[Comparison between flexible laryngeal mask airway and reinforced tracheal tube used for lumbar vertebral surgery in prone position].

OBJECTIVE: To estimate the safety and feasibility of flexible laryngeal mask airway (FLMA) for lumbar vertebral surgery in prone position. METHODS: In the study, 120 adult patients scheduled for lumbar vertebral surgery under intravenous general anesthesia were divided into group FLMA and reinforced tracheal tube (RTT) group at random. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at the beginning of anesthesia induction (T0) and on the time of artificial airway intubation (T1), 1 min after intubation (T2), extubation (T3), 1 min after extubation (T4) as well. The number and time required for intubation were recorded. Peak airway pressure (PPEAK), airway sealing pressure (PAS) in group FLMA and fiberoptic bronchoscopy scale (FBS) were recorded after artificial airway intubation, turned over into prone position and after the operation started, as well as on the time of 1 hour after the operation started, 2 hours after operation started and when the operation stopped. Finally, respiratory complications after extubation, including hypoxemia, laryngospasm, coughing, vomiting, hoarseness, and pharyngalgia, were observed and whether there was blood or sewage inside and outside the artificial airway was recorded. RESULTS: There was no difference in the number and time required for intubation between the two groups (P>0.05). There was no difference in PPEAK and FBS between the two groups, and also the same at the different time points in each group (P>0.05). PAS in group FLMA was the same at the diverse time points during anesthesia (P>0.05) and always higher than PPEAK in the perioperative period. In group FLMA, there was no difference in HR, SBP and DBP between the time points of T2 and T1, also of T4 and T3 (P>0.05). In group RTT, HR, SBP and DBP were significantly higher between the time points of T2 and T1 (P<0.01); SBP was significantly higher between the time points of T4 and T3 (P<0.01), DBP and HR were higher between the time points of T4 and T3 (P<0.05). SBP in group FLMA was significantly lower than in group RTT at T2 (P<0.01), HR and DBP were lower than those in group RTT simultaneously (P<0.05). On the time point of T4, SBP, DBP and HR in group FLMA were lower than those in group RTT (P<0.05). The incidence of coughing and pharyngalgia after extubation was significantly lower in group FLMA than in group RTT (P<0.01), with the incidence of hoarseness was lower in group FLMA than in group RTT (P<0.05). There was no difference in the incidence of hypoxemia, vomiting and blood seen outside the cuff between the two groups (P>0.05) while no laryngospasm and sewage seen outside the artificial airway in each group. CONCLUSION: For suitable patients, FLMA can be used in mechanical ventilation forlumbar vertebral surgery in prone position with more stable circulation and less respiratory complications than RTT. Further clinical validation is needed for the safety of FLMA.

The role of IVS14+1 G > A genotype detection in the dihydropyrimidine dehydrogenase gene and pharmacokinetic monitoring of 5-fluorouracil in the individualized adjustment of 5-fluorouracil for patients with local advanced and metastatic colorectal cancer: a preliminary report.

AIM: We retrospectively investigated the relationship between IVS14+1 G > A genotype of the dihydropyrimidine dehydrogenase (DPD) gene with plasma concentration of 5-fluorouracil (5-FU) as well as adverse reactions in 80 patients with locally advanced or metastatic colorectal cancer. PATIENTS AND METHODS: Eighty patients with un-resectable locally advanced or metastatic colorectal cancer were treated with Folfox-6 regimen, which repeated every two weeks for at least three cycles. Single nucleotide polymorphisms for DPD gene were analyzed before chemotherapy by high-resolution melting (HRM) analysis. The plasma concentration of fluorouracil was measured by high performance liquid chromatography (HPLC) after continuous infusion of fluorouracil over 12 h in each cycle. The average values of plasma concentrations in each cycle were calculated, and the factors related to plasma concentration of 5-FU were screened by stepwise regression. RESULTS: All patients were divided into three groups according to the predictive confidence interval of plasma concentration of 5-FU, and the average plasma concentrations of fluorouracil in each cycle of these three groups were less than or equal to 26.83 mg/L, 26.83-40.62 mg/L, and more than 40.62 mg/L, respectively. Stepwise regression analysis showed that the plasma concentration of fluorouracil was associated with myelosuppression, hand-foot syndrome, diarrhea, overall survival (OS) and DPD genotype. In efficacy, the median progression-free survival PFS (mPFS) and OS (mOS) of group 2 and group 3 were both significantly higher than those of group 1. CONCLUSIONS: Among the advanced colorectal cancer patients receiving fluorouracil-based chemotherapy, those with plasma concentration of 5-FU above 26.83 mg/L can obtain better survival; for patients with heterozygous DPD IVS14+1 mutation, 5-FU dose should be appropriately reduced according to last plasma concentration to reduce adverse reactions, while the homozygous ones should avoid application of 5-FU and its derivatives.