在无痛胃镜检查中的临床应用研究l-().ppt

讨论——日间麻醉 关于无痛胃肠镜检查患者低血压及 心律失常的发生率 关于日间麻醉甲氧明的使用 关于无痛胃肠镜诊疗中甲氧明的使用 目前此类研究尚少 实验结论 1、无痛胃肠镜麻醉中，患者术前存在不同程度循环血容量不足。在应用舒芬太尼和丙泊酚复合麻醉下，可能会出现循环抑制，特别是肠镜检查患者，低血压的发生率较高。重度低血压和循环抑制还可能造成严重心脏事件。严密观察、及时纠正低血压非常重要。 实验结论 2.甲氧明升压作用平和，效果确切，无痛胃肠镜检查麻醉诱导后静注甲氧明2mg/kg可预防低血压，使循环更平稳。 3.预防性使用甲氧明可减少麻黄碱等升压药的使用，减少恶心呕吐等并发症。 * 国外研究表明依托咪酯乳剂的注射痛发生率显著低于丙泊酚，这与两种药物本身的理化性质及其对溶媒的溶解性质有关。 Br J Anaesth. 2006; 97(4):536-9 Etomidate-Lipuro is associated with considerably less injection pain in children compared with propofol with added lidocaine. BACKGROUND: Propofol is associated with a high incidence of injection pain in children, even if given together with lidocaine. A new lipid formulation of etomidate (Etomidate-Lipuro) has been found in adults to cause very little discomfort during i.v. injection. The aim of the present prospective, double-blind, randomized trial was to compare the incidence of injection pain during i.v. induction of anaesthesia between propofol with added lidocaine (previous standard) and this new etomidate formulation in paediatric patients. METHODS: A total of 110 paediatric patients, aged 2-16 years, scheduled for outpatient surgery were planned to be included in the study. The primary end point of the study was the incidence of injection pain during induction of anaesthesia as assessed by a four-point scale as described previously. The occurrence of myoclonic muscular activity was registered as a secondary end point (four-point scale). An interim analysis after 80 patients was requested by the Ethics Committee. RESULTS: The study was stopped after the inclusion of 80 patients. A significantly lower incidence of injection pain was found in the Etomidate-Lipuro group as compared with the propofol-lidocaine group (5.0% vs 47.5%, P0.001). The use of etomidate was associated with a significantly higher incidence of myoclonic activity compared with propofol-lidocaine (85.0% vs 15%, P0.001). CONCLUSIONS: The use of a new lipid formulation of etomidate is associated with significant