Clinical Research on Constant Infusion of Propofol for Conscious Sedation under Combined Spinal-epidural Anesthesia_West China Medical Journal

Authors：

FAN Dan , XIE Binrong , WANG Yu ,  LAN Zhixun

Department of Anesthesiology, Sichuan Academy of Meclical Scineces & Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding?author：

LAN Zhixun, Email: fandan1976@163.com

Keywords：

麻醉，硬膜外; 丙泊酚; 鎮靜

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【摘要】　目的　探討腰硬聯合麻醉復合丙泊酚恒速輸注清醒鎮靜的可行性、理想的藥物劑量、術中知曉情況以及麻醉質量和效果。　方法　收集2009年3-12月480例美國麻醉醫師協會（ASA）Ⅰ～Ⅲ級擬在腰硬聯合麻醉下行下腹部、會陰部、下肢手術的患者480例，隨機分為咪達唑侖組（M組）、丙泊酚Ⅰ組（PA組）、丙泊酚Ⅱ組（PB組）、丙泊酚Ⅲ組（PC組），每組各120例。四組患者均于腰2-3或腰3-4行腰硬聯合麻醉，蛛網膜下腔注入輕比重0.2 %布比卡因12～15 mg，麻醉平面確切后，M組予以咪達唑侖0.04~0.06 mg/kg，PA組先予以負荷量丙泊酚0.50 mg/kg再以2.00 mg/（kg?h）劑量持續泵注，PB組予以負荷量丙泊酚0.75 mg/kg再以3.00 mg/（kg?h）劑量持續泵注，PC組予以負荷量丙泊酚1.00 mg/kg再以3.75 mg/（kg?h）劑量持續泵注。觀察患者給藥前（T0）、給藥1（T1）、3（T2）、5（T3）、10（T4）、30（T5）、60 min（T6）各時點血流動力學平均動脈血壓（MAP）、心率（HR）的變化、腦電雙頻指數（BIS）值及鎮靜評分、術中所看到的圖片的回憶及不良反應。　結果　各組在給予鎮靜藥后MAP、HR均有所下降，但測量值的變化在正常范圍內；在T3時間點，各組BIS值及鎮靜/警醒OAA/S評分降低，與T0比較，差異有統計學意義（P lt;0.05）；與其他3組比較，在T4、T5、T6時點PC組BIS值與OAA/S評分降低，差異有統計學意義（P lt;0.05），PC組的鎮靜遺忘滿意率高于其他3組；各組間未見發生嚴重的舌后墜、呼吸暫停和血氧飽和度（SpO2） lt;90%。　結論　在下腹部、下肢手術中，應用腰硬聯合麻醉復合1.00 mg/kg負荷量的丙泊酚繼而以3.75 mg/（kg?h）劑量持續泵注，可取得良好的鎮靜效果，不良反應小。
【Abstract】　Objective　 To investigate the feasibility, ideal dose, intra-operative awareness as well as the quality and effectiveness of constant infusion of propofol under combined spinal-epidural anesthesia (CSEA) for conscious sedation.　Methods　 A total of 480 patients at ASA grade Ⅰ-Ⅲ to be operated in the lower abdomen, perineum and lower limbs under CSEA from March to December 2009 were randomly divided into four groups: midazolam group (M group), propofol group Ⅰ (PA group), propofol group Ⅱ (PB group), and propofol group Ⅲ (PC group), with 120 patients in each group. All four groups of patients underwent CSEA at L2-3 or L3-4 and accepted pinal injection of 12-15 mg of 0.2% hypobaric bupivacaine. After the anesthetic plane was confirmed, patients in M group accepted 0.04-0.06 mg/kg of midazolam; patients in PA group accepted propofol at a loading dose of 0.50 mg/kg followed by continuous infusion at a dose of 2.00 mg/(kg?h); patients in PB group accepted propofol at a loading dose of 0.75 mg/kg followed by continuous infusion at a dose of 3.00 mg/(kg?h); patients in PC group accepted propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg?h). The change of hemodynamics including the mean arterial pressure (MAP) and the heart rate (HR), bispectral index (BIS) values, sedation scores, memory of pictures seen during operation and adverse effects before drug administration (T0), at minute 1 (T1), 3 (T2), 5 (T3), 10 (T4), 30 (T5) and 60 (T6) after drug administration were observed.　Results　 MAP and HR decreased in all the four groups after administration of sedatives, but the changes of measured values were within normal ranges. BIS value and the Observer’s Assessment of Alertness and Sedation (OAA/S) scale decreased in all groups at T3, compared with those at T0 (P lt;0.05). Compared with the other 3 groups, BIS valueand OAA/S scale were significantly lower in PC group at T4, T5 and T6 (P lt;0.05), and the satisfaction rate of sedation and amnesia was much higher. No serious glossocoma, apnea and SpO2 below 90% was observed in all the four groups.　Conclusion　 During the surgery of lower abdomen and lower limbs, application of CSEA combined with propofol at a loading dose of 1.00 mg/kg followed by continuous infusion at a dose of 3.75 mg/(kg?h) can achieve a good sedative effect, with little side effect.

Citation： FAN Dan,XIE Binrong,WANG Yu,LAN Zhixun. Clinical Research on Constant Infusion of Propofol for Conscious Sedation under Combined Spinal-epidural Anesthesia. West China Medical Journal, 2011, 26(3): 413-416. doi: Copy

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1. 　曹國平. 腰麻-硬膜外麻醉在老年患者股骨頸骨折手術中的應用[J]. 臨床麻醉學雜志, 2006, 22(10): 795.
2. 　Mathews DM, Rahman SS, Cirullo PM, et al. Increases in bispectral index lead to interventions that prevent possible intraoperative awareness[J]. Br J Anaesth, 2005, 95(2): 193-196.
3. 　Schmidt GN, Bischoff P, Standl T, et al. Comparative evaluation of the datex-ohmeda S/5 entropy module and the bispectral index monitor during propofol remifentanil anesthesia[J]. Anesthesiology, 2004, 101(6): 1283-1290.
4. 　戴體俊. 麻醉藥理學[M]. 2 版. 北京: 人民出版社, 2005: 79-80.
5. 　Struys MM, Vereecke H, Moerman A, et al. Ability of the bispectral index, autoregressive modelling with exogenous inputderived auditory evoked potentials, and predicted propofol concentrations to measure patient responsiveness during anesthesia with propofol and remifentanil[J]. Anesthesiology, 2003, 99(4): 802-812.
6. 　Orser BA, Mazer CD, Baker AJ, et al. Awareness during anesthesia[J]. CMAJ, 2008, 178(2): 185-188.
7. 　Avidan MS, Zhang L, Burnside BA, et al. Anesthesia awareness and the bispectral index[J]. N Engl J Med, 2008, 358(11): 1097-1108.
8. 　Luginbühl M, Wüthrich S, Petersier-Felix S, et al. Different benefit of bispectral index(BIS) in desflurance and propofol anesthesia[J]. Acta Anaesthesiol Scand, 2003, 47(2): 165-173.

West China Medical Journal

Clinical Research on Constant Infusion of Propofol for Conscious Sedation under Combined Spinal-epidural Anesthesia

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