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Objective To evaluate anesthesia efficacy of sevoflurane combined midazolam and remifentanil and propofol in patients undergoing short surgery. Methods Fifty ASA Ⅰ or Ⅱ patients who scheduled for elective surgery under general anesthesia were enrolled in study. The anesthesia was induced with intravenous injection of midazolam 0.03 mg/kg and sevoflurane inhalation. Induction of anesthesia was started with 6% sevoflurane and fresh gas flow rate of 6 L/min. The inspired concentration of sevoflurane was reduced to 2% as soon as eyelash reflexes of these patients were abolished. At the same time, remifentanil 2 μg/kg was injected slowly over 1 min,and 30 s later,patients were mechanically ventilated after tracheal intubation. 2% sevoflurane was kept inhaling, and remifentanil and propofol were kept pumping for anesthesia maintenance. The mean arterial pressure (MAP), heart rate, pulse oxygen saturation (SpO_2) and bispectral index (BIS)were recorded before administration,at the time of the disappearance of eyelash reflex, immediately before tracheal intubation,and immediately after tracheal intubation. The time period from sevoflurane inhalation to the disappearance of eyelash reflex was also recorded. And conscious recovery, spontaneous breathing recovery,the endotracheal extubafion time and OAAS score were recorded. Results All patients were successfully intubated at the first attempt. The satisfactory intubation conditions were found in 82% (41/50) of cases. The time period from sevoflurane inhalation to the disappearance of eyelash reflex was (73 ± 12) s. MAP,heart rate and SpO_2 remained stable and BIS was maintained at 45-55 before and after tracheal intubation, and all patients were quick recovery. Conclusion The anesthesia efficacy of sevoflurane combined midazolam and remifentanil and propofol without muscle relaxant in patients undergoing short surgery is smooth, safe and reliable.
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Objective To evaluate the role of bispectral index (BIS) in assessing the depth of sedation in hypogastric operation of children. Methods Forty children undergoing hypogastric operation were divided into two groups with 20 cases each by pre-school (age 3-5) (Ⅰ group) and school (age 6-12)(Ⅱ group). Sedation was solely maintained with TCI propofol. The infusion was adjusted till adequate scdation (OAA/S≤ 1 score) before sacral block. The course of propofol infusion and BIS of recovery period were closely observed. Sedation scores were assessed by special anesthetists. Results During recovery period, the mean values of BIS were gradually increased, when BIS > 76 predicted 94% sensitivity and 50% specificity in Ⅰ group, 100% sensitivity and 100% specificity in Ⅱ group. ROC area under the curve of the two groups were 0.917 ± 0.007, 0.955 ± 0.004. Conclusions BIS can predict fairly well the level of consciences during recovering periods. BIS monitoring is an effective and reliable method to guide children recovery.
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Objective Meta-analysis was performed to compare the myocardial protection of sevoflurane versus propofol in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods Electronic databases were searched to identify all randomized controlled trials (RCTs) published to September 2008 which compared sevoflurane with propofol in patients undergoing CABG surgery. Two authors independently assessed the quality of each study to meet the inclusion criteria and extracted perioperative data, including patients' preoperative information (baseline characteristics, heart function, disease history and situation of medication), surgical variables (number of grafts and iachemia time) and outcome data such us cardiac index after CPB, postoperative cardiac troponin Ⅰ (cTnⅠ) levels, mechanical ventilation time, positive inotropic drugs, intensive care unit (ICU) and hospital stay length, postoperative mortality, myocardial infarction, myocardial ischemia and atrial fibrillation. Then Meta analysis was performed using RevMan 5.0 software. Results A total of 696 patients from 13 prospective RCTs were inchided in the Meta analysis, 402 out of 696 patients were allocated into sevoflurane group, and 294 into propofol group. There were no significant differences in postoperative mechanical ventilation time, usage rate of positive inotropic drugs, postoperative mortality, incidence of myocardial infarction and atrial fibrillation between the two groups ( P > 0.05 ). Cardiac index after CPB was significantly higher, postoperative cTnl level and incidence of postoperative myocardial ischernia lower, and ICU and hospital stay length shorter in the sevoflurane group than in the propofol group ( P < 0.05 ). Conclusion Sevoflunme has better myocardial protection than propofol in patients undergoing CABG surgery.
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Objective To evaluate the recovery and hemedynamics of total intravenous anaesthesia (TIVA) with propofol and remifentanil. Methods Thirty ASA Ⅰ - Ⅱ patients undergoing hperoscopic oper-ation were randomly divided into the TIVA group(group A,n=15) and the combined intravenous with inhala-tion anaesthesia greup(group B,n=15). Anaesthesia was induced in the same manner in both greups:Midazo-lam 0.05mg/kg,vecurium 0.1mg/kg,propofol 1.5mg/kg and remifentanil 1.5 μg/kg.Remifentanil was infused 2.5 μg/ml) in group A or with sevoflurane( 1.3% end-tidal) in group B to maintain anaesthesia. With termi-nation of surgery,anaesthetic delivery was discontinued simuhaneously.Bp,HR at all stages and recovery profiles were recorded. Results (1)Between before inflation and after inflation or between at the end of op-eration and the basic values in group A,there were no significant differences in Bp,HR. (2) Times from stop-ping administration of anaesthetics until full spontaneous respiration and eye opening were similar for two groups.Time for trachcal extubation was significantly less in the group A than group B. (3)The rates of post-operative nausea or vomiting were similar. Conclusion The application of TIVA with propefol and remifen-tanil is associated with better hemodynamic stability and better recovery profile as compared to the combined intravenous with inhalation anaesthesia.
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Objective To investigate the effects of multiple doses of propefol on long-term cognitive function in neonatal rats.Methods Twenty-four 7-day old SD rats weighing 12-16 g were randomly divided into 3 groups(n=8 each):group Ⅰ control(C)received intraperitoneal(IP)normal saline(NS)7.5 ml/kg once a day × 7 days:groupⅡ propofol 1(P1)received NS 7.5 ml/kg IP once a day×6 days+propofol 75 mg/kg IP on the 7 th day and group Ⅲ propofol 2(P2)received propefol 75 mg/kg IP once a day × 7 days.Learning and memory function were assessed using Morris water maze when the rats were 4 weeks old.The animals were decapitated immediately after the tests.The cortex and hippocampus were isolated for determination of aspartate (Asp),glutamic acid(Glu),glycine(Gly)and γ-aminobutyric acid(GABA)contents using high performance liquid chromatography(HPLC).Results Long-term learning and memory function significantly declined in group P2 as compared with group C and P1.The content of Asp in hippocampus and the Glu content and Glu/GABA ratio in cortex and hippocampus were significantly lower in group P2 than in group C and P1.There was no significant difference in Gly and GABA content in cortex and hippocampus among the 3 groups.Conclusion Multiple doses of propefol decreases long-term cognitive function by decreasing the levels of excitatory amino acid transmitters in the brain in neonatal rats.