RESUMO
Purpose: We designed this trial to compare the recovery time of remimazolam and propofol in elderly patients undergoing painless gastrointestinal endoscopy. Patients and Methods: In this randomized, non-Inferiority trial, 360 patients aged 65 years or older, scheduled for elective outpatient gastrointestinal endoscopy, were randomly assigned to the remimazolam combined with fentanyl (RF) group or the propofol combined with fentanyl (PF) group. The primary outcome was the post-anesthesia care unit (PACU) stay time, defined as the time from the end of the examination to scoring 9 points using the Modified Post-Anesthetic Discharge Scoring System (MPADSS) criteria. Secondary outcomes included sedation-related adverse events, recall, injection pain, as well as postoperative Quality of Recovery-15 (QoR-15) scores and Pittsburgh Sleep Quality Index (PSQI) scores at 1 day, 1 week, and 1 month postoperatively. Results: A total of 351 patients completed the study, with 174 receiving remimazolam and 177 receiving propofol. The PACU stay time in RF group was non-inferior to that in PF group [14 (11, 18) vs 13 (10, 17), mean difference 1 (95% confidence interval 0, 2), P=0.084 for noninferiority]. However, remimazolam was associated with lower rate of hypoxemia [4.7% (8/180) vs 12.4% (22/180), P=0.011], reduced use of vasoactive drugs [1 (0, 1) vs 1 (1, 2), P<0.001], less injection pain [2 (1.2%) vs 35 (21.3%), P<0.001], and lower recall [20 (11.8%) vs 36 (20.3%), P=0.034]. There were no differences in the QoR-15 scores and PSQI scores at postoperative 1 day, 1 week, and 1 month between groups. Conclusion: This non-inferiority study revealed that in elderly outpatients undergoing gastrointestinal endoscopy, remimazolam achieved recovery times comparable to propofol, with fewer associated complications.
Assuntos
Benzodiazepinas , Endoscopia Gastrointestinal , Pacientes Ambulatoriais , Propofol , Humanos , Propofol/administração & dosagem , Idoso , Feminino , Masculino , Benzodiazepinas/administração & dosagem , Benzodiazepinas/efeitos adversos , Período de Recuperação da Anestesia , Hipnóticos e Sedativos/administração & dosagem , Idoso de 80 Anos ou maisRESUMO
Objective: Ciprofol is a novel anesthetic agent, its efficacy and safety had been verified and its clinical implementation has been expanded. However, the knowledge about ciprofol in children is meager. The aim of study is to evaluate the safety and effectiveness of ciprofol in general anesthesia in children undergoing adenoidectomy and adenotonsillectomy, compared with propofol. Materials: We retrospectively analyzed data of children who underwent adenoidectomy or adenotonsillectomy with general anesthesia from June to August 2023 to evaluate the safety and effectiveness of ciprofol. The primary outcomes included hemodynamic changes during induction and postoperative complications in post-anesthesia care unit. The secondary outcomes were extubation time, pediatric anesthesia emergence delirium (PAED) score. Meanwhile, subgroup analysis was performed based on age. Results: 301 children met the inclusion criteria, 157 received ciprofol induction and 144 received propofol. Patient demographics and operation-related information were similar in the two groups. However, the dosage of dexmedetomidine in the propofol group was significantly higher than that of the ciprofol group (p=0.001). The trends of hemodynamic shift during induction and intubation were the same in the two groups. The PAED scores on post-extubation 10min and 20min were significantly reduced in the ciprofol group (p<0.001 and p=0.046). Moreover, in the ≤72 months and the >72 months subgroups, the scores were also significantly lower in the ciprofol group on post-extubation 10min. With the score of >10, the incidence of emergence delirium of the ciprofol group was significantly lower on post-extubation 10min and 20min in the population and the ≤72 months subgroups (p=0.03 and p=0.02). There were no obvious postoperative complications in both groups. Conclusion: Ciprofol exhibited advantageous characteristics in the induction of children, such as stable hemodynamics, a relatively lower incidence of postoperative delirium without apparent post-anesthesia complications. Ciprofol may emerge as a novel option for general anesthesia in pediatric patients.
Assuntos
Adenoidectomia , Anestesia Geral , Tonsilectomia , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pré-Escolar , Criança , Adenoidectomia/efeitos adversos , Anestesia Geral/efeitos adversos , Tonsilectomia/efeitos adversos , Propofol/administração & dosagem , Propofol/efeitos adversos , Complicações Pós-Operatórias , Lactente , Estudos de CoortesRESUMO
BACKGROUND: The primary objective of anesthesiologists during the induction of anaesthesia is to mitigate the operative stress response resulting from endotracheal intubation. In this prospective, randomized controlled trial, our aim was to assess the feasibility and efficacy of employing Index of Consciousness (IoC, IoC1 and IoC2) monitoring in predicting and mitigating circulatory stress induced by endotracheal intubation for laparoscopic cholecystectomy patients under general anesthesia (GA). METHODS: We enrolled one hundred and twenty patients scheduled for laparoscopic cholecystectomy under GA and randomly allocated them to two groups: IoC monitoring guidance (Group T, n = 60) and bispectral index (BIS) monitoring guidance (Group C, n = 60). The primary endpoints included the heart rate (HR) and mean arterial pressure (MAP) of the patients, as well as the rate of change (ROC) at specific time points during the endotracheal intubation period. Secondary outcomes encompassed the systemic vascular resistance index (SVRI), cardiac output index (CI), stroke volume index (SVI), ROC at specific time points, the incidence of adverse events (AEs), and the induction dosage of remifentanil and propofol during the endotracheal intubation period in both groups. RESULTS: The mean (SD) HR at 1 min after intubation under IoC monitoring guidance was significantly lower than that under BIS monitoring guidance (76 (16) beats/min vs. 82 (16) beats/min, P = 0.049, respectively). Similarly, the mean (SD) MAP at 1 min after intubation under IoC monitoring guidance was lower than that under BIS monitoring guidance (90 (20) mmHg vs. 98 (19) mmHg, P = 0.031, respectively). At each time point from 1 to 5 min after intubation, the number of cases with HR ROC of less than 10% in Group T was significantly higher than in Group C (P < 0.05). Furthermore, between 1 and 3 min and at 5 min post-intubation, the number of cases with HR ROC between 20 to 30% or 40% in Group T was significantly lower than that in Group C (P < 0.05). At 1 min post-intubation, the number of cases with MAP ROC of less than 10% in Group T was significantly higher than that in Group C (P < 0.05), and the number of cases with MAP ROC between 10 to 20% in Group T was significantly lower than that in Group C (P < 0.01). Patients in Group T exhibited superior hemodynamic stability during the peri-endotracheal intubation period compared to those in Group C. There were no significant differences in the frequencies of AEs between the two groups (P > 0.05). CONCLUSION: This promising monitoring technique has the potential to predict the circulatory stress response, thereby reducing the incidence of adverse reactions during the peri-endotracheal intubation period. This technology holds promise for optimizing anesthesia management. TRAIL REGISTRATION: Chinese Clinical Trail Registry Identifier: ChiCTR2300070237 (20/04/2022).
Assuntos
Anestesia Geral , Monitores de Consciência , Frequência Cardíaca , Intubação Intratraqueal , Monitorização Intraoperatória , Humanos , Anestesia Geral/métodos , Intubação Intratraqueal/métodos , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto , Monitorização Intraoperatória/métodos , Frequência Cardíaca/fisiologia , Colecistectomia Laparoscópica/métodos , Estado de Consciência/efeitos dos fármacos , Estresse Fisiológico , Pressão Arterial , Propofol/administração & dosagemRESUMO
BACKGROUND: Opioid-reduced multimodal analgesia has been used clinically for many years to decrease the perioperative complications associated with opioid drugs. We aimed to assess the clinical effects of opioid-reduced anesthesia during thoracoscopic sympathectomy. METHODS: Surgical patients (n = 151) with palmar hyperhidrosis were randomly divided into control (Group C, 73 patients) and test (Group T, 78 patients) groups. All patients were administered general anesthesia using a laryngeal mask. In Group C, patients received propofol, fentanyl, and cisatracurium for anesthesia induction, and maintenance was achieved with propofol and remifentanil, along with mechanical ventilation during the operation. In Group T, anesthesia was induced with propofol, dezocine, and dexmedetomidine (DEX) and maintained with propofol, DEX, and an intercostal nerve block, along with spontaneous breathing throughout the operation. Perioperative complications related to opioid use include hypotension, bradycardia, hypertension, tachycardia, hypoxemia, nausea, vomiting, urine retention, itching, and dizziness were observed. To assess the impact of these complications, we recorded and compared vital signs, blood gas indices, visual analogue scale (VAS) scores, adverse events, and patient satisfaction between the two groups. RESULTS: Perioperative complications related to opioid use were similar between groups. There were no significant differences in the type of perioperative sedation, analgesia index, respiratory and circulatory indicators, blood gas analysis, postoperative VAS scores, adverse reactions, propofol dosage, postoperative recovery time, and patient satisfaction. CONCLUSIONS: In minimally invasive surgeries such as thoracoscopic sympathectomy, opioid-reduced anesthesia was found to be safe and effective; however, this method did not demonstrate clinical advantages. TRIAL REGISTRATION: Chinese Clinical Trial Register: ChiCTR2100055005, on December 30, 2021.
Assuntos
Analgésicos Opioides , Hiperidrose , Simpatectomia , Toracoscopia , Humanos , Feminino , Masculino , Hiperidrose/cirurgia , Adulto , Estudos Prospectivos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Toracoscopia/métodos , Simpatectomia/métodos , Adulto Jovem , Propofol/administração & dosagem , Anestesia Geral/métodos , Atracúrio/administração & dosagem , Atracúrio/análogos & derivados , Satisfação do Paciente , Dexmedetomidina/administração & dosagem , Fentanila/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Remifentanil/administração & dosagem , Bloqueio Nervoso/métodos , Tetra-Hidronaftalenos , Compostos Bicíclicos Heterocíclicos com PontesRESUMO
Introduction: This study investigates the application of bispectral index (BIS) monitoring in rigid bronchoscopy to enhance anesthetic delivery and patient outcomes, a topic that remains underexplored. Materials and Methods: A retrospective analysis of 155 patients undergoing elective rigid bronchoscopy under general anesthesia was conducted. Patients were divided into BIS-monitored and conventional anesthesia groups. Inclusion criteria were adults aged over 18 years with American Society of Anesthesiologists (ASA) physical status I-IV. Result: No significant demographic differences were found between the groups. The BIS group showed significant reductions in propofol usage (231.40 ± 74.63 mg vs. 190.19 ± 91.83 mg, p= 0.003) and prednol dosage (94.27 ± 42.56 mg vs. 79.71 ± 18.97 mg, p= 0.020). Remifentanil administration approached statistical significance (56.99 ± 34.69 mcg vs. 45.36 ± 36.75 mcg, p= 0.055). Conclusions: No significant demographic differences were found between the groups. The BIS group showed significant reductions in propofol usage (231.40 ± 74.63 mg vs. 190.19 ± 91.83 mg, p= 0.003) and prednol dosage (94.27 ± 42.56 mg vs. 79.71 ± 18.97 mg, p= 0.020). Remifentanil administration approached statistical significance (56.99 ± 34.69 mcg vs. 45.36 ± 36.75 mcg, p= 0.055).
Assuntos
Anestesia Geral , Broncoscopia , Propofol , Remifentanil , Humanos , Masculino , Feminino , Broncoscopia/métodos , Estudos Retrospectivos , Pessoa de Meia-Idade , Propofol/administração & dosagem , Remifentanil/administração & dosagem , Anestesia Geral/métodos , Adulto , Monitores de Consciência , Idoso , Anestésicos Intravenosos/administração & dosagem , Monitorização Intraoperatória/métodosRESUMO
INTRODUCTION: Remimazolam is an ultra-short-acting benzodiazepine with a predictable and quick recovery that was FDA approved in 2020. As a relatively new medication, it is not as mainstream as other sedatives such as propofol or midazolam. This research aims to highlight the differences, benefits, and drawbacks of remimazolam in comparison to other short-term sedatives in order to bring greater awareness, and to consolidate the current knowledge of the effects of remimazolam. METHODS: The PubMed database was used to search for current relevant research to review. The search terms used were: "remimazolam", "midazolam", "propofol", and procedural sedation. The search also used qualifiers using only publications in English and published within the last five years. This query yielded 26 articles which were reviewed for content and relevance. RESULTS: Sixteen of the reviewed studies resulted in common themes suggesting remimazolam to be an effective alternative for procedural sedation with fewer adverse effects. Primarily, remimazolam is observed to have decreased procedural hypotension, bradycardia, and injection site pain. With no studies demonstrating an increased frequency of bradycardia, remimazolam is theorized to be superior to propofol in respect to sedation-associated bradycardia. One specific study notes a 14% decrease in frequency of bradycardia compared to propofol. Further benefits of remimazolam over propofol include the availability of an effective and reliable antidote, flumazenil. CONCLUSION: In being that remimazolam has primarily been used and studied in short-term sedation, we can only confidently conclude remimazolam's safety in these settings. There is little research being done in the way of ICU sedation or general anesthesia, but with the relatively similar, or decreased rates of adverse events with remimazolam, we suspect an increase in clinical research of remimazolam in these settings. With continued robust research, remimazolam could become more widely accepted as a safe alternative to current sedatives.
Assuntos
Benzodiazepinas , Hipnóticos e Sedativos , Midazolam , Propofol , Humanos , Benzodiazepinas/efeitos adversos , Midazolam/administração & dosagem , Propofol/efeitos adversos , Propofol/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/administração & dosagemRESUMO
OBJECTIVE: This study evaluated the 50% effective dose (ED50) and 95% effective dose (ED95) of butorphanol tartrate in patients undergoing painless gastroscopy. METHODS: Patients who underwent painless gastroscopy at Binzhou Medical University Hospital were divided into the youth, middle-aged, and older groups. The ED50 and ED95 required for successful sedation using butorphanol tartrate were measured using the Dixon up-and-down method in patients in the different age groups. Patients in each group were administered intravenous butorphanol 5 minutes before gastroscopy. Each patient was administered 2 mg/kg propofol. The ED50 and ED95 of butorphanol were calculated using probit analysis. RESULTS: In total, 95 patients were included. The ED50s of butorphanol in the youth, middle-aged, and older groups were 7.384, 6.657, and 6.364 µg/kg, respectively. The ED95s of butorphanol doses in these groups were 9.108, 8.419, and 7.348 µg/kg, respectively. CONCLUSIONS: The ED50 and ED95 varied among the age groups, indicating that the effective dose decreases with age.
Assuntos
Butorfanol , Gastroscopia , Humanos , Butorfanol/administração & dosagem , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Gastroscopia/métodos , Idoso , Fatores Etários , Relação Dose-Resposta a Droga , Adulto Jovem , Adolescente , Propofol/administração & dosagemRESUMO
Research into the role of thalamocortical circuits in anesthesia-induced unconsciousness is difficult due to anatomical and functional complexity. Prior neuroimaging studies have examined either the thalamus as a whole or focused on specific subregions, overlooking the distinct neuronal subtypes like core and matrix cells. We conducted a study of heathy volunteers and functional magnetic resonance imaging during conscious baseline, deep sedation, and recovery. We advanced the functional gradient mapping technique to delineate the functional geometry of thalamocortical circuits, within a framework of the unimodal-transmodal functional axis of the cortex. Here we show a significant shift in this geometry during deep sedation, marked by a transmodal-deficient geometry. This alteration is closely linked to the spatial variations in the matrix cell composition within the thalamus. This research bridges cellular and systems-level understanding, highlighting the crucial role of thalamic core-matrix functional architecture in understanding the neural mechanisms of states of consciousness.
Assuntos
Estado de Consciência , Imageamento por Ressonância Magnética , Propofol , Tálamo , Humanos , Tálamo/diagnóstico por imagem , Tálamo/efeitos dos fármacos , Tálamo/fisiologia , Propofol/farmacologia , Masculino , Adulto , Feminino , Estado de Consciência/efeitos dos fármacos , Estado de Consciência/fisiologia , Mapeamento Encefálico/métodos , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/efeitos dos fármacos , Sedação Profunda , Adulto Jovem , Pessoa de Meia-IdadeAssuntos
Anestésicos Intravenosos , Colangiopancreatografia Retrógrada Endoscópica , Etomidato , Propofol , Humanos , Propofol/efeitos adversos , Propofol/administração & dosagem , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Etomidato/efeitos adversos , Etomidato/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: The effects of anesthetics on liver and kidney functions after infantile living-related liver transplantation (LRLT) are unclear. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) or desflurane-based inhalation anesthesia on postoperative liver and kidney functions in infant recipients after LRLT and to evaluate hepatic ischemia-reperfusion injury (HIRI). METHODS: Seventy-six infants with congenital biliary atresia scheduled for LRLT were randomly divided into two anesthesia maintenance groups: group D with continuous inhalation of desflurane and group P with an infusion of propofol. The primary focus was to assess alterations of liver transaminase and serum creatinine (Scr) levels within the first 7 days after surgery. And the peak aminotransferase level within 72 h post-surgery was used as a surrogate marker for HIRI. RESULTS: There were no differences in preoperative hepatic and renal functions between the two groups. Upon the intensive care unit (ICU) arrival, the levels of aspartate aminotransferase (AST, P = 0.001) and alanine aminotransferase (ALT, P = 0.005) in group P were significantly lower than those in group D. These changes persisted until the fourth and sixth days after surgery. The peak AST and ALT levels within 72 h after surgery were also lower in group P than in group D (856 (552, 1221) vs. 1468 (732, 1969) U/L, P = 0.001 (95% CI: 161-777) and 517 (428, 704) vs. 730 (541, 1100) U/L, P = 0.006, (95% CI: 58-366), respectively). Patients in group P had lower levels of Scr upon the ICU arrival and on the first day after surgery, compared to group D (17.8 (15.2, 22.0) vs. 23.0 (20.8, 30.8) µmol/L, P < 0.001 (95% CI: 3.0-8.7) and 17.1 (14.9, 21.0) vs. 20.5 (16.5, 25.3) µmol/L, P = 0.02 (95% CI: 0.0-5.0) respectively). Moreover, the incidence of severe acute kidney injury was significantly lower in group P compared to that in group D (15.8% vs. 39.5%, P = 0.038). CONCLUSIONS: Propofol-based TIVA might improve liver and kidney functions after LRLT in infants and reduce the incidence of serious complications, which may be related to the reduction of HIRI. However, further biomarkers will be necessary to prove these associations.
Assuntos
Desflurano , Isoflurano , Rim , Transplante de Fígado , Fígado , Propofol , Humanos , Propofol/administração & dosagem , Propofol/efeitos adversos , Transplante de Fígado/efeitos adversos , Desflurano/administração & dosagem , Lactente , Masculino , Feminino , Isoflurano/análogos & derivados , Isoflurano/administração & dosagem , Isoflurano/efeitos adversos , Rim/efeitos dos fármacos , Fígado/efeitos dos fármacos , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Doadores Vivos , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/efeitos adversos , Creatinina/sangue , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Testes de Função Hepática , Período Pós-Operatório , Testes de Função Renal , Atresia Biliar/cirurgiaRESUMO
BACKGROUND: Cardiac troponin I, a particular biomarker, is released into the bloodstream in response to myocardial injury. OBJECTIVES: To evaluate perioperative changes in high-sensitivity cardiac troponin I (hs-cTnI) concentration during ovariohysterectomy in cats undergoing three different anaesthesia protocols. METHODS: Twenty-one female mixed-breed cats owned by clients aged (2.2 ± 0.7 years) and weight (3.2 ± 0.5 kg) were included in our study. The cats were divided into three groups: propofol-isoflurane (PI) group (n = 7), xylazine-ketamine (XK) group (n = 7) and xylazine-isoflurane (XI) group (n = 7). After pre-anaesthetic propofol (6 mg/kg IV) was administered to cats in Group PI, a mask was placed, and anaesthesia was maintained with 3.0% isoflurane in oxygen. Cats in Group XK underwent general anesthetization with xylazine hydrochloride (2 mg/kg IM) and, 10 min later, ketamine hydrochloride (10 mg/kg IM). Cats in Group XI were administered xylazine hydrochloride (2 mg/kg IM), and then anaesthesia (3.0% isoflurane and oxygen) was continued with a mask. Blood samples were collected from all cats; preoperatively and postoperatively at 0 and 12 h (Pre-, Post-0 h and Post-12 h, respectively). Serum hs-cTnI concentrations were measured with the Advia Centaur TnI-Ultra. RESULTS: In all 21 cats, hs-cTnI concentration increased at Post-0 h and 12 h measurement points compared to Pre-. In the XK group, hs-cTnI concentrations exhibited a significant increase at the Post-0 h (51.30 ng/L) and Post-12 h (157.70 ng/L) time points compared to Pre- (6.70 ng/L) (p < 0.05). CONCLUSIONS: The XK group increased the concentration of hs-cTnI more than other protocols. In the PI group, the increase in hs-cTnI concentrations at Post-0 and 12 h increased less than the other two groups (p < 0.05). The PI group was found to induce less myocardial damage.
Assuntos
Isoflurano , Ketamina , Propofol , Troponina I , Xilazina , Animais , Gatos/cirurgia , Troponina I/sangue , Feminino , Xilazina/administração & dosagem , Ketamina/administração & dosagem , Propofol/administração & dosagem , Isoflurano/administração & dosagem , Histerectomia/veterinária , Ovariectomia/veterinária , Período Perioperatório/veterinária , Anestésicos Inalatórios/administração & dosagem , Anestesia/veterinária , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/farmacologia , Anestesia Geral/veterináriaRESUMO
BACKGROUND: In the neurological examination, it is crucial to identify the possible location of the lesion in order to determine the appropriate treatment process. In aggressive animals, chemical restraint may be necessary due to their non-cooperative behaviour. However, sedatives may distort the results of examinations. Therefore, a drug should be found that has minimal impact on the examination results. OBJECTIVES: To investigate the effects of acepromazine, xylazine, and propofol on spinal reflexes in healthy dogs. METHODS: In a randomized, blinded study, ten native adult mixed-breed dogs were participated in three groups with a 1-week washout period between each group. Before performing each step, the spinal reflexes were evaluated. Then, in the first group, acepromazine (0.05 mg/kg, IM), in the second group, xylazine (1 mg/kg, IM), and in the third group, propofol (3 mg/kg, IV for initial bolus and 0.1 mg/kg/min for maintenance) were injected for sedation. The spinal reflexes were reevaluated at maximum sedation and at 15, 30, and 45 min thereafter. RESULTS: Acepromazine increased the patellar reflex and decreased the panniculus reflex. Xylazine increased the cranial tibial reflex and decreased the panniculus reflex, while propofol decreased the withdrawal, and extensor carpi radialis reflexes, and suppressed the palpebral and gag reflexes. CONCLUSIONS: The drugs used in the present study did not have a significant impact on the most important reflexes evaluated in neurological examinations. Among the drugs, acepromazine has the least effects compared to other drugs, making it a suitable choice for sedation.
Assuntos
Acepromazina , Hipnóticos e Sedativos , Propofol , Reflexo , Xilazina , Animais , Acepromazina/farmacologia , Acepromazina/administração & dosagem , Xilazina/farmacologia , Xilazina/administração & dosagem , Propofol/farmacologia , Propofol/administração & dosagem , Cães/fisiologia , Hipnóticos e Sedativos/farmacologia , Hipnóticos e Sedativos/administração & dosagem , Reflexo/efeitos dos fármacos , Masculino , FemininoRESUMO
The aim of this study was to evaluate the efficacy of fast-track cardiac anesthesia using target-controlled infusion of sufentanil and propofol in valve replacement surgery. The clinical data of 88 patients with rheumatic heart disease undergoing valve replacement surgery were retrospectively analyzed and grouped based on different treatment methods. Among them, 44 cases received fast-track cardiac anesthesia using target-controlled infusion of fentanyl and propofol from November 2019 to July 2021 were set as the control group, and 44 cases received fast-track cardiac anesthesia using target-controlled infusion of sufentanil and propofol from August 2021 to February 2022 were set as the study group. The study group showed shorter postoperative awakening time, extubation time, and hospital stay duration, and lower dosage of dopamine and nitroglycerin consumption compared to the control group (Pâ <â .05). At T5 and T6, both groups exhibited higher ACTH, cortisol (Cor), and C3a than at T0, and the study group showed significantly lower ACTH, Cor, and C3a at T5 and T6 than the control group (Pâ <â .05). At T7, the control group showed higher ACTH, Cor, and C3a than at T0, and ACTH, Cor, and C3a were significantly lower in the study group than in the control group at T7 (Pâ <â .05). Fast-track cardiac anesthesia using target-controlled infusion of sufentanil and propofol in valve replacement surgery has demonstrated favorable application effects, which stabilizes hemodynamics, alleviates myocardial damage, suppresses endocrine stress responses, and does not increase adverse reactions, thereby exhibiting good safety.
Assuntos
Anestésicos Intravenosos , Implante de Prótese de Valva Cardíaca , Propofol , Sufentanil , Humanos , Sufentanil/administração & dosagem , Propofol/administração & dosagem , Masculino , Feminino , Estudos Retrospectivos , Anestésicos Intravenosos/administração & dosagem , Pessoa de Meia-Idade , Implante de Prótese de Valva Cardíaca/métodos , Adulto , Cardiopatia Reumática/cirurgia , Anestesia em Procedimentos Cardíacos/métodos , Tempo de Internação/estatística & dados numéricos , Infusões Intravenosas , Período de Recuperação da AnestesiaRESUMO
BACKGROUND: To compare the efficacy and safety of ciprofol, propofol, propofol and etomidate mixture or ciprofol and etomidate mixture in patients undergoing painless gastroscopic anesthesia, and to explore the optimal plan to relieve the patient's discomfort. METHODS: A total of 120 patients scheduled for painless gastroscopy were randomly assigned to 4 groups: propofol (Group P), ciprofol (Group C), propofol-etomidate mixture (Group P-E), and ciprofol-etomidate mixture (Group C-E). The success rate of gastroscopy examination, patient satisfaction, incidence of injection pain, hemodynamic parameters, induction time, procedure time, the consumption of drugs, awakening time, and incidence of adverse events were evaluated. RESULTS: All patients in the study successfully completed the gastroscopy. The satisfaction of patients in Group C-E was significantly higher than that in Group P (Pâ <â .05), but there was no statistical significance in the patient satisfaction among the other groups. Compared with Group P, the incidence of injection pain in Groups C and C-E significantly decreased (Pâ <â .05). There were no significant differences in the SBP, diastolic blood pressure, HR, and SpO2 among the 4 groups (Pâ >â .05). The awakening time of Group C was significantly longer than that of Groups P and P-E (Pâ <â .05), but there was no statistically significant difference in the awakening time of other groups. CONCLUSION: Ciprofol demonstrated efficacy in inducing sedation or anesthesia during painless gastroscopy that was similar to propofol, while exhibiting a comparable safety profile. Moreover, the combination of propofol and etomidate, as well as the combination of ciprofol and etomidate, were both shown to be equally safe and effective for this clinical application. These findings suggest that ciprofol can be considered as a safe and effective alternative for painless gastroscopy, and the ciprofol-etomidate mixture may be a better choice.
Assuntos
Anestésicos Intravenosos , Etomidato , Gastroscopia , Propofol , Humanos , Propofol/efeitos adversos , Propofol/administração & dosagem , Masculino , Método Duplo-Cego , Feminino , Etomidato/efeitos adversos , Etomidato/administração & dosagem , Gastroscopia/métodos , Adulto , Pessoa de Meia-Idade , Anestésicos Intravenosos/efeitos adversos , Anestésicos Intravenosos/administração & dosagem , Satisfação do Paciente , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/administração & dosagem , Resultado do TratamentoRESUMO
BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has become an important tool in the diagnosis and staging of mediastinal lymph node lesions in lung cancer. Adequate sedation is an important part of the procedure as it provides patient comfort and potentially increases diagnostic yield. The sedation modality varies among centers and includes moderate sedation/conscious sedation, deep sedation, and general anesthesia. The object of this study will be the evaluation of patient's comfort and level of satisfaction with the involved health care providers (bronchoscopist and anesthesiologist) of remifentanil administration in target-controlled infusion (TCI) for conscious sedation in patients undergoing EBUSTBNA, with a prospective randomized study design versus the of standard sedation protocol with midazolam and/or fentanest and/or propofol. METHODS: This study was carried out at the "Campus Biomedico di Roma" University Hospital between September 2021 and November 2021, with a total number of 30 patients enrolled who met the eligibility criteria, randomly divided into 2 groups: group 1 "REMIFENTANIL TCI" (experimental group) where the patients performed the EBUS-TBNA procedure under conscious sedation with infusion of remifentanil TCI with a target between 3 ng/mL and 6 ng/mL and group 2 "STANDARD" (control group) with patients undergoing conscious sedation with the association of midazolam and/or fentanest and/or propofol in refracted boluses based on clinical needs. Complications, safety, and level of satisfaction of the operator, the anesthesiologist, and the patient were evaluated. RESULTS: The results show that sedation with remifentanil in TCI can improve the comfort level of patients, reducing the risks associated with the procedure (lower frequency of oversedations and hypotension), allowing for greater intraprocedural safety. Furthermore, the level of satisfaction of the anesthesiologist and that of the operator appears to be significantly higher in the Remifentanil group. CONCLUSION: The execution of a mild to moderate sedation with Remifentanil in TCI in patients undergoing EBUS is safe, tolerated, and allows to obtain greater intraprocedural comfort. Further studies and larger and more representative samples are obviously needed to confirm and strengthen the validity of a remifentanil TCI-based sedation in endoscopic diagnostics.
Assuntos
Sedação Consciente , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Pulmonares , Midazolam , Remifentanil , Humanos , Remifentanil/administração & dosagem , Sedação Consciente/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos , Estudos Prospectivos , Neoplasias Pulmonares/patologia , Midazolam/administração & dosagem , Masculino , Satisfação do Paciente , Feminino , Padrão de Cuidado , Pessoa de Meia-Idade , Propofol/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Fentanila/administração & dosagem , Broncoscopia/métodos , Idoso , AdultoRESUMO
OBJECTIVE: To compare the efficacy of dexmedetomidine versus ketofol for moderate sedation in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Department of Anaesthesia, SICU and Pain Management, Sindh Institute of Urology and Transplantation, Karachi, Paksitan, from December 2021 to June 2022. METHODOLOGY: Sixty-two patients aged 20-60 years of any gender scheduled for elective ERCP were included. Patients were randomly divided into Dexmedetomidine group (2ml ampule of 100ug/ml diluted in 18ml of normal saline) and Ketofol group (2ml ketamine and 10ml of propofol 1% diluted in 8ml of normal saline) for sedation. The mean difference in time to achieve Ramsay Sedation Scale (RSS) score of 4 and Modified Aldrete's Score (MAS) of 9 were noted as outcomes in each group. In addition, complications during the procedure and recovery were also noted. RESULTS: The mean age was 39.15 ± 9.82 years. There were 33 (53.2%) males and 29 (46.8%) females. The mean time to achieve RSS 4 was significantly lower in patients who were treated with Dexmedetomidine as compared to Ketofol, i.e., 11.84 ± 1.77 minutes vs. 13.10 ± 1.64 minutes respectively (p-value 0.005, 95% CI -2.12 to -0.39). Similarly, the mean time to achieve MAS score 9 was significantly lower in patients who were treated with Dexmedetomidine as compared to Ketofol, i.e., 11.19 ± 1.72 minutes vs. 12.23 ± 1.84 minutes, respectively (p-value 0.026, 95% CI -1.94 to -0.13). CONCLUSION: Dexmedetomidine proved to be more effective than Ketofol for sedation in ERCP, achieving faster sedation and quicker recovery. KEY WORDS: Dexmedetomidine, Ketofol, Sedation, Endoscopic Retrograde Cholangiopancreatography.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Dexmedetomidina , Hipnóticos e Sedativos , Ketamina , Propofol , Humanos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/efeitos adversos , Dexmedetomidina/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Feminino , Masculino , Adulto , Ketamina/administração & dosagem , Ketamina/efeitos adversos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Propofol/administração & dosagem , Propofol/efeitos adversos , Pessoa de Meia-Idade , Sedação Consciente/métodos , Adulto JovemRESUMO
BACKGROUND: Benzodiazepines reduce postoperative nausea and vomiting (PONV); however, conflicting results have been reported regarding the use of remimazolam, a novel benzodiazepine. OBJECTIVE: This meta-analysis examines whether remimazolam reduces PONV incidence compared with propofol or volatile agents used in general anesthesia. MATERIAL AND METHODS: Electronic databases, including PubMed, EMBASE, CENTRAL, and Web of Science, were searched on 31 July 2023. The primary outcome was the incidence of PONV. Secondary outcomes included PONV severity, rescue antiemetic use, amounts of remifentanil used, and participant satisfaction scores. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using a random-effects model. The risk of bias (RoB) was assessed using the Cochrane RoB2 tool. RESULTS: A total of 1514 adult patients from 11 randomized controlled trials were included. The incidences of PONV in the remimazolam and control groups were 16.1% and 16.5%, respectively. Remimazolam did not increase the incidence of PONV (OR 0.62; 95% CI, 0.37-1.04; pâ¯= 0.0676; I2â¯= 48%). Subgroup analysis showed a significant reduction in PONV with remimazolam vs. volatile agents (OR 0.25; 95% CI, 0.13-0.47; Pâ¯= 0.0000; I2â¯= 0%) but not vs. propofol (OR 1.04; 95% CI, 0.70-1.56; pâ¯= 0.8332; I2â¯= 0%). More remifentanil was used in the remimazolam group vs. the volatile group, with no significant difference between remimazolam and propofol groups. Participant satisfaction scores were higher with remimazolam. CONCLUSION: Remimazolam did not increase PONV risk compared to propofol and reduced PONV incidence compared to volatile agents, with higher participant satisfaction. To validate the present findings, further well-planned large clinical trials are required.