OBJECTIVETo compare the effect and hemodynamics of sevoflurane(SEV) and propofol (PRO) in combined anesthesia induction with remifentanil for tracheal intubation fibreoptic bronchoscope (FOB).

METHODSTwenty-four patients without difficult airway undergoing elective surgery with tracheal intubation general anesthesia were randomly divided into SEV and PRO group. FOB intubation was performed with sevoflurane or propofol administration combined with remifentanil induction. Blood pressure (BP), heart rate (HR), SPO2 and Narcotrend index (NI) were monitored to evaluate the anesthetic depth during the induction. The time to loss of consciousness (LOC), intubation time, intubation score, anesthetic dosage and adverse effects were recorded.

RESULTSNo significant difference was found between the two groups in the time to LOC, intubation time, intubation score, remifentanil dosage. Intubation was performed successfully in both groups. BP and HR of both groups decreased after the induction and did not increase after the intubation, with variation within the normal range. No significant difference in BP and HR was found between the two groups. NI of both groups decreased after the induction and during intubation. NI of SEV group 2 min after intubation was higher than that of PRO group. There was no significant difference in NI between the two groups at the other time points. No significant adverse effects or recall of the intubation procedure were reported.

CONCLUSIONAnesthesia induction FOB intubation with sevoflurane and propofol, both in combination with remifentanil, can be applied in surgical patients without contraindications to general anesthesia, and both methods can provide fast induction and good intubation condition with stable hemodynamics.

Adult ; Aged ; Anesthesia ; methods ; Anesthetics, Inhalation ; therapeutic use ; Anesthetics, Intravenous ; therapeutic use ; Bronchoscopes ; Hemodynamics ; Humans ; Intubation, Intratracheal ; methods ; Methyl Ethers ; therapeutic use ; Middle Aged ; Piperidines ; therapeutic use ; Propofol ; therapeutic use

BACKGROUNDIn recent years, increasing numbers of patients are accepting neoadjuvant chemotherapy before their operation in order to get a better prognosis. But chemotherapy has many side-effects. We have observed that patients who accepted neoadjuvant chemotherapy are more sensitive to anesthetics. The aim of this study was to determine the median effective dose (EC(50)) of intravenous anesthetics for neoadjuvant chemotherapy patients to lose consciousness during target-controlled infusion.

METHODSTwo hundred and forty breast cancer patients undergoing elective operations were assigned to six groups according to treatment received before their operation and the use of intravenous anesthetics during anesthesia; non-adjuvant chemotherapy + propofol group (group NP, n = 40), Taxol + propofol group (group TP, n = 40), adriamycin + cyclophosphamide + 5-Fu + propofol group (group CP, n = 40), non-adjuvant chemotherapy + etomidate group (group NE, n = 40), taxol + etomidate group (group TE, n = 40), adriamycin + cyclophosphamide + 5-Fu + etomidate group (group CE, n = 40). We set the beginning effect-site concentration (Ce) of propofol as 3.0 µg/ml and etomidate as 0.2 µg/ml. The concentration was increased by steps until the patient was asleep, (OAAS class I-II), then gave fentanyl 3 µg/kg and rocuronium 0.6 mg/kg and intubated three minutes later. The patients' age, height, and weight were recorded. BIS was recorded before induction, at the initial effect-site concentration and at loss of consciousness. The effect-site concentration was recorded when patient lost consciousness.

RESULTSThere were no significant differences between groups in general conditions before treatment; such as BIS of consciousness, age, sex and body mass index. The EC(50) of propofol in the NP, TP and CP groups was 4.11 µg/ml (95%CI: 3.96 - 4.26), 2.94 µg/ml (95%CI: 3.36 - 3.47) and 2.91 µg/ml (95%CI: 3.35 - 3.86), respectively. The EC50 of etomidate in the NE, TE and CE groups was 0.61 µg/ml (95%CI: 0.55 - 0.67), 0.38 µg/ml (95%CI: 0.33 - 0.44), and 0.35 µg/ml (95%CI: 0.34 - 0.36), respectively. There was no significant difference of BIS level before induction or in BIS50 level in any group when patients lost consciousness.

CONCLUSIONSThe EC(50) of intravenous anesthetics to cause loss of consciousness in neoadjuvant chemotherapy groups is lower than in the control group. There was no significant difference of BIS level at which patients lost consciousness.

Adult ; Anesthetics, Intravenous ; therapeutic use ; Breast Neoplasms ; drug therapy ; surgery ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Etomidate ; therapeutic use ; Female ; Fluorouracil ; therapeutic use ; Humans ; Middle Aged ; Neoadjuvant Therapy ; adverse effects ; Paclitaxel ; therapeutic use ; Propofol ; therapeutic use ; Unconsciousness ; chemically induced

OBJECTIVETo compare the efficacy and safety of remifentanil and fentanyl in patients undergoing a modified radical mastectomy or total hysterectomy.

METHODSFifty-four patients were evenly randomised into remifentanil group and fentanyl group. Anesthesia was induced by propofol (1 - 2 mg/kg) and either remifentanil (2 microg/kg) or fentanyl (2.5 microg/kg), and was maintained with inhalation of nitrous oxide in oxygen (2:1) and continuous infusion of either remifentanil (0.2 microg.kg(-1).min(-1)) or fentanyl (0.03 microg.kg(-1).min(-1)).

RESULTSThe number of patients exhibiting light anesthesia responses in the remifentanil group during intubation and the maintenance of anesthesia was significantly less than that in the fentanyl group. Both systolic and diastolic blood pressures in the fentanyl group were significantly higher than those in the remifentanil group during intubation, skin incision, maintenance of anesthesia and extubation. The time to opening eyes on command and the time for extubation after surgery was comparable between the two groups. More patients in the remifentanil group (25 patients) required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (5 patients, P < 0.05). There was no significant difference between the two groups in terms of side effects.

CONCLUSIONSUnder the condition of this study protocol, the anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia.

Adolescent ; Adult ; Anesthetics, Intravenous ; therapeutic use ; Blood Pressure ; drug effects ; Female ; Fentanyl ; therapeutic use ; Humans ; Mastectomy, Modified Radical ; Pain, Postoperative ; drug therapy ; Piperidines ; therapeutic use

Although rare, intraoperative anaphylaxis can lead to significant morbidity and mortality. Aquafol(R) (Daewon Pharmaceutical Co. Ltd., Seoul, Korea), a microemulsion propofol, was developed to eliminate lipid solvent-related adverse events, and was used in clinical anesthesia since 2009 with little data about severe side effects such as anaphylaxis. A healthy 16-yr-old male patient who had past medical history with two previous operations of no complications developed cardiovascular shock with generalized erythema following administration of microemulsion propofol during anesthesia induction. Intravenous injection of epinephrine and steroid rescued him. He remained in a stable state without any problems postoperatively and was discharged. Clinicians should consider this rare but serious complication during induction of anesthesia with propofol.
Adolescent ; Anaphylaxis/*chemically induced/drug therapy ; Anesthetics, Intravenous/*administration & dosage/adverse effects ; Bronchodilator Agents/therapeutic use ; Dexamethasone/therapeutic use ; Emulsions/chemistry ; Epinephrine/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Injections, Intravenous ; Male ; Propofol/*administration & dosage/adverse effects

BACKGROUNDWavelet index (WLI) is a new parameter for monitoring depth of anesthesia based on Wavelet analysis. We observed the change of WLI and bispectral index (BIS) in patients regain of consciousness (ROC) in the absence of frontalis electromyographic (EMG) interference. The aim of this study was to compare the ability of WLI and BIS for reflecting ROC in patients undergone surgery.

METHODSTwelve patients who were scheduled for maxillofacial surgeries were enrolled in the study. BIS and WLI values were monitored continually. After being given midazolam and remifentanil, patients were asked to squeeze the investigator's hand ever 30 seconds. Patients were continuously given propofol until loss of consciousness (LOC1). Tunstall's isolated forearm technique was used to test the surgical consciousness in patients. After total muscle relaxation, endotracheal intubations were performed, and the patients were connected to a ventilator. Then, propofol was withdrawn until the patients showed regain of consciousness (ROC1) and an awareness reaction. After the command test, patients were readministered with propofol until loss of consciousness (LOC2). After surgery, all of the sedatives were withdrawn, and the patients were let to regain consciousness (ROC2).

RESULTSThe BIS values of twelve patients at ROC1 after using muscle relaxant were much lower than those at LOC1 and ROC2 without using muscle relaxant, showing statistical significance (P < 0.05). Meanwhile, the WLI values of twelve patients at ROC1 after using muscle relaxant were much higher than those at LOC1 and equal to ROC2 without using muscle relaxant, showing statistical significances (P < 0.05) between ROC1 and LOC1.

CONCLUSIONSThis study showed that under muscle relaxation or facial paralysis, when there is no EMG signal, BIS can not accurately reflect regain of consciousness in surgical patients, but WLI can reflect it accurately. So WLI may have advantages for reflecting state of consciousness in surgical patients.

Adolescent ; Adult ; Anesthesia, Intravenous ; methods ; Anesthetics, Intravenous ; therapeutic use ; Consciousness ; drug effects ; Female ; Humans ; Male ; Midazolam ; therapeutic use ; Middle Aged ; Monitoring, Intraoperative ; Piperidines ; therapeutic use ; Propofol ; therapeutic use ; Surgery, Oral ; Young Adult

OBJECTIVETo investigate the effect of a single dose of ropivacaine combined with sufentanilfor thoracic paravertebral block (TPVB) on pain and enhanced recovery after surgery (ERAS) in patients undergoing video-assisted thoracosopic surgery.

METHODSSixty patients undergoing video-assisted thoracosopic surgery were randomly divided into three groups to receive intravenous combined general anesthesia (group C), a single dose of ropivacainefor thoracic paravertebral block before surgery combined with intravenous and general anesthesia(group T), or a single dose of ropivacaineand sufentanilfor thoracic paravertebral blockcombined with intravenous and general anesthesia (group T). None of the patients used postoperative analgesia pump, and tramadol hydrochoride injection (100 mg) was given in cases with NRS scores > 4 after the surgery. The data were recorded including analgesics used for nerve block before the operation, intravenous dosage of sufentanilduring operation, total dose of sufentanilused (intravenous+nerve block), intravenous remifentanil dose during operation, NRS scores at 4, 6, 24, 48 h after the surgery, rescue analgesia in the first postoperative 24 h after surgery, ICU stay and hospital stay after the surgery.

RESULTSCompared with those in group C, the intravenous sufentanildose, total sufentanildose, intravenous remifentanildose during operation, NRS scores at 4 and 6, 24 h, and ICU stay and hospital stay after the surgery were significantly decreased in groups Tand T(P<0.05). The total dose of opioids during the operation and NRS scores at 4 and 6 h were significantly lower in group Tthan in group T(P<0.05), but the total dose of sufentanil, ICU stay and hospital stay were simialr between the two groups.

CONCLUSIONA single dose of ropivacaine combined with sufentanilfor thoracic paravertebral blockbefore surgery can reduce the total dose opioids, produce the optimal analgesic effect, and promote postoperative recovery of the patients.

Amides ; administration & dosage ; therapeutic use ; Analgesics, Opioid ; therapeutic use ; Anesthesia, General ; Anesthetics, Intravenous ; therapeutic use ; Humans ; Injections ; Nerve Block ; methods ; Pain Management ; Pain Measurement ; Pain, Postoperative ; Piperidines ; therapeutic use ; Postoperative Period ; Sufentanil ; therapeutic use ; Thoracic Surgery, Video-Assisted

Although several studies examined factors that influence conscious sedation, investigation was limited into the gender and age. The aim of this prospective study is to identify the clinical variables of successful conscious sedation during gastrointestinal endoscopy. A total of 300 subjects who underwent gastrointestinal endoscopy were enrolled in a prospective fashion. They completed a questionnaire to assess height, weight, drinking, smoking, education level, recent medication, past medical history, previous experience of conscious sedation, preprocedural anxiety, and apprehension about the procedure. Efficacy of sedation and amnesia were evaluated by the subject and the endoscopist. Amnesic and sedative effects were proportionally related with age (p<0.0001). Preprocedural anxiety level was higher in women (p=0.0062), younger subjects (p=0.035), slender subjects (p=0.041), and in those without previous experience of conscious sedation (p=0.0034). This anxiety level was also related to increased pain (p=0.0026) and alertness (p=0.0003) during the procedure. Lower dose of midazolam is needed for sedation in older subjects. Subjects with a high level of preprocedural anxiety such as women, younger subjects, slender subjects, and those without previous experience of conscious sedation should be sedated with great caution because generally, they complain of much more severe pain and alertness during the procedure.
Age Factors ; Anesthetics, Intravenous/therapeutic use ; Body Weight ; *Conscious Sedation ; *Endoscopy, Gastrointestinal ; Female ; Humans ; Male ; Midazolam/therapeutic use ; Pain/drug therapy ; Prospective Studies ; Questionnaires ; Treatment Outcome

OBJECTIVE: To evaluate the anesthesia effect of etomidate and propofol on painless abortion surgery. 
 METHODS: After screening the Cochrane Library, Pubmed, China National Knowledge Infrastructure (CNKI), WANFANG, VIP database, the literatures regarding the anesthesia effect of etomidate and propofol on painless abortion surgery were collected from 1995 to 2014. The randomized controlled trials (RCTs) were selected, the quality evaluation was performed and the data was analyzed by using RevMan5.3 software.
 RESULTS: A total of 1 130 patients were included in 9 RCTs. The results of Meta analysis were as follows: the anesthesia induction time in the etomidate group was less than that in propofol group (MD=-0.14, 95% CI -0.24 to -0.04, P=0.004); there were more adverse reactions, such as myoclonus, nausea and vomiting, in the etomidate group compared with the propofol group (P<0.001); the incidence of pain in the etomidate group was less than that in the propofol group (P<0.001); there was no significant difference in the incidence of respiratory depression between the 2 groups (P>0.05); the surgery time, analgesia and duration from withdrawal to the wake-up was not significantly different between the 2 groups (P>0.05). 
 CONCLUSION Etomidate had a shorter anesthesia induction time than propofol in the painless abortion surgery. The incidence of reverse reactions such as myoclonus, nausea and vomiting, was more common in application of etomidate, whereas the incidence of injection pain was more common in the use of propofol group. There was no significant difference in respiratory depression between the 2 drugs. The comprehensive efficacy of propofol is better than etomidate.
Abortion, Induced ; Anesthesia ; Anesthetics, Intravenous ; China ; Etomidate ; therapeutic use ; Female ; Humans ; Pain ; prevention & control ; Pregnancy ; Propofol ; therapeutic use ; Randomized Controlled Trials as Topic

We examined whether pretreatment with a small dose of thiopental was effective in reducing pain induced by the intravenous injection of rocuronium. Withdrawal movement was used to assess pain reduction. Ninety patients were randomly assigned to one of two groups: patients in the control group were pretreated with 2 mL saline, and those in the thiopental group were pretreated with 2 mL (50 mg) thiopental. Thiopental 5 mg/kg was injected intravenously. After a loss of consciousness, the upper arm was compressed with a rubber tourniquet, and the pretreatment drugs were administered. Thirty seconds later the tourniquet was removed and 0.6 mg/kg rocuronium was administered. Withdrawal movement was assessed using a four-grade scale: no movement, movement limited to the wrist, to the elbow or to the shoulder. The frequency of withdrawal movement in the group pretreated with thiopental was lower than in the control group (34 vs. 13, p 0.05). We concluded that pretreatment with 2 mL (50 mg) thiopental is effective in reducing pain caused by the intravenous injection of rocuronium.
Thiopental/*therapeutic use ; Pain Measurement ; Pain/chemically induced/*prevention & control ; Neuromuscular Nondepolarizing Agents/*adverse effects ; Middle Aged ; Male ; Injections, Intravenous ; Humans ; Female ; *Anesthetics, Intravenous ; Androstanols/*adverse effects ; Adult

OBJECTIVETo investigate the effect of flurbiprofen preemptive analgesia combined with intravenous propofol anesthesia in induced abortion.

METHODSTotally 175 women (ASA class I) undergoing induced abortion were randomized into 5 groups. In K10, K5, and K1 groups, the patients were given 50 mg flurbiprofen 10, 5 and 1 min before the operation, respectively, and in F group, 1 microg/kg of fentanyl was administered 10 min before the operation. All the 4 groups had intravenous induction with 2 mg/kg propofo1. The patients in P group received propofol at 2 mg/kg as the control group. The heart rate (HR), mean arterial pressure (MAP) and SpO2 were monitored during the operation, and the induction time, recovery time, propofol dosage and adverse effect were recorded. The anesthetic effect of the protocols was assessed according to the visual analogue scale (VAS) and the overall patient satisfaction.

RESULTSHR, MAP, propofol consumption and the incidences of adverse effects during the operation were significantly higher in P group than in the other groups. F group had the highest incidence of respiratory depression among the 5 groups. The VAS in K10 group was significantly lower than that in K5 and K1 groups (P<0.05), but similar to that in F group (P>0.05). The overall patients' satisfaction was significantly higher than that in the other 4 groups.

CONCLUSIONFlurbiprofen preemptive analgesia combined with intravenous propofol is safe and effective for anesthesia during induced abortion.

Abortion, Induced ; Adolescent ; Adult ; Analgesics ; administration & dosage ; therapeutic use ; Anesthesia ; methods ; Anesthetics, Intravenous ; administration & dosage ; therapeutic use ; Drug Therapy, Combination ; Female ; Flurbiprofen ; administration & dosage ; therapeutic use ; Humans ; Propofol ; administration & dosage ; therapeutic use ; Time Factors ; Treatment Outcome