Observation Of Midazolam Combined With Three Opioid Drugs Respectively For Painless Bronchoscopy In Adults

Objective:We aim at observing of anesthetic effect and complications of midazolam combined with three different opioid drugs respectively on the basis of spraying topical anesthesia for painless bronchoscopy in adults,and exploring more effective and safer anesthetic method for bronchoscopy.Methods:A total of 150 patients who were undergoing bronchoscopic pathology（through pulmonary CT selected）in our hospital,rated ASA II^III,aged 45⁷0 years old,height 155¹75cm,weight 45⁷5kg,BMI18²7kg/m² between Sep in 2016 and Mar in 2017,were enrolled into the study.The patients are randomly divided into following three groups:S group（a combination of sufentanil 0.1ug/kg with midazolam0.07mg/kg,n=50）,F group（a combination of fentanyl 1ug/kg with midazolam 0.07mg/kg,n=50）,R group（a combination of remifentanil0.8ug/kg induced with midazolam 0.07mg/kg,and remifentanil0.05ug/kg/min maintained,n=50）.Anesthetic and operative times in three groups were observed and recorded.MAP,HR,SpO₂ and BIS in three groups were recorded before anesthesia（T0）,before surgery（T1）,when bronchoscope passed through the glottis（T2）,5min after starting bronchoscopic examination（T3）,when operator was inspecting the pathology（T4）and 2min post-operatively（T5）.Anesthetic efficacy,body moving levels,nausea,respiratory depression,airway spasm and bad memories in three groups were evaluated and recorded.Results:（1）General information:There were not significantly different between the three groups in gender composition ratio,age,height,weight,BMI,ASA classification（P>0.05）.（2）Operative and anesthetic time comparison:There were not significantly diffenrent between the three groups in operative time（P>0.05）.Anesthetic time in S group and in F group was longer than that in R group（P<0.01）.（3）MAP,HR,SpO₂,BIS comparison:Group comparison:MAP:MAP from T1-to-T4 in three groups was lower than that at T0（P<0.01）.HR:HR at T1 in three groups was slower than that at T0（P<0.01）.SpO₂:Sp O₂ at T3 and T4 in F group and S group was lower than that at T0and SpO₂ from T2-to-T4 in R group was lower than that at T0（P<0.05,P<0.01）.BIS from T1-to-T4 in three groups was lower than that at T0（P<0.01）.Comparison between groups:MAP、HR、BIS:There was no significant difference between the three groups in MAP、HR、BIS（P>0.05）.SpO₂:There were not significantly different between F group and S group in SpO₂（P>0.05）;SpO₂ at T3 in R group was lower than that in S group and SpO₂ at T3 and T4 in R group was lower than that in F group（P<0.05,P<0.01）.（4）Anesthetic effect comparison:The rate of excellent effect in F group was lower than that in S group（P<0.05）and there were not significantly different between in S group and F group in excellent and good rate（89.80%vs 81.63%,P>0.05）.The rate of good effect in R group was lower than that in S group（P<0.05）and the rate of fair effect in R group was higher than that in S group（P<0.05）and the rate of excellent and good effect in R group was lower than that in S group（89.80%vs 64.00%,P<0.01）.The rate of excellent and good effect in R group was lower than that in F group（81.63%vs 64.00%,P<0.01）.（5）Adverse reaction comparison:There were not significantly different between the three groups in the rate of nausea,body moving levels,bad memories（P>0.05）.The rate of respiratory depression and airway spasm in R group were higher than that in S group and F group（P<0.05）.Conclusion:A combination of midazolam 0.07 mg/kg with sufentanil 0.1ug/kg or fentanyl 1ug/kg on the basis of 1%tracaine spraying anesthesia for bronchoscopic anesthesia,are effective and safe methods,which have better anesthetic efficacy and less respiratory and airway spasm in spite of a little longer anesthetic time.