Anesthetic effect of sufentanil combined with propofol in different target-controlled concentrations in patients with breast cancer / 中国基层医药

Objective@#To explore the anesthetic effect of sufentanil combined with propofol with different target control concentration for breast cancer patients.@*Methods@#From January 10, 2015 to December 20, 2017, according to the digital table, 80 patients with breast cancer in the Maternal and Child Health Hospital of Cixi were randomly divided into three groups: group A(28 cases, the intraoperative sufentanil plasma target control concentration was 0.2ng/mL), group B (27 cases, the intraoperative sufentanil plasma target control concentration was 0.4ng/mL), group C (24 cases, the intraoperative sufentanil plasma target control concentration was 0.8ng/mL). The plasma target control concentration of propofol in three groups was 3μg/mL.The hemodynamic level[mean arterial pressure(MAP), heart rate(HR)], blood oxygen saturation(SpO2), recovery time, respiratory recovery time and incidence of adverse reactions were compared among the three groups.@*Results@#The MAP of T2, T3 and T4 in group A, group B and group C[T2: (78.56±7.42)mmHg vs.(76.98±7.65)mmHg vs.(69.36±7.69)mmHg; T3: (88.24±7.61)mmHg vs.(86.95±7.59)mmHg vs.(69.41±7.70)mmHg; T4: (72.32±7.51)mmHg vs.(69.24±7.21)mmHg vs.(66.52±6.85)mmHg], HR[T2: (73.65±8.75)times/min vs.(73.49±8.69)times/min vs.(68.36±7.79)times/min; T3: (76.75±8.95)times/min vs.(75.58±7.96)times/min vs.(68.65±7.36)times/min; T4: (71.42±7.41)times/min vs.(70.24±6.49)times/min vs.(64.39±6.62)times/min] showed significant differences[F(MAP)= 8.524, 15.365, 5.325; F(HR)=8.104, 12.521, 5.015, all P<0.05]. However, there were no statistically significant differences in SpO2 among group A, group B and group C in T2, T3 and T4(all P>0.05). There were no statistically significant differences in resuscitation time and respiratory recovery time among group A, group B and group C (all P>0.05). There was no statistically significant difference in the incidence of adverse reactions among group A, group B and group C(P>0.05).@*Conclusion@#0.8ng/mL sufentanil combined with 3μg/mL propofol has better anesthetic effect on patients undergoing breast cancer surgery, which is helpful to maintain hemodynamic stability.

Comparisons of Vascular Pain during Intravenous Administration: Thiopental and Propofol / 대한마취과학회지

BACKGROUND: Even though propofol having many clinical merits, a vascular pain during intravenous administration of it could maKe us choose other induction agents. One of many METHODS to decrease vascular pain, the use of propofol preserved in a cold temperature (1 4degeesC) was introduced and Known to be effective. The purpose of this study was to compare vascular pain of cold propofol with that of thiopental as induction agents. METHODS: Sixty adult patients for elective surgery were randomly assigned to the two groups according to receiving thiopental (Group I, n = 30) or propofol (Group II, n = 30), then they were divided randomly into two subgroups according to the selection of vascular size; vein on the dorsum of hand or antecubital fossa. As an induction agent, 2.5% thiopental (5 mg/Kg) or cold 1% propofol (2 mg/Kg) were given intravenously during 40 sec. The severity of vascular pain (classified by 4 points verbal category system) and the incidences of pain were compared according to the induction agents and the selection of vascular size. The incidences of moderate to severe pain according to the selection of induction agents were compared. RESULTS: There was no significant difference in the severity, incidence of pain or incidence of moderate to severe pain in both groups, There was no significant difference in the incidence of pain according to the vascular size. CONCLUSIONS: As cold propofol was given slowly (during 40 sec), the vascular pain was not significant to hinder the selection of propofol as an induction agent compared with that of thiopental.

The Effect of Propofol on Blood Pressure and Heart Rate during Induction of Anesthesia and Endotracheal Intubation in Patients with Sinus Bradycardia / 대한마취과학회지

BACKGROUND: Bradycardia frequently occurs in intravenous anesthesia with propofol. Patients with sinus bradycardia have increased vagal tone at rest. The purpose of this study is to evaluate the effect of propofol on blood pressure and heart rate during induction of anesthesia in patients with sinus bradycardia. METHODS: Sixteen adult patients were studied. No anticholinergics were used before induction. Anesthesia was induced intravenously with midazolam 0.03 mg/kg, propofol 2 mg/kg, lidocaine 1 mg/kg and vecuronium 0.12 mg/kg. Anesthesia was maintained with continuous infusion of propofol 150 microgram/ kg/min and 100% O2. Hemodynamic data were recorded 3 minutes after midazolam injection, immediately after propofol injection, 1 and 2 minutes after propofol continuous infusion, and immediately, 1, 3 and 5 minutes after intubation. RESULTS: Heart rate significantly increased after intravenous injection of propofol (P < 0.05) and was maintained during the study. There was no incidence of bradycardia. CONCLUSIONS: Anesthesia induction and maintenance with propofol could be a suitable and safe ansethetic method for patients with sinus bradycardia.

The Effect of Midazolam, Fentanyl and a Small Dose of Etomidate for Prevention of Myoclonus during Induction of Anesthesia with Etomidate / 대한마취과학회지

BACKGROUND: The hypothesis that subcortical disinhibition is the reason for etomidate-induced myoclonus suggest that drugs acting on the subcortical area may reduce myoclonus. To verify the hypothesis, premedication with placebo, etomidate of a small dosage, midazolam and fentanyl were compared. METHODS: Sixty ASA physical status I or II patients undergoing elective surgery were allocated into four groups. All groups were induced with etomidate 0.3 mg/kg and vercuronium 0.1 mg/kg and maintained with 50% N2O and 1.5-2% enflurane. Group I (n = 15) received normal saline 3 ml 5 minutes before the etomidate 0.3 mg/kg administration, group II (n = 15) received 0.05 mg/kg etomidate 50 seconds before the etomidate 0.3 mg/kg administration, group III received midazolam 0.05 mg/kg 5 minutes before the etomidate 0.3 mg/kg and group IV received 2 microgram/kg fentanyl 5 minutes before the etomidate 0.3 mg/kg. In all patients, the grade, starting time, maintenance time of myoclonus and vital signs were checked and compared between the four groups. RESULTS: In group IV, myoclonus did not develope except in one patient and there were no differences in the incidence of myoclonus between the others. All premedicating drugs do not affect vital signs. CONCLUSIONS: We find that fentanyl reduces the incidence of etomidate-induced myoclonus but midazolam and a small dose of etomidate are not effective.

Effects of Acute Myocardial Ischemia on Regional Function of the Remote Nonischemic Myocardium in Dogs / 대한마취과학회지

INTRODUCTION: During an acute myocardial ischemia, maintenance of overall ventricular function may depend on remote nonischemic myocardium. Whereas fentanyl has minimal hemodynamic effects, volatile anesthetics, including halothane and isoflurane cause negative inotropic and lusitropic effects in normal myocardium. This investigation examined the effects of volatile anesthetics in comparision with fentanyl on compensatory responses to brief left anterior descending coronary artery (LAD) occlusion in remote normal myocardium (left circumflex coronary artery (LCX) supply) in an open-chest canine model. METHODS: Thirty-six mongrel dogs, acutely instrumented for measurement of pressure (left ventricle (LV) and aorta), flows (pulmonary trunk and LCX) and dimensions in ischemic and non-ischemic myocardium, were subjected to a 10-min LAD occlusion during fentanyl (n=10), halothane (n=13), or isoflurane (n=13) anesthesia. Regional contractile function was assessed using percent systolic shortening (%SS) and the preload recruitable stroke work slope (Mw). Diastolic function was evaluated using a regional time constant for intramyocardial pressure decline of LV (IMPtau), peak lengthening rate (dL/dtmax) and a regional chamber stiffness constant (Kp). RESULTS: Acute LAD occlusion caused immediate deterioration of anterior wall function similarly without changes in cardiac index, mean arterial pressure and dP/dtmax in all three groups. LV end-diastolic pressure (LVEDP), LVPtau, and heart rate increased and dP/dtmin decreased to the same extent with regional myocardial ischemia in all groups. During fentanyl anesthesia, acute myocardial ischemia was associated with an increase in %SS (26%) and Mw (48%) in LCX area without changes in IMPtau and dL/dtmax. With halothane or isoflurane anesthesia, %SS, Mw and IMPtau showed similar changes as those in fentanyl in response to LAD occlusion. However, dL/dtmax was increased (47 and 45% in the halothane and isoflurane groups, respectively) and Kp was increased (34 and 33% in the halothane and isoflurane groups, respectively) less compared to fentanyl (78%). Enhanced function in LCX zone was associated with a comparable increase (21~28% from baseline) in LCX flow in all groups. CONCLUSION: Enhanced regional contractility following acute coronary occlusion in nonischemic myocardium during fentanyl anesthesia is well-preserved with volatile anesthetics in an open-chest canine model. In addition, diastolic functions are also enhanced rather than depressed during anesthesia with volatile anesthetics. Halothane and isoflurane, however, do not differ in the compensatory responses to acute regional ischemia.

Does Lidocaine Mixture for Preventing The Pain on Propofol Injection Affect Anesthetic Induction and Hemodynamic Responses to Tracheal Intubation / 대한마취과학회지

Background: We hypothesized that intravenous lidocaine mixed with propofol may have an influence on anesthesia induction and hemodynamic responses to propofol induction and endotracheal intubation as well as propofol-induced pain on injection. Methods: Seventy-five patients were allocated to group L1 (2% lidocaine 1.5 mg/kg, n=25), group L2 (2% lidocaine 2 mg/kg, n=25) or group C (normal saline 0.05 mL/kg, n=25) according to the lidocaine dosage mixed with propofol 2 mg/kg. The pain on injection was scored as none, mild, moderate, and severe. The site of pain and recall of pain were also recorded. Loss of verbal response was observed during induction. Mean arterial blood pressure (MAP) and heart rate (HR) were recorded before anesthetic induction (baseline value), immediately before and after endotracheal intubation, and every min until 5 min thereafter. Results: Ninety-two percent of patients reported pain upon injection in group C, whereas 8% of the patients in group L1 and no patient in group L2. Loss of verbal response before injection of total dose of propofol was observed in 44% in group L2, 36% in group L1 and 28% in group C. Lowered MAP caused by propofol increased significantly after endotracheal intubation in all three groups (p<0.05). HR increased immediately and 1 min after endotracheal intubation in all three groups (p<0.05). Conclusions: Our results indicate that intravenous lidocaine 1.5 mg/kg or 2 mg/kg mixed with propofol 2 mg/kg significantly reduces the incidence and the degree of pain, but does not affect anesthesia induction and hemodynamic responses to propofol and tracheal intubation.

Protective Effect of Ketamine on DNA Fragmentation in Astroglial Ischemic Model: Use of the TUNEL Assay to Determine Apoptosis / 대한마취과학회지

BACKGROUND: Ketamine, a dissociative anesthetic, was known to be beneficial in reducing neuronal or astroglial damage by anoxic or ischemic insults. Detection of DNA fragments in situ using the terminal deoxyribonucleotidyl transferase (TDT)-mediated dUTP-digoxigenin nick end labelling (TUNEL) assay is recently applied to investigate active cell death. Therefore, we tried to investigate the relationship of ketamine effect with DNA breakdown in the condition of low ATP. METHODS: Experimetal protocols are as follows: Astrocytoma cells were harvested and plated to chamber slides. Then experimental cells were divided to four groups as control group, iodoacetate (IAA)/carbonylcyanide m-chlorophenylhydrazone (CCCP) 1.5 mM/20 micrometer treated group, and IAA/ CCCP with ketamine 1 mM or 0.1 mM. In situ labelling of fragmented DNA was conducted with commercially available kits (In situ cell death detection kit, Boehringer Mannheim). Stained cells were observed by the use of light microscope. RESULTS: TUNEL-positive reaction appeared in energy depleted astrocytes. However, TUNEL-positive cells were not observed after perfusion with iodoacetate/CCCP and ketamine 0.1 mM or 1.0 mM together. CONCLUSIONS: We report here that in vitro addition of ketamine 0.1 mM or 1 mM protected DNA breakdown of astrocytes from energy depletion. These results suggest that ketamine may have potential effect in preventing ischemic damage in clinical setting.

Effects of Intravenous anesthetics on EEG coherence:A preliminary study / 中华麻醉学杂志

Objective:Coherence analysis of the EEG is used to study the synchrony or coupling between cortical areas underlying the electrodes. However,the effects of intravenous anesthetics on EEG coherence have not been defined. Method: Forty patients were administered with intravenous thiopental (5mg/kg),propofol (2.5mg/kg ), ketamine(4mg/kg)or fentanyl(10?g/kg). The changes of coherences in total and in a given frequency band of the EEG(?.?.?.?) were measured with an AXON Systems Sentinel-4 Neurological monitor between two pair electrodes(Cz-F_7 vs Cz-F_8 and Cz-A_1 vs Cz-F_2). Result: The anesthetics had significantly different effects on the coherence by either increase or decrease. The variability of the coherences had no regular pattern,and no relationship to excitement or depression of the anesthetics and to potency of them. Conclusion:Each anesthetic above selectively depresses and excites generators of the EEG in quite different ways.