目的探讨复合阿芬太尼时丙泊酚或环泊酚抑制人工流产术中体动反应的半数有效剂量。方法选择2021年10月-2022年4月在嘉兴市第二医院妇科手术中心行择期无痛人工流产术的患者,年龄18~35岁,体质量指数(body mass index,BMI)18~28kg/m^(2),...目的探讨复合阿芬太尼时丙泊酚或环泊酚抑制人工流产术中体动反应的半数有效剂量。方法选择2021年10月-2022年4月在嘉兴市第二医院妇科手术中心行择期无痛人工流产术的患者,年龄18~35岁,体质量指数(body mass index,BMI)18~28kg/m^(2),美国麻醉医师协会(American Society of Anesthesologists,ASA)分级为Ⅰ或Ⅱ级,胎儿年龄<10周,初次妊娠或无经阴道分娩史。采用随机数字表法将患者分为2组:丙泊酚组(P组)和环泊酚组(C组)。麻醉诱导时静脉注射阿芬太尼后给予改良序贯法设定剂量的丙泊酚或环泊酚,若术中患者出现肢体不自主运动并影响术者手术操作且需追加麻醉药物即判定为阳性反应,并且静脉追加丙泊酚或环泊酚0.5mg/kg或0.1mg/kg,下一例患者丙泊酚或环泊酚增加一个剂量梯度。反之则下一例患者丙泊酚或环泊酚减少一个剂量梯度,相邻患者的丙泊酚或环泊酚剂量梯度分别为0.5mg/kg和0.1mg/kg。采用Probit回归分析法计算丙泊酚和环泊酚的50%有效剂量(median effective dose,ED_(50))、95%有效剂量(95% effective dose,ED_(95))及相应的置信区间(confidence interval,CI)。结果P组丙泊酚抑制人工流产术中体动反应的ED_(50)(95%CI)为1.815(1.315~2.319)mg/kg,ED_(95)(95%CI)为2.901(2.368~6.447)mg/kg;C组环泊酚抑制体动反应的ED_(50)(95%CI)为0.381(0.279~0.484)mg/kg,ED_(95)(95%CI)为0.613(0.501~1.344)mg/kg,两者对应的等效比值为4.76(4.71~4.79)。结论复合阿芬太尼时环泊酚抑制人工流产术中体动反应的效价大于丙泊酚。展开更多
目的应用序贯法探讨丙泊酚或不同剂量瑞马唑仑对舒芬太尼抑制老年患者气管插管反应的半数有效剂量(50%effective dose,ED_(50))的影响。方法选择2022年10至12月在气管插管全身麻醉下接受择期手术的老年患者,美国麻醉医师协会(American S...目的应用序贯法探讨丙泊酚或不同剂量瑞马唑仑对舒芬太尼抑制老年患者气管插管反应的半数有效剂量(50%effective dose,ED_(50))的影响。方法选择2022年10至12月在气管插管全身麻醉下接受择期手术的老年患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ、Ⅱ级,年龄65~80岁,将患者采用随机数字表法分为4组:丙泊酚组(P组,诱导时给予丙泊酚2mg/kg)和瑞马唑仑组(R1、R2、R3组,诱导时分别静脉注射瑞马唑仑0.2、0.3、0.4mg/kg)。麻醉诱导时给予Dixon序贯法设定剂量的舒芬太尼后,静脉注射丙泊酚或相应剂量瑞马唑仑及顺式阿曲库铵0.15mg/kg,待4个成串刺激(train of four,TOF)计数为0时行气管插管。若气管插管反应阳性,则下一例患者舒芬太尼剂量提高1个浓度梯度,否则降低1个浓度梯度,各相邻浓度之间的比为1∶1.1,直至出现7个转折点终止研究。采用Probit回归分析计算舒芬太尼抑制老年患者气管插管反应ED_(50)和95%有效剂量(95%effective dose,ED_(95))以及相应的95%置信区间(confidenceinterval,CI)。记录所有患者低血压、心动过缓、注射痛等不良反应的发生情况。结果本研究共纳入老年患者113例,P、R1、R2、R3组分别24、28、30、31例。丙泊酚2mg/kg或0.2、0.3、0.4mg/kg瑞马唑仑时舒芬太尼抑制老年患者气管插管反应的ED_(50)和ED_(95)及相应95%CI分别为:P组ED_(50)为0.236μg/kg(95%CI:0.218~0.256),ED_(95)为0.266μg/kg(95%CI:0.250~0.398);R1组ED_(50)为0.284μg/kg(95%CI:0.265~0.309),ED_(95)为0.329μg/kg(95%CI:0.306~0.478);R2组ED_(50)为0.239μg/kg(95%CI:0.221~0.260),ED_(95)为0.282μg/kg(95%CI:0.261~0.415);R3组ED_(50)为0.198μg/kg(95%CI:0.182~0.211),ED_(95)为0.231μg/kg(95%CI:0.216~0.303)。与P组相比,R1、R2、R3组低血压、心动过缓、注射痛发生率较低(P<0.05)。R2组舒芬太尼ED_(50)与P组相类似,但低血压、注射痛发生率与P组相比较低。结论随着瑞马唑仑剂量的增加,舒芬太尼抑制老年患者气管插管反应的ED_(50)逐渐降低;在ED_(50)相近的情况下,瑞马唑仑相较于丙泊酚诱导的低血压、心动过缓、注射痛发生率更低,因而在老年患者气管插管全身麻醉中,使用瑞马唑仑诱导更具有优势。展开更多
Background Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim w...Background Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose （ED50） of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation. Methods Thirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon＇s up-and-down method. Patient＇s reaction score at laryngoscopy and an Observer＇s Assessment of Alertness/Sedation Scale （OAA/S） were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. ED50 of remifentanil was calculated by the modified Dixon up-and-down method, and the probit analysis was then used to confirm the results obtained from the modified Dixon＇s up-and-down method. In the patients who were scored as ＂accept＂, patient＇s OAA/S and reactJon scores at dJfferent observed points, JntubatJng conditJon score and patient＇s tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted. Results ED50 of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon＇s up-and-down method was （0.62±0.02） μg/kg. Using probit analysis, ED50 and ED95 of remifentanil were 0.63 μg/kg （95% CI, 0.54-0.70） and 0.83 μg/kg （95% CI, 0.73-2.59）, respectively. Nineteen patients who were scored as ＂accept＂ had an OAA/S of 〉15 and tolerated well laryngoscopy without significant discomfort or gagging. The mean intubating condition score was 1.8±0.8. The endotracheal tube was well tolerated. During awake laryngoscopy and intubation, blood pressure and heart rate were also kept stable. The postoperative follow up showed that no patient recalled discomfort and pain for airway manipulation. Conclusions When combined with midazolam 0.1 mg/kg and airway topical anesthesia, ED50 of remifentanil for successful awake laryngoscopy and Jntubation is 0.62 μg/kg in bolus followed by continuous infusJon of 0.062 μg·kg·min^-1. This sedation and analgesia regimen can provide patient safety and comfort, ensure adequate intubating conditions, maintain hemodynamic stability, and prevent negative recall of the airway procedure.展开更多
文摘目的探讨复合阿芬太尼时丙泊酚或环泊酚抑制人工流产术中体动反应的半数有效剂量。方法选择2021年10月-2022年4月在嘉兴市第二医院妇科手术中心行择期无痛人工流产术的患者,年龄18~35岁,体质量指数(body mass index,BMI)18~28kg/m^(2),美国麻醉医师协会(American Society of Anesthesologists,ASA)分级为Ⅰ或Ⅱ级,胎儿年龄<10周,初次妊娠或无经阴道分娩史。采用随机数字表法将患者分为2组:丙泊酚组(P组)和环泊酚组(C组)。麻醉诱导时静脉注射阿芬太尼后给予改良序贯法设定剂量的丙泊酚或环泊酚,若术中患者出现肢体不自主运动并影响术者手术操作且需追加麻醉药物即判定为阳性反应,并且静脉追加丙泊酚或环泊酚0.5mg/kg或0.1mg/kg,下一例患者丙泊酚或环泊酚增加一个剂量梯度。反之则下一例患者丙泊酚或环泊酚减少一个剂量梯度,相邻患者的丙泊酚或环泊酚剂量梯度分别为0.5mg/kg和0.1mg/kg。采用Probit回归分析法计算丙泊酚和环泊酚的50%有效剂量(median effective dose,ED_(50))、95%有效剂量(95% effective dose,ED_(95))及相应的置信区间(confidence interval,CI)。结果P组丙泊酚抑制人工流产术中体动反应的ED_(50)(95%CI)为1.815(1.315~2.319)mg/kg,ED_(95)(95%CI)为2.901(2.368~6.447)mg/kg;C组环泊酚抑制体动反应的ED_(50)(95%CI)为0.381(0.279~0.484)mg/kg,ED_(95)(95%CI)为0.613(0.501~1.344)mg/kg,两者对应的等效比值为4.76(4.71~4.79)。结论复合阿芬太尼时环泊酚抑制人工流产术中体动反应的效价大于丙泊酚。
文摘目的应用序贯法探讨丙泊酚或不同剂量瑞马唑仑对舒芬太尼抑制老年患者气管插管反应的半数有效剂量(50%effective dose,ED_(50))的影响。方法选择2022年10至12月在气管插管全身麻醉下接受择期手术的老年患者,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ、Ⅱ级,年龄65~80岁,将患者采用随机数字表法分为4组:丙泊酚组(P组,诱导时给予丙泊酚2mg/kg)和瑞马唑仑组(R1、R2、R3组,诱导时分别静脉注射瑞马唑仑0.2、0.3、0.4mg/kg)。麻醉诱导时给予Dixon序贯法设定剂量的舒芬太尼后,静脉注射丙泊酚或相应剂量瑞马唑仑及顺式阿曲库铵0.15mg/kg,待4个成串刺激(train of four,TOF)计数为0时行气管插管。若气管插管反应阳性,则下一例患者舒芬太尼剂量提高1个浓度梯度,否则降低1个浓度梯度,各相邻浓度之间的比为1∶1.1,直至出现7个转折点终止研究。采用Probit回归分析计算舒芬太尼抑制老年患者气管插管反应ED_(50)和95%有效剂量(95%effective dose,ED_(95))以及相应的95%置信区间(confidenceinterval,CI)。记录所有患者低血压、心动过缓、注射痛等不良反应的发生情况。结果本研究共纳入老年患者113例,P、R1、R2、R3组分别24、28、30、31例。丙泊酚2mg/kg或0.2、0.3、0.4mg/kg瑞马唑仑时舒芬太尼抑制老年患者气管插管反应的ED_(50)和ED_(95)及相应95%CI分别为:P组ED_(50)为0.236μg/kg(95%CI:0.218~0.256),ED_(95)为0.266μg/kg(95%CI:0.250~0.398);R1组ED_(50)为0.284μg/kg(95%CI:0.265~0.309),ED_(95)为0.329μg/kg(95%CI:0.306~0.478);R2组ED_(50)为0.239μg/kg(95%CI:0.221~0.260),ED_(95)为0.282μg/kg(95%CI:0.261~0.415);R3组ED_(50)为0.198μg/kg(95%CI:0.182~0.211),ED_(95)为0.231μg/kg(95%CI:0.216~0.303)。与P组相比,R1、R2、R3组低血压、心动过缓、注射痛发生率较低(P<0.05)。R2组舒芬太尼ED_(50)与P组相类似,但低血压、注射痛发生率与P组相比较低。结论随着瑞马唑仑剂量的增加,舒芬太尼抑制老年患者气管插管反应的ED_(50)逐渐降低;在ED_(50)相近的情况下,瑞马唑仑相较于丙泊酚诱导的低血压、心动过缓、注射痛发生率更低,因而在老年患者气管插管全身麻醉中,使用瑞马唑仑诱导更具有优势。
文摘Background Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose （ED50） of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation. Methods Thirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon＇s up-and-down method. Patient＇s reaction score at laryngoscopy and an Observer＇s Assessment of Alertness/Sedation Scale （OAA/S） were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. ED50 of remifentanil was calculated by the modified Dixon up-and-down method, and the probit analysis was then used to confirm the results obtained from the modified Dixon＇s up-and-down method. In the patients who were scored as ＂accept＂, patient＇s OAA/S and reactJon scores at dJfferent observed points, JntubatJng conditJon score and patient＇s tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted. Results ED50 of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon＇s up-and-down method was （0.62±0.02） μg/kg. Using probit analysis, ED50 and ED95 of remifentanil were 0.63 μg/kg （95% CI, 0.54-0.70） and 0.83 μg/kg （95% CI, 0.73-2.59）, respectively. Nineteen patients who were scored as ＂accept＂ had an OAA/S of 〉15 and tolerated well laryngoscopy without significant discomfort or gagging. The mean intubating condition score was 1.8±0.8. The endotracheal tube was well tolerated. During awake laryngoscopy and intubation, blood pressure and heart rate were also kept stable. The postoperative follow up showed that no patient recalled discomfort and pain for airway manipulation. Conclusions When combined with midazolam 0.1 mg/kg and airway topical anesthesia, ED50 of remifentanil for successful awake laryngoscopy and Jntubation is 0.62 μg/kg in bolus followed by continuous infusJon of 0.062 μg·kg·min^-1. This sedation and analgesia regimen can provide patient safety and comfort, ensure adequate intubating conditions, maintain hemodynamic stability, and prevent negative recall of the airway procedure.
