Objective To evaluate the sedative effects of fentanyl on ventilated patients in intensive care unit (ICU ).Methods Thirty orotracheal intubated and mechanical ventilated medical patients in ICU were randomly divided into two groups，ie.Midazolam group (group M) and midazolam combined with fentanyl group with a proportion of 100∶1 (group M+F) The sedatives were continuously intravenously infused to achieve a target motor activity assessment scale (MAAS) of 3 and ventilator synchrony score of adaptation to the intensive care environment (ATICE) ≥3 after loading dose of midazolam.The sedation level was evaluated and the infusion rate was adjusted to maintain the target sedation goal every 2 h and the hemodynamic，respiratory and sedative parameters were recorded simultaneously.The oxygenation index were measured at 12 and 24 h.The infusion were ceased after 24 h,then the sedative degree was assessed every 30 min until MAAS ≥3 and the recover time were recorded.Results There were no significant differences in blood pressure，oxygenation index and adjustive frequency of drugs between the two groups (all Pgt;0.05).The heart rate，respiratory rate and airway pressure in group M+F decreased significantly than those in Group M (Plt;0.05).The amount of midazolam used and cost of sedatives were lower than those in group M (Plt;0.05).Satisfactory degree of sedation or ventilator synchrony and awakeness score of ATICE in group M+F were higher than those in group M.The recover time was shorter in groupM+F (Plt;0.05).Conclusion In medical ventilated patients, fentanyl improves the sedative effect of midazolam and reduces the dose of midazolam,hence,reduce the total cost of sedatives.
Objective To carry out a meta-analysis to evaluate the efficacy and safety of dexmedetomidine in comparison with midazolam as preoperative drug. Methods All randomized controlled trials (RCTs) about dexmedetomidine as preoperative drug compared with midazolam were identified. Meta analysis was performed by using the statistical software RevMan 4.2.10 on the basis of strict quality evaluation. Results Thirteen RCTs involving 806 patients were included. The results of meta analyses showed that dexmedetomidine was better than midazolam in decreasing perioperative blood pressure and heart rate, decreasing dosage of anesthetics, shortening of emergence time, and decreasing the occurrence of agitation, while the occurrence of perioperative hypotention and bradycardia of dexmedetomidine was much more than midazolam. The statistical outcomes showed that there were no differences between the two drugs in the satisfactory score, postoperative sedation score, the number of people needing analgesia, and occurrence of nausea and vomitting. Conclusion Significant advantages in favour of dexmedetomidine as preoperative drug are observed. Dexmedetomidine is safe except for more incidences of hypotension and bradycardia.
目的:讨论胃镜检查中更加舒适的一种镇静镇痛方法。方法:芬太尼-异丙酚为Ⅰ组,咪唑安定-异丙酚组为Ⅱ组。观察记录各组术中的反应、胃镜操作时间、麻醉药物起效时间、苏醒时间和清醒时间,检查前中后BP、HR和SpO2的变化,及术后问卷调查。结果:Ⅰ组药物的起效快,受检者苏醒及清醒时间短,术中不适反应少,与Ⅱ组比较有统计学意义(Plt;0.01)。结论:镇静无痛苦胃镜检查中芬太尼-异丙酚联合用药更舒适。
ObjectiveTo explore the efficacy and safety of different sedative and analgesic methods in emergent endotracheal intubations in RICU. Methods110 cases of tracheal intubation in critically ill patients were divided into 5 groups randomly: ① control group(given no sedative or analgesic drug before intubation); ② fentanyl group(given intravenous fentanyl 2 μg/kg before intubation,followed by fentanyl 2 μg·kg-1·h-1 maintenance); ③ dexmedetomidine hydrochloride+fentanyl group(given dexmedetomidine hydrochloride 1 μg/kg+fentanyl 2 μg/kg before intubation,followed by dexmedetomidine hydrochloride 0.5 μg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ④ midazolam+fentanyl group(given midazolam 0.05 mg/kg+fentanyl 2 μg/kg before intubation,followed by midazolam 0.05 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance); ⑤ Propofol+fentanyl group(given propofol 1 mg/kg+fentanyl 2 μg/kg before intubation,followed by propofol 0.4 mg·kg-1·h-1+fentanyl 2 μg·kg-1·h-1 maintenance).The mean arterial pressure(MAP),heart rate(HR),respiratory frequency(RR),PaO2/FiO2,Riker sedation score and agitation were monitored before,during and after intubations.The one-time success rate of intubation and severe arrhythmia (sinus bradycardia,frequent ventricular premature,ventricular fibrillation,and cardiac arrest) incidence rate were recorded. ResultsThe one-time success rates of intubations of the propofol+fentanyl group (95.4%) and the midazolam+fentanyl group (90.9%) were higher than that in the dexmedetomidine hydrochloride+fentanyl group (86.4%,P<0.05),while one-time intubation success rate of three groups were higher than that of the fentanyl group (45.4%) and the control group (31.8%,P<0.05).5 minutes after intubation,the PaO2/FiO2 index of 5 groups of patients were higher than those before intubation,but the PaO2/FiO2 index of the control group and the fentanyl group were lower than those in the other three groups(P<0.05).The occurrence of serious arrhythmia rate in the dexmedetomidine hydrochloride+fentanyl group (0%),the midazolam+fentanyl group (9%) and the propofol+fentanyl group (9%) were lower than that in the control group (13.6%) and the fentanyl group (18.2%).The MAP during intubation and 2 minutes after intubation of the propofol+fentanyl group and the midazolam+fentanyl group were lower than that in the other three groups(P<0.05).The proportion of patients with Riker sedation and agitation score≤4 at intubation in the dexmedetomidine hydrochloride+fentanyl group (68.2%) was lower than that in the propofol+fentanyl group(90.9%) and the midazolam+fentanyl group (86.4%,P<0.05),but higher than those in the fentanyl group(22.7%)and the control group(18.2%,P<0.05). ConclusionPropofol,midazolam or dexmedetomidine hydrochloride with fentanyl are all effective and safe methods of sedation and analgesia in emergent endotracheal intubation in RICU.Dexmedetomidine hydrochloride with fentanyl is an ideal sedative relatively with less influence on cardiovascular system and less myocardial oxygen consumption.