Objective To systematically assess the effectiveness and safety of 5-HT3 receptor antagonists in preventing propofol injection induced pain. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2012), CNKI, CBM, VIP and WanFang Data were searched from their inception to September, 2012 to collect the randomized controlled trials (RCTs) about 5-HT3 receptor antagonists in preventing propofol injection induced pain. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and assessed the quality of methodology. Then meta-analysis was performed using RevMan 5.2 software. Results A total of 15 RCTs involving 1 413 patients were included. The results of meta-analysis showed that: a) the incidence of propofol injection induced pain in the 5-HT3 group was obviously lower than the control group (RR=0.14, 95%CI 0.09 to 0.21, Plt;0.000 01); b) as to the severity of pain, there was no statistical difference between the two groups (RR=0.84, 95%CI 0.56 to 1.26, P=0.39); the 5-HT3 group was obviously lower that the control group in the incidence of both moderate pain (RR=0.25, 95%CI 0.19 to 0.34, Plt;0.000 01) and severe pain (RR=0.16, 95%CI 0.10 to 0.24, Plt;0.000 01); and c) as to the incidence of postoperative adverse reaction: the 5-HT3 group was obviously lower that the control group in the incidence of nausea and vomiting (RR=0.19, 95%CI 0.11 to 0.34, Plt;0.000 01) and shivering (RR=0.20, 95%CI 0.12 to 0.33, Plt;0.000 01) as well. Conclusion 5-HT3 receptor antagonists can effectively prevent the propofol injection induced pain, alleviate its severity, and reduce the postoperative adverse reactions. For the quantity and quality limitation of the included studies, this conclusion still needs to be further proved by performing more high quality studies.
Objective To systematically review the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. Methods Such databases as PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and VIP were electronically searched from inception to December 2012, for comprehensively collecting randomized controlled trials (RCTs) on the impacts of general anesthesia using sevoflurane versus propofol on the incidence of emergence agitation in pediatric patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results A total of 9 RCTs involving 692 children were included, of which, six were pooled in the meta-analysis. The results of meta-analysis showed that: a) after anesthesia induction using sevoflurane, intravenous propofol maintenance was associated with a lower incidence of emergence agitation compared with sevoflurane maintenance (RR=0.57, 95%CI 0.39 to 0.84, P=0.004); and b) patients anesthetized with total intravenous propofol had a lower incidence of emergence agitation compared with total inhalation of sevoflurane (RR=0.16, 95%CI 0.06 to 0.39, Plt;0.000 1). Conclusion The incidence of emergence agitation after general anesthesia using sevoflurane is higher than that using propofol. Due to the limited quantity and quality, the application of sevoflurane should be chosen based on full consideration into patients’ conditions in clinic.
Objective To systematically review the effects of lidocaine for preventing pain on injection of propofol. Methods Databases including The Cochrane Library (Issue 4, 2012), PubMed, MEDLINE, Ovid, HighWire, EMbase, CBM and CNKI were searched electronically to collect literature published from January, 1985 to December, 2012. Randomized controlled trials (RCTs) were indentified about lidocaine for preventing injection pain of propofol. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assess the quality of the included studies. Then meta-analysis was performed using RevMan 5.1 software. Results Fifteen trials involved 1 332 patients were included. The results of meta-analysis indicated that, adding lidocaine into propofol lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.36, 95%CI 0.30 to 0.44, Plt;0.000 01); using different doses of lidocaine before injection lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.59, 95%CI 0.47 to 0.75, Plt;0.000 1); using different doses of lidocaine after venous occlusion lowered the incidence of pain on injection compared with blank control, with a significant difference (RR=0.44, 95%CI 0.37 to 0.52, Plt;0.000 01). Conclusion Lidocaine could reduce the pain on injection of propofol. Using lidocaine 40 mg after venous occlusion is a relatively effective method to lower the incidence of pain on injection which is more suitable for outpatient who receive intravenous anesthesia without preoperation medication.
Objective To systematically review the clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
Objective To evaluate the efficacy and safety of COX inhibitor flurbiprofen axetil in relieving propofol injection pain and preemptive analgesia after general anesthesia. Methods Databases such as PubMed, CBM, Springer, Ovid, CNKI and ISI were searched to identify randomized controlled trials (RCTs) about flurbiprofen axetil in relieving propofol injection pain and preemptive analgesia after general anesthesia published from 2000 to 2010. The methodological quality of the included RCTs was assessed and the data were extracted according to the Cochrane Handbook 5.0.1. Meta-analysis was performed by using RevMan 4.2.10 software. Results A total of 15 RCTs involving 1 425 patients were included. The results of meta-analyses showed that: a) Relieving propofol injection pain: Compared with the placebo group, flurbiprofen axetil could prevent the propofol injection pain (RR=3.13, 95%CI 1.08 to 9.11, P=0.04), and relieve the moderate and severe pain in injecting propofol (RR=0.57, 95%CI 0.40 to 0.81, P=0.002; RR=0.14, 95%CI 0.05 to 0.34, Plt;0.000 1, respectively), but there were no significant differences in relieving mild pain between the two groups; b) Preemptive analgesia: the visual analog scale (VAS) of post-operation at 2-hour (WMD= –2.25, 95%CI –4.20 to –0.29, P=0.02), 4-hour (WMD= –1.99, 95%CI –3.19 to –0.79, P=0.001), 8-hour (WMD= –1.39, 95%CI –1.86 to –0.93, Plt;0.000 01) and 12-hour (WMD= –2.70, 95%CI –4.73 to –0.68, P=0.009) was decreased when flurbiprofen axetil was injected before the operation, but there were no significant differences in VAS of post-operation at 48-hour between the two groups. When flurbiprofen axetil was injected at the end of the operation, VAS of post-operation at 12-hour (WMD= –0.94, 95%CI –1.73 to –0.16, P=0.02) was decreased, but there were no significant differences in VAS of post-operation at 24-hour between the two groups; flurbiprofen axetil could lessen the need for opioid analgesics (RR=0.47, 95%CI 0.27 to 0.82, P=0.008); and c) Safety: there were no significant differences in postoperative nausea, vomit and somnolence between the two groups. Conclusion Flurbiprofen axetil can significantly prevent or relieve the propofol injection pain; flurbiprofen axetil injected before operation can relieve post-operative pain at 2-, 4-, 8- and 12-hour; flurbiprofen axetil injected at the end of the operation can relieve post-operative pain at 12-hour. Yet more RCTs are required to discuss its effects on nausea, vomit and somnolence.
目的 探讨全凭静脉麻醉中腺苷对丙泊酚用量的影响。 方法 2011年1月－12月期间59例行择期手术的患者全凭静脉麻醉，随机分为腺苷静脉持续输注组（A组）和对照组（B组），A组患者麻醉诱导后持续输注腺苷70 μg/（kg·min），直至术毕。B组麻醉后按常规处理。比较两组患者麻醉时间、苏醒时间、瑞芬太尼用量，麻醉过程中平均动脉压（MAP）、心率，以及麻醉过程中丙泊酚的用量。同时记录使用腺苷过程中的不良反应。 结果 两组患者麻醉时间、苏醒时间、瑞芬太尼用量比较均无明显差异，无统计学意义（P＞0.05）。两组患者麻醉过程中MAP、心率比较亦无明显差异，无统计学意义（P＞0.05）。两组患者麻醉过程中丙泊酚平均用量比较，A组明显低于C组，差异有统计学意义（P＜0.05），且不良反应发生率低。 结论 腺苷能明显降低全凭静脉麻醉中丙泊酚的使用剂量。
目的 评价地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查的效果。 方法 将2012年10月－12月拟行纤维支气管镜检查，且按美国麻醉医师协会分级Ⅰ或Ⅱ级的60例患者，随机分为芬太尼组（F组）、地佐辛组（D组）、生理盐水组（N组）,每组20例。采用双盲法给药，静脉注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理盐水0.1 mL/kg，5 min后3组缓慢静脉注射丙泊酚2 mg/kg诱导后置入喉罩，术中保留自主呼吸，持续泵入丙泊酚4～6 mg/（kg·h）维持麻醉，观察3组患者诱导前（T0）、诱导后时（T1）、纤维支气管镜操作时（T2）、术毕时（T3）及拔除喉罩时（T4）的生命体征，记录丙泊酚总用量、苏醒时间、苏醒时的呼吸道疼痛视觉模拟评分（VAS），记录术中及术后有关并发症的发生情况。 结果 与N组相比，D、F两组丙泊酚总用量减少、苏醒时间缩短，头昏及术中体动发生率、VAS评分明显降低（P＜0.05）；呼吸暂停的发生率D组最低（P＜0.05）；恶心、呕吐的发生率F组最高（P＜0.05）。 结论 地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查，麻醉效果满意，术后镇痛效果好，值得临床推广。
目的:比较七氟醚吸入麻醉和丙泊酚、瑞芬太尼静脉麻醉用于小儿手术的临床效果。方法:100例1～8岁的患儿随机分为丙泊酚、瑞芬太尼组(A组)与七氟醚吸入组(B组）。麻醉诱导后,A组持续输注丙泊酚和瑞芬太尼维持麻醉,B组吸入七氟醚维持麻醉。术中根据生命体征调整丙泊酚、瑞芬太尼的输注速度及七氟醚的吸入浓度,记录术中循环变化、术后麻醉恢复情况。结果:与B组相比,A组术中MAP下降明显(Plt;005)。结论:与A组相比,B组术中生命体征控制平稳;术后清醒迅速、完全、平稳,拔管时间无明显差异。
目的：探讨丙泊酚、芬太尼用于纤支镜检查的安全性。方法：60例纤支镜检查患者分为丙泊酚组和对照组。丙泊酚组采用芬太尼1～15 μg/kg,丙泊酚1～2 mg/kg静脉麻醉，观察检查前、纤支镜进入声门后5分钟、检查后的HR、BP、RR 、SpO2变化及两组病例术中、术后的反应。结果：丙泊酚组检查中HR、BP较对照组平稳(P＜0.01), RR、SpO2变化与对照组比较无明显统计学差异(P＞0.05)，丙泊酚组检查中、检查后不良反应少，苏醒快，患者满意。结论：丙泊酚、芬太尼用于纤支镜检查，减少了患者的恐惧与痛苦，提供了良好的检查条件，同时也是安全可行的。