Objective To investigate the analgesic effect and safety of intravenous flurbiprofen axetil combind with fentanyl and propofol on coloscopy.Methods Ninety patients undergone coloscopy were randomly assigned into three groups according to different analgesics received(30 in each,groupⅠ: fentanyl 1?g/kg;groupⅡ flurbiprofen axetil combined with fentany 0.5?g/kg;group Ⅲ: fentany 0.5?g/kg).Patients in group Ⅱ received intravenous flurbiprofen axetil 1mg/kg 10min before examination.All patients were given intravenous midazolam 0.02mg/kg 2mins before examination,however patients in group Ⅰ received intravenous fentanyl 1?g/kg followed by intravenous propofol 0.5-1mg/kg,whereas patients in group Ⅱ and Ⅲ received intravenous fentanyl 0.5?g/kg followed by equal dosage of propofol.Propofol was administrated according to patients' reaction during examination.After the examination all patients were transferred to recovery room.BP,HR and SpO2 were measured before and after drug administration,when the coloscope reached the splenic flexure of the colon and after the examination.Dosage of propofol and fentanyl,duration of coloscopy,side effects and patients' memory of pain during examination were recorded.Results Propofol dosages of the three groups were 82.0?23.8mg,73.0?25.0mg and 108.2?36.5mg,respectively.Propofol dosage of group Ⅲ was much larger than that of groups Ⅰand Ⅱ(P0.05).Dizziness and nausea occurred in 17 patients in group Ⅰ when they left the recovery room,whereas the same side effects only appeared in one patient in group Ⅱ and 3 patients in group Ⅲ,respectively.It was shown by follow-up that all patients of the three groups had no memory of pain.Conclusion Intravenous flurbiprofen axetil may strengthen intraoperative analgesia during coloscopy,reduce the dosage of fentanyl and propofol,and decrease the side effects of anesthesia.

Objective To study the effects of acute hypervolemi c hemodilution (AHH) on the coagulation and cardiac function in elderly surgical p atients. Method Sixty surgical patients, aged 60 to70, ASA Ⅰ~ Ⅱ, were randomly divided into three groups (n=20 for each group). 6% HES 50 0~1000ml was infused in a rate of 20ml/min during vasodilation with isoflurane i nhalation (group 1), nitroglycerin (group 2), or nicardipine (group3) with the a id of an intravenous injection pump. The blood coagulation and cardiac functions were observed during hemodilution. Results No significant diff erence was found among the three groups on cardiac function and coagulation func tion during 500ml 6% HES infusion. When the volume of infusion was over 1000ml, the parameters of cardiac function increased and those of coagulation decrease d significantly (P

Objective To study the effects of total intravenous anesthesia and combined inhalation and intravenous anesthesia on arousing time and recovery quality in rectifying surgery of scoliosis. Methods Forty patients (ASAⅠ-Ⅱ) were divided randomly into total-intravenous anesthesia group and combined inhalation and intravenous anesthesia group (n=20 each). Target controlled infusion (TCI) with propofol (2-4?g/ml) was used for maintenance in total intravenous anesthesia group, while isoflurane (0.8%-1.5%) and nitrous oxide (50%) were used in combined inhalation and intravenous anesthesia group. TCI remifentanyl (2-6ng/ml) was used for maintenance in both groups. Results Arousing time were 19.7?5.1min in total intravenous anesthesia group, but 11.9?3.3 min in combined inhalation and intravenous anesthesia group (P

Objective To compare the influences of sulfentanyl or fentanyl combined with midazolam on respiratory function in slow induction of anesthesia.Methods Forty ASA Ⅰ-Ⅱ patients were divided into two groups.Anesthesia was induced with midazolam 0.03mg/kg in both groups,and fentanyl 2?g/kg(i.v.)was given in fentanyl group or sulfentanyl 0.2?g/kg(i.v.)in sulfentanyl group.Five minutes later,2ml of 1% decicaine was administered by cricothyroid membrane puncture to facilitate the intubation.Respiratory indexes(respiratory frequency,VT,MVV,PETCO2,SPO2),circulatory indexes(MAP,HR)and sedation level were measured before and 1,2,3,4,5 minute(s)after injection of drugs,at cricothyroid membrane puncture,and pre-and post-intubation.Results Patients showed respiratory depression(respiratory frequency was reduced)in both groups 2 minutes after injection of drugs.However,respiratory frequency was decreased more markedly in fentanyl group than that in sulfentanyl group.Ten out of 20 patients were obliged to receive breathing intervention in fentanyl group,but two in sulfentanyl group.Conclusion In combination with midazolam,sedative effect of sulfentanyl is stronger than that of fentanyl in equivalent analgesic dose,but with less respiratory depression.Sulfentanyl may be more suitable for slow induction of anesthesia.

Thirty patients, randomly assigned into three groups, received bolus injection of ketamine 0. 5mg/ kg,midazolam 40ug/kg and one of the three narcotics: fentanyl 3ug/kg (group F ) or sufentanil 0. 4ug/kg (group S)or dihydroetorphine 0. 3ug/kg(group D)just before incision, and then a constant infusion of ketamine 0. 8mg/kg, midazolam 40ug/kg and fentanyl 3ug/kg (or sufentanil 0. 4ug/kg, or dihydroetorphine 0. 3ug/kg)mixture in 100ml normal saline at a rate of 3ml/min for 30 min in beginning, and 1 - 1. 5ml/min thereafter for maintenance. The infusion of narcotics and midazolam was terminated about 45min, and he tamine 15min prior to the end of surgery. Blood pressure and heart rate were all stable,with recovery time shortest in group S (6. 5min ) and longest in group D (12. 5min). Anesthesia were satisfactory in all the patients,except one in group D. It is concluded that this combination of tv anesthetics may be simple and effective and can be considered as an alternative anesthesia technique in the management of mass casualties.

Objective: To observe changes of EEG parameters,including bispectral index (BIS),spectral edge frequency(SEF)and median frequency(MF),and the association between the changes of EEG variables and hemodynamic responses to intubation during induction by propofol with or without fentanyl. Method: Twenty-four ASA grade Ⅰ-Ⅱ patients were randomly assigned to double-blindly receiving intravenous propofol/normal saline (group P, n=12)or propofol/fentanyl 2?g/kg(group PF,n=12), respectively. Intubation was performed following 5-min maintenance of BIS within 45?5. EEG and hemodynamic variables were recorded at endpoints of pre-induction, pre-intubation and post-intubation. Result:In group P,blood pressure and heart rate at post-intubation were significantly increased compared with pre-induction value(P

Objective To determine the threshold of stroke volume variation (SVV) in determining the volume expansion responsiveness during fluid therapy in patients ventilated with different tidal volumes. Methods Fifty ASA Ⅰ or Ⅱ patients aged 20-75 yr undergoing elective gastrointestinal surgery under general anesthesia were randomly divided into 2 tidal volume groups (n = 25 each):group Ⅰ VT 8 ml/kg (group V1) and group ⅡVT 10 ml/kg (group V2). Radial artery was cannulated and connected to Vigelo monitor for continuous monitoring of cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI) and SVV. Internal jugular vein was cannulated for CVP monitoring. Anesthesia was induced with milazolam, propofol, fentanyl and rocuronium and maintained with intravenous propofol and remifentanil infusion. BIS was maintained at 40-50 during anesthesia. The patients were intubatel and mechanically ventilated (VT 8/10 ml/kg, RR 8-12 bpm, oxygen flow 2 L/min). 6％ HES 130/0.4 7 ml/kg was infused iv at a rate of 0.4 ml·kg-1 ·min-1 after induction of anesthesia. MAP, HR, CVP, CI, SVV, SVI and SVRI were recorded before and at 3 min after fluid therapy. The changing rate of SVV (△SVV) and CI (△CI) were calculated. The criterion for effective volume expansion was △CI 15%. The ROC curve for SVV in determring the volume expansion responsiveness was plotted and the diagnostic threshold was determined. Results ROC curve showed that the diagnostic threshold of SVV was 10.5 % in group V1 and 13.5% in group V2. The sensitivity and specificity in determining effective volume expansion were 93.3 % and 75.0 % in group V1 and 87.5 % and 85.7 % in group V2 respectively. The area under the curve for SVV and 95% confidence interval (CI) were 0.946 (0.860-1.031) in group V1 and 0.951 (0.868-1.034) in group V2. △SVV was negatively correlated with △CI in group V1 (=0.553) and V2 (= 0.602). Conclusion The threshold of SVV in determining the volume expansion responsiveness during fluid therapy is 10.5% and 13.5% in mechanically ventilated patients with tidal volume of 8 and 10 ml/kg respectively.

Objective To study the effects of midazolam on expression of vascular endothelial growth factor (VEGF) of gerbils following total cerebral ischemia-reperfusion injury to look for an experimental basis for the rational clinical use of midazolam. Methods Seventy-two male gerbils (Mongolian gerbil) were randomly assigned into three groups (24 each): sham injury group, injury group and midazolam treatment group. Total cerebral ischemia was reproduced by blocking the bilateral carotid arteries for 10 minutes with bulldog clamps. When reperfusion began, with release of the clamps, 5mg/kg of midazolam was intraperitoneally injected to the animals in midazolam group, and 50ml/kg of normal saline was given by the same way in the gerbils in injury group. Then the parameters listed below were observed: positron emission tomography (PET) images at 6h, 1d, 3d and 7d after reperfusion, and the expression of VEGF in cerebral tissue was immunohistochemically assessed. Results No obvious abnormality was found in the cerebral tissue of sham injury group. For the animals in the injury group and midazolam treatment group, the brain reinfusion area enlarged obviously (P

Objective To study the performance of deep hypothermic circulatory arrest and the anesthestic management for giant intracranial basilar artery aneurysm. Methods Seven patients undergoing resection of giant intracranial basilar artery aneurysm were included in the study. By monitoring cerebral oximetry (rSO_2), body temperature and electrocardiogram (ECG), brain and other vital organs were guaranteed to maintain oxygen supply/demand balance in perioperative management, especially during the circulatory arrest period under deep hypothermia. The measured parameters, the outcome of patients and the complications were observed and recorded. Results Even in profound hypothermic condition, rSO_2 was degraded significantly during circulatory arrest, and recovered after in circuit. Low flow perfusion maintained cerebral oxygen supply/demand balance better than circulatory arrest. In all 7 cases, cerebral anoxia caused by circulation arrest after operation were not observed. Conclusion Deep hypothermic circulation arrest could be applied effectively in the resection of giant intracranial basilar artery aneurysm with brain protective measure and monitoring. To improve the outcomes of the patients, avoiding cerebral anoxia and of local vessel injuries is important.

Objective To compare the analgesic effect, adverse effects of patient-controlled epidural analgesia (PCEA) vs patient-controlled intravenous analgesia (PCIA) and their influences on stress response in thoracotomy patients. Methods 33 ASA I-II patients undergoing elective esophagectomy were randomly assigned to receive either morphine plus droperidol (Group PCIA, n=17) or morphine plus bupivacaine (Group PCEA, n=16) for 3 days postoperatively. Serum concentrations of cortisol, angiotensin Ⅱ (Ang Ⅱ), endothelin (ET) and blood glucose were measured before operation, at the end of the operation and on the next morning after operation. Pain scores with visual analogue scale (VAS) at rest, deep breathing and with cough, and adverse effects were also recorded. Results Blood glucose and cortisol were increased to similar levels in both groups at the end of the operation, but were much lower in Group PCEA postoperatively (P0.05). Pain scores with VAS were much lower in Group PCEA, especially when the patient was at deep breathing or during coughing (P