小尾寒羊主动脉瓣及二尖瓣置换过程中的麻醉管理
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摘要
背景:目前有关小尾寒羊心脏手术实验麻醉方法方面的研究甚少,其有效性和安全性尚需大量的实验进行验证。目的:探讨小尾寒羊心脏手术麻醉方法的有效性和安全性。方法:市售雄性小尾寒羊40只,年龄(10.95±0.89)月,体质量(71.3±7.7) kg。小尾寒羊肌注氯胺酮8-12 mg/kg+东莨菪碱10-20μg/kg(或者静注氯胺酮2.5-3.5 mg/kg+东莨菪碱10-15μg/kg)进行基础麻醉,再静脉注射丙泊酚和芬太尼全身麻醉下行主动脉瓣及二尖瓣置换。观察气管插管反应、小尾寒羊围术期(切皮前5min、切皮后5 min、体外转机前5 min、体外停机后5 min、术毕、术后1 d)生命体征、血流动力学变化、麻醉恢复情况及围术期并发症。结果与结论:(1)所有动物气管插管均成功;(2)围术期镇静镇痛效果满意,生命体征平稳;无体动发生,能很好地耐受瓣膜置换术;(3)围术期血气分析显示内环境稳定;(4)未发生反流误吸;无死亡;(5)结果说明,丙泊酚复合异氟烷加小剂量芬太尼全身麻醉用于小尾寒羊心脏手术血流动力学平稳,术后苏醒快,麻醉效果好,安全性高。
BACKGROUND: At present, there are few studies on the anesthetic methods for cardiac surgeries in Small-Tailed Han sheep, and further experimental verifications on the effectiveness and safety are still required.OBJECTIVE: To evaluate the safety and effectiveness of anesthetic methods for cardiac surgeries in Small-Tailed Han sheep. METHODS: Forty Small-Tailed Han sheep, aged(10.95±0.89) months, weighing(71.3±7.7) kg, underwent aortic valve plus mitral valve replacement after basic anesthesia with intramuscular ketamine(8-12 mg/kg)+scopolamine(10-20 μg/kg) or with intravenous ketamine(2.5-3.5 mg/kg)+scopolamine(10-15 μg/kg) and general anesthesia with intravenous propofol and fentanyl. The bucking response in endotracheal intubation, vital signs, hemodynamic changes, recovery condition and complications were observed during the perioperation(5 minutes before incision, 5 minutes after incision, 5 minutes before in vitro transfer, 5 minutes after in vitro shutdown, immediately after surgery, 1 day after surgery). RESULTS AND CONCLUSION: None of the animals failed in intubation. Perioperative sedation and analgesia were satisfactory, and vital signs were stable; perioperative blood gas analysis shows stable internal environment; no body movement occurred, and all cases well tolerated valve replacement; no regurgitation and aspiration occurred during operation; and there were no deaths during the procedure. Anesthesia with propofol and isoflurane plus low-dose fentanyl has the advantages of rapid recovery, stable hemodynamics and good anesthetic effect, which is a safe and effective anesthesia scheme for cardiac surgery in Small-Tailed Han sheep.
BACKGROUND: At present, there are few studies on the anesthetic methods for cardiac surgeries in Small-Tailed Han sheep, and further experimental verifications on the effectiveness and safety are still required.OBJECTIVE: To evaluate the safety and effectiveness of anesthetic methods for cardiac surgeries in Small-Tailed Han sheep. METHODS: Forty Small-Tailed Han sheep, aged(10.95±0.89) months, weighing(71.3±7.7) kg, underwent aortic valve plus mitral valve replacement after basic anesthesia with intramuscular ketamine(8-12 mg/kg)+scopolamine(10-20 μg/kg) or with intravenous ketamine(2.5-3.5 mg/kg)+scopolamine(10-15 μg/kg) and general anesthesia with intravenous propofol and fentanyl. The bucking response in endotracheal intubation, vital signs, hemodynamic changes, recovery condition and complications were observed during the perioperation(5 minutes before incision, 5 minutes after incision, 5 minutes before in vitro transfer, 5 minutes after in vitro shutdown, immediately after surgery, 1 day after surgery). RESULTS AND CONCLUSION: None of the animals failed in intubation. Perioperative sedation and analgesia were satisfactory, and vital signs were stable; perioperative blood gas analysis shows stable internal environment; no body movement occurred, and all cases well tolerated valve replacement; no regurgitation and aspiration occurred during operation; and there were no deaths during the procedure. Anesthesia with propofol and isoflurane plus low-dose fentanyl has the advantages of rapid recovery, stable hemodynamics and good anesthetic effect, which is a safe and effective anesthesia scheme for cardiac surgery in Small-Tailed Han sheep.
引文
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[11]Blumer S,Costa L,Peretz B.Success of Dental Treatments under Behavior Management,Sedation and General Anesthesia.J ClinPediatr Dent.2017;41(4):308-311.
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[15]E GX,Huang YF,Zhao YJ,et al.Dynamic comparison of genetic diversity in a Small Tail Han sheep population using meta-analysis.Genet Mol Res.2015;14(4):14607-14614.
[16]Chi X,Li M,Mei W,et al.Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post-cesarean section pain management and lactation after general anesthesia-a prospective,randomized,double-blind,controlled study.J Pain Res.2017;10:1521-1527.
[17]Ishii K,Makita T,Yamashita H,et al.Total intravenous anesthesia with propofol is associated with a lower rate of postoperative delirium in comparison with sevoflurane anesthesia in elderly patients.J Clin Anesth.2016;33:428-431.
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[19]Practice Advisory for the Prevention,Diagnosis,and Management of Infectious Complications Associated with Neuraxial Techniques:An Updated Report by the American Society of Anesthesiologists Task Force on Infectious Complications Associated with Neuraxial Techniques and the American Society of Regional Anesthesia and Pain Medicine.Anesthesiology.2017,126(4):585-601.
[20]Freundlich RE,Ehrenfeld JM.Anesthesia information management:clinical decision support.CurrOpinAnaesthesiol.2017;30(6):705-709.
[21]Balkarli H,Kilic M,Ozturk I.Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty.Braz J Anesthesiol.2017;67(2):205-209.
[22]Garret-Bernardin A,Cantile T,D'Anto V,et al.Pain Experience and Behavior Management in Pediatric Dentistry:A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.Pain Res Manag.2017;2017:7941238.
[23]Izgi M,Basaran B,Muderrisoglu A,et al.Evaluation of the stability and stratification of propofol and ketamine mixtures for pediatric anesthesia.Paediatr Anaesth.2018;28(3):275-280.
[24]Jia LJ,Tang P,Brandon NR,et al.Effects of Propofol General Anesthesia on Olfactory Relearning.Sci Rep.2016;6:33538..
[25]O O,Churgin SM,Sladky KK,et al.Anesthetic Induction and Recovery Parameters in Bearded Dragons(PogonaVitticeps):Comparison of Isoflurane Delivered in 100%Oxygen Versus21%Oxygen.J Zoo Wildl Med.2015;46(3):534-539.
[26]任培银,谢小英.依托咪酯联合芬太尼在心脏病患者非心脏手术麻醉中的效果观察[J].中国处方药.2018,16(4):81-82.
[27]Davis TC.Anesthesia Information Management Systems.Annu Rev Nurs Res.2017;35(1):71-90.
[28]Bindu B,Bindra A,Rath G.Temperature management under general anesthesia:Compulsion or option.J Anaesthesiol Clin Pharmacol.2017;33(3):306-316.
[29]Goldberg SF,Pozek JJ,Schwenk ES,et al.Practical Management of a Regional Anesthesia-Driven Acute Pain Service.Adv Anesth.2017;35(1):191-211.
[30]Flaherty DC,Hoxha B,Nelson S,et al.Peri-and intraoperative management of the goat during acute surgical experimentation.Lab animal.2010;39(3):80-85.
[31]周成斌,庄建,温树生,等.胎羊体外循环中的麻醉管理[J].南方医科大学学报,2009,29(12):2401-2403.
[2]郑家伟,邱蔚六,张志愿,等.山羊颈部血管的解剖与组织学观察[J].上海口腔医学.2000,9(1):39-41.
[3]Andres J,Pogatzki-Zahn E,Huygen F,et al.Controlling acute pain to improve the quality of postoperative pain management:an update from the European Society of Regional Anesthesia meeting held in Maastricht(September 2016).Pain management.2017;7(6):513-522.
[4]邓小明,朱科明.常用实验动物麻醉[M].上海:第二军医大学出版社,2001.
[5]Berglund IG,Bjorkman B,Enskar K,et al.Management of Children with Autism Spectrum Disorder in the Anesthesia and Radiographic Context.J Dev Behav Pediatr.2017;38(3):187-196.
[6]Biocic M,Vidosevic D,Boric M,et al.Anesthesia and perioperative pain management during cardiac electronic device implantation.J Pain Res.2017;10:927-932.
[7]Adami C,Levionnois O,Spadavecchia C.Acute pulmonary edema and airway hemorrhage in a goat during sevoflurane anesthesia.Schweiz Arch Tierheilkd.2011;153(2):86-88.
[8]Goins AE,Smeltz A,Ramm C,et al.General Anesthesia for Transcatheter Aortic Valve Replacement:Total Intravenous Anesthesia is Associated with Less Delirium as Compared to Volatile Agent Technique.J Cardiothorac Vasc Anesth.2018;32(4):1570-1577.
[9]Brown CHt,Hasan RK,Brady MB.Is Less Really More?Conscious Sedation or General Anesthesia for Transcatheter Aortic Valve Replacement.Circulation.2017;136(22):2141-3.
[10]Pani S,Cagino J,Feustel P,et al.Patient Selection and Outcomes of TransfemoralTranscatheter Aortic Valve Replacement Performed with Monitored Anesthesia Care Versus General Anesthesia.J CardiothoracVascAnesth.2017;31(6):2049-2054.
[11]Blumer S,Costa L,Peretz B.Success of Dental Treatments under Behavior Management,Sedation and General Anesthesia.J ClinPediatr Dent.2017;41(4):308-311.
[12]Nakanishi T,Yoshimura M,Sakamoto S,et al.Unexpected Systolic Anterior Motion of the Mitral Valve Diagnosed by Transthoracic Echocardiography after the Induction of General Anesthesia.Masui.2017;66(5):538-541.
[13]Patzelt J,Ulrich M,Magunia H,et al.Comparison of Deep Sedation With General Anesthesia in Patients Undergoing Percutaneous Mitral Valve Repair.J Am Heart Assoc.2017;6(12).pii:e007485.
[14]Lv SJ,Yang Y,Li FK.Parity and litter size effects on maternal behavior of Small Tail Han sheep in China.Anim Sci J.2016;87(3):361-369.
[15]E GX,Huang YF,Zhao YJ,et al.Dynamic comparison of genetic diversity in a Small Tail Han sheep population using meta-analysis.Genet Mol Res.2015;14(4):14607-14614.
[16]Chi X,Li M,Mei W,et al.Comparison of patient-controlled intravenous analgesia with sufentanil versus tramadol in post-cesarean section pain management and lactation after general anesthesia-a prospective,randomized,double-blind,controlled study.J Pain Res.2017;10:1521-1527.
[17]Ishii K,Makita T,Yamashita H,et al.Total intravenous anesthesia with propofol is associated with a lower rate of postoperative delirium in comparison with sevoflurane anesthesia in elderly patients.J Clin Anesth.2016;33:428-431.
[18]Chemonges S,Shekar K,Tung JP,et al.Optimal management of the critically ill:anaesthesia,monitoring,data capture,and point-of-care technological practices in ovine models of critical care.Biomed Res Int.2014;2014:468309.
[19]Practice Advisory for the Prevention,Diagnosis,and Management of Infectious Complications Associated with Neuraxial Techniques:An Updated Report by the American Society of Anesthesiologists Task Force on Infectious Complications Associated with Neuraxial Techniques and the American Society of Regional Anesthesia and Pain Medicine.Anesthesiology.2017,126(4):585-601.
[20]Freundlich RE,Ehrenfeld JM.Anesthesia information management:clinical decision support.CurrOpinAnaesthesiol.2017;30(6):705-709.
[21]Balkarli H,Kilic M,Ozturk I.Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty.Braz J Anesthesiol.2017;67(2):205-209.
[22]Garret-Bernardin A,Cantile T,D'Anto V,et al.Pain Experience and Behavior Management in Pediatric Dentistry:A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System.Pain Res Manag.2017;2017:7941238.
[23]Izgi M,Basaran B,Muderrisoglu A,et al.Evaluation of the stability and stratification of propofol and ketamine mixtures for pediatric anesthesia.Paediatr Anaesth.2018;28(3):275-280.
[24]Jia LJ,Tang P,Brandon NR,et al.Effects of Propofol General Anesthesia on Olfactory Relearning.Sci Rep.2016;6:33538..
[25]O O,Churgin SM,Sladky KK,et al.Anesthetic Induction and Recovery Parameters in Bearded Dragons(PogonaVitticeps):Comparison of Isoflurane Delivered in 100%Oxygen Versus21%Oxygen.J Zoo Wildl Med.2015;46(3):534-539.
[26]任培银,谢小英.依托咪酯联合芬太尼在心脏病患者非心脏手术麻醉中的效果观察[J].中国处方药.2018,16(4):81-82.
[27]Davis TC.Anesthesia Information Management Systems.Annu Rev Nurs Res.2017;35(1):71-90.
[28]Bindu B,Bindra A,Rath G.Temperature management under general anesthesia:Compulsion or option.J Anaesthesiol Clin Pharmacol.2017;33(3):306-316.
[29]Goldberg SF,Pozek JJ,Schwenk ES,et al.Practical Management of a Regional Anesthesia-Driven Acute Pain Service.Adv Anesth.2017;35(1):191-211.
[30]Flaherty DC,Hoxha B,Nelson S,et al.Peri-and intraoperative management of the goat during acute surgical experimentation.Lab animal.2010;39(3):80-85.
[31]周成斌,庄建,温树生,等.胎羊体外循环中的麻醉管理[J].南方医科大学学报,2009,29(12):2401-2403.