Propofol

摘要： Endotracheal intubation is one of the most common,yet most dangerous procedure performed in the intensive care unit(ICU).Complications of ICU intubations include severe hypotension,hypoxemia,and cardiac arrest.Multiple observational studies have evaluated risk factors associated with these complications.Among the risk factors identified,the choice of sedative agents administered,a modifiable risk factor,has been reported to affect these complications(hypotension).Propofol,etomidate,and ketamine or in combination with benzodiazepines and opioids are commonly used sedative agents administered for endotracheal intubation.Propofol demonstrates rapid onset and offset,however,has drawbacks of profound vasodilation and associated cardiac depression.Etomidate is commonly used in the critically ill population.However,it is known to cause reversible inhibition of 11β-hydroxylase which suppresses the adrenal production of cortisol for at least 24 h.This added organ impairment with the use of etomidate has been a potential contributing factor for the associated increased morbidity and mortality observed with its use.Ketamine is known to provide analgesia with sedation and has minimal respiratory and cardiovascular effects.However,its use can lead to tachycardia and hypertension which may be deleterious in a patient with heart disease or cause unpleasant hallucinations.Moreover,unlike propofol or etomidate,ketamine requires organ dependent elimination by the liver and kidney which may be problematic in the critically ill.Lately,a combination of ketamine and propofol,“Ketofol”,has been increasingly used as it provides a balancing effect on hemodynamics without any of the side effects known to be associated with the parent drugs.Furthermore,the doses of both drugs are reduced.In situations where a difficult airway is anticipated,awake intubation with the help of a fiberoptic scope or video laryngoscope is considered.Dexmedetomidine is a commonly used sedative agent for these procedures.

摘要： Objective:To investigate the effects of propofol and ketamine on seizure duration,hemodynamics,and recovery of electroconvulsive therapy(ECT).Methods:This prospective randomized trial included patients who had undergone ECT under anesthesia.Patients received injection of propofol 1.5 mg/kg i.v.(the propofol group)or ketamine 0.8-1.2 mg/kg i.v.(the ketamine group)during ECT.Seizure duration,hemodynamics,and recovery were recorded and compared between the two groups.Results:This trial included 44 patinets with 22 patients receiving propofol and 22 patients receiving ketamine.The total dose of propofol and ketamine was(105.68±25.27)mg and(81.36±24.55)mg,respectively.The motor seizure and electroencephalogram seizure duration were prolonged in the ketamine group(P0.05);however,the mean systolic blood pressure during the procedure was significantly higher in the ketamine group(P=0.04).Besides,spontaneous eye-opening in the ketamine group took longer than that of the propofol group(P=0.001).Conclusion:Both propofol and ketamine are safe as anesthetic agents for modified ECT,and ketamine provides a longer seizure duration without hemodynamic instability or any significant complication.

摘要： Opioid-induced hyperalgesia negatively affects physiological pain management and presents a complex causal mechanism, involving, pharmacodynamic and pharmacokinetic factors of interactions with receptors, opioid-independent ascending systems and with pro-nociceptive systems. After approval by the CEUA, 42 male Wistar rats were divided into 7 groups: In group 1 (GCSSL) the animals received 1 ml of 0.9% saline solution intraperitoneally (IP);in group 2 (GFTSL), they received fentanyl at a dose of 100 ug·kg-1 IP;in the remaining groups (3, 4, 5, 6 and 7) the animals received IP, fentanyl at a dose of 100 ug·kg-1 followed also by IP route of: group 3 (GFTKP) ketoprofen at a dose of 5 mg·kg-1;group 4 GFTKT), ketamine up to a dose of 10.0 mg·kg-1;group 5 (GFTLI), incisional lidocaine up to a dose of 10 mg·kg-1;group 6 (GFTLP), intraperitoneal lidocaine up to a dose of 10 mg·kg-1 and group 7 (GFTPP), propofol up to a dose of 60 mg·kg-1. Under general anesthesia, all animals with a plantar surgical incision. Hyperalgesia was evaluated by applying Von Frey filaments on the 2nd, 1st, 3rd and 5th days after treatment. In the 2nd hour and on the 5th day after the procedure, there was no hyperalgesia associated with the use of fentanyl, however, on the 1st and 3rd postoperative days there was hyperalgesia that was attenuated by ketoprofen, ketamine, lidocaine infiltrated in the incision and intraperitoneally, an effect not observed with the use of propofol. The results suggest fentanyl-induced hyperalgesia and the efficacy of ketoprofen, ketamine, incisional lidocaine and intraperitoneal lidocaine in reducing this effect.

摘要： Objective:To explore the application of thoracic nerve block and propofol anesthesia in the treatment and perioperative period.Methods:A total of 40 patients with thoracotomy for esophageal cancer between May 2020 and September 2021 in the hospital were selected to participate in this study.All the patients were divided into reference and experimental groups according to the anesthesia protocol.For the experimental group,the parathoracic vertebral nerve block scheme was used under ultrasound guidance,with general anesthesia in the same manner,and after the surgical treatment of both groups,the patient-controlled intravenous analgesia(PCIA)regimen was applied to both patients.The time of surgery for the two patient groups,intraoperative propofol,postoperative pain conditions and postoperative blood glucose and NE,E,DA levels were measured and conducted for comparative analysis.Results:There is no significant differences between the two groups,besides,in the experimental group,propofol in surgery was less than that in the reference group;At the T6~T9 timepoint,patients in the experimental group had lower VAS scores in quiet and active conditions than those in the reference group;At the T9 timepoint,blood glucose and NE levels were higher than the T1,T4,T5 time point levels in each group;At the T4,T4 timepoint,E levels in both groups were lower than the T1,T9 time point level in each group;at T9 time point,the DA level was higher in the reference group than the T1,T4 time point level in each group;at T9 Time point,blood glucose and NE,E,DA were lower than those in the reference group.Conclusions:In the treatment of thoracotomy in elderly patients,thoracic paravertebral nerve block compound propofol anesthesia program can be used to patients,with striking anesthesia effect and remarkable recovery effect in perioperative period,which is conducive to relieving postoperative pain and worth promotion and application.

摘要： BACKGROUND Children are a unique patient population.Anesthesia for pediatric abdominal surgery has long been achieved mainly with intravenous amiodarone and propofol alone or combined with other anesthetics.The incidence of complications and postoperative adverse reactions is relatively high owing to the imperfect development of various protocols for children.Choosing the most appropriate anesthesia program is an important means of reducing adverse reactions.AIM To explore the clinical value of propofol combined with lidocaine-assisted anesthesia in pediatric surgery.METHODS A total of 120 children who underwent abdominal surgery at our hospital from January 2016 to March 2018 were selected and divided into groups A and B using the random number table method,with 60 patients in each group.Group B received ketamine for anesthesia,while group A received ketamine,propofol,and lidocaine.The pre-and postoperative heart rate(HR);mean arterial pressure(MAP);arterial oxygen saturation(SpO_(2));serum adrenocorticotropic hormone(ACTH),interleukin-6(IL-6),and cortisol(Cor)levels;restlessness score during the recovery period[Paediatric Anesthesia Emergence Delirium Scale(PAED)];and adverse reactions were compared between the two groups.RESULTS The HR,MAP,and SpO_(2) Level at five minutes before initiating anesthesia were compared between groups A and B,and the difference was not statistically significant(P>0.05).At 10 and 20 minutes after anesthesia initiation,the HR and MAP were lower in group A compared with group B(P0.05);however,the postoperative serum ACTH,IL-6,and Cor levels in group A were lower compared with group B(P<0.05).Furthermore,the visual analog scale scores of group A at 2 h and 8 h postoperative were lower than those in group B,and the differences were statistically significant(P<0.05).The mean PAED score in group A was lower than that in group B(P<0.05),and the incidence of restlessness in group A was 23.33%lower than that in group B(36.67%)(P<0.05).The incidence of adverse reactions was lower in group A than in group B(6.25%vs 16.25%).CONCLUSION The anesthetic effect of propofol combined with lidocaine and ketamine in pediatric surgery was better than that of ketamine alone,and had less influence on hemodynamics and pediatric stress response indices,lower incidence of restlessness in the recovery period,and lower incidence of adverse reactions.

摘要： BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.AIM To compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.METHODS We enrolled 61 American Society of Anesthesia(ASA) class Ⅰ-Ⅱ outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index(PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.RESULTS For the propofol group, the mean postoperative global PSQI score(3.3 ± 1.3) was lower than the mean preoperative global PSQI score(4.9 ± 2.3)(P < 0.001);for the sevoflurane group, the mean postoperative global PSQI score(6.5 ± 2.8) was higher than the mean preoperative global PSQI score(5.5 ± 3.2)(P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.CONCLUSION Sleep quality assessed by the PSQI is better improved in ASA class Ⅰ-Ⅱ female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.

摘要： BACKGROUND Although propofol generally reduces blood pressure,rarely,it causes hypertension.However,the mechanism by which propofol increases blood pressure has not been established,and so far,there are only a few reported cases.CASE SUMMARY A 46-year-old woman,diagnosed with thyroid cancer,was administered general anesthesia with propofol and remifentanil for a thyroid lobectomy.An increase in the concentrations of intravenous anesthetics further increased her blood pressure.The blood pressure remained stable when anesthesia was maintained with sevoflurane and remifentanil after the interruption of propofol administration.CONCLUSION We concluded that propofol administration was the cause of increased blood pressure.

摘要： BACKGROUND The ideal depth of general anesthesia should achieve the required levels of hypnosis,analgesia,and muscle relaxation while minimizing physiologic responses to awareness.The choice of anesthetic strategy in patients with coronary heart disease(CHD)undergoing major noncardiac surgery is becoming an increasingly important issue as the population ages.This is because general anesthesia is associated with a risk of perioperative cardiac complications and death,and this risk is much higher in people with CHD.AIM To compare hemodynamic function and cardiovascular event rate between etomidate-and propofol-based anesthesia in patients with CHD.METHODS This prospective study enrolled consecutive patients(American Society of Anesthesiologists grade II/III)with stable CHD(New York Heart Association class I/II)undergoing major noncardiac surgery.The patients were randomly allocated to receive either etomidate/remifentanil-based or propofol/remifentanil-based general anesthesia.Randomization was performed using a computer-generated random number table and sequentially numbered,opaque,sealed envelopes.Concealment was maintained until the patient had arrived in the operating theater,at which point the consulting anesthetist opened the envelope.All patients,data collectors,and data analyzers were blinded to the type of anesthesia used.The primary endpoints were the occurrence of cardiovascular events(bradycardia,tachycardia,hypotension,ST-T segment changes,and ventricular premature beats)during anesthesia and cardiac troponin I level at 24 h.The secondary endpoints were hemodynamic parameters,bispectral index,and use of vasopressors during anesthesia.RESULTS The final analysis included 40 patients in each of the propofol and etomidate groups.The incidences of bradycardia,hypotension,ST-T segment changes,and ventricular premature beats during anesthesia were significantly higher in the propofol group than in the etomidate group(P<0.05 for all).The incidence of tachycardia was similar between the two groups.Cardiac troponin I levels were comparable between the two groups both before the induction of anesthesia and at 24 h after surgery.When compared with the etomidate group,the propofol group had significantly lower heart rates at 3 min after the anesthetic was injected(T1)and immediately after tracheal intubation(T2),lower systolic blood pressure at T1,and lower diastolic blood pressure and mean arterial pressure at T1,T2,3 min after tracheal intubation,and 5 min after tracheal intubation(P<0.05 for all).Vasopressor use was significantly more in the propofol group than in the etomidate group during the induction and maintenance periods(P<0.001).CONCLUSION In patients with CHD undergoing noncardiac major surgery,etomidate-based anesthesia is associated with fewer cardiovascular events and smaller hemodynamic changes than propofol-based anesthesia.

摘要： Objective:To observe the anesthetic effect of dexmedetomidine combined with the mixture of propofol and etomidate on painless gastroscopy in children.Methods:A total of 80 pediatric patients who underwent painless gastroscopy in the Guangxi Minzu Hospital from January 2019 to September 2020 were randomly divided into two groups,A and B,with 40 patients in each group.Group A was given A mixture of etomidate 20 mg and propofol 0.2g,Dexmedetomidine was pumped into group B 10min before surgery,0.4 g/kg.HR,SBP,DBP,SpO2 and BIS were continuously monitored after entering the room.The doses of propofol and etomidate were recorded,as well as the time of waking and leaving the hospital.Adverse reactions such as hypotension,hypoxemia,nausea,vomiting and dizziness were recorded too.Results:Compared with group A,the dosage of propofol and etomidate in group B was significantly reduced(P<0.001),the time of waking and out of the chamber were significantly shortened(P<0.001),the body movement in the incidence of intraoperative was significantly reduced(P<0.001),and the nausea,vomiting and dizziness in the incidence of postoperative were significantly reduced(P<0.05).Conclusion:Dexmedetomidine combined with propofol and etomidate mixture can be safely used in painless gastroscopy in children,which can significantly reduce the dosage of propofol and etomidate,reduce the occurrence of adverse reactions,and shorten the time of resuscitation and discharge.

摘要： Objective:To explore the effect of propofol(Prof)on the proliferation,migration and invasion of human gastric cancer cell MGC-803 and its molecular mechanism.Methods:The MTT method was used to study the effects of Prof with different doses and durations on the viability of MGC-803 cells.Hoechst 33258 staining and electron microscopy were used to detect the effects of Prof on MGC-803 cell apoptosis.Transwell experiments were used to detect the effects of Prof on the migration and invasion of MGC-803 cells.RT-PCR detects the effect of Prof on the expression of miR-195 in MGC-803 cells,and Western Blot detects the effect of Prof on the protein expression of JAK/STAT signaling pathway.Results:Compared with 0μg/ml Prof,5μg/ml,10μg/ml and 20μg/ml Prof treatment with 24h,48h and 72h can significantly reduce cell viability(P<0.05).Compared with the Control group,the percentage of Hoechst 33258 staining positive cells in the Prof group and the apoptosis rate under the electron microscope were significantly increased(P<0.05).Compared with the Control group,the cell migration rate and invasion rate of the Prof group were significantly reduced(P<0.05).Compared with the Control group,the expression of miRNA-195 in the Prof group cells was increased significantly(P<0.05).Compared with the Control group,the activity of p-Jak1 and p-STAT3 proteins in the Prof group were significantly reduced(P<0.05).Conclusion:Prof can reduce the cell viability,migration and invasion of gastric cancer cell MGC-803,and promote its apoptosis.Its mechanism may be related to the promotion of miR-195 expression and inhibition of JAK/STAT signal pathway activity.

摘要： 一种不含防腐剂的Propofol水包油乳剂的无菌的稳定药物制剂,其包括优化量的豆油和蛋黄卵磷脂,具有适合的pH范围,以在偶然的,外在的污染后的至少24小时,防止微生物显著增加。本制剂的低pH值显示出最佳的抗菌活性。本制剂中降低的脂肪含量还使长期使用镇静剂的患者减少高血脂的负担。