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Efeitos do rocurônio, sugamadex e complexo rocurônio‐sugamadex sobre a coagulação em ratos 罗库溴铵、苏加马定和罗库溴铵-苏加马定复合物对大鼠凝血的影响
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.08.007
Ismar Lima Cavalcanti , Estêvão Luiz Carvalho Braga , Nubia Verçosa , Alberto Schanaider , Louis Barrucand , Hans Donald de Boer , Luiz Vane

Background and objectives

Sugammadex is an alternative pharmacological drug capable of reversing neuromuscular blockades without the limitations that are presented by anticholinesterase drugs. Coagulation disorders that are related to treatment with sugammadex were reported. The exact mechanism of the effects on coagulation are not fully understood. The objective of this research is to evaluate the effects of rocuronium, sugammadex and the rocuronium‐sugammadex complex on coagulation in an experimental model in rats.

Methods

This is an experimental randomized animal study. Wistar rats were randomly assigned into the following groups: the Control Group; the Ssal Group – 0.5 mL of intravenous saline; the Sugammadex Group – intravenous sugammadex (100 mg.kg‐1); and the Rocuronium‐Sugammadex Group – intravenous solution with rocuronium (3.75 mg.kg‐1) and sugammadex (100 mg.kg‐1). Anesthesia was performed by using isoflurane with controlled ventilation. Coagulation factors were measured 10 minutes after the end of the preoperative preparation and 30 minutes after the administration of the drugs in accordance with the chosen groups.

Results

Platelet counts, prothrombin times and activated partial thromboplastin times were similar between the groups and between the moments within each group. There were reductions in the plasma fibrinogen levels between sample times 1 and 2 in the Rocuronium‐Sugammadex group (p = 0.035).

Conclusions

The rocuronium‐sugammadex complex promoted reductions in plasma fibrinogen counts, although the levels were still within normal limits.

背景和目的:sugammadex是一种能够逆转神经肌肉阻滞的替代药物,没有抗胆碱酯酶药物的局限性。与糖madex治疗相关的凝血功能障碍也有报道。对凝血作用的确切机制尚不完全清楚。本研究的目的是在实验模型中评价罗库溴铵、糖胺酮和罗库溴铵-糖胺酮复合物对大鼠凝血的影响。方法采用随机动物实验研究。Wistar大鼠随机分为两组:对照组;Ssal组:静脉注射生理盐水0.5 mL;Sugammadex组:静脉注射Sugammadex (100 mg.kg‐1);罗库溴铵- Sugammadex组-静脉注射罗库溴铵(3.75 mg.kg‐1)和Sugammadex (100 mg.kg‐1)。麻醉采用异氟醚并控制通气。在术前准备结束后10分钟和给药后30分钟,按所选组测定凝血因子。结果血小板计数、凝血酶原时间、活化部分凝血活酶时间组间及组内瞬间间无明显差异。Rocuronium - Sugammadex组血浆纤维蛋白原水平在样品次数1和2之间有所降低(p = 0.035)。结论罗库溴铵-糖胺酮复合物可促进血浆纤维蛋白原计数降低,但其水平仍在正常范围内。
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引用次数: 1
Dexametasona perineural em bloqueio de plexo braquial interescalênico com levobupivacaína guiado por ultrassonografia para artroscopia de ombro em regime ambulatorial: ensaio clínico controlado e randomizado 超声引导左布比卡因对肩关节镜门诊的周神经地塞米松阻滞臂间神经丛:一项随机对照临床试验
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.07.003
Mateus Meira Vasconcelos , João Paulo Jordão Pontes , Alexandre de Menezes Rodrigues , Demócrito Ribeiro de Brito Neto , Rodrigo Rodrigues Alves , Fernando Cássio do Prado Silva , Denis Fabiano de Souza

Background and objectives

In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting.

Methods

After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound‐guided interscalene brachial plexus block were randomized into Group D – blockade performed with 30 mL of 0.5% levobupivacaine with vasoconstrictor and 6 mg (1.5 mL) of dexamethasone and Group C – 30 mL of 0.5% levobupivacaine with vasoconstrictor and 1.5 mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24 hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS).

Results

Seventy‐four patients were recruited and 71 completed the study (Group C, n = 37; Group D, n = 34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440 ± 0 min vs. 1267 ± 164 min, p < 0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08 ± 1.72 vs. 0.02 ± 0.17, p < 0.001) and a greater number of patients (68.4% vs. 0%, p < 0.001) required rescue analgesia in the first 24 hours. The incidence of postoperative nausea and vomiting was not statistically significant.

Conclusion

Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.

背景与目的在肩关节镜手术中,门诊患者需要通过局部阻滞来控制术后疼痛。神经周围地塞米松可能延长这些阻滞的效果。本研究的目的是评估神经周地塞米松对门诊关节镜肩关节手术术后感觉阻滞延长的影响。方法经研究伦理委员会批准并获得知情同意后,在全麻和超声引导下进行关节镜肩关节手术的患者随机分为D组和C组,D组为0.5%左布比卡因+血管收缩剂30 mL +地塞米松6 mg (1.5 mL), C组为0.5%左布比卡因+血管收缩剂30 mL + 0.9%生理盐水1.5 mL。评估术后4个时刻(0、4、12、24小时)感觉阻滞持续时间,以及是否需要抢救镇痛、恶心呕吐发生率和视觉模拟疼痛评分(VAS)。结果共招募74例患者,71例完成研究(C组,n = 37;D组,n = 34)。我们的研究结果显示,D组敏感阻滞的平均时间延长(1440±0 min vs 1267±164 min), p <0.001)。根据VAS评分,C组患者的平均疼痛评分较高(2.08±1.72比0.02±0.17,p <0.001)和更多的患者(68.4% vs. 0%, p <0.001)需要在最初24小时内进行抢救性镇痛。术后恶心呕吐发生率无统计学意义。结论神经周地塞米松可明显延长左旋布比卡因引起的斜角肌间臂丛阻滞的感觉阻滞,降低术后疼痛强度和抢救性镇痛需求。
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引用次数: 2
Anafilaxia por corante azul patente V: relato de caso e revisão da literatura 专利蓝色染料过敏反应V:病例报告和文献综述
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.05.005
Diogo Costa, Mauro Mendonça, Michael Lopes, Ana Luísa Fernandes, Sara Nunes, Sofia Müller

Background

Anaphylaxis is a constant perioperative concern due to the exposure to several agents capable of inducing hypersensitivity reactions. Patent blue V (PBV), also known as Sulfan Blue, a synthetic dye used in sentinel node research in breast surgery, is responsible for 0.6% of reported anaphylactic conditions. We present a case of a 49‐year‐old female patient who underwent left breast tumorectomy with sentinel lymph node staging using PBV and experienced an anaphylactic reaction.

Methods

We conducted a literature search through PubMed for case reports, case series, reviews, and systematic reviews since 2005 with the keywords “anaphylaxis” and “patent blue”. We then included articles found in these publications’ reference sections.

Results

We found 12 relevant publications regarding this topic. The main findings are summarized, with information regarding the clinical presentation, management, and investigation protocol. Hypotension is the most common clinical manifestation. The presentation is usually delayed when compared with anaphylaxis from other agents, and cutaneous manifestations are occasionally absent. Patients may have had previous exposure to the dye, used also as a food, clothes and drug colorant.

Conclusion

The diagnosis of anaphylaxis in patients under sedation or general anesthesia may be difficult due to particularities of the perioperative context. According to the published literature, the presentation of the reaction is similar in most cases and a heightened clinical sense is key to address the situation appropriately. Finding the agent responsible for the allergic reaction is of paramount importance to prevent future episodes.

背景:由于暴露于几种能够诱发超敏反应的药物,过敏反应是围手术期经常关注的问题。专利蓝V (PBV),也被称为硫丹蓝,是一种用于乳房手术前哨淋巴结研究的合成染料,报告的过敏症状中有0.6%是由它引起的。我们报告了一例49岁的女性患者,她接受了左乳房肿瘤切除术,并使用PBV进行前哨淋巴结分期,并出现了过敏反应。方法通过PubMed检索2005年以来的病例报告、病例系列、综述和系统综述,检索关键词为“过敏反应”和“专利蓝”。然后,我们收录了在这些出版物的参考部分中找到的文章。结果检索到12篇相关文献。总结了主要发现,并提供了有关临床表现,管理和调查方案的信息。低血压是最常见的临床表现。与其他药物引起的过敏反应相比,其表现通常延迟,偶尔没有皮肤表现。患者以前可能接触过这种染料,这种染料也被用作食品、衣服和药物的着色剂。结论镇静或全麻患者的围手术期环境的特殊性,可能使过敏反应的诊断较为困难。根据已发表的文献,在大多数情况下,反应的表现是相似的,提高临床意识是适当处理这种情况的关键。找到导致过敏反应的药物对于预防未来的过敏反应至关重要。
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引用次数: 3
ESPID – escore simplificado preditivo de intubação difícil ESPID -困难插管的简化预测评分
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.10.004
Vinícius Caldeira Quintão , Cláudia Marquez Simões , Maria José Carvalho Carmona
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引用次数: 0
Nível de S100B e disfunção cognitiva após prostatectomia radical laparoscópica assistida por robô: estudo observacional prospectivo 机器人辅助腹腔镜根治性前列腺切除术后S100B水平与认知功能障碍:前瞻性观察研究
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.06.006
Nilgun Kavrut Ozturk , Ali Sait Kavakli , Ulku Arslan , Guzin Aykal , Murat Savas

Background

The present study investigated the association between Postoperative Cognitive Dysfunction (POCD) and increased serum S100B level after Robotic‐Assisted Laparoscopic Radical Prostatectomy (RALRP).

Methods

The study included 82 consecutive patients who underwent RALRP. Serum S100B levels were determined preoperatively, after anesthesia induction, and at 30 minutes and 24 hours postoperatively. Cognitive function was assessed using neuropsychological testing preoperatively and at 7 days and 3 months postoperatively.

Results

Twenty‐four patients (29%) exhibited POCD 7 days after surgery, and 9 (11%) at 3 months after surgery. Serum S100B levels were significantly increased at postoperative 30 minutes and 24 hours in patients displaying POCD at postoperative 7 days (p  =  0.0001 for both) and 3 months (p = 0.001 for both) compared to patients without POCD. Duration of anesthesia was also significantly longer in patients with POCD at 7 days and 3 months after surgery compared with patients without POCD (p = 0.012, p = 0.001, respectively), as was duration of Trendelenburg (p = 0.025, p = 0.002, respectively). Composite Z score in tests performed on day 7 were significantly correlated with duration of Trendelenburg and duration of anesthesia (p = 0.0001 for both).

Conclusions

S100B increases after RALRP and this increase is associated with POCD development. Duration of Trendelenburg position and anesthesia contribute to the development of POCD.

Trial Registry Number

Clinicaltrials.gov (N° NCT03018522).

本研究探讨了机器人辅助腹腔镜根治性前列腺切除术(RALRP)术后认知功能障碍(POCD)与血清S100B水平升高之间的关系。方法纳入82例连续行RALRP的患者。术前、麻醉诱导后、术后30分钟和24小时测定血清S100B水平。术前、术后7天和3个月分别采用神经心理测试评估认知功能。结果24例(29%)术后7天出现POCD, 9例(11%)术后3个月出现POCD。与无POCD的患者相比,出现POCD的患者在术后7天(p = 0.0001)和3个月(p = 0.001)后30分钟和24小时血清S100B水平显著升高。POCD患者术后7天和3个月的麻醉时间也明显长于无POCD患者(p = 0.012, p = 0.001), Trendelenburg患者的麻醉时间也明显长于无POCD患者(p = 0.025, p = 0.002)。第7天进行的综合Z评分与Trendelenburg持续时间和麻醉持续时间显著相关(p = 0.0001)。结论RALRP后ss100b升高,与POCD的发生有关。Trendelenburg体位的持续时间和麻醉对POCD的发展有影响。试验注册号clinicaltrials .gov (N°NCT03018522)。
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引用次数: 2
Segurança ocupacional da equipe na prática de ECT durante a pandemia de COVID‐19 COVID - 19大流行期间ECT实践中的团队职业安全
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.10.002
Renato Ferreira Araujo, Lucio de Oliveira Quites
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引用次数: 1
Anestesia geral sem opioide e recuperação induzida da anestesia em paciente com distrofia miotônica tipo‐1: relato de caso 1型肌强直营养不良患者全身麻醉无阿片类药物及麻醉诱导恢复:病例报告
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.07.004
Hande Gurbuz , Kemal Tolga Saracoglu

Myotonic dystrophy type‐1 (Steinert disease) is an autosomal dominant, progressive multisystem disease in which myotonic crisis can be triggered by several factors including pain, emotional stress, hypothermia, shivering, and mechanical or electrical stimulation. In this report, dexmedetomidine‐based general anesthesia, in combination with a thoracic epidural for laparoscopic cholecystectomy in a patient with Steinert disease, is presented. An Aintree intubation catheter with the guidance of a fiberoptic bronchoscope was used for intubation to avoid laryngoscopy. Prolonged anesthetic effects of propofol were reversed, and recovery from anesthesia was accelerated using an intravenous infusion of theophylline.

肌强直性营养不良1型(Steinert disease)是一种常染色体显性、进行性多系统疾病,其中肌强直性危象可由疼痛、情绪紧张、体温过低、寒战和机械或电刺激等多种因素引发。在这篇报道中,我们报道了右美托咪定全麻结合胸硬膜外麻醉用于腹腔镜胆囊切除术的一例Steinert疾病患者。为了避免喉镜检查,在纤维支气管镜引导下使用安特里插管导管插管。异丙酚的长期麻醉效果被逆转,静脉输注茶碱加速麻醉恢复。
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引用次数: 0
Propofol‐cetamina versus dexmedetomidina‐cetamina para sedação durante endoscopia digestiva alta em pacientes pediátricos: estudo clínico randomizado 异丙酚-氯胺酮与右美托咪定-氯胺酮在小儿上消化道内镜下的镇静作用:一项随机临床研究
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.08.005
Akram M. Amer, Azza M. Youssef, Hala S. El‐Ozairy, Ahmed M. El‐Hennawy

Background and objectives

Day‐case pediatric sedation is challenging. Dexmedetomidine is a sedative analgesic that does not induce respiratory depression. We compared dexmedetomidine to propofol when it was added to ketamine for sedation during pediatric endoscopy, regarding recovery time and hemodynamic changes.

Methods

We enrolled 120 patients (2−7 years in age) and randomly assigned them into two groups. Each patient received intravenous (IV) ketamine at a dose of 1 mg.kg‐1 in addition to either propofol (1 mg.kg‐1) or dexmedetomidine (0.5 μg.kg‐1). The recovery time was compared. Hemodynamics, oxygen saturation, need for additional doses, postoperative complications and endoscopist satisfaction were monitored.

Results

There was no significant difference in hemodynamics between the groups. The Propofol‐Ketamine (P‐K) group showed significantly shorter recovery times than the Dexmedetomidine‐Ketamine (D‐K) group (21.25 and 29.75 minutes respectively, p < 0.001). The P‐K group showed more oxygen desaturation. Eleven and six patients experienced SpO2 < 92% in groups P‐K and D‐K, respectively. A significant difference was noted regarding the need for additional doses; 10% of patients in the D‐K group needed one extra dose, and 5% needed two extra doses, compared to 25% and 20% in the P‐K group, respectively (p = 0.001). The P‐K group showed less post‐procedure nausea and vomiting. No statistically significant difference between both groups regarding endoscopist satisfaction.

Conclusions

The P‐K combination was associated with a shorter recovery time in pediatric upper gastrointestinal endoscopy, while the D‐K combination showed less need for additional doses.

Registration number

Clinical trials.gov (NCT02863861).

背景与目的:小儿镇静是一项具有挑战性的研究。右美托咪定是一种不引起呼吸抑制的镇静镇痛药。我们比较了右美托咪定和异丙酚在小儿内镜检查中加入氯胺酮镇静时的恢复时间和血流动力学变化。方法选取年龄在2 ~ 7岁的患者120例,随机分为两组。每位患者静脉注射氯胺酮,剂量为1mg。除异丙酚(1 mg.kg‐1)或右美托咪定(0.5 μg.kg‐1)外。比较恢复时间。监测血流动力学、血氧饱和度、需要额外剂量、术后并发症和内镜医师满意度。结果两组患者血流动力学指标无明显差异。异丙酚-氯胺酮(P‐K)组的恢复时间明显短于右美托咪定-氯胺酮(D‐K)组(分别为21.25和29.75分钟),P <0.001)。P - K组表现出更高的氧饱和度。11例和6例患者出现SpO2和lt;P - K组和D - K组分别为92%。注意到在需要额外剂量方面存在显著差异;D‐K组10%的患者需要额外的一次剂量,5%的患者需要额外的两次剂量,而P‐K组分别为25%和20% (P = 0.001)。P - K组术后恶心和呕吐较少。两组在内窥镜医师满意度方面无统计学差异。结论:P - K联合用药可缩短小儿上消化道内窥镜检查的恢复时间,而D - K联合用药无需额外剂量。注册号:clinical trials.gov (NCT02863861)。
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引用次数: 7
Comparação entre morfina subaracnoidea e bloqueio do nervo femoral para analgesia após reconstrução ligamentar de joelho: estudo clínico randomizado 膝关节韧带重建后股神经阻滞与蛛网膜下腔吗啡的比较:一项随机临床研究
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2019.08.006
Joana Zulian Fiorentin , Alexandre Vieira Martins , Juan Manuel Vélez Cañola , Linda Cecilia Gutierrez , Fábio Perches , Thiago Mamôru Sakae , Sérgio Bernardo Tenório

Background and objectives

There is no consensus of the ideal technique to provide analgesia in knee ligament reconstructions. The aim of this study was to compare the intensity of postoperative pain in these patients under different modalities of analgesia.

Method

Randomized and controlled clinical trial of patients undergoing reconstruction of the anterior cruciate ligament (ACL) with flexor tendons between December 2013 and 2014. All patients underwent spinal anesthesia and rescue analgesia with tramadol. The Groups C, M, R0,375 and R0,25 were compared with only the previously described technique, subarachnoid morphine (100 μg) or femoral nerve block with 25 mL of 0.375% ropivacaine and 0.25%, respectively. Pain intensity at 6, 12 and 24 hours, age, sex, rescue analgesia, adverse reactions and satisfaction were evaluated.

Results

Among the 83 eligible patients, a predominance of males (85.7%) was observed, between 28 and 31 years. The Group C requested more opioid (27.3%) than the other groups, without significance when compared. There were no significant differences in pain intensity at 6, 12 and 24 hours. There was a higher incidence of urinary retention in the Group M (23.8%) than in the R0,375 (0%) and prolonged quadriceps motor block in the R0,375 Group (30%) than in the M and C Groups (0%), with statistical significance (p < 0.05).

Conclusion

There was no difference in the intensity of postoperative pain in patients submitted to anterior cruciate ligament reconstruction with flexor tendons under the analgesic modalities evaluated, despite the predominance of urinary retention in the M Group and motor block in the R0,375 Group.

背景与目的在膝关节韧带重建中提供镇痛的理想技术尚未达成共识。本研究的目的是比较这些患者在不同镇痛方式下的术后疼痛强度。方法对2013年12月~ 2014年12月行屈肌腱前交叉韧带(ACL)重建术的患者进行随机对照临床试验。所有患者均行脊髓麻醉和曲马多抢救镇痛。C组、M组、R0、375组和R0、25组分别采用上述方法、蛛网膜下腔吗啡(100 μg)或0.375%罗哌卡因和0.25%罗哌卡因阻断股神经25 mL进行比较。评估6、12、24小时疼痛强度、年龄、性别、抢救镇痛、不良反应及满意度。结果83例符合条件的患者中,28 ~ 31岁男性居多(85.7%)。C组阿片类药物需求量大于其他组(27.3%),差异无统计学意义。6、12、24小时疼痛强度差异无统计学意义。M组尿潴留发生率(23.8%)高于r0375组(0%),r0375组延长股四头肌运动阻滞发生率(30%)高于M组和C组(0%),差异均有统计学意义(p <0.05)。结论不同镇痛方式下屈肌腱前交叉韧带重建术患者的术后疼痛强度无显著差异,但M组以尿潴留为主,r0375组以运动阻滞为主。
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引用次数: 1
Efeito da pré‐administração de flurbiprofeno axetil na CE50 do propofol durante anestesia em pacientes não estimulados: estudo clínico randomizado 非刺激患者麻醉前给药氟比洛芬ax乙基对异丙酚CE50的影响:随机临床研究
IF 1 Q3 Medicine Pub Date : 2020-11-01 DOI: 10.1016/j.bjan.2020.08.006
Jing Ma, Mian Peng, Fei Wang, Lei Chen, Zong‐Ze Zhang, Yan‐Lin Wang

Background and objectives

Preoperative use of flurbiprofen axetil (FA) is extensively adopted to modulate the effects of analgesia. However, the relationship between FA and sedation agents remains unclear. In this study, we aimed to investigate the effects of different doses of FA on the median Effective Concentration (EC50) of propofol.

Methods

Ninety‐six patients (ASA I or II, aged 18–65 years) were randomly assigned into one of four groups in a 1:1:1:1 ratio. Group A (control group) received 10 mL of Intralipid, and groups B, C and D received 0.5 mg.kg‐1, 0.75 mg.kg‐1 and 1 mg.kg‐1 of FA, respectively, 10 minutes before induction. The depth of anesthesia was measured by the Bispectral Index (BIS). The “up‐and‐down” method was used to calculate the EC50 of propofol. During the equilibration period, if BIS ≤ 50 (or BIS > 50), the next patient would receive a 0.5 μg.mL‐1‐lower (or‐higher) propofol Target‐Controlled Infusion (TCI) concentration. The hemodynamic data were recorded at baseline, 10 minutes after FA administration, after induction, after intubation, and 15 minutes after intubation.

Results

The EC50 of propofol was lower in Group C (2.32 μg.mL‐1, 95% Confidence Interval [95% CI] 1.85–2.75) and D (2.39 μg.mL‐1, 95% CI 1.91–2.67) than in Group A (2.96 μg.mL‐1, 95% CI 2.55–3.33) (p = 0.023, p = 0.048, respectively). There were no significant differences in the EC50 between Group B (2.53 μg.mL‐1, 95% CI 2.33–2.71) and Group A (p ˃ 0.05). There were no significant differences in Heart Rate (HR) among groups A, B and C. The HR was significantly lower in Group D than in Group A after intubation (66 ± 6 vs. 80 ± 10 bpm, p < 0.01) and 15 minutes after intubation (61 ± 4 vs. 70 ± 8 bpm, p < 0.01). There were no significant differences among the four groups in Mean Arterial Pressure (MAP) at any time point. The MAP of the four groups was significantly lower after induction, after intubation, and 15 minutes after intubation than at baseline (p < 0.05).

Conclusion

High‐dose FA (0.75 mg.kg‐1 or 1 mg.kg‐1) reduces the EC50 of propofol, and 1 mg.kg‐1 FA reduces the HR for adequate anesthesia in unstimulated patients. Although this result should be investigated in cases of surgical stimulation, we suggest that FA pre‐administration may reduce the propofol requirement when the depth of anesthesia is measured by BIS.

背景与目的术前应用氟比洛芬酯(FA)调节镇痛效果被广泛采用。然而,FA和镇静药物之间的关系尚不清楚。在本研究中,我们旨在探讨不同剂量FA对异丙酚中位有效浓度(EC50)的影响。方法96例ASA I或II型患者,年龄18-65岁,按1:1:1:1的比例随机分为四组。A组(对照组)给予Intralipid 10 mL, B、C、D组给予0.5 mg。Kg‐1,0.75 mg。Kg‐1和1mg。分别于诱导前10分钟注射kg - 1 FA。采用双谱指数(BIS)测定麻醉深度。采用“上-下”法计算异丙酚的EC50。在平衡期间,如果BIS≤50(或BIS >50),下一位患者接受0.5 μg。mL - 1 -低(或高)异丙酚靶控输注(TCI)浓度。血流动力学数据记录于基线、FA给药后10分钟、诱导后、插管后和插管后15分钟。结果C组异丙酚EC50较低,为2.32 μg;mL‐1,95%可信区间[95% CI] 1.85-2.75)和D (2.39 μg。mL‐1,95% CI 1.91 ~ 2.67)高于A组(2.96 μg)。mL‐1,95% CI 2.55-3.33) (p = 0.023, p = 0.048)。B组大鼠EC50值(2.53 μg)与对照组比较,差异无统计学意义。mL‐1,95% CI 2.33-2.71)和A组(p < 0.05)。A、B、c组患者插管后心率(HR)差异无统计学意义。D组患者插管后心率(HR)明显低于A组(66±6 vs 80±10 bpm, p <0.01)和插管后15分钟(61±4 vs 70±8 bpm, p <0.01)。四组患者各时间点平均动脉压(MAP)差异无统计学意义。四组在诱导后、插管后和插管后15分钟的MAP均显著低于基线时(p <0.05)。结论:大剂量FA (0.75 mg。kg‐1或1mg .kg‐1)降低异丙酚的EC50,而1mg。kg‐1 FA可降低未刺激患者充分麻醉时的HR。虽然在手术刺激的情况下,这一结果还有待研究,但我们认为,当用BIS测量麻醉深度时,FA预给药可能会减少异丙酚的需用量。
{"title":"Efeito da pré‐administração de flurbiprofeno axetil na CE50 do propofol durante anestesia em pacientes não estimulados: estudo clínico randomizado","authors":"Jing Ma,&nbsp;Mian Peng,&nbsp;Fei Wang,&nbsp;Lei Chen,&nbsp;Zong‐Ze Zhang,&nbsp;Yan‐Lin Wang","doi":"10.1016/j.bjan.2020.08.006","DOIUrl":"10.1016/j.bjan.2020.08.006","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Preoperative use of flurbiprofen axetil (FA) is extensively adopted to modulate the effects of analgesia. However, the relationship between FA and sedation agents remains unclear. In this study, we aimed to investigate the effects of different doses of FA on the median Effective Concentration (EC50) of propofol.</p></div><div><h3>Methods</h3><p>Ninety‐six patients (ASA I or II, aged 18–65 years) were randomly assigned into one of four groups in a 1:1:1:1 ratio. Group A (control group) received 10 mL of Intralipid, and groups B, C and D received 0.5 mg.kg<sup>‐1</sup>, 0.75 mg.kg<sup>‐1</sup> and 1 mg.kg<sup>‐1</sup> of FA, respectively, 10 minutes before induction. The depth of anesthesia was measured by the Bispectral Index (BIS). The “up‐and‐down” method was used to calculate the EC50 of propofol. During the equilibration period, if BIS ≤ 50 (or BIS &gt; 50), the next patient would receive a 0.5 μg.mL<sup>‐1</sup>‐lower (or‐higher) propofol Target‐Controlled Infusion (TCI) concentration. The hemodynamic data were recorded at baseline, 10 minutes after FA administration, after induction, after intubation, and 15 minutes after intubation.</p></div><div><h3>Results</h3><p>The EC50 of propofol was lower in Group C (2.32 μg.mL<sup>‐1</sup>, 95% Confidence Interval [95% CI] 1.85–2.75) and D (2.39 μg.mL<sup>‐1</sup>, 95% CI 1.91–2.67) than in Group A (2.96 μg.mL<sup>‐1</sup>, 95% CI 2.55–3.33) (<em>p</em> = 0.023, <em>p</em> = 0.048, respectively). There were no significant differences in the EC50 between Group B (2.53 μg.mL<sup>‐1</sup>, 95% CI 2.33–2.71) and Group A (<em>p</em> ˃ 0.05). There were no significant differences in Heart Rate (HR) among groups A, B and C. The HR was significantly lower in Group D than in Group A after intubation (66 ± 6 vs. 80 ± 10 bpm, <em>p</em> &lt; 0.01) and 15 minutes after intubation (61 ± 4 vs. 70 ± 8 bpm, <em>p</em> &lt; 0.01). There were no significant differences among the four groups in Mean Arterial Pressure (MAP) at any time point. The MAP of the four groups was significantly lower after induction, after intubation, and 15 minutes after intubation than at baseline (<em>p</em> &lt; 0.05).</p></div><div><h3>Conclusion</h3><p>High‐dose FA (0.75 mg.kg<sup>‐1</sup> or 1 mg.kg<sup>‐1</sup>) reduces the EC50 of propofol, and 1 mg.kg<sup>‐1</sup> FA reduces the HR for adequate anesthesia in unstimulated patients. Although this result should be investigated in cases of surgical stimulation, we suggest that FA pre‐administration may reduce the propofol requirement when the depth of anesthesia is measured by BIS.</p></div>","PeriodicalId":21261,"journal":{"name":"Revista brasileira de anestesiologia","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.bjan.2020.08.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38736168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Revista brasileira de anestesiologia
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