Header Page of 123 B GIO DC V O TO B QUC PHềNG VIN NGHIấN CU KHOA HC Y DC LM SNG 108 T C LUN NH GI HIU QU Vễ CM V TNH AN TON CA GY Mấ PROPOFOL KIM SOT NNG CH CHO NI SOI TN SI NIU QUN NGC DềNG BNH NHN NGOI TR Chuyờn ngnh: Gõy mờ hi sc Mó s: 62720122 LUN N TIN S Y HC NGI HNG DN KHOA HC: PGS.TS Nguyn Th Quý GS.TS Nguyn Quc Kớnh H NI - NM 2015 Footer Page of 123 Header Page of 123 LI CM N Tụi xin chõn thnh cỏm n: - ng y v Ban giỏm c Vin nghiờn cu khoa hc y dc lõm sng 108 - GS TS Nguyn Quc Kớnh, PGS TS Nguyn Th Quý l cỏc Thy Cụ hng dn - PGS TS Lờ Th Vit Hoa v cỏc Thy Cụ B mụn, Khoa Gõy mờ hi sc Vin nghiờn cu khoa hc Y dc lõm sng 108 - TS Nguyn Quang Chung v cỏc Thy Cụ phũng Sau i hc - GS Nguyn Th v cỏc Thy Cụ Hi ng chm Lun ỏn cp c s - Cỏc Thy phn bin c lp - TS Phan Tụn Ngc V v cỏc ng nghip khoa Phu thut gõy mờ hi sc, PGS TS Trn Lờ Linh Phng v cỏc phu thut viờn khoa Ngoi tit niu bnh vin i hc y dc thnh ph H Chớ Minh - ng y v Ban giỏm c, cỏc ng nghip khoa Gõy mờ hi sc bnh vin 30/4 B cụng an - V v cỏc tụi ó tn tỡnh hng dn, ng viờn, chia s, to iu kin ly s liu v gúp nhiu ý quý bỏu tụi hon thnh lun ỏn ny T c Lun Footer Page of 123 Header Page of 123 LI CAM OAN Tụi xin cam oan õy l cụng trỡnh nghiờn cu ca riờng tụi Cỏc s liu, kt qu nờu lun ỏn l trung thc v cha tng c cụng b bt k cụng trỡnh no khỏc Tỏc gi T c Lun Footer Page of 123 Header Page of 123 MC LC Trang T VN CHNG TNG QUAN TI LIU 1.1 PHU THUT NGOI TR 1.1.1 nh ngha phu thut v gõy mờ ngoi trỳ 1.1.2 La chn BN cho PTNT 1.1.3 Tỡnh hỡnh PTNT 1.1.4 Phu thut tỏn si tit niu ngoi trỳ 1.2 GY Mấ TNH MCH KIM SOT NNG CH 1.2.1 Lch s gõy mờ tnh mch kim soỏt nng ớch 1.2.2 Mt s khỏi nim c bn nguyờn lý gõy mờ KSN 1.2.3 Cỏc nghiờn cu v gõy mờ propofol KSN 14 1.3 PROPOFOL 15 1.3.1 c im lý húa 15 1.3.2 Dc ng hc 16 1.3.3 Dc lc hc 17 1.3.4 S dng trờn lõm sng 19 1.3.5 Gõy mờ tnh mch propofol KSN 19 1.4 MT N THANH QUN PROSEAL 22 1.4.1 Cu trỳc 22 1.4.2 Ch nh v chng ch nh ca MNTQ 23 1.4.3 Tai bin ca MNTQ 24 1.4.4 Nhng cũn bn cói 24 1.5 LA CHN PHNG PHP Vễ CM CHO TN SI NIU QUN NI SOI 25 Footer Page of 123 Header Page of 123 1.5.1 Gõy tờ ti ch 26 1.5.2 Gõy tờ ty sng, gõy tờ ngoi mng cng 27 1.5.3 Gõy mờ ton thõn 27 CHNG I TNG V PHNG PHP NGHIấN CU 30 2.1 I TNG NGHIấN CU 30 2.1.1 Tiờu chun la chn 30 2.1.2 Tiờu chun loi tr 30 2.1.3 Tiờu chun loi mu nghiờn cu 31 2.2 PHNG PHP NGHIấN CU 31 2.2.1 Thit k nghiờn cu 31 2.2.2 C mu 31 2.2.3 Phng tin nghiờn cu 32 2.2.4 Cỏc ch tiờu ỏnh giỏ 34 2.2.5 Cỏc nh ngha, tiờu chun ỏp dng nghiờn cu 36 2.2.6 Phng phỏp tin hnh 43 2.2.7 Phõn tớch s liu 47 2.2.8 o c nghiờn cu 47 2.2.9 S nghiờn cu 49 CHNG KT QU NGHIấN CU 51 3.1 C IM BNH NHN V CAN THIP 51 3.1.1 c im BN 51 3.1.2 c im can thip 53 3.2 HIU QU Vễ CM NHểM 54 3.2.1 ỏnh giỏ mờ theo PRST 54 3.2.2 Cỏc ỏnh giỏ v thi gian 55 3.2.3 Tiờu th propofol v fentanyl 56 Footer Page of 123 Header Page of 123 3.2.4 S ln BN c ng gõy mờ 57 3.2.5 S ln iu chnh mỏy TCI/BT 58 3.2.6 S ln t MNTQ 58 3.2.7 S hi lũng ca phu thut viờn 59 3.2.8 ỏnh giỏ mc au ca BN (theo VAS) 60 3.2.9 S c tnh gõy mờ, s ln in thoi t bỏc s v nguyn vng gõy mờ ln sau 60 3.2.10 Xut vin, nm li qua ờm v nhp vin ngoi d kin 61 3.2.11 Cỏc giỏ tr ca gõy mờ propofol KSN 61 3.3 TNH AN TON TRONG GY Mấ CA NHểM 63 3.3.1 Thay i tn s tim can thip 63 3.3.2 Thay i HATT ti cỏc thi im 64 3.3.3 Thay i HATTr ti cỏc thi im 65 3.3.4 Thay i HATB ti cỏc thi im 66 3.3.5 S dng ephedrin, atropin v dch truyn 68 3.3.6 Thay i SpO2 ti cỏc thi im 69 3.3.7 Thay i EtCO2 ti cỏc thi im 70 3.3.8 p lc trung bỡnh v ỏp lc dũ ng th 71 3.3.9 Tỏc dng khụng mong mun ca MNTQ 71 3.3.10 im OAA/S v phũng hi tnh 72 3.3.11 Cỏc bin chng khỏc hu phu 73 CHNG BN LUN 74 4.1 C IM BNH NHN V CAN THIP 74 4.1.1 c im BN 74 4.1.2 c im v can thip 76 4.2 HIU QU Vễ CM 78 Footer Page of 123 Header Page of 123 4.2.1 im PRST 78 4.2.2 Cỏc ch tiờu v thi gian 79 4.2.3 Tiờu th propofol v fentanyl 87 4.2.4 S ln BN c ng gõy mờ v s ln iu chnh mỏy TCI/BT 89 4.2.5 S ln t MNTQ, kớch thớch t v rỳt MNTQ 91 4.2.6 S thun li ca can thip 93 4.2.7 Mc au v s hi lũng ca BN 94 4.2.8 Xut vin, nm li qua ờm v nhp vin li 95 4.2.9 Cỏc giỏ tr ca gõy mờ propofol KSN 97 4.3 TNH AN TON TRONG GY Mấ 101 4.3.1 Thay i tun hon 101 4.3.2 Thay i hụ hp 104 4.3.3 im OAA/S v phũng hi tnh 105 4.3.4 Cỏc tỏc dng khụng mong mun ca MNTQ 107 4.3.5 Cỏc tai bin, bin chng khỏc hu phu 109 4.3.6 Cỏc bin chng sau xut vin 111 KT LUN 112 KIN NGH 114 DANH MC CễNG TRèNH NGHIấN CU TI LIU THAM KHO PH LC Footer Page of 123 Header Page of 123 DANH MC CH VIT TT TRONG LUN N Vit tt Ni dung BN Bnh nhõn BT Bm tiờm in GMHS Gõy mờ hi sc HA Huyt ỏp HATB Huyt ỏp trung bỡnh HATT Huyt ỏp tõm thu HATTr Huyt ỏp tõm trng KSN Kim soỏt nng ớch MNTQ Mt n qun NKQ Ni khớ qun N Nng N Nng ớch PTNT Phu thut ngoi trỳ Footer Page of 123 Header Page of 123 BNG I CHIU THUT NG ANH - VIT Vit tt ASA FASA IAAS OAA/S p-LMA Ting Anh Ting Vit American Society of Hip hi gõy mờ hi sc Hoa Anesthesiologists K Federated ambulatory surgery Hip hi phu thut ngoi trỳ association liờn bang International Association for Hip hi phu thut ngoi trỳ Ambulatory Surgery quc t Observers Assesment of an thn v phũng hi Alertness/Sedation tnh ProSeal laryngeal mask Mask qun proseal Air way SAMBA The Society for Ambulatory Hip hi gõy mờ ngoi trỳ Anesthesia TCI Target controlled infusion Kim soỏt nng ớch VAS Visual Analogue Scale Thang tớnh im au MADPE Median Absolute Performance Trung v ca cỏc giỏ tr tuyt Error i v hiu nng MDPE Median Performance Error Sai lch trung v hiu nng BMI Body Mass Index Ch s c th LBM Lean Body Mass Ch s c nc Footer Page of 123 Header Page 10 of 123 DANH MC CC BNG Trang Bng 1.1 Hiu nng ca mt s phng thc vi propofol 13 Bng 1.2 Cỏc thụng s dc ng hc chớnh mụ hỡnh Marsh 20 Bng 2.1 im PRST ca Evans 38 Bng 2.2 Tiờu chun phũng hi tnh theo Aldrete sa i 39 Bng 2.3 Tiờu chun xut vin theo Chung sa i 40 Bng 2.4 im an thn OAA/S 41 Bng 3.1 Gii, tui, cõn nng v BMI 51 Bng 3.2 ASA v Mallampati 52 Bng 3.3 V trớ si niu qun 53 Bng 3.4 Thi gian gõy mờ, thi gian can thip 53 Bng 3.5 mờ theo PRST nhúm 54 Bng 3.6 ỏnh giỏ v thi gian 55 Bng 3.7 Tiờu th propofol v fentanyl 56 Bng 3.8 C ng gõy mờ 57 Bng 3.9 iu chnh mỏy gõy mờ 58 Bng 3.10 S ln t MNTQ 58 Bng 3.11 S hi lũng ca phu thut viờn theo VAS tớnh ngc 59 Bng 3.12 Mc au ca BN ti mt s thi im nghiờn cu 60 Bng 3.13 S c tnh v nguyn vng gõy mờ ln sau 60 Bng 3.14 Xut vin, nm li qua ờm v nhp vin li 61 Bng 3.15 N nóo (Ce, àg/ml) ca propofol ti cỏc thi im nhúm TCI 62 Bng 3.16 Thay i tn s tim 63 Bng 3.17 Thay i HATT 64 Footer Page 10 of 123 Header Page 137 of 123 Patients Undergoing Carotid Surgery: A Quality of Anesthesia and Recovery Profile", Anesthesia & Analgesia, 93 (3), pp 560-565 66 Glen JB (1998), "The development of Diprifusor': a TCI system for propofol", Anaesthesia, 53, pp 13-21 67 Gravningsbrồten, Nicklasson, Raeder (2009), "Safety of laryngeal mask airway and short-stay practice in office-based adenotonsillectomy", Acta Anaesthesiol Scand, 53 (2), pp 218-222 68 Greif R, Laciny S, Rapf B, Hickle RS, Sessler DI (1999), "Supplemental oxygen 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et al (2005), "Individual Effect-Site Concentrations of Propofol are Similar at Loss of Consciousness and at Awakening", Anesth Analg, 100 (1), pp 107-110 74 Hughes MA, Glass PS, Jacobs JR (1992), "Context-sensitive half-life in multicompartment", 76 (3), pp 334-341 75 Huseyin Sen, Ferhat Ates, Ali Sizlan, et al (2009), "Effect of music on sedation during local urological surgeries", Anatol J Clin Investig 3(2), pp 131-135 76 Jayashree Sood (2005), "Laryngeal mask airway and its variants", Indian J Anaesth, 49 (4), pp 725-780 77 Jean Wong, Yoshani De Silva, Doris Tong, et al (2009), "Development of the Functional Recovery Index for Ambulatory Surgery and Anesthesia", Anesthesiology 110 (3), pp 596-602 78 Jin Young Lee, Eun Jin Kim (2009), "Awareness during total intravenous anesthesia for endoscopic thyroidectomy - A case report ", Korean J Anesthesiol, 57 (5), pp 670-672 79 Jinhye Min, Young Ho Kim, Young Keun Chae, et al (2008), "A Comparison of Remifentanil versus Fentanyl as an Adjuvant to Propofol Anesthesia for Ureteroscopic Lithotripsy", Korean J Anesthesiol, 54 (3), pp 283-288 80 A Junger, J Klasen, B Hartmann, M Benson, R Rohrig, D Kuhn, G Hempelmann (2002), "Shorter discharge time after regional or intravenous anaesthesia in combination with laryngeal mask airway compared with balanced anaesthesia with endotracheal intubation", Eur J Anaesthesiol, 19 (2), pp 119-24 81 Kamaza Tomiei, Ikeda Kazuyuki, Morita Koji, Anesthesiology (1997), "Redution by fentanyl of the Cp50 values of propofol and Footer Page 138 of 123 Header Page 139 of 123 hemodynamic respones to various stimuli", Anesthesiology, 87 (2), pp 213-227 82 Kailash Bhatia (2012), "Day case surgery and anesthesia", Anesthetics for jonior doctors allied professionals, 25, 166-171 83 Kamaza Tomiel, et al (2000), "Optimal propofol plasma concentration during upper gastrointestinal endoscopy in young, middle aged, and elderly patients", Anesthesiology, 93, pp 662-669 84 Kaya S., Turhanoglu S., Karaman 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intravenous infusion and multicompartment accumulation", Eur J Pharmacol, 4, pp 317324 Footer Page 139 of 123 Header Page 140 of 123 89 Kwong FK, Fun GC, Keng FC (1999), "Laryngeal mask insertion using thiopental and low dose atracurium: a comparison with propofol", Can J Anaesth, 46 (7), pp 670-674 90 Lance Lichtor J (2008), "Adult preoperative preparation: equipment and monitoring", ed 2, Springer, pp 144-166 91 Lasersohn (2009), "Gastro-oesophageal reflux disease (GORD) To tube or not?", SAJAA 15 (3), pp 13-18 92 Laszlo Hollos, Nick Enraght (2001), "Effect Site Targeted Propofol Infusion In Clinical Practice: Comparison To Diprifusor", The Internet Journal of Anesthesiology, (3), pp 183-225 93 Lee JS, Gonzalez, Chuang, Perrott D (2008), "Comparison of methohexital and propofol use in ambulatory procedures in oral and maxillofacial surgery", J Oral Maxillofac Surg, 66 (10), pp 19962003 94 Lee SK (2010), "Pain on Injection with Propofol", Korean Journal of Anesthesiology, 59 (5), pp 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of 123 Header Page 142 of 123 106 Park HK, Paich SH, Oh SJ, et al (2004), "Ureteroscopic lithotripsy under local anesthesia: anallysis of the effectiveness and patient tolerability", Uro Today International Journal, (6), pp 77 107 Paul Aylin, Susan Williams, Brian Jarman, Alex Bottle (2005), "Trends in day surgery rates ", British medical Journal, 331, pp 803 108 Paul F White (2005), "Ambulatory Anesthesia Advances into New Millennium", Anesth Analg, 90, pp 1234-1235 109 Payne, Moore, Elliott, et al (2005), "Anaesthesia for day case surgery: a survey of adult clinical practice in the UK", European Journal of Anaesthesiology, (4), 311-324 110 Paek CM, Lee BJ, Kang JM (2009), "No supplemental muscle relaxants are required during propofol and remifentanil total intravenous anesthesia for laparoscopic pelvic surgery", J Laparoendosc Adv Surg Tech A, 19 (1), pp 33-37 111 Picard V, Dumont L, Pellegini M (2000), "Quality of recovery in children: sevoflurane versus propofol", Acta Anaesthesiol 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PropofolRemifentanil Anesthesia", Anesthesiology 99, pp 34-41 117 Schnider T.W, Shafer S.L (1995), "Evolving clinically usefull predictors of recovery from intravenous anesthetics", Anesthesiology, 83 (5), pp 902-905 118 Schnider, Minto, et al (1998), "The Influence of Method of Administration and Covariates on the Pharmacokinetics of Propofol in Adult Volunteers ", Clinical Investigations, 88 (5), pp 11701182 119 Schraag S (2001), "Theoretical basic of TCI anesthesia: history, concept and clinical perspectives", Best practice and research clinical anesthesia, 15 (1), pp 1-17 120 Schutter, Kloos, Schwilden, et al (1988), "Total intravenous anaesthesia with propofol and alfentanil by computer-assisted infusion", Anaesthesia, 43 (1), pp 2-7 121 Sebel P S., Bowdle, Ghoneim, et al (2004), "The incidence of awareness during anesthesia: a multicenter United States study", Anesth Analg, 99 (3), pp 833-839 122 Servin F, Nathan N (1998), "TCI compared with manually controlled infusion of propofol: a multicentre study", Anaesthesia, 1, pp 8286 Footer Page 143 of 123 Header Page 144 of 123 123 Song D, Joshi GP, White PF (1998), "Fastrack eligibility after ambulatory anesthesia: a comparison of desflurane, sevoflurane and propofol", Anesth analg, 86, pp 267-273 124 Sreevastava DK, Upadhyaya KK, Maj MVU Reddy, et al (2008), "Automated target controlled infusion systems: The future of total intravenous anesthesia", Methods in Medicine, 64 (3), pp 260-262 125 Stoelting Robert K., Hillier Simon C (2006), "Handbook of Pharmacology and Physiology in Anesthetic Practice", 2sd ed, Lippincott Williams & Wilkins, pp 152-154 126 Sukhminder Jit Singh Bajwa, Sukhwinder Kaur Bajwa, Jasbir Kaur (2010), "Comparison of two drug combinations in total intravenous anesthesia: Propofolketamine and propofolfentanyl", Saudi Journal of Anaesthesia, (2), pp 72-79 127 Taheri A, Hajimohamadi, Soltanghoraee, Moin (2009), "Complications of using LMA during anesthesia undergoing major ear surgery", Acta Otorhinolaryngol Ital J, 29 (3), pp 151-155 128 Tang Jun, Chen, White Paul F., Watcha Mehernoor, Wender Ronald, Naruse Robert, Kariger Robert, Sloninsky Alexander (1999), "Recovery Profile, Costs, and Patient Satisfaction with Propofol and Sevoflurane for Fast track Office-based Anesthesia", Anesthesiology, 91 (1), pp 253-261 129 Taylor AL, Oakley, Das S, Parys (2002), "Day-case ureteroscopy: an observational study", BJU Int, 89 (3), pp 181-185 130 Tong J Gan, Tricia A Meyer, Christian C, Apfel, Frances Chung (2007), "Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting", Ambulatory Anesthesiology, 105 (6), pp 1615-1628 Footer Page 144 of 123 Header Page 145 of 123 131 Twersky, Rebecca MD, Fishman, David MD, Homel, Peter (1997), "What Happens After Discharge? Return Hospital Visits After Ambulatory Surgery", Anesthesia & Analgesia, 84 (2), pp 319-324 132 Varvel JR, Donoho DL, Shafer SL (1992), "Measuring the predictive performace of computer controlled infusion pums", J pharmacokinet Biopharm, 20, pp 63-94 133 Vuyk, et al (2000), "Population pharmacokinetics of propofol for TCI in the elderly", Anesthesiology, 93 (6), pp 1557 134 Wang, Mcloughlin, Paech, et al (2007), "Low and moderate Remifentanil infusion rates not alter target-controlled infusion Propofol concentrations necessary to maintain Anesthesia as assessed by Bispectral index monitoring", Anesthesia and Analgesia, 104 (2) 135 Waters RM (1919), "The down-town anesthesia clinic", ed Anesth Analg., 33, pp.71-73 136 Watson K R, Shah M V (2000), "Clinical comparison of single agent anaesthesia with sevoflurane versus target controlled infusion of propofol", Br J Anaesth., 85 (4), pp 541-546 137 Wills TE, Burns JR (1994), "Ureteroscopy: an outpatient procedure?", The Journal of Urology 151 (5), pp 1185-1187 138 Yeganeh, Roshani, Yari M, Almasi A (2010), "Target-controlled infusion anesthesia with propofol and remifentanil compared with manually controlled infusion anesthesia in mastoidectomy surgeries.", Middle east J anesthesiol, 20 (6), pp 785-793 Footer Page 145 of 123 Header Page 146 of 123 PHIU THU THP S LIU BNH NHN (Nhúm TCI) Hnh chớnh: H tờn BN: Tui gii CC .CN S HS: .Chn oỏn: PP m: BS m: Ngy m TS, bnh kốm theo: .ASA Mallampati BMI: Hiu qu GM: Tin mờ: Mida .mg Khi mờ: fentanyl .àg ThgKM giõy Thg K t MNTQ phỳt Thg t giõy S ln t: Thgian GM phỳt Thg m ph Kthớch: C K Th li sau: ph MNTQ s p lc ng th: CmH2O p lc rũ khớ:.CmH2O Rỳt MNTQ: Kthớch: C K Tnh GM: C K S hi lũng ca PTV (VAS ngc):im C ng KM: C K C ng CT: C 3.Tớnh an ton: 3.1 Trong GM: N (Ce) mờ: àg/ml Thgian HT trờn mỏy: Thc t (ph) Footer Page 146 of 123 K Header Page 147 of 123 - S thay i M (l/ph), HA (mmHg), Th (l/ph), SpO2 (%), EtCO2 (mmHg) v mờ cỏc thi im: Thi im Ce M HAT HA TS T TTr th SpO2 EtCO2 T0:Nhn bnh T1:Trc KM T2:Mt tri giỏc T3:Trc t MNTQ T4:1ph sau t MNTQ T5:Trc CT T6:1ph sau CT T7:5ph sau CT(trongCT) T8:Cui CT (5ph trc kt thỳc CT)(T T9:Hi tnh T10:Trc rỳt MNTQ T11:Sau rỳt MNTQ Ghi chỳ: CT: can thip Tt HA: C K Mch chm: C K Tt SpO2: C K Nụn ma: K Footer Page 147 of 123 C mờ PRST iu chnh TCI Header Page 148 of 123 Tai bin MTQ: Chy mỏu: C K H: C Tro ngc, hớt sc: C K K Rũ khớ: C Chng d dy: C K K Tng liu: Propofol: mg, atropine mg, ephedrine mg Dch truyn trongCT: .ml Thuc khỏc: 3.2 Trong HP (Trc XV): Khụng qua PHT: im OAA/S: Thi gian nm HT:phỳt VAS hi tnh:im.Thg nm HP(thgXV): gi Gi 10 11 12 13 14 15 16 17 18 19 20 M HA Th SpO2 Tt HA: C K Tt SpO2: C gỏy): C Sdng ephedrine:mg Dch truyn HP ml K H tr HH (do tt li, ngỏy, phi búp búng, kờ cao vai K Th < 10 hay >25l/ph: C K TB MNTQ: au hng, khn ting, khú nut: C au (VAS): im Nụn ma: C tiu: C K Bớ tiu: C K K K Lnh run: C Chúng mt: C K K au ng Mt nh hng: C K 3.3 Sau XV ngy (Qua T): au theo VAS:.im Bớ tiu: C au hng, khn ting, khú nut: C K Chúng mt:C K K S ln T t BS ng ý gõy mờ nu phi can thip ln sau: C Footer Page 148 of 123 K Header Page 149 of 123 PHIU THU THP S LIU BNH NHN (Nhúm BT) Hnh chớnh: H tờn BN: Tui gii CC .CN S HS: .Chn oỏn: PP m: BSm: Ngy m TS, bnh kốm theo: .ASA Mallampati BMI: Hiu qu GM: Tin mờ: Mida .mg Khi mờ: fentanyl .àg ThgKM giõy Thg Kt MNTQ phỳt Thg t giõy S ln t: Kthớch: C K Thgian GM phỳt Thg m ph Th li sau: ph MNTQ s p lc ng th: CmH2O p lc rũ khớ:.CmH2O Rỳt MNTQ: Kthớch: C K Tnh GM: C S hi lũng ca PTV (VAS ngc):im C ng KM: C K C ng CT: C 3.Tớnh an ton: 3.1 Trong GM: Liu propofol KM: mg ( mg/kg) Thgian HT: phỳt Footer Page 149 of 123 K K Header Page 150 of 123 - S thay i M (l/ph), HA (mmHg), Th (l/ph), SpO2 (%), EtCO2 (mmHg) v mờ cỏc thi im: Thi im Liu propofol ml/g mg/kg/g Mch HA HA TS T th TT T0: Nhn bnh T1:Trc KM T2:Mt trigiỏc T3:Trc t MNTQ T4:1ph sau t T5:Trc CT T6:1ph sau CT T7:5 ph sauCT (trongCT) T8:Cui CT (5ph trc kt thỳc CT) T9:Hi tnh T10: Trc rỳt MNTQ T11: Sau rỳt MNTQ Ghi chỳ: CT: can thip Tt HA: C Tt SpO2: C Footer Page 150 of 123 K Mch chm: C K Nụn ma: C K K SpO2 EtCO2 mờ PRST iu chnh BT Header Page 151 of 123 Tai bin MTQ: Chy mỏu: C K H: C Tro ngc, hớt sc: C K K Rũ khớ: C Chng d dy: C K K Tng liu: Propofol: mg, atropine mg, ephedrine mg Dch truyn trongCT: .ml Thuc khỏc: 3.2 Trong HP (Trc XV): Khụng qua PHT: im OAA/S: Thi gian nm HT:phỳt VAS hi tnh:im.Thg nm HP(thgXV): gi Gi 10 11 12 13 14 15 16 17 18 19 20 M HA Th SpO2 Tt HA: C K Tt SpO2: C gỏy): C Sdng ephedrine:mg Dch truyn HP ml K H tr HH (do tt li, ngỏy, phi búp búng, kờ cao vai K Th < 10 hay >25l/ph: C K TB MTQ: au hng, khn ting, khú nut: C au (VAS): im Nụn ma: C tiu: C K Bớ tiu: C K K K Lnh run: C Chúng mt: C K K au ng Mt nh hng: C K 3.3 Sau XV ngy (Qua T): au theo VAS:.im au hng, khn ting, khú nut: C Bớ tiu: C K K Chúng mt: C K S ln T t BS ng ý gõy mờ nu phi can thip ln sau: C Footer Page 151 of 123 K ... [6] - Nm 2012, V Tun Vit v cng s bỏo cỏo v gõy mờ propofol cho ni soi i trng ngoi trỳ [24] - Nm 2013, Nguyn Quang Bỡnh bỏo cỏo v an thn propofol cho phu thut rng ngoi trỳ [3] Footer Page 19 of... i sinh lý mang thai - BN suy thn: thi gim gõy kộo di tỏc dng ca cỏc thuc, thi gian phc hi ú lõu hn - BN cú bnh gan: cỏc thuc la chn phi khụng c cho gan, ớt thi tr qua ng mt, thi gian tỏc dng... thi gian bỏn hy ph thuc bi cnh ca sufentanil l 20 phỳt nu truyn di gi; 60-120 phỳt nu truyn 10 gi Vi fentanyl l 150 phỳt sau truyn gi, propofol l < 40 phỳt vi thi gian truyn > 10 Thi gian bỏn