Anesthetic management of patients undergoing cardiac myxoma resection: a single-center retrospective analysis.

Background: Myxomas are the most common primary cardiac tumors. Intracardiac myxomas, although benign, could cause serious consequences such as tricuspid or mitral valve obstruction, hemodynamic collapse, and acute heart failure, which pose challenges during anesthetic management. The current study was designed to summarize the anesthetic management of patients undergoing cardiac myxoma resection. Methods: This study was performed retrospectively from the perioperative period of patients who underwent myxoma resection. Patients were divided into two groups according to whether the myxoma prolapsed into the ventricle (group O) or not (group N) to evaluate the impact of tricuspid or mitral valve with obstruction. Results: 110 patients, aged 17-78 years, undergoing cardiac myxoma resection between January 2019 and December 2021 were collected, and their perioperative characteristics were recorded. In the preoperative evaluation, common clinical symptoms included dyspnea and palpitation, whereas embolic events occurred in 8 patients, including 5 (4.5%) cerebral thromboembolic events, 2 (1.8%) femoral artery, and 1 (0.9%) obstructive coronary artery. According to the echocardiography, left atrial myxoma was detected in 104 (94.5%) patients, the average dimension of myxoma was 4.03 cm ± 1.52 cm in the largest diameter, and 48 patients were divided into group O. During intraoperative anesthetic management, hemodynamic instability occurred in 38 (34.5%) patients after anesthesia induction. More patients in group O had hemodynamic instability (47.9% vs. 24.2%, p = 0.009) than in group N. The mean postoperative length of stay in the hospital was 10.64 ± 3.01 days, and most of the patients made an uneventful postoperative recovery. Conclusions: Anesthetic management for myxoma resection can be composed by assessing the myxoma, particularly the echocardiography evaluation and preventing cardiovascular instability. Typically, tricuspid or mitral valve with obstruction is a premier ingredient in anesthetic management.

[Correlation analysis of one-year postoperative mortality,preoperative serum indexes and postoperative nutrition guidance in elderly hip fracture patients].

OBJECTIVE: To analyze the influence of preoperative serum nutritional indexes and postoperative nutritional guidance on 1-year mortality in elderly patients with hip fracture. METHODS: From January 2015 to December 2017, 396 elderly patients with hip fracture were included in the study, including 267 females and 129 males, aged 68 to 80(75.48±2.62) years; the course of disease was 2 to 10 (6.12±1.35) days;all patients were followed up for 1-year, and were divided into death group and survival group according to whether the patients died or not. Multivariate logistic regression model was used to analyze the influencing factors of 1 year mortality. RESULTS: Duringthe follow-up, 4 patients lost contact and were treated as shedding, among which 67 patients died and 325 patients survived. The age, male patients, patients with more than three basic diseases, American Society of Anesthesiologists grade Ⅲ-Ⅳ and patients with postoperative complications in the death group were significantly higher than those in the survival group (all P<0.05). There was no significant difference in body mass index(BMI), number of smokers, fracture type and operation type (all P>0.05). The serum albumin (ALB), prealbumin (PA), lymphocyte (LYM), lymphocyte percentage(LYM%), hemoglobin(HB), transferrin(TRF), total protein(TP) in the death group were significantly lower than those in the survival group (t=5.884, 5.826, 2.020, 5.665, 4.726, 4.935, 2.862;all P<0.05). The number of patients receiving nutritional guidance in the death group was significantly less than that in the survival group (χ2=12.597, P= 0.000). There were no significant difference on white blood cell(WBC) and red blood cell(RBC) between two groups. Multivariate logistic regression analysis showed that old age, male and not receiving significant nutritional guidance were independent risk factors for 1 year mortality of elderly patients with hip fracture (OR=1.309, 43.548, 6.032;all P<0.05);high serum ALB, PA, HB, LYM% levels and combined with two or less basic diseases were protective factors (OR=0.958, 0. 913, 0.985, 0.954, 0.832; all P<0.05). CONCLUSION: Advanced age, male and multiple underlying diseases were independent risk factors for 1-year mortality in elderly patients with hip fracture, while higher preoperative nutritional level and routine nutritional guidance were protective factors.

[Effects of different ventilation mode on pulmonary function during minor operation of general anesthesia with SLIPA laryngeal mask].

OBJECTIVE: To retrospectively analyze the effects of different ventilation modes on pulmonary function during minor operation of general anesthesia with streamlined liner of the pharynx airway (SLIPA) laryngeal mask and assess its safety of spontaneous respiration during general anesthesia. METHODS: A total of 76 adult patients (aged 28 - 44 years old, American Society of Anesthesiologists physical status I-II) scheduled for operations were randomly allocated into the mechanical ventilation and spontaneous respiration group (n = 38 each). Anesthetic induction was performed intravenously with propofol (2 mg/kg), sulfentanyl (0.5 µg/kg) and cisatracurium besylate (0.3 mg/kg) (in mechanical ventilation group). Anesthesia was maintained by sevoflurane at 0.7 minimum alveolar concentration (MAC), mixture of atmosphere and oxygen at 1:1 and a continuous infusion of propofol at the speed of 4 mg×kg(-1)h(-1). Neostigmine (2 mg) and atropine (1 mg) were administered intravenously before the extraction of SLIPA laryngeal mask in order to antagonize the residual effects of muscle relaxation. The parameters including heart rate (HR), mean blood pressure (MAP) and end-tidal pressure of CO(2) (P(ET)CO(2)), blood gas analysis and the alveolar-arterial oxygen gradient [P(A-a)DO(2)], respiratory index (RI) and dead volume/tidal volume (V(D)/V(T)) were calculated at Different time points. RESULTS: No significant differences were found in HR (spontaneous respiration group: 76 ± 7, 78 ± 6, 79 ± 7/min; mechanical ventilation group: 77 ± 6, 80 ± 5, 79 ± 6/min), MAP (spontaneous respiration group: 91 ± 10, 89 ± 9, 90 ± 9mm Hg; mechanical ventilation group: 89 ± 10, 88 ± 9, 92 ± 8) mm Hg at the monitored time points between two groups (P > 0.05). At the time of 30 min and 60 min after insertion, the pH value was significantly lower in spontaneous respiration group (7.351 ± 0.028, 7.338 ± 0.025) than those in mechanical ventilation group (7.391 ± 0.031, 7.389 ± 0.032). The values of PaCO(2) (42 ± 4, 46 ± 6) mm Hg and P(ET)CO(2) (41 ± 5, 45 ± 3) mm Hg were higher than those in mechanical ventilation group (37 ± 3, 35 ± 5; 37 ± 4, 36 ± 4) mm Hg (P < 0.05). No significant difference was found in the P(A-a)DO(2), RI or V(D)/V(T) at the monitored time points between two groups (P > 0.05). CONCLUSION: Neither mechanical ventilation mode nor spontaneous respiration ventilation mode has any effect upon pulmonary function by during minor operation of general anesthesia with SLIPA laryngeal mask. Spontaneous respiration can offer a sufficient supply of oxygen but it carries the risk of CO(2) accumulation.

[Clinical study of visual plasticity in teenage and adults with amblyopia].

OBJECTIVE: Human visual plasticity was studied by the observation of the effects of treatment in teenage and adult amblyopia. METHODS: One hundred and two cases (125 eyes) were diagnosed as amblyopia according to the national criteria of amblyopia. These patients were divided into teenage group (15 - 17 years old, 47 cases and 57 eyes) and adult group (18 - 45 years old, 55 cases and 68 eyes). Eye examination, including best correct visual acuity, laser interference fringes visual acuity (IVA), degree and patterns of amblyopia, and nature of fixation were performed in these two groups before amblyopic treatment. Patients were treated with correct spectacle, optical and drug penalization (including far and near penalization, as well as light penalization), combined with occlusion and assisted with red light pleoption. All patients were followed up for 1 - 5 years, with an average of 2.9 years. RESULTS: Fifty five eyes (44%) were cured (23 eyes recovered, 32 eyes basically cured), 37 eyes (29.6%) were improved, 33 eyes (26.4%) were nullified and the total improvement rate was 73.6%. Different ages did not influence the results of treatment significantly (P > 0.05). Outcome of foveal fixation and parafoveal fixation was much better than that of paramacular fixation and peripheral fixation (P < 0.005). The curative efficiency of amblyopia was also dependent on the degree of amblyopia (P < 0.005). Curative effects of ametropic and anisometropic amblyopia were better than that of strabismic and deprivable amblyopia (P < 0.01). Visual acuity predicted by IVA before the treatment was the same as real results after the treatment in 112 eyes among 125 eyes (92.8%). The correlation efficient between the predicted and real vision was statistically significant (r = 0.886 2, P < 0.000 1). CONCLUSIONS: Vision in most teenage and adult amblyopia can be improved by amblyopic therapy. Therefore, it seems that human visual plasticity exists permanently during the whole life. Visual acuity after the treatment can be predicted by pre-treatment IVA. Results of amblyopia treatment are closely related with the degree and patterns of amblyopia and are also dependent on the cooperation of the patients.