Target-controlled Infusion Of Propofol Combined With Fentanyl Or Dexmedetomidine Conscious Sedation For Colonoscopy In The Diagnosis And Treatment Of Observation And Comparison

Objective:To study and compare the target-controlled infusion (TCI) combinedwith different dosage of fentanyl and propofol target controlled propofolinfusion of dexmedetomidine conscious sedation and analgesia werepainless enteroscopy in the diagnosis and treatment of clinical feasibility,safety and conscious sedation is required when the target controlledpropofol blood concentration.Method:choose150cases in our hospital from2014October--2014December outpatient painless colonoscopy patients, aged between20~55years old, ASA I~II, were randomly divided into5groups, each group of30cases. Conscious sedation group, the first group was given propofoltarget controlled infusion (TCI) combined with dexmedetomidinesedation anesthesia, first infusion of dexmedetomidine loading dose of0.5ug/kg10minutes to finish,10minutes after the start of propofol TCI;The second group was given propofol target controlled infusion (TCI)anesthesia sedation composite1ug/kg fentanyl, first infusion of fentanyl1ug/kg,1minutes after the start of propofol TCI;The third group wasgiven propofol target controlled infusion (TCI) anesthesia sedationcomposite1.5ug/kg fentanyl, first infusion of fentanyl1.5ug/kg,1minutes after the start of propofol TCI; Propofol target controlled infusion (TCI) process is the target plasma concentration of preliminary design forthe0.4ug/ml, and when the effect compartment concentration equilibrium,in increments of0.1ug/ml, until the alertness/sedation scale (OAA/S)=3,began to colonoscopy, observation, recording of the patient’s vital signs(such as HR, MAP, SPO2) changes, target concentration of propofol, totaldosage of propofol and the incidence of adverse reactions, at the backmirror, stop target controlled infusion. And compared to the results of thethree groups, select the best group (group A) and group B, the traditionalmanual infusion of propofol group (1.5~2mg/kg) and C group Continuousinfusion of propofol (400ml/h speed continuous infusion of propofol,propofol during the process of bronchoscopy sustained4-6mg.kg-1.h-1administration) compared to explore the methods of anesthesia, morereasonable, more safety, more feasible painless. And compared to theresults of the three groups, select the best group (A group), A group and Bgroup of traditional manual infusion of propofol group (1.5~2mg/kg) andC group improved target controlled infusion of propofol group (Targeteffect site concentration is4times the loss of consciousness duringconcentration, target concentration mirror after insertion to2.5times)compared to explore anesthesia method is more reasonable and moresafety, more feasible painless.Results:1. There were no significant differences in age, weight, gender,colonoscopy and operation time of patients between the five groups(p>0.05), no statistical significance.2. Conscious sedation group:Third of three groups of fentanyl (1.5ug/kg) is the best group (groupA);Because the second groups of fentanyl (1ug/kg) group test failure rateis higher, has ruled out. But the first groups long induction time (about10 minutes), do not apply to the shorter duration of colonoscopy. So incontrast, the third group is the optimal group, set to A group.3. Comparison of the control group and continuous infusion groupwith manual infusion:The effect of the three groups on the circulatory system was nosignificant difference, no significant.The total dosage of propofol Bgroup>C group>A group;The incidence of hypoxemia is B group>Cgroup>A group; Adverse reaction rate was B group>C group>Agroup;The recovery time is B group>C group>A group. Compared withthe B group, the total dosage of propofol was less, the vital signs weremore stable and the adverse reactions were less than A group and Cgroup，because for conscious sedation, patients in the natural non REMsleep, wake up at any time, save the patients recovery time, high turnoverrate. Is more effective, more feasible, safer anesthesia method.Conclusion:propofol target controlled infusion (TCI) composite1.5ug/kgfentanyl and propofol target controlled infusion (TCI) composite ofdexmedetomidine for sedation painless colonoscopy is feasible, safe, themost effective one is composite1.5ug/kg fentanyl, the optimal dose andconscious sedation is target plasma concentration of1.0~1.5ug/ml.