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Objective:To explore whether the simulation training system for transesophageal echocardiography (TEE) can improve the effectiveness of standardized training of resident anesthesiologists.Methods:A total of 72 resident anesthesiologists without experience in cardiac ultrasound were randomly divided into traditional teaching group (36 residents) and simulation training group (36 residents). Before and after the teaching, theoretical examinations of 5 knowledge points related to cardiac ultrasound were conducted. After a standardized rotation of 2 months, the students were re-examined for both theories and operations, and clinical indicators were recorded. SPSS 23.0 was used for the t-test, rank sum test, chi-square test, or Fisher's exact test. Results:There was no significant difference in scores of theoretical examinations between the two groups of students before teaching. After teaching, the scores of the simulation training group were higher than those of the traditional teaching group, and the differences were significant in cross-sectional recognition and image diagnosis ( P<0.05). After rotation, there was no significant difference in theoretical examination between the two groups of students, but the score of operation was significantly higher in the simulation training group than in the traditional teaching group ( P<0.05). During the rotation period, the incidence of TEE-related complications was relatively low and the quantitative score of clinical operational skill assessment was relatively high in the simulation training group ( P<0.05). Conclusion:Anesthesia residents who receive training with the simulation system before TEE training can quickly acquire operational skills, reduce related complications, and more accurately identify and obtain standard TEE sections, which has significant value for clinical teaching.
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Objective To investigate the relationship between the occurrence of adverse events during operation and postoperative complications in emergency general surgery patients, and to analyze the risk factors of postoperative complications.Methods We retrospectively analyzed 689 e-mergency general patients undergoing general anesthesia emergency surgery during the period of Sep 1,2015 to Sep 1,2016 in the First Affiliated Hospital of Nanjing Medical University.The clinical fac-tors that may influence the outcomes and postoperative complications were collected and analyzed using univariate analysis and multivariate Logistic regression analysis.Results Among the 689 patients enrolled in the study,there were 165 (23.9%)patients who had major complications within 30 days after surgery.The most common postoperative complications were respiratory complications (40.6%).The inde-pendent risk factors of postoperative complications including age (OR 1.880,95%C I 1.448-2.440),ASA classification (OR 3.303,95%C I 2.303-4.736),intraoperative hypotension duration more than 20 minutes (OR 2.501,95%C I 1.387-4.510),intraoperative rapid arrhythmia (OR 2.173,95% C I 1.002-4.711) and surgical level (OR 1.814,95% C I 1.060-3.103).Conclusion Emergency general surgery in patients with intraoperative hypotension duration more than 20 minutes and the occurrence of rapid arrhythmia are independent risk factors for postoperative complications.During the circulation man-agement of emergency surgical patients,the reduction of systolic blood pressure in the operation should be controlled within 20% of the base value to reduce the risk of postoperative complications.
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Objective To compare the impact of patient controlled epidural analgesia with patient controlled intravenous analgesia on postoperative recovery and complications in patients undergoing laparotomy pancreatic surgeries.Methods Forty patients undergoing pancreatic surgeries, 27 males and 13 females, aged 18-70 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n=20 each).Patients in group E received T8-9 or T9-10 epidural block, 2% lidocaine test dose was given to ensure the location of epidural catheter, after that, each patient in group E was given 0.375% ropivacaine 5 ml into epidural space before skin incising and incision closures.Meanwhile, patients in groups E and V received propofol-sevoflurane combined intravenous inhalation anesthesia.After surgery, patients in group E received patient controlled epidural analgesia while patients in group V received patient controlled vein analgesia.Length of hospital stay, time to ambulation and exhaust defecation were recorded.Other complications were compared.Results Compared to group V, patients in group E showed earlier ambulation [(50.4±4.2) h vs (64.2±5.0) h, P<0.01], shorter hospital stays [(18.5±8.5) d vs (21.5±6.8) d, P<0.05].There was no statistically significant difference in flatus time between the two groups [(39.7±4.1) h vs (39.5±8.4) h].There was no significant difference in complications between the two groups.Conclusion The present study shows that for patients undergoing pancreatic surgeries, patient controlled epidural analgesia could effectively release post-operative pain, shorten the ambulation time and length of hospital stay with no extra complications.