ABSTRACT
Objective:To evaluate the optimization strategy of labor analgesia in obese parturients using dural puncture epidural (DPE) combined with programmed intermittent epidural bolus (PIEB).Methods:Eighty American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ obese primiparae, who were at full term with a singleton fetus in vertex presentation, aged 20-40 yr, with body mass index of 30-40 kg/m 2, at 37-42 week gestation, with cervical dilation of 2-5 cm, and with visual analogue scale score ≥50 mm, were divided into 2 groups ( n=40 each) using a random number table method: DPE plus PIEB group (DPEP group) and DPE plus continuous epidural infusion group (DPEC group). All parturients received DPE labor analgesia, and parturients received PIEB (DPEP group) and continuous epidural infusion (DPEC group) to maintain analgesia during labor. In DPEP group, the patient-controlled epidural analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval and background infusion at 2 ml/12 min after an initial dose of 8 ml. In DPEC group, the patient-controlled epidural analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval and background infusion at 10 ml/h after an initial dose of 8 ml. The analgesia solution contained 0.1% ropivacaine plus 0.3 μg/ml sufentanil. The time to achieve adequate analgesia, consumption of ropivacaine per unit time, height of sensory block at the thoracic vertebral level, modified Bromage score, effective pressing times of patient-controlled analgesia, the number of rescue analgesia, Apgar score, delivery mode, occurrence of adverse reactions and maternal satisfaction with labor analgesia were recorded. Results:Compared with DPEC group, the time to achieve adequate analgesia was significantly shortened, the consumption of ropivacaine per unit time was decreased, and the number of rescue analgesia and effective pressing times of patient-controlled analgesia were decreased in DPEP group ( P<0.05). There were no significant differences in the height of sensory block at the thoracic vertebral level, modified Bromage score, Apgar score, delivery mode, incidence of adverse reactions and maternal satisfaction with labor analgesia between the two groups ( P>0.05). Conclusions:DPE combined with PIEB offers faster onset and better effect and achieves a greater local anesthetics-sparing effect when used for labor analgesia in obese parturients.
ABSTRACT
Objective To evaluate the effects of different doses of dexmedetomidine on the anterograde amnesia of propofol in the patients undergoing gynecological surgery.Methods Sixty patients,aged 20-50 yr,with body mass index of 18-25 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic total hysterectomy,were randomly divided into 3 groups (n =20 each) using a random number table:propofol group (group C),low-dose dexmedetomidine combined with propofol group (group D1) and high-dose dexmedetomidine combined with propofol group (group D2).Dexmedetomidine 0.2 and 0.4 mg/kg were infused intravenously over 15 min in D1 and D2 groups,respectively.Target-controlled infusion of propofol was then started at an initial target plasma concentration (Cp) of 0.5 μg/ml.The Cp increased to 0.9,1.3,1.7 and 2.1 μg/ml in turn and maintained at each level for 3 min.After entering the operating room (baseline),at the end of dexmedetomidine infusion,and when Cp was maintained at each level for 3 min after being increased to 0.9,1.3,1.7 and 2.μg/ml in turn,and amnestic test and OAA/S score were performed.The Cp of propofol and BIS value were calculated when the amnestic rate reached 95 ％.The development of hypotension,bradycardia,respiratory depression,and upper airway obstruction was also recorded.Results Compared with group C,the amnestic rate was increased,the Cp of propofol and incidence of respiratory depression were decreased when the amnestic rate reached 95％,BIS value was increased (P ＜ 0.05),and no significant change was found in the incidence of the other adverse events in D1 and D2 groups (P ＞ 0.05).Compared with group D1,the amnesia rate was increased,the Cp of propofol was decreased and the BIS value was increased when the amnestic rate reached 95 ％ in group D2 (P ＜ 0.05),and no significant change was found in the incidence of the other adverse events in D1 and D2 groups (P ＞ 0.05).Conclusion The optimum dose of dexmedetomidine enhancing the anterograde amnesia of propofol is 0.4 μg/kg in the patients undergoing gynecological surgery.