膀胱镜检查的可行性和安全性。方法将30位择期行膀胱镜检查患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级,分为2组(L和H组),2组均无术前用药。常规监护后进行效应室靶控...目的研究靶控输注瑞芬太尼用于无痛膀胱镜检查的可行性和安全性。方法将30位择期行膀胱镜检查患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级,分为2组(L和H组),2组均无术前用药。常规监护后进行效应室靶控输注瑞芬太尼,L组浓度为2μg/L,H组浓度为4μg/L,待到达靶浓度后开始手术操作。术中患者主诉疼痛或出现体动时以1μg/L为单位提高瑞芬太尼靶浓度,最高不超过6μg/L。若脉搏血氧饱和度低于90%则给予面罩加压给氧。在麻醉中观察并记录无创血压、心率、脉搏血氧饱和度、视觉模拟评分(visual analogue score,VAS)、脑电双频指数(bispectral index,BIS)、合并症发生率(呼吸抑制、血压下降、恶心、呕吐、咳嗽和躁动)以及瑞芬太尼用药总量、追加次数、最高靶浓度,并在2组间进行比较。结果 2组患者VAS评分均可达2～4分,L和H组平均BIS值分别为89±10和86±13(P>0.05)。2组患者靶控至预定浓度后血压有明显下降,进镜时收缩压、心率与入室时比较差异无统计学意义(P>0.05),L组与H组辅助呼吸发生率为2/15和8/15(P=0.02)。L和H组术中轻微体动的发生率分别为5/15和1/15(P=0.08)。瑞芬太尼总用药量分别为(125.5±77.7)μg和(242.5±72.6)μg。结论本实验中靶控输注瑞芬太尼,对于膀胱镜检能达到足够的麻醉深度,具有安全性和可行性。靶浓度为2～4μg/L时可提供适合的镇痛强度,同时能够减少不良反应。展开更多
Background:Awake craniotomy(AC)has become gold standard in surgical resection of gliomas located in eloquent areas.The conscious sedation techniques in AC include both monitored anesthesia care(MAC)and asleep-awake-as...Background:Awake craniotomy(AC)has become gold standard in surgical resection of gliomas located in eloquent areas.The conscious sedation techniques in AC include both monitored anesthesia care(MAC)and asleep-awake-asleep(AAA).The choice of optimal anesthetic method depends on the preferences of the surgical team(mainly anesthesiologist and neurosurgeon).The aim of this study was to compare the difference in physiological and blood gas data,dosage of different drugs,the probability of switching to endotracheal intubation,and extent of tumor resection and dysfunction after operation between AAA and MAC anesthetic management for resection of gliomas in eloquent brain areas.Methods:Two-hundred and twenty-five patients with super-tentorial tumor located in eloquent areas underwent AC from 2009 to 2021 in Xijing Hospital.Forty-one patients underwent AAA technique,and the rest one-hundred eighty-four patients underwent MAC technique.Anesthetic management,dosage of different drugs,intraoperative complications,postoperative outcomes,adverse events,extent of resection and motor,and sensory and language dysfunction after operation were compared between MAC and AAA.Result:There was no significant difference in gender,KPS score,MMSE score,glioma grade,type,and growth site between the patients in the two groups,except the older age of patients in MAC group than that in AAA group.During the whole process of operation,there were greater pulse pressure difference(P=0.046),shorter operation time(P=0.039),less dosage of remifentanil(P=0.000),more dosage of dexmedetomidine(P=0.013),more use of antiemetics(81%,P=0.0067),lower use of vasoactive agent(45.1%,P=0.010),and lower probability of conversion to general anesthesia(GA,P=0.027)in MAC group than that in AAA group.Blood gas analysis showed that PetCO2(P=0.000),Glu concentration(P=0.000),and PaCO2(P=0.000)were higher,but SPO2(P=0.002)and PaO2(P=0.000)were lower in MAC group than that in AAA group.In the postoperative recovery stage,compared with that of AAA group,the probability of dysfunction in MAC group at 1,3,5,and 7 days after operation was lower,which were 27.8%vs 53.6%(P=0.003),31%vs 68.3%(P=0.000),28.8%vs 63.4%(P=0.000),and 25.6%vs 58.5%(P=0.000),respectively.Conclusion:Compared with AAA,it seems that MAC has more advantages in the management for resection of gliomas in eloquent brain areas,and MAC combined with multiple monitoring such as cerebral cortical mapping,neuronavigation,and ultrasonic detection is worthy of popularization for the resection of gliomas in eloquent brain areas.展开更多
文摘目的研究靶控输注瑞芬太尼用于无痛膀胱镜检查的可行性和安全性。方法将30位择期行膀胱镜检查患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ～Ⅱ级,分为2组(L和H组),2组均无术前用药。常规监护后进行效应室靶控输注瑞芬太尼,L组浓度为2μg/L,H组浓度为4μg/L,待到达靶浓度后开始手术操作。术中患者主诉疼痛或出现体动时以1μg/L为单位提高瑞芬太尼靶浓度,最高不超过6μg/L。若脉搏血氧饱和度低于90%则给予面罩加压给氧。在麻醉中观察并记录无创血压、心率、脉搏血氧饱和度、视觉模拟评分(visual analogue score,VAS)、脑电双频指数(bispectral index,BIS)、合并症发生率(呼吸抑制、血压下降、恶心、呕吐、咳嗽和躁动)以及瑞芬太尼用药总量、追加次数、最高靶浓度,并在2组间进行比较。结果 2组患者VAS评分均可达2～4分,L和H组平均BIS值分别为89±10和86±13(P>0.05)。2组患者靶控至预定浓度后血压有明显下降,进镜时收缩压、心率与入室时比较差异无统计学意义(P>0.05),L组与H组辅助呼吸发生率为2/15和8/15(P=0.02)。L和H组术中轻微体动的发生率分别为5/15和1/15(P=0.08)。瑞芬太尼总用药量分别为(125.5±77.7)μg和(242.5±72.6)μg。结论本实验中靶控输注瑞芬太尼,对于膀胱镜检能达到足够的麻醉深度,具有安全性和可行性。靶浓度为2～4μg/L时可提供适合的镇痛强度,同时能够减少不良反应。
基金funded by multidisciplinary MDT diagnosis and treatment fund for glioma and academic discipline boosting of Xijing Hospital.
文摘Background:Awake craniotomy(AC)has become gold standard in surgical resection of gliomas located in eloquent areas.The conscious sedation techniques in AC include both monitored anesthesia care(MAC)and asleep-awake-asleep(AAA).The choice of optimal anesthetic method depends on the preferences of the surgical team(mainly anesthesiologist and neurosurgeon).The aim of this study was to compare the difference in physiological and blood gas data,dosage of different drugs,the probability of switching to endotracheal intubation,and extent of tumor resection and dysfunction after operation between AAA and MAC anesthetic management for resection of gliomas in eloquent brain areas.Methods:Two-hundred and twenty-five patients with super-tentorial tumor located in eloquent areas underwent AC from 2009 to 2021 in Xijing Hospital.Forty-one patients underwent AAA technique,and the rest one-hundred eighty-four patients underwent MAC technique.Anesthetic management,dosage of different drugs,intraoperative complications,postoperative outcomes,adverse events,extent of resection and motor,and sensory and language dysfunction after operation were compared between MAC and AAA.Result:There was no significant difference in gender,KPS score,MMSE score,glioma grade,type,and growth site between the patients in the two groups,except the older age of patients in MAC group than that in AAA group.During the whole process of operation,there were greater pulse pressure difference(P=0.046),shorter operation time(P=0.039),less dosage of remifentanil(P=0.000),more dosage of dexmedetomidine(P=0.013),more use of antiemetics(81%,P=0.0067),lower use of vasoactive agent(45.1%,P=0.010),and lower probability of conversion to general anesthesia(GA,P=0.027)in MAC group than that in AAA group.Blood gas analysis showed that PetCO2(P=0.000),Glu concentration(P=0.000),and PaCO2(P=0.000)were higher,but SPO2(P=0.002)and PaO2(P=0.000)were lower in MAC group than that in AAA group.In the postoperative recovery stage,compared with that of AAA group,the probability of dysfunction in MAC group at 1,3,5,and 7 days after operation was lower,which were 27.8%vs 53.6%(P=0.003),31%vs 68.3%(P=0.000),28.8%vs 63.4%(P=0.000),and 25.6%vs 58.5%(P=0.000),respectively.Conclusion:Compared with AAA,it seems that MAC has more advantages in the management for resection of gliomas in eloquent brain areas,and MAC combined with multiple monitoring such as cerebral cortical mapping,neuronavigation,and ultrasonic detection is worthy of popularization for the resection of gliomas in eloquent brain areas.
