Objective To assess the correlation between bispectral index (BIS) and richmond agitation sedation scale (RASS) and sedation-agitation scale (SAS) through the spearman correlation coefficient by systematic review. Methods Databases including PubMed, EMbase, Web of Science, The Cochrane Library (Issue 7, 2016), CNKI, VIP, WanFang Data and CBM were searched from inception to July 2016 to collect literature on the correlation between BIS and RASS and SAS. The studies were screened according to the inclusion and exclusion criteria. After extracting data and assessing the quality of the included studies, meta-analysis was conducted using Comprehensive Meta Analysis 3.0 software. Results A total of 12 studies involving 397 patients were included. BIS was positively correlated with RASS score and SAS, and the summary correlation coefficient was 0.742 with 95% CI 0.678 to 0.795 and 0.605 with 95% CI 0.517 to 0.681, respectively. Conclusion BIS has a good correlation with RASS and SAS, which will provide more options for assessing sedation of patients with mechanical ventilation in ICU.
ObjectiveTo know the fundamental status of painless digestive endoscopy in China. MethodsA 23-item survey including multiple choices and fill-in-the-blank questions on 3 pages was performed on anesthesiologists in China excluding Taiwan, Macao and Hong Kong on www.xqnmz.com and www.dxy.cn/bbs from November 1 to December 31, 2013, among which 5 questions were on personal details, 9 on hospital and department, and 9 on clinic details. The results about the basic facts, risk factors of anesthesia and drug use and monitoring of painless digestive endoscopy in China were analyzed. ResultsA total of 726 questionnaires were collected, among which 667 (91.87%) were considered valid. Interviewed hospitals included hospitals from 31 provinces, municipalities and autonomous regions excluding Taiwan, Macao and Hong Kong. Thirty questionnaires were from the first-grade hospitals (4.5%), 292 from the second-grade (43.78%), and 345 from the third-grade (51.72%). And 69.12% of the questionnaires showed these hospitals could only carry out painless gastroscopy and/or colonoscopy, while 80.81% showed the number of the mean painless endoscopy cases was 0-30 per day; 47.23% of the respondents working in digestive endoscopy center had to complete the anesthesia procedure alone, and 35.83% of the respondents illustrated their digestive endoscopy centers had established the post anesthesia care unit; 62.97% were equipped with anesthesia apparatus or ventilator; 89.96% were equipped with tracheal intubation tool; and 21.44% were equipped with defibrillator. Among them, 25.79% did not prepare rescue medicines regularly in digestive endoscopy center. Propofol was the most frequently used anesthetic, and composited fentanyl was at the highest use rate for gastrointestinal endoscopy. Respondents who used electrocardiogram, non-invasive blood pressure and pulse oxygen saturation the least to monitor during painless gastroscopy and colonoscopy took up 43.48% and 46.08% respectively. ConclusionPainless digestive endoscopy needs further development and standardization with the regulation of related guidelines and standardized residents training.
ObjectiveTo explore the efficacy and safety of different sedative and analgesic methods in emergent endotracheal intubations in RICU. Methods110 cases of tracheal intubation in critically ill patients were divided into 5 groups randomly: ① control group(given no sedative or analgesic drug before intubation); ② fentanyl group(given intravenous fentanyl 2 μg/kg before intubation,followed by fentanyl 2 μg·kg-1·h-1 maintenance); ③ dexmedetomidine hydrochloride+fentanyl group(given dexmedetomidine hydrochloride 1 μg/kg+fentanyl 2 μg/kg before intubation,followed by dexmedetomidine hydrochloride 0.5 μg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ④ midazolam+fentanyl group(given midazolam 0.05 mg/kg+fentanyl 2 μg/kg before intubation,followed by midazolam 0.05 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ⑤ Propofol+fentanyl group(given propofol 1 mg/kg+fentanyl 2 μg/kg before intubation,followed by propofol 0.4 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance).The mean arterial pressure(MAP),heart rate(HR),respiratory frequency(RR),PaO2/FiO2,Riker sedation score and agitation were monitored before,during and after intubations.The one-time success rate of intubation and severe arrhythmia (sinus bradycardia,frequent ventricular premature,ventricular fibrillation,and cardiac arrest) incidence rate were recorded. ResultsThe one-time success rates of intubations of the propofol+fentanyl group (95.4%) and the midazolam+fentanyl group (90.9%) were higher than that in the dexmedetomidine hydrochloride+fentanyl group (86.4%,P<0.05),while one-time intubation success rate of three groups were higher than that of the fentanyl group (45.4%) and the control group (31.8%,P<0.05).5 minutes after intubation,the PaO2/FiO2 index of 5 groups of patients were higher than those before intubation,but the PaO2/FiO2 index of the control group and the fentanyl group were lower than those in the other three groups(P<0.05).The occurrence of serious arrhythmia rate in the dexmedetomidine hydrochloride+fentanyl group (0%),the midazolam+fentanyl group (9%) and the propofol+fentanyl group (9%) were lower than that in the control group (13.6%) and the fentanyl group (18.2%).The MAP during intubation and 2 minutes after intubation of the propofol+fentanyl group and the midazolam+fentanyl group were lower than that in the other three groups(P<0.05).The proportion of patients with Riker sedation and agitation score≤4 at intubation in the dexmedetomidine hydrochloride+fentanyl group (68.2%) was lower than that in the propofol+fentanyl group(90.9%) and the midazolam+fentanyl group (86.4%,P<0.05),but higher than those in the fentanyl group(22.7%)and the control group(18.2%,P<0.05). ConclusionPropofol,midazolam or dexmedetomidine hydrochloride with fentanyl are all effective and safe methods of sedation and analgesia in emergent endotracheal intubation in RICU.Dexmedetomidine hydrochloride with fentanyl is an ideal sedative relatively with less influence on cardiovascular system and less myocardial oxygen consumption.
目的:探讨老年手术患者椎管内麻醉后应用异丙酚镇静,脑电双频指数、异丙酚血药浓度和镇静深度之间的相关性［1］。方法:48例ASAⅠ~Ⅱ级择期手术患者,分为老年组(65~85岁)和年轻组(18~40岁),每组24例。为尽快达到稳态血药浓度,采用靶控输注方式给药。异丙酚靶浓度从0.5 μg/mL起逐渐增加,直至患者对轻推无反应(意识消失),每个浓度维持5min。连续记录EEG参数,在每一稳态血药浓度末,记录BIS、95%SEF, 桡动脉取血(高效液相色谱法测定异丙酚血药浓度),并评定镇静深度(OAA/S评分法)。用Spearman’s等级相关进行相关分析,并计算预测概率 (Pk) 值。结果:两组BIS (r=0.935~0.955) 与镇静水平的相关性优于血药浓度(r =0.849~0.870)和95%SEF(r =0.503~0.571),BIS的Pk值高(0.942~0.972)。在同一镇静评分(OAA/S 4~1)时,老年组BIS值明显高于年轻组(Plt;0.01),而血药浓度低于年轻组(Pgt;0.05)。结论:BIS在监测异丙酚镇静水平及预测意识消失方面有重要价值,在同一镇静评分时,老年人BIS值高于年轻人。
ObjectiveTo evaluate the application of dexmedetomidine for moderate sedation in patients undergoing endoscopic ultrasonography.MethodsPatients who were planned to undergo endoscopic ultrasonography in West China Hospital of Sichuan University from February to June 2019 were randomly divided into dexmedetomidine group (trial group) and propofol group (control group). The basic conditions, success rate of endoscopic ultrasound diagnosis and treatment, sedation-related adverse events, implementation of airway management, postoperative comfort evaluation and endoscopic physician satisfaction score of the two groups were compared.ResultsA total of 120 patients were eventually enrolled, 60 in each group. There was no significant difference in the basic conditions of the two groups (P>0.05). The success rate of endoscopic ultrasound diagnosis and treatment in two groups were 100%. There was no significant difference in the incidence of bucking, apnea and bradycardia between the two groups (P>0.05). The incidence of hypotension (15.0% vs. 31.7%), hypoxemia (6.7% vs.20.0%) in the trial group was lower than those in the control group, the differences were statistically significant (P<0.05). The proportion of patients in the trial group who performed airway management was lower than that in the control group (1.7% vs. 28.3%), and the difference was statistically significant (P<0.05). There was no significant difference in postoperative pain score, the first time to get out of bed and postoperative 15-item quality of recovery questionnaire score between the two groups (P>0.05). The incidence of nausea and vomiting at 6 hours after operation (48.3% vs. 3.3%) and 24 hours after operation (10.0% vs. 0.0%) and the time required for recovery of gastrointestinal function ［(201.4±178.4) vs. (148.5±75.7) min］ in the trial group were higher than those in the control group (P<0.05). The median (the lower and upper quartile) of comfort score of patients and satisfaction score of endoscopic physicians were 8 (6, 10) and 8 (7, 9) in the trial group, respectively, and were 10 (9, 10) and 9 (8, 10) in the control group, with statistically significant differences (P<0.05).ConclusionModerate sedation with dexmedetomidine could provide good sedative and analgesic effects in endoscopic ultrasonography. It has little effect on respiration and blood pressure, but the incidence of postoperative nausea and vomiting were higher than deep sedation with propofol. And patient comfort and endoscopic physician satisfaction also need to be improved.
Objective Sedation and/or analgesia is often applied during noninvasive positive pressure ventilation (NIPPV) to make patients comfortable, and thus improve the synchronization between patients and ventilator. Nevertheless, the effect of sedation and/or analgesia on the clinical outcome of the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation remains controversial. Methods A retrospective study was conducted on patients with AECOPD who received NIPPV after extubation in seven intensive care units in West China Hospital, Sichuan University between December 2013 and December 2017 . A logistic regression model was used to analyze the association between the use of sedation and/or analgesia and clinical outcomes including rate of NIPPV failure (defined as the need for reintubation and mechanical ventilation), hospital mortality, and length of intensive care unit stay after extubation. Results A total of 193 patients were included in the analysis, and 62 cases of these patients received sedation and/or analgesia during NIPPV. The usage of sedation and/or analgesia could result in failure of NIPPV (adjusted odd ratio [OR] 0.10, 95% confidence interval [CI] 0.02 - 0.52, P=0.006) and death (adjusted OR=0.13, 95%CI 0.04 - 0.42, P=0.001). Additionally, intensive care unit stay after extubation was longer in the patients who did not receive sedation and/or analgesia than those who did (11.02 d vs. 6.10 d, P< 0.01). Conclusion The usage of sedation and/or analgesia during NIPPV can decrease both the rate of NIPPV failure and hospital mortality in AECOPD patients after extubation.
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：探讨脑电双频指数(BIS)监测在机械通气患者镇静深度评价中的价值。方法：选取15例机械通气患者，静脉注射咪唑安定达到SAS评分3～4分，持续或间断给药维持镇静深度，记录患者每2小时的SAS镇静分级评分及BIS，观察24小时。比较SAS评分与BIS值的相关性。计算BIS的敏感度和特异度，根据ROC曲线和BIS评价镇静深度的敏感度和特异度，寻找最适BIS值。结果:随镇静深度的加深，BIS明显降低，BIS与SAS评分呈正相关(r=0.662，P＜0.05)；SAS评分3～4分(镇静适度)时对应的BIS临界值为69.5～79。结论：BIS监测与SAS评分之间具有良好的相关性，能同步客观地监测机械通气患者的镇静深度，具有一定的临床诊断价值。