Application of propofol and remifentanil combined with low dose of midazolam intravenous anesthesia in gynecological outpatient surgery

Abstract

Objective To observe the efficacy and safety of propofol and remifentanil combined with low dose of midazolam intravenous anesthesia in gynecological outpatient surgery. Methods 120 patients with gynecological outpatient surgery were randomly divided into control group and observation group. The control group received intravenous injection of remifentanil 1μg/kg, propofol 1.2mg/kg, the observation group received intravenous injection of midazolam 0.02mg/kg, remifentanil 1μg/kg, propofol 1.2mg/kg, until the disappearance of eyelashes began operation. Intraoperative anesthesia could be added propofol 20-40mg.The anesthesia onset time, to the sedation (Ramsay) score of 4, points wake up time of the two groups were observed, the sedative satisfaction, delirium incidence and the average delirium score, the incidence of adverse reactions were recorded. Results After operation and when fully awake, the mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) and expiratory interval (RR) of the two groups were decreased, and rised somewhat at fully awake, there were significant differences in the vital signs between the two groups before and after treatment (the control group after operation: MAP: t=15.09, P=0.00; HR: t=16.54, P=0.00; SpO2: t=4.01, P=0.00; RR: t=3.40, P=0.00; the observation group after operation: MAP: t=10.86, P=0.00; HR: t=12.82, P=0.00; SpO2: t=2.45, P=0.01; RR: t=2.77, P=0.00). At fully awake, the vital signs of the control group were statistically significant compared with before treatment(MAP: t=11.18, P=0.00; HR: t=5.73, P=0.00; SpO2: t=1. 73, P=0.04; RR: t=2.32, P=0.01). The SpO2 and RR of the observation group had no statistically significant differences compared with preoperative(MAP: t=6.42, P=0.00; HR: t=3.72, P=0.00; SpO2: t=1.48, P=0.07; RR: t=0.26, P=0.39). The changes of vital signs in the observation group were smaller than those in the control group, the MAP and HR after operation and at full recovery, postoperative SpO2 and RR at fully recovery compared with the control group(after operation: MAP: t=4.23, P=0.00; HR: t=4.23, P=0.00; SpO2: t=1.35, P=0.09; RR: t=0.61, P=0.27; at fully awake: MAP: t=3.74, P=0.00; HR: t=2.41, P=0.00; SpO2: t=0.16, P=0.44; RR: t=2.06, P=0.02), the differences were no statistically significant between the two groups (all P<0.05). The duration of sedation was (2.21±0.50)min, the time of the Ramsay score was (9.07±1.66)min, and the time of withdrawal was shorter than that of the control group (4.52±1.01)min, the difference was statistically significant (Time Ramsayscore of 4 points minutes t=13.33, P=0.00; wake time t=5.92, P=0.00); The satisfaction degree of sedation in the observation group was 97.50%, which was higher than 92.50% in the control group, and the incidence of delirium in the observation group was 6.67%, which was lower than 13.33% in the control group, but the difference was not statistically significant(χ2=1.05, P=0.30; χ2=1.48, P=0.22). The mean delirium score of the observation group was (16.11±3.03)points, which was lower than (19.23±4.21)points of the control group, the difference was statistically significant (t=4.66, P=0.00). The main adverse reactions of the two groups were mainly gastrointestinal reactions, lethargy, respiratory depression, forgetting and so on.All adverse reactions were mild and did not affect treatment.There was no significant difference in the incidence of adverse reactions between the two groups (χ2=0.10, P=0.75). Conclusion Propofol and remifentanil combined with low dose of midazolam intravenous anesthesia for gynecological outpatient surgery has significant effect on anesthesia, which does not affect patients' vital signs, with high safety and low incidence of adverse reactions. Key words: Propofol; Remifentanil; Midazolam; Hypnotics and sedatives; Ambulatory surgical procedures