| Objective:By using six groups of anesthetics in different combinations in anesthesia for radiofrequency ablation(RFA)of liver cancer,the present research aimed to select the optimal combination of anesthetics based on analgesic effect,patient’s hemodynamic change and occurrence rate of adverse reaction.Methods:120 liver cancer patients who were prepared to undergo RFA were se lected according to the following inclusion criteria:50 to 75 years old;18 Kg/m2<body mass index(BMI)<28Kg/m2;ASA Ⅱ～Ⅲ.All the patients were randomly divided into six groups:A(propofol plus sufentainil);B(propofol plus remifentanil);C(midazolam plus sufentainil);D(midazolam plus remifentanil);E(midazolam plus nalbuphine hydrochloride);F(dexmedetomidine hydrochloride plus remifentanil).After locating tumors under the guidance of ultrasonagraphy or computed tomography(F need to continuous inject dexmedetomidine hydrochloride by micropump 10～15minutes in advance),these anesthetics were administrated via peripheral veins for each group according to the following dosage:A:propofol 1.25mg/kg,sufentainil 0.1ug/kg;B:propofol 1.25mg/kg,remifentanil 0.5ug/kg;C:midazolam 0.075mg/kg,sufentainil 0.1ug/kg;D:midazolam 0.075mg/kg,remifentanil 0.5ug/kg;E:midazolam 0.075mg/kg,nalbuphine hydrochloride 0.1 mg/kg;F:first intravenous inject dexmedetomidine hydrochloride according to the loading-dose of lug/kg,require the injection by micropump to be finished in 10 minutes,subsequently according to the maintenance dose of 0.25ug/(kg-h)to pump inject until the end of operation.Until the patient’s Bispectral Index(BIS)was maintained at 65～85,or Ramsay slassiflcation was maintained at 3～4,inform the surgeon that the operation can be carried out.Heart rate(HR),systolic pressure(SBP),diastolic blood pressure(DBP),pulse oxygen Saturation(Sp02),respiratory rate(RR)and end-tidal partial pressure of carbon dioxide(PETC02)before the beginning of procedural sedation and analgesia(PSA)(T1),5min after the beginning of PSA(T2),10min after the beginning of PSA(T3)and at the end of RFA(T4)were observed for each group.Also,whether patient could follow the corresponding instructions of surgeon,and presence of hypotension,body movement,respiratory depression,nausea or vomiting or not were observed.Follow-up was conducted 2 hours after operation,and patient’s satisfaction with the analgesic effect during procedure and presence of postoperative complication or not were recorded.Results:The all results of quotients were as follows.1.Comparisons of hemodynamic indexes such HR,SBP and DBP between the six groups.A comprehensive analysis was made on the above indexes of the six groups.The impacts of anesthetics on hemodynamic indexes in group A and B were greater than those in group C,D,E and F,showing statistically significant differences,but there was no statistically significant difference between group A and B(P>0.05)and between group C,D,E and F(P>0.05).2.Comparisons of respiratory stability indexes such as Sp02,RR and PETC02 between the six groups.A comprehensive analysis was made on the above indexes of the six groups.The impacts of anesthetics on respiratory stability in group A,B and D were more obvious than those in group C,E and F,showing statistically significant differences(P<0.05),but there was no statistically significant difference between group A,B and D(P>0.05)and between C,E and F(P>0.05).3.Comparison of intra-operative alertness between the six groups.The above indexes of the six groups were analyzed.The influences of anesthetics on intra-operative alertness and compliance with surgeon’s instructions in group C,D,E and F were evidently higher than those in group A and B,showing statistically significant differences(P<0.05),but there was no statistically significant difference between group C,D,E and F(P>0.05)and between group A and B(P<0.05).4.Comparison of intra-operative adverse reactions between the six groups.The above indexes of the six groups were analyzed.The numbers of patients with adverse reactions due to anesthetics in group C and E were obviously smaller than those in group A,B,D and F,showing statistically significant differences(P<0.05),but there was no statistically significant difference between group C and E(P>0.05)and between group A,B,D and F(P>0.05).5.Comparison of post-operative adverse reactions between the six groups.The follow-up suggested that these groups had no statistically significant differences in the occurrence rates of post-operative mild adverse reactions included post-operative drowsiness,nausea and dizziness.However,The numbers of patients with severe adverse reactions included post-operative vomiting and headache in group E were obviously higher than those in group A,B,C,D and F,showing statistically significant differences(P<0.05).And there was no statistically significant difference between group A,B,C,D and F(P>0.05).No other post-operative adverse reactions were found.6.Comparison of patient’s satisfaction with the analgesic effect during procedure between the six groups.Six groups of patients was basic satisfied with the analgesic effect,showing no statistically significant difference(P>0.05).Conclusions:When anesthesia is induced by PSA for primary liver cancer patients who were prepared to undergo RFA,the use of group C anesthetics(midazolam and sufentanil)achieves a good analgesic effect,stable hemodynamics,less respiratory inhibition,higher intra-operative alertness and better compliance with surgeon’s relevant instructions,leads to less intra-operative and post-operative reactions and requires a simpler procedure.Thus,it is the most optimal anesthetics combination. |
