Effect of Different Sufentanil Concentration Regimens on Postoperative Pain Control and Its Adverse Events in Intravenous Patient-controlled Analgesia / 中国医学科学院学报

Objective To compare the analgesic effect and incidences of adverse events of different sufentanil concentration regimens in postoperative intravenous patient-controlled analgesia(PCA).Methods We retrospectively analyzed the clinical data of 6231 patients undergoing elective general anesthesia using sufentanil as postoperative intravenous PCA regimen in Peking Union Medical College Hospital from January 2004 to December 2016.These patients were subcategorized into 4 groups according to the sufentanil concentration regimens:0.4 μg/ml(SF4,n=1421),0.6 μg/ml(SF6,n=2489),0.8 μg/ml(SF8,n=1326),and 1.0 μg/ml(SF10,n=995).Total drug consumption within 48 h after surgery,analgesic effect,and incidences of adverse events were compared among these four groups.Results The cohort consisted of 2874 males(46.1%)and 3357 females(53.9%)in the age group from 3 years to 91 years(median:52.5 years).The postoperative 48 h sufentanil consumption was significantly different among these four groups in terms of volume(χ=87.316,P<0.001)and dosage(χ=20.261,P<0.001).Meanwhile,the VAS scores at rest and during activity on postoperative day 1(POD1)and POD2 showed no statistical significance among these four groups (both P>0.05).As for the adverse events,the sedation score in POD1(χ=9.042,P=0.029)and incidence of no bowl movement on both POD1(χ=7.855,P=0.012)and POD2(χ=5.635,P=0.044)were significantly different among groups,whereas the incidences of other adverse events showed no significant difference(all P>0.05).Conclusion In patients using intravenous sufentanil PCA as their postoperative analgesia regimen after general anesthesia,regimens with higher sufentanil concentrations may result in more adverse events such as sedation and no bowl movement without improving analgesic outcomes.

Topical anesthetic effects of compound lidocaine cream coated endotracheal tube to prevent cough and agitation during extubation in thyroidectomy under general anesthesia / 基础医学与临床

Objective To evaluate the topical anesthetic effects of compound lidocaine cream ( CLC) coated endo-tracheal tube on the prevention of cough/agitation during extubation in thyroidectomy under general anesthesia . Methods 42 patients scheduled for thyroidectomy in Peking Union Medical College Hospital were continuously en -rolled in this prospective double-blinded randomized controlled trial .Patients were randomized into two groups . Group L were intubated with endotracheal tube coated with CLC , while the control group , group C with liquid par-affin .The end point of study was spontaneous or induced cough /agitation during extubation .Hemodynamic parame-ters and the consumption of opioids were recorded .Patients were followed for major complications during their stay in hospital .Results Spontaneous cough/agitation rate was lower in group L than group C ( 15% vs 65%, P<0.01 );so was induced cough/agitation (35%vs 90%, P<0.001 );the value of SBP ×HR was lower in group L at 1 min after extubation ( P<0.05 ) .Conclusions The topical anesthetic effects of CLC coated endotracheal tube could prevent cough and agitation during extubation in thyroidectomy under general anesthesia .

Effects of different sequences of intravenous administration on fentanyl-induced cough during induction of general anesthesia / 中华麻醉学杂志

Objective To evaluate the effects of different sequences of intravenous administration on fentanyl-induced cough during induction of general anesthesia.Methods One hundred patients of both sexes,aged 18-70 yr,weighing 42-88 kg,of ASA physical status Ⅰ or Ⅱ,scheduled for elective surgery under general anesthesia,were equally randomized to 2 groups using a random number table:fentanyl-propofol group (group FP) and propofol-fentanyl group (group PF).In FP group,fentanyl 3 μg/kg was injected intravenously over 3 s,and then propofol 1.5 mg/kg was injected intravenously.In PF group,propofol 1.5 mg/kg was injected intravenously,and then fentanyl 3μg/kg was injected intravenously over 3 s.The development,intensity and onset time of cough were recorded within 1 min after fentanyl injection.Results Compared with FP group,the incidence of cough was significantly decreased,and no significant change was found in the intensity and onset time of cough in PF group.Conclusion Administration in the propofol-fentanyl sequence can reduce the development of fentanyl-induced cough as compared with that in the fentanyl-propofol sequence during induction of general anesthesia.

A placebo-controlled clinical trial to evaluate the efficacy and safety of domestic palonosetron hydrochloride injection on the prevention of postoperative nausea and vomiting / 临床麻醉学杂志

Objective To evaluate the efficacy and safety of domestic palonosetron hydrochlo-ride injection on its prevention of postoperative nausea and vomiting.Methods A multi-centered,ran-domized,double-blinded and placebo-controlled clinical trial was carried out.A total of 281 patients were enrolled,with 141 of patients in study group and 140 of patients in control group respectively. 0.075 mg of intravenous palonosetron hydrochloride injection was delivered in the study group before anesthesia induction.The drug was substituted by 1.5 ml of NS in the control group.All anesthesia inductions were conducted by the intravenous injection of propofol,fentanyl and rocuronium,and were maintained with sevoflurane and fentanyl.Complete remission rate and treatment failure cut-off time of vomiting were evaluated at 0-6 h,6-72 h,0-72 h postoperatively.Results In the study group CR% 0-6 h,6-72 h and 0-72 h were 107 (75.89%),104 (73.76%)and 92 (65.25%),the control group was 81 (57.86%),70 (50%)and 62 (42.86%),CR% of the study group was significantly higher than that of the control group (P <0.01).Insignificant statistical difference but significant clin-ical difference exists in their treatment failure cut-off time,386.5 min and 300.0 min,respectively be-tween the groups.Conclusion Domestic palonosetron hydrochloride injection is safe and effective in the prevention of postoperative nausea and vomiting.

The clinical evaluation of desflurane, sevoflurane, isoflurane and enflurane in balanced anesthesia / 中华麻醉学杂志

To compare the effects of desflurane, sevoflurane, isoflurane and enflurane on cardiovascular response to surgical procedures and recovery from anesthesia. Method: The 40 patients scheduled for abdominal hysterectomy under balanced anesthesia were randomly divided into desflurane (D), sevoflurane (S), isofluane(I)and enflurane(E)groups. After induction of anesthesia and endotracheal intubation, 6% of desflurane, 2% of sevoflurane,1. 15% of isoflurane and 1.7% of enflurane in oxygen and nitrous oxide(1:2) were inhaled in D,S,I and Egroups, respectively. The fractional end tidal alveolar concentration of inhaled anesthetics(Fa) was adjusted to 1MAC during the maintenance of anesthesia. 2?g?kg~(-1)?h~(-1) of fentanyl was infused simultaneously, and the rate of infusion was decreased by 50 percent after infusion for half an hour. Heart rate(HR), systolic pressure(SP), diastolic pressure(DP), SpO_2, and P_(ET)CO_2 were monitored continuously. Volume of minute ventilation(Ve)was observed before induction of anesthesia and 5, 15, 30, 45min after extubation. The recovery parameters of conciousness were also observed. Result: There was no significant difference among the four groups in hemodynamics. Within 30rain after extubation, Ve in I and E groups were lower than that before inductoin of anesthesia and that in D and S groups. The recovery time in D and S groups were significantly shorter thanthat in E and I groups. Conclusion: In balanced anesthesia,desflurane can effectively inhibit the cadiovascular response to surgical procedures and the recovery from anesthsia is faster than any other vaporized anesthetics.

The profile of pharmacokinetics of desflurane during balance anesthesia for abdominal surgery patients / 中华麻醉学杂志

Objective: This trial was designed to study the profile of the pharmacokinetics of desflurane in balance anesthesia. Method:Forty ASA physical status Ⅰ and Ⅱ patients undergoing abdominal surgery were admitted to this study. All patients were anesthetized with balance anesthesia technique,which received delivered concentration(FD)of 6% desflurane in a fresh gas(O_2: N_2O=1:2)inflow of 3L/min until end-tidal target concentration(FA)of 3% des flurane was obtained, then the FD was adjusted to maintain the target concentration, 30 min later the inflow was decreased to 1.5L/min. As well as nitrous oxide,oxygen and carbon dioxide concentrations were measured at the common gas outlet and the endotracheal tube connector respectively. At same time fentanyl and atracurium were given as necessary. The SpO_2,BP,and HR were also measured. We observed the time of target concentration reached during wash-in period, and also the time of FA: FAO = 1/2 during wash-out period at the end of operation. Result: During the first 30 min of 3L/min flow administration,the target concentration was obtained at 2.9 min,and was kept stable during the whole procedure,even during low flow(1.5L/min)it was not required to increase the FD to maintain FA at the target concentration. The wash-out time of FA:FAO= 1/2 was 2.0 min from stopping adminstration. The time of spontaneous breath recovery, open eye, extubation.reciting of name and birthday and discharge from recovery room was 6, 5.8.6,9.0,12.0 and 30 min respectively. The parameters of cardiac function were stable during operation. Con clusion: During the balance anesthesia with desflurane.even at relative low flow.the FD of desflurane provides a reasortable surrogate of FI and FA. The lower solubility of desflurane favors its safe use in low-flow technique.and the anesthesia depth can be controlled more easy.

Anesthetic management of patient with McCune-Albright syndrome for subtotal adrenalectomy / 中华麻醉学杂志

Objective A 23-year-old female patient who had a past history of sexual - precocity and fracture developed hyperhyroidism 8 months ago. Radiological examination revealed enlargement of sella turcica and a adrenal gland nodule. The patient was diagnosed to have McCune -Albright syndrome and scheduled for resection of left subtotal adrenalectomy under general anesthesia. The patient was taking (1) thiamazole 5 mg t. i. d. and propranolol 10 mg q. d. for hyperthyroidism; (2) adalat 10 mg t. i. d. and potassium citrate 20 ml t. i. d. for Cushing syndrome and (3) calcium tablets for osteoporosis. Anesthesia was induced with intravenous midazolam 1 mg, fentanyl 50 ?g and vecuronium 1 mg followed by propofol 150 mg and succinyl choline 100 mg. The patient was intubated and mechanically ventilated (VT = 500 ml, RR =10 bpm, I: E = 1 :2) . PET CO2 was maintained between 35 - 45 mm Hg. Anesthesia was maintained with inhalation of isoflurane and N2O - O2 (1:2) and intermittent i.v. boluses of fentanyl and vecuronium. The BP was increased to 180/110 mm Hg after induction of anesthesia. Urapidil 10 mg was given intermittently i.v. During the exploration of adrenal gland BP was again increased to 200/140 mm Hg. Nitroglycerin was infused i.v. and BP was decreased to 120-130/80-90 mm Hg and was kept at this level till the end of operation. Hydrocortisone succinate 100 mg was infused i.v. slowly after operation. The operation went smoothly. The patient was extubated and the postoperative course was uneventful.

Muscle relaxation by pipecuronium during desflurane, enflurane and isoflurane anesthesia / 中华麻醉学杂志

Objective To compare the effects of desflurane, enflurane and isoflurane on onset time,duration of action and recovery time of pipecuronium. Methods Thirty ASA Ⅰ-Ⅱ patients aged 18-60yr weighing40-80 kg were randomly divided into 3 groups: (1) desflurane group (n = 10); (2) enflurane group(n = 10) and(3) isoflurane group (n = 10). The patients were premedicated with intramuscular pethidine 1 mg?kg~(-1) andatropine 0 .01 mg?kg. Anesthesia was induced with midazolam 0. 03 mg?kg~(-1), propofol 0.5-1 .0 mg?kg~(-1)andfentanyl 2?g?kg~(-1) .When the patients fell asleep neuromuscular function was monitored by accelerography usingTOF stimulation. Pipecuronium 0.045 mg?kg~(-1) was given i. v. as soon as T_1 was 100 % blocked (T_1= 0), anotherdose of propofol was given, making the total dose of propofol amount to 2.5 mg' kg?kg~(-1).Tracheal intubation wasperformed. The patients were mechanically ventilated and P_(ET) CO_2 was maintained at 35-45 mm Hg. Desflurane oreaflurane or isoflurane was inhaled with N_2O-O_2(2: 1) .The end-tidal desflurane, enflurane or isofluraneconcentration was maintained at 0. 65 MAC(desflurane= 3. 9 %, enflurane = 1. 1 %, isoflurane = 0. 75 % ). Duringoperation when deeper anesthesia was needed intermittent i. v. blouses of fentanyl were given. The onset time, thetime needed for T_1 to return to 5 %, 10 %,25 %, 50 %,75 % of control and recovery index were recouled andcompared among the three groups.Results The demographic data including age, weight, sex and types ofoperation were not significantly different among the 3 groups. Three were no significant differences in onset time,recovery time (time for T_1 to return to 5 %, 10 %,25 %,50 % and 75 % of control) and recovery index amongthe 3 groups. Conclusion Desflurane can prolong the duration of action and recovery time of pipecuronium justlike enflurane and isoflurane but there were no significant differences among the 3 groups.