ABSTRACT
A total of 60 ankylosing spondylitis patients scheduled for elective surgery with anticipated difficult airway were enrolled and randomly assigned into either dexmedetomidine (D) or midazolam plus sufentanil (MF) group.Group D:topical nasal anesthesia and a loading dose of dexmedetomidine at 1.0 μg/kg in 10 min; group MF:intravenous infusion of 0.05 mg/kg midazolam plus 3 μg/kg sufentanil.Fiberoptic bronchoscopic (FOB)-assisted awake nasotracheal intubation was performed.Mean arterial pressure (MAP),heart rate (HR),Pulse oxygen saturation (SpO2),Ramsay score and success rate of intubation were recorded and compared between two groups.The intubation conditions and level of comfort were also evaluated.MAP and HR of group D at FOB through postnaris (T1),peep the epiglottis(T2),intubation success immediately(T3)and 1 min after intubation(T4) were significantly lower (P ＜ 0.05 or P ＜ 0.01) than those of group MF while Ramsay sedation scores were obviously higher (P ＜ 0.05) than those of group MF.Group D with endotracheal intubation comfort level 5 score of grade 1-2 were 8 and 14 cases and were significantly higher than 4 and 10 cases of group MF.Immediately after intubation,level 3 scores in grade 1 of group D (n =21) were significantly higher than group MF (n =12) ; initial success rate of intubation in group D was obviously higher than that in group MF (70％,n =21 vs.47％,n =14).And the incidence of unpleasant intubation memory in group D was lower than that in group MF (37％,n =11 vs.67％,n =20).Fiberoptic bronchoscopic-assisted nasotracheal intubation offers better conditions for intubation and reduces the incidence rate of intraoperative awareness.
ABSTRACT
Objective To observe the clinical effects of sufentanil combined with sevoflurane for anesthesia induction in the elderly.Methods A total of 84 patients undergoing elective laparoscopic were randomly divided into 4 groups by dose of Sufentanil (21 cases,each):0.25,0.50,0.75 and 1.00 μg/kg sufentanil.Mean arterial pressure (MAP)and heart rate (HR)were measured at baseline (To),immediately before intubation(T1),immediately,1,3 and 5 min after intubation(T2-5).Intubation scores were also recorded.Results The intubation scores including visual analogue score (VAS) and Ramsay score at 10 min,30 min and 60 min after tube drawing were as the following sequence:1.0 μg/kg ＞ 0.75 μg/kg ＞0.5 μg/kg ＞ 0.25 μg/kg sufentanil (F =5.78.P＜ 0.05).Compared with T0,MAP and HR decreased in each group at T1,while increased at T2 in group A (P＜0.05).As compared with T0,MAP was decreased and HR was slower at T1 in the 4 groups (F=34.99,P＜0.05),but MAP level was increased in 0.25 μg/kg sufentanil group at T2 (F=12.48,P＜0.05).Compared with group of 0.25 μg/kg sufentanil,MAP was reduced in 0.75 μg/kg and 1.00 μg/kg groups at T4 andT5 (F =6.98,6.25,P＜0.05).MAP was also lower in 0.75μg/kg and 1.00μg/kg groups than in 0.50 μg/kg sufentanil group at T2-T5(F=7.08,20.56,P＜0.05).Conclusions Sufentanil of 0.25 0.50 μg/kg combined with sevoflurane can provide excellent intubating conditions and stable hemodynamics during anesthesia induction in patients undergoing gynecologic surgery.
ABSTRACT
OBJECTIVE To analyze the morbility of nosocomial pulmonary acquired infection and related factors after operation of head injury,and inquire into effective countermeasures. METHODS By methods of retrospective investigation,280 patients in hospital form Jan 2005 to Jan 2007 operated for craniocerebral trauma had investigated on mortality rates of pulmonary infection and related factorsRESULTS The rates of pulmonary infection was 18.2% in 280 patients,the death rate was 38.7% in infected group. and group 13.7% in uninfected. The risk factors of nosocomial pulmonary infection were lower immunity among elderly patients,long-time in hospital,general anesthesia intubation,trachea incision and the use of respiraters. CONCLUSIONS The mortality and morbidity rates of pulmonary infection are both higher for the head injury patients. It's important to prevent infection. According to the main risk factors,to take corresponding protection measures,comprehensive supervision,and emphasis enhencing prevention and control;meanwhile to improve the quality of treatment and nurse,and reduce morbility and death rates of pulmonary infection.