| Objective:With the prolongation of life expectancy, the number of elderly patients withgallblad der and pancreatic diseases has increased in recent years. Patient characteristics: reduce d immunity responses, unobvious symptoms inconsistent with condition, seriously ill at admission, poor general condition. Some patients with ASA grade III have combined diseases. These patients are perioperative high-risk patients for anesthesia. As an advan ced and repeatable minimally invasive technology, ERCP has many benefits: little effect on function, diagnosis and operation of gallstone diseases, postoperative review. To el derly patients, ERCP is a safe alternative for operation. Recent years, more and more patients undergone ERCP. It is important for us to focus on intraoperative safety mana gement and related adverse effects or surgical complications. We have searched the rel evant literature and compared the advantages and disadvantages of anesthesia for ERC P. We found that intravenous anesthesia is the first choice for ERCP. Compared to sed ation anesthesia, intravenous anesthesia with propofol and opioid analgesics is associate d with comfortable feelings. Compared to general anesthesia, intravenous anesthesia is associated with fast onset of effect. However, intravenous anesthesia for ERCP is also associated with disadvantages such as narrow dose range,high risk of cardiopulmonar y complications, hypoxia and hypotension. In my opinion, based on intravenous anesth esia, use awake intubation to reduce the incidence of respiratory complications, hypoxi a, carbon dioxide retention, acidosis, aspiration pneumonia. And use combined sedation and analgesic drugs to reduce the dosage of single drug and the incidence of related complications. To high-risk elderly patients, it will reduce the adverse effect for physi ological functions, lower the risk of anesthesia. Furthermore, it will cover the shortage of intravenous anesthesia for elderly patients. At present, the anesthesia for ERCP in clinical practice is still a vacancy.The objective of this study is to observe the clinical effect of dexmedetomidine a wake intubation for elderly patients undergone ERCP. It may guidance the treatment o f elderly patients with ERCP and instruct awake intubation for patients with severe dis eases.Contents:80 elderly patients(ASA grade II or III) who had undergone elective ERCP at PLA 307 hospital from October,2013 to November 2015 were randomly divided into two groups: Group A(dexmedetomidine) and Group B(midazolam). All patients were required to undergo surface anesthesia in throat. Dexmedetomidine was infused at rate of 0.5μg/kg in group A. Midazolam was infused at rate of 0.03 mg/kg and dezocin e was infused at rate of 0.1 mg/kg after 5 minutes; cricothyroid membrane puncture an d trachea surface anesthesia after 7 minutes; endotracheal intubation after 10 minutes. A nd propofol was infused at rate of 1.5 mg/kg, Began to do ERCP after Ramsay sedati on scores achieve 5-6. Propofol was infused at rate of 3-5mg/kg/h to maintain sedatio n during the operation. NS(physiological saline) was infused at rate of 0.125 ml/kg in Group B. The remaining steps in group B were similar with group A. Observe and r ecord the operation time, anesthesia recovery time, the dosage of propofol; heart rate(HR), systolic blood pressure(SBP), pulse oxygen saturation SPO2 at T0, T1, T2, T3,T4, T5, T6; Ramsay sedation scores and anesthesia.Method:Data were analyzed by Statistical Package for the Social Science(SPSS) 19.0 for Windows(SPSS Inc. Chicago, IL, USA). Categorical data are presented as number a nd percentage, rate between groups were analyzed by chi-square test. Categorical data as normal distribution, were presented as( x +s), and comparison between groups ana lyzed by One-way ANOVA test as appropriate. P value of less than 0.05 was consider ed as statistical significance.Results:Baseline characteristics were comparable in the 2 groups. This difference, however, w as not statistically significant(P>0.05). At T0,difference of HR and SBP between 2 gr oups was not statistically significant(P>0.05). From T2 to T6, HR of patients in group A was lower than that of patients in group B. SBP of patients in group A was also lower at T3(P < 0.05). And degree of sedation and anesthesia effect of patients in gr oup A were better than patients in group B(P < 0.05). Dosage of propofol in group A was more less than group B.Conclusion:In this study, use dexmedetomidine for sedation, midazolam for accelerating the o nset time, dezocine for long analgesia, combined awake intubation and propofol intrav enous anesthesia in elderly patients undergone ERCP. Sedation and anesthesia effects i s satisfactory; safe airway is established and ensure the intraoperative oxygen supply; r estrain perianesthesia surgical stress reactions; hemodynamic is stable during the operati on; quickly anesthesia recovery. It is a safety and feasible anesthesia method for ERC P. |
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