ABSTRACT
Purpose: This study aimed to compare the efficacy and safety of remimazolam tosilate-remifentanil (RT-RF) vs dexmedetomidine-remifentanil (Dex-RF) for outpatients undergoing fiberoptic bronchoscopy (FB). Patients and methods: We conducted a double-blind, randomized, prospective study involving a total of 146 outpatients undergoing FB divided into two groups. The RT-RF (RR) group (n = 73) received an initial dose of 12 mg/kg/h of RT for 10 min followed by a maintenance dose of 1-2 mg/kg/h, while the Dex-RF (DR) group (n = 73) received an initial dose of 0.5 µg/kg of Dex for 10 min followed by a maintenance dose of 0.2-0.7 µg/kg/h. All outpatients also received 0.05-0.2 µg/kg/min RF to maintain the Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale <3. The primary outcome was rate of successful FB completed. Secondary outcomes were time metrics, hemodynamics, intubating conditions, oxygen saturation, coughing severity, number of remedies, total dose of fentanyl, RF, RT, and Dex, incidence of dreaming, patient and bronchoscopist satisfaction, willingness to repeat bronchoscopy, and adverse events. Results: The FB successful completion rate was 94.52% (95% CI: 89.20-99.90) in the RR group and 91.78% (95% CI: 85.30-98.20) in the DR group. Compared with patients in the DR group, the onset time, time to fully alert, and hospital discharge were all significantly shorter in the RR group (p < 0.01), and hemodynamics were more stable in the RR group. Intubating conditions, clinically acceptable intubating conditions, lowest oxygen saturation, coughing severity, consumption of fentanyl and RF, number of remedies, and patient and bronchoscopist satisfaction were similar between the groups (p > 0.05), as were demographic characteristics, incidence of dreaming, willingness to repeat bronchoscopy, and adverse events (p > 0.05). Conclusion: RT-RF has non-inferior efficacy, better time metrics and hemodynamic stability for outpatients undergoing FB than Dex-RF. Systematic Review Registration: [http://www.chictr.org.cn/showproj.aspx?proj=66673], identifier [ChiCTR2000041524].
ABSTRACT
BACKGROUND: Ultrasound guided-deep serratus anterior plane block (USG-DSAPB) has been used for pain management of patients undergoing modified radical mastectomy (MRM), but evidence supporting their adjuvant analgesic benefits is limited. We explored the efficacy and safety of preemptive use of ropivacaine combined with different doses of dexmedetomidine (DEX) in USG-DSAPB for patients undergoing MRM. METHODS: Ninety-five female patients undergoing unilateral MRM were allocated randomly to two groups. Group RD1 had 20 mL of 0.5% ropivacaine with 5 mg of dexamethasone and 0.5 µg·kg-1 DEX in USG-DSAPB. Group RD2 had 20 mL of 0.5% ropivacaine with 5 mg of dexamethasone and 1 µg·kg-1 DEX in USG-DSAPB. The primary outcome was sufentanil consumption 72 h after USG-DSAPB. Secondary outcomes were: postoperative pain scores and level of sedation; intraoperative hemodynamics; duration of post-anesthesia care unit (PACU) stay; prevalence of moderate-to-severe pain; one-time puncture success; procedure time of blockade; time to first rescue analgesia; requirement of rescue analgesia; satisfaction scores of patients and surgeons; duration of hospital stay; adverse events; prevalence of chronic pain; quality of postoperative functional recovery. RESULTS: Compared with the RD1 group, the visual analog scale score for coughing was significantly lower at 4, 8, 12 h and sufentanil consumption was significantly lower at 4, 8, 12, 24, and 48 h after surgery in the RD2 group (P < 0.05). The time to first rescue analgesia was significantly longer in the RD2 group (P < 0.05). The requirement for rescue analgesia was significantly higher in the RD1 group (P < 0.05). The prevalence of moderate-to-severe pain, number of patients using vasoactive agents, duration of PACU stay, as well as consumption of propofol, remifentanil, and DEX were significantly lower in the RD2 group (P < 0.05). There were no significant differences between the two groups with respect to one-time puncture success, procedure time of blockade, total dermatomal spread, satisfaction scores of patients and surgeons, postoperative complications, duration of hospital stay, 40-item Quality of Recovery questionnaire (QoR-40) score, or prevalence of chronic pain (P > 0.05). CONCLUSIONS: We discovered that 1 µg·kg-1 (not 0.5 µg·kg-1) DEX combined with 20 mL of 0.5% ropivacaine and 5 mg of dexamethasone in USG-DSAPB could provide superior postoperative analgesia for patients undergoing MRM. However, the quality of postoperative functional recovery and prevalence of chronic pain were similar.Clinical Trial Registration: http://www.chictr.org.cn/showproj.aspx?proj=54929, identifier: ChiCTR2000033685.
ABSTRACT
In this study, typical moss crusts, which were dominated by the species Didymodon vinealis (Brid.) Zand., were collected from the Loess Plateau and a 65-day cultivation experiment was performed to study the effects of five kinds of nutrient solutions (Knop, Murashige-Skoog (MS), Benecke, Part and Hoagland), two kinds of carbohydrates (glucose and sucrose) and three kinds of plant growth regulators (thidiazuron (TDZ), 6-benzylaminopurine (6-BA) and naphthaleneacetic acid (NAA)) on the coverage, plant density, and plant height of moss crusts. The main conclusions are as follows. (1) All Knop, MS, Benecke, Part and Hoagland nutrient solutions improved the coverage and plant density of moss crusts to different degrees and the promotional effects of the Hoagland nutrient solution were most significant. (2) Glucose and sucrose could promote the formation of moss crusts, but they inhibited the development of moss crusts at concentrations greater than 10 g/L. (3) With an increase in concentration, the effects of TDZ on the development of moss crusts changed from "enhanced" to "inhibited". Regardless of whether the concentration was high or low, 6BA had no significant effects on the growth of moss crusts, and NAA reduced the development of moss crusts. Results suggest that nutrient solutions (e.g. Hoagland), low concentration carbohydrates solutions, and some plant growth regulators (e.g. 1 mg/L TDZ) enhance the development of moss crusts in Loess Plateau under the appropriate environmental conditions.
