Background and Purpose: Stepwise propofol target-controlled infusion (TCI) can achieve a less disturbed condition of hemodynamics and respiration. Its combination with dexmedetomidine may have some advantages for patients. We studied the effects of different loading doses of dexmedetomidine on the bispectral index (BIS) under stepwise propofol TCI. Methods: Forty patients were randomly assigned into groups D1.0, D0.5, D0.25 and D₀, in which dexmedetomidine at 1.0, 0.5, 0.25 or 0 µg•kg–1 was infused over 10 min followed by 0.5 µg•kg–1•h–1 and stepwise propofol TCI, which was administered with target effect site concentration (Ce) at 0.5 µg•ml–1, and increased until 2.5 µg•ml–1 by 1.0 µg•ml–1 after 5 min reaching target Ce. BIS, heart rate, MAP, pulse oxygen saturation, RR and end-tidal carbon dioxide pressure were recorded before loading dose (T₀), at 5 min (T5 min) and 10 min (T10 min) after starting infusion, after 5 min reaching Ce of 0.5, 1.5 and 2.5 µg•ml–1 (Tp0.5, Tp1.5 and Tp2.5). Results: BIS values in group D1.0 were significantly lower compared with those in group D₀ since T10 min and those in groups D0.5 and D0.25 since Tp0.5. In group D1.0, heart rate decreased significantly at T5 min and T10 min, heart rate at T10 min was significantly lower compared with that in group D₀. MAP remained stable during the loading dose infusion and decreased to some degree after propofol infusion in all groups. Changes in pulse oxygen saturation, RR and end-tidal carbon dioxide pressurewere similar among the groups without respiration depression. Conclusion: A loading dose of dexmedetomidine of 1.0 µg•kg–1, not 0.5 µg•kg–1 or less, over 10 min followed by 0.5 µg•kg–1•h–1 can definitely decrease the BIS under stepwise propofol TCI with clinically stable blood pressure and without respiration depression, while attention should be paid to decreased heart rate.
Multifunctional cotton textiles that are highly breathable
are
desirable in a broad range of applications. However, it is still a
big challenge to scale up production of such multifunctional cotton
textiles. Herein, we developed a simple, scalable, and benign strategy
to fabricate highly breathable multifunctional cotton textiles via
mild surface modification. The 1,4-dihydropyridine (DHP) ring and
gentamycin sulfate (GS) molecules were firmly attached to the cellulose
chains under room temperature via a one-pot method. The resulting
modified cotton textile showed integrated performances with bright
fluorescence, good antibacterial behavior, hydrophobic behavior (contact
angle of 134°), and UV-blocking (UPF being up to 69.2), which
are very stable toward washing and various solvents. There is no obvious
change in the whiteness, thermal stability, and mechanical performance
of cotton fabrics after the surface modification. What’s more,
the air permeability of the modified cotton fabric was up to 31.3
(cm3/cm2)/s. This study not only focuses on
the materials design and large-scale fabrication but also provides
stable and multifunctional cotton textiles with broad application
prospects for many fields.
Objectives:
The purpose was to compare the effects of 3 different dose combinations of bupivacaine and sufentanil on the onset of analgesia and the occurrence of side effects.
Materials and Methods:
One hundred sixty-nine pregnant women were randomly assigned to 3 groups: the B1S5 group received 0.1% bupivacaine+5 μg sufentanil in 15 mL; the B125S5 group received 0.125% bupivacaine+5 μg sufentanil in 15 mL; and the B1S10 group received 0.1% bupivacaine+10 μg sufentanil in 15 mL. The primary outcome was the analgesic onset time, and the secondary outcomes were mode of delivery, patient satisfaction, maternal and neonatal side effects (pruritus, hypotension, sedation, motor block, decreased fetal heart rate, fever, and interference with breastfeeding).
Results:
The median (inter-quartile range) time to achieve effective analgesia was significantly faster in the B125S5 group than in the B1S5 group (10 [11-14 {4-30}] min vs. 15 [17-20 {5-30}] min, P<0.001). There was no significant difference in the analgesia onset time between the B1S10 and B125S5 groups (10 [11-14 {4-30}] min vs. 12 [13-15 {3-30}] min, P=0.202). Pruritus, hypotension, motor block, maternal satisfaction, delivery mode, decreased fetal heart rate, total bupivacaine dose and breastfeeding scores were not significantly different among the 3 groups except the sufentanil dosage and incidence of mild drowsiness and fever (the B1S10 group had significantly higher fever than the other groups).
Discussion:
The B125S5 combination may be superior to the B1S5 and B1S10 combinations as an initial dose for epidural analgesia to achieve rapid effective analgesia with minimal side effects.
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