Zhuang T Fang, Christine Nguyen-Buckley, Tristan Grogan, Alan Zamora, Natalia MacDougall, Theodora Wingert
{"title":"新型单注射器多模态阿片类药物或非阿片类药物6-2-2混合物的精确镇静。","authors":"Zhuang T Fang, Christine Nguyen-Buckley, Tristan Grogan, Alan Zamora, Natalia MacDougall, Theodora Wingert","doi":"10.1016/j.jclinane.2025.112013","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study is to determine the efficacy and safety of sedation/analgesia using mixtures of propofol, opioids or non-opioid sedatives, and lidocaine or etomidate in one single syringe.</p><p><strong>Design: </strong>A retrospective case review was undertaken.</p><p><strong>Setting: </strong>University outpatient surgical center.</p><p><strong>Patients: </strong>1,376 adult patients undergoing ophthalmic surgery with ocular blocks and monitored anesthesia care were studied.</p><p><strong>Intervention: </strong>The 6 opioid-based mixtures contained 6 portions of propofol, 2 portions of opioid (alfentanil, fentanyl, a combination of alfentanil and fentanyl, or alfentanil and hydromorphone), and 2 portions of lidocaine or ketamine in a single syringe, in a 6:2:2 volume ratio. The non-opioid mixture contained 6 portions of propofol, 2 portions of ketamine, and 2 portions of etomidate. A bolus dose for all mixtures was calculated based on the patient's age and weight: < 40 yr, 1.2 mL/10 kg; 40-59 yr, 1 mL/10 kg; 60-69 yr, 0.8 mL/10 kg; 70-84 yr, 0.6 mL/10 kg; ≥85 yr, 0.5 mL/10 kg, and delivered by hand push or infusion pump intravenously (IV). For patients with a body mass index (BMI) >25, the adjusted weight for dosing (AWFD) was used: AWFD = ideal body weight (IBW) + 0.3 x (Actual weight [AW] - IBW). Ocular blocks were performed when patients reached a moderate level of sedation. Blood pressure (BP), heart rate (HR), oxygen saturation, clinical signs of sedation, responses to blocks, apnea and need for airway support, and recall were recorded.</p><p><strong>Measurement and main results: </strong>91 %-98 % of all patients had no pain during ocular blocks and 98-99 % had no head movement, except in the KE6-2-2 without K10 (bolus only) group. The readiness time was 46-51 s for the opioid groups and 36- 43 s for the non-opioid groups. In the opioid groups, 97 %-99 % had no apnea and 88 %-94 % had no oxygen desaturation, while 99 % had no apnea and 96 % had no oxygen desaturation in the non-opioid groups. Heart rate and blood pressure decreased <10 % in the opioid groups while there was nearly no change in the non-opioid groups.</p><p><strong>Conclusion: </strong>Adjusted for age and weight, the bolus dose of the 6-2-2 mixture met the sedation requirements for ocular blocks in most patients with favorable outcomes and minimal airway or hemodynamic compromise regardless of which mixture was used.</p>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"107 ","pages":"112013"},"PeriodicalIF":5.1000,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Precision sedation with novel single syringe multimodal opioid or non-opioid 6-2-2 mixtures.\",\"authors\":\"Zhuang T Fang, Christine Nguyen-Buckley, Tristan Grogan, Alan Zamora, Natalia MacDougall, Theodora Wingert\",\"doi\":\"10.1016/j.jclinane.2025.112013\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>The purpose of this study is to determine the efficacy and safety of sedation/analgesia using mixtures of propofol, opioids or non-opioid sedatives, and lidocaine or etomidate in one single syringe.</p><p><strong>Design: </strong>A retrospective case review was undertaken.</p><p><strong>Setting: </strong>University outpatient surgical center.</p><p><strong>Patients: </strong>1,376 adult patients undergoing ophthalmic surgery with ocular blocks and monitored anesthesia care were studied.</p><p><strong>Intervention: </strong>The 6 opioid-based mixtures contained 6 portions of propofol, 2 portions of opioid (alfentanil, fentanyl, a combination of alfentanil and fentanyl, or alfentanil and hydromorphone), and 2 portions of lidocaine or ketamine in a single syringe, in a 6:2:2 volume ratio. The non-opioid mixture contained 6 portions of propofol, 2 portions of ketamine, and 2 portions of etomidate. A bolus dose for all mixtures was calculated based on the patient's age and weight: < 40 yr, 1.2 mL/10 kg; 40-59 yr, 1 mL/10 kg; 60-69 yr, 0.8 mL/10 kg; 70-84 yr, 0.6 mL/10 kg; ≥85 yr, 0.5 mL/10 kg, and delivered by hand push or infusion pump intravenously (IV). For patients with a body mass index (BMI) >25, the adjusted weight for dosing (AWFD) was used: AWFD = ideal body weight (IBW) + 0.3 x (Actual weight [AW] - IBW). Ocular blocks were performed when patients reached a moderate level of sedation. Blood pressure (BP), heart rate (HR), oxygen saturation, clinical signs of sedation, responses to blocks, apnea and need for airway support, and recall were recorded.</p><p><strong>Measurement and main results: </strong>91 %-98 % of all patients had no pain during ocular blocks and 98-99 % had no head movement, except in the KE6-2-2 without K10 (bolus only) group. The readiness time was 46-51 s for the opioid groups and 36- 43 s for the non-opioid groups. In the opioid groups, 97 %-99 % had no apnea and 88 %-94 % had no oxygen desaturation, while 99 % had no apnea and 96 % had no oxygen desaturation in the non-opioid groups. Heart rate and blood pressure decreased <10 % in the opioid groups while there was nearly no change in the non-opioid groups.</p><p><strong>Conclusion: </strong>Adjusted for age and weight, the bolus dose of the 6-2-2 mixture met the sedation requirements for ocular blocks in most patients with favorable outcomes and minimal airway or hemodynamic compromise regardless of which mixture was used.</p>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"107 \",\"pages\":\"112013\"},\"PeriodicalIF\":5.1000,\"publicationDate\":\"2025-10-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jclinane.2025.112013\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jclinane.2025.112013","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Precision sedation with novel single syringe multimodal opioid or non-opioid 6-2-2 mixtures.
Objectives: The purpose of this study is to determine the efficacy and safety of sedation/analgesia using mixtures of propofol, opioids or non-opioid sedatives, and lidocaine or etomidate in one single syringe.
Design: A retrospective case review was undertaken.
Setting: University outpatient surgical center.
Patients: 1,376 adult patients undergoing ophthalmic surgery with ocular blocks and monitored anesthesia care were studied.
Intervention: The 6 opioid-based mixtures contained 6 portions of propofol, 2 portions of opioid (alfentanil, fentanyl, a combination of alfentanil and fentanyl, or alfentanil and hydromorphone), and 2 portions of lidocaine or ketamine in a single syringe, in a 6:2:2 volume ratio. The non-opioid mixture contained 6 portions of propofol, 2 portions of ketamine, and 2 portions of etomidate. A bolus dose for all mixtures was calculated based on the patient's age and weight: < 40 yr, 1.2 mL/10 kg; 40-59 yr, 1 mL/10 kg; 60-69 yr, 0.8 mL/10 kg; 70-84 yr, 0.6 mL/10 kg; ≥85 yr, 0.5 mL/10 kg, and delivered by hand push or infusion pump intravenously (IV). For patients with a body mass index (BMI) >25, the adjusted weight for dosing (AWFD) was used: AWFD = ideal body weight (IBW) + 0.3 x (Actual weight [AW] - IBW). Ocular blocks were performed when patients reached a moderate level of sedation. Blood pressure (BP), heart rate (HR), oxygen saturation, clinical signs of sedation, responses to blocks, apnea and need for airway support, and recall were recorded.
Measurement and main results: 91 %-98 % of all patients had no pain during ocular blocks and 98-99 % had no head movement, except in the KE6-2-2 without K10 (bolus only) group. The readiness time was 46-51 s for the opioid groups and 36- 43 s for the non-opioid groups. In the opioid groups, 97 %-99 % had no apnea and 88 %-94 % had no oxygen desaturation, while 99 % had no apnea and 96 % had no oxygen desaturation in the non-opioid groups. Heart rate and blood pressure decreased <10 % in the opioid groups while there was nearly no change in the non-opioid groups.
Conclusion: Adjusted for age and weight, the bolus dose of the 6-2-2 mixture met the sedation requirements for ocular blocks in most patients with favorable outcomes and minimal airway or hemodynamic compromise regardless of which mixture was used.
期刊介绍:
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.