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Objective:To evaluate the efficacy of remimazolam-propofol-sufentanil for anesthesia in patients undergoing painless gastroscopy.Methods:Eighty American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 20-59 yr, weighing 44-69 kg, scheduled for elective painless gastroscopy, were divided into 2 groups ( n=40 each) using a random number table method: remimazolam-propofol-sufentanil group (group RPS) and propofol-sufentanil group (group PS). The patients in group RPS received successive intravenous injection of sufentanil 0.1 μg/kg, remimazolam 0.15 mg/kg and propofol (at a rate of 4 mg/s). The patients in group PS received intravenous injection of sufentanil 0.1 μg/kg and propofol (at a rate of 4 mg/s). When Observer′ s Assessment of Alertness/Sedation Scale score was 0, gastroscopy was performed.The consumption of propofol, time of anesthesia, time for gastroscopy, emergence time and discharge time were recorded.The number of intraoperative assisted respiration cases, body movement and occurrence of adverse reactions at the time of discharge were observed. Results:Compared with group PS, the consumption of propofol was significantly decreased, and the time of anesthesia, emergence time and discharge time were shortened in group RPS ( P<0.05). There was no significant difference in the time for gastroscopy, the number of intraoperative assisted respiration cases, body movement and the occurrence of adverse reactions at discharge time between the 2 groups ( P>0.05). Conclusion:Remimazolam-propofol-sufentanil produces better efficacy for anesthesia than propofol-sufentanil in patients undergoing painless gastroscopy.
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Objective:To compare the clinical effects of dexmedetomidine assisted lumbar plexus nerve block and propofol-remifentanil general anesthesia in the patients aged over 70 years undergoing total hip replacement. Methods:Totally 58 patients(≥70 years old) with selective total hip replacement were divided into dexmedetomidine assisted lumbar plexus nerve block group(group A,28 cases) and propofol-remifentanil general anesthesia group (group B,30 cases) according to the time order of operation. The perioperative stability of respiratory and circulatory,postoperative recovery,anesthesia complications in 24 h after the surgery and anes-thesia satisfaction were evaluated and compared between the groups. Results:The vital signs of group A during the operation had no significant difference among each time point(P>0.05). There was statistical signification in blood pressure and heart rate before and after the anesthesia induction and the tracheal intubation in group B(P<0.05). Perioperative cardiovascular drug use in group B was significantly more than that in group A(P<0.01). Totally 20 cases in group A were directly sent back to the ward after the operation, another 8 cases was in anesthesia recovery room for 0.5~1-hour observation. Totally 12 cases with postoperative controlled breathing in group B were directly sent back to the intensive care unit,another 7 cases pulled out the endotracheal tube and were sent back to the intensive care unit and another 11 cases were observed in anesthesia recovery room for 1-2 h. The occurrence of postoperative cognitive dysfunction in group B was significantly higher than that in group A(P<0.05),while the anesthesia satisfaction was extremely lower than that in group A(P<0.01). Conclusion:For the patients aged over 70 years undergoing total hip replacement,dexmedetomidine at moderate dose assisted lumbar plexus nerve block is more ideal anesthesia.
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Objective:To compare the sedative effect and safety of different doses of dexmedetomidine in the patients undergoing total abdominal hyserectomy. Methods:A total of 120 patients undergoing total abdominal hysterectomy were randomly divided into four groups, different doses of dexmedetomidine groups(D1 group, D2 group and D3 group)and midazolam group(M group) with 30 pa-tients in each. Dexmedetomidine groups received intravenous pump infusion of dexmedetomidine (0. 5 μg·kg-1 ) 10 minutes before the operation, and then the different dexmedetomidine groups were received continuous infusion of dexmedetomine of different doses:D1 group of 0. 4μg·(kg·h) -1, D2 group with 0. 6μg·(kg·h) -1 and D3 group with 0. 8μg·(kg·h) -1;M group received in-travenous pump infusion of midazolam (0. 06 mg·kg-1) 10 minutes before the operation, and then with 0. 04 mg·(kg·h) -1 con-tinuous infusion. The mean arterial pressure( MAP) , heart rate( HR) , respiratory rate( RR) , oxyhemoglobin saturation( SpO2 ) were recorded at the following time points:the moment of entering the operating room(T0), the block effect of epidural anesthesia was satis-fied (T1),10 min(T2),20 min(T3)and 40 min(T4)after the drug infusion, and the end of the operation(T5), and the duration of the medicine use and the whole operation were recorded as well. The sedation degrees were evaluated with Ramsay scale, and the am-nesic scores, adverse drug reactions and patient satisfaction were recorded after the operation. Results:Compared with that of the other groups, HR of D3 group was obviously lower after T3 (P<0. 05);and after T2, HR was significantly lower than that at T0 (P<0. 05 or P<0. 01). Compared with the other groups, RR of M group was obviously lower at T3 and T4 (P<0. 05). Compared with those at T0 , the sedative effects of all the groups were much remarkable(P<0. 05 or P<0. 01);and the Ramsay score of D3 group at T3 and T4 was higher than that in D1 group or M group(P<0. 05). There were no obvious adverse reactions in the four groups. Conclusion:The use of dexmedetomidine in the patients undergoing total abdominal hyserectomy might not lead to the risk of respiratory depression as the use of midazolam, while the dose of dexmedetomidine should be less than 0. 8 μg·(kg·h) -1.
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Objective To investigate the analgesic efficacy and spinal neurotoxicity of intrathecal (IT) different doses of dexmedetomidine in rats. Methods Sixty male SD rats weighing 180-220 g were randomly divided into 5 groups ( n = 12 each): groupnormal control (group C); group IT normal saline (group N); different doses of dexmedetomidine groups received IT dexmedetomidine 0.75, 1.50 and 3.00 μg/kg respectively (groups D1.3). Paw withdrawal threshold to mechanical stimulation (PWMT)with yon Frey filaments and tail flick latency (TFL) to a thermal nociceptive stimulus were measured before (To, baseline) and at 30 or60 rin after IT dexmedetomidine or normal saline administration (T1, T2 ) and the percentage of the maximum possible effect ( MPE ) was calculated. Lumbar segment of the spinal cord ( L4-6 ) was removed for microscopic examination and determination of c-Fos expression (by immuno-histochemistry) at 7, 24 and 48 h after IT dexmedetomidine or normal saline administration. Results PWMT, TFL and the percentage of MPE were significantly increased after IT dexmedetomidine as compared with the baseline values at T0 in groups D1-3 ( P ＜ 0.05). PWMT was significantly higher at T1 and TFL and the percentage of MPE were higher at T2 in groups D1-3 than in groups C and N,and in group D3 than in groups D1,2 ( P ＜ 0.05). At 7,24 h after IT dexmedetomidine c-Fos protein expression was significantly higher in group D3 than in groups C and N( P ＜ 0.05). There was no significant difference in c-Fos expression at 48 h after IT dexmedetomidine between group D3 and groups C and N ( P ＞ 0.05 ). At 24 h after IT dexmedetomidine c-Fos protein expression was significantly higher in group D3 than in other 4 groups( P ＜ 0.05). Slight spinal cord injury was observed at 24 h after IT dexmedetomidine in group D3. Conclusion IT dexmedetomidine has antinociceptive effect. High dose dexmedetomidine IT can produce transient reversible toxicity to the spinal cord.
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Objective To investigate analgesic effects of the selective blocking of descending facilitation targeting μ opioid receptor positive neurons in the rostral ventromedial medulla ( RVM) in a rat model of bone cancer pain. Methods Forty-eight adult female Wistar rats weighing 180-200 g were randomly divided into 6 groups: group Ⅰ control ( n = 3) ;group Ⅱ bone cancer pain induced by intra-tibia inoculation of Walker 256 mammary gland carcinoma cells ( n = 9) ;group Ⅲ-Ⅵ received a single intra-RVM micro-injection of PBS (group Ⅲ), dermorphin (group Ⅳ) , saporin (group Ⅴ) and dermorphin-saporin ( group Ⅵ) respectively at 28 days before intra-tibia inoculation ( n = 9 each) . Starting from 3 to 20 days after intra-tibia inoculation, mechanical allodynia was assessed and recorded. The animals were sacrificed on 7, 14 and 20 days after intra-tibia inoculation, after repetitive non-noxious tactile stimulation of the hindpaw. The total number of Fos-positive neurons in the spinal dorsal horn was measured as a marker indicative of central sensitization. Results The animals developed nociceptive hypersensitivity after intra-tibia cancer cell inoculation in group Ⅱ -Ⅵ . Nociceptive hypersensitivity was significantly decreased during 4-7 days after the onset of nociception in group Ⅵ (dermorphin-saporin). The number of Fos positive neurons in bilateral spinal dorsal horn was significantly increased by intra-tibia inoculation of cancer cells in group Ⅱ-Ⅵ as compared with control group and was significantly lower at day 14 and 20 after inoculation in group Ⅵ (dermorphin-saporin) than in group Ⅱ - Ⅴ.Conclusion Selective blocking of descending facilitation targeting μ opioid receptor positive neurons in RVM can effectively reduce nociceptive hypersensitivity induced by intra-tibia inoculation of Walker56 mammary gland carcinoma cells.