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1.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 32(1): 102-7, 2010 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-20236598

RESUMO

OBJECTIVE: To evaluate the residual paralysis after a single intubating dose of rocuronium and its effect of residual paralysis after a single dose of rocuronium on the postoperative pulmonary function of patients undergoing laparoscopic gynecological surgeries. METHODS: Sixty American Society of Anesthesiologists (ASA) I - II patients undergoing laparoscopic gynecological surgeries were randomly divided into rocuronium (R) group (n = 30) and rocuronium + neostigmine (R + N) group (n = 30).All patients received midazolam (0.02 mg/kg), fentanyl (1 microg/kg), propofol(1.5-2 mg/kg), and rocuronium (0.6 mg/kg) to facilitate tracheal intubation and no more relaxant thereafter. Anesthesia was maintained with isoflurane and nitrous oxide in oxygen (N(2)O:O(2) = 1:1). At the end of the procedure, neuromuscular blockade was not reversed in R group, while antagonism was accomplished with neostigmine (0.04 mg/kg) and atropine (0.02 mg/kg) in R + N group. Immediately after tracheal extubation and on arrival in the PACU, the train-of-four (TOF) ratio at the adductor pollicis of all patients were measured using acceleromyography. Forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), and peak expiratory flow rate (PEFR) of all patients were measured using spirometry before surgery, after administration of midazolam and fentanyl, immediately after tracheal extubation, on arrival in the PACU, and after the TOF ratio recovered to 1.0. The TOF ratio and pulmonary function between two groups were compared. RESULTS: Immediately after tracheal extubation and on arrival in the PACU, the mean TOF ratio in R group was significantly lower than that in R + N group (P < 0.05). The mean time to achieve TOF ratio of 0.9 and 1.0 in R group was significantly longer than in R + N group (P < 0.05). Immediately after tracheal extubation and on arrival in the PACU, FVC, FEV(1), and PEFR were significantly lower in R group than in R + N group (P < 0.05). FVC, FEV(1), and PEFR after administration of midazolam and fentanyl and after TOF ratio recovered to 1.0 were significantly lower than the baseline values in all patients (P < 0.01). CONCLUSIONS: After a single intubating dose of rocuronium, residual paralysis exists in the majority of patients undergoing laparoscopic gynecological surgeries. The pulmonary function is impaired after the surgery, even after recovery of TOF ratio to 1.0.


Assuntos
Androstanóis/efeitos adversos , Fármacos Neuromusculares não Despolarizantes/efeitos adversos , Paralisia/induzido quimicamente , Adolescente , Adulto , Extubação , Androstanóis/administração & dosagem , Feminino , Procedimentos Cirúrgicos em Ginecologia , Humanos , Intubação Intratraqueal , Laparoscopia , Pessoa de Meia-Idade , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Período Pós-Operatório , Testes de Função Respiratória , Rocurônio , Adulto Jovem
2.
Anesth Analg ; 103(4): 983-5, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17000816

RESUMO

Malignant hyperthermia has rarely been reported in China. We report the first case of malignant hyperthermia, verified by caffeine-halothane contracture test and genetic testing, in a Chinese patient.


Assuntos
Anestesia Geral/efeitos adversos , Hipertermia Maligna/diagnóstico , Cafeína , China/epidemiologia , Halotano , Humanos , Técnicas In Vitro , Masculino , Hipertermia Maligna/epidemiologia , Hipertermia Maligna/genética , Hipertermia Maligna/terapia , Pessoa de Meia-Idade , Contração Muscular/efeitos dos fármacos
3.
Chin Med Sci J ; 21(1): 57-61, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16615287

RESUMO

OBJECTIVE: To investigate the changes of perioperative serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures. METHODS: Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation. Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol. pHi and plasma lactate were also measured at the same time points. RESULTS: Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation. CRP was not detectable until the first day after operation. Peak concentration of IL-6 had positive relationship with CRP. These variables changed more significantly in colorectal group than that in orthopaedic group (P < 0.05). pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P < 0.05). CONCLUSION: IL-6 may reflect tissue damage more sensitively than CRP. Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.


Assuntos
Neoplasias Colorretais/sangue , Interleucina-6/sangue , Deslocamento do Disco Intervertebral/sangue , Estenose Espinal/sangue , Adulto , Idoso , Proteína C-Reativa/metabolismo , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/cirurgia , Feminino , Determinação da Acidez Gástrica , Mucosa Gástrica/metabolismo , Humanos , Hidrocortisona/sangue , Concentração de Íons de Hidrogênio , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/cirurgia , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Estenose Espinal/fisiopatologia , Estenose Espinal/cirurgia
4.
Zhonghua Wai Ke Za Zhi ; 43(7): 463-7, 2005 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-15854376

RESUMO

OBJECTIVE: To investigate the relationship between the circadian rhythm of perioperative cortisol secretion and neuropsychological states in patients undergoing coronary artery bypass grafting surgery. METHODS: Forty male patients scheduled for elective coronary artery bypass grafting (CABG) under hypothermic cardio-pulmonary bypass (CPB) or off-pump were enrolled in this study. They were allocated into CPB group or off-pump group with 20 patients in each group. Blood samples were withdrawn during surgery at specific time-points and every 3 h for 24 h in the immediate postoperative period. Plasma cortisol was measured by radioimmunoassay. All subjects were investigated preoperatively as well as 7 to 10 d and 3 months postoperatively with a comprehensive neuropsychologic assessment, while depression and anxiety were assessed by Self-Rating Depression Scale and the State-Trait Anxiety Inventory respectively. RESULTS: During postoperative 24 h, three patients in the CPB group and 7 patients in the off-pump group were demonstrating a circadian secretion pattern, while they were disturbed in the remaining patients in both groups. Postoperative depression scores of patients in both groups were significantly higher than preoperative values. Postoperative anxiety scores of patients in the CPB group were significantly higher than those in the off-pump group. The CABG with CPB patients showed a significant deficit in the Digit Span subtest of the WAIS-R and the Stroop colour word interference test. The disturbed cortisol circadian secretion in the CPB group correlated with depression and the Stroop colour word interference test, whereas in the off-pump group it correlated with depression, Digit Span subtest (forward), symbol digit modalities test and the Stroop colour word interference test. Degree of depression correlated with some items of cognitive dysfunctions. CONCLUSION: Perioperative secretion rhythm of cortisol in patients undergoing CABG surgery with CPB or off-pump was disturbed. The disordered cortisol may correlate directly or indirectly through mood with neuropsychological deficits.


Assuntos
Ritmo Circadiano , Ponte de Artéria Coronária/psicologia , Hidrocortisona/metabolismo , Ponte Cardiopulmonar , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária sem Circulação Extracorpórea/psicologia , Circulação Extracorpórea , Humanos , Hipotermia Induzida , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório
5.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 26(2): 188-91, 2004 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-15171559

RESUMO

OBJECTIVE: To observe the effectiveness of using cell saver (CS) during surgery on blood sparing and its impact on patient's hematology and coagulation function. METHODS: One-hundred and thirty-eight patients undergoing elective surgery were recruited for intraoperative blood salvage using CS. Blood routine, blood chemistry and coagulation function were measured before surgery, after infusion of salvaged blood and postoperative day 1, respectively. RESULTS: In total, 112,056 ml of packed red blood cells were collected, with a mean value of 812 ml per patient. The percentage of autologous blood transfusion volume to the total blood transfusion volume was from 48% to 89%. Allogenic blood transfusion rate was from 5% to 100%. Compared with the values before surgery, the hemoglobin concentration, platelet count, plasma total protein and fibrinogen concentration decreased significantly after the transfusion of salvaged blood and the first postoperative day (P < 0.05 or P < 0.01), while the prothrombin time was significantly prolonged (P < 0.05). CONCLUSIONS: The use of CS during surgery can, to a certain extent, reduce the requirement of allogenic blood. However, reinfusion of large amount of salvaged blood may affect coagulation function.


Assuntos
Perda Sanguínea Cirúrgica , Transfusão de Sangue Autóloga/métodos , Ponte de Artéria Coronária , Adulto , Idoso , Testes de Coagulação Sanguínea , Volume Sanguíneo , Procedimentos Cirúrgicos Eletivos , Feminino , Próteses Valvulares Cardíacas , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Tempo de Protrombina
6.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 26(1): 66-9, 2004 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-15052778

RESUMO

OBJECTIVE: To compare the efficacy and safety of remifentanil with fentanyl used for intraoperative anesthesia. METHODS: Fifty-four patients undergoing modified radical mastectomy or total hysterectomy were randomly assigned to remifentanil group or fentanyl group with 27 cases in each group. Anesthesia was induced with propofol (2 mg/kg) and either remifentanil (2 micrograms/kg) or fentanyl (2.5 micrograms/kg), and was maintained with inhalation of nitrous oxide in oxygen (2:1) and a continuous infusion of either remifentanil (0.2 microgram.kg-1.min-1) or fentanyl (0.03 microgram.kg-1.min-1). Depth of anesthesia, hemodynamic changes, recovery profile of anesthesia, postoperative analgesia and adverse reactions were observed. RESULTS: The number of patients exhibited light depth of anesthesia during tracheal intubation and maintenance in the remifentanil group was significantly fewer than that in the fentanyl group (P < 0.05). Hemodynamic changes during intubation, skin incision, maintenance of anesthesia and extubation in the remifentanil group were significantly smaller than those in the fentanyl group (P < 0.05, P < 0.01). The time to opening eyes on command and the time for extubation after surgery were comparable between the two groups. More patients in the remifentanil group required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (P < 0.05). There was no significant difference between the two groups in the aspect of adverse reactions. CONCLUSION: The anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability compared with fentanyl without compromising recovery from anesthesia.


Assuntos
Anestésicos Intravenosos/uso terapêutico , Histerectomia , Mastectomia Radical Modificada , Piperidinas/uso terapêutico , Adolescente , Adulto , Neoplasias da Mama/fisiopatologia , Neoplasias da Mama/cirurgia , Feminino , Fentanila/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Humanos , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle , Remifentanil
7.
Zhonghua Yi Xue Za Zhi ; 84(6): 456-9, 2004 Mar 17.
Artigo em Chinês | MEDLINE | ID: mdl-15061961

RESUMO

OBJECTIVE: To investigate the circadian rhythm of perioperative melatonin secretion in patients undergoing coronary artery bypass grafting surgery. METHODS: Forty male patients scheduled for elective coronary artery bypass grafting surgery (CABG) under hypothermic cardiopulmonary bypass (CPB) or off-pump were allocated into two groups of 20 patients: CPB group and off-pump group. Blood samples were withdrawn from all patients immediately before the induction of anesthesia (baseline), 10 min after the induction of anesthesia, 10 min after heparinization, 30 min after commencement of CPB (or 2h after skin incision), before reversal of heparin with protamine, at the end of surgery, and. every 3 hours after operation until the twenty-fourth hour. The plasma concentration of melatonin was measured by using enzyme-linked immunosorbent assay. RESULTS: The plasma melatonin concentrations during and after CPB were higher than the baseline value in the CPB group. There were no differences in the melatonin concentrations in the off-pump group. In the CPB group the melatonin concentrations after induction, during CPB, and after CPB were 7.2 +/- 3.4, 10.5 +/- 5.2, and 9.5 +/- 4.0 respectively, all significantly higher than those in the off-pump (5.5 +/- 2.5, 6.3 +/- 2.0, and 5.7 +/- 2.1 respectively, all P < 0.05). During the twenty-four hours after operation, two patients in the CPB group and six patients in the off-pump group showed circadian rhythm of melatonin secretion. CONCLUSION: The perioperative circadian rhythm of melatonin secretion in patients undergoing CABG surgery with CPB or off-pump is disturbed, however relatively more patients under off-pump group regain secretion rhythm of melatonin in the immediate postoperative period. CPB may be one of the reasons for perioperative melatonin circadian secretion disturbance.


Assuntos
Ritmo Circadiano/fisiologia , Ponte de Artéria Coronária , Circulação Extracorpórea , Melatonina/metabolismo , Ensaio de Imunoadsorção Enzimática , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória
8.
Zhonghua Yi Xue Za Zhi ; 84(2): 107-10, 2004 Jan 17.
Artigo em Chinês | MEDLINE | ID: mdl-14990123

RESUMO

OBJECTIVE: To evaluate the effects on blood sparing and risk of hematogenous tumor dissemination of the use of blood salvage machine in oncologic surgeries. METHODS: The clinical data of 13 patients, 6 with malignant tumors and 7 with benign tumors, who received the use of blood salvage machine during oncologic surgeries based on informed consent, were analyzed. RESULTS: In total 42,575 ml of packed red blood cells were collected during surgery with a mean value of 3 275 ml (400 - 1500 ml) per patient. The average amount of allogenic transfusion per patient was 1 530 ml (0 - 8,000 ml). The number of blood salvage machine use in oncologic surgeries accounted for 8.6% (13/152) of the total number of blood salvage machine use in surgeries in that period. The perioperative mortality rate of the oncologic surgeries with the use of blood salvage machine was 7.7% (1/13). The post-operative metastasis rate of liver and lung was 15.4% (2/13). CONCLUSION: The use of blood salvage machine during oncologic surgeries improves the blood sparing effect. However, it cannot be used routinely, since it may result in hematogenous tumor cell dissemination.


Assuntos
Transfusão de Sangue Autóloga , Neoplasias/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 26(6): 666-70, 2004 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-15663229

RESUMO

OBJECTIVE: To compare the preemptive analgesia efficacy between two cycloxygenase-2 inhibitors, rofecoxib and etoricoxib in the ambulatory uterine evacuation patients. METHODS: In this randomized, double-blinded, placebo-controlled trial 60 patients were randomly divided into three groups and received a single dose of placebo, rofecoxib 50 mg, or etoricoxib 120 mg, respectively, before operation. Patient's visual analogue score (VAS) was rated postoperatively at 15 min, 30 min, 60 min, time-to-discharge, 6 h and 24 h. Fentanyl (in post-anesthesia care unit) and paracetamol (at home) were supplementary analgesics and the dosage was also recorded. Patient's satisfaction score was rated at 24 h postoperatively. RESULTS: Etoricoxib 120 mg and rofecoxib 50 mg were significantly superior to placebo at 6 h postoperatively (P < 0.05) while there was no significant differences of VAS at other time points. The amounts of Fentanyl used in post-anesthesia care unit were similar in three groups, but paracetamol taken at home was much less in rofecoxib group and etoricoxib group than in placebo group (P < 0.01). Compared to rofecoxib, etoricoxib provided better pain relief after discharge (P < 0.05). The overall pain management satisfaction score was significantly higher in etoricoxib group (96 +/- 7) than in other groups (P < 0.01). CONCLUSION: Preemptive rofecoxib 50 mg and etoricoxib 120 mg may significantly decrease VAS at 6 h postoperatively, and reduce the usage of analgesics in ambulatory uterine evacuation patients. Etoricoxib 120 mg offeres better pain relief at home compared with rofecoxib 50 mg.


Assuntos
Aborto Induzido , Procedimentos Cirúrgicos Ambulatórios , Inibidores de Ciclo-Oxigenase/uso terapêutico , Lactonas/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Piridinas/uso terapêutico , Sulfonas/uso terapêutico , Aborto Induzido/efeitos adversos , Acetaminofen/uso terapêutico , Adolescente , Adulto , Analgésicos não Narcóticos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Método Duplo-Cego , Etoricoxib , Feminino , Fentanila/uso terapêutico , Humanos , Medição da Dor , Cuidados Pré-Operatórios
10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 25(5): 594-8, 2003 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-14650166

RESUMO

OBJECTIVE: To investigate perioperative patterns of melatonin and cortisol secretion rhyme in patients undergoing coronary artery bypass grafting surgery. METHODS: Eleven male patients scheduled for elective coronary artery bypass grafting surgery (CABG) under hypothermic cardiopulmonary bypass (CPB) were enrolled in the study. Anesthesia was induced and maintained with propofol (3 mg.kg-1.h-1) and supplemented with fentanyl (15 micrograms/kg). Blood samples were taken during surgery at specific time-points and every 3 h in the immediate postoperative period and postoperative day 2 and day 3. Plasma melatonin and cortisol levels were measured by radioimmunoassay and enzyme-linked immunosorbent assay respectively. RESULTS: During surgery, plasma melatonin levels were below the minimum sensitivity level but low levels, without circadian variation, were measured during the immediate postoperative period. During postoperative day 2 and day 3, circadian secretion patterns of melatonin were present in 10 patients and showed an inverse correlation with light intensity exposed (r = -0.480, P = 0.01). Plasma cortisol levels in the immediate postoperative period were significantly higher than those before induction of anesthesia (P < 0.01). During postoperative day 2 and day 3, only 3 patients regained circadian secretion of cortisol. CONCLUSIONS: It is concluded that melatonin and cortisol secretion are disrupted during cardiac surgery and in the immediate postoperative period.


Assuntos
Ritmo Circadiano , Ponte de Artéria Coronária , Melatonina/metabolismo , Ponte Cardiopulmonar , Doença das Coronárias/fisiopatologia , Doença das Coronárias/cirurgia , Humanos , Hidrocortisona/metabolismo , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Período Pós-Operatório
11.
Chin Med J (Engl) ; 116(10): 1527-31, 2003 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14570616

RESUMO

OBJECTIVE: To investigate clinical features of pheochromocytoma and summarize experiences of anesthetic management during the perioperative period. METHODS: Two hundred and fifty eight patients who were diagnosed with pheochromocytoma in our hospital were reviewed retrospectively for clinical features. According to different preoperative pharmalogical preparations, perioperative mortalities were analyzed in three periods (Period 1: January 1955 - December 1975; Period 2: January 1976 - December 1994; Period 3: January 1995 - July 2001). In Period 3, hemodynamic changes in the patients undergoing different anesthetic methods were analyzed. RESULTS: About 5.8% (15/258) of pheochromocytoma was an integral part of multiple endocrine neoplasia (MEN) type II or mixed type. Sixty percent (149/249) of the patients who had undergone surgery possessed evidence of catecholamine cardiac toxicity preoperatively. Impaired glucose tolerance was found in 59% (147/249) of the patients before surgery. Perioperative mortality was significantly decreased from 8% (5/60) in Period 1 to 1.2% (1/75) in Period 2 (P < 0.01). No perioperative deaths occurred in Period 3. The volume infused during the operation was significantly higher both in the epidural anesthesia group (3474 ml +/- 624 ml, P < 0.01) and in the epidural plus general anesthesia group (3654 ml +/- 475 ml, P < 0.01) than in the general anesthesia group (2534 ml +/- 512 ml). There were favorable hemodynamic characteristics in patients before removal of the tumor in the epidural anesthesia group and in the epidural plus general anesthesia group, as compared with the general anesthesia group. CONCLUSIONS: A positive surgical outcome of the excision of pheochromocytoma depends on multiple factors, including careful assessment of potential vital organ damage before surgery and restoration of blood volume by establishing alpha-blockade preoperatively, meticulous anesthetic management of patients during surgery, and appropriate circulatory support after surgery.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Anestesia/métodos , Feocromocitoma/cirurgia , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/mortalidade , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Adulto , Idoso , Anestesia Epidural , Anestesia Geral , Volume Sanguíneo , Criança , Diagnóstico por Imagem , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/diagnóstico , Feocromocitoma/mortalidade , Feocromocitoma/fisiopatologia , Estudos Retrospectivos
12.
Chin Med J (Engl) ; 116(9): 1386-90, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-14527372

RESUMO

OBJECTIVE: To compare the efficacy and safety of remifentanil and fentanyl in patients undergoing a modified radical mastectomy or total hysterectomy. METHODS: Fifty-four patients were evenly randomised into remifentanil group and fentanyl group. Anesthesia was induced by propofol (1 - 2 mg/kg) and either remifentanil (2 microg/kg) or fentanyl (2.5 microg/kg), and was maintained with inhalation of nitrous oxide in oxygen (2:1) and continuous infusion of either remifentanil (0.2 microg.kg(-1).min(-1)) or fentanyl (0.03 microg.kg(-1).min(-1)). RESULTS: The number of patients exhibiting light anesthesia responses in the remifentanil group during intubation and the maintenance of anesthesia was significantly less than that in the fentanyl group. Both systolic and diastolic blood pressures in the fentanyl group were significantly higher than those in the remifentanil group during intubation, skin incision, maintenance of anesthesia and extubation. The time to opening eyes on command and the time for extubation after surgery was comparable between the two groups. More patients in the remifentanil group (25 patients) required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (5 patients, P < 0.05). There was no significant difference between the two groups in terms of side effects. CONCLUSIONS: Under the condition of this study protocol, the anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia.


Assuntos
Anestésicos Intravenosos/uso terapêutico , Fentanila/uso terapêutico , Mastectomia Radical Modificada , Dor Pós-Operatória/tratamento farmacológico , Piperidinas/uso terapêutico , Adolescente , Adulto , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Remifentanil
13.
Chin Med J (Engl) ; 116(7): 996-1000, 2003 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12890370

RESUMO

OBJECTIVE: To investigate the effectiveness of using a medium molecular weight hydroxyethyl starch solution (HES) administered as a replacement for estimated blood loss (EBL) during cytoreductive surgery for ovarian cancer on splanchnic oxygenation. METHODS: Forty-two patients undergoing cytoreductive surgery for ovarian cancer were enrolled in this prospective randomized study. As soon as the EBL exceeded 10% but was less than 20% of the estimated blood volume, the patients were randomly assigned to receive either a volume of lactated Ringer's solution (LRS) equal to three times the EBL (LRS group, n = 22) or a volume of 6% HES equal to the EBL (HES group, n = 20). Tissue oxygenation was assessed indirectly by measuring tonometric parameters, including the difference between gastric intramucosal PsCO(2) and arterial PaCO(2) (Ps-a CO(2) gap), gastric intramucosal pH (pHi) and arterial lactate acid concentration at 30 min after induction of anesthesia (baseline value), 1 hour and 2 hours after skin incision, and at the end of surgery. RESULTS: At the end of surgery,the Ps-a CO(2) gap in the HES group (8.7 +/- 1.6 mmHg) was significantly lower than that of the LRS group (18.74 +/- 4.4 mmHg, P < 0.01), while the pHi (7.30 +/- 0.05 mmHg) in the HES group was significantly higher than that of the LRS group (7.21 +/- 0.07 mmHg, P < 0.01). There was no significant difference between the two groups in terms of arterial lactate acid concentration. CONCLUSION: In patients undergoing major surgery with relatively large blood losses, volume resuscitation with medium molecular weight hydroxyethyl starch solution may improve splanchnic blood flow and tissue oxygenation.


Assuntos
Perda Sanguínea Cirúrgica , Derivados de Hidroxietil Amido/uso terapêutico , Neoplasias Ovarianas/cirurgia , Oxigênio/metabolismo , Circulação Esplâncnica , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos
14.
Chin Med Sci J ; 18(1): 54-8, 2003 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-12901530

RESUMO

OBJECTIVE: To investigate the efficacy and safety of tetracaine hydrochloride in patient-controlled epidural analgesia (PCEA) after pulmonary lobectomy. METHODS: Forty-three patients scheduled for elective pulmonary lobectomy under general anesthesia were randomly allocated into either tetracaine group (22 patients) or ropivacaine group (21 patients). In the tetracaine group, 0.15% tetracaine was used for postoperative PCEA, while 0.3% ropivacaine was used in the ropivacaine group. The duration of postoperative analgesia was 48 h. The PCEA included a bolus of 6 ml with a lockout time of 1 h. Postoperative pain score was measured by visa analogue scale (VAS). Forced expired volume at the 1st second (FEV1.0), forced vital capacity (FVC), FEV1.0/FVC and peak expired flow (PEF) were measured preoperatively and daily after surgery. Hemodynamics were monitored and recorded before and after each administration of local anesthetics during the period of the study. RESULTS: VAS scores in both groups decreased significantly after a bolus injection of local anesthetics. There was no significant difference between the two groups in VAS either before or after the administration of PCEA. On the 1st and 2nd days after the operation, pulmonary function was reduced in both groups. However, there were no significant differences between the percentage of the changes of FEV1.0, FEV1.0/FVC and PEF in the two groups. There were also significant differences between the percentage of the changes of heart rate, mean arterial blood pressure and SpO2 after administration of local anesthetics. There was no significant difference in overall satisfaction with pain relief. CONCLUSIONS: The analgesic effect of 0.15% tetracaine is similar to that of 0.3% ropivacaine used in patient-controlled epidural analgesia after thoracotomy. No serious side effects were observed.


Assuntos
Analgesia Controlada pelo Paciente , Anestésicos Locais/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Pneumonectomia , Tetracaína/uso terapêutico , Adolescente , Adulto , Amidas/uso terapêutico , Analgesia Epidural , Analgesia Controlada pelo Paciente/métodos , Humanos , Pessoa de Meia-Idade , Medição da Dor , Ropivacaina
15.
Zhonghua Yi Xue Za Zhi ; 83(2): 114-7, 2003 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-12812678

RESUMO

OBJECTIVE: To investigate the effect of medium molecular weight hydroxyethyl starch solution (HES) administered as replacement for estimated blood losses (EBL) during cytoreductive surgery for ovarian carcinoma on splanchnic oxygenation. METHODS: Cytoreductive surgery was operated upon forty-two patients with ovarian carcinoma. As soon as the EBL was higher than 10% but less than 20% of the estimated blood volume, the patients were randomly assigned to receive a volume of lactated Ringer's solution (LRS) equal to three times the EBL (LRS group, n = 22) or a volume of 6% HES equal to the EBL (HES group, n = 20). Tissue oxygenation was assessed indirectly by measuring the tonometric parameters of stomach, including difference between gastric intramucosal PsCO(2) and arterial PaCO(2) (Ps-aCO(2) gap), gastric intramucosal pH (pHi) and arterial lactate acid concentration 30 min after induction of anesthesia (baseline value), 1 h and 2 h after skin incision, and at the end of surgery. RESULTS: At the end of surgery, the Ps-aCO(2) gap was 8.7 mm Hg +/- 1.6 mm Hg in the HES group, significantly lower than that in the LRS group (18.74 mm Hg +/- 4.4 mm Hg, P < 0.01), while the pHi in the HES group was 7.30 +/- 0.05, significantly higher than that in the LRS group (7.21 +/- 0.07, P < 0.01). There was no significant difference in arterial lactate acid concentration between the two groups. CONCLUSION: In patients undergoing major surgery, volume resuscitation with medium molecular weight HES improves the splanchnic blood flow and tissue oxygenation.


Assuntos
Perda Sanguínea Cirúrgica , Derivados de Hidroxietil Amido/uso terapêutico , Neoplasias Ovarianas/cirurgia , Oxigênio/metabolismo , Circulação Esplâncnica , Adolescente , Adulto , Feminino , Mucosa Gástrica/metabolismo , Humanos , Pessoa de Meia-Idade , Substitutos do Plasma/uso terapêutico
16.
Chin Med J (Engl) ; 116(2): 208-11, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12775231

RESUMO

OBJECTIVE: To investigate clinical features and anesthetic management of multiple endocrine neoplasia (MEN) associated with pheochromocytoma. METHODS: Medical records of patients who were diagnosed as multiple endocrine neoplasia associated with pheochromocytoma in our hospital from April 1977 to April 2001 were reviewed retrospectively. The demographic data, clinical presentations, family history, biochemical examinations, type of MEN, sequence of different surgical procedures, anesthetic methods and hemodynamics during surgery were analyzed. RESULTS: Thirteen cases of MEN associated with pheochromocytoma were investigated, accounting for 6% (13/213) of the pheochromocytoma patients admitted into our hospital. Nine of the 13 patients presented as type IIa MEN (Sipple syndrome), one as type IIb MEN, and three as mixed MEN. Four patients with type IIa MEN had a family history of similar disease. Five patients with other coexisting endocrine disorders first underwent excision of the pheochromocytomas, although only two had hypertensive symptoms at the time of admittance. Seven patients without histories of hypertension received surgical treatment for pheochromocytoma secondly. The excision of pheochromocytoma was performed under general anesthesia in 8 patients and epidural block in 4 patients. Marked hemodynamic fluctuation was recorded in 8 patients. No perioperative death was recorded. CONCLUSION: Pheochromocytoma may be linked to other endocrine disorders during MEN, either as the main clinical presentation or most frequently as an occult tumor. Recognition of this feature of pheochromocytoma is of importance to the improvement of diagnosis and treatment both for pheochromocytoma and MEN.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Anestesia/métodos , Neoplasia Endócrina Múltipla/cirurgia , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Adrenalectomia , Adulto , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla/fisiopatologia , Feocromocitoma/diagnóstico , Feocromocitoma/fisiopatologia , Estudos Retrospectivos
17.
Zhonghua Yi Xue Za Zhi ; 82(8): 523-6, 2002 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-12133496

RESUMO

OBJECTIVE: To investigate the clinical features of pheochromocytoma and summarize the experience of anesthetic management during perioperative period. METHODS: Two hundred and fifty eight medical records of patients who were diagnosed as pheochromocytoma in Peking Union Medical College Hospital were reviewed retrospectively for clinical features, anesthetic management and perioperative mortality. RESULTS: About 5.8% (15/258) of pheochromocytomas was an integral part of multiple endocrine neoplasia (MEN) type II or mixed type. Sixty percent (149/249) of the patients undergoing surgery possessed evidence of catecholamine cardiac toxicity preoperatively, including abnormal ECG, myocardial hypertrophy and decreased left ventricular ejective fraction. Impaired glucose tolerance was found in 59% (147/249) of patients before surgery. The volume infused during operation was significantly higher both in the epidural anesthesia group (3 474 ml +/- 624 ml, q(1) = 5.72, P < 0.01) and in the epidural plus general anesthesia group (3 654 ml +/- 475 ml, q(2) = 5.83, P < 0.01) than that in the general anesthesia group (2 534 ml +/- 512 ml). There were favorable hemodynamic characteristics before removal of the tumor in the epidural anesthesia group and epidural plus general anesthesia group, as compared with in the general anesthesia group. Perioperative mortality was significantly decreased from 8% (5/60) in period 1 (from 1955 to 1975) to 1.2% (1/75) in period 2 (from 1976 to 1994) (chi(2) = 4.05, P < 0.01). No perioperative death (0/111) occurred in period 3 (from 1995 to 2001). CONCLUSION: A good surgical outcome for the excision of pheochromocytoma depends on multiple factors, including careful assessment of potential end organ damages and restoration of blood volume by establishing alpha-blockade during the preoperative period, meticulous anesthetic management during surgery, and appropriate circulatory support after surgery.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Anestesia , Feocromocitoma/cirurgia , Adolescente , Neoplasias das Glândulas Suprarrenais/fisiopatologia , Adulto , Idoso , Anestesia/efeitos adversos , Anestesia/métodos , Catecolaminas , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Feocromocitoma/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
18.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 24(4): 424-6, 2002 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-12905668

RESUMO

OBJECTIVE: To summarize experience of perioperative anesthetic management for patients undergone excision of pheochromocytoma and complicated with catecholamine cardiomyopathy. METHODS: Perioperative anesthetic management for surgical treatment of three cases of pheochromocytoma complicated with catecholamine cardiomyopathy was described and discussed according to literature reports. RESULTS: The catecholamine cardiomyopathy of the three cases presented with left ventricular hypertrophy, congestive cardiac failure and acute myocardial infarction. After removal of the pheochromocytoma under general anesthesia, a prolonged hypotension occurred in all of the three cases. In order to maintain stable hemodynamics, large dose of catecholamine was required after surgery. All of the three patients were survived and discharged. CONCLUSIONS: It is suggested that myocardial dysfunction may be another important factor for the prolonged hypotension after removal of the tumor. Meticulous preoperative assessment of heart function is of primary importance for the management of anaesthesia during surgical procedures.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Anestesia Geral , Cardiomiopatias/etiologia , Catecolaminas/sangue , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/sangue , Adulto , Cardiomiopatias/sangue , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Feocromocitoma/sangue
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