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Objective To observe the skin temperature changes on blocked area of ultrasoundguided thoracic paravertebral block and to explore the accuracy of the temperature changes in predic ting the effect of nerve block in breast cancer patients.Methods One hundred and twenty breast cancer patients undergoing modified radical mastectomy,aged 29-67 years,ASA physical status Ⅰ-Ⅲ,were selected for the study.Before general anesthesia induction,ultrasound-guided thoracic paravertebral block was performed.After the block site T34 was determined,25 ml 0.25％ ropivacaine was injected around the thoracic paravertebral space.The skins of palm and axillary regions both in blocked and unblocked sites were randomly selected.The skin temperature before nerve block and 15 min after were recorded,and the skin temperature changes were calculated.The sensitivity and specificity of the temperature changes in determining the effect of thoracic paravertebral block was assessed by using the receiver operating characteristic curve (ROC).Pearson correlation was used to analyze the correlation.Results The value of area under curve (AUC) of the ROC of the skin temperature changes in palm regions responding to the effects of block was 0.892 (95％CI 0.803-0.947).The cut-off value was 0.9C which sensitivity and specificity was 87.3％ and 75.9％,respectively.The AUC in axillary regions was 0.813 (95％CI 0.756 0.884),the cut-off value was 0.4 C which sensitivity and specificity was 80.7％ and 71.6％,respectively.The value of AUC in palm regions was larger than in axillary regions (P＜0.05).Conclusion The present study demonstrated that the changes of the skin temperature in palm and axillary regions have a high accuracy in predicting the effect of T3-4 thoracic paravertebral block,which can be used in determining the success of T3-4 thoracic paravertebral block.The assessment of temperature changes in palm regions is more accuracy than in axillary.
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Objective To observe the reactivity of pupillary diameter variation responding to numerical rating scale on postoperative pain to explore the accuracy of pupillary diameter variation for pain assessment.Methods Eighty patients after selected surgery (male 43 cases,female 37 cases,aged 24-79 years,ASA gradeⅠorⅡ)were included for the trial.After endotracheal extubation and on arri-val in the post-anaesthesia care unit (PACU),the levels of pain on numerical rating scale (NRS)were rated and recorded subsequently.If NRS was within 0-3,no analgesic was administered and 50 μg fentanyl was administrated after 5 min if NRS rated in 4-10.The pupillary diameter (PD),systolic blood pressure (SBP)and heart rate (HR)were recorded every minute during 20 minute after first NRS evaluation,the corresponding maximum variation of above index were calculated simultaneously in 10 minutes with NRS 0-3,after 5 minutes with NRS 0-3 to 4-10,after 5 minutes with NRS 4-10 to 0-3,in 10 minutes with NRS 4-10 which were marked respectively with ΔPD,ΔSBP and ΔHR.With the variation of NRS as a criterion,the reactivity of ΔHR,ΔSBP and ΔPD responding to NRS varia-tion were assessed by analysing the receiver operating characteristic curve (ROC),the area under the receiver operating characteristic curve (AUC)was calculated.Results The patients' ROC value ofΔHR,ΔSBP and ΔPD responding to NRS variation were AUCΔPD 0.904 (95% CI 0.822-0.987 ), AUCΔSBP 0.65 1(95%CI 0.5 10-0.781)and AUCΔHR 0.588(95%CI 0.444-0.733)respectively.Value of AUCΔPD was larger than that of AUCΔSBP and AUCΔHR respectively (P < 0.05 ).Importantly, operating characteristic curve (ROC)analysis showed that the diagnostic cutoff value of ΔPD was 41.3% with a sensitivity of 80.0% and a specificity of 93.5% and the diagnostic cutoff value of ΔSBP was 10.3% with a sensitivity of 62.4% and a specificity of 71.5%.Conclusion This study demon-strated that the accuracy of ΔPD was higher than ΔSBP and ΔHR responding to pain/analgesia evalu-ation.ΔPD was a valuable index for assessment of postoperative pain.
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Objective To investigate the feasibility and safety*with the low dose fentanyl for valve replacement fast track cardiac anesthesia. Methods 40 cases with cardiac valve replacement were divided into two groups,group Ⅰ :20 cases with fast track anesthesia,group Ⅱ :20 cases with large dose fentanyl anesthesia. The blood presure, HR, SpO2, CVP,Temperature, airway pressure were observed at different time points. The postoperative extubation time,ICU stay,hospital stay,postoperative pulmonary complications were recorded. Results The fentanyl(μg/kg) of group Ⅰ (23. 25 ± 1.32) was less than that of group Ⅱ ( 35.75 ± 6. 84) ( P < 0. 05 ); Extubation time (hours), ICU stay ( hours),length of stay (days) were ( 7.92 ± 3. 16), (25. 12 ± 7.50), ( 28.50 ± 8. 94 ) in group Ⅰ , and that were (13.70±5.63) ,(37.53 ±13. 19) ,(38.00 ± 12. 90) in group Ⅱ. The group Ⅰ were shorter than the group Ⅱ ,P<0. 05; There were four cases of lung infection in group Ⅱ, no one in group Ⅰ ( P < 0. 05 ); There were significant differences between the two groups. There were no significant differences in the remaining observations. Conclusion The low dose fentanyl anesthesia for fast track anesthesia in heart valve replacement surgery was reliable and safe;It could help to reduce postoperative extubation time, ICU stay time and hospital stay time and reduce postoperative pulmonary complications and hospital costs.
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Objective To explore the dose and effects of mixtures of pethidine and haloperidol for Postoperative Deliri-um. Methods Retrospective analysis was conducted on treatment dose and effects of 85 cases of patients with deliri-um during narcotic awake period or 1 day to 2 days after operation by mixtures (haloperidol with pethidine) from 2005 to 2006 in Affiliated Hospital of Hainan Medical College. Results 1/4 dose of mixture (pethidine 100 mg and haloperidol 5 mg) cured 9 patients, 1/2 dose of mixture cured 61 cases, we add 1/4 dose of mixture when 10 cases occurred delirium again ,5 cases added 1/2 dose of mixture again, all were cured. After administration ,aublood pres-sure declined all, but all were within normal range, the 17 cases's pulse oxygen saturation is less than 95%, Conclu-sion The mixture (haloperidol with pethidine) can be effective treatment for delirium during awake period of general anesthesia or after operation. However, application of low dose therapy from the beginning, and attention to its impact on respiration.