Application Of Midazolam-Remifentanil Conscious-Sedation And Analgesia In High Intensity Focus Ultrasound Treatment

Objective : To observe the efficacy, safety and feasibility of midazolam-remifentanil conscious-sedation and analgesia during the treatment of liver tumor, pancreatic tumor, hysteromyoma or breast tumor using High Intensity Focus Ultrasound (HIFU).Methods: Eighty patients with liver tumor, pancreatic tumor, hysteromyoma or breast tumor, 18⁶5 years old, ASAâ… ^{â…¡}, being treated by HIFU, were included and allocated into liver tumor group, pancreatic tumor group, hysteromyoma group and breast tumor group, 20 cases in each group. A bolus of midazolam 0.02mg kg^-1 and remifentanil 1μg kg^-1 was applied in all the patients in each group as loading dose, followed by infusion of midazolam 0.05 mg·kg^-1·h^-1 and remifentanil 0.05μg·kg^-1·min^-1. The dosage was adjusted in 3 min interval according the Ramsy rank and Verbal Rating Scale. The SP, DP, HR, RR, SpO2 and BIS were recorded in the following periods, pre-anesthesia (T0), 3 min (T1), 5 min (T2), 10 min (T3), start of operation (T4), duration of operation (T5), post-operation 5 min (T6), and 10 min (T7). the dosage and adverse effects of drugs were also recorded. Arterial blood samples and venous blood samples were collected for blood gas analysis and measurement of cortisol in T0, T5, T7. Satisfaction Rank of Patient and Satisfaction Rank of Operater were collected after the procedures.Results: The SP and DP of the patients in all groups were decreased compared with the base line values after the induction of anesthesia(P<0.05), and elevated during operating procedure compared with the base line values (P<0.05) and those in the post-operation period. The tendency of HR was similar to SP and DP. RR of the patients in all groups reduced compared with the baseline values (P<0.05), with the lowest rate of 9.2/min, however the lowest level of SpO2 was 93.9%, and both of them returned to baseline values. The blood gas analysis and cortisol were not significant difference in T0, T5, T7. The BIS values ranged 88.7⁹0.3 during the procedure and returned to baseline. The average of Ramsy Rank were 3.95⁴.15, and the average of VRS score were 0¹. Both of the Satisfaction Rank of Patient and Satisfaction Rank of Operater were greater than 3 point. The dosage of midazolam and remifentanil consumed in breast tumor group was greater than those in other groups(P<0.05), and the dosage of midazolam and remifentanil were similar among the other groups. No adverse effects and complications associated with anesthesia occurred in any patient.Conclusion : midazolam-remifentanil conscious-sedation and analgesia was an effective and safe measures for the HIFU procedure to treat the liver tumor, pancreatic tumor, hysteromyoma or breast tumor and gained the favorable operator's satisfaction and patient's tolerance and compliance.