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首页> 外文期刊>The Internet Journal of Anesthesiology >Effect Of Intravenous Infusion Of Propofol On Platelet Function During ENTProcedures For Endoscopic Carbon Dioxide Laser , Septoplasty And EndoscopicNasal Surgery
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Effect Of Intravenous Infusion Of Propofol On Platelet Function During ENTProcedures For Endoscopic Carbon Dioxide Laser , Septoplasty And EndoscopicNasal Surgery

机译：内镜二氧化碳激光鼻内窥镜鼻内窥镜鼻内窥镜手术中静脉输注异丙酚对血小板功能的影响。

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Propofol has inhibitory effect on platelet aggregation by using high dose more than9mg/kg.bw./hour.Also reduce the platelets count during surgery after 30 minutes from start. But has insignificant effect on bleeding time.It was happend in 3%of our cases,using propofol and 10% of cases using more than 9mg/kg.bw./hour.we recommended further study ,using different laboratory techniquies Background Most E.N.T.surgical procedures require a dry operative field and suitable hypotensive anesthetic techniques. Propofol “2,6 diisopropyl phenol”, is a intravenous anesthetic agent that is used for induction, total intravenous anesthesia (TIVA) and conscious sedation with reasonable pharmacokinetic profile (5). As it reduces the blood pressure with little effect on the pulse rate, it has been used for hypotensive anesthesia (6). A number of studies claimed that propofol could impair platelet activity. Platelets participate in a sequence of events that lead to the formation of platelet plug and finally stable fibrin clot formation at the site of vessel interruption (7). This study is conducted to evaluate the effect of changing propofol infusion rate on platelet count and aggregation . Methods This is a prospective study which was approved by the local ethics committee for ENT and anesthesia department . The technique was explained to each patient and a written consent was obtained. Ninety patients, of ASA I and II classification, scheduled for endoscopic nasal, septoplastic and endoscopic carbon dioxide laser sugery, were chosen .We excluded patients with a history of blood disease, a family history of blood disorder, renal or hepatic disease. Patients were also informed to stop aspirin or any non-steroidal anti-inflammatory drugs 3 weeks before the operation (8). Patients were divided into 3 groups, 30 patients each. A special chart was used to record history, data, laboratory results and concentration of propofol infusion . One day before the operation, patients were admitted and investigated for ECG, chest X-ray, complete blood count CBC, bleeding time and the first sample of blood (2ml) was sent for platelet aggregation (9). All patients were premedicated in the morning of the operation at 6 am with 10 mg valium and 10 mg metochlopramide oral tablets (10). In the theatre, patients were monitored for ECG, non-invasive blood pressure, pulse oxymetry, end-tidal carbon dioxide and rectal temperature. A gauge 18 venous canula was inserted in the right anticubital vein and kept for anesthetic drugs and iv fluid administration .On the left arm a sphygmomanometer cuff was applied to measure the blood pressure and also to measure bleeding test by fixing the pressure at 40 mm/Hg . Another 18 gauge venous canula was inserted into one vein at the dorsum of right or left foot to take blood samples for CBC and patelet aggregation, with a Dinamap (electrical blood pressure to measure and record systolic, diastolic, main arterial blood pressure). Blood samples were taken before starting propofol infusion then every 30 minutes during the infusion. Following the end of the infusion, additional blood samples were taken after 60 minutes, 2 hours and 24 hours . All the patients reveived Ringer’s lactate solution at a rate of 8-10 ml/min (11). Anesthesia was induced in all patients using fentanyl 1mcg/kg iv bolus , followed by sodium thiopental 5mg/kg by slow iv injection and then succinylcholine 1mg/kg iv. An oral endotracheal tube was inserted after mask ventilation with 4-2 oxygen-air mixture. Anesthesia was maintained with isoflurane 1.5 % concentration and propofol iv drip, spontanous +/- assistance ventilation.Patients were divided into three groups , the first group, 30 patients, with propofol infusion rate at 2-5mg/kg/hr., the second group, 30 patients, at 6-8mg/kg/hr. and the third group at 9-12mg/kg/hr. Propofol infusion rate was titrated according to blood pressure, heart rate, length of the operation, and end-tidal carbon dioxide (12). At the en
机译：丙泊酚通过使用大于9mg / kg.bw. / hour的高剂量对血小板聚集具有抑制作用，并且在开始手术后30分钟内还可以减少手术期间的血小板计数。但是对出血时间影响不明显。在我们的病例中有3％使用丙泊酚，有10％的病例使用9mg / kg.bw. / hour。我们建议进一步研究，使用不同的实验室技术背景大多数耳鼻喉科程序需要干手术场和合适的降压麻醉技术。丙泊酚“ 2,6二异丙基苯酚”是一种静脉麻醉剂，可用于诱导，完全静脉麻醉（TIVA）和具有合理药代动力学特征的有意识镇静作用（5）。由于它可以降低血压而对脉搏率几乎没有影响，因此已被用于降压麻醉（6）。许多研究声称丙泊酚会损害血小板活性。血小板参与一系列事件，这些事件导致血小板栓塞的形成，并最终在血管中断部位形成稳定的纤维蛋白凝块（7）。本研究旨在评估改变异丙酚输注率对血小板计数和聚集的影响。方法这是一项前瞻性研究，已获耳鼻喉科和麻醉科地方伦理委员会批准。向每位患者解释了该技术，并获得了书面同意。选择了90例ASA I和II级，计划经内镜鼻腔，鼻中隔成形术和内镜下二氧化碳激光手术治疗的患者。我们排除了有血液病史，血液病家族史，肾或肝病的患者。还告知患者在手术前3周停用阿司匹林或任何非甾体类抗炎药（8）。将患者分为3组，每组30位患者。使用特殊图表记录历史，数据，实验室结果和异丙酚输注浓度。手术前一天，患者入院并进行了心电图检查，胸部X线检查，全血CBC计数，出血时间，并送出了第一份血液样本（2ml）进行血小板聚集（9）。所有患者在手术前早上6点用10 mg缬氨酸和10 mg甲氨蝶呤口服片剂进行了药物治疗（10）。在剧院中，监测患者的心电图，无创血压，脉搏血氧仪，潮气末二氧化碳和直肠温度。将一条18号静脉插管插入右抗肘静脉，并保持麻醉药和静脉输液的作用。在左臂上，使用血压计袖带测量血压，并通过将压力固定在40 mm /来测量出血测试汞将另一个18号静脉插管插入右脚或左脚背侧的一条静脉中，采集血样进行CBC和血小板聚集，并使用Dinamap（电血压来测量和记录收缩压，舒张压，主动脉血压）。在开始输注异丙酚之前，然后在输注期间每30分钟采集一次血样。输注结束后，在60分钟，2小时和24小时后再采集血样。所有患者均以8-10毫升/分钟的速度摄取林格氏乳酸溶液（11）。所有患者均使用芬太尼1mcg / kg静脉推注，随后通过缓慢静脉注射的硫喷妥钠5mg / kg，然后静脉注射琥珀酰胆碱1mg / kg诱导麻醉。用4-2氧气-空气混合物进行面罩通气后，插入口腔气管插管。异氟醚1.5％浓度和异丙酚静脉滴注，自发+/-辅助通气维持麻醉。患者分为三组，第一组30例，丙泊酚输注速度为2-5mg / kg / hr。组30名患者，剂量为6-8mg / kg / hr。第三组为9-12mg / kg / hr。根据血压，心率，手术时间和潮气末二氧化碳滴定丙泊酚的输注速率（12）。在en

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