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AIM: To determine the median effective plasma concentration (Cp50) of propofol inhibiting body movement when combined with butorphanol in patients undergoing hysteroscopic surgery. METHODS: Twenty-one patients scheduled for elective hysteroscopic surgery under non-intubated intravenous anesthesia, age 20-55 years old, ASA physical status or Ⅱ, were enrolled in this study, and anesthesia was induced by target-controlled infusion of propofol. Hysteroscopy was performed only when the plasma concentration and the concentration of the effector chamber were balanced. Butorphanol 20 μg/kg was injected intravenously at 5 min before surgery. The depth of anesthesia and adverse reactions during anesthesia was monitored. The plasma target concentration (Cp) of propofol was determined by up-and-down method, the first patient was 2.5 μg/mL, each time Cp increased/decreased by 10% in the next patient depending on whether or not body movement occurred. The patients were divided into positive and negative groups according to the results. The Cp50 and 95% confidence inlerval (CI) of propofol inhibiting body movement were calculated by up-and-down formula when combined with butorphanol in patients undergoing hysteroscopic surgery. RESULTS: The Cp50(95%CI) of propofol required to inhibit body movement was 2.23(2.12-2.34) μg/mL when combined with butorphanol in patients undergoing hysteroscopic surgery. None of the patients had serious adverse reactions. CONCLUSION: The Cp50 of propofol required to inhibit body movement is 2.23 μg/mL when combined with 20 μg/kg butorphanol in patients undergoing hysteroscopic surgery. It provides a reference for safe dosage of anesthesia in hysteroscopic surgery.
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Objective To study the effects of dexmedetomidine on the swallowing reflex. Methods Sixty adult volunteers (ASAⅠ-Ⅱ) were randomly divided into two groups, dexmedetomidine sedation group and propofol sedation group respectively. The BIS value was maintained between 60-65 in both groups. Swallowing reflex was induced by water injection in the pharynx at different depths of sedation, and the swallowing movements were observed. Meanwhile, the RR, SpO2 and OAA/S scores were recorded. Results The swallowing reflex existed in dexmedetomidine sedation group when BIS values was maintained at 60, which had significant difference compared with that in propofol sedation group. The RR, SpO2, OAA/S score in dexmedetomidine sedation group also had statistical difference compared with that in propofol sedation group during swallowing reflex test. Conclusions Slow infusion of dexmedetomidine to maintain the BIS value above 60 will not affect swallowing reflex, and can obtain satisfactory hemodynamic stability. It′clinical safety is high.
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Objective To observe and compare the control effect of monitored anesthesia care on stress reaction of operation under local anesthesia.Methods Fourty-five patients who undered ophthalmology and otolaryngology operation and ASA Ⅰ or Ⅱ class,aged 20-55 years were enrolled.They were randomly divided into 3 groups:monitored anesthesia care(M group),general anesthesia (G group),and local anesthesia (L group).All of three groups were performed local nerve block anesthesia.Mean arterial blood pressure (MAP)、heart rate (HR) were recorded at enter room (T1),the strongest operation stimulation (T2),the end of operation (T3).At the same time,the levels of blood glucose,plasma cortisol (Cor) were assayed.The scores of state of anxiety (S-AI) before operation and after operation in two groups were compared.Results The levels of MAP and Cor at T2,T3 and HR at T2 in G group and M group were significantly lower than those at T1:(68.1 ± 8.2),(78.8 ± 12.8) mmHg (1 mmHg =0.133 kPa) vs.(95.7 ± 11.3) mmHg;(80.8 ± 11.7),(86.2 ± 9.0)mmHg vs.(94.7 ± 11.5) mmHg;(207.0 ±71.8),(135.2 ± 60.9) nmol/L vs.(336.7 ± 121.4) nmol/L;(220.8 ± 113.2),(190.4 ± 149.0) nmol/L vs.(347.8 ± 154.6) nmol/L;(68.1 ± 10.6) beats/min vs.(79.9 ± 14.2)beats/min;(70.3 ± 10.1) beats/min vs.(80.6 ± 12.2) beats/min,there were significant differences (P ＜0.05).The level of blood glucose at T3 was significantly lower than that at T1 in G group [(4.9 ± 0.7) mmol/L vs.(5.5 ± 0.6) mmol/L],there was significant difference (P ＜ 0.05).The levels of MAP,Cor at T2 in G group and M group,at T3 in G group were significantly lower than those at the same point in L group:[(68.1 ± 8.2),(80.8 ± 11.7) mmHg vs.(93.4 ± 12.5) mmHg,(207.0 ± 71.8),(220.8± 113.2) nmol/L vs.(367.1 ± 157.3)nmol/L,(78.8 ± 12.8) mmHg vs.(92.6 ± 15.3) mmHg,(135.2 ± 60.7) nmol/L vs.(311.9 ± 165.6) nmol/L],there were significant differences (P ＜ 0.05).The scores of S-AI at postoperative in G group and L group were significantly lower than that at preoperative:(31.5 ± 6.6) scores vs.(44.3 ± 15.0) scores,(35.2 ± 11.5) scores vs.(49.3 ± 14.2) scores,there were significant differences (P ＜ 0.05).Conclusion Monitored anesthesia care can alleviate stress reaction in operation with local anesthesia,while its effect is similar with general nesthesia.
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ObejectiveTo evaluate the efficacyofacupointthread embedding in easing painafterMilligan-Morgan(M-M)for mixed hemorrhoids.MethodSixty patients undergone M-M for mixed hemorrhoids were randomized into a treatment group of 30 cases and a control group of 30 cases. After M-M, patients in the treatment group received thread embedding at Changqiang (GV1) and bilateral Zhibian (BL54), while the control groupdidn’treceive any intervention. The onset time of post-operative pain, average pain index within a week, and pain index after defecation, electromyogram (EMG), change of anal canal pressure, patients’ satisfaction, and adverse-event rate were observed.ResultThe average pain index and pain index after defecation in the treatment group were significantly lower than that in the control group (P0.05). According to the motor unit potential (MUP) analysis, there were significant differences in comparing the amplitude (Ampl) and Ar/Am of the restingphase between the two groups (P0.05). There were significant differences in comparing the patients’satisfaction, adverse-event rate, and use of analgesics between the two groups (P<0.05). ConclusionAcupoint thread embedding can produce a content analgesic effect, and it’s safe and reliable.
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ObjectiveTo determine the depth of sedation induced by target-controlled infusion (TCI) of propofol required to inhibit the swallowing reflex.MethodsThirty-five ASA Ⅰ or Ⅱ healthy volunteers,aged 20-60 yr,with body mass index ＜ 30 kg/m2,were enrolled in the study.Sedation was performed with TCI of propofol.The initial target plasma concentration (Cp) of propofol was set at 2.4 μg/ml and the Cp increased or decreased by 0.2 μg/ml every 5 min until the BIS value reached the predetermined level.The initial Cp of propofol was increased or decreased by 0.3 μg/ml in the next subject according to the BIS value in the previous one.The up-and-down sequential experiment was pedormed.The BIS value was set at 65 in the first subject and the ratio of the BIS value between the two consecutive subjects was 1.1.The BIS value was increased or decreased depending on the occurrence of the swallowing reflex in the previous subject.The half-effective BIS value (BIS50) and 95％confidence interval (CI) of propofol inhibiting the swallowing reflex were calculated by up-and-down sequential method.ResultsThe BIS50 of propofol required to inhibit the swallowing reflex was 64.4 (95％ CI 59.3-69.8).ConclusionThe BIS50 and 95％ CI of propofol administered by TCI and required to inhibit the swallowing reflex is 64,4 (59.3-69.8).