Comparison Of Anesthetic Efficacy Of Propofol Combined With Different Doses Of Alfentanil In Painless Gastroscopy:A Prospective Randomized Controlled Study

Objective:Opioids are synergistic when used in combination with propofol,and a variety of opioids have been shown to be used as adjunctive agents for painless gastroscopy.In this trial,the efficacy and safety of alfentanil for painless gastroscopy was assessed by observing the effects of propofol in combination with different doses of alfentanil on intraoperative sedation and postoperative recovery in patients undergoing gastroscopy.Methods:In this study,300 patients who underwent painless gastroscopy at Liaoning Provincial People’s Hospital from June 2021 to March 2022 were selected.The age range was 18-70 years,ASA class I-II.A set of random numbers was generated using SPSS to randomly divide the 300 patients equally into four groups of 75 cases each.After entering the gastroscopy room,patients were placed in the left lateral position,upper limb venous access was opened,oxygen was administered via nasal cannula（3L/min）,and vital indicators were monitored by the anesthesiologist,including:ECG（Electrocardiogram）,HR（Heart Rate）,Sp O₂（Pulse Blood Oxygen Saturation）,SBP（Systolic Blood Pressure）,DBP（Diastolic Blood Pressure）,MAP（Mean Arterial Pressure）.After preparation,patients were injected intravenously with 0.2ml/kg 0.9%saline（group A）,2μg/kg alfentanil（group B）,3μg/kg alfentanil（group C）and 4μg/kg alfentanil（group D）according to the group,and 1min later,all patients were induced sedation with intravenous injection of 1.5mg/kg propofol.Both alfentanil and propofol were injected within 60s.Gastroscopy could be initiated when the MOAA/S（Modified Observer’s Assessment of Alertness/Sedation）score was<2（does not respond to mild stimulation or shaking）,and this level of sedation was maintained intraoperatively.The patient’s vital signs were continuously monitored during the operation,and the following time points were recorded,including:the patient entered the gastroscopy room（T1）;1 minute after the intravenous injection of propofol（T2）;the gastroscope reached the duodenal bulb（T3）;and at the end of the operation（T4）.If body movement or coughing occurred during the operation,additional 0.5mg/kg propofol was administered.After the procedure,patients were transferred to the PACU（Post-Anesthesia Care Unit）,and the MOAA/S score of all patients was assessed intermittently until the MOAA/S score reached 5（responds readily to name spoken in a normal tone）.The vital signs of patients were monitored dynamically until the patients’Aldrete Score reached 10,and then they were allowed to leave.The primary outcome（awakening time）and secondary outcomes were recorded,including intraoperative hemodynamic changes,propofol dosage,incidence of body movement,coughing,hypoxemia,hypotension,hypertension,bradycardia and tachycardia,postoperative recovery time,incidence of nausea,vomiting,drowsiness and dizziness.Patients’and endoscopists’satisfaction was assessed by using the VAS（Visual Analogue Scale）.Results:1.The study finally counted 300 valid cases.During the operation,patients in groups B,C and D had a progressively lower total dose of propofol use（P<0.05）,a progressively shorter onset of sedation（P<0.05）and a significantly lower incidence of somatic movements and choking than in group A（P<0.05）2.As the dose of alfentanil was increased,the hemodynamic fluctuations were more significant in groups B,C and D.The incidence of hypotension was significantly higher in groups C and D than in group A（P<0.05）;the incidence of bradycardia was significantly higher in group D than in groups A and B（P<0.05）.3.During the recovery period,only patients in groups C and D awoke earlier and had a lower incidence of dizziness compared to group A（P<0.05）.However,the recovery time required by patients in groups B,C and D was shorter（P<0.05）and the operator satisfaction was higher in all three groups compared to group A（P<0.05）;however,patients in groups B,C and D took less time to recover after surgery and had higher endoscopists’satisfaction（P<0.05）.Conclusion:When sedation was induced by intravenous injection of 1.5 mg/kg propofol during painless gastroscopy,3μg/kg alfentanil can provide better efficacy and safety.In clinical application,it can be used as a reference to adjust the dose of alfentanil according to the actual physical condition of patients.