ABSTRACT
Objective To explore the clinical application of the Shikani optical style(SOS)in guiding nasal tracheal intubation.Methods A retrospective analysis was made on clinical data of 60 patients who underwent selective operation under general anesthesia through nasal tracheal intubation from January 2017 to December 2022.According to the guidance methods of nasal tracheal intubation,the patients were divided into three groups with 20 cases in each group:video laryngoscope guided nasal tracheal intubation group(group V),fiberoptic bronchoscopy guided nasal tracheal intubation group(group F),and SOS guided nasal tracheal intubation group(group S).The grading of glottis exposure and epistaxis during tracheal intubation were recorded,as well as the success rate,completion time,and incidence of postoperative complications related to nasal tracheal intubation.Results The glottis exposure in the group F and group S were both grade Ⅰ.Among the group V,there were 7 cases of gradeⅠ,10 cases of gradeⅡ,and 3 cases of grade Ⅲ.The glottis exposure effect of patients in the group F and S was significantly better than that of the group V(Z =-4.274,P = 0.000;Z =-4.274,P = 0.000).There were 15 and 14 patients in the group F and the group S without epistaxis,and 5 and 6 patients with mild epistaxis,respectively.There were no patients with severe epistaxis in the group F and the group S.In the group V,there were 7 patients without epistaxis,10 patients with mild epistaxis,and 3 patients with severe epistaxis.The degree of epistaxis in the group F and the group S was significantly less than that in the group V(Z =-2.678,P =0.007;Z =-2.402,P =0.016).The median time for tracheal intubation in the group S was 37.5(34.3,41.5)s,significantly shorter than 45.0(39.8,72.5)s in the group V and 89.0(76.0,102.5)s in the group F(Z =15.703,P =0.013;Z =32.050,P =0.000),with the group V being significantly shorter than the group F(Z =-16.347,P =0.009).The nasal tracheal intubation failed in 2 cases in the group V,while was all successfully completed in the group F and the group S.The difference of success rate was not statistically significant among the three groups(P>0.05).There were no statistically significant differences in the rates of postoperative nasopharyngeal pain and nasal congestion among the three groups(P>0.05).Conclusion The method of SOS-guided nasal tracheal intubation can provide good glottis exposure and achieve a satisfactory success rate of tracheal intubation without increasing the risk of adverse reactions,which can be regarded as a safe and effective method of nasal tracheal intubation.
ABSTRACT
Objective To explore the safety and feasibility of single-segment paravertebral nerve block(PVNB)in elderly patients undergoing inguinal hernioplasty.Methods A retrospective analysis was made on clinical data of 58 elderly patients who underwent open tension-free inguinal hernioplasty from January 2016 to December 2022.According to the anesthesia method,they were divided into two groups with 29 cases in each:single-segment PVNB group(P group)and single subarachnoid block group(S group).Patients in the P group were given L1 single-segment PVNB guided by ultrasound combined with peripheral nerve stimulators or simple peripheral nerve stimulators by using 0.4%ropivacaine 20 ml.Patients in the S group underwent puncture in the interspinous space between L3/4 and received 0.5%bupivacaine 10 mg.The mean arterial pressure and heart rate before anesthesia(T0),at the time of skin incision(T1),at the time of hernia sac dissection(T2),and at the time of wound closure(T3)were recorded,and the block levels,anesthetic effect,remedial rate of fentanyl,local anesthetic toxicity,peripheral nerve injury,urinary retention,delirium,and nausea and vomiting of the patients were recorded.The patient's satisfaction with anesthesia was followed up.Results All the 58 patients underwent surgery smoothly.The difference in block levels was statistically significant between the two groups of patients(Z =-4.144,P =0.000),while the differences in the remedial rate of fentanyl,anesthesia effect,and anesthesia satisfaction were not statistically significant(χ2 =0.269,P =0.604;Z =-1.430,P =0.153;Z =-1.395,P =0.163).There were no statistically significant differences in mean arterial pressure and heart rate changes between the two groups at different time points(F =0.002,P = 0.960;F =0.260,P =0.612).The rate of urinary retention in the P group was significantly lower than that in the S group(0.0%vs.24.1%,Fisher's test,P =0.010).There were no statistically significant differences in rates of dilirium and nausea and vomitting(P>0.05).All the patients did not experience local anesthetic toxicity or peripheral nerve injury during the perioperative period.Conclusion Single-segment PVNB can provide comprehensive anesthesia and analgesia for elderly patients undergoing inguinal hernioplasty,helping to maintain the stability of intraoperative hemodynamics and reducing the risk of postoperative adverse reactions.
ABSTRACT
Ultrasound-guided thoracic nerve block plays an important role in anesthesia and analgesia, but it is not easy to be mastered. This article discusses the application value of flipped classroom combined with 3D Body anatomy software for anesthesia specialty residents to learn ultrasound-guided thoracic paravertebral nerve block. This innovative education model includes three parts: before class, during class and after class. Before class, the teachers study the syllabus and make teaching micro-videos, and the cross-sectional anatomy added into the 3D Body anatomy software helps the residents understand. During class, teachers divide the residents into groups to report and exchange their learning experience, organize discussions, and finally give them comments. After class, the instructor will assign homework, assess the residents, and evaluate their satisfaction. This teaching model helps residents master the ultrasound-guided thoracic nerve block, and obtains satisfactory evaluation from the trainees, which is helpful for promotion.
ABSTRACT
Objective:To investigate and analyze the awareness of malignant hyperthermia (MH) in anesthesiology nurses in mainland China.Methods:From November 2021 to January 2022, anesthesiology nurses of secondary hospitals or above in Chinese mainland were enrolled by convenience sampling and investigated by a self-designed questionnaire on the awareness of MH.The system automatically recorded the situation of questionnaires.Results:A total of 2 058 anesthesiology nurses participated in the survey, distributed in 21 provinces, 2 autonomous regions (Ningxia Hui Autonomous Region, Guangxi Zhuang Autonomous Region) and 4 municipalities directly under the central government, and 2 049 questionnaires were effectively received with effective recovery of 99.56%.The correct answers to questions related to the treatment of MH, characteristics of the disease, classification, susceptible population, screening method of the susceptible population, genetic mode, inducing factors, the first symptoms and the best infusion time of dantrolene, preparation method of domestic dantrolene and the first dose were 86.58%, 82.33%, 58.18%, 50.90%, 50.76%, 50.42%, 45.73%, 32.89%, 51.25%, 48.32% and 46.51%, respectively.Only 27.13% of anesthesiology nurses expressed that dantrolene was available in their hospital.The scores of knowledge about MH among anesthesiology nurses in hospitals of province-level municipalities and provincial capital cities were significantly higher than those in other cities ( P<0.001). The scores of knowledge about MH among the anesthesiology nurses in secondary hospitals were significantly higher than those in tertiary hospitals ( P<0.05). There was no significant difference in the scores of knowledge about MH among anesthesiology nurses with different professional titles, educational backgrounds, and working years ( P>0.05). Conclusions:Anesthesiology nurses in mainland China have insufficient awareness of MH.Popularizing the knowledge about MH and strengthening the awareness of MH in medical staff in the department of anesthesiology throughout the country may be of great significance in improving the diagnosis and treatment of MH in China.
ABSTRACT
A 14-year-old male pediatric patient was admitted to the hospital mainly because of neck and back deformity, with limited activity for 7 yr, dysphagia and short of breath for more than 10 months.He was diagnosed with cervical lordosis deformity, RyR1 gene-related myopathy, high possibility of multi-minicore disease and being susceptible to malignant hyperthermia.Posterior cervical orthopedic internal fixation surgery was successfully performed under total intravenous anesthesia with propofol.The vital signs were stable during anesthesia and operation which lasted for 10 h. The patient was admitted to intensive care unit after the uneventful operation.When emerging from general anesthesia, the patient suddenly presented with symptoms of muscular fasciculation in the head, face, trunk and limbs, along with elevated body temperature as high as 39.4℃, severe acidosis and hypercapnia, meanwhile, the blood creatine kinase, blood myoglobin and urinary myoglobin gradually increased.The patient was diagnosed with malignant hyperthermia based on the clinical grading scale score of 63.Dantrolene sodium was infused intravenously, combined with multiple treatments such as physical cooling, correction of acidosis and electrolyte disturbance, alkalization of urine, intermittent hemofiltration and plasma exchange.The arrhythmia and delirium were treated symptomatically.The pediatric patient was fully recovered and discharged with good outcomes.
ABSTRACT
The present study was aimed to explore the neuroprotective role of imatinib in global ischemia-reperfusion-induced cerebral injury along with possible mechanisms. Global ischemia was induced in mice by bilateral carotid artery occlusion for 20 min, which was followed by reperfusion for 24 h by restoring the blood flow to the brain. The extent of cerebral injury was assessed after 24 h of global ischemia by measuring the locomotor activity (actophotometer test), motor coordination (inclined beam walking test), neurological severity score, learning and memory (object recognition test) and cerebral infarction (triphenyl tetrazolium chloride stain). Ischemia-reperfusion injury produced significant cerebral infarction, impaired the behavioral parameters and decreased the expression of connexin 43 and phosphorylated signal transducer and activator of transcription 3 (p-STAT3) in the brain. A single dose administration of imatinib (20 and 40 mg/kg) attenuated ischemia-reperfusion-induced behavioral deficits and the extent of cerebral infarction along with the restoration of connexin 43 and p-STAT3 levels. However, administration of AG490, a selective Janus-activated kinase 2 (JAK2)/STAT3 inhibitor, abolished the neuroprotective actions of imatinib and decreased the expression of connexin 43 and p-STAT3. It is concluded that imatinib has the potential of attenuating global ischemia-reperfusion-induced cerebral injury, which may be possibly attributed to activation of JAK2/STAT3 signaling pathway along with the increase in the expression of connexin 43.
Subject(s)
Animals , Mice , Brain , Carotid Arteries , Cerebral Infarction , Connexin 43 , Imatinib Mesylate , Ischemia , Learning , Memory , Motor Activity , Neuroprotection , Phosphotransferases , Reperfusion , Reperfusion Injury , STAT3 Transcription Factor , Transducers , WalkingABSTRACT
Objective:To explore the risk factors of deep vein thrombosis (DVT) of the lower extremity in patients with breast cancer after surgery.Methods:A total of 95 female patients (the experimental group) with DVT of the lower extremity after breast cancer surgery in Shanxi Provincial Cancer Hospital from May 2016 to May 2019 were retrospectively analyzed, and 85 female breast cancer patients without DVT of the lower extremity after surgery from January 2019 to May 2019 were treated as the control group. The general information and plasma total cholesterol (TC), triglyceride (TG), D-dimer (D-D) levels were compared between the two groups, and the risk factors for DVT of the lower extremity in patients with breast cancer after surgery were explored.Results:The body weight [(69.05±6.49) kg vs. (61.75±6.62) kg], body mass index (BMI) [(29.89±1.78) kg/m 2 vs. (24.23±1.33) kg/m 2] and the age [(51.57±5.93) years old vs. (45.44±5.21) years old] in the experimental group were higher than those in the control group, and the differences were statistically significant (all P < 0.01). The TC level in the experimental group was slightly higher than that in the control group, and the difference was not statistically significant ( P > 0.05); the TG level in the experimental group was higher than that in the control group, and the difference was statistically significant ( P < 0.01); the D-D level of the experimental group at 10 d after operation was higher than that of the control group, and the difference was statistically significant ( P < 0.01). Logistic regression analysis showed that body weight > 66.25 kg ( OR = 1.507, 95% CI 1.101-2.122, P = 0.021), BMI > 25.43 kg/m 2 ( OR = 1.518, 95% CI 1.067-2.123, P = 0.017), TG≥1.8 mmol/L ( OR = 1.324, 95% CI 1.077-2.139, P = 0.045), postoperative D-D > 5.0 mg/L ( OR = 1.525, 95% CI1.110-2.231, P = 0.027), and surgery duration ≥ 2 h ( OR = 1.470, 95% CI 1.017-2.122, P = 0.033) were independent influencing factors of DVT in breast cancer patients. Conclusions:Breast cancer patients are prone to DVT of the lower extremity after operation. For patients with large body weight, high BMI, high blood lipids, high D-D and the operation duration ≥ 2 h, the postoperative prevention for DVT should be carried out early. Once there is a condition of lower extremity swelling, early treatment should be given.
ABSTRACT
Residency training is an indispensable part in the standardized training system of residents. The anesthesiology department of Peking University Third hospital launched the tutorial system in this residency training project as an initial exploration. Our study explored the concrete way of implementation of the tutorial system in the residency training program, including clarifying selection of the tutor, teachers' responsibilities, requirements for the residency, training contents and ways. Preliminary practice shows that tutorial system can enhance responsibilities of teachers, sense of belong of residents, and the quality of training.
ABSTRACT
Case-oriented Workshop training mode is a professional training method which has been highly praised by anesthesiologists in recent years. It is of great significance to stimulate the participation of anesthesiologists and strengthen the application of the extended focused assessment with sonography for trauma (EFAST) in perioperative anesthesia management. The training of EFAST is divided into two stages: the first stage is about the relevant knowledge of EFAST and watching standardized operations on site, and the second stage is for each trainee to practice the operations under the guidance of the teacher until they can complete them independently. The EFAST adopts Workshop training mode, and the trainees can complete the target area scanning in about 90 seconds on average. It can maximize the training effectiveness and comprehensively improve the trainees' mastery of knowledge and skills in an all-round way. It is a training mode worthy of promotion in anesthesiology department.
ABSTRACT
The coronavirus disease 2019(COVTD-19)epidemic has caused wide concern all over the world, including China. In order to fight against epidemic situation, the professional knowledge and practice of anesthesiologists in standard prevention, disinfection and isolation, hand hygiene, environmental sanitation, aseptic operation, occupational protection and other aspects of infection control need to be improved and standardized. Aiming at solving the main problems existing in anesthesia-related infection control in China, we put forward the following suggestions after considering COVID-19 epidemic situation deeply and sorting out the relevant laws, regulations and normative requirements.(1) In terms of standard prevention, during the diagnosis and treatment of suspected or confirmed COVID-19 patients, anesthesia practioners should wear protective equipment according to the tertiary protective measures, including wearing N95 medical respirator, goggles or protective screen, wearing protective clothing, etc.(2) In terms of hand hygiene, hand washing or hand sanitization should be carried out in strict accordance with the hand hygiene regulations when anesthetizing confirmed or suspected COVID-19 cases. Double gloves are essential, after contact with the patient, remove and discard the outer gloves if you need to touch the anesthetic machine or other areas.(3) In terms of environmental sanitation, anesthesiologists should promptly clean and disinfect small areas of patients′ blood and other contamination when performing operations for suspected or confirmed COVID-19 cases. After the operation, the person in charge of infection control in the operating room should strictly implement the technical specification for disinfection of medical institutions, clean and disinfect the operating room (air, object surface, ground, etc.), medical instruments, and objects used by patients, especially the surfaces frequently touched by anesthesiologists.(4) In terms of anesthesia machine disinfection, it is recommended to combine the use of anesthesia internal circuit disinfection machine with the use of artificial nose at the expiratory end and inspiratory end. High efficiency and low capacity hydrophobic filter are preferred in order to make bacteria and virus clearance rate>99.999%. The respiratory pathway filter should be replaced every 3-4 h. (5) In term of isolation, confirmed or suspected COVID-19 cases should be operated in the negative pressure operating room. Medical personnel should inform laminar flow engineering technical personnel to check in time, when necessary to replace the hepa filter for negative pressure operating room.(6) In other aspects, when anesthesia is performed for COVID-19 patients, sharp instruments in anesthesia operation should be carefully handled to prevent stabbing. Latrogenic occupational exposure treatment process should be initiated immediately after stabbing occurs.
ABSTRACT
The original version of this article unfortunately contained some mistakes.
ABSTRACT
Objective To evaluate the accuracy of target-controlled infusion (TCI) of sufentanil at low concentration.Methods Sixty patients with American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-68 yr,scheduled for elective surgery under general anesthesia,were included in this study.Anesthesia was induced and maintained with sufentanil TCI combined with propofol TCI,and muscle relaxation was maintained by intermittent injection of rocuronium as needed.The patients were divided into 3 groups (n=20 each) using the sealed envelope method:0.08 ng/ml group (group Ⅰ),0.10 ng/ml group (group Ⅱ) and 0.12 ng/ml group (group Ⅲ).Arterial blood samples were collected in 10 patients randomly selected from each group for measurement of plasma sufentanil concentrations by liquid chromatography-mass spectrometry/mass spectrometry.The accuracy of sufentanil TCI was evaluated by calculating bias (median performance error),precision (median absolute performance error) and wobble.Results In Ⅰ,Ⅱ and Ⅲ groups,the bias of sufentanil TCI was-6.1％,-10.2％ and-5.0％,respectively,the precision was 19.4％,15.8％ and 14.2％,respectively,and the wobble was 20.9％,11.0％ and 10.8％,respectively.The pooled bias,precision and wobble were-7.1％,16.8％ and 13.5％ in Ⅰ,Ⅱ and Ⅲ groups,respectively.Conclusion The accuracy of sufentanil TCI at low concentration is considered acceptable in clinical anesthesia,and the measured plasma sufentanil concentration is approximately 7％ lower than the target plasma sufentanil concentration in surgical patients.
ABSTRACT
Objective To investigate the risk factors of postoperative cardiovascular complica-tions in elderly patients with hip fracture during hospitalization.Methods A retrospective analysis was conducted according to the medical records of 693 elderly patients with hip fracture admitted to our hospital from January,2005 to December,2015.There were 257 males and 436 females,aged 65-103 years and body mass index (BMI)16.5-33.1 kg/m2,ASA physical status Ⅱ-Ⅳ.The demo-graphic data,preoperative comorbidities,time before surgery,surgical types,anesthetic methods, operation time and blood loss were recorded.Multivariate logistic regression analysis was applied to analyze the risk factors of postoperative cardiovascular complications in elderly patients with hip frac-ture during hospitalization.Results Postoperative cardiovascular complications occurred in 46 (46/693,morbidity:6.64%),including angina pectoris,arrhythmia,heart failure,myocardial infarction and sudden cardiac death.Univariate analysis showed that the independent variables of postoperative cardiovascular complications were age,cardiac comorbidities,hypertention,diabetes mellitus,cere-brovascular disease,renal insufficiency and anesthetic methods (P < 0.05).Multiple logistic regression analysis showed that age(OR=1.11,95% CI 1.06-1.17,P<0.001),cardiac comorbidi-ties (OR=1.98,95% CI 1.02-3.85,P=0.045),hypertention(OR=2.61,95% CI 1.23-5.51,P=0.012),diabetes mellitus (OR=2.06,95% CI 1.04-4.09,P=0.039),cerebrovascular disease (OR=2.14,95% CI 1.06-4.32,P=0.033)and renal insufficiency (OR=17.42,95% CI 3.69-82.80,P<0.001)were independent risk factors for postoperative cardiovascular complications in elderly patients with hip fracture during hospitalization.Conclusion Age,cardiac comorbidities,hy-pertention,diabetes mellitus,cerebrovascular disease and renal insufficiency are independent predictors for postoperative cardiovascular complications in elderly patients with hip fracture during hospitalization.
ABSTRACT
Objective To compare combined spinal-epidural anesthesia (CSEA) versus lumbar plexus-sciatic nerve block (LPSB) in elderly patients undergoing internal fixation of hip fractures.Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients,aged 66-94 yr,with body mass index of 15.2-28.0 kg/m2,scheduled for internal fixation of hip fractures,were randomly assigned into CSEA group and LPSB group using SPSS 18.0 software,with 30 patients in each group.In CSEA group,intrathecal catheter was successfully placed at L3,4 interspace,0.5％ hyperbaric bupivacaine 8-10 mg was injected into the subarachnoid space and then an epidural catheter was placed.In LPSB group,posterior lumbar plexus block was performed with 0.4％ ropivacaine 25-30 ml and parasacral sciatic nerve block with 0.4％ ropivacaine 15-20 ml.Dexmedetomidine 0.4-0.6 μg · kg-1 · h-1 was infused during the procedure to maintain the Observer's Assessment of Alertness/Sedation Scale score of 3 or 4 in two groups.Patient-controlled intravenous analgesia was performed with sufentanil and lasted for 48 h.The anesthesia time,volume of intraoperative fluid infused,blood loss,consumption of dexmedetomidine,requirement for vasoactive agents,cardiovascular events,consumption of sufentanil within 24 and 48 h after surgery,rescue analgesia and postoperative adverse reactions were recorded.Results Compared with CSEA group,the anesthesia time was significantly prolonged,the volume of intraoperative fluid infused and consumption of ephedrine were reduced,the consumption of dexmedetomidine was increased,the incidence of bradycardia was decreased,the postoperative consumption of sufentanil was reduced,the rescue analgesia rate was decreased,and no significant change was found in the incidence of postoperative adverse events in LPSB group (P＞0.05).Conclusion LPSB can maintain hemodynamics stable and provide postoperative analgesic effect,with better anesthetic efficacy than CSEA when used for internal fixation of hip fractures in elderly patients.
ABSTRACT
The medical records of firstly diagnosed patients with the discharge diagnosis contained " placenta implantation,cesarean section" at Peking University Third Hospital from 2012 to 2016,were collected.The records included the type of placenta implantation,anesthetic methods,intraoperative blood loss,abdominal aorta balloon placement,hysterectomy,requirement for intensive care unit (ICU) admission and length of hospital stay,and the anesthetic management experience was summarized in the patients with placenta implantation undergoing cesarean section.A total of 156 patients were included in this study,and among the 156 patients,there were 70 cases of accreta (44.9％),50 cases of increta (32.1％) and 36 cases of percreta (23.1％).The intraoperative blood loss was (624±451) ml,(2100±1283) ml and (5281 ±3114) ml,the ratio of neuraxial anesthesia was 92％,62％ and 14％,the ratio of neuraxial anesthesia combined with general anesthesia was 4％,20％ and 61％,and the ratio of general anesthesia was 4％,18％ and 25％ in the patients of accreta,of increta and of percreta,respectively.The abdominal aorta balloon was placed during surgery in 14 cases,and among the 14 cases,there were 3 cases of increta and 11 cases of percreta.Forty-nine patients were transferred to ICU after operation,and among the 49 patients,there was 1 case of accreta,16 cases of increta and 32 cases of percreta.Anesthesiologists should pay attention to the preoperative interview and assessment,actively try to work with multi-departments,make anesthetic regimen according to patient's condition,closely monitor patient's vital signs during operation,concern about the operating process and blood loss,and ensure proper infusion and transfusion for the patients with placenta implantation undergoing cesarean section,and in addition,the critically ill patients should be transferred to ICU after operation for intensive monitoring and treatment.
ABSTRACT
Objective@#To evaluate the usage of ultrasound guided wire-localization, nano-carbon staining and the combination of the above two methods in detecting sentinel lymph node (SLN) in breast cancer.@*Methods@#A total of 159 cases of breast cancer from May 2015 to December 2017 in Shanxi Provincial Cancer Hospital were selected, and they were treated with ultrasound guided wire-localization, nano-carbon staining and combination of the two methods separately to detect SLN before the operation. After the operation, SLN and axillary lymph node in each group were marked and made pathological diagnosis.@*Results@#There were 69 cases with pathological diagnosis of SLN metastasis and 90 cases without abnormal representation. With the patient as the unit, the sensitivity of ultrasound guided wire-localization was 100.0% (69/69), the sensitivity of nano-carbon staining was 98.6% (68/69), and the sensitivity of combination of the two methods was 97.1% (67/69). The specificity of ultrasound guided wire-localization was 3.3% (3/90), the specificity of nano-carbon staining was 2.2% (2/90), and the specificity of combination of the two methods was 5.6% (5/90). With the count of SLN as the unit, the combination of the two methods had the highest diagnostic efficiency in detecting SLN, and the difference was statistical significant (χ2 = 34.31, P < 0.001).@*Conclusions@#Ultrasound guided wire-localization and nano-carbon staining are safe and accessible methods for detecting SLN. It provides a precise treatment for early breast cancer, and it can protect medical staff from radiation, which is expected to be the best method for detection of SLN in breast cancer.
ABSTRACT
Objective To evaluate the effects of epinephrine and phenylephrine on evoked potentials in a rat model of acute hemorrhagic shock. Methods Eighteen SPF healthy male Sprague-Dawley rats, aged 11 weeks, weighing 250-350 g, were divided into 3 groups ( n=6 each) using a random number table meth-od: acute hemorrhagic shock group ( HS group) , epinephrine group ( E group) and phenylephrine group ( P group). The animals were anesthetized with intraperitoneal 10％ chloral hydrate 300 mg∕kg and tracheos-tomized, and spontaneous breathing was kept. Acute hemorrhagic shock was induced by withdrawing 40％ of the blood volume from the right internal jugular vein. Epinephrine 2 μg·kg-1 ·min-1 ( 0. 01 mg∕ml, 0. 3 ml) and phenylephrine 20μg·kg-1·min-1 (0. 1 mg∕ml, 0. 3 ml) were intravenously infused after the end of blood letting in E and P groups, respectively. Mean arterial pressure ( MAP ) , somatosensory evoked po-tential (SSEP) and motor evoked potentials (MEP) were recorded before blood letting, at the time of with-drawing 20％of the blood volume, at the end of blood letting, and at 3 min after administration ( at the corre-sponding time point in group HS) . Results The MAP and amplitudes of MEP and SSEP were significantly decreased at the end of blood letting than at the time of withdrawing 20％ of the blood volume in three groups (P<0. 05). Compared with HS group, the MAP and amplitudes of MEP and SSEP were significantly in-creased at 3 min after administration in E group, and the MAP was increased at 3 min after administration ( P<0. 05 or 0. 01) , and no significant change was found in amplitudes of MEP and SSEP in P group ( P>0. 05) . Conclusion Epinephrine exerts no effect on evoked potential monitoring, however, phenylephrine affects the accuracy of evoked potential monitoring in a rat model of acute hemorrhagic shock.
ABSTRACT
Intraoperative cell salvage (IOCS) has been widely used to reduce allogeneic blood transfusion and prevent blood transfusion related complications during surgery.However, due to the risk of transfusion related reaction, contamination, and immunological reaction, its use for tumor patients has been controversial and limited.To explore the feasibility of the application of IOCS in cancer patients, we reported 2 cases of renal cell carcinoma (RCC) with tumor embolism in IVC that underwent radical nephrectomy,and inferior caval venous thrombectomy receiving IOCS combined with leukocyte depletion filter (LDF) from August 2016 to November 2016 in our hospital.The cell saver blood salvage (Haemone-tics, 5+) was used for these 2 cases.The salvaged blood was filtered through the LDF before infusion.For case 1 (male 45-year-old) the total operation time was 505 min, and the estimated blood loss was 4 500 ml.A total of 1 000 mL autologous blood, 12 u allogeneic packed red blood cells (PRBC), 1 200 mL fresh frozen plasma (FFP) were infused during the procedure.The patient was discharged from hospital after 75 days without complications.The postoperative follow-up for 3 months showed no tumor recurrence or metastasis.For case 2 (a male patient, aged 51 years), the total operation time was 490 min, and the estimated (blood loss was 7 000 mL.the patient received 2 700 mL autologous blood transfusion, 12 u allogeneic packed red blood cells (PRBC), and 2 400 mL fresh frozen plasma (FFP).The patient was discharged from hospital after 86 days without severe complications.the postoperative follow-up for 6 months showed no tumor recurrence or metastasis for this patient.Other relevant retrospective studies with this technique showed that cell salvage could be used safely in many kinds of cancer patients, for example, bladder cancer, liver cancer and kidney cancer.Furthermore,numerous researches have proved the safety and efficacy of the combination of these two techniques, the intraoperative cell salvage technique and leucocyte depletion filter in cancer patients.Here we only reported two cases using IOCS and LDF.Further work is needed to determine whether the use of intraoperative cell salvage combined with leukocyte depletion filter can be used safely for patients with HCC.
ABSTRACT
Objective:To investigate the effects of early rehabilitation training after total knee arthroplasty surgery by continuous femoral nerve block (CFNB) with or without periarticular local infiltration analgesia (PLIA).Methods:In this randomized,double-blind,controlled study,100 patients undergoing primary unilateral total knee arthroplasty in patients with knee osteoarthritis were enrolled.All the patients received CFNB for postoperative analgesia before combined spinal epidural anesthesia.They were randomly divided into 2 groups (n =50 each):CFNB group,CFNB combined with PLIA group (PLIA group).Group PLIA received periarticular local infiltration analgesia with 20 mL ropivacaine (5 g/L),while the equal volume of normal saline was used instead of ropivacaine in group CFNB.Postoperative pain during rest and passive exercises including front and rear portions of knees,the time of ability to perform an active straight leg raise,the time of ability to reach 90° knee flexion,and preoperative and postoperative hospital for special surgery knee score (HSS) were evaluated.Results:Compared with group CFNB,the visual analogue scores (VAS) of front of knees at rest time in group PLIA had no significant difference (P ＞ 0.05);there were significant differences at 4,8,12,24 h postoperation in portions of knees at rest time (P ＜ 0.05);the VAS had significant differences at 24 h in passive exercises of knees (P ＜ 0.05);the VAS had significant differences at 12,24 h in portions of knees at passive exercises of the knees (P ＜ 0.05);the time of ability to perform an active straight leg raise had significant differences in the two groups (P ＜ 0.05).Conclusion:Compared with CFNB postoperative analgesia alone,CFNB with PLIA could relieve rest pain and pain during passive movement after total knee arthroplasty.CFNB with PLIA could shorten the time to perform an active straight leg raise and the time of ability to reach 90° knee flexion.And so some patients could improve postoperative rehabilitation training.
ABSTRACT
Objective:To evaluate the feasibility and success rate of in-plane ultrasound-guided paravertebral block using laterally intercostal approach.Methods:In the study,27 patients undergoing elective thoracic surgery were selected to do paravertebral block preoperatively.The fifth intercostal space was scanned by ultrasound probe which was placed along the long axis of the rib and 8 cm lateral to the midline of the spine.The needle was advanced in increments aiming at the space between the internal and innermost intercostal muscles.Once the space between the muscles was achieved,20 mL of 0.5％ (mass fraction) ropivacaine was injected and a catheter was inserted.Whether the tip of catheter was in right place was evaluated by ultrasound image.The block dermatomes of cold sensation were recorded 10,20 and 30 min after the bolus drug was given.Then 0.2％ ropivacaine was infused with 6 mL/h via the catheter by an analgesia pump postoperatively.The block dermatomes of cold sensation and pain score were recorded 1,6,24 and 48 h postoperatively.Results:The first attempt success rate of catheteration was 81.48 ％ (22/27);the tips of catheter were proved in right places after the second or third attempt in 5 patients.The median numbers of the block dermatomes 10,20 and 30 min after the bolus drug was given were 2,3,4;the median numbers of block dermatomes were 5,5,5,4,and of pain score were 1,1,2,2 at 1,6,24,48 h postoperatively;no case of bilateral block,pneumothorax or vessel puncture occurred.Conclusion:Thoracic paravertebral block using laterally intercostal approach is feasible,which has high success rate of block and low rate of complications.