Efficacy Of Opioid-free Anesthesia For Digestive Endoscopy In Patients With High Risk Of Nausea And Vomiting

Objective To observe the effect of opioid-free anesthesia in the sedation of patients with high risk of nausea and vomiting during digestive endoscopy.Methods this study is a prospective double-blind randomized controlled trial,choose from February 2022 to June 2022 in Hebei province people’s hospital of painless endoscopy examination of nausea and vomiting high-risk patients 141 cases,ASA class I or II,patients by stratified random assigned to opioid anesthesia group(P group)or propofol-sufentanil group(group S).In group P,saline 0.1ml/kg was injected intravenously,and 3 minutes later,propofol was given by intravenous titration at a constant rate(injection rate: 4mg/s)until bisspectral index(BIS)<60 for endoscopic examination.In group S,sufentanil(1μg/ml)0.1ml/kg was injected intravenously after entering the room,and 3 minutes later propofol was injected intravenously at a constant rate to induce anesthesia until bispectral index(BIS)<60,and then endoscopy was performed.PONV score was used to evaluate the occurrence of PONV in all patients after operation.The intraoperative and postoperative adverse events,hemodynamic changes,total anesthesia time,stay time in recovery room and propofol consumption were observed and recorded.Results1 Comparison of the incidence of intraoperative and postoperative adverse reactions between the two groups: compared with group S,the incidence of postoperative PONV and postoperative dizziness in group P was decreased(P<0.05);There was no significant difference in the incidence of hypotension and respiratory depression between the two groups.2 Comparison of anesthesia time,propofol dosage,PACU stay time and patient satisfaction between the two groups: compared with group S,the time of recovery and recovery room stay time of patients in group P were shortened,and patient satisfaction was relatively higher(P<0.05);Compared with P group,the dosage of propofol in group S was decreased(P<0.05);There was no significant difference in anesthesia duration between the two groups(P>0.05).3 Comparison of SBP,DBP,MAP,Sp O2 and HR changes at 5 time points between the two groups: Hemodynamic changes at T2 and T3 were statistically different from those in the previous period(P<0.05);There were no significant differences in hemodynamic changes and Sp O2 values at other time between the two groups.4 Comparison of general situation indicators between the two groups:there were no significant differences in age,BMI,ASA grading,examination type and Apfel score between the two groups(P>0.05).ConclusionCompared with the anesthesia method combined with sufentanil,the opioid-free anesthesia method of propofol is more conducive to reduce the incidence of intraoperative and postoperative adverse reactions,improve patient satisfaction,and is more suitable for the sedation of digestive endoscopy in patients with high risk of nausea and vomiting.