The Differential Effects of Prostaglandin E1 and Nitroglycerin on Regional Cerebral Oxygenation
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In Response: We thank Dr. Spahn for his comments regarding our recent article. As he points out, there were several errors in the units of doses. We would like to correct the mistakes and also provide additional information concerning the study protocol. Prostaglandin E, and nitroglycerin were infused IV at a rate of 0.3 [micro sign]g [center dot] kg-1 [center dot] min-1 and 5 [micro sign]g [center dot] kg-1 [center dot] min-1, respectively. Anesthesia was induced by an IV dose of 30 [micro sign]g/kg of fentanyl, 0.2 mg/kg of midazolam and 0.2 mg/kg of vecuronium. Vecuronium was supplemented at a rate of 0.1 mg [center dot] kg-1 [center dot] 30 min-1 by the end of operation. The study reported in this article was completed within 1 h after the induction. No other drug was given in this study. The administration protocol of the anesthetics and the muscular relaxant was exactly the same for each group. Considering the hemodynamic stability of the patients, their anesthesia status was thought to be stable and sufficient for the stimulus in this study. Before the operation, the patients in this study had been under the same preoperative medication protocol at least for 1 wk. That pro-tocol was oral administration of 20 mg/d isosorbide dinitrate and 10 mg/d nitrendipine. Because the body weights of the patients were within the 40-60 kg range, the dose was not modified according to the body weight. Yuji Kadoi, MD Department of Anesthesiology and Reanimatology; Gunma University School of Medicine; Maebashi 371, JapanKeywords:
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Objective To compare the effiect of three kinds of methods,make sedation anesthesia and safty have the ahemative for easy endoscopy.Methods 90 patients were randomized into three groups,Group A used(propofor,midazolam and fentanyl group,n=30),Group B used(propofor,fentanyl group,n=30),Group C used(propofor group,n=30).Group A used midazolam 1mg iv combined with propoful 1.5mg/kg in 3mg/s speed and fentanyl 10μg/kg.Group B used fentanyl 10μg/kg combined with propofor 2mg/kg in 3mg/s.Group C used propofor 2mg/kg iv in 3mg/s.Heart rate,blood pressure and SpO2 were measured before the procedure and monitored continuously during and after the procedure.Results Group A presented on obvious sedation and anesthesia compared with Group B and C,P0.05.Conclusion Propofor combined with midazolam and fentanyl presents optimal effective in sedation and anesthesia for endoscopy.
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Objective:To study the applicability and side effects of propofol combined with low dose midazolam and fentanyl in patients undergoing gastroscopy.Methods:200 ASAⅠ~Ⅲ patients undergoing gastroscopy were randomly divided into analgesia group(Ⅰ)and control group(Ⅱ).In groupⅠ(n=100),propofol 1～1.5mg/kg,Midazolam 0.03mg/kg,Fentanyl 0.4μg/kg were given intravenously slowly,gastroscope was inserted till loss of lid relax occurred.Group Ⅱ(n=100),patients received regular gastroscopy.SBP MAP and HR were measured during operation and after operation.Results:Successful rate of gastroscopy in group Ⅰ(100%)was higher than in group Ⅱ(91%).In group ⅠSBP MAP and HR at the fifth minute after operation were significantly decreased compared with pre-operation values(P0.05).In group Ⅱ SBP MAP and HR were significantly increased compared with pre-operation values(P0.05).In the two groups SBP MAP and HR returned normal after operation.Recovery time and Leaving time were(6.30±2.40)min and(17.45±4.50)min respectively.In groupⅠ,the satisfiable score and acceptable rate of next gastroscopy were singnificantly higher than in group Ⅱ(P0.05).Conclusions:Propofol combined with low dose Midazolam and Fentanyl is applicable and safe in analgesia gastroscope.
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Objective To evaluate the sedative and analgesic effect and the safety of fentanyl combined with midazolam or propofol for colonoscopy in elderly patients.Methods Eighty elderly patients were randomly divided into 2 groups: midazolam-fentanyl group(Group MF) and propofol-fentanyl group(Group PF);colonoscopy was undergone by one doctor.The effect of sedation and analgesia,operation time,the reaction of patients,the blood pressure(MBP),oxygen saturation value(SpO2),and pulse and breath rates were observed.Results Analgesic and sedative effect were satisfactory in two groups.But Group PF was better than Group MF(P 0.05).The operation time was shorter in Group MF[(6.7 ± 1.6)min] than in Group PF[(9.2 ± 1.1)min].Patients showed a high percentage of comfort in two groups(Group MF 9.4 ± 0.5,Group PF 9.7 ± 0.3,P 0.05).During operation,MBP,SpO2,and pulse were significantly lower in Group PF than in Group MF.Con-clusion fentanyl-propofol or midazolam-fentany is effective in colonoscopy of elderly patients,but fentanyl-propofol is safer and superior to midazolam-fentang in the procedure.
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AIM To observe the influence of combining fentanyl, midazolam and propofol for induction and maintenance in intravenous anesthesia on physiological indices of surgical patients. METHODS 60 patients undergoing general anesthesia were induced with fentanyl, midazolam and propofol, then maintained by combining infusion of these drugs and by intermittent injection of vecuronium and fentanyl. ECG, BP, HR, SpO 2, and P ET CO 2 were monitored during the anesthesia . RESULTS The indices of hemodynamics were stable. Physiological responses were stable and no compliction was observed. CONCLUSION The total intravenous anesthesia fits the need of all kinds of surgeries.
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Objective To observe the effects of propofol or midazolam combined with fentanyl on GABA_A receptor in acutely dissociated hippocampal pyramidal neurons of neonatal rats, so as to reveal the possible mechanism of the combined anesthesia. Methods Whole-cell patch-clamp technique was used to record the GABA_A receptor-induced currents (I_GABA) in four groups(n=5 of each), ie, propofol(groupⅠ), propofol combined with fentanyl(groupⅡ), midazolam (groupⅢ) and midazolam combined with fentanyl(groupⅣ). Results 0.3-30.0 μmol/L propofol (groupⅠ,Ⅱ) and 0.03-100.0 μmol/L midazolam (groupⅢ, Ⅳ) facilitated I_GABA with the greatest enhancement at 3.0 μmol/L of each (P0.05). Following 0.01 μmol/L fentanyl pretreatment for 10 minutes, the facilitation of I_GABA by 3.0 μmol/L propofol increased significantly [(127.2±11.2)% (groupⅠ) vs (212.5±14.9)% (groupⅡ), P0.05, n=5], whereas the effects of midazolam were not changed by fentanyl pretreatment [(158.2±34.0)% (groupⅢ) vs (116.3±46.0)% (groupⅣ), P0.05, n=5]. Conclusion Fentanyl can enhance the effects of propofol on GABA_A receptor, but not influence those of midazolam. Propofol or midazolam combined with fentanyl may prevent the neuroexcitatory effects of fentanyl, supporting their use in combination for clinical anesthesia.
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Objective To investigate the effect of midazolam,fentanyl combined with propofol in painless artificial abortion.Methods 400 ASAⅠ-Ⅱ patients were randomly divided into 2 groups,200 cases in each group:groupⅠ(midazolam fentanyl combined with propofol) and group Ⅱ(fentanyl combined with propofol).Results The freakout rate of groupⅠwas sigmifcantly lower than that of group Ⅱ(P0.05).The anesthesia effect of group Ⅰwas better than that of group Ⅱ(P0.05).The awake time and the discharge time of two groups were similar.conclusion Midazolam,fentanyl combined with propofol is more effective and safe anesthesia for painless artificial abortion.
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To the Editor.— Myron Yaster et al are to be congratulated for their candid discussion of the near fatal experience with midazolam-fentanyl described in their article.1 By 1988 at least 88 deaths had been reported to the Food and Drug Administration under similar circumstances; and these represent only the tip of the iceburg because most occurrences are not reported. Yaster has warned quite correctly that all sedatives become general anesthetics if enough drug is given. Fentanyl, as does any opiate, prolongs and potentiates in unpredictable fashion the effects of midazolam (Versed).
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