Bronchoesophageal Fistula, Endobronchial Metastases, General Anesthetic Drug Adverse Reaction
Conditions
Brief summary
This study is a prospective, randomized, controlled trial. In this study, 30 patients who underwent endotracheal tumor resection under rigid bronchoscope or stent placement for acquired tracheoesophageal fistula were selected as the subjects. The patients were randomly divided into remazolam general anesthesia group (R group) and propofol general anesthesia control group (P group). Remazolam general anesthesia group (R group): Remazolam 0.4 mg/kg, oxycodone 0.2 mg/kg and rocuronium 0.9 mg/kg were given for anesthesia induction. Propofol general anesthesia control group (P group): Propofol 1.5mg/kg, oxycodone 0.2mg/kg and rocuronium 0.9mg/kg were given for induction of anesthesia. After induction, high-frequency jet ventilation was used in both groups, the respiratory rate was 30-60 times/min, the inspiratory-to-breath ratio was 1:2, and the driving pressure was 0.8-1.0 KPa. Group R was given remazolam 1mg/kg/h and remifentanil 6-8ug/kg/h for maintenance. Group P was given propofol 4-8 mg/kg/h and remifentanil 6-8ug/kg/h for anesthesia maintenance. The dosage of propofol or remazolam was adjusted according to BIS and intraoperative hemodynamic changes. Rocuronium bromide 10 mg was added every half hour. Intraoperative application of vasoactive drugs to maintain mean arterial pressure above 60mmHg to avoid perioperative hypotension. Blood oxygen saturation and end-tidal carbon dioxide were monitored to avoid perioperative hypoxemia and hypercapnia, and warm measures were used to maintain the patient's intraoperative body temperature above 36.0°C. After surgery, group R was treated with sugammadex sodium 2-4 mg/kg to antagonize rocuronium bromide, and 0.5 mg of flumazenil was used to antagonize remazolam by intravenous injection; group P was treated with sugammadex 2-4 mg/kg to antagonize rocuronium.
Interventions
DRUGRemifentanil
Remifentanil is an esterase-metabolized opioid
DRUGoxycodone
Oxycodone is an opiate painkiller.
DRUGRemimazolam
Remimazolam is a new drug innovation in anesthesia. It combines the properties of two unique drugs already established in anesthesia - Midazolam and remifentanil. It acts on GABA receptors like midazolam and has organ-independent metabolism like remifentanil.
DRUGPropofol
Propofol is used to put you to sleep and keep you asleep during general anesthesia for surgery or other medical procedures.
DRUGRocuronium
Rocuronium is a non-depolarizing neuromuscular blocker
Sugammadex sodium is an organic sodium salt that is the octasodium salt of sugammadex. Used for reversal of neuromuscular blockade induced by rocuronium and vecuronium in adults undergoing surgery
DRUGFlumazenil
Flumazenil is used to reverse the effects of a benzodiazepine
Sponsors
Zhejiang Cancer Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients undergoing bronchoscopy endotracheal tumor resection or stenting of acquired tracheoesophageal fistula within a limited time * \>18 Years * ASA Ⅱ-Ⅳ
Exclusion criteria
* \<18Years * Refuse to participate * A history of schizophrenia, epilepsy, Parkinson's disease or myasthenia gravis; * Severe hepatic dysfunction (Child-Pugh class C) * Severe renal dysfunction (requiring dialysis) * Patients with ASA grade Ⅴ and above * Emergency Surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Recovery time in seconds | postoperative, 2 hours | Taking the stop of general anesthesia as the starting point for timing, the time for the patient to correctly complete the three commands of nodding, mouth opening and tongue extension is recorded, with seconds as the timing unit |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Intraoperative mean arterial blood pressure in mmHg | Intraoperative，4hours | Fluctuations in intraoperative systolic, diastolic pressures and mean arterial pressure will be recorded |
| Perioperative Nutrition Status Assessment Scale (PONS) in YES or NO | Baseline, 1 year | PONS is a modified version of the malnutrition universal screening tool and determines the presence of nutrition risk based on BMI, recent body weight loss, decrement of dietary intake, and preoperative albumin concentration. |
| Onset time in seconds | Induction of anesthesia，10 minutes | The time from the start of peripheral intravenous injection of general anesthetic to the patient's loss of consciousness. Time is measured in seconds. |
| Modified Brice Questionnaire in YES or NO | postoperative，24 hours | Modified Brice interview over quality assurance techniques in detecting intraoperative awareness. |
| Intraoperative heart rate in beats per minute | Intraoperative，4hours | Fluctuations in intraoperative heart rate will be recorded |
| The incidence of postoperative vomiting in rate | postoperative，24 hours | The proportion of cases of postoperative vomiting in the enrolled patients |
| The incidence of Postoperative delirium in rate | postoperative，24 hours | The proportion of cases of postoperative delirium in the enrolled patients |
Countries
China
Outcome results
None listed