Application of titrated target-controlled infusion anesthesia in laparoscopic colorectal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the effect of titrated target-controlled infusion with propofol and remifentanil on anesthetics consumption and anesthesia depth in patients undergoing elective laparoscopic colorectal surgery.</p><p><b>METHODS</b>Sixty ASA I-III patients for elective laparoscopic colorectal surgery were enrolled. Titrated target-controlled infusion (TCI) with propofol and remifentanil was performed. Plasma concentration of the drugs was administered by titrated method to maintain bispectral index (BIS) in the range of 40-60 with systolic blood pressure (SBP) fluctuation within 20% of the basic value. BIS, SBP, plasma concentration of propofol and remifentanil were recorded at different time points. Awareness during operation was inquired postoperatively.</p><p><b>RESULTS</b>During the entire anesthesia period, the blood pressure was stable and BIS was maintained less than 60. There was no awareness during operation. The plasma concentrations (95% confidence interval) for TCI of propofol and remifentanil were 2.55-2.65 mg/L and 4.09-4.26 μg/L respectively when existing surgical stimulation during anesthesia, and the plasma target concentration of propofol was lower than the recommended dosages.</p><p><b>CONCLUSION</b>Titrated target-controlled infusions with propofol and remifentanil for elective laparoscopic colorectal surgery can maintain proper anesthesia depth and reduce the drug consumption.</p>

A pilot study of the effect of pressure-driven lidocaine spray on airway topical anesthesia for conscious sedation intubation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Difficult airway remains not only a challenge to the anesthesiologists, but also a life-threatening event to the patients. Awake intubation is the principal choice to deal with difficult airway, and a key point for awake intubation is airway topical anesthesia. Yet, so far there is no ideal topical anesthesia approach for awake intubation. This study aimed at evaluating the effect of pressure-driven (by 10 L/min oxygen flow) lidocaine spray on airway topical anesthesia in order to find a powerful and convenient method for airway topical anesthesia for conscious sedation intubation.</p><p><b>METHODS</b>Thirty adult patients referred for elective surgery under general anesthesia, aged 18 - C60 years and Mallampati class I or II, were recruited for the study. Before topical anesthesia, the observer's assessment of alert and sedation (OAA/S) scale was controlled between 3 and 4 by intravenous midazolam (0.03 mg/kg), propofol (2 mg×kg(-1)×h(-1)) and remifentanil (0.05 µg×kg(-1)×min(-1)). Ten minutes after sedation, topical anesthesia was performed with the pressure-driven lidocaine spray; the driving pressure was achieved by an oxygen flow of 10 L/min. After topical anesthesia, tracheal intubation was performed and the intubation condition was assessed with modified the Erhan's intubation condition score by an experienced anesthesiologist, and a score of less than 10 was considered to be satisfactory. Attempts to intubate the patient were recorded, and the complications such as local anesthetic toxicity, mucosa injury, and respiration depression were also recorded. The mean arterial blood pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at different time points before and after intubation. Patients were asked 24 hours after the operation whether they could recall the events during intubation.</p><p><b>RESULTS</b>All patients were intubated at the first attempt, the average intubation condition score was 7.0 ± 1.1, from 6 to 10, satisfied intubation condition. MAP and HR increased significantly but mildly immediately after the tracheal intubation (P < 0.05), and decreased to the pre-intubation level soon after intubation. There were no related complications and patients had no recall of the intubation procedures.</p><p><b>CONCLUSIONS</b>Topical anesthesia with pressure driven 2% lidocaine spray, where pressure is achieved by 10 L/min oxygen flow, can offer satisfactory intubation conditions for conscious sedation intubation.</p>