ObjectiveTo systematically assess the effectiveness and safety of I.V. infusion of dezocine for prevention of myoclonus caused by etomidate. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 6, 2014), CNKI, WanFang Data and VIP were electronically searched from inception to May 2014 for randomized controlled trials (RCTs) on I.V. infusion of dezocine for prevention of myoclonus caused by etomidate. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2.3 software. ResultsTen RCTs were included. The results of meta-analysis indicated that, dezocine could reduce the incidence of myoclonus induced by etomidate (RR=0.24，95%CI 0.12 to 0.45, P<0.000 1), and was better than fentanyl (RR=0.30, 95%CI 0.17 to 0.51, P<0.000 1); dezocine could reduce the amount of etomidate (MD=-4.70, 95%CI -6.62 to -2.79, P<0.000 01); compared with fentanyl, dezocine could reduce the incidence of injection pain (OR=0.25, 95%CI 0.10 to 0.62, P=0.003); dezocine did not increase the incidence of respiratory depression (OR=2.61, 95%CI 0.12 to 56.03, P=0.54). ConclusionI.V. infusion of dezocine before etomidate administration could reduce myoclonus incidence caused by etomidate, reduce the amount of etomidate, and is better than fentanyl; which could also reduce the incidence of injection pain, and not increase the incidence of respiratory depression.
The mechanisms of general anesthesia, which was introduced about 170 years ago, remain poorly understood. Even less well understood are the effects of general anesthesia on the human body. Recently we identified 18 G-protein coupled receptor (GPCR) genes of Daphnia pulex, an invertebrate model organism. Phylogenetic analysis identified these genes to be the homologs of the human γ-aminobutyric acid, type B (GABAB) receptor, metabotropic glutamate receptors (mGluR), adrenergic receptor, serotonin (5-HT) receptor, dopamine receptor and muscarinic acetylcholine receptor (mAChR). Using reverse transcription and quantitative PCR techniques, we systematically measured the effects of propofol, etomidate and ethanol on these 18 GPCR mRNA expressions in Daphnia pulex.
ObjectiveTo investigate the effect of etomidate and propofol on inflammatory cytokines and cortisol for patients with lung adenocarcinoma. MethodSixty patients scheduled for lung cancer surgery under general anesthesia were studied. All patients were randomly divided into an etomidate total intravenous anesthesia group (group E, 30 patients, 16 males and 14 females at age of 58.0±5.0 years) and a propofol total intravenous anesthesia group (group P, 30 patients, 17 males and 13 females at age of 55.0±5.0 years), with 30 patients in each group. ResultsThe concentration of IL-6 in serum of patients in the two groups at time points T1, T2 and T3 was significantly higher than those at time point T0 (P < 0.01). The concentration of IL-10 and TNF-α in serum of patients at time points T1 and T2 was significantly higher than those at time point T0 (P < 0.01). And the difference of the concentration of TNF-α in serum of patients at time points T0 and T3 was not statistically significant (P > 0.05). The level of Cor of patients in the group E at time point T0 was slightly higher than those at time point T1, but lower than that at time points T2 and T3. There was no statistical difference in the concentration of IL-6 and TNF-α in serum of patients between the two groups. The level of IL-10 of patients in the group E at time points T2 and T3 was lower than those in the group P (P < 0.05), but no significant difference was observed at the other time points. The concentration of Cor in the patients in the group E at time point T1 was lower than that in the group P (P < 0.01), but no significant difference was observed either at the other time points. ConclusionThe effect of etomidate used for maintenance of general anesthesia on the inflammatory factors is essentially similar to that of propofol.
目的:觀察依托咪酯持續輸注用于麻醉誘導和維持對腎上腺皮質功能的抑制程度以及評價是否會造成嚴重不良后果。方法:擇期行普外手術患者60例,隨機分成依托咪酯組(E組)和異丙酚組(P組)。兩組患者常規麻醉誘導后,E組和P組分別采用瑞芬太尼0.1～0.4 μg/kg·min,復合依托咪酯或異丙酚維持,據BIS值調整依托咪酯或異丙酚的輸注速率。分別測定麻醉前,手術結束時,術后24 h,術后48 h患者血清皮質醇濃度,記錄各組的血壓,心率,睜眼時間,拔管時間和術后不良反應。結果:與麻醉前比較,E組和P組患者在手術結束時皮質醇濃度均降低,但E組降低更明顯(Plt;0.05),48 h后恢復正常甚至高于麻醉前水平;與誘導前相比,異丙酚組患者誘導后平均動脈壓(MAP)明顯低于誘導前,而依托咪酯組無明顯變化;E組的拔管時間比P組長(Plt;0.05),而睜眼時間無明顯差異(Pgt;0.05).結論:1依托咪酯和異丙酚均能抑制患者腎上腺皮質功能,且依托咪酯組更為明顯,在術后48 h基本恢復正常,甚至高于術前水平。2依托咪酯在麻醉誘導和維持中比異丙酚具有血流動力學穩定性。3依托咪酯持續輸注用于全身麻醉維持并不造成圍術期嚴重不良后果。
ObjectiveTo observe the protective effect of etomidate (ET) on cultured retinal ganglion cells (RGC) with mechanical injury in vitro. MethodsNew Sprague-Dawley rat RGC was cultured in vitro and identified by double immunofluorescent labeling of Thy1.1 and microtubule associated protein 2. The cultured primary cells were randomly divided into control group, RGC scratch group, ET low dose group (1 μmol/L), ET medium dose group (5 μmol/L) and ET high dose group (10 μmol/L). The RGC mechanical injury model was established by using iris knife to culture cells in RGC scratch group and ET group with different concentration. Seven days after modeling, the RGC survival rate of each group was detected by cell count Kit 8 proliferation assay. The apoptosis rate of RGC was detected by Annexin Ⅴ/propyl iodide double staining. Single factor analysis of variance was used to compare the groups. The pairwise comparison between groups was tested by the least significant difference method. ResultsThe survival rates of RGC in RGC scratch group, ET low dose group, ET medium dose group and ET high dose group were (72.60±2.97)%, (73.73±1.14)%, (79.19±1.79)% and (83.88±0.94)%, respectively. The RGC apoptosis rates of control group, RGC scratch group, ET low dose group, ET medium dose group and ET high dose group were (5.08±0.17)%, (18.67±1.24)%, (17.96±0.74)%, (15.11± 0.56)% and (11.67±1.32)%, respectively. Comparison of RGC survival rate between groups: compared with RGC scratch group, the cell survival rate of ET low-dose group, ET medium-dose group and ET high-dose group was increased, and the difference between RGC scratch group and ET low-dose group was not statistically significant (P=0.728); the differences between RGC scratch group, ET medium dose group and ET high dose group were statistically significant (P＜0.001); the difference between ET medium dose group and ET high dose group was statistically significant (P=0.002). Comparison of apoptosis rate of RGC among groups: the apoptosis rate of RGC scratch group was significantly higher than that of control group, the difference was statistically significant (P＜0.001). Compared with RGC scratch group, the apoptosis rate of ET low-dose group, ET medium-dose group and ET high-dose group was decreased, and there was no statistical significance between RGC scratch group and ET low-dose group (P=0.869). The differences of apoptosis rate between RGC scratch group, ET medium dose group and ET high dose group were statistically significant (P＜0.05). The difference of apoptosis rate between ET medium dose group and ET high dose group was statistically significant (P=0.007). ConclusionET has neuroprotective effect on RGC cultured in vitro with mechanical injury, and the protective effect increases with the increase of ET dose in a certain range.
目的:旨在評價預注維庫溴銨聯合稀釋依托咪酯減輕依托咪酯全麻誘導中肌陣攣的效果。方法:本研究為前瞻性、雙盲、隨機對照研究。80名ASA I-II級、年齡18～60歲、擬行膽囊切除術的全麻患者被隨機分為4組:組1,預注維庫溴銨0.01 mg/kg;組2,依托咪酯用生理鹽水由2 mg/mL 稀釋為1 mg/mL;組3,預注維庫溴銨聯合稀釋依托咪酯;組4,生理鹽水對照組+非稀釋依托咪酯組。根據分組給予患者預注維庫溴銨0.01 mg/kg或同等量的生理鹽水,觀察并詢問患者有無呼吸困難,并記錄呼吸頻率和脈搏氧飽和度(SpO2)。3分鐘后推注稀釋或無稀釋依托咪酯0.3 mg/kg,詢問患者有無注射痛并做疼痛評分,觀察有無肌陣攣并評估其程度。2分鐘后給予維庫溴銨0.1 mg/kg、芬太尼3 μg/kg和丙泊酚1 mg/kg行氣管插管。實驗期間同時記錄無創動脈血壓(BP)和心率(HR)。結果:組1和組4分別有2例(10%)和3例(15%)患者述輕度注射疼痛,而組2和組3無患者述注射疼痛。組1、組2和組3肌陣攣的發生率明顯低于組4(30%、40%和15% vs 70%,Plt;0.05)。且組1、組2和組3肌陣攣的程度多為輕中度,而組4多為中重度。四組患者均未述任何呼吸困難,呼吸頻率無明顯降低,SpO2無明顯變化。四組患者BP和HR變化一致,無明顯差別。結論:預注小劑量維庫溴銨或稀釋依托咪酯可明顯降低依托咪酯引起肌陣攣的發生率并減輕其程度。且這兩種方法聯合應用比單獨應用效果更佳,具有一定程度的協同作用。
ObjectiveTo observe the effect of dexmedetomidine combined with etomidate on the clinical safety and the tracheal extubation response after general anesthesⅠa in elderly patient undergoing thyroidectomy. MethodsFifty patients (aged between 65 and 75 years, ASAⅠor Ⅱ) scheduled for thyroid surgery between July 2012 and January 2013 were randomly divided into two groups:dexmedetomidine group (group D) and control group (group C) with 25 patients in each group. Group D received dexmedetomidine of 0.5 μg/(kg·h) through intravenous infusion after anesthesia induction, and the intravenous infusion was stopped five minutes before the end of surgery. Normal saline was infused at the same volume in group C at the same time. Patients were induced with etomidate at 0.2 mg/kg for anesthesia, and etomidate and remifentanil were used for the anesthesia maintenance during the operation. Heart rate (HR), systolic blood pressure SBP), diastolic blood pressure (DBP) and bispectral index (BIS) were recorded 5 (T1), 15 (T2) and 30 (T3) minutes after the beginning of the operation, and 15 (T4) and 5 (T5) minutes before the end of the operation. Moreover, the time of eye opening, time of extubation, the number of patients with restlessness and etomidate requirement were recorded. ResultsCompared with group C, HR and MAP at the time points of T2 and T5 in group D did not obviously change, but the number of restlessness patients in group D was significantly less than in group C (P<0.05). There was no statistically significant difference in time of eye opening and time of extubation between the two groups (P>0.05). Etomidate requirement in group D was[(8.6±2.1) μg/(kg·min)], which was significantly lower than that in group C[(14.4±3.4) μg/(kg·min)] (P<0.05). ConclusionDexmedetomidine combined with etomidate is efficient and safe for elderly patients undergoing thyroidectomy, and this method can effectively reduce cardiovascular responses to tracheal extubation, decrease the incidence of postoperative restlessness, and reduce the requirement of etomidate during the operation.
目的:比較瑞芬太尼聯合異丙酚或依托咪酯全麻在腹腔鏡婦科手術中的臨床效果。方法:擇期腹腔鏡婦科手術80例,隨機分成瑞芬太尼異丙酚組(RP組)和瑞芬太尼依托咪酯組(RE組),各40例。兩組全麻誘導用藥相同,維持麻醉RP組采用瑞芬太尼聯合異丙酚、RE組采用瑞芬太尼聯合依托咪酯。記錄基礎值、誘導后、插管后1 min、3 min、氣腹時、氣腹后10、20、30、40 min的動脈收縮壓(SBP)、舒張壓(DBP)、心率(HR);記錄停藥至自主呼吸恢復、睜眼、拔除氣管導管、恢復定向能力的時間;記錄清醒即刻及清醒后1、2、4、8、12、16、20、24 h患者疼痛程度,采用VAS評分;記錄24 h內不良反應發生情況。 結果: 兩組SBP、DBP均在誘導后明顯低于基礎值(Plt;001), 插管后恢復,氣腹開始后趨于平穩;兩組HR均在誘導后減慢(Plt;001),插管后及氣腹開始時恢復。RP組自主呼吸恢復、呼之能睜眼、拔除氣管導管及恢復定向能力的時間均明顯短于RE組(Plt;001)。麻醉清醒即刻、清醒后1、2、4、8 h VAS評分RE組明顯低于RP組(Plt;005),12、16、20、24 h VAS評分兩組比較無顯著性差異(Pgt;005)。術后發生惡心嘔吐患者數RP組明顯減少(Plt;005)。 結論:全麻行腹腔鏡婦科手術時,瑞芬太尼聯合異丙酚或依托咪酯都能緩解氣腹及手術引起的血流動力學變化,瑞芬太尼聯合異丙酚術后蘇醒快且能明顯降低術后惡心嘔吐的發生率,但術后疼痛較為嚴重。