| Background and Objective:For elderly patients with many basic diseases,painless gastrointestinal endoscopy is prone to blood pressure and respiratory depression.When analgesia is insufficient,nausea,vomiting and body movement caused by gastrointestinal endoscopy operation will also increase the risk of aspiration pneumonia and digestive tract injury.In addition,painless gastrointestinal endoscopy also has postoperative abdominal pain,nausea,vomiting,myoclonus and other adverse reactions.Therefore,anesthesiologists should find a most reasonable anesthesia method to bring safety and comfort to the elderly patients in painless gastrointestinal endoscopy.In recent years,it has been confirmed by experiments that the combined use of etomidate and propofol in a volume ratio of 1:2 can provide more stable respiration and circulation,reduce the incidence of nausea,vomiting and muscle tremor associated with etomidate,and achieve an ideal sedative effect compared with the single use of propofol or etomidate.At present,the majority of domestic hospitals still choose the simple μ receptor agonist sufentanil as the choice of gastrointestinal endoscopy analgesic drugs.However,excitation of μ-receptors can inhibit respiration,inhibit gastrointestinal peristalsis,and cause nausea and vomiting.Oxycodone can stimulate κ receptor,has a unique advantage for the analgesia of visceral pain,and has a low affinity with μ receptor,so the adverse reactions related to μ receptor are reduced.At the same time,it has been reported that the use of oxycodone during general anesthesia can maintain stable hemodynamic and respiratory parameters.The purpose of this study was to compare the safety and efficacy of oxycodone versus sufentanil in the presence of etomidate and propofol 1:2 mixture(EP mixture)as a sedative in painless gastrointestinal endoscopy in elderly patients.Methods:A total of 80 elderly patients(65-79-year-old,ASA Ⅰ-Ⅲ)of painless gastrointestinal endoscopy were enrolled in this study.The patients were randomly assigned to two groups using a random number table:oxycodone group(O,n=40)and sufentanil group(S,n=40).After entering the room,the upper limb venous access was opened,and the patient was placed in the left decubitus position.The patient was connected to ECG monitoring,and the heart rate,the blood pressure of the left upper limb and the oxygen saturation of the finger pulse of the right fingertip were monitored.The dental pad was put on,oxygen was inhaled and nitrogen was removed,and the oxygen flow was 6L/min.Group O:oxycodone 0.05mg/kg was slowly injected intravenously.Group S:sufentanil 0.05ug/kg was slowly injected intravenously.Etomidate 20mg ratio of 1%propofol 200mg,volume ratio of 1:2,EP mixture was prepared.3 min after opioids were administered,EP mixture 0.15-0.2ml/kg was slowly injected intravenously.After the patients fell asleep and the eyelash reflex disappeared for 30s,the sedation degree of the patients was assessed using the RASS sedation scale(Richmond Agitation-Sedation Scale).When the RASS score of the two groups was ≤-2,the gastroenterologist began to perform painless gastroscopy,and colonoscopy was performed after the gastroscopy.When the patient’s RASS score was>-2,1-2ml EP mixture was added.When the patient experienced physical reaction due to pain,1-2ml EP mixture was added.Gastrointestinal endoscopy was performed after the patient’s body movement disappeared.After surgery,the patient was sent to PACU(Post Anesthesia Care Unit)for monitoring and resuscitation management.After the Aldrete score ≥9,the patient was sent back to the ward.Records the mean arterial pressure(MAP),heart rate(HR)and pulse oxygen saturation(SpO2)of patients at home time(T0),2 min after induction(T1),1 min after inserting gastroscopy(T2),4 min after inserting gastroscope(T3),5 min after inserting colonoscopy(T4),10 min after insert colonoscopy(T5),15 min after the insert colonoscopy(T6).Record the gastroscopy duration,colonoscopy duration,surgical procedures,the additional doses of EP mixture and the number of body movements due to pain.Record the number of hypoxemia,low blood pressure,high blood pressure,tachycardia,bradycardia,myoclonus and postoperative nausea and vomiting.VAS scores of abdominal pain were recorded immediately after leaving PACU,1h,2h,and 4h.Statistical analysis was performed on the collected data.Results:There were no significant differences in the basic characteristics,basic vital signs,operative duration and procedures between the two groups.MAP in group O was higher than that in group S at T1,and the difference was statistically significant(P=0.004).MAP of group O was lower than that of group S at T2 and T4,and the difference was statistically significant(P=0.025,P=0.017).At T2 and T4,HR in group O was lower than that in group S,and the difference was statistically significant(P=0.014,P=0.036).SpO2 in group O was higher than that in group S at T2 and T3,and the difference was statistically significant(P=0.029,P=0.016).Compared with group S,the additional dose of EP mixture,the number of body movement,hypotension and hypoxemia in group O were lower,and the difference was statistically significant(P=0.014,P=0.002,P=0.007,P=0.034).There was no significant difference in the incidence of hypertension,tachycardia,bradycardia,myoclonus,nausea and vomiting between the two groups(P>0.05).At 0h,1h,2h and 4h after leaving PACU,the abdominal VAS score of group O was lower than that of group S,with statistical significance(P=0.001,P=0.008,P=0.001,P=0.000).ConclusionsIn painless gastrointestinal endoscopy of the elderly,when etomidate and propofol 1:2 mixture was selected as the sedative,oxycodone was selected as the analgesic compared with sufentanil for more stable circulation and respiration,better analgesic effect and longer postoperative analgesic effect.However,there were no significant differences in other adverse reactions. |
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