ABSTRACT
Comfort medical treatment has aroused the attention of all walks of life.Perioperative analgesia will be one of the important components.The analgesic guidelines of American Society of Anesthesiologists (ASA) and anesthesiology are all advocating multi mode analgesia.Transversus abdominis plane (TAP) block is considered to be one of the effective methods of multimode analgesia in the perioperative period.It can provide analgesia for surgical perioperative period,reduce the dosage of opioid after operation and the incidence of adverse reactions.We review the relevant factors on patient selection,anesthetic seletion and clinical efficacy for TAP block by reviewed relative literatures,aiming to provide new methods and ideas for clinical practice.TAP block opens new ideas for perioperative analgesia,and it is a new direction of multimode analgesia during perioperative period.
ABSTRACT
Objective To explore the clinical value of combined treatment of sufentanil and propofol in children during anesthesia induction.Methods 72 children were selected,and they were randomly divided into three groups by full random allocation method:observation group A,observation group B and control group,24 cases in each group.The observation group A was given intravenous infusion of sufentanil(0.01g · kg-1 · min-1),the observation group B was given intravenous infusion of sufentanil (0.02g · kg-1 · min-1),the control group was given intravenous saline infusion,then given propofol target controlled infusion after 30min.The bispectral index (BIS),propofol effect chamber (EC),OAA/S score and time of induction of anesthesia (LOC) time were recorded in the three groups.Results There was a significant correlation between BIS and propofol EC and OAA/S scores in the three groups,and there was a negative correlation between BIS and propofol EC (r =-0.82,-0.79,-0.88,all P ＜ 0.01).BIS and OAA/S score was positively correlated (r =0.86,0.81,0.89,all P ＜ 0.01).Compared with the control group [(9.11 ± 1.04) min],the LOC time of the observation group A and B [(5.37 ± 0.89) min,(4.49 ± 0.63) min] was significantly shortened (t =13.39,18.61,all P ＜ 0.01).The propofol EC of control group was (2.44 ± 0.5) μg/mL,the propofol EC of the observation group A and B [(1.38 ± 0.35) μg/mL,(1.14 ± 0.27) μg/mL] decreased during anesthesia induction (t =8.40,11.04,all P ＜ 0.01),and the effect of the observation group B was better than that of the observation group A (t =3.95,2.67,all P ＜ 0.05).There was no statistically significant difference in BIS between the observation group A and control group [(70 ± 4) vs.(69 ± 7),t =0.61,P ＞ 0.05].The BIS of observation group B (78 ± 5) was significantly higher than that of the observation group A and control group (t =6.12,5.13,all P ＜ 0.01).Conclusion Sufentanil combined with propofol for anesthesia in children has a synergistic effect,which is beneficial to reduce the amount of propofol EC during anesthesia induction,shorten the time of LOC and enhance the sedative effect of propofol,and it is worthy of further clinical application.
ABSTRACT
Objective To investigate the clinical effects of different dose of remifentanil with double-tube type laryngeal mask airway (LMA) ventilation in the aged patients undergoing total hip-arthroplasty (THA).Methods Sixty ASA class Ⅰ-Ⅱ grade patients undergoing THA were enrolled in the study.The patients were divided into three groups according to remifentanil dose with 20 cases each,0.2 μ g/ (kg· min)group,0.3 μ g/(kg· min) group and 0.4 μ g/(kg· min) group.Heart rate and mean arterial pressure (MAP)were measured immediately before anesthesia induction,immediately after anesthesia induction,immediately after inserting LMA,the set of operation,15 min during operation and discontinuation of anesthetic.Results All patients were successfully operated without intraoperative awareness.In 0.2 μ g/(kg·min) group,the patients suffered from the heart rate and MAP fluctuations,the high incidence of body movement (45.0％,9/20),and the maximum amount of propofol [(82.4 ± 21.6) mg].In 0.3 μg/(kg· min) group,heart rate and MAP had the better fluctuation,and patients might wake up faster postoperatively.In 0.4 μ g/(kg· min) group,heart rate and MAP significantly decreased,the amount of efedrina [(5.2 ± 4.3) mg] was the largest in the three groups,the recovery time [(5.2 ± 1.3) min] was the longest Conclusion Remifentanil 0.3 μg/(kg·min) compound with propofol with double-tube type LMA can be used for total intravenous anesthesia in the elderly patients with THA,with hemodynamic stability,fewer complications,and reliable ventilation.