The Clinical Obeservation Of Pre-injected Nalmefene In Hysteroscopic Surgery Under Intravenous Anesthesia

Objective: To observe the influence of pre-injection of nalmefene onfentanyl’s side effects in patients keep spontaneous breathing undergoinghysteroscopic surgery induction of intravenous anesthesia.Method:80patients undergoing hysteroscopic surgery from december2014to february2015were choosed, whose ASA were betweenⅠor Ⅱ. Theywere divided into two groups using random form method: group A(nalmefenegroup, n=40),group B (normal saline group, n=40).Patients were routinelymonitored BP, HR and SpO2after entering the operating room, and adoptedlithotomy position. During operation all patients kept spontaneous breathingthrough mask inhalation of pure oxygen, oxygen flow was2L/min. Group Areceived nalmefene0.25μg/kg2min before intravenous anesthesia introduction.Groups B were given equivalent saline. Then observe and record:①buckingcaused by fentanyl1min after introduction;②The number of cases patientswith intraoperative SpO2<90%;③SBP,DBP,HR,SpO22min beforeinduction (T0),1min after induction (T1),5min after induction (T2),10minafter induction(T3), the end of the surgery (T4),5min after the surgery(T5)and leaving the operating room (T6);④the duration of eye opening afterrousing, recovery time of orientation ability, and the time between Anesthesiaemergence and leaving operating room;⑤VAS analgesic score5min,30minand120min after the operation. Result:①there is no significant difference between the two groups inage, height, weight, duration of surgery, propofol and fentanyl dosage (p0.05);②3cases (8%) occurred bucking in group A, and22(55%) cases in group B,there is significant difference between the two groups in the occurrence ofbucking in T1（p <0.01）. A, B two groups of intraoperative SpO2<90%ofpatients were5cases and27cases respectively, significantly less in group Acompared to B (p <0.01).③The SBP,DBP,HR in group A at T1wassignificantly lower than group B (p <0.01). There is no significant differencebetween the two groups in SBP, DBP, HR at T2, T3, T4, T5, T6(p＞0.05). TheSpO2at T2,T3,T4in group A was significantly higher than group B (p <0.01);④for the duration of eye opening after rousing, recovery time of orientationability, and the time between Anesthesia emergence and leaving operatingroom were significant less than group B (p <0.01);⑤There is no significantdifference between the two groups in VAS analgesic score(p＞0.05).Conclusion: Before anesthesia induction administration small dose ofhydrochloride nalmefenecan reduced fentanyl’s side effect of bucking, reducehemodynamic change caused bybucking, and antagonize respiratoryarrestcaused by fentanyl.Small dose of hydrochloride nalmefene can providesatisfiedsnooze effect, shortened the wake time and operating room stayingtime; nosignificant enhancement or reduction of fentanyl’s analgesic effectwere observed.