ObjectiveTo systematically review the safety of propofol versus sevoflurane for pediatric surgery. MethodsEMbase, PubMed, The Cochrane Library, CSCD, CNKI, WanFang Data were searched to collect randomized controlled trials (RCTs) about propofol versus sevoflurane for pediatric surgery from inception to January 2015. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then metaanalysis was performed by using RevMan 5.3 software. ResultsFifteen RCTs involving 1 065 children were included finally. Meta-analysis results showed that, compared with the sevoflurane group, the propofol group could reduce the incidence of emergence agitation (OR=0.23, 95%CI 0.16 to 0.34, P<0.000 01) and the incidence of postoperative vomiting (OR=0.32, 95%CI 0.20 to 0.51, P<0.000 01). There were no significant differences between the two groups in extubation time (MD=0.98, 95%CI -0.26 to 2.21, P=0.12), eye-opening time (MD=3.32, 95%CI -2.65 to 9.29, P=0.28) and postoperative analgesic requirements (OR=0.60, 95%CI 0.30 to 1.23, P=0.16). ConclusionIn reducing the incidence of emergence agitation and postoperative vomiting, propofol is superior to sevoflurane, so propofol is safer than sevoflurane for children's surgery.
Objective To explore the effects of propofol and thiopental sodium injection on convulsive seizure in electro-convulsive therapy(ECT) and to provide evidence to help the selection of intravenous anaesthetics in improved ECT. Methods Total of 111 patients who received ECT in the 3rd Pepole’s Hospital of Panzhihua from July to December 2005 were divided into a thiopental sodium group (n =62) and a propofol group (n =49). These patients received intravenous anaesthesia with suxamethonium plus thiopental sodium or propofol for the implementation of ECT, respectively. The status of convulsive seizure was compared between the two groups. Results There were no significant differences between the two groups in terms of main demographic data, disease category and ECT parameters (Pgt;0.05). Motor seizure and electricity discharge lasted significantly longer in the propofol group than in the thiopental sodium group (Plt;0.01). Conclusion Thiopental sodium can increase the excitation threshold of brain cortical neurons and decrease the level of convulsive seizure induced by ECT. Propofol may decrease the excitation threshold, and increase the level of convulsive seizure under the same ECT parameters, but may have the potential to induce epileptic seizure.
Objective To assess the safety and efficacy of sufentanil combined with propofol for painless fiberbronchoscopy. Methods A total of 120 patients undergoing fiberbronchoscopy were divided into two groups according to their admission sequence: group S (sufentanil + propofol, n=60) and group F (fentanil + propofol, n=60). Parameters including heart rate (HR), systol ic blood pressure (SBP), diastol ic blood pressure (DBP), saturation of blood oxygen (SPO2), dose of propofol, duration of the procedure, waking time and score of Observer’s Assessment of Alertness/Sedation (OAA/S) scale were recorded. Results The HR increased significantly 3 minutes after drug administration in both groups (Plt;0.05). The SPO2 decreased significantly 3 minutes after drug administration in both groups (Plt;0.05). The average dose of propofol and OAA/a score were similar between the two groups (Pgt;0.05). The waking time was significantly shorter in group S than in group F (Plt;0.05). Conclusion Sufentanil combined with propofol could offer a good sedative/analgesic effect during painless fiberbronchoscopy.
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.
ObjectiveTo investigate the effect of etomidate and propofol on inflammatory cytokines and cortisol for patients with lung adenocarcinoma. MethodSixty patients scheduled for lung cancer surgery under general anesthesia were studied. All patients were randomly divided into an etomidate total intravenous anesthesia group (group E, 30 patients, 16 males and 14 females at age of 58.0±5.0 years) and a propofol total intravenous anesthesia group (group P, 30 patients, 17 males and 13 females at age of 55.0±5.0 years), with 30 patients in each group. ResultsThe concentration of IL-6 in serum of patients in the two groups at time points T1, T2 and T3 was significantly higher than those at time point T0 (P < 0.01). The concentration of IL-10 and TNF-α in serum of patients at time points T1 and T2 was significantly higher than those at time point T0 (P < 0.01). And the difference of the concentration of TNF-α in serum of patients at time points T0 and T3 was not statistically significant (P > 0.05). The level of Cor of patients in the group E at time point T0 was slightly higher than those at time point T1, but lower than that at time points T2 and T3. There was no statistical difference in the concentration of IL-6 and TNF-α in serum of patients between the two groups. The level of IL-10 of patients in the group E at time points T2 and T3 was lower than those in the group P (P < 0.05), but no significant difference was observed at the other time points. The concentration of Cor in the patients in the group E at time point T1 was lower than that in the group P (P < 0.01), but no significant difference was observed either at the other time points. ConclusionThe effect of etomidate used for maintenance of general anesthesia on the inflammatory factors is essentially similar to that of propofol.
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.
ObjectiveTo study the feasibility of using propofol and remifentanil for reduction of shoulder joint dislocation in the conscious elderly patients, and compare its efficacy with brachial plexus block anesthesia. MethodsSeventy elderly patients (American Sociaty of Anesthesiologist physical statusⅠ-Ⅱ) who underwent shoulder dislocation reduction in our hospital between August 2011 and December 2013 were randomly divided into two groups, each group having 35 cases. Patients in group A received brachial plexus nerve block anesthesia downlink gimmick reset, while patients in group B received the use of remifentanil-propofol and lidocaine compound liquid intravenous drop infusion for anesthesia downlink manipulative reduction. After successful anesthesia, two groups of patients were treated with traction and foot pedal method (Hippocrates) to reset. We observed the two groups of patients in the process of reduction, and recorded their hemodynamic changes, reset time, discharge time, postoperative satisfaction, intra-operative memory, breathing forgotten (breathing interval was longer than 15 seconds) and visual analogue scale (VAS) scores, and then comparison was made between the two groups. ResultsPatients in both the two groups successfully completed manipulative reduction. Compared with group A, patients in group B had more stable hemodynamic indexes during the process of reduction, shorter reduction time, better anesthesia effect and higher postoperative satisfaction degree, and the differences were statistically significant (P<0.05). There was no significant difference in terms of time of leaving the operation room between the two groups (P>0.05). VAS score was higher in group A than that in group B (P<0.05). The occurrence of intra-operative memory amnesia and breathing forgotten phenomenon existed in part of the patients after operation in group B, but they did not occur in patients in group A. ConclusionRemifentanyl propofol-lidocaine compound fluid can be safely used in conscious elderly patients for shoulder joint dislocation reconstructive surgery, and it functions quickly with complete analgesia and stable hemodynamic indexes.
Objective To evaluate the sedative and analgesic efficacy and adverse effect of dexmedetomidine versus propofol on the postoperative patients in intensive care unit (ICU). Methods The relevant randomized controlled trials (RCTs) were searched in The Cochrane Library, MEDLINE, PubMed, SCI, SpringerLinker, ScinceDirect, CNKI, VIP, WanFang Data and CBM from the date of their establishment to November 2011. The quality of the included studies was evaluated after the data were extracted by two reviewers independently, and then the meta-analysis was performed by using RevMan 5.1. Results Ten RCTs involoving 793 cases were included. The qualitative analysis results showed: within a certain range of dosage as dexmedetomidine: 0.2-2.5 μg/(kg·h), and propofol: 0.8-4 mg/(kg·h), dexmedetomidine was similar to propofol in sedative effect, but dexmedetomidine group needed smaller dosage of supplemental analgesics during the period of sedative therapy. The results of meta-analysis showed: the percentage of patients needing supplemental analgesics in dexmedetomidine group was less than that in propofol group during the period of sedative therapy (OR=0.24, 95%CI 0.08 to 0.68, P=0.008). Compared with the propofol group, the duration of ICU stay was significantly shorter in the dexmedetomidine group (WMD= –1.10, 95%CI –1.88 to –0.32, P=0.006), but the mechanical ventilated time was comparable between the two groups (WMD=0.89, 95%CI –1.15 to 2.93, P=0.39); the incidence of adverse effects had no significant difference between two groups (bradycardia: OR=3.57, 95%CI 0.86 to 14.75, P=0.08; hypotension: OR=1.00, 95%CI 0.30 to 3.32, P=1.00); respiratory depression seemed to be more frequently in propofol group, which however needed further study. Mortalities were similar in both groups after the sedative therapy (OR=1.03, 95%CI 0.54 to 1.99, P=0.92). Conclusion Within an exact range of dosage, dexmedetomidine is comparable with propofol in sedative effect. Besides, it has analgesic effect, fewer adverse effects and fewer occurrences of respiratory depression, and it can save the extra dosage of analgesics and shorten ICU stay. Still, more larger-sample, multi-center RCTs are needed to provide more evidence to support this outcome.
To investigate the effect of propofol intra-aortic and intravenous infusion on the concentration of propofol for an ischemia-reperfusion spinal cord injury in rabbits. Methods Forty-six healthy adult New Zealand white rabbits were randomly divided into 3 groups: sal ine infusion group (group N, n=10), propofol intra-aortic infusion group (group A, n=16) and propofol intravenous infusion group (group V, n=16). The infrarenal abdominal aorta was occluded for 30 min during which propofol 50 mg/kg was infused continuously intra-aortic or intravenous with a pump in group A and V. In group N, the same volume of normal sal ine was infused in the same way and at the same rate as in group A. Upon reperfusion, propofol concentration of the spinal segments of L4-6 and T6-8 was examined in group A and V. At 48 hoursafter reperfusion, the neurological outcomes were recorded in each group. Results Mean blood pressure in group V from the time of 5 minutes after occlusion decreased more than in group N (P lt; 0.05) and than in group A from the time of 10 minutes after occlusion(P lt; 0.05). The mean blood pressure in group N increased more than in group A from 15 minutes after occlusion (P lt; 0.05). The heart rate increased more in group V from 10 minutes after occlusion than in group N and A (P lt; 0.05) in which no difference was observed. The propofol concentration in L4-6 of group A (26 950.5 ± 30 242.3) ng/g was higher than that in T6-8 of group A (3 587.4 ± 2 479.3) ng/g and both L4-6 (3 045.9 ± 2 252.9) ng/g and T6-8 (3 181.1 ± 1 720.9) ng/g of group V(P lt; 0.05). The paraplegia incidence was lower (30%) and the median of normal neurons was higher (8.4) in group A than in group N (80%, 2.2) and group V(100%, 1.9), (P lt; 0.05). There was no significant difference in group N and V in paraplegia incidenceand the median of normal neurons (P gt; 0.05). Conclusion Intra-aortic infusion shows a better neurological outcome than intravenous infusion and could contribute to higher concentration of propofol in the ischemia spinal cord.
Objective To investigate clinical application and safety evaluation of sedative demulcent anesthesia in therapeutic endoscopic retrograde cholangiopancreatography (ERCP).Methods Totally 1660 patients underwent ERCP at the First Hospital of Lanzhou University were prospectively divided into two groups: venous sedative demulcent group (n=800, using sufentanil and midazolam and propofol continuing infusion) and conventional sedative demulcent group (n=860, using common medicine). The heart rate (HR), respiration (R), blood pressure (BP) and peripheral oxygen saturation (SpO2) of pre-anesthesia, post-anesthesia, during operation and after analepsia in every group were detected. The narcotism was evaluated by Ramsaymin grading method and the related adverse reactions such as cough, restlessness, harmful memory, and abdominal pain after operation were recorded. Results Compared with conventional sedative demulcent group, vital signs of patients in venous sedative demulcent group were more stable. For postoperative adverse reactions, abdominal pain, abdominal distension and nausea and vomiting were respectively 4.4%(35/800), 2.6%(21/800) and 3.6%(29/800) in venous sedative demulcent group, which were respectively higher of the incidence of 36.3%(312/860), 49.0%(421/860) and 53.0%(456/860) in conventional sedative demulcent group (P＜0.01). The postoperative satisfaction and adverse reactions recall between venous sedative demulcent group and conventional sedative demulcent group was respectively significant different (96.9% vs. 2.9%, 4.8% vs. 97.9%, P＜0.01). Conclusion Sufentanil and midazolam and propofol continuing infusion have good effect of sedative demulcent anesthesia, which can be widely used.