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Objective:To evaluate the efficay of different doses of remimazolam for anesthesia induction during reoperation in asthenic patients with tracheotomy.Methods:One hundred and twenty patients of both sexes, aged 19-64 yr, with a modified frailty index score ≥3, of American Society of Anesthesiologists physical status Ⅳ, scheduled for reoperation after tracheotomy, were divided into 4 groups ( n=30 each)using a random number table method: propofol group (group C) and different doses of remimazolam groups (R 1, R 2 and R 3 groups). Anesthesia was induced with intravenous sufentanil 5 μg, propofol 1.5 mg/kg in group C and with remimazolam 0.1, 0.2 and 0.3 mg/kg in R 1, R 2 and R 3 groups, respectively.The tracheotomy cannula was replaced with a reinforced endotracheal intubation (ID=6.0 mm) when bispectral index value ≤ 65.Mean arterial pressure and heart rate were recorded before induction (T 0), immediately before replacement of the tube (T 1) and immediately after replacement of the tube (T 2). The onset time of anesthesia and adverse reactions such as hypotension, bradycardia and bucking during replacement of the tube, and requirement for rescue sedation were recorded. Results:Compared with group C, mean arterial pressure was significantly increased at T 1, 2 in group R 1 and group R 2, the onset time of anesthesia was significantly prolonged, the incidence of hypotension and bradycardia was decreased in R 1, R 2 and R 3 groups, and the requirement for rescue sedation in group R 1 and incidence of bucking in group R 1 and group R 2 were increased ( P<0.05 or 0.01). Compared with group R 1, heart rate at T 2 was significantly decreased, the onset time of anesthesia was shortened, and the requirement for rescue sedation and incidence of bucking were decreased in C, R 2 and R 3 groups, and the incidence of hypotension was significantly increased in group R 3 ( P<0.05 or 0.01). Compared with group R 2, the onset time of anesthesia was significantly shortened in group R 3 ( P<0.05). Conclusions:Remimazolam 0.2 mg/kg provides good efficacy when used for anesthesia induction with fewer side effects during reoperation in asthenic patients with tracheotomy.
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Objective:To evaluate the efficacy of remimazolam combined with low-dose propofol for sedation during induction of anesthesia.Methods:A total of 228 patients of both sexes, aged 18-64 yr, with body mass index of 19-35 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic cholecystectomy, were divided into 2 groups ( n=114 each) by a random number table method: remimazolam combined with low-dose propofol group (group R) and propofol group (group P). Anesthesia was induced with intravenous injection of sufentanil 0.3 μg/kg, remimazolam 0.3 mg/kg, propofol 0.5 mg/kg and micuronium 0.2 mg/kg in group R, and sufentanil 0.3 μg/kg, propofol 2 mg/kg and micuronium 0.2 mg/kg in group P. Endotracheal intubation was performed when bispectral index value ≤ 50.Before induction (T 0), immediately before intubation (T 1), at 1 min (T 2) and 3 min (T 3) after intubation, mean arterial pressure (MAP) and heart rate (HR) were recorded.The anesthesia induction time and the incidence of hypotension and bradycardia were recorded in the two groups. Results:There was no significant difference in MAP and HR at T 0 between the two groups ( P>0.05). Compared with the value at T 0, MAP in two groups and HR were significantly decreased at T 1-3 in group P ( P<0.01). Compared with group P, the anesthesia induction time was significantly prolonged, and hypotension and bradycardia was decreased in group R ( P<0.05). Conclusion:The combination of remimazolam and low-dose propofol exerts better efficacy for sedation during induction of anesthesia than propofol alone.
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Objective To compare the efficacy of different doses of dexmedetomidine for sedation in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS) surgery.Methods Seventy-five patients of both sexes with PD,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 48-72 yr,with body mass index of 18-24 kg/m2,undergoing elective DBS surgery,were divided into 3 groups (n =25 each) using a random number table method:different doses of dexmedetomidine groups (D1-3 groups).Dexmedetomidine was intravenously infused in a loading dose of 0.5 μg/kg at 10 min before local infiltration anesthesia with 0.25 ％ ropivacaine 10-20 ml,followed by an infusion of 0.3,0.5 and 0.8 μg · kg-1 · h-1 in D1-3 groups,respectively.The infusion of dexmedetomidine was suspended during neurological test,the patients were awakened,and dexmedetomidine was infused at 0.3,0.5 and 0.8 μg · kg-1 · h-1 until the end of the surgery after the test.Bispectral index (BIS) value was recorded immediately before anesthesia (T0),immediately after administration prior to wake-up (T1) and during neurological test (T2).The wake-up time and adverse reactions such as requirement for rescue analgesics,pulse oxygen saturation (SpO2) ＜ 90％ and snoring were recorded.Results Compared with group D1,the requirement for rescue analgesics and BIS value at T1,2 were significantly decreased in D2 and D3 groups,and the wake-up time was significantly prolonged,and the incidence of SpO2 ＜ 90％ and snoring was increased in group D3 (P＜0.05 or 0.01).Compared with group D2,the requirement for rescue analgesics and BIS value at T1 were significantly decreased,the wake-up time was prolonged,and the incidence of SpO2 ＜90％ and snoring was increased in group D3 (P＜0.05 or 0.01).Conclusion Dexmedetomidine 0.5 μg · kg-1 · h-1 can produce good sedative efficacy and safety for DBS surgery in patients with PD.
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Objective To evaluate the efficacy of a type of endotracheal tube of extended with terminal swelling and resistance bending pressure for airway management during mechanical ventilation in children in prone position.Methods Sixty pediatric patients with cerebral palsy of both sexes,aged 3-7 yr,weighing 11-23 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective selective functional posterior rhizotomy,were randomly allocated into 2 groups (n =30 each) using a random number table:endotracheal tube of extended with terminal swelling and resistance bending pressure group (group E) and reinforced tracheal tube group (group C).After induction of anesthesia,the type of endotracheal tube of extended with terminal swelling and resistance bending pressure was inserted in group E,and the reinforced endotracheal tube was inserted in group C.The tidal volume,minute ventilation,dynamic lung compliance,arterial oxygen saturation and end-tidal pressure of carbon dioxide in pressurecontrolled ventilation mode were recorded in the two groups.Tube shedding caused by using of the extended tube was recorded during operation.Blood samples were collected from the femoral artery for blood gas analysis.Results Compared with group C,the tidal volume and minute ventilation were significantly increased (P＜0.05),and no significant change was found in dynamic lung compliance,arterial oxygen saturation and end-tidal pressure of carbon dioxide in group E (P＞0.05).Compared with the value before anesthesia,no significant change was found in pH value,arterial oxygen partial pressure and partial pressure of arterial carbon dioxide at the end of operation in the two groups (P＞0.05).In group C,the extended tube wasused in 3 patients,and among the 3 cases,one patient developed tube shedding which was treated immediately.Conclusion The type of endotracheal tube of extended with terminal swelling and resistance bending pressure provides better efficacy than the reinforced endotracheal tube when used for airway management during mechanical ventilation in children in prone position.
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Objective To evaluate the accuracy of nostril width method in intubation model choose in children with cerebral pal‐sy FSPR surgery .Methods Three hundred and fifty six cases of cerebral palsy FSPR surgery were selected ,the endotracheal intu‐bation were selected by nose width method and modified weight method ,and then we made a comparison between the two methods . Kappa consistency test and rank correlation analysis were both used to analyze the consistency .Results With Kappa=0 .81 ,rank correlation coefficient 0 .905 ,we could know that there was high degree of consistency between the two methods (P<0 .01) ,of which 298 cases (83 .7% ) children selected the same model intubation strengthen model in different method ,58 cases (16 .3% ) pe‐diatric intubation choice of two methods differ by one model .Conclusion Nostril width method was simple and reliable to select in‐tubation in pediatric surgery to strengthen FSPR model .
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Objective To evaluate the effect of cerebral palsy factor on the sensitivity of postopera?tive pain in the pediatric patients. Methods Twenty?five pediatric patients with cerebral palsy of both se?xes, of American Society of Anesthesiologists physical statusⅠorⅡ, aged 3-7 yr, weighing 11-25 kg, scheduled for elective lower abdominal or lower extremity surgery, served as cerebral palsy group ( group P). Another 25 pediatric patients without cerebral palsy of both sexes, of American Society of Anesthesiol?ogists physical status Ⅰ orⅡ, aged 3-7 yr, weighing 11-25 kg, served as control group ( group C) . At 2 h after surgery, pain was evaluated by using CRIES ( crying, requires O2 saturation, increased vital sign, expression and sleeplessness) . Peripheral venous blood samples were collected before surgery, and at 2 and 24 h after surgery, and the concentrations of plasmaβ?endorphin were measured by radio?immunity method, and the concentration of plasma catecholamine ( adrenaline) was determined by high performance liquid chromatography. Results Compared with the value before surgery, the plasma concentrations of β?endorphin were significantly decreased, and the concentrations of plasma catecholamine were increased after surgery in the two groups (P < 0?01). Compared with group C, the CRIES score was significantly in?creased after surgery, the concentration of plasmaβ?endorphin was decreased before and after surgery, and the concentration of plasma catecholamine was increased after surgery in group P ( P< 0?05 or 0?01) . Con?clusion The sensitivity of postoperative pain is increased in the pediatric patients with cerebral palsy.
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Objective To investigate the effect of dexmedetomidine on emergence agitation (EA) following sevoflurane anesthesia in children with cerebral palsy.Methods Fifty ASA physical status Ⅰ or Ⅱ children with cerebral palsy of both sexes,aged 2-12 yr,scheduled for elective muscle strength muscle tension adjustment method,were randomly allocated into 2 groups (n =25 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv injection of sufentanil 0.3 μg/kg,cisatracurium 0.15 mg/kg,and propofol 1.5 mg/kg.The patients were tracheal intubated and mechanically ventilated.Dexmedetomidine 0.5 μg/kg was intravenously infused over 15 min after induction of anesthesia in group D and the equal volume of normal saline was given in group C.The operation was begun at the end of administration.Anesthesia was maintained with inhalation of 2％-4％ sevoflurane and the concentration was adjusted to achieve a target BIS value of 45-60.The heart rate,systolic blood pressure and diastolic blood pressure were recorded before infusion of dexmedetomidine (T1) and at skin incision (T2).The extubation time,emergence time and consumption of sevoflurane were also recorded.The end-tidal sevoflurane concentration was recorded at T1,T2,and the end of operation (T3).The adverse cardiovascular events and occurrence of EA were also recorded.The degree of EA was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale.The peripheral venous blood samples were collected at T1,T2,T3 and extubation (T4) for determination of the blood glucose level and serum cortisol concentration.Compared with group C,the emergence time and extubation time were significantly shortened,and the consumption of sevoflurane,end-tidal sevoflurane concentrations at T2 and T3,PAED scores,incidence of agitation,and the blood glucose level and serum cortisol concentration at T4 were significantly decreased in group D (P ＜0.05 or 0.01).There was no significant difference in the incidence of bradycardia or heart rate,systolic blood pressure and diastolic blood pressure at each time point between the two groups (P ＞ 0.05).Conclusion Dexmedetomidine can decrease the development and degree of EA following sevoflurane anesthesia in children with cerebral palsy.