Research On The Application Of Butorphanol Tartrate Nasal Spray In Painless Gastrointestinal Endoscopy

Objective:Patients undergoing painless gastrointestinal(GI)endoscopy were anesthetized with propofol combined with butorphanol nasal spray,butorphanol injection and sufentanil injection respectively.The anesthetic efficacy and safety of propofol combined with butorphanol nasal spray were evaluated by comparing the propofol consumption,patients’ and endoscopists’satisfaction with sedation,the incidence of side effects and so on,thus to find an alternative anesthetic protocol for painless endoscopy intheoutpatient department.Methods:From December 2020 to May 2021,255 patients recruited for painless GI endoscopy were divided into three groups via random number table,n=85 persons per group.The inclusion criteria included age of 18～65 years old,body mass index(BMI)of 18～28kg/m2 and American society ofanesthesiologists(ASA)status of Ⅰ～Ⅱ.Group N,lmg butorphanol administered intranasally 30 min before the examination,and 1ml saline were given 3min before propofol induction;Group V,0.5mg butorphanol administered intravenously and Group S,5μg sufentanil given intravenously just 3min before propofol anesthesia,while patients of group V and S were all given equal volume of saline administered intranasally 30 min before the examination.Propofol was administered throughout the examination.Bispectralindex(BIS)scores were maintained at 40～60.Record the general patient information,including gender,age,height,weight,BMI,ASA classification,operation time.Record the total dosage of propofol,injection pain of propofol,hypoxemia,cough reflex,body movement,awake time,Modified Observer’s Alertness/Sedation scale(MOAA/S score),discharge time,patients’ and endoscopists’satisfaction(5-P o i nt Likert Scale,Likert)score,dizziness and drowsiness,post-operation nausea and vomiting(PONV),visual analoguescore(VAS)2hafter the examination,and vasoactive drugs consumption.In addition,the patient’s heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO2)and BIS values were recorded before anesthesia induction(T0),when intubation(T1)and anesthesia recovery(T2).Results:Demographic information,including gender,age,weight,height,ASA classification,and operation duration,were similar among the groups(P>0.05).The propofol consumption in group N(146±25μg.kg-1.min-1)was statistically lower than those in group V(170±28μg.kg-1.min-1)and Group S(160±27μg.kg-1.min-1)(bothP<0.05).The incidence of propofol injection pain in group N was significantly lower than that in group S(P<0.05).Compared with group V and group S,the awake time in group N was significantly shorter after the examination(bothP<0.05),the median score of MOAA/S was increased(bothP<0.05),and the incidence of hypoxemia was lower(bothP<0.05).However,the incidence of drowsiness and dizziness in group V was significantly higher than that in group N(P<0.05).Meanwhile,compared with group N and group S,the discharge time in group V(20±5min)was statistically longer(both P<0.05)and the median score of patients’ satisfaction was significantly lower(both P<0.05).There were no significant differences in endoscopists’satisfaction,cough reflex,body movement,PONV and VAS among the three groups(P>0.05).Conclusion:Propofol combined with 1mg intranasal butorphanol has a good anesthetic effect,higher patients’ and endoscopists’ satisfactionin painless GI endoscopy.Compared with combinations of butorphanol injection,butorphanol nasal spray reduced the incidence of side effects such as drowsiness and dizziness.It is an alternative procedural sedation protocol for short outpatient examination.