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Objective:To evaluate the dose-response relationship of alfentanil inhibiting gag reflex when combined with propofol in elderly patients undergoing painless gastroscopy.Methods:Patients of American Society of Anesthesiologists physical statusⅠor Ⅱ, aged ≥60 yr, scheduled for elective painless gastroscopy, were selected. Propofol 1.5 mg/kg combined with alfentanil was given intravenously in all the patients. The dose of alfentanil was determined by the Dixon up-and-down method. The initial dose of alfentanil was set at 5 μg/kg. The dose of alfentanil in the next patient was determined according to the development of gag reflex, and the ratio between the two successive doses was 1.1. The median effective dose (ED 50) and 95% confidence interval of alfentanil-induced inhibition of gag reflex when combined with propofol in elderly patients undergoing painless gastroscopy were calculated using the by up-and-down sequential allocation. Results:The ED 50 (95% confidence interval) of alfentanil-induced inhibition of gag reflex when combined with propofol 1.5 mg/kg was 2.8 (2.4-3.2) μg/kg in elderly patients undergoing painless gastroscopy. Conclusion:When combined with propofol 1.5 mg/kg, the ED 50 of alfentanil inhibiting gag reflex is 2.8 μg/kg in elderly patients undergoing painless gastroscopy.
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Objective:To evaluate the relationship between postoperative acute kidney injury (AKI) and preoperative dehydration in the patients undergoing surgery for gastrointestinal tumor.Methods:A total of 231 patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged≥18 yr, undergoing elective surgery for gastrointestinal tumor with general anesthesia, were enrolled.Preoperative dehydration index was calculated according to preoperative urine color, specific gravity, osmotic pressure and creatinine.Preoperative dehydration was defined as dehydration index≥3.5.AKI was defined according to the Kidney Disease Improving Global Outcomes criteria.Logistic regression analysis was conducted to assess the association between preoperative dehydration and postoperative AKI.Results:Of the 231 patients who met our inclusion criteria, 27 (11.7%) developed postoperative AKI, and 13 patients (48.1%) had preoperative dehydration among the patients developed postoperative AKI.The results of logistic analysis showed that preoperative dehydration was an independent risk factor for postoperative AKI in the patients undergoing surgery for gastrointestinal tumor ( OR=4.03, 95% confidence interval 1.72-9.39). Conclusion:Preoperative dehydration is an independent risk factor for postoperative AKI in the patients undergoing surgery for gastrointestinal tumor.
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Objective To evaluate the effects of different doses of dexmedetomidine on propofol-induced inhibition of responses to laryngeal mask airway (LMA) insertion when combined with fentanyl in patients undergoing gynecological operation.Methods One hundred and twenty-five ASA Ⅰ-Ⅱ female patients,aged 20-60 yr,scheduled for elective short-time surgery,were randomly divided into 5 groups (n =25 each):normal saline group (group NS) and different doses of dexmedetomidne groups (groups D1-4).Normal saline 40 ml and dexmedetomidne 0.4,0.6,0.8,1.0 μg/kg (in 40 ml of normal saline) were infused over 10 min in groups NS and D1-4,respectively.1％ propofol was then given by target-controlled infusion.The concentration of propofol was determined by using modified Dixon's up-and-down method.The initial plasma concentration of propofol was 3.0 μg/ml and the ratio between the 2 successive concentrations was 1.1.Fentanyl 1.5 μg/kg was injected intravenously when the effect-site concentration of propofol reached the preset plasma concentration.LMA was inserted 4 min later.When LMA insertion was successful,the concentration of propofol was decreased in the next patient and when LMA insertion failed,the concentration of propofol was increased in the next patient.Failure of LMA insertion was defined as difficulty in inserting LMA or body movement,corner of mouth movement,biting LMA,swallowing and/or lacrimation during insertion.The median effective target effect-site concentration and 95％ confidence interval of propofol blunting responses to LMA insertion when combined with fentanyl were calculated.Results The median effective target effect-site concentration (95％ confidence interval) of propofol blunting responses to LMA insertion when combined with fentanyl were 3.09 (2.83-3.36),2.48 (2.26-2.73),2.29 (2.18-2.41),2.04 (1.95-2.12) and 1.67 (1.55-1.81) μg/ml in groups NS and D1 4,respectively.Conclusion Dexmedetomidine can enhance propofol-induced inhibition of responses to LMA insertion when combined with fentanyl in dose-dependent manner in patients undergoing gynecological operation.
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ObjectiveTo investigate the effect of dexmedetomidine on postoperative intracranial pressure (ICP) in patients with severe brain injury.MethodsNinety ASA Ⅱ or Ⅲ patients with severe brain injury,aged 19-64 yr,with Glasgow coma scale 3-7,undergoing emergency craniotomy,were randomly divided into 3 groups (n =30 each):control group (group C) and 2 different doses of dexmedetomidine groups (groups D1,D2 ).Anesthesia was induced with propofol 1.5-2.0 mg/kg,fentanyl 4 μg/kg and vecuronium 0.1 mg/kg and maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of vecuronium.The patients were mechanically ventilated after tracheal intubation.Dexmedetomidine 0.3 and 0.7 μg· kg- 1· h- 1 were infused after tracheal intubation in groups D1 and D2 respectively and the infusion was maintained for 48 h.ICP was monitored after operation and maintained ＜ 30 mm Hg by iv injection of hexadecadrol,mannitol and glycerol fructose within 2 d after operation.Venous blood samples were obtained from peripheral vein after anesthesia induction and at 6,12 and 24 h after operation (T0-3) for determination of sertum IL-1β and TNF-α concentrations by ELISA.The clinical results were evaluated using Glasgow prognosis score at 3 months after operation.The amount of hexadecadrol,mannitol and glycerol fructose consumed during 2 d after operation was recorded.ResultsCompared with T0,serum IL-1βand TNF-α concentrations were significantly higher at T1-3 in the three groups ( P ＜ 0.05).The serum IL-1β and TNF-α concentrations at T1-3 and the amount of hexadecadrol,mannitol and glycerol fructose consumed were significantly lower,and the clinical results were significant better in groups D1 and D2 than in group C,and in group D2 than in group D1 ( P ＜ 0.05).ConclusionDexmedetomidine can reduce postoperative ICP in patients with severe brain injury in a dose-dependent manner which is helpful for improving prognosis.The decrease in IL-1β and TNF-α levels and inhibition of inflammatory response may be involved in the mechanism.
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Objective To evaluate the incidence of postanesthetic shivering in patients undergoing radical operation for lung cancer under dexmedetomidine-assisted anesthesia.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 50-75 yr,height 158-180 cm,weighing 48-79 kg,scheduled for radical operation for lung cancer under general anesthesia combined with epidural anesthesia,were randomly divided into 2 groups ( n =40 each): normal saline control group (group C) and dexmedetomidine group(group D).Anesthesia was induced with midazolam,fentanyl,propofol and rocuronium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent epidural ropivacaine.BIS was maintained at 40-55.Group D received dexmedetomidine intravenous infusion at 0.5 μg · kg- 1· h- 1 from immediately after tracheal intubation until 1 h before the end of operation,and group C received the equal volume of normal saline.The shivering within 1 h after operation was scored and recorded.Results The incidence rate of postanesthetic shivering was 50％ in group C and 10％ in group D.Compared with group C,the incidence rate and degree of shivering were decreased in group D( P ＜ 0.05).Conclusion Dexmedetomidine-assisted anesthesia can reduce the incidence of postanesthetic shivering in patients undergoing radical operation for lung cancer.
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Objective To investigate the effect of preemptive analgesia with parecoxib sodium on postoperative cognitive junction in the elderly patients.Methods Sixty ASA ⅠorⅡ patients aged 69-83 yr weighing 47-73 kg undergoing elective operation on the femoral head or hip joint were randomly divided into 2 groups (n=30 each):control group (group C) and parecoxib group (group P).Their preoperative mini-mental state examination scores were more than 23.Parecoxib sodium 40 mg in 5 ml normal saline was injected iv before induction of anesthesia in group P. Patient-controlled intravenous analgesia with fentanyl and tramadol was used in all patients. VAS score was maintained ≤3. If VAS score was more than 3, a bolus of fentanyl 0.2 μg/kg was given iv.Venous blood samples were taken at 1 day before and 1, 4, 24 and 72 h after operation for determination of plasma concentrations of cortisol.Cognitive function was assessed by mini-mental state examination. The total amount of fentanyl and tramadol consumed was recorded. Results Plasma cortisol concentrations and incidence of postoperative cognitive dysfunction were significantly lower and the total amount of fentanyl and tramadol consumed was smaller in group P than in group C.Conclusion Preemptive analgesia with parecoxib sodium 40 mg can reduce the incidence of postoperative cognitive dysfunction in the elderly patients.
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@# Presented in this paper is a report on the Quadriplegia Index of Function(QIF) in usewith 16 cases of quadriplegic patients.Compared with the Barthel Index and Japan ADL Scale,QIF wasfound to be more sensitive and effective to document the small but significant funtional gains made byquadriplegics during medical rehabilitation,therefore,authors suggest that QIF should be widely usedin the rehabilitation evaluation of quadriplegic patients.