ABSTRACT
Objective:To evaluate the efficacy of long-interval programmed intermittent epidural bolus (PIEB) during the incubation period for labor analgesia.Methods:Seventy-eight nulliparous parturients who were at full term with a singleton fetus in vertex presentation, aged 22-35 yr, with body mass index of 18.0-30.0 kg/m 2, of American Society of Anesthesiologists physical statusⅠorⅡ, were divided into 2 groups ( n=39 each) using a random number table method: routine epidural bolus using a stepwise approach group (C group) and long-interval PIEB group (L group). Epidural puncture was performed at L 2, 3, and the analgesia solution was 0.1% ropivacaine and 0.5 μg/ml sufentanil in the two groups.The parturients in group C received 8 ml pulse dose per hour during the incubation period (cervical dilatation <3 cm), and 10 ml pulse dose per hour during the active phase (cervical dilatation ≥3 cm). In group L, the first pulse dose was 10 ml during the incubation period, 1.5 h later the anesthesia plane was detected, and 10 ml pulse dose was immediately given when the plane was lower than T 10, otherwise it was reevaluated 15 min later.After the interval time reached 2 h, a pulse dose 10 ml was given regardless of whether the plane was lower than T 10, and the pulse dose 10 ml was given at 1 h interval during the active phase.The numerical rating scale scores were recorded when the cervical dilatation was 3, 6 and 10 cm, and at the time of baby delivery.The duration of labor, total consumption of analgesics, and Bromage grade of lower extremities were recorded.The Apgar score <7 at 1 and 5 min after birth was recorded.The maternal adverse reactions and scores for satisfaction with analgesia were also recorded. Results:Thirty puerperae were finally enrolled in each group.The first stage of labor and total duration of labor were significantly shortened, and the total consumption of analgesics was decreased in group L ( P<0.01). There were no significant differences in the numerical rating scale scores at each time point, duration of second and third stages of labor, Bromage grade of lower extremities, incidence of adverse reactions, score for satisfaction with analgesia, and incidence of Apgar score < 7 after birth between the two groups ( P>0.05). Conclusions:When PIEB is used for labor analgesia, prolonging the infusion interval time of epidural bolus to 1.5-2.0 h during the incubation period can produce satisfactory analgesic effect and further decrease the consumption of analgesics and reduce the influence on labor stages when compared with administration using a stepwise approach.
ABSTRACT
Objective To explore propofol dosage difference between in morning and at after-noon undergoing gynecological clinic short operation.Methods One thousands and nine hundred fifty eight female patients,aged 1 6-50 yr,of ASA physical status Ior II,undergoing gynecology clinic short operation,according to the operation time,were divided into two groups,Group morning (8:30-1 1:30,n =1047)and group afternoon (14:00-1 7:00,n =91 1).Each patient was intravenously injected fentanyl 0.01 μg/kg,and then propofol 2.5 mg/kg.When the observer’s assessment of alertness/se-dation (OAA/S)scores reached 0 score,the operation began.If the body moved,the surgery was stopped and 25 mg propofol was intravenously injected quickly.After 10 seconds observation,if the body movement existed,25 mg more propofol was performed,until the movement disappeared.Re-cord patients’year,height,weight,body mass index,and the heart beat,blood pressure of pre-op-eration,the number of times of cervix uteri expansion per vagina,the history of labor per vagina,the total dosage of propofol and the time length of sedation.Results The dosage of group afternoon (1 52.1 6±65.90)mg was higher than group morning’s (135.69±37.67)mg (P <0.05).There was no significant difference of time lengths of sedation between the two groups.Additional use of propofol in the afternoon group 387 (42.5%)was higher than group morning’s 1 99 (23.5%)(P <0.05).Conclusion In gynecological clinic short operation,the propofol dosage in afternoon was higher than that in the morning group.But the sedation time length in afternoon was not longer than that in the morning.