الملخص
Objective:To compare the efficacy of pecto-intercostal fascial plane (PIFP) block versus transversus thoracic muscle plane (TTP) block under ultrasound guidance in coronary artery bypass grafting with general anesthesia.Methods:Ninety American Society of Anesthesiologists Physical Status classification Ⅱor Ⅲ patients of either sex, aged 50-79 yr, scheduled for elective coronary artery bypass grafting, were divided into 3 groups ( n=30 each) using a random number table method: PIFP block combined with general anesthesia group (PG group), TTP block combined with general anesthesia group (TG group), and general anesthesia group (G group). After anesthesia induction, bilateral PIFP block was performed under ultrasound guidance in group PG, TTP block was performed under ultrasound guidance in group TG. Three groups used the same general anesthesia method and patient-controlled intravenous analgesia after surgery. Visual analog scale scores (cough, position change, etc) at rest and during activity were recorded at 6, 12, 18 and 24 h after operation. The total consumption of intraoperative sufentanil, extubation time, length of stay in intensive care units, rate of rescue analgesia, effective pressing times of patient-controlled analgesia, incidence of postoperative nausea and vomiting, skin pruritus and nerve block-related adverse events were recorded. The operation time of nerve block was recorded and ultrasound-guided needle visibility score was assessed in PG group and TG group. Results:Compared with group G, the total consumption of intraoperative sufentanil was significantly reduced, the extubation time and length of stay in intensive care units were shortened, visual analog scale scores at rest and during activity were decreased at 6, 12 and 18 h after operation, the rate of rescue analgesia was decreased, and the effective pressing times of patient-controlled analgesia were decreased in group PG and group TG ( P<0.05), and no significant change was found in the aforementioned parameters in PG and TG groups ( P> 0.05). Compared with group TG, the operational time of nerve block was significantly shortened, and the ultrasound-guided needle visibility score was increased in group PG ( P<0.05). No nerve block-related adverse events were found in PG and TG groups. There was no significant difference in the incidence of postoperative nausea and vomiting and skin pruritus among the three groups ( P>0.05). Conclusions:PIFP block can provide good perioperative analgesia and promote the rapid recovery in the patients undergoing coronary artery bypass grafting with general anesthesia. Although the analgesic effect of PIFP blockade is similar to that of TTP blockade, PIFP blockade is more clinically valuable due to its simpler operation and less relative risk.
الملخص
Objective:To evaluate the correlation between ultrasound parameters of internal carotid artery blood flow and regional cerebral oxygen saturation (rScO 2) in elderly patients undergoing coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). Methods:Sixty-four elderly patients undergoing elective CABG under CPB, aged 60-80 yr, regardless of gender, with body mass index of 18.1-28.9 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, with New York Heart Association class Ⅱ or Ⅲ, with left ventricular ejection fraction≥50%, were selected. The rScO 2 and ultrasonic parameters of internal carotid artery including peak systolic velocity (PSV-ICA), end-diastolic velocity (EDV-ICA), diameter (D-ICA) and blood flow volume (Q-ICA) were recorded before anesthesia induction (T 0), at surgical skin incision (T 1), at 30 and 60 min of CPB (mean value was calculated, T 2), and at 30 and 60 min after termination of CPB (mean value was calculated, T 3). The ratio of unilateral internal carotid artery blood flow to cardiac output (Q/CO) was calculated. The receiver operating characteristic curve was used to analyze the accuracy of ultrasound parameters of internal carotid artery blood flow in predicting rScO 2 < 60%. Results:PSV-ICA was positively correlated with rScO 2 at T 0, T 1 and T 3 ( P<0.05), but no correlation was found between PSV-ICA and rScO 2 at T 2 ( P>0.05). There was no correlation between EDV-ICA and rScO 2 at each time point ( P>0.05). Q-ICA was positively correlated with rScO 2 at each time point ( P<0.05). Q/CO was not correlated with rScO 2 at T 1 ( P>0.05), but Q/CO was positively correlated with rScO 2 at T 2 and T 3 ( P<0.05). During the non-CPB period (T 0, T 1, T 3), the cutoff values of PSV-ICA and Q-ICA in predicting rScO 2< 60% were 51.35 cm/s and 283.5 ml/min respectively, the sensitivity was 0.900 and 0.900 respectively, and the specificity was 0.610 and 0.857 respectively (AUC=0.761, P=0.006; AUC=0.903, P< 0.001). During the CPB period, the cutoff values of Q-ICA and Q/CO in predicting rScO 2<60% were 296.5 ml/min and 5.84% respectively, the sensitivity was 0.900 and 0.800, and the specificity was 0.545 and 0.659 (AUC=0.764, P=0.001; AUC=0.748, P=0.002), respectively. Conclusions:PSV-ICA and Q-ICA are positively correlated with rScO 2 during the non-CPB period, and Q-ICA and Q/CO are positively correlated with rScO 2 during the CPB period in elderly patients undergoing CABG. PSV-ICA, Q-ICA and Q/CO can accurately predict rScO 2<60%.
الملخص
Objective To compare the effects of dobutamine with those milrinone on myocardial strain in patients undergoing valve replacement surgery.Methods Fifty-five patients udergoing valve replacement surgery, 27 males and 28 females, aged 40-75 years, falling into ASA physical statusⅡ orⅢ, New York Heart Association (NYHA) ⅡorⅢ, were included in this study.They were divided into 3 groups by using a random number table:intravenous infusion dobutamine group (group D, n=18), intravenous infusion milrinone group (group M, n=20) and intravenous infusion saline group (group C, n=17).All patients were used general anesthesia.In groups D, the patients received intravenous infusion dobutamine (4μg·kg-1·min-1) for an hour starting from 15 min after termination of CPB.In group M, the patients did intravenous infusion milrinone (0.4μg·kg-1·min-1) in the same way.In group C, the patients got intravenous infusion saline also.After induction of anesthesia, these patients were recorded for hemodynamic measurement at three points after induction of anesthesia and before splitting of sternum (T0), starting from 15 min after termination of CPB (T1), intravenous infusion medicine for 30 min (T2), intravenous infusion medicine for one hour (T3):HR, CVP, cardiac output (CO), left ventricular ejection fraction (LVEF), right ventricular fractional area change (RVFAC), cardiac index (CI) and systemic vascular resistance index (SVRI) and strained indicator:global longitudinal strain of left ventricle (S-LVL), global circumferential strain of the left ventricle (S-LVM), global longitudinal strain of right ventricle (S-RV).Results Compared with group M, HR in group D at T2 and T3 was higher (P<0.05).Compared with group C, HR in group D at T3 was higher (P<0.05).And CI in group D at T2 was higher than that in groups C and M (P<0.05).Compared with groups C, S-LVMin groups D and M at T2 and T3 were stronger, S-LVL, S-RV in group D and S-RV in group M at T3 were stronger (P<0.05).Conclusion Intravenous infusion dobutamine can improve S-LVM, S-LVLand S-RV;Intravenous infusion milrinone can improve S-LVMand S-RV.
الملخص
Objective To evaluate the effect of dobutamine or milrinone on intraventricular syn-chronization in the patients undergoing cardiac valve replacement with cardiopulmonary bypass ( CPB). Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 40-75 yr, of New York Heart AssociationⅡorⅢ, scheduled for elective cardiac valve replacement with CPB, were divided into 3 groups (n＝20 each) using a random number table: control group ( group C), dobutamine group ( group D) and milrinone group ( group M). Dobutamine 4 μg·kg-1·min-1was intravenously infused for 60 min starting from 15 min after termination of CPB in group D. Milrinone 0. 4 μg·kg-1·min-1was intravenously infused for 60 min starting from 15 min after termination of CPB in group M. The equal volume of normal saline was given instead in group C. The parameters of heart function were monitored using transesophageal echocardiography. After induction of anesthesia and before splitting the sternum (T0), at 15 min after termination of CPB (T1), and at 30 and 60 min of dobutamine, milri-none or normal saline infusion (T2, average value at two time points), the parameters of intraventricular synchronization were calculated with QLAB software (9. 1 version): standard deviation of time to peak sys-tolic velocity of the left ventricular longitudinal strain 7 segments (LVSDt-L), standard deviation of time to peak systolic velocity of the right ventricular longitudinal strain 7 segments (RVSDt), standard deviation of time to peak systolic velocity of the left ventricular circumferential strain 6 segments (LVSDt-C). Results Compared with group C, LVSDt-C, LVSDt-L and RVSDt were significantly decreased at T2in group D (P＜0. 05), and no significant change was found in the indices mentioned above at each time point in group M (P＞0. 05). RVSDt was significantly higher at T2in group M than in group D ( P＜0. 05). Compared with the baseline at T0, LVSDt-L was significantly increased at T2in group C, and RVSDt was significantly in-creased at T2in group M ( P＜0. 05). Conclusion Intravenously infusing dobutamine after CPB can im-prove the ventricular synchronization, however, intravenously infusing milrinone may increase the right ventricular asynchronization in the patients undergoing cardiac valve replacement.
الملخص
Objective To evaluate the hemodynamic changes induced by local infiltration with different concentrations of adrenaline during endoscopic sinus surgery under general anesthesia using impedance cardiography (ICG) .Methods Sixty-nine ASA Ⅰ or Ⅱpatients of both sexes (37 males, 32 females) aged 18-60 yrs undergoing elective endoscopic sinus surgery under general anesthesia were randomized to receive local infiltration of nasal mucous membrane with 4 ml of lidocaine containing 20 ?g (group Ⅰ) or 40?g (group Ⅱ) or no adrenaline (group Ⅲ-control) . Hemodynamic changes were monitored by ICG. MAR, HR, cardiac index (CI), systemic vascular resistance index (SVRI) and acceleration index (ACI) were recorded before (baseline) and at 0.75, 1.5, 2.25, 3.0, 3.75, 4.5, 5.25 and 6.0 min after local nasal adrenaline infiltration.Results MAP was significantly decreased while HR increased at 1.5 min after adrenaline infiltration as compared to the baseline values in group Ⅰ and Ⅱ (P