摘要:目的:分析与比较七氟醚吸入麻醉和丙泊酚静脉复合麻醉应用于三聚氰胺致婴幼儿输尿管结石手术的麻醉效果。方法:60例输尿管结石患儿随机分为七氟醚(Sev)组(n=30)和丙泊酚(Pro)组(n=30)。观察并记录诱导时间、气管内插管时间、苏醒时间、拔除气管插管时间、PACU滞留时间。记录麻醉诱导和苏醒期的不良反应。另外记录两组病人诱导前、插管前、插管后3 min、5 min、15 min、30 min时点的血压、心率、脉搏血氧饱和度(SPO2)。结果:七氟醚组诱导时间(63.2±6.9)s长于丙泊酚组(38.2±12.7)s,七氟醚组拔除气管插管时间(11.9±4.7)min短于丙泊酚组(15.6±8.2)min,两组相比有统计学意义(Plt;0.05)。七氟醚组躁动发生率53.3%显著高于丙泊酚组13.3%(Plt;0.01)。七氟醚组在插管前、插管后各时点的血压、心率与诱导前相比,差异无统计学意义(Pgt;0.05),丙泊酚组插管前、插管后3 min、5 min与诱导前相比血压、心率显著降低(Plt;0.05),与同时间点七氟醚组相比血压显著降低(Plt;0.05)。结论:两种麻醉方法均可安全有效用于婴幼儿输尿管结石手术,七氟醚组血流动力学更平稳,但躁动发生率较高。Abstract: Objective: To analyze and compare sevoflurane with propofol for anesthesia in infants with Melamineinduced ureteral stone surgery. Methods: Sixty infants who were to undergo Melamineinduced ureteral stone surgery were randomly divided into sevoflurane (Sev) group (n=30) and propofol (Pro) group (n=30). Observe and record the induction of anesthesia time, intubation time, awakening time, time to extubation, time to stay at PACU. Record adverse effects during induction of anesthesia and the awake period. In addition, recorded BP, HR, SPO2 of two groups before induction and intubation, after 3min、5min、15min、30min after intubation. Results: Induction time ［（63.2 ± 6.9） s］ in sevoflurane group was longer than propofol group ［(38.2±12.7） s］,but extubation time ［（11.9 ± 4.7） min］ was shorter than propofol group ［(15.6 ± 8.2） min］, there was significantly different between two groups (Plt;0.05). The incidence of restlessness in sevoflurane group 53.3% was significantly higher than propofol group 13.3% (Plt;001). In sevoflurane group the BP, HR before intubation compare with after intubation has no significant difference (Pgt;0.05). Compared with before induction,the BP, HR before induction, after intubation 3 min, 5 min, decreased significantly (Plt;0.05) in propofol group.when compared the same point with sevoflurane group, blood pressure decreased significantly (Plt;0.05). Conclusion: Both propofol and sevoflurane can be used effectively and safely for anesthesia of ureteral calculi stone surgery in pediatric. The hemodynamics is more stable but restlessness is more common in sevoflurane group.
目的:观察、比较七氟醚吸入麻醉与全凭静脉麻醉在小儿先天性心脏病手术中的应用。方法: 40例择期行先天性心脏病房室缺矫治术患儿,随机分为七氟醚组和全凭静脉麻醉组(TIVA组),每组各20例。七氟醚组患儿以七氟醚吸入诱导,复合小剂量芬太尼、咪达唑仑、维库溴铵,麻醉维持为七氟醚吸入+芬太尼、维库溴铵;静脉组患儿肌注氯胺酮后,以芬太尼、咪达唑仑、维库溴铵诱导,维持使用丙泊酚持续泵入+芬太尼、维库溴铵。比较两组术中各时点血流动力学变化、手术麻醉时间与芬太尼、维库溴铵用量、术后呼吸支持时间、清醒时间、拔管时间,比较两组不良反应发生情况。结果: 两组患儿均维持比较稳定的血流动力学状态。七氟醚组芬太尼与维库溴铵用量明显低于TIVA组,呼吸支持时间、清醒时间、拔管时间明显低于TIVA组。七氟醚组2例术后发生躁动,3例发生恶心,稍高于TIVA组。结论: 七氟醚应用于小儿先心房室缺矫治术,可提供稳定的血流动力学状态,并降低芬太尼与肌松剂用量,实现术后早拔管、改善患者预后、降低医疗费用。
目的:观察七氟醚靶控用于低流量吸入麻醉维持的临床规律及血流动力学变化,寻求靶控下的药物量化指标。方法:选择60例20～60岁手术患者,随机分2组每组30例:P组(丙泊酚)常规实施全凭静脉TCI靶控麻醉;S组(七氟醚),实施低流量七氟醚靶控吸入麻醉(BIS值40)。分别记录诱导前(T1),插管后5(T2)、15(T3)、30(T4)45(T5)、60(T6)、90(T7)、120(T8)min时的、MBP、HR、;Sev组患者加记各个时点的七氟醚IT、ET的MAC值。结果:T2点两组均比T1 降低(Plt;0.05),S 组高于P组(Plt;0.05),两组比较T3至T7无显著性差异(Pgt;0.05);S 组T3 至T7 各点ET值无统计学差异,ET%:2.46,约1.4 MAC。结论:(1)七氟醚诱导较静脉麻醉诱导患者血流动力学稳定,(2)低流量七氟醚靶控吸入麻醉维持平稳,调控简便,效果良好。
【摘要】 目的 确定在不同浓度七氟醚复合瑞芬太尼诱导无肌松气管插管时瑞芬太尼的半数有效量（ED50）。 方法 2009年7月-2009年11月择期手术患者60例，ASA I~II，年龄20~59岁，按照入室的顺序随机分为Ⅰ组（2%七氟醚组）和Ⅱ组（3%七氟醚组），预冲8%七氟醚诱导，眼睑反射消失后，调节七氟醚呼气末浓度分别维持在2%或3%，同时按照序贯法注入瑞芬太尼，瑞芬太尼注射90 s后气管插管。记录麻醉诱导前、患者意识消失时、插管前1 min、插管后1 min及插管后3 min心率、平均动脉压的变化。 结果 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量（ED50）及其相对应的95%可信区间分别为0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。 结论 2%、3%的七氟醚复合瑞芬太尼诱导气管插管时瑞芬太尼的半数有效量及其相对应的95%可信区间分别为0.585 μg/kg及0.533～0.626 μg/kg和0.492 μg/kg及0.451～0.572 μg/kg。【Abstract】 Objective To determine the half effective dose (ED50) of remifentanil dose for tracheal intubation without neuromuscular relaxant in adult when combined with different concentration of sevoflurane. Methods Sixty ASA Ⅰ to Ⅱ adult aged 20 to 59 years old, scheduled for elective surgery under general anesthesia were enrolled in this study between July 2009 to November 2009. All patients were ranged randomly into Group Ⅰ (2% sevoflurane) and Group Ⅱ (3% sevoflurane).Anesthesia was induced with 8% sevoflurane in 100% oxygenat at 6 L/min.After the loss of eyelash reflex, remifentanil was injected over 30 s, end-tidal sevoflurane concentration 2% or 3% was maitained. The dose of remifentanil was determined by up-and-down method. In 90 s after the end of bolus administration of remifentanil, the trachea was intubated. Mean blood pressure and heart rate were recorded at anaesthetic induction, the loss of eyelash reflex, before, in 1 min and 3 min after intubation. Results ED50 values (95% confidence intervals)of remifentanil for tracheal intubation during 2% and 3% sevoflurane induction without neuromuscular relaxant were 0.585 μg/kg and 0.533 - 0.626 μg/kg, and 0.492 μg/kg and 0.451 - 0.572 μg/kg, respectively. Conclusion ED50 values (95% confidence intervals)of remifentanil for tracheal intubation 2% and 3% sevoflurane induction without neuromuscular relaxant are 0.585 μg/kg (0.533 - 0.626 μg/kg) and 0.492 μg/kg (0.451 - 0.572 μg/kg), respectively.
Objective We aimed to determine the efficacy and complication of sevoflurane maintenance in children. Methods Trials were collected through electronic searches of MEDLINE, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, and CMBdisk (from the date of building the database to April 2008). We also checked the bibliographies of retrieved articles. Results A total of 20 trials involving 1 592 patients were included. The Metaanalysis showed: ① Recovery time: sevoflurane was similar with propofol [WMD=0.22, 95%CI (–2.86, 3.30)], but slower than desflurane [WMD=5.01, 95%CI (2.87, 7.16)], and faster than isoflurane [WMD= –0.55, 95%CI (– 0.74, –0.37)]; ② Discharge time: sevoflurane was similar with propofol [WMD= –4.39, 95%CI (–10.02, 1.25)], desflurane[WMD=1.13, 95%CI (–3.25, 5.51)], and isoflurane [WMD= –8.17, 95%CI (–17.94, 1.60)]; ③ Postoperative agitation: sevoflurane was much more obvious than propofol [RR=5.53, 95%CI (2.99, 10.21)], but superior than desflurane [RR=0.55, 95%CI (0.35, 0.88)], and similar with isoflurane [RR=1.24, 95%CI (0.85, 1.800]; ④ Postoperative nausea and vomiting (PONV): sevoflurane was much more severe than propofol [RR=2.17, 95%CI (1.21, 3.90)], and no difference with desflurane [RR=0.88, 95%CI (0.61, 1.25)]; ⑤ Oculocardiac reflex: sevoflurane was less than propofol [RD= – 0.42, 95%CI (–0.56, –0.27)], and no difference with desflurane [RR=0.93, 95%CI (0.61, 1.41)]. Conclusion The limited current evidence shows no difference between sevoflurane and propofol in recovery time, while the effect of sevoflurane is faster than isoflurane and slower than desflurane. There are no differences among sevoflurane, desflurane, isoflurane, and propofol in discharge time. The incidence of postoperative agitation of sevoflurane is higher than that of propofol, but lower than that of other inhaled anesthetics. The incidence of PONV of sevoflurane is higher than that of propofol. The incidence of oculocardiac reflex of sevoflurane is lower than that of propofol and similar with that of desflurane.
ObjectiveTo evaluate the effects of sevoflurane and propofol on preoperative implicit and explicit memories in general anaesthesia patients of elective surgery. MethodsThe surgical inpatients in Sichuan Provincial People's Hospital were enrolled from December 2013 to May 2014, and were randomly divided into three groups (S, P, M). In Group S, anesthesia was induced and maintained with sevoflurane. In Group P, anesthesia was induced and maintained with propofol. Midazolam was not utilized throughout the whole anaesthesia for the above groups. Patients in Group S and Group P were given a list of test materials to remember and listen before the anesthesia. Within 12 to 36 hours after operation, memory was assessed, based on the Buchner's model applied on the process dissociation procedure (PDP) using a phrases task. The Group M was given the same test materials, and received test with the PDP in 12 to 36 hours before surgery. Value A and value R were used to represent the implicit memory score and the explicit memory score, respectively. ResultsA total of 150 patients were included, and 50 cases were included in each group. During testing, 2 cases were excluded, 3 cases were loss to follow-up, so finally 49 cases were included in the Group S, 47 cases in the Group P and 49 cases in the Group M. The results showed that there were significant differences in the implicit memory score (A) and the explicit memory score (R) among the three groups (all P values <0.05). The explicit memory score (R) of the Group M was higher than those of the Group P and Group S (all P values <0.05), the implicit memory score (A) in the Group M was higher than those of the Group S and Group P (all P values <0.05), and the implicit memory score (A) in the Group S was higher than that of the Group P (P<0.05). ConclusionPropofol and sevoflurane can decrease the score of explicit memory after anesthesia within 12 to 36 hours, and there are no significant differences in explicit memory between the two drugs. Both propofol and sevoflurane can decrease the score of implicit memory, but the influence of sevoflurane on the implicit memory is less than propofol within 12 to 36 hours.
Objective To assess the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia. Methods Such databases as PubMed (1966 to March 2012), The Cochrane Library (Issue 1, 2012), EBSCO (ASP) (1984 to March 2012), Journals@Ovid Full Text (1993 to March 2012), CBM (1978 to March 2012), CNKI (1979 to March 2012), VIP (1989 to March 2012), and WanFang Data (1998 to March 2012) were searched to collect randomized controlled trials (RCTs) about the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia, and the references of the included studies were also retrieved. Two researchers extracted the data and evaluated the methodological quality of the included studies independently. Then the RevMan 5.2 software was used for meta-analysis. Results A total of 16 RCTs involving 1 217 patients were included. The results of meta-analysis showed that, compared with the placebo, dexmedetomidine could reduce the occurrence of emergence agitation (OR=0.18, 95%CI 0.13 to 0.25, Plt;0.000 01) and increase the occurrence of postoperative lethargy (OR=0.14, 95%CI 0.03 to 0.68, P=0.01), but there were no differences in the occurrence of side effects including bronchospasm, bucking, breathholding, and oxygen desaturation. Dexmedetomidine could also reduce mean arterial blood pressure (MAP) and heart rate (HR) of pediatric patients during the recovery period after sevoflurane anesthesia, but it increased emergence time (MD=2.14, 95%CI 0.95 to 3.33, P=0.000 4), extubation time (MD=1.26, 95%CI 0.51 to 2.00, P=0.000 9) and the time of staying in PACU (MD=4.72, 95%CI 2.07 to 7.38, P=0.000 5). Conclusions For pediatric patients recovering from sevoflurane-based general anesthesia, dexmedetomidine can reduce the occurrence of emergence agitation, and is helpful to maintain the hemodynamic balance. But it prolongs emergence time, extubation time (or the time of using the laryngeal mask) and the time of staying in PACU, and increases the occurrence of postoperative lethargy.
目的 研究七氟醚诱导气管插管减轻短期内行两次手术的脑性瘫痪患儿术前焦虑的效果。 方法 2009年12月－2011年7月选择需要短期内行两次全身麻醉（全麻）手术的痉挛性脑性瘫痪患儿60例，美国麻醉医师协会（ASA）Ⅰ～Ⅱ级。随机分为A组常规麻醉诱导气管插管（30例）和B组七氟醚诱导气管插管（30例）；分别在一期及二期手术术前访视时（M1、M3）、入手术室时（M2、M4）对两组患儿进行改良耶鲁围术期焦虑量表评估；并分别在一期及二期手术麻醉诱导期（N1、N2）对两组患儿进行诱导期合作度量表的标准评定。 结果 同组一期、二期手术比较，A组患儿二期手术术前焦虑更明显（P＜0.05），二期入手术室时焦虑更明显（P＜0.05），二期手术合作度更差（P＜0.05）；B组患儿两次手术术前焦虑无明显变化（P＞0.05），一期入手术室时焦虑明显（P＜0.05），一期手术合作度较差（P＜0.05）。两组之间，一期手术两组患儿焦虑情况无明显区别（P＞0.05），二期手术A组比B组的患儿焦虑更明显（P＜0.05），两次手术B组都比A组的患儿合作度更好（P＜0.05）。 结论 七氟醚麻醉诱导气管插管能够有效减轻短期内需要进行两次手术的痉挛性脑性瘫痪患儿的术前焦虑，提高患儿二期手术的合作度，提供良好的手术麻醉条件，保证患儿的围术期安全。