Dissertation
Dissertation > Medicine, health > Surgery > Surgical operation > Anesthesiology

The Clinical Summary of Application of MAC in ERCP

Author XuQiangGuo
Tutor ZhangTieZuo
School Dalian Medical University
Course Anesthesiology
Keywords MAC ERCP hemodynamic BIS adverse reactions
CLC R614
Type Master's thesis
Year 2011
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Objective: According to BIS monitoring regulate the depth of sedation in ERCP patients, and the strengths and weaknesses of MAC in the application of ERCP, and the ways of reduce adverse reactions and complications in ERCP patients.Methods:109 patients undergoing ERCP were selected in the General Hospital of Shenyang Military Region in November 2010. Age of 28~88 years old, ASAⅠ~Ⅳlevel. All patients were fasted 6 hours, water deprivation 2 hours before surgery, and finish the physical and chemical examinations. Routine prepare sedatives, hypnotics, analgesics (opioid, NSAID type, COX-2 inhibitor) drugs, antiemetic drugs, only saliva drugs, muscle relaxants and some first-aid medicines. After Into the operation room , open patients’upper extremity venous, monitoring ECG, BP (NIBP / IAP), HR, RR, SPO2, ETCO2, BIS, T. Induction of anesthesia: Intravenous tropisetron 3~5mg, fentanyl 0.5-1.5μg/kg, flurbiprofen axetil 20~50mg, penehyclidine hydrochloride 0.5mg, propofol 1~1.5mg/kg ( or etomidate 0.15~0.3mg/kg). Anesthesia was maintained with continuous intravenous infusion of remifentanil 0.5μg/kg·min, propofol 5~8 mg / kg·h. According to BIS values, body movement and breathing, circulation adjusts dose to maintain patients in the more stable state. Observed treatment, monitoring, intraoperative management and the rational and effective method for perioperative hemodynamic stability. Observe intraoperative respiratory depression, awareness, body movement, regurgitation and aspiration, the incidence of airway obstruction and the appropriate range of BIS values and postoperative patient satisfaction and doctors the incidence of nausea and vomiting.Results: Hemodynamics of patients were stable in the course of MAC, blood pressure undulated less than 30%, except 2 patients (1.83%) with preoperative septic shock used vasoactive drugs, the other patients were not using vasoactive drugs. Respiratory depression occurred in 5 cases (4.58%), 2 cases of incomplete obstruction of upper respiratory (1.83%), intraoperative BIS values were maintained between 40-85, 9 patients occurd body movement (8.25%), No patients had intraoperative awareness and reflux aspiration, no postoperative nausea and vomiting.Conclusion: MAC is different from general anesthesia and local anesthesia. It can make patients overcome fear, anxiety and tension of the operation, in the operation, with perfect analgesia, patients feel quiet comfortable. vital signs were stable; After surgery patients awake quickly, feel comfortable and less adverse reaction. The effect is good and safe. MAC is ideal for ERCP. It should be widely applied. But the process of MAC is not implemented on a reliable airway protection, the risk of vomiting, regurgitation aspiration is still exist; the body movement appears occasionally in the surgery, which merits we should further study and solve.

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