Effects of remazolam vs propofol on hemodynamics during induction of anaesthesia in elderly patients: area under curve method / 中华麻醉学杂志

Objective:To evaluate the effects of remazolam and propofol on the hemodynamics during induction of anaesthesia in elderly patients using the area under curve (AUC) method.Methods:Eighty elderly patients of either sex, aged 65-75 yr, with body mass index of 20-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective non-cardiac surgery, were divided into 2 groups ( n=40 each) by using a random number table method: remazolam group (R group) and propofol group (P group). Remazolam 1 mg/ml or propofol 10 mg/ml was slowly and intravenously injected through titration to achieve loss of responsiveness to verbal command. The accumulative areas under the curve below (AUC MAP-) or above (AUC MAP+ ) baseline mean arterial pressure and under the curve below or above 10% of baseline heart rate at the same time (AUC HR-, AUC HR+ ) were calculated within the first 10 min after administration of propofol or remazolam. The use of vasoactive drugs and injection pain were recorded during this period. The intraoperative awareness during the 24-h follow-up after surgery and development of cardiovascular complications, cerebral infarction and oliguria or anuria within 30 days after surgery were recorded. Results:Compared with R group, AUC MAP- was significantly enlarged (the mean difference 59.375 mmHg·min, 95% confidence interval 26.763-91.987 mmHg·min), AUC HR- was enlarged ( P<0.05), and no significant change was found in AUC MAP+, AUC HR+, requirement for vasoactive drugs, frequency of vasoactive drugs, and postoperative complications in P group ( P>0.05). No injection pain or intraoperative awareness was found in two groups. Conclusions:Remazolam is superior to propofol in maintaining hemodynamic stability during anesthesia induction in elderly patients.

Advances in anesthesia research of modified electroconvulsive therapy / 上海交通大学学报（医学版）

Modified electroconvulsive therapy (MECT) is a fast and effective physical therapy method currently widely used in psychiatry. The anesthesia target of this treatment is to calm the patients, relax the muscles and maintain stability in histodynamics during treatment, meanwhile avoiding affecting efficacy, because too deep anesthesia can inhibit discharge of the cerebral cortex. However, current anesthetic drugs in MECT, including muscle relaxants, intravenous anaesthetics, inhalation anaesthetics, analgesics, etc., lack the best compatibility of anesthesia induction. This review discusses the application and compatibility of these drugs in MECT in recent years, in order to provide reference for the best anesthesia induction protocol for MECT.

Application of oxycodone hydrochloride injection on anesthesia and postoperative analgesia in patients undergoing radical resection of colorectal cancer / 医学研究生学报

Objective　The choice of perioperative analgesic drugs for radical resection of colorectal cancer is controversial. The purpose of this paper is to investigate the efficacy of oxycodone hydrochloride injection on anesthesia and postoperative analgesia in patients with radical resection of colorectal cancer, to provide a basis for the selection of such surgical analgesics.　Methods　Between July 2017 and December 2017, selection of 38 patients with colorectal cancer underwent elective open surgical operation in the Eastern Theater General Hospital, the age range was 18～65 years, the BMI range was 18～25 kg/m2, the ASA was Ⅱ or Ⅲ grade, who were divided to two groups according to randomized, single blind and controlled methods, the oxycodone group was group O, the sufentanil was group S, each group had 19 cases. Oxycodone 0.3 mg/kg (group O) and sufentanil 0.3 μg/kg (group S) were given at general anesthesia induction in both groups.The anesthesia maintenance medication was consistent in both groups. When sewing skin, the group O were given oxycodone 0.15 mg/kg, the group S were given sufentanil 0.15 μg/kg , and who were given PCIA postoperative, the group O were given oxycodone 1 mg/kg and Azhasi 10 mg, while the group S were given sufentanil 2.5 μg/kg and Azhasi 10 mg, which were diluted with normal saline to 100 mL. The NRS score postoperative and the Ramsay sedation scores were recorded when extubating（T1）, 4 hours after operation（T2）, 12 hours after operation（T3）, 24 hours after operation（T4） and 48 hours after operation（T5）in two groups ; the plasma cortisol, MAP(mean arterial pressure) and HR(heart rate) before and after intubation in two groups were recorded; the extubation time, first bowel ventilation time, PCIA compressions and adverse reactions in two groups were recorded.　Results　The age, weight, anesthesia duration had no significant difference in two groups (P> 0.05). Compared with group S, the NRS scores were obvious decreased in group O at all time points（P 0.05). Compared with before intubation, the MAP were both decreased at intubation and after intubation 5min in group O (P 0.05) .　Conclusion　Compared with sufentanil, oxycodone was safer and more effective on general anesthesia induction and postoperative analgesia in radical resection of colorectal cancer.

Evaluación de la estabilidad hemodinámica en pacientes sometidos a cirugía abdominal tratados con morfina durante la inducción anestésica / Evaluation of hemodynamic stability in patients undergoing abdominal surgery treated with morphine during anesthesia induction

Los opioides son los fármacos más potentes utilizados para atenuar los efectos cronotrópicos y vasoconstrictores que se producen durante la laringoscopia. Se realizó un estudio descriptivo transversal con el objetivo de evaluar la estabilidad hemodinámica de los pacientes ingresados al Hospital Central Universitario Dr. Antonio María Pineda para cirugía abdominal tratados con morfina durante la inducción anestésica. La muestra incluyó 30 pacientes con una edad promedio de 38 ± 4,6 años, predominio del sexo masculino (56,6%) y ASA II (53,3%). Los procedimientos quirúrgicos más frecuentes fueron colecistectomía (40%), hernioplastia umbilical (20%) e inguinal (16,6%). Durante la inducción, 26,7%, 10% y 50% de los pacientes registró un aumento de la PAS, PAD y PAM > 20 mmHg en comparación con los valores basales. A los 5 minutos post-inducción, todos los pacientes mostraron disminución de los valores de la presión arterial sistólica y diastólica y sólo 10% de los pacientes de la PAM. No se registraron efectos adversos a la morfina. Estos resultados demuestran que la morfina a una dosis de 0,1 mg/kg por vía endovenosa 30 minutos antes de la inducción permite brindar mayor confort para el paciente con mínimos cambios hemodinámicos y sin efectos adversos(AU)

Opioids are the most potent drugs used to mitigate the chronotropic and vasoconstrictor effects that occur during laryngoscopy. A cross-sectional descriptive study was conducted in order to evaluate the hemodynamic stability of morphine during anesthetic induction in patients undergoing abdominal surgery in the Hospital Central Universitario Dr. Antonio María Pineda. The sample included 30 patients with an average age of 38 ± 14.63 years predominantly male (56.67%) and ASA II (53.33%). 40% of patients underwent cholecystectomy and 20% umbilicoplasty and 16.67% inguinal hernia repair. During anesthesia induction, 26.7%, 10% and 50% of patients showed an increase in systolic, diastolic and mean blood pressure > 20 mmHg compared to basal values. Five minutes post induction, all patients showed decreased values of systolic and diastolic blood pressure and only 10% of patients showed changes in mean arterial blood pressure. No adverse effects were recorded. These results show that morphine at a dose of 0.1 mg/kg intravenously 30 minutes before induction allows greater comfort for the patient with minimal hemodynamic changes and no adverse effects(AU)

¿Existe relación entre la concentración de inducción anestésica de sevofluorano y la incidencia de agitación postanestésica en niños? / Is there a relationship between the concentration of sevofluoran anesthetic induction and the incidence of post-anesthetic agitation in children?

Introducción. La inducción anestésica con sevofluorano se asocia con agitación postanestésica (APA) en niños. Concentraciones de sevofluorano mayores a 6% producen actividad cerebral epileptiforme, la que podría estar relacionada a APA. El propósito de este estudio fue comparar el efecto de dos diferentes concentraciones de inducción anestésica con sevofluorano sobre la incidencia de APA, en niños sometidos a cirugía infraumbilical. Método. Estudio prospectivo y doble ciego, en pacientes de 2 a 7 años, operados de fimosis o hernia inguinal con anestesia general y bloqueo epidural caudal. Los pacientes fueron aleatorizados para recibir sevofluorano 5 por ciento (grupo S5) o sevofluorano 8 por ciento (grupo S8). Se registraron variables demográficas, signos vitales, profundidad anestésica utilizando índice biespectral (BIS) y respuesta motora durante distintos momentos de la anestesia. Se evaluó la presencia de agitación en pabellón y recuperación utilizando la escala de APA pediátrica (PAED). Análisis estadístico: t-test o Mann-Whitney y test Chi-cuadrado o Fisher, p < 0,05 considerada significativa. Resultados. Se reclutaron 33 pacientes, 16 en el grupo S5 y 17 en el grupo S8. Ambos grupos fueron comparables en cuanto a variables demográficas, signos vitales, respuesta motora y valores de BIS. No hubo diferencias significativas en la incidencia de APA en pabellón (S5: 31,3 por ciento y S8: 35,3 por ciento) y en recuperación (S5: 43,8 por ciento y S8: 41,2 por ciento), entre los grupos. Conclusión. No habría relación entre la concentración de inducción anestésica de sevofluorano y la incidencia de APA en niños sometidos a cirugía infraumbilical con anestesia general y bloqueo caudal. (AU)

Introduction. Induction of anesthesia with sevoflurane is associated with post-anesthetic agitation (PAA) in children. Sevoflurane concentration greater than 6% produces epileptiform brain activity, which could be related to PAA. The aim of this study was to compare the effect of two different sevoflurane concentrations for anesthesia induction on the incidence of PAA in children undergoing infraumbilical surgery. Method. Prospective, double blind study, performed in patients 2 to 7 years of age, undergoing circumcision or inguinal hernia repair under general anesthesia and epidural caudal block. Patients were randomized to receive sevoflurane 5 percent (S5 group) or sevoflurane 8 percent (S8 group), during anesthesia induction. Demographic variables, vital parameters, anesthesia depth using bispectral index (BIS) and motor responses during different moments of anesthesia were recorded. The presence of agitation in the operating room and recovery room were determined using the pediatric PAA scale (PAED). Statistical analysis: t-test or Mann-Whitney, and Chi-square or Fisher test, p < 0.05 considered significant. Results. Thirty-three patients were enrolled, 16 in the S5 group and 17 in the S8 group. Demographic variables, vital parameters, motor responses and BIS values were comparable between both groups. There were no significant differences in the incidence of PAA in the operating room (S5: 31.3 percent percent and S8: 35.3 percent) or in the recovery room (S5: 43,8 percent and S8: 41.2 percent), between both groups. Conclusion. Sevoflurane concentration used for induction of anesthesia would not be related to the incidence of PAA in children undergoing infraumbilical surgery under general anesthesia and epidural caudal block. (AU)

Comparison of Oxycodone and Sufentanil applied in laparoscopic cholecystectomy anesthesia induction / 中国内镜杂志

Objective To compare the analgesia effects of Oxycodone hydrochloride with Sufentanil in laparoscopic cholecystectomy (LC) anesthesia induction. Method Sixty patients scheduled for elective LC, ASAⅠ or Ⅱ , were randomly divided into two groups (30 in each): Oxycodone group (group O) and Sufentanil group (Group S). Induction of anesthesia: group O: Propofol 1.0 ~ 2.0 mg/kg, Oxycodone 0.3 mg/kg, Vecuronium 0.1 mg/kg. Group S: Propofol 1.0 ~ 2.0 mg/kg, Sufentanil 0.3 μg/kg and Vecuronium 0.1 mg/kg. The value of HR, SBP, DBP of the two groups were recorded in the operation room (T0), after anesthesia induction (T1), 1 min after insertion laryngeal mask (T2), the instant of pneumoperitoneum establishment (T3), separation of the gallbladder (T4), the time of wake up (T5), leave the recovery room (T6). The numeric pain rating scale (NRS) were recorded at T4, T5, 4 hours later (T7), 8 hours later (T8), one day later (T9). Then recorded the wake time and additional analgetic cases. Recorded the adverse reactions. Results The average HR, SBP and DBP fluctuations in the two groups were not more than 20.0 % of the basal values. There was no significant difference in wake time between the two groups. There were 11 cases of patients, the NRS>4, in Sufentanil group requires additional analgesics after they wake up, more than Oxycodone group (P = 0.040). The NRS score was lower in Oxycodone group than group S in T5, T7, T8, T9, but they had no statistically significant difference. There was no significant difference in adverse reactions between the two groups. Conclusion 0.3 mg/kg Oxycodone and 0.3 μg/kg Sufentanil for anesthesia induction of LC, the anesthesia and analgesia effect is good, can satisfy the clinical anesthesia and postoperative analgesic requirements. The analgesic effect of 0.3 mg/kg Oxycodone may be comparable or better than 0.3 μg/kg Sufentanil.

Effect of oxycodone on hemodynamics and stress response in general anesthesia induction / 实用医学杂志

Objective To investigate the effect of oxycodone and sufentanil with equivalent dose on hemo-dynamics and stress response in general anesthesia induction. Methods One hundred and twenty ASA I orⅡpa-tients with abdominal surgery were randomly divided into oxycodone group(group O,n=60)and sufentanil group (group S,n = 60). Anesthesia was induced with iv oxycodone 0.20 mg/kg(group O)or sufentanil 0.25 μg/kg (group S)respectively,together with iv propofol 2.0 ~ 2.5 mg/kg and cisatracurium 0.2 mg/kg. The patients were tracheally intubated using a single-lumen endotracheal tube. Mean arterial pressure(MAP),heart rate(HR),plas-ma levels of epinephrine(E)and norepinephrine(NE),cortisol(Cor)and blood sugar(Glu)and the occurrence of bucking before anesthesia induction(T0),immediately before intubation(T1),at the moment of intubation(T2), 1 min(T3)and 5 min(T4)after intubation were observed. Results Compared with these at T0,MAP and HR in 2 groups were lower at T1(P0.05). MAP and HR were significantly higher at T2 and T3(P 0.05). Plasma levels of E ,NE,Cor and Glu increased obviously at T2 and T3 in 2 groups(P 0.05). Conclusion Compared with sufentanil ,oxycodone of equivalent dose used for general anesthesia induction can effectively keep smooth on hemodynamics and decrease stress response.

Application of solving difficulty of pediatric patients into the operating room by using combined inhalation anesthesia induction device / 临床麻醉学杂志

Objective To discuss the feasibility and safety of sevoflurane inhale anesthesia with portable combined inhalation anesthesia induction device in solving the difficulty of children entering the operation room.Methods One hundred pediatric patients were enrolled into the study.The pediatric patients were randomly divided into two groups,50 cases in each group.Group A was fraught with a new mode of administration,using portable combined inhalation anesthesia induction device with sevoflurane 2 ml before entering the operation room;group B was fraught with a traditional mode of administration,using in-tramuscular injection with ketamine 4-5 ml/kg before entering the operation room.The analog scale of anes-thetic effect,the number of body movement,adverse reaction were compared between the two groups. Results Compared with group B,time of falling asleep and retention time in the operating room was signif-icantly shorter (P <0.01).And body movement during vein puncture decreased significantly (P <0.01). Moreover,the incidence of adverse affect showed significant reduce compared with group B (P < 0.05 ). Conclusion The combined inhalation anesthesia induction device is simple to produce and easy to carry.To solve the difficulty of convoying children into the operating room,combined inhalation anesthesia induction device with sevoflurane is more effective, safer and more humanized way when compared with the traditional one.

Effect of parents accompany comfort anesthesia technique on child anesthesia induction compliance / 重庆医学

Objective To investigate the effect of parents accompany comfort anesthesia technique on child anesthesia induction compliance.Methods Two hundreds and thirteen children cases undergoing elective operation under general anesthesia were selected,aged 2-12 years old,ASA grade Ⅰ-Ⅱ,developmental normal,without mental system and cognitive dysfunction,and randomly divided into the experimental group 1,2 and control group.The children cases in the experimental group 1 conducted the anesthesia induction by their parents accompany on the operation day,while those in the experimental 2 conducted the anesthesia induction on the operation day after conducting the comfort anesthesia technique guidance.The control group was performed the conventional follow up before operation,the anesthesia induction was performed by the operation nurses and anesthesia doctor accompany on the operation day.Results There were statistically significant differences between the cases of slightly large age,with surgical experience,parents non-anxiety and psychological internal control type with the control group(P＜0.05).The difference between conducting the anesthesia induction guidance and non-conducting the anesthesia induction guidance was not statistically significant(P＞0.05).Conclusion The parents accompany comfort anesthesia induction technique can effectively increase the compliance during the anesthesia induction period in the children patients with slightly large age,operation experience,parents non-anxiety and psychological internal control type.

Effect of parents accompany comfort anesthesia technique on child anesthesia induction compliance / 重庆医学

Objective To investigate the effect of parents accompany comfort anesthesia technique on child anesthesia induction compliance.Methods Two hundreds and thirteen children cases undergoing elective operation under general anesthesia were selected,aged 2-12 years old,ASA grade Ⅰ-Ⅱ,developmental normal,without mental system and cognitive dysfunction,and randomly divided into the experimental group 1,2 and control group.The children cases in the experimental group 1 conducted the anesthesia induction by their parents accompany on the operation day,while those in the experimental 2 conducted the anesthesia induction on the operation day after conducting the comfort anesthesia technique guidance.The control group was performed the conventional follow up before operation,the anesthesia induction was performed by the operation nurses and anesthesia doctor accompany on the operation day.Results There were statistically significant differences between the cases of slightly large age,with surgical experience,parents non-anxiety and psychological internal control type with the control group(P＜0.05).The difference between conducting the anesthesia induction guidance and non-conducting the anesthesia induction guidance was not statistically significant(P＞0.05).Conclusion The parents accompany comfort anesthesia induction technique can effectively increase the compliance during the anesthesia induction period in the children patients with slightly large age,operation experience,parents non-anxiety and psychological internal control type.

The effect of taking Preoperative oral clear water 2 hours before surgery on anesthesia induction and postoperative nausea and vomiting during pediatric interventional heart surgery / 实用医学杂志

Objective To investigate the effect of different forbidden drink schemes on anesthesia induction and postoperative nausea and vomiting during pediatric interventional heart surgery.Methods One hundred and twenty pediatric patients underwent cardiac interventional procedures under general anesthesia were randomized into group A,B and C,with 40 patients in each group.Patients in cach group were fasted for 8 h preoperatively.Water was prohibited for patients in group A for 6 h preoperatively.Patients in groups B and C orally took 10％ glucose solution and a multivitamin drink (Outfast) at 2 h preoperatively,respectively.Nausea and vomiting after anesthesia induction were recorded for 24 h postoperatively.Results The sedation and mask acceptance scores were significantly higher in group B and C than those in group A,and were significantly higher in group C than those in group B (P ＜ 0.05,resoectively).Following anesthesia induction,MAP was significantly higher in group B and C than that in group A (P ＜ 0.05,resoectively).Both the severity and incidence of postoperative nausea and vomiting were higher in group B and C than those in group A,and was lower in group C than that in group B (P ＜ 0.05,resoectively).Conclusions Taking clear water orally 2 hours before surgery can decrease the restlessness of pediatric interventional heart surgery during anesthesia induction period,with stable smooth hemodynamics,reducing the degree of PONV.

Observation on the clinical application of target-controlled infusion of propofol guided by Narcotrend for anesthetic induction in renal transplantation patients / 临床麻醉学杂志

Objective To observe the hemodynamic change and stress reaction of target-con-trolled infusion (TCI)of propofol guided by Narcotrend for anesthetic induction in renal transplanta-tion patients.Methods Forty patients (25 males,1 5 females,aged 21-38 years,ASA grade Ⅲ orⅣ)undergoing related living donor kidney transplantation were randomly divided into two groups:group A and group B (n =20).Group A was induced using TCI system with propofol under the moni-toring of Narcotrend.Group B was induced with propofol manually.HR,MAP,Narcotrend index (NTI),blood glucose (Glu)and plasma cortisol (Cor)were measured before induction (T0 ),before tracheal intubation (T1 ),and 1 (T2 ),3 (T3 ),and 5 (T4 )minutes afterwards.Results HR and MAP at T1 were lower than those at T0 (P < 0.05 )in two groups,they were significantly lower in group B than in group A at corresponding points(P <0.05).HR and MAP in group B increased sig-nificantly (P <0.05)and were significantly higher than those in group A (P <0.05)at T2 and T3 . There was no obvious difference in Glu and Cor between T0 and T2-T4 in group A.Glu and Cor at T2-T4 were obviously higher than those at T0 (P <0.05)in group B and those at corresponding points in group A (P <0.05).Conclusion TCI of propofol guided by Narcotrend in renal transplantation pa-tients can better control the depth of anesthesia,attenuate the stress reaction caused by tracheal intu-bation,and keep hemodynamic smooth during anesthesia induction.

Optimum dose of Oxycodone for anesthesia induction in patients undergoing laparoscopic cholecystectomy / 中国内镜杂志

Objective To determine the optimum dose of Oxycodone for anesthesia induction in patients undergoing laparoscopic cholecystectomy. Methods Ninety patients, ASA Ⅰ or Ⅱ , scheduled for elective LC, were randomly divided into 3 groups using random number table (O 1~O 3 groups, n = 30 each). Anesthesia was induced with iv Propofol 1.00~2.00 mg/kg, Oxycodone 0.20 mg/kg, 0.3 mg/kg and 0.4 mg/kg (O 1~O 3 groups, respectively), and Vecuronium 0.10 mg/kg. Before anesthesia induction ( T0 ), 1 min after Laryngeal Mask intubating ( T1 ), the instant of pneumoperitoneum ( T2 ), separation of the gallbladder ( T3 ), wake up immediately ( T4 ), leaving the recovery room ( T5 ), the heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. At T4, leaving the recovery room ( T5 ), 4 hours after the operation ( T6 ), 8 hours after operation (T7), the numeric pain rating scale (NRS) were recorded. The overall amount of remifentanil and Oxycodone were record. The wake up time, additional analgetic cases and the adverse reactions were recorded. Results The average HR, SBP and DBP fluctuations in the O 2 and O 3 groups were not more than 20.00% of the basal values. There was no significant difference in wake up time between the three groups. There were 22 cases of patients, the NRS> 4, in O1 group requires additional analgesics after they wake up, more than O 2 and O 3 group (7, 3 respectively, P < 0.05). The overall Oxycodone consumption of the three groups were O1: (18.93 ± 4.34) mg (0.90~2.60 mg),O2: (25.50 ± 4.49) mg (1.40~3.00 mg), O3: (26.10 ± 4.55) mg (1.80~3.40 mg) (F = 23.79, P = 0.000). There was no significant difference in adverse reactions between the three groups, but one patient had respiratory depression in O3 group. Conclusion The optimum dose of Oxycodone for anesthesia inducing in laparoscopic cholecystectomy were 0.30 mg/kg.

Application of oxycodone hydrochloride in the induction of general anesthesia / 临床麻醉学杂志

Objective To explore the clinical effect and safety of oxycodone hydrochloride in the induction of genenral anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 35-75 years,sched-uled for colorectal surgery,undergoing general aneasthesia were randomly divided into two groups with 30 cases in each group:fentanyl group (group F)and oxycodone hydrochloride group (group O).Fentanyl 2 μg/kg+propofol 2 mg/kg+cisatracurium 0.1 5 mg/kg (group F)or oxycodone 0.2 mg/kg+propofol 2 mg/kg + cisatracurium 0.1 5 mg/kg (group O)was administered intravenously for general anesthesia induction.MAP and HR were monitored and recorded before the induction (T0 ),1 min before intubation (T1 ),at the time of intubation (T2 ),1 min after intubation (T3 )and 5 min after intubation (T4 ).Side-effect incidence of each group,operation time,wakening time,extuba-tion time and visual analogue scale (VAS)were recorded.Results Compared with group F,MAP in group O were lower than that of group F at T1 (P <0.05),while HR between two groups at T0-T4 showed no significant difference.In group F,there were statistical significances in MAP and HR be-tween T1-T3 and T0 ;in group O,there were statistical significances in MAP between T1-T2 and T0 , and HR at T2-T3 was significantly higher than that at T0 (P <0.05).No statistical significance were obtained between two groups in the operation time,wakening time and extubation time.The incidence of cough and the VAS of group O was less than that of group F with statistical significance (P <0.05).Conclusion Oxycodone hydrochloride used for the intubation of general anesthesia is practica-ble.

Etomidate induction of general anesthesia guided by cerebral state index in elderly hypertensive patients / 中国医师进修杂志

Objective To study the effect of target controlled infusion of etomidate and propofol during general anesthesia induction period on haemodynamics and stress by cerebral state index (CSI) in elderly hypertensive patients. Methods Forty ASAⅠor Ⅱelderly hypertensive patients undergoing selective laparoscopic cholecystectomy were randomly divided into two groups by random digits table method with 20 cases each: propofol group and etomidate group. CSI, mean arterial pressure (MAP), heart rate, blood glucose, concentration of plasma cortisol in the two groups were observed before induction of anesthesia, at 1 min before intubation, and at 1 min, 3 min and 5 min after intubation. Results The level of CSI, MAP, heart rate, blood glucose, cortisol between two groups at before induction of anesthesia had no significant difference (P>0.05).The levels of CSI in two groups at 1 min before intubation, and at 1 min, 3min after intubation were significantly lower than that at before induction of anesthesia, but compared with that at 1 min before tracheal intubation, CSI was significantly higher in two group at 1 min, and 3 min after intubation, and there was significant difference (P0.05). Compared with before induction of anesthesia, the concentrations of blood glucose and cortisol at 1min before intubation in patients of the two groups decreased significantly, while glucose and cortisol concentrations at 1 min, 3 min and 5 min after intubation in two group significantly increased , and there was significant difference (P<0.05);cortisol concentration in etomidate group at 1 min before intubation and 1 min, 3 min, 5 min after intubation was significantly lower than that at the same period in propofol group:(260.6 ± 39.6) nmol/L vs. (290.2 ± 35.6) nmol/L, (380.3 ± 37.6) nmol/L vs.(410.8 ± 46.6) nmol/L, (361.2 ± 25.2) nmol/L vs. (392.6 ± 31.6) nmol/L, (352.3 ± 25.6) nmol/L vs. (370.3 ± 28.8) nmol/L, and there were significant differences (P < 0.05). Conclusions During induction of general anesthesia with the guidance of cerebral state index, target controlled infusion of etomidate has more stable hemodynamics, and also attenuates the stress response to tracheal intubation in elderly hypertensive patients.

A novel technique of anesthesia induction in supine position with impaled knife in the back.

Current technique of airway management for impaled knife in the back includes putting the patient in lateral position and intubation. We present here a novel technique of anesthesia induction (intubation and central line insertion) in a patient with impaled knife in the back which is simple and easily reproducible. This technique can be used for single lung ventilation using double lumen tube or bronchial blocker also if desired.

Effects of Dexmedetomidine on Hemodynamics of Patients Underwent Cardiac Valve Replacement in the An-esthesia Induction / 中国药房

OBJECTIVE:To observe the effects of dexmedetomidine on hemodynamics of patients underwent cardiac valve re-placement in the anesthesia induction. METHODS:92 patients underwent cardiac valve replacement were randomly divided into ob-servation group and control group,with 46 patients in each group. Both groups received routine anesthesia induction regimen of midazolam 1-2 mg/kg+ fentanyl 0.05 mg/kg+ propofol 1-2 mg/kg+ cis-atracurium 0.15 mg/kg. Observation group was additionally given dexmedetomidine 0.5 μg/kg,within 10 min with pumps,and then maintained with 0.4 μg/(kg·h)till the end of operation;control group was additionally given constant volume of normal saline with pumps. SBP,DBP,MAP,HR,cardiac output(CO), cardiac index(CI),stroke volume(SV),stroke volume variation(SVV)before anesthesia induction(T0),5 min after medication (T1),2 min after anesthesia induction (T2),1 min after intubation (T3),3 min after intubation (T4) and 5 min after intubation (T5)were recorded in 2 groups as well as OAA/S at T0 and 5 min after pumping dexmedetomidine(T1). ADR of 2 groups during anesthesia was also recorded. RESULTS:There was no significantly difference in SVV of 2 groups at T0-T5 (P>0.05);SBP, DBP,MAP,HR,CO,CI and SV of observation group at T0-T5 were all better than those of control group,with statistical signifi-cance(P0.05),and OAA/S of observa-tion group at T1 was decreased significantly and lower than control group,with statistical significance(P0.05). CON-CLUSIONS:Dexmedetomidine can reduce the influence of anesthesia on the hemodynamics of patients underwent cardiac valve re-placement with good safety.

Bechmarking anesthesia-controlled times at a tertiary general hospital in the Philippines

The need to measure and improve quality in the health care management setting necessitates the development of performance standards. The drive for operating room (OR) efficiency has led administrators to investigate the anesthesia-controlled times (ACTs), which are the specific periods of anesthesia task completion including preparation for anesthetic induction, anesthetic induction itself and the wake up time or time to emergence from anesthesia.OBJECTIVES: This study aims to conduct an internal benchmarking of ACTs using a secondary analysis of the data collected in a cross sectional survey of randomly selected elective surgical cases from October 2011 to January 2012, looking into the efficiency status of the operating room under the Department of Surgery of the Philippine General Hospital (PGH).METHODS: Mean observed times for each of the milestone comprising the ACT were calculated taking in consideration the various anesthetic techniques, type of surgical procedures, duration of the operation and the anesthesiologist's experience. Analysis of variance and Fisher's exact test were used to determine the association of these factors with length of the ACT. For those where an association was noted, a multivariate analysis was done to determine its impact on the actual ACT.RESULTS: Based on data from 539 cases, a set of benchmarks for ACT that better reflects the local setting, is proposed for the different surgical procedures and anesthetic techniques. This includes times for anesthesia preparation of 5 mins, anesthesia induction of 10 minutes and emergence times of 10 mins for total intravenous anesthesia; 20,15 and 15 mins for inhalational anesthesia; 15,10, 10mins for spinal anesthesia; 20, 25, 10 mins for epidural anesthesia and 10, 25, and 15 minutes for combined general-regional anesthesia.CONCLUSION: It is imperative to standardize ATCs in order to reduce variability and improve efficiency. The first step in achieving this goal is to describe the standards in a particular institution, which in turn may be used as a benchmark by other institutions in a similar setting.

Clinical observation of target-controlled infusion of propofol during anesthesia induction in intracranial aneurysms interventional treatment / 中国医师进修杂志

Objective To observe the effects of target-controlled infusion ofpropofol on hemodynamics during anesthesia induction in intracranial aneurysms interventional treatment.Methods Ninety patients in intracranial aneurysms interventional treatment were divided into three groups by random digits table method with 30 cases each:control group (group C),plasma drug concentration in target controlled infusion group (group P) and effect of chamber drug concentration in target controlled infusion group (group E).The induction of anesthesia:patients in group C were single intravenous injected with propofol of 2 mg/kg; patients in group P were set target plasma concentration of propofol with 4 μ g/ml.Patients in group E were set the effect target concentration of propofol with 4 μ g/ml.Three groups were set the concentration of remifentanil 4 ng/ml with plasma controlled infusion,and cisatracurium was injected with 0.2 mg/kg.Electrocardiogram,mean arterial pressure (MAP),heart rate (HR),end-tidal pressure of carbon dioxide,bispectral index,pulse oxygen saturation were continuously monitored.Before the time of induction (T0),immediately before intubation (T1),after intubation 1 min (T2),3 min (T3),5 min (T4),10 min (T5),arterial pressure and HR were recorded and the number of using vasoactive drugs were recorded.Results The level of MAP and HR among three groups at T0 had no significant difference (P ＞ 0.05).The level ofMAP and HR in three groups at T1 was significantly lower than that at T0.(P ＜ 0.05).The level of MAP and HR in group P was lower than that in group E and group C,and there was significant difference (P ＜ 0.05).The incidence of using vasoactive agen in group P was significantly lower than that in group C [6.7％(2/30) vs.40.0％ (12/30)],and there was significant difference (P ＜0.01).Conclusion Hemodynamics is relatively stable during anesthesia induction using plasma target controlled infusion with propofol in patients undergoing interventional therapy for intracranial aneurysm.

Effect of Sufentanil Combined with Dexmedetomidine on Hemodynamic and Narcotrend Index During Pediatric Anesthesia Induction / 医药导报

Objective To investigate the effect of different doses of sufentanil combined with dexmedetomidine ( DEX) on hemodynamic and Narcotrend index ( NI) during pediatric anesthesia induction. Methods A total of 45 children with lower abdominal surgery were randomly divided into three groups evenly: sufentanil 0. 1 μg·kg-1+ DEX (S1 group),sufentanil 0. 2 μg·kg-1+DEX (S2 group),and sufentanil 0. 3μg·kg-1+DEX (S3 group). Patients in each group began with intubation at the peak point of administration. Blood pressure,heart rate,perfusion index (PI) and NI were detected at the baseline (t0), delivering DEX 0.5 μg·kg-1·h-1 and sufentanil intravenously for 5 min (t1),delivering sufentanil for 3 min (t2),time of intubation ( t3 ) ,1 min ( t4 ) ,and 5 min ( t5 ) after intubation. The application rate of atropine and propofol was recorded. Patient recovery time and adverse reactions were observed. Results Compared with basicline value at t0 time point, hemodynamic parameters and NI were decreased at t1 and t2 ,while PI was increased in both groups. At t3 ,t4 ,and t5 ,all of the indicators in S1 group were significantly different from those at t0 ,and also significantly different from those in S2 and S3 group. Six patients were treated with propofol in S1 group and four presented with agitation after operation,more than S2 and S3 groups. Three patients were treatment with atropine in S3 group. Conclusion Sufentanil (0. 2 μg·kg-1 ) combined with dexmedetomidine can be used to induce intubation for pediatric anesthesia with stable hemodynamic profile and low incidence of adverse effects.