Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China; Department of Anesthesiology, Chongqing General Hospital, Chongqing, China.
Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
Ann Palliat Med. 2021 Jan;10(1):61-73. doi: 10.21037/apm-20-2217.
Elderly patients with painless colonoscopy often complain listlessness, fatigue when they left postanesthesia care unit (PACU). These patients also commonly occur hypotension during anesthesia. However, intravenous infusion and blood volume assessment are seldom performed in elderly patients. Therefore, we aimed to observe the effect of intravenous infusion and to explore the value of inferior vena cava diameter (IVCD) measurement by ultrasound in rapid recovery.
Randomized, controlled, clinical trials, elderly patients (aged ≥60 years) with painless colonoscopy were randomly divided into two groups: intravenous infusion versus no intravenous infusion was administered procedure. The primary outcome observed was the time required for complete recovery from anesthesia. Secondary outcomes included willingness to accept follow-up colonoscopy, discomfort symptoms, changes in the inferior vena cava (IVC)-related parameters. Hypotension was defined as a ≥20% decrease in systolic blood pressure (SBP) from baseline. The patients in the two groups were divided into non-hypotensive and hypotensive subgroups, respectively. Receiver operating characteristic (ROC) curves were used to determine the efficacy of the IVC-related parameters for predicting hypotension and the optimal threshold.
A total of 65 patients were enrolled, including 34 patients in the infusion group and 31 patients in the conventional group. Administration of intravenous infusion reduced the time required for complete recovery and increased the willingness to accept follow-up colonoscopy and reduced discomfort symptoms. The IVC-related parameters were changed before and after bowel preparation and after reaching infusion loading dose. The ROC curve was used to predict hypotension during anesthesia. The maximum value of inferior vena cava diameter (IVCDmax) was the best predictive efficacy in the both groups [area under the ROC curve (AUC) =0.839, AUC =0.877, respectively].
Intravenous infusion promotes the rapid recovery of elderly patients with painless colonoscopy. Measurement of the IVCDmax can help to guide intravenous infusion.
行无痛结肠镜检查的老年患者常在离开麻醉后恢复室（PACU）时主诉乏力、疲劳。这些患者在麻醉期间也常发生低血压。然而，老年患者很少进行静脉输液和血容量评估。因此，我们旨在观察静脉输液的效果，并探讨超声测量下腔静脉直径（IVCD）在快速康复中的价值。
随机、对照、临床试验，将行无痛结肠镜检查的老年患者（年龄≥60 岁）随机分为两组：静脉输液组和无静脉输液组。主要观察指标为麻醉后完全恢复所需的时间。次要观察指标包括愿意接受后续结肠镜检查、不适症状、下腔静脉（IVC）相关参数的变化。低血压定义为收缩压（SBP）从基线下降≥20%。两组患者分别分为低血压亚组和非低血压亚组。受试者工作特征（ROC）曲线用于确定 IVC 相关参数预测低血压的效果及其最佳阈值。
共纳入 65 例患者，其中静脉输液组 34 例，常规组 31 例。静脉输液可减少完全恢复所需的时间，增加愿意接受后续结肠镜检查的意愿，并减轻不适症状。在肠道准备前后和达到输液负荷剂量后，IVC 相关参数发生变化。ROC 曲线用于预测麻醉期间的低血压。IVCDmax 值最大时预测效果最佳[两组的曲线下面积（AUC）分别为 0.839 和 0.877]。
静脉输液可促进行无痛结肠镜检查的老年患者快速康复。测量 IVCDmax 有助于指导静脉输液。
