RESUMO
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.
RESUMO
Objective:To evaluate the effect of thoracic paravertebral block (TPVB) combined with general anesthesia on the postoperative brain injury in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods:A total of 100 patients of either sex, aged ≥65 yr, with body mass index of 20-24 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective thoracoscopic radical resection of lung cancer, were divided into 2 groups ( n=50 each) by using a random number table method: general anesthesia group (G group) and TPVB combined with general anesthesia group (TG group). TPVB was performed before induction of anesthesia in group TG.Anesthesia was induced with IV midazolam, etomidate, rocuronium and sufentanil and maintained with infusion of propofol and remifentanil and intermittent IV boluses of cis-atracurium.Patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia after surgery.Venous blood samples were taken at 5 min after entering the operating room and 24 and 72 h after surgery to determine the concentrations of S100β, neuron-specific enolase, Tau protein, β amyloid and interleukin-6 in plasma.The cognitive function was assessed by using the Mini Mental State Examination Scale and Montreal Cognitive Assessment Scale at 1 day before surgery and 24 and 72 h after surgery, and cognitive dysfunction was recorded.The quality of night sleep was assessed using Numerical Rating Scale at 1 day before surgery, on the day of surgery and on day 3 after surgery.The occurrence of nausea and vomiting within 72 h after operation, perioperative consumption of sufentanil, effective pressing times of PCA within 24 h after operation and requirement for postoperative rescue analgesia were recorded. Results:No postoperative nausea and vomiting was found and no patients required rescue analgesia in either group.Compared with group G, the concentrations of S100β, neuron-specific enolase and interleukin-6 in plasma, Montreal Cognitive Assessment scale score, and incidence of cognitive dysfunction were significantly decreased at 24 h after surgery, sleep quality score was increased, and the perioperative sufentanil consumption and effective pressing times of PCA were reduced ( P<0.05), and no significant change was found in plasma Tau protein and β amyloid concentrations in group TG ( P>0.05). Conclusions:TPVB combined with general anesthesia is helpful in reducing postoperative brain injury in elderly patients undergoing thoracoscopic radical resection of lung cancer.