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OBJECTIVE：To observe the a nesthetic effect and safety of dexmedetomidine combined with butorphanol for laparoscopic radical resection of colorectal cancer. METHODS ：Totally 180 patients undergoing elective laparoscopic radical resection of colorectal cancer were selected from our hospital during Apr. 2019-May 2020. They were randomly divided into control group（group C ），dexmedetomidine group （group D ），butorphanol group （group B ），dexmedetomidine+butorphanol group （group E），with 45 cases in each group. Group C received rountine anesthesia of Etomidate emulsion injection+Sufentanil citrate injection+ Cisatracurium besylate for injection. Group D was given Dexmedetomidine injection 0.5 μg/kg by pumping 15 min before induction ， and received rountine anesthesia indution performed in group C. Group B was given intravenous injection of Butorphanol tartrate injection 0.02 mg/kg when anesthesia indution ，and received rountine anesthesia performed in group C. Anesthesia induction in group E was the same as that in group D+B. The dosage of sufentanil and the maintenance concentration of sevoflurane were observed；average arterial pressure （MAP）and heart rate （HR）at the time of entering the room （T0），1 min after intubation （T1）， 1 min after skin incision （T2），and 5 min after extubation （T3），extubation time ，Ramsay sedation score 5 min after extubation and VAS score ，the occurrence of ADR were recorded. RESULTS ：One patient in group C and two patients in Group E were excluded due to the conversion of laparoscopic surgery to open surgery. The rest of the patients completed the study. At T 1-T3，MAP and HR in group C ，D and B were significantly higher than those at T 0（P＜0.05），while there was no significant difference in MAP or HR in group E at T 1-T3，compared with those at T 0（P＞0.05）. MAP of group D and B at T 1-T2 as well as MAP of group E at T 1-T3 were significantly lower than that of group C ，the order was group E ＜group B ＜Group D （except for group B compared with group D at T 3）；HR of group D and E at T 1-T3 as well as that of group B at T 1-T2 were significantly lower than group C ，and the order was group E ＜group B ＜Group D （except for group B compared with group D at T 3）（P＜0.05）. The amount of sufentanil and VAS score of group B ，D，E were significantly lower than that of group C ，and the order was group E ＜group B ＜group D ， VAS score of group E ＜group D ，B（P＜0.05）. The maintenance concentration ，extubation time ，nausea and vomiting ，the incidence of agitation during recovery period in group E were significantly lower or shorter than group C ，D，B. Ramsay sedation score was significantly higer than group C ，D and B. The nausea and vomiting ，the incidence of emergence agitation in group E ＜ group D ，B（P＜0.05）. There was no statistical significance in the maintenance concentration of sevoflurane ，Ramsay sedation score or extubation time among group C ，D and B ，VAS score ，the incidence of nausea and vomiting ，the incidence of agitation during recovery period between group D and B （P＞0.05）. CONCLUSIONS ：Dexmedetomidine combined with butorphanol can effectively reduce the amount of intraoperative anesthetics and the occurrence of stress reaction ，improve the quality of resuscitation，and reduce the incidence of postoperative ADR.
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Objective@#To observe the anesthesia and hemodynamic effect of etomidate compound remifentanyl in laparoscopic surgery.@*Methods@#From January 2016 to May 2016, 160 patients with gynecologic laparoscopic surgery in the Second Hospital of Shanxi Medical University were selected and randomly divided into observation group and control group according to the digital table, with 80 cases in each group.The observation group received the etomidate compound remifentanyl anesthesia, while the control group received the propofol compound remifentanyl anesthesia.the The anesthesia effect, awakening time, extubation time, pain relief time and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) before and after extubation of the two groups were observed and recorded.@*Results@#The excellent and good rate in the observation group was 98.0%, which was significantly higher than 86.0% in the control group (χ2=4.444, P<0.05). The waking time, extubation time, analgesic time in the observation group were shorter than those in the control group, the differences were no statistically significant(t=1.875, 1.631, 1.761, all P>0.05). At tracheal intubation, the SBP, DBP, HR and other indicators between the two groups had no statistically significant differences(t=1.301, 1.093, 1.097, all P>0.05). After induction of anesthesia, the SBP, DBP in the observation group were higher than those in the control group, the differences were statistically significant(t=6.182, 7.388, all P<0.05), but HR between the two groups had no statistically significant difference(t=1.428, P>0.05). After laparoscopic placement and tracheal extubation, the SBP and DBP in the observation group were significantly higher than those in the control group, the differences were statistically significant (t=5.781, 5.028, all P<0.05), and the SBP in the observation group was higher than that in the control group after tracheal extubation(t=1.203, 1.039, all P<0.05).@*Conclusion@#The anesthesia effect of etomidate compound remifentanyl is superior to propofol compound remifentanyl, the hemodynamic parameters of SBP, DBP, HR are more stable during the period of anesthesia, the curative effect is clear.
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Abstract Introduction: The importance and benefits of breastfeeding for the babies and mothers are well established and documented in the literature. However, it is frequent that lactating mothers need to undergo general or spinal anesthesia and, due to the lack of information, many of them interrupt breastfeeding after anesthesia. There are limited data available regarding anesthetics transfer to breast milk. This review aims to develop some considerations and recommendations based on available literature. Methods: A systematic search of the literature was conducted by using the following health science databases: Embase, Lilacs, Pubmed, Scopus, and Web of Science. The latest literature search was performed on April 6th, 2018. Additional literature search was made via the World Health Organization's website. We used the following terms for the search strategy: "Anesthesia" and "Breastfeeding", and their derivatives. Results: In this research, 599 registers were found, and 549 had been excluded by different reasons. Fifty manuscripts have been included, with different designs of studies: prospective trials, retrospective observational studies, reviews, case reports, randomized clinical trials, case-control, and website access. Small concentrations of the most anesthetic agents, are transferred to the breast milk; however, their administration seem to be safe for lactating mothers when administered as a single dose during anesthesia and this should not contraindicate the breastfeeding. On the other hand, high-doses, continuous or repeated administration of drugs increase the risk of adverse effects on neonates, and should be avoided. Few drugs, such as diazepam and meperidine, produce adverse effects on breastfed babies even in single doses. Dexmedetomidine seems to be safe if breastfeeding starts 24 h after discontinuation of the drug. Conclusions: Most of the anesthetic drugs are safe for nursing mothers and offer low risk to the breastfed neonates when administered in single-dose. However, high-dose and repeated administration of drugs significantly increase the risk of adverse effects on neonates. Moreover, diazepam and meperidine should be avoided in nursing women. Finally, anesthesiologists and pediatricians should consider individual risk/benefit, with special attention to premature neonates or babies with concurrent diseases since they are more susceptible to adverse effects.
Resumo Introdução: A importância e os benefícios do aleitamento materno para os bebês e para as mães estão bem estabelecidos e documentados na literatura. No entanto, é frequente que mães lactantes precisem se submeter à anestesia geral ou raquianestesia e, devido à falta de informações, muitas delas interrompem a amamentação após a anestesia. Existem poucos dados disponíveis sobre a transferência de anestésicos para o leite materno. O objetivo desta revisão foi desenvolver algumas considerações e recomendações com base na literatura disponível. Métodos: Uma busca sistemática da literatura realizada usando com os seguintes bancos de dados em ciências da saúde: Embase, Lilacs, Pubmed, Scopus e Web of Science. A pesquisa bibliográfica mais recente foi realizada em 6 de abril de 2018. Uma pesquisa bibliográfica adicional foi realizada através do site da Organização Mundial da Saúde. Usamos os seguintes termos para a estratégia de busca: "Anestesia" e "Aleitamento materno" e seus derivados. Resultados: Nesta pesquisa, 599 registros foram encontrados e 549 foram excluídos por diferentes razões. Foram incluídos 50 manuscritos, com diferentes modelos de estudo: estudos prospectivos, estudos observacionais retrospectivos, revisões, relatos de casos, ensaios clínicos randômicos, caso-controle e acesso a sites. Pequenas concentrações da maioria dos agentes anestésicos são transferidas para o leite materno; entretanto, sua administração parece ser segura para mães lactantes quando administrados em dose única durante a anestesia e isso não deve contraindicar o aleitamento materno. Por outro lado, altas doses, administração contínua ou repetida dos fármacos aumentam o risco de efeitos adversos em neonatos e devem ser evitados. Poucas drogas, como diazepam e meperidina, produzem efeitos adversos em bebês amamentados, mesmo quando administradas em doses únicas. Dexmedetomidina parece ser segura se a amamentação começar 24 horas após a interrupção do medicamento. Conclusões: A maioria dos anestésicos é segura para mães que amamentam e oferecem baixo risco para os recém-nascidos amamentados quando a administração é em dose única. No entanto, altas doses e repetidas administrações de drogas aumentam significativamente o risco de efeitos adversos em recém-nascidos. Além disso, diazepam e meperidina devem ser evitados em mulheres que amamentam. Finalmente, anestesiologistas e pediatras devem considerar o risco-benefício individual, com atenção especial para os recém-nascidos prematuros ou bebês com doenças concomitantes, pois são mais suscetíveis a efeitos adversos.
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Humans , Female , Infant, Newborn , Infant , Breast Feeding/methods , Anesthesia/methods , Milk, Human/metabolism , Time Factors , Lactation/psychology , Randomized Controlled Trials as Topic , Dose-Response Relationship, Drug , Anesthesia/adverse effects , Anesthetics/administration & dosage , Anesthetics/adverse effectsABSTRACT
Objective To study the clinical effect of sevoflurane combined with remifentanil in laparoscopic cholecystectomy (LC).Methods50 cases of laparoscopic cholecystectomy in Tianjin Haihe Hospital from February 2015 to September 2016 were selected as the research object, and randomly divided into the control group and the experimental group, each group had a total of 25 cases.The patients in control group were treated with continuous intravenous infusion of propofol.The experimental group received sevoflurane.Patients in the experimental group and the control group were given remifentanil after surgery.Compared with the experimental group and control group of patients with the degree of recovery and related Linchuan indicators.ResultsAfter the corresponding anesthesia, the control group of patients with recovery time was (13.4±3.1) minutes, the score was (4.1±1.2) points, extubation time was (14.6±3.7) minutes.However, the extubation time and recovery time of the control group were significantly longer than those of the experimental group, and the recovery score was lower than that of the experimental group, with statistical difference (P<0.05).There was no obvious adverse reaction in the experimental group and the control group, and there was no significant difference in the changes of cardiovascular factors.ConclusionSevoflurane combined with remifentanil for laparoscopic cholecystectomy can improve the anesthetic effect to a great extent, stable operation and postoperative patients with cardiovascular function, recovery time is short, the clinical significance of only one step promotion and application.
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OBJECTIVE:To compare the anesthetic effect and safety of dexmedetomidine hydrochloride and propofol in pain-less colonoscopy. METHODS:80 patients who underwent painless colonoscopy was retrospectively analyzed and divided into group A and group B. Group A was given loading dose of 1 mg/kg propofol within 30 s and maintained with 6 mg/(kg·h);group B was given loading dose of 0.3 μg/kg Dexmedetomidine hydrochloride injection by micropump for slow pumping 5 min and maintained with 0.2-0.3 μg/(kg·h). Mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO2)and respiratory rate(RR)be-fore examination (T0),before microscopic examination (T1),1 min (T2) and 10 min(T3) after microscopic examination,1 min (T4)and 5 min(T5)after colonoscopy withdrawal,onset time of anesthesia,entry time,examination time and discharge time,pa-tients with adjunctive use of fentanyl and incidence of adverse reactions in 2 groups were observed. RESULTS:MAP in group A at T1 was significantly lower than T0,HR in 2 groups at T1-T3 was significantly lower than T0,the differences were statistically signifi-cant(P0.05). Onset time of an-esthesia,patients with adjunctive use of fentanyl and incidence of adverse reactions in group B were significantly lower than group B,the differences were statistically significant(P<0.05). CONCLUSIONS:Both dexmedetomidine hydrochloride and propofol has good anesthetic effect in painless colonoscopy,but dexmedetomidine has better safety.
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Objective To evaluate the anesthetic effect and safety of ropivacaine combined with lidocaine caudal block in the treatment of pediatric laparoscopic hernia surgery.Methods A total of 70 cases with pediatric hernia surgery in Ningbo Women and Children’s Hospital from May 2014 to October 2015 in this study were divided into control group and experimental group with 35 cases in each group.The patients in the both groups were given routine examination, preoperative anesthesia induction, adopted 7 scalp injection needles to prick into the hiatus sacralis,patients in control group were treated by 1% lidocaine hydrochloride injection mixed liquid 1 mL/kg;patients in the experimental group were treated by 0.25%lidocaine hydrochloride injection and 0.25% ropivacaine hydrochloric injection mixed liquid 1 mL/kg; pediatric hernia surgery, intraoperative continuous pumped into propofol injection 4-6 mL/kg and maintain the mask to the oxygen.The visual analog pain scored( VAS) , visual satisfaction scored ( VSS) and adverse reactions were compared at the end of operation, after operation 0 h,0.5 h,1 h,2 h,4 h,8 h and 24 h.Results The sensory and motor block effective time in the experimental group were later than the control group, the sensory and motor block duration time were shorter than the control group (P<0.05).VAS score of the experimental group was significant lower than control group after operation 2 h ( P<0.05 ) . After operation, postoperative 0.5 h, postoperative 1 h, the VSS score of the experimental group was significant lower than control group ( P<0.05 ) .Lower limbs numbness discomfort duration time of the experimental group was significant lower than control group after operation ( P<0.05 ) . Postoperative agitation rate of the experimental group 8.57% was significant lower than the control group 34.29% (P<0.05).The incidence of adverse reactions of experimental group 5.71% was significant lower than the control group 25.71% ( P<0.05 ) .Conclusion Ropivacaine combined with lidocaine caudal block in the treatment of pediatric hernia surgery has the remarkable effect, with high safety.
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Objective:To observe the clinical effect of the combined use of dexmedetomidine and propofol for anesthesia in the elderly patients with painless gastroscopy. Methods:Totally 70 elderly patients with painless gastroscopy were selected and randomly divided into the observation group (35 cases) and the control group (35 cases). The observation group was given dexmedetomidine and propofol for anesthesia, while the control group was given propofol for anesthesia. The anesthesia induction time, the vital signs and recovery time of the patients, intraoperative complications and postoperative adverse reactions were observed and compared between the two groups. Results:The anesthesia induction time of the observation group was shorter than that of the control group (P<0. 01). The mean arterial pressure (MAP) in T2, T3 and T4 stage in the two groups were significantly lower than that in T1 stage (P<0. 05, P<0. 01). The HR in T3 stage and RR in T2 stage in the control group were lower than those in T1 stage (P<0. 05). The RR in T2 stage in the observation group was significantly lower than that in T1 stage (P<0. 05). The MAP in T2 and T3 stage in the observation group was significantly higher than that in the control group (P<0. 01), while that in T4 stage in the observation group was significant-ly lower than that in the control group (P<0. 05). The HR in T3 stage in the observation group was significantly higher than that in the control group (P<0. 05). The incidence of intraoperative complications in the observation group was 5. 7%, while that in the con-trol group was 22. 9%, and there was significant difference between the two groups (P<0. 05). The recovery time in the observation group was shorter than that in the control group (P<0. 01). Conclusion:Dexmedetomidine combined with propofol has better anes-thesia effect and higher safety than propofol alone, which is worthy of clinical promotion.
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Objective To explore the narcotic effect of three inhalation induced methods of sevoflurane.Methods According to the different inhalation methods of sevoflurane,60 patients with elective upper abdominal surgery under intubation general anesthesia were divided into group A (vital capacity breathing),group B (tidal volume breathing),and group C (gradually increasing the concentration of sevoflurane),each group 20 cases.The sevoflurane concentration of A group and B group was 9％,which of group C was 4％,and oxygen pipeline was prefilled by oxygen flow(3L/min).The heart rate(HR),mean blood pressure(MAP),diastolic blood pressure(DBP) and systolic blood pressure(SBP) values and the effect of muscle relaxants were observed and recorded at T1 (basic indicators),T2 (eyelash reflex),T3 (before intubation),T4 (intubation time 2 min),T5 (intubation time 4 min),T6 (intubation time 6 min).Results The SBP,DBP,and MAP of group A,B and C at different time points were all inhibited(all P ＜0.05),and the significant inhibitory effect was at time point T3 (all P ＜0.01).There was no close correlation between HR changes and the muscle relaxant effect of group A,B and C at different point(all P ＞ 0.05).Conclusion Three kinds of sevoflurane inhalation induction can lower blood pressure,and they are safe,reliable,and able to be accepted by the patients.
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OBJECTIVE: To optimize the formulation of ketamine hydrochloride for intranasal administration that was of effective anesthetic effect.METHODS: Using ketamine hydrochloride injection as basic preparation,various nasal absorption enhancer or viscosity modifiers(0.5%,1% and 2% azone,EDTA,carbomer,2-hydroxypropyl-?-cyclodextrin,carboxymethyl cellulose) were added to make different nasal drops.After intranasal administration,the anesthetic effect was evaluated to find the optimum formulation.The behavior of anesthetic induction period and anesthetic index were used to evaluate the anesthetic effect.RESULTS: The perfect anesthetic effect was achieved when the formulation was prepared by adding 1% azone in ketamine hydrochloride injection(at a dose of 10 mg?kg-1).The anesthetic time was long.The muscle relaxing time,eyelid reflecting disappearing time,pain disappearing time and righting reflecting disappearing time were(21.4?7.1) min,(11.4?4.6) min,(15.6?5.7) min and(12.0?4.8) min,respectively.CONCLUSIONS: Optimal formulation of ketamine hydrochloride for intranasal administration was obtained when 1% azone was added as an absorption enhancer.
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Objective:To observe the anesthetic effects of SumianxinⅡ combined with diazepam on the Beagle dogs in experimental periodontal surgery to Provide the reference. Methods:Healthy adult male Beagle dogs were anesthetized with SumianxinⅡat the doses of 0.05、0.1、0.15 ml/kg in the combination group and diazepam(0.1 ml) by hip intramuscular injection simultaniously. Added injection dosage was half of the first dosage. Healthy adult Beagle dogs in the contral group were only anesthetized with SumianxinⅡ at the doses of 0.05、0.1、0.15 ml/kg by hip intramuscular injection. The time of adding anesthetic was not sure in surgery. Anesthesia induction period,initial duration of anesthesia,and adverse reactions after anesthesia were compared between the two groups. Results: The combined treatment group induction dose respectively (11.00?1.41) min,(9.00?0.82) min,(12.75?0.50) min,For the first time maintaining anesthesia(29.75?6.62) min,(46.00?5.29) min,(45.25?6.02) min,Intraoperative additional one times longer cansustain anesthesia for(38.75?3.50) min,(45.25?4.03) min,(37.25?2.75) min. Pure Sumianxin Ⅱ new standards of sleep narcotic induction respectively respectively was (15.75?2.50) min,(14.25?2.99) min,(14.50?2.08) min,For the first time maintaining anesthesia was (20.75?5.19) min,(20.5?3.42) min,(22.25?5.19) min,the time of adding anesthetic was not sure in surgery. 2 Dogs died in SumianxinⅡ group. United drug group simple Sumianxin Ⅱ induction period in each group by t test,Sumianxin Ⅱat the doses of 0.1 ml/kg supplemented with 0.3 ml dose stability (P
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0.05); awake time were (10.08?5.67) min and (15.50?3.47) min (P
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OBJECTIVE:To investigate the analgesic and hypnotic effects of oral isoflurane(Iso)and sevoflurane(Sev). METHODS:180 mice were randomly divided into 18 groups(n=10). It included in hot-plate test(n=60),writhing test(n= 60),i.e. NS group,Iso1 group(1 mL?kg-1),Iso2 group(2 mL?kg-1),Iso3 group(3 mL?kg-1),Sev1 group(5 mL?kg-1),Sev2 group(10 mL?kg-1). Another six groups were included in sleeping test,i.e. NS group,Iso1 group(6 mL?kg-1),Iso2 group(8 mL?kg-1),Iso3 group(10 mL?kg-1),Sev1 group(20 mL?kg-1),Sev2 group(40 mL?kg-1). Hot-plate test,writhing test,sleeping test were employed to evaluate the hot- plate pain threshold(HPPT),writhing times(WT)and sleeping time(ST)respectively after i.g. administration of Iso and Sev to evaluate analgesic and hypnosis effect. RESULTS:As compared with NS group,Iso(1～3 mL?kg-1)and Sev(5,10 mL?kg-1)with intragastric administration could increase the HPPT and decrease the WT(P
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The authors have already reported good local anesthetic effects of meperidine and pentazocine clinically in patients scheduled for various surgeries, followed by experimental evaluation of toxic effects of two drugs on the sciatic nerve of rats. Intraspinal (spinal, epidural) morphine as well as other narcotics administration has been widely used and well established for pain control. The action mechanism of intraspinal narcotics has been well defined, and meperidine and Pentazocine have been reported to be used as a sole agent for spinal anesthesia. We assurned that the action mechanism of subarachoid meperidine or pentazocine might be different to some extent from that of morphine. This investigation was primarily undertaken to examine the difference in action between meperidine and morphine and also to evaluate neurotoxic effects on sciatic nerve of dogs. Adult Korean dogs were chosen as exoerunebtak abunaks because it is easy to observe physiologic activity with responses and to avoid of manipulating trauma. The dogs were intubated and anesthetised with halothane and nitrous oxide. The sciatic nerve of the dogs was exposed and stimulated by a nerve stimulator to observe myoneural response and then injectied with 1% morphine 0.5 mg (Group 1), 5% meperidine 25 mg (Group 2) and 3% pentazocine 15 mg (Group 3). The dog was carefully observed in recovery room to see the myoneural activity After 1 week, 1 month or 2 months of careful observation, a specimen was taken under reanesthesia at 1 week, 1 month and 2 months after the careful obaervation, When the sciatic nerve was stimulated by a nerve stimulator, the normal muscle twitch was observed clearly in Group 1 with themorphine injection but was not observed in Group 2 with meperidine and Group 3 with pentazocine injection. Complete motor paralysis was noticed in Group 2 and 3 during the recovery period which lasted about 90 minutes, almost the same as the duration of drugs for spinal anesthesia, No complications were noticed in the 3 group during the periods of one week one month and two months. All specimens were examined and no abnormal findings were observed in the 3 groups. All specimens of the 3 groups were investigated under electrom microscopic examination and they revealed mild vacuolizations scattered in axon and ummyelinated nerves on the only some of the specimens and these were not significant. Severe nerve damage which was seen in the meperidine group of a preliminary experiment was not observed in this study. As a result of this investigation, we have not observed significant toxic effects microscopically or fuctioually.