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Let me tell you the good news first.
This year I have been promoted to attending doctor, and I have taken a step forward in my doctor's career.
Closer to home, after being promoted to the attending doctor, you need to undertake more clinical work in the departments.
Painless gastrointestinal endoscopy is one of the key points; although the previous intermittent implementation under the protection of senior professional titles, I have not carefully observed and thought about the following question: What indicators are The best entry point for painless gastroscopy? First explain my dosing plan: first give sufentanil 5ug, and then slowly inject propofol until you fall asleep.
Our usual practice is to use the disappearance of eyelash reflexes and the unresponsiveness of the jaw to be used as a sign that the patient can start the microscopy after falling asleep.
This was also taught to me by my superior doctor many years ago; the results have proved to be good, but There are still a large proportion of patients experiencing physical movement and nausea, indicating that sometimes the anesthesia is still shallow.
Is there a better entry index? I accidentally noticed the change of heart rate during induction of anesthesia: a rapid rise occurs in the center of the patient during the process of falling asleep, and then slowly decreases after about ten seconds, and it can generally be reduced to the basal heart rate before falling asleep.
I chose as the entry point when the heart rate rose to the highest point and then began to fall.
I found that none of the patients had physical movement or nausea, and the blood pressure monitoring was within the acceptable range.
I tried dozens of cases and got similar results.
Originally, I was thinking of designing a clinical experiment to verify this good "discovery".
Unexpectedly, I searched and found that there was already a "first step" in the search.
The article by Qin Jing and other doctors in the Journal of Guangzhou Medical University in April 2020 has given it very good.
The answer to, directly to the conclusion: using the heart rate as the entry point of the painless gastroscope has fewer adverse events and fewer interventions than touching the eyelashes of the patient, and the patient’s vital signs are more stable when the patient’s heart rate is entered at the highest point.
But apart from this, there are no more similar studies.
There are so many painless gastroscopy examinations done every year in China, so there should be more research on such meaningful topics. This article also analyzed the mechanism of the bolus injection of propofol causing the heart rate to rise first and then fall: 1.
When induced by propofol, directly dilate the peripheral blood vessels to cause a drop in blood pressure and activate the sympathetic nervous system (SNS) to increase the heart rate; 2.
Propofol also reduces SNS outgoing impulse by 34%.
During its steady-state infusion, SNS outgoing impulse is reduced by 37%, and propofol can excite central vagus and inhibit baroreflex, resulting in a later heart rate drop.
When the heart rate drops from the highest point, the blood pressure is lower.
At this time, it is at a deeper depth of anesthesia, which has a strong inhibitory effect on noxious stimuli.
Experimental observations have also confirmed this.
Earlier access to the lens may not have enough depth of anesthesia, and too late It may delay the time, pulse oxygen and blood pressure are lower; it is recommended to insert a gastroscope when the heart rate rises to the highest point and then drops to the heart rate before the intravenous bolus of propofol, which I call the heart rate drop bronchoscopy is the best.
Finally, let me talk about my personal thoughts.
Compared to subjective eyelash reflexes or jaw support, heart rate changes are the most quantifiable and objective indicator; if the above results can be confirmed by more and larger studies, artificial intelligence anesthesia can do Painless gastroscopy has a solid theoretical foundation and operability, and the conversion of such objective indicators into codes will be a blessing for programmers.
A little thought, share with everyone, and look forward to greater research.
References: Qin Jing, Song Mingjuan, Xu Wenqing.
Comparison of heart rate changes and touching eyelashes as a painless gastroscope entry point[J].
Journal of Guangzhou Medical University, 2020, v.
48;No.
232(02):47-50 .
(Click "Read Full Text" to view the summary) Recommendation: What is the appropriate intraoperative oxygen concentration? Previous post: What problems should be paid attention to in anesthesia for patients after radiotherapy
This year I have been promoted to attending doctor, and I have taken a step forward in my doctor's career.
Closer to home, after being promoted to the attending doctor, you need to undertake more clinical work in the departments.
Painless gastrointestinal endoscopy is one of the key points; although the previous intermittent implementation under the protection of senior professional titles, I have not carefully observed and thought about the following question: What indicators are The best entry point for painless gastroscopy? First explain my dosing plan: first give sufentanil 5ug, and then slowly inject propofol until you fall asleep.
Our usual practice is to use the disappearance of eyelash reflexes and the unresponsiveness of the jaw to be used as a sign that the patient can start the microscopy after falling asleep.
This was also taught to me by my superior doctor many years ago; the results have proved to be good, but There are still a large proportion of patients experiencing physical movement and nausea, indicating that sometimes the anesthesia is still shallow.
Is there a better entry index? I accidentally noticed the change of heart rate during induction of anesthesia: a rapid rise occurs in the center of the patient during the process of falling asleep, and then slowly decreases after about ten seconds, and it can generally be reduced to the basal heart rate before falling asleep.
I chose as the entry point when the heart rate rose to the highest point and then began to fall.
I found that none of the patients had physical movement or nausea, and the blood pressure monitoring was within the acceptable range.
I tried dozens of cases and got similar results.
Originally, I was thinking of designing a clinical experiment to verify this good "discovery".
Unexpectedly, I searched and found that there was already a "first step" in the search.
The article by Qin Jing and other doctors in the Journal of Guangzhou Medical University in April 2020 has given it very good.
The answer to, directly to the conclusion: using the heart rate as the entry point of the painless gastroscope has fewer adverse events and fewer interventions than touching the eyelashes of the patient, and the patient’s vital signs are more stable when the patient’s heart rate is entered at the highest point.
But apart from this, there are no more similar studies.
There are so many painless gastroscopy examinations done every year in China, so there should be more research on such meaningful topics. This article also analyzed the mechanism of the bolus injection of propofol causing the heart rate to rise first and then fall: 1.
When induced by propofol, directly dilate the peripheral blood vessels to cause a drop in blood pressure and activate the sympathetic nervous system (SNS) to increase the heart rate; 2.
Propofol also reduces SNS outgoing impulse by 34%.
During its steady-state infusion, SNS outgoing impulse is reduced by 37%, and propofol can excite central vagus and inhibit baroreflex, resulting in a later heart rate drop.
When the heart rate drops from the highest point, the blood pressure is lower.
At this time, it is at a deeper depth of anesthesia, which has a strong inhibitory effect on noxious stimuli.
Experimental observations have also confirmed this.
Earlier access to the lens may not have enough depth of anesthesia, and too late It may delay the time, pulse oxygen and blood pressure are lower; it is recommended to insert a gastroscope when the heart rate rises to the highest point and then drops to the heart rate before the intravenous bolus of propofol, which I call the heart rate drop bronchoscopy is the best.
Finally, let me talk about my personal thoughts.
Compared to subjective eyelash reflexes or jaw support, heart rate changes are the most quantifiable and objective indicator; if the above results can be confirmed by more and larger studies, artificial intelligence anesthesia can do Painless gastroscopy has a solid theoretical foundation and operability, and the conversion of such objective indicators into codes will be a blessing for programmers.
A little thought, share with everyone, and look forward to greater research.
References: Qin Jing, Song Mingjuan, Xu Wenqing.
Comparison of heart rate changes and touching eyelashes as a painless gastroscope entry point[J].
Journal of Guangzhou Medical University, 2020, v.
48;No.
232(02):47-50 .
(Click "Read Full Text" to view the summary) Recommendation: What is the appropriate intraoperative oxygen concentration? Previous post: What problems should be paid attention to in anesthesia for patients after radiotherapy
