Propofol sedation in routine endoscopy:A case series comparing target controlled infusion vs manually controlled bolus concept

BACKGROUND Many studies have addressed safety and effectiveness of non-anaesthesiologist propofol sedation(NAPS)for gastrointestinal(GI)endoscopy Target controlled infusion(TCI)is claimed to provide an optimal sedation regimen by avoiding under-or oversedation.AIM To assess safety and performance of propofol TCI sedation in comparison with nurse-administered bolus-sedation.METHODS Fouty-five patients undergoing endoscopy under TCI propofol sedation were prospectively included from November 2016 to May 2017 and compared to 87 patients retrospectively included that underwent endoscopy with NAPS.Patients were matched for age and endoscopic procedure.We recorded time of sedation and endoscopy,dosage of medication and adverse events.RESULTS There was a significant reduction in dose per time of propofol administered in the TCI group,compared to the NAPS group(8.2±2.7 mg/min vs 9.3±3.4 mg/min;P=0.046).The time needed to provide adequate sedation levels was slightly but significantly lower in the control group(5.3±2.7 min vs 7.7±3.3 min;P<0.001),nonetheless the total endoscopy time was similar in both groups.No differences between TCI and bolus-sedation was observed for mean total-dosage of propofol rate as well as adverse events.CONCLUSION This study indicates that sedation using TCI for GI endoscopy reduces the dose of propofol necessary per minute of endoscopy.This may translate into less adverse events.However,further and randomized trials need to confirm this trend.

Propofol Target-Controlled Infusion Modeling in Rabbits:Pharmacokinetic and Pharmacodynamic Analysis

This study aimed to establish a new propofol target-controlled infusion（TCI） model in animals so as to study the general anesthetic mechanism at multi-levels in vivo. Twenty Japanese white rabbits were enrolled and propofol（10 mg/kg） was administrated intravenously. Artery blood samples were collected at various time points after injection, and plasma concentrations of propofol were measured. Pharmacokinetic modeling was performed using Win Nonlin software. Propofol TCI within the acquired parameters integrated was conducted to achieve different anesthetic depths in rabbits, monitored by narcotrend. The pharmacodynamics was analyzed using a sigmoidal inhibitory maximal effect model for narcotrend index（NI） versus effect-site concentration. The results showed the pharmacokinetics of propofol in Japanese white rabbits was best described by a two-compartment model. The target plasma concentrations of propofol required at light anesthetic depth was 9.77±0.23 μg/m L, while 12.52±0.69 μg/m L at deep anesthetic depth. NI was 76.17±4.25 at light anesthetic depth, while 27.41±5.77 at deep anesthetic depth. The effect-site elimination rate constant（ke0） was 0.263/min, and the propofol dose required to achieve a 50% decrease in the NI value from baseline was 11.19 μg/m L（95% CI, 10.25–13.67）. Our results established a new propofol TCI animal model and proved the model controlled the anesthetic depth accurately and stably in rabbits. The study provides a powerful method for exploring general anesthetic mechanisms at different anesthetic depths in vivo.

Clinical evaluation of target controlled infusion system for sufentanil administration

Background Sufentanil target controlled infusion （TCI） provides stable analgesia, better hemodynamic control than a bolus injection of intravenous anesthetics, anticipated recovery and improved quality of anesthesia during perioperative period. This study evaluated the accuracy and feasibility of TCI system for sufentanil at high concentrations in Chinese surgical patients. Methods Twelve low risk adult patients undergoing elective surgery under general anesthesia were included in this study. Sufentanil was administered with a specific TCI system incorporating the population pharmacokinetic data of sufentanil previously reported, using a target effect-site concentration of sufentanil 4 or 6 ng/ml. Sufentanil TCI duration was 30 minutes. Frequent arterial blood samples were taken during and up to 24 hours after sufentanil TCI for determination of plasma sufentanil concentrations by liquid chromatography-mass spectrometry/mass spectrometry. The changes of circulatory system function during the procedure, recovery profile and adverse effects were recorded. Measured plasma sufentanil concentrations were compared with the values predicted by the TCI system. The bias （median performance error, MDPE）, precision （median absolute performance error, MDAPE） and wobble （variability of performance error） of the sufentanil TCI system were determined. Results All patients had stable cardiovascular variables during induction and maintenance of anesthesia. Time to eye opening and extubation were （5.6±1.7） minutes when TCI set to 4 ng/ml and （7.2±2.3） minutes when set to 6 ng/ml. There was no episode of agitation, muscle rigidity or intraoperative awareness. The bias （MDPE）, precision （MDAPE） and wobble of the sufentanil TCI system were -3.7%, 18.9% and 19.6% respectively during TCI, and the MDPE, MDAPE and wobble were -29.1%, 31.7% and 15.0% respectively after TCI （up to 8 hours）. Conclusions The TCI system programmed for sufentanil at 4 or 6 ng/ml was considered acceptable for clinical use in low risk Chinese surgical patients. But the relatively larger MDPE and MDAPE after TCI suggest improvements of the Dharmacokinetic model are needed.

Two-stage analysis of pharmacokinetics of sufentanil administered by target-controlled infusion in Chinese patients

Background Sufentanil is a suitable choice for target-controlled infusion （TCI） because of its shorter context-sensitive half-time. The current study was to estimate the pharmacokinetics of sufentanil TCI in Chinese patients using the two-stage analysis. Methods Twelve adult patients with American Society of Anesthesiologists （ASA） physical status I or II undergoing elective surgery under general anesthesia were included. Anesthesia was induced with propofol, rocuronium and sufentanil administered by TCI lasting for 30 minutes, with target effect-site concentration of sufentanil 4 or 6 ng/ml. Frequent arterial blood samples （1.5 ml） were taken during and up to 24 hours after sufentanil TCI. Before the end of surgery, another arterial blood sample （1.0 ml） was drawn for the blood-gas analysis. Plasma sufentanil concentrations were determined by liquid chromatography-tandem mass spectrometry （limit of quantitation was 5 pg/ml）. The data were analyzed with the two-stage approach, linear regression and correlation analysis. Results The pharmacokinetics of sufentanil TCI were adequately described by a three-compartment model. The variables were derived as follows： the volume of central compartment （V1） was 5.4 L, volume of distribution at steady-state （Vdss） was 222.6 L, metabolic clearance （CI1） was 0.84 L/min and elimination half-life （t~/2y） was 389 minutes. Patients＇ age, gender and PaCO2 correlated significantly with the pharmacokinetic parameters. The Vdss, volume of slowly equilibrating compartment （V3） and t1/2 y increased, and rapid distribution clearance （012） decreased with increasing patient age. Male patients had larger values of Vdss, volume of rapidly equilibrating compartment （V2） and V3 than female patients. The Vdss and V3 increased with higher PaCO2 values. There were no significant correlations between the pharmacokinetic variables and body weight, height, lean body mass, plasma albumin, sufentanil dose, duration of surgery, pH or base excess of blood （BE-B）. Conclusions The pharmacokinetics of sufentanil TCI in Chinese patients can be optimally described by a three-compartment model. The pharmacokinetic analysis technique may affect the pharmacokinetic parameters and correlations.

Pharmacokinetics of sufentanil administered by target-controlled infusion in Chinese surgical patients

Background Target-controlled infusion （TCI） has been recently developed and successfully implemented in clinical practice. This study was conducted to determine the pharmacokinetics of TCI administered sufentanil in Chinese surgical patients. Methods The pharmacokinetics of sufentanil was investigated in 12 adult patients, aged 23-76 years, scheduled for prolonged surgery under general anesthesia. Anesthetic induction was carried out with propofol, rocuronium and TCI administered sufentanil aiming for target effect-site concentration of sufentanil 4 or 6 ng/ml. Sufentanil TCI lasted for 30 minutes. Frequent arterial blood samples （1.5 ml） were drawn during and up to 24 hours after sufentanil TCI. Plasma sufentanil concentrations were measured by liquid chromatography-tandem mass spectrometry; limit of sensitivity of mass spectrometry was 5 pg/ml. The data were analyzed with the nonlinear mixed-effect model program. Results The pharmacokinetics of TCI administered sufentanil were optimally described by a three-compartment model with the following parameters： the central volume of distribution （V1） = 5.4 L, the volume of distribution at steady-state （Vdss） = 195.4 L, systemic clearance （CI1） = 1.10 L/min, and elimination half-life （t1/2 Y） = 271.8 minutes. Both age and gender affected the pharmacokinetic parameters. The rapid distribution clearance （012） was negatively correlated with patient age, and the volume of slowly equilibrating compartment （V3） was positively correlated with age. The Cl2 and the volume of rapidly equilibrating compartment （V2） were influenced by gender with male patients showing higher values of Cl2 and V2 than female patients. There was no relationship of body weight, lean body mass, plasma albumin, or target effect-site concentration of sufentanil with any of the pharmacokinetic parameters studied. Conclusions The pharmacokinetics of TCI administered sufentanil in Chinese patients can be adequately described by a three-compartment model. Pharmacokinetics adjusted to the individual patient should improve the accuracy of TCI systems.

Relationship between depth of anesthesia and effect-site concentration of propofol during induction with the target-controlled infusion technique in elderly patients

Background There are few studies to assess whether the effect-site concentration of propofol can predict anesthetic depth during the target-controlled infusion （TCI） induction in elderly patients. This study aimed to evaluate the relationship between effect-site concentration of propofol and depth of anesthesia during the TCI induction in elderly patients. Methods Ninety patients （60-80 years） with an American Society of Anesthesiologists （ASA） physical status of 1-3, undergoing scheduled abdominal and thoracic surgery under general anesthesia were randomly allocated into one of three groups, Group S1, S2 and S3 （30 patients in each group）. The patients in Group S1 received propofol with a target plasma concentration of 4.0 pg/ml; patients in Group S2 received propofol with an initial target plasma concentrations of 2.0 IJg/ml that was raised to 4.0 pg/ml 3 minutes later; patients in Group S3 received an infused scheme of 3 steps; starting from a target plasma concentration of 2.0 pg/ml that was increased stepwised by 1 pg/ml until a target plasma concentration of 4.0 pg/ml was achieved, the interval between the two steps was 3 minutes. When an Observer＇s Assessment of Alertness/Sedation （OANS） score of 1 was achieved, remifentanil （effect-site concentration （Ce） of 4.0 ng/ml） and rocuronium 0.9 mg/kg were administered. Tracheal intubation was started 2 minutes after rocuronium injection. Changes of propofol Ce, blood pressure （BP）, heart rate （HR）, and bispectral index （BIS） were recorded. Results When an OAA/S score of 1 was achieved, Ce of propofol were （1.7±0.4） pg/ml, （1.9±0.3） pg/ml, （1.9±0.4） pg/ml and the BIS values were 64±5, 65±8, and 62±8 in Groups S1, S2 and S3. Before intubation, Ce of propofol was （2.8±0.2） pg/ml, （2.8±0.3） pg/ml, （2.7±0.3） pg/ml, and the BIS values were 48±7, 51±7, and 47±5 in Groups S1, S2 and S3. By linear regression analysis, a significant correlation between Ce of propofol and BIS values was found （r=-0.580, P 〈0.01）. Systolic blood pressure （SBP） before intubation was significantly lower in Group S1 than in Groups S2 and S3. SBP and HR after intubation in the three groups were significantly increased when compared with pre-intubation values, but they did not exceed baseline values Conclusions During the TCI induction, Ce of propofol with （1.9±0.3） pg/ml may make the elderly patients unconscious. When remifentanil with a Ce of 4.0 ng/ml is added a Ce of propofol with （2.8±0.3） pg/ml is suitable for intubation. The Ce of propofol has a close correlation with the BIS values. Also, a two-step TCI technique seems to be a more suitable method of anesthesia induction in elderly patients compared with the no-stepwise TCI technique and three-step TCI technique.

Comparison of C50 for Propofol-remifentanil Target-controlled Infusion and Bispectral Index at Loss of Consciousness and Response to Painful Stimulus in Elderly and Young Patients

Background：In this prospective randomized study,we compared the predicted blood and effect-site C50 for propofol and remifentanil target-controlled infusion （TCI） and the bispectral index （BIS） values at loss of consciousness （LOC） and response to a standard noxious painful stimulus （LOS） in elderly and young patients,respectively.We hypothesized that the elderly patients will require lower target concentration of both propofol and remifentanil at above two clinical end-points.Methods：There were 80 American Society of Anesthesiologists （ASA） physical status Ⅰ Ⅱ unpremedicated patients enrolled in this study,they were divided into elderly group （age ≥65 years,n =40） and young group （aged 18-54 years,n =40）.Propofol was initially given to a predicted blood concentration of 1.2 μg/ml and thereafter increased by 0.3 μg/ml every 30 s until Observer＇s Assessment of Alertness and Sedation score was 1.The propofol level was kept constant,and remifentanil was given to provide a predict blood concentration of 2.0 ng/ml,and then increased by 0.3 ng/ml every 30 s until loss of response to a tetanic stimulus.BIS （version 3.22,BIS Quattro sensor） was also recorded.Results：In elderly group,the propofol effect-site C50 at LOC of was 1.5 （1.4-1.6） μg/ml,was significantly lower than that of young group,which was 2.2 （2.1-2.3） μg/ml,the remifentanil effect-site C50 at LOS was 3.5 （3.3-3.7） ng/ml in elderly patients,was similar with 3.7 （3.6-3.8） ng/ml in young patients.Fifty percent of patients lost consciousness at a BIS value of 57.3 （56.4-58.1）,was similar with that of young group,which was 55.2 （54.0-56.3）.Conclusion：In elderly patients,the predicted blood and effect-site concentrations of propofol at LOC were lower than that of young patients.At same sedation status,predicted blood and effect-site concentrations of remifentanil required at LOS were similar in elderly and young patients.BIS were not affected by age.Low-propofol/high-opioid may be optional TCI strategy for elderly patients.

Concentrations of propofol in cerebral spinal fluid: target-controlled infusion

Background Although the performance of target-controlled infusion (TCI) have been studied extensively, the accuracy and safety of a TCI system that targets the effect site remains to be demonstrated. This study was to investigate the relations of TCI of propofol to its concentrations in cerebral spinal fluid (CSF), the effect-site concentrations and bispectral index (BIS).Methods Twelve mongrel dogs were used for investigations. The target effect-site concentration was set at 3μg/ml and the infusion was lasted for 15 minutes. CSF and blood samples were then collected and propofol concentrations were determined by using high performance liquid chromatography with fluorescence detection. BIS and hemodynamic data were monitored continuously.Results The predicted plasma concentrations were generally overestimated. Median performance error (MDPE) and absolute median performance error (MDAPE) were -10.0% and 29.9% respectively. Propofol CSF concentrations were much lower than its effect-site concentrations. Changes in BIS were consistent with propofol concentrations in CSF, both of which changed direction at 5 minutes while the effect-site concentrations relatively lagged behind. Better correlation ( r2 = 0. 9195) was found between BIS and CSF concentrations, when compared with that between BIS and effect-site concentrations (r2=0. 554).Conclusion With 1% enflurane inhaled, the inconsistency of drug effect to the effect-site concentrations may result from inaccuracy of pharmacokinetic parameters. CSF may show effect-site concentrations more accurately than plasma when using target effect-site concentration infusion.

急性高容量血液稀释(AHHD)对靶控输注(TCI)不同溶剂丙泊酚血药浓度的影响

目的 观察急性高容量血液稀释（acute hypervolemic hemodilution,AHHD）对靶控输注（target controlled infusion,TCI）不同溶剂丙泊酚血药浓度及脑电双频指数（bispectral index,BIS）的影响,以指导血液稀释期间麻醉药丙泊酚的使用。方法 40例ASA Ⅰ～Ⅱ级择期手术患者随机分为4组：长链丙泊酚稀释组（LH组）与未稀释组（L组）,中长链丙泊酚稀释组（MH组）与未稀释组（M组）,每组10例。全程使用丙泊酚TCI静脉麻醉,以血浆靶浓度4 μg/mL进行诱导气管插管,插管后即刻降至3 μg/mL持续输注。在3 μg/mL丙泊酚TCI 10 min时,LH和MH组以15 mL/kg输注羟乙基淀粉130/0.4氯化纳注射液实施血液稀释,L和M组输注乳酸林格氏液。于术前（T0）、3 μg/mL丙泊酚输注10 min （T1）、70 min （T2）、90 min （T3）时,采集动脉血,测定血球压积（hematocrit,Hct）,用HPLC法测定丙泊酚浓度,同时观察BIS的变化。结果 T2、T3与T0相比较,LH组Hct值分别降低25.6%、28.2%,MH组Hct值分别降低28.9%、28.2%。T2、T3时LH、MH组丙泊酚血药浓度分别为1.80、1.78 μg/mL和1.84、1.76 μg/mL,均明显低于靶控浓度3 μg/mL （P〈0.05）。稀释组丙泊酚血药浓度明显低于未稀释组（P〈0.05）。LH、MH组在T2、T3时的BIS值分别为49.89、49.55和49.66、49.33,较L、M组的41.89、41.22和40.55、40.67明显升高（P〈0.01）。不同溶剂丙泊酚间的血药浓度无明显差异。结论 AHHD后丙泊酚的血药浓度较TCI设定值明显下降,且BIS值有所上升,因此为了维持麻醉深度可能需要增加丙泊酚剂量,且两种不同溶剂丙泊酚间没有差异。

靶控输注不同浓度舒芬太尼对丙泊酚TCI镇静催眠的影响

目的在麻醉诱导期观察靶控输注(TCI)不同浓度舒芬太尼对丙泊酚镇静催眠效应的影响。方法 60例择期手术全麻患者,年龄25～60岁,ASAⅠ～Ⅱ级。随机分为4组,每组15例。A组为单纯丙泊酚组;B、C、D组为丙泊酚+舒芬太尼组,舒芬太尼的靶效应浓度分别为0.1、0.2、0.3ng/ml。B、C、D组在TCI舒芬太尼达平衡后,TCI丙泊酚。记录舒芬太尼达平衡后1min和丙泊酚效应浓度达1.0、1.5、2.0、2.5、3.0μg/ml时的脑电双频谱指数(BIS)和OAA/S评分。结果在单纯输注舒芬太尼期间,BIS和OAA/S评分无明显变化;随丙泊酚浓度升高,患者BIS和OAA/S评分逐渐下降;相同丙泊酚浓度时,各组间的BIS值无明显差别;丙泊酚浓度为1.0、1.5、2.0μg/ml时,D组的OAA/S评分(4.1±0.3、4.3±0.7、3.1±1.1)明显低于A组(4.1±0.7、3.1±1.3、2.1±1.0,P<0.05)。结论麻醉诱导期间输注0.1ng/ml和0.2ng/ml浓度的舒芬太尼不增强丙泊酚的镇静催眠效应,0.3ng/ml的舒芬太尼可以增加丙泊酚的镇静催眠效应。

丙泊酚靶控输注(TCI)用于无痛拔牙的临床研究

目的 :观察丙泊酚靶控输注 (TCI)在门诊拔牙手术中的临床应用。方法 :6 0例门诊拔牙患者 ,随机分为靶控输注 (TCI)组、人工输注 (MCI)组和对照组 ,记录两组丙泊酚的平均用量 ,意识消失的时间及恢复时间及术后恶心、呕吐发生率 ,同时记录血压、心率、镇静深度。结果 :患者意识消失所需要的时间TCI组显著低于MCI组 (P <0 .0 5 ) ,意识消失时所需的丙泊酚剂量TCI组大于MCI组。整个手术过程丙泊酚的平均用量TCI组略低于MCI组 ,意识恢复时间TCI组也比MCI组缩短 (P <0 .0 5 )。TCI组与MCI组在MAP、HR、SpO2 比较无显著性差异 ,血流动力学维持平稳 ;但对照组MAP、HR在手术过程中波动明显 ,有显著性的统计学差异。结论 :伍用丙泊酚麻醉明显优于常规局麻下拔牙 ;丙泊酚靶控输注 (TCI)与人工丙泊酚输注 (MCI)相比 ,诱导迅速 ,苏醒快 ,麻醉维持更加平稳。

TCI异丙酚镇静在牙科畏惧症小儿拔牙术的应用

目的:观察56例牙科畏惧症小儿行拔牙手术时采用靶控输注(target controlled infusion,TCI)异丙酚镇静的效果,探讨靶控输注镇静剂方式在牙科畏惧症小儿拔牙时的安全性及适用性。方法:56例牙科畏惧症拔牙小儿静脉TCI异丙酚,血浆靶控浓度设定为1.5μg/ml,测定镇静后拔牙时小儿心率(HR)及脉搏氧(SpO2),并测量镇静值,与拔牙前测量值进行比较。结果:小儿在拔牙时的HR轻度下降,SpO2在实施TCI镇静剂前后无显著变化,小儿均处于中度镇静状态,Ramsay镇静评分5.2±0.8,镇静评分前后比较有显著意义。结论:TCI镇静技术用于小儿牙科畏惧症拔牙术具有良好的镇静效果,对呼吸及循环系统无明显影响,适用于小儿拔牙术中畏惧症的控制和治疗。

罗库溴铵TCI与间断单次静注肌松效应比较

目的比较采用Szenohradszkay模型罗库溴铵药代学参数进行TCI与间断单次静注法的肌松效应。方法择期全麻腹部手术病人 30例 ,分为靶控组和对照组各 15例。靶控组 :TCI泵采用Szenohradszkay模型罗库溴铵药代学参数 ,设定罗库溴铵靶浓度为 3μg/mL ,术中保持T1<10 % ;对照组 :静脉快速 (5s内 )注入 0 .6mg/kg罗库溴铵为插管剂量 ,术中当T1恢复至 2 5 %时间断追加罗库溴铵 0 .15mg/kg。结果起效时间和期间用药量两组均有显著差异 (P <0 .0 1) ,而总用药量、T175 %、恢复指数、TOF70 %均无显著性差异 (P >0 .0 5 )。两组取得的插管条件和T1最大抑制程度相似。结论在中小手术中罗库溴铵TCI法取得了与单次静注法相似的肌松效应 。

老年患者异丙酚分步TCI时预测效应室浓度及麻醉深度指数的变化

目的探讨老年患者异丙酚分步靶控输注(TCI)时预测效应室浓度(CE)的变化及其相应镇静程度和麻醉深度指数(CSI)变化的关系。方法 20例老年患者,进行异丙酚分步TCI,靶浓度从0.5μg/mL开始递增,递增梯度为0.5μg/mL,每1靶浓度输注5min,直至清醒镇静评分(OAA/S)为0后继续输注5min停止,试验中每间隔20s行OAA/S评分,监测并记录患者平均动脉压(MAP)、心率(HR)及脉搏血氧饱和度(SpO2),预测效应室浓度和CSI值。计算在丧失语言反应及意识消失时的预测效应室浓度的CE05、CE50和CE95以及CSI05、CSI50与CSI95。结果随着异丙酚效应室浓度增加,CSI逐渐降低,CSI与OAA/S评分均有较好的相关性。出现语言反应消失时的CE50与CSI50分别为1.3μg/mL和69.7μg/mL;出现意识消失时的CE50与CSI50分别为1.5μg/mL和64.3μg/mL。结论 CSI与预测效应室浓度、OAA/S呈高度相关性,可以较好地监测老年人异丙酚麻醉的深度。

瑞芬太尼复合丙泊酚TCI用于腹腔镜结肠癌根治术效果

目的比较瑞芬太尼复合丙泊酚靶控输注（TCI）和芬太尼持续泵注复合丙泊酚靶控输注麻醉对腹腔镜结肠癌根治术患者的麻醉效果。方法行腹腔镜结肠癌根治术患者80例，ASAI一Ⅱ级。麻醉方法随机分为A组（40例）：靶控输注瑞芬太尼（血浆靶浓度3ng／ml）复合丙泊酚（血浆靶浓度3μg/m1）；B组（40例）：持续泵入芬太尼[3μg／（kg·h）]，靶控输注丙泊酚（血浆靶浓度3μg/ml）；比较两组患者麻醉前（T0）、诱导成功后（T1）、插管后（T2）、切皮时（T1）、停药时（T4）、睁眼时（T5）的心率（HR）、平均动脉压（MAP）、动脉血氧饱和度（SpO2）、脑电双频指数（BIS）、手术时间、恢复自主呼吸时间、睁眼时间、拔管时间及术后患者出现恶心、呕吐、躁动等不良反应情况。结果A组患者麻醉诱导成功后（T3）至停药时（T4）HR与麻醉前（To）相比明显减慢（P〈0．01），睁眼时（T5）HR较麻醉前明显增快（P〈0．01）；B组HR在麻醉过程中与麻醉前比较未见明显差异（P〉0．05），两组患者HR在T0～T4期间未见明显差异，T5时A组高于B组（P〈0．05）。所有患者T1～T4期间MAP、BIS比T0均明显下降（P〈0．01），SpO2未见明显改变（P〉0．05）。丽组患者在MAP、SpO2、BIS方面的差异无统计学意义（P〉0．05）。A组患者呼吸恢复时间、睁眼时间、拔管时间均早于B组，VAS评分A组高于B组（P〈0．01），而在手术时间及术后并发症方面未见明显差异（P〉0．05）。结论瑞芬太尼复合丙泊酚靶控输注在腹腔镜结肠癌根治术中能够维持稳定的血流动力，术后苏醒快，是腹腔镜结肠癌根治术安全可靠的麻醉方式。

丙泊酚TCI与BIS技术应用于神经外科血管内治疗麻醉的临床研究

目的研究神经外科血管内治疗病人进行神经安定麻醉时,丙泊酚靶浓度控制输注(TCI)的效应室浓度(Ce)变化规律及相应警觉/镇静评分(OAA/S)级别和脑电双频指数(BIS)的变化。方法对择期行神经外科血管内治疗的63例病人进行TCI。待OAA/S逐次达到5、4、3、2级时,记录相应的心率(HR)、平均动脉压(MAP)、氧饱和浓度(SpO2)、呼吸次数(RR)和BIS,并记录丙泊酚靶浓度(Ct)和Ce。结果①Ce变化与Ct变化有较好的一致性。随镇静逐渐加深,OAA/S级别降低,Ct、Ce明显增加(P<0.05),BIS明显下降(P<0.05)。②BIS与Ct、Ce呈显著负相关(相关系数r分别为-0.914和-0.925,P<0.05),OAA/S与BIS呈显著正相关(r=0.934,P<0.05),OAA/S与Ct、Ce呈显著负相关(r分别为-0.917和-0.919,P<0.05)。③OAA/S级别下降,HR、MAP、RR和SpO2明显下降(P<0.05)。结论麻醉科医生可以选择OAA/S级别或丙泊酚Ce来调定麻醉深度,OAA/S 3级(Ct为2.02μg/ml)是神经外科血管内治疗麻醉的最佳选择。

电针复合TCI靶控输注在单肺通气食管癌开胸手术麻醉中的应用与安全性

目的探讨电针复合靶控输注(Target Controlled Infusion,TCI)在单肺通气食管癌开胸手术麻醉中的应用价值。方法选取于我院拟行单肺通气食管癌开胸切除手术患者60例作为研究对象。随机将其分为试验组与对照组,对照组30例采取气管插管全麻及TCI靶控输注维持麻醉深度,试验组30例则在对照组方案基础上辅助电针麻醉,记录两组患者手术麻醉时间、药物用量、苏醒时间、并发症;以及术前(T_(Ⅰ))、插管前即刻(T_(Ⅱ))、插管后1 min(T_(Ⅲ))、切皮即刻(T_(Ⅳ))、去骨时(T_(Ⅴ))、拔管即刻(T_(Ⅵ))时平均动脉压(MAP)、平均心率(HR)、BIS值;术前、术后1天、术后3天简易智能精神状态检查量表(MMSE);并于麻醉诱导前(T_(0))、手术开始2 h(T_(1))、术后1天(T_(2))、术后3天(T_(3))时抽取患者外周静脉血检测IL-1β、IL-6、IL-10、TNF-α浓度。结果试验组手术用时、麻醉时间略低于对照组,但差异无统计学意义(P>0.05),试验组异丙酚、舒芬太尼用量以及苏醒时间均明显低于对照组(P<0.05);T_(Ⅱ)时两组平均动脉压(Mean Arterial Pressure,MAP)、心率(Heartrate,HR)较术前明显降低,且试验组MAP明显低于对照组(P<0.05),但两组T_(Ⅱ)时HR比较无显著差异(P>0.05);T_(Ⅲ)、T_(Ⅵ)时对照组MAP、HR明显高于T_(Ⅰ)时,而试验组MAP、HR与T_(Ⅰ)比较无显著差异(P>0.05)。术后1天、3天试验组简易智能精神状态检查量表(Mini-Mental State Examination,MMSE)评分低于对照组,有显著性差异(P<0.05)。T_(1)、T_(2)、T_(3)时试验组白介素-1β(IL-1β)、白介素-6(IL-6)、肿瘤坏死因子(Tumor Necrosis Factor-α,TNF-α)水平明显低于对照组(P<0.05),白介素-10(IL-10)水平明显高于对照组(P<0.05)。结论采用电针复合TCI靶控输注麻醉方案可有效提升单肺通气食管癌开胸手术麻醉效果,能够降低患者术后认知功能障碍发生风险。

BIS指导丙泊酚TCI在小儿眼科手术中的应用

目的探讨脑电双频谱指数(BIS)指导丙泊酚靶控输注(TCI)用于小儿眼科手术对血流动力学的影响和术后恢复情况。方法择期行眼科手术的患儿40例,随机分成BIS监测丙泊酚TCI组(Ⅰ组)和丙泊酚静脉注射组(Ⅱ组),每组20例。观察并记录麻醉诱导前、插管前、插管后即刻、手术开始时、手术开始后30min及拔管时6个时间点的BIS值及血液动力学的变化,记录清醒拔管时间,评估术后恶心、呕吐的情况。结果与诱导前相比,两组诱导后SBP、DBP均有下降(P<0.05);Ⅰ组HR的变化与诱导前相比差异无显著性,Ⅱ组较诱导前相比,HR加快且差异有显著性(P<0.05)。气管插管后,Ⅱ组HR明显快于I组(P<0.05);Ⅰ组血压的变化幅度小于Ⅱ组,插管前、插管后即刻与Ⅱ组比较,差异有显著性(P<0.05)。Ⅰ组患者睁眼时间、拔管时间均显著短于Ⅱ组(P<0.01)。结论BIS监测丙泊酚TCI应用于小儿眼科手术麻醉是安全有效的,不仅能够保持围术期血流动力学稳定、减少丙泊酚的用量,而且术后恶心、呕吐发生率低,术后恢复迅速且质量高。

异丙酚和芬太尼开环和闭环TCI对血流动力学的影响

目的观察采用异丙酚和芬太尼双通道开环靶控输注(OLTCI)和闭环靶控输注(CLTCI)进行麻醉诱导时,患者血流动力学的变化。方法选择24例施行甲状腺手术的女性患者(ASAⅠ～Ⅱ级),随机分为OLTCI组和CLTCI组(n=12)。OLTCI组以靶控浓度3μg/mL异丙酚和3ng/mL芬太尼分别行麻醉诱导和维持;CLTCI组分别以脑电双频指数(BIS)值和心率(HR)与收缩压乘积为反馈指标行双通道CLTCI,异丙酚和芬太尼起始靶控浓度分别为3μg/mL和3ng/mL,递增或递减浓度分别为0.5μg/mL和0.5ng/mL,最高靶控浓度分别为6μg/mL和5ng/mL。于不同时间点分别记录两组的心率(HR)、平均动脉压(MAP)、心率变异性、BIS值的变化以及异丙酚和芬太尼的用药量。结果CLTCI组:插管后1min和模拟切皮刺激后1min记录的BIS值有所升高,但升高幅度均小于OLTCI组,且控制在64以内(分别为58.9±1.1和59.9±4.1)。与插管前相比,两组在插管后1min记录的MAP均有所升高,但OLTCI组的升高幅度明显大于CLTCI组(P<0.05)。两组的芬太尼总用药量无明显差异,OLTCI组异丙酚总用药量大于CLTCI组。结论与OLTCI比较,以BIS和HR与收缩压乘积作为反馈指标行异丙酚和芬太尼双通道CLTCI能更好地维持稳定的血流动力学和麻醉深度。