ABSTRACT
Objective To investigate the effect of propofol or sevoflurane on the quality of neuromuscular blockade with cisatracurium during comparable depth of anesthesia in elderly patients.Methods A total of 60 patients aged over 60 years [classified as American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ] were selected.Patients were randomized into 2 groups:propofol group (induction of anesthesia with propofol) and sevoflurane group (induction of anesthesia with sevoflurane) (n=35,each).Neuromuscular blocking effect was monitored by muscle response to ulnar nerve stimulation.The rates of cisatracurium injection at different time points,time of loss of consciousness and the onset time of cisatracurium neuromuscular block were compared between the two groups.Results The rate of cisatracurium injection was significantly decreased at 60 minutes,90 min,120 min in sevoflurane group(29.82％,42.28％,37.15％),and the onset time of cisatracurium neuromuscular block was significantly shorter in sevoflurane group than in propofol group [(148.62±28.54)s vs (96.53±23.69)s,P＜0.05].Conclusions Compared with propofol,sevoflurane can greatly shorten the onset time of cisatracurium and enhance the effect of cisatracurium neuromuscular block with stable hemodynamics.
ABSTRACT
Objective To observe the clinical efficacy and safety of close-loop muscle relaxant injcction system (CLMRIS) combined with auditory evoked potentials index for monitoring in elderly patients during general anesthesia.Methods A total of 100 patients undergong abdominal operation with ASA Ⅰ-Ⅱ anesthesia in our hospital from February 2012 to October 2012 were selected.Patients were randomly divided into 2 groups:the traditional group (n=50) and the CLMRIS group (n=50).The traditional group was anaesthetized according to clinical experience,and the CLMRIS group was used with the muscle relaxant guided by the close-loop muscle relaxant injection system.The auditory evoked potential (AEP) index and the life index were observed,and the dose of muscle relaxant,the time of consciousness recovery,dynamic response rate during operation and the adverse reaction were recorded at the time points at entering the operating room,induction of anesthesia,tracheal intubation,incision,into the abdominal,exploration,closing abdomen,skin suture,consciousness recovery,tracheal extubation,out of room (T0-T10).Results The vital signs in all patients were stable.The dynamic response rate during operation was lower in the CLMRIS group than in the traditional group at each time points of T8-T10 (all P＜0.05).There was no increase in mean artery pressure (MAP) and heart rate in groups at the time points of T0-T1,T8-T10 (all P＞0.05).The time of tracheal intubation,tracheal extubation and consciousness recovery were shorter in the CLMRIS group than in the traditional group [(268±30.4) min vs.(172±23.7) min,(14±6.4) min us.(18±7.9) min,(8.8±2.9) min vs.(12.2±4.6) min,respectively,t=3.277,6.341,3.346,all P＜0.05].There were no significant differences in AEP index between groups at the time of T0 (P＞0.05),but at the time of T1,the AEP index was lower in CLMRIS group than in the traditional group (P＜0.05).Conclusions The application of close loop muscle relaxant injection system can improve the safety of general anesthesia in the elderly and reduce the incidence of postoperative residual paralysis.The CLMRIS combined with the auditory evoked potential for monitoring depth of anesthesia can prevent and reduce the incidence of intraoperative awareness,has a strong controllability in general anesthesia with smooth induction,and can reduce the dose of anesthetic drugs to achieve the best anesthetic effect.
ABSTRACT
Objective To introduce the nursing care of severe asthma patients treated by sedatives and muscle relaxants combined with mechanical ventilation. Methods Nurses with more than 3 years of working experiences in respiratory intensive care unit participated in the nursing care,such as ventilation monitoring,sedative effect assessment and artificial airway management. Results All the 18 patients were treated successfully,and the duration of mechanical ventilation ranged from 6 to 192 hours. The indicators of circulation and arterial gas after weaning were improved significantly (P<0.01). Conclusion Proper nursing care and correct sedative effect assessment is an important point to ensure treatment efficacy and reduce complications for severe asthma patients treated by sedatives and muscle relaxants combined with mechanical ventilation.
ABSTRACT
BACKGROUND AND OBJECTIVES: Pain is one of the most troublesome discomfort accompanying tonsillectomy. Pharyngeal muscle spasm is one of the causes of post-tonsillectomy pain. We investigated the effect of an oral central muscle relaxant agent (chlorophenesin carbamate: CPC) on post-tonsillectomy pain. MATERIALS AND METHOD: Thirty adult patients undergoing tonsillectomy were included in this study. Basic pain control per oral administration consisted of 3.0 g/day (t.i.d.) salicylsalicylic acid and intramuscular injection of 5 mg diclofenac sodium (DCF) on demand. The patient population was divided into CPC group (n=15) and control group (n=15) randomly. CPC Group (n=15) received additional oral ingestion of 375 mg (t.i.d.) CPC for 7 days after operation. Pain assesment was peformed using visual analogue scale (VAS) at rest and while swallowing at the first (POD1) and seventh (POD7) day of the operation. Pain relief score (PRS) is the difference between VAS at POD1 and POD7. The number of injection of DCF was compared also. RESULTS: VAS of CPC group and the control at POD1 were 1.9+/-1.7/4.8+/-2.3 (rest/swallowing) and 2.8+/-1.6/5.2+/-1.9, respectively. VAS of CPC group and the control at POD7 were 1.5+/-1.8/3.4+/-1.9 and 1.8+/-1.3/3.5+/-1.5, respectively. The VAS scores of the two groups at POD1 and POD7 are not significantly different. The PRS of CPC group and the control group were 1.7+/-0.7/1.4+/-1.4 (rest/swallowing) and 1.0+/-1.0/1.6+/-1.2 (rest/swallowing), respectively. No significant difference in PRS was observed between the two study groups. The number of injection of DCF between the two groups is not significantly different. CONCLUSION: No significant benefit is found for the use of oral muscle relaxant agent after tonsillectomy.