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Objective:To compare the effects of total intravenous anesthesia and inhalation anesthesia on early postoperative immune function, recurrence and metastasis by Meta-analysis in patients with malignant tumors.Methods:The PubMed, Embase and Cochrane Library were searched by computer from January 2010 to January 2020. The randomized controlled trials of surgical treatment using total intravenous anesthesia or inhalation anesthesia in patients with malignant tumors were collected. The RevMan 5.3 and STATA 15.0 softwares were used to analyze the impact of 2 anesthesia methods on early postoperative immune function indexes and tumor recurrence and metastasis in patients with malignant tumors. The immune function indexes included interleukin (IL)-6, IL-10, transforming growth factor (TGF)-β, vascular endothelial growth factor (VEGF)-C and natural killer (NK) cell.Results:A total of 8 articles were included, with a total of 665 patients. Meta analysis results show that, compared with inhalation anesthesia, total intravenous anesthesia could significantly reduce the levels of IL-6, TGF-β and VEGF-C in patients with malignant tumors after surgery ( SMD = - 0.35, - 0.26 and - 0.64; 95% CI - 0.58 to - 0.12, - 0.49 to - 0.02 and - 0.99 to - 0.28; P<0.01 or <0.05); the 2 anesthesia methods had no significant effect on IL-10 and NK cell in patients with malignant tumors after surgery ( SMD = 0.16 and 0.18, 95% CI - 0.07 to 0.39 and - 0.23 to 0.60, P>0.05); and the 2 anesthesia methods had no significant effect on tumor recurrence and metastasis in patients with malignant tumors ( RR = 0.70, 95% CI 0.47 to 1.03, P = 0.07). Conclusions:Total intravenous anesthesia may improve the early postoperative immune function in patients with malignant tumor by reducing the levels of pro-cancer factors IL-6, TGF-β and VEGF-C, but total intravenous anesthesia has no obvious effect on reducing postoperative tumor recurrence and metastasis in patients with malignant tumor.
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Objective:To investigate the effect of ultrasound-guided transversus abdominis plane (TAP) block combined with iliohypogastric/ilioinguinal TAP block in high-risk elderly patients undergoing inguinal hernia repair.Methods:Sixty male patients undergoing elective inguinal hernia repair, aged ≥70 years, BMI 18-23 kg/m 2, ASAⅢ-Ⅳ grade, were randomly divided into two groups: ultrasound-guided lateral TAP block combined with iliohypogastric/ilioinguinal TAP block group (combined group) and lateral TAP block group (lateral group), with 30 cases in each group. In the combined group, the injection concentration of 0.375% ropivacaine 20 ml was at the iliohypogastric/ilioinguinal TAP puncture site and the lateral TAP puncture site was also 20 ml, and the lateral group only injected 0.375% 20 ml at the lateral TAP puncture site. The Visual Analogue Scale (VAS) of the two groups were compared at surgical skin incision (T 1), opening of external oblique aponeurosis (T 2), free hernia sac (T 3), separation of preperitoneal space and patch placement (T 4), suture of transverse abdominal fascia (T 5), suture of external oblique abdominal aponeurosis (T 6) and skin incision are closed (T 7); The VAS were compared during rest and activity at 2, 4, 6, 8, 12 and 24 hours after surgery. The cumulative consumption of relief analgesics was compared. Results:Compared with the lateral group, the VAS of the combined group during T 3-T 5 was significantly lower ( P<0.05). The VAS score at 4, 6 and 8 hours after operation in the combined group was also significantly lower ( P<0.05). There was no statistical significance in VAS score at rest between the two groups 24 h after operation ( P>0.05). The cumulative consumption of relief analgesics in the combined group was lower ( P<0.05). The difference of adverse events between the two groups was not statistically significant ( P>0.05). Conclusion:In high-risk elderly patients, ultrasound-guided transverse abdominal muscle plane two-point block can be used as a safe alternative method of intraoperative analgesia.
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Objective:To compare the effects of ultrasound-guided double transverse abdominis plane block (TAPB) under regional anesthesia sedation and local infiltration anesthesia in inguinal hernia repair in elderly patients.Methods:A total of 60 elderly patients who underwent unilateral inguinal hernia repair in Shengjing Hospital of China Medical University from March to September 2019 were selected. The patients were divided into 2 groups by random digits table method. Thirty cases were treated with ultrasound-guided double TAPB (lateral TAPB combined with iliohypogastric/ilioinguinal TAPB) under regional anesthesia sedation (observation group) and 30 cases with local infiltration anesthesia (control group). The local anesthetic was 0.375% ropivacaine in observation group and 0.5% lidocaine in control group. The mean arterial pressure (MAP) and heart rate were recorded at these time points: preanesthesia (T 1), beginning of skin incision (T 2), operation of external oblique aponeurosis (T 3), anatomy of hernial sac (T 4), operation of placing patch (T 5), suturing of external oblique aponeurosis (T 6) and closing skin incision (T 7). The visual analogue scale (VAS) at T 2 to T 5 and 2, 4, 6, 12 and 24 h after surgery were recorded. The occurrence of general anesthesia, postoperative remedial analgesia, nausea and vomiting, local anesthetic intoxication, accidental intraperitoneal injection and cardiovascular and cerebrovascular accident were recorded. Results:Both groups of patients were successfully anesthetized and completed the operation. There was no statistically significant difference in operation time between observation group and control group: (37.20 ± 6.46) min vs. (38.03 ± 4.87) min, P>0.05. There were no statistical difference in MAP and heart rate at T 1 between 2 groups ( P>0.05). The MAP and heart rate at T 2 to T 7 in observation group were significantly lower than those in control group, and there were statistical differences ( P<0.05). The VAS at T 2 to T 5 and 4 to 12 h after operation in observation group was significantly lower than that in control group: (1.87 ± 0.94) scores vs. (4.73 ± 1.11) scores, (1.33 ± 0.24) scores vs. (6.77 ± 1.04) scores, (2.10 ± 0.99) scores vs. (7.30 ± 0.65) scores, (2.39 ± 0.63) scores vs. (5.07 ± 0.87) scores, (2.60 ± 0.17) scores vs. (4.47 ± 0.65) scores, (3.13 ± 0.51) scores vs. (6.32 ± 0.44) scores and (4.28 ± 0.76) scores vs. (6.60 ± 0.57) scores, and there was statistical difference ( P<0.05). There was no statistical difference in VAS 2 and 24 h after surgery between 2 groups ( P>0.05). The rates of general anesthesia and postoperative remedial analgesia in observation group were significantly lower than those in control group: 0 vs. 33.3% (10/30) and 6.7% (2/30) vs. 83.3% (25/30), and there were statistical differences ( P<0.05). There was no significant difference in the incidence of nausea and vomiting between 2 groups ( P>0.05). There were no local anesthetic poisoning, accidental intraperitoneal injection, cardiovascular and cerebrovascular accident in 2 groups. Conclusions:Compared with local infiltration anesthesia, ultrasound-guided double TAPB under regional anesthesia and sedation can provide complete intraoperative and postoperative analgesia during inguinal hernia repair in elderly patients, with more stable hemodynamics and better comfort.
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Dexmedetomidine (DEX) is an α2 adrenalin-receptor agonist with potent sedation,analgesia,anti-anxiety and anti-sympathetic effect.Moreover,DEX exert no inhibition of respiratory function with high safety and has considerable clinical application prospect.Children often experience emergency agitation (EA) and other uncomfortable symptom which is associated with special physical and mental state.Thus,an ideal pediatric anesthetic premedication is getting a lot of attention.DEX is superior to other premedication in sedation with high safety.Compared with others,DEX by nasal spray is an ideal drug delivery method to reduce the side effects and facilitate the implementation of the drug.The relevant research progress of the effective dose,efficacy and safety will be reviewed.
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Dexmedetomidine (DEX ) is an α2 adrenalin-receptor agonist with potent sedation, analgesia, anti-anxiety and anti-sympathetic effect. Moreover, DEX exert no inhibition of respiratory function with high safety and has considerable clinical application prospect. Children often experience emergency agitation (EA) and other uncomfortable symptom which is associated with special physical and mental state. Thus, an ideal pediatric anesthetic premedication is getting a lot of attention. DEX is superior to other premedication in sedation with high safety. Compared with others, DEX by nasal spray is an ideal drug delivery method to reduce the side effects and facilitate the implementation of the drug. The relevant research progress of the effective dose, efficacy and safety will be reviewed.
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Pain is a common and crucial problem in clinical practice, because it has a profound influence on patients in perioperative period. Butorphanol, among plenty of analgesics, is widely used in clinical trials for its various advantages and better analgesic effects. As a typical agonist-antagonist opioid analgesic agent, butorphanol, however, shows different clinical manifestations with different affinity for opioid receptors 25∶4∶1 (κ∶μ∶δ). Besides, butorphanol provides remarkable analgesic and sedative effect in preemptive analgesia, induction and recovery period in general anesthesia, and postoperative analgesia And it could be as a adjuvant to local anaesthesia either. Compared with other opioid drugs, butorphanol is less likely to have side effect on respiratory depression. In addition, its physical dependence is extremely low.