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Objective To summarize the perioperative outcomes of patients undergoing endovascular repair,and to screen out related preoperative risk factors in order to provide reference for the promotion of postoperative rehabilitation of patients.Methods The clinical data of 2 896 patients undergoing elective endovascular repair in the Department of Vascular Surgery,Zhongshan Hospital,Fudan University from Jan.2013 to Dec.2014 were analyzed to screen out related preoperative risk factors of postoperative complications retrospectively.Results A total of 148 patients had postoperative complications,including 2 cases of death during hospitalization.The incidence of complications in the patients older than 75 years old,with hypertension,diabetic mellitus,renal dysfunction,chronic obstructive pulmonary disease (COPD) or ASA physical status more than grade Ⅱ is 9.7％,8.1 ％,14.3 ％,8.0 ％,29.7 ％,6.3 ％,respectively.The multivariate Logistic regression analysis identified that patients older than 75 years old (P =0.000,OR =43.29,95％CI:22.51-83.28),with hypertension (P=0.000,OR=3.822,95 ％CI:2.37-6.16),diabetic mellitus (P=0.025,OR=1.714,95％CI:1.07 -2.75),renal dysfunction (P =0.017,OR =2.692,95 ％ CI:1.19-6.07) or COPD (P =0.000,OR =7.158,95％CI:3.83-13.37) and ASA physical status more than grade Ⅱ (P =0.000,OR =27.77,95％CI:13.79-55.93) were the independent risk factors with postoperative complications of endovascular repair surgery.Conclusions The patients older than 75 years old,with hypertension,diabetic mellitus,renal dysfunction or COPD and ASA physical status more than grade Ⅱ were the independent risk factors for endovascular repair surgery.
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Objective To study the effect of preoperative blood pressure control on postoperative cardiovascular events in patients with hypertension and gastrointestinal surgery. Methods A total of 238 hypertensive patients who underwent gastrointestinal surgery were selected and divided into control group (n =118)and non-control group (n =120)according to thehypotensor treatment.During the operation,the same anesthetic regimen was used.The use of vasoactive drugs was recorded during anesthesia.Bladder chalone C (Cys C)and cardiac troponin T (cTnT)were de-tected in blood before and after the operation,and so were N-terminal B type natriuretic peptide (NT-proBNP)level on the 1st and 5th day after the operation.The postoperative hospitalization time,fol-low-up of cardiovascular events 28 and 90 days after discharge were recorded.Results Compared with the non-control group,the total dosage of ephedrine in the control group was significantly re-duced [(3.41±1.04)mg vs (7.46 ± 3.29)mg,P <0.05 ],total dose of phenylephrinewas signifi-cantly reduced [(0.17±0.10)mg vs (0.46 ±0.16)mg,P <0.05],postoperative hospital stay was significantly shorter [(5.92±1.15)d vs (9.65±1.61)d,P <0.05],NT-proBNP level in the control group on the 1st day after the operation [(108.00 ± 47.11 )pg/L vs (250.38 ± 62.92 )pg/L,P <0.01]and 5 days after the operation [(62.07 ±25.31)pg/L vs (199.02 ± 60.32)pg/L,P <0.01 ] was obviously reduced.There was no statistical difference in Cys C andcTnT between the two group-safter operation.The incidence of cardiovascular adverse events in the control group was significantly lower than that in the non-control group (28 d:13.6% vs 62.7%,90 d:23.3% vs 23.3%,P <0.05).Conclusion Strict control of preoperative blood pressure control in patients with hypertension can significantly reduce the incidence of cardiovascular events.
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Background and purpose:Perioperative hypothermia will affect the prognosis of cancer patients. Amino acid infusion can increase the core temperature by endogenous thermogenesis. And the forced-air warming system has gained high acceptance as a measure for rewarming. This study aimed to find out whether amino acid infusion was effective to treat postoperative hypothermia and how well the treatment effect was when compared with the forced-air warming system.Methods:Fifty-seven ASAⅠ orⅡ patients aged 18-60 years undergoing elective esophageal or gastric cancer operation under epidural-general anesthesia and whose core temperature were below 36℃. When admitted to the recovery room wererandomly divided into 3 groups (n=19): GroupⅠ received intravenous infusion of mixed amino acid at a rate of 2 mL·kg-1·h-1 (A); GroupⅡ received a forced-air system (B); groupⅢreceived no therapy (C). Rectal temperature and thermal comfort were recorded per 5 min during the ifrst 1 h and oral temperature and thermal comfort were recorded at the 2, 6 and 24 h. ABG was recorded when patients were admitted to the recovery room and at the ifrst hour.Results:At the ifrst hour, the rectal temperature and thermal comfort of groups A and B were higher when compared with group C (P0.05). At the second and sixthhour, the temperature and thermal comfort of group A were higher when compared with group B and C (P0.05). At the 24th hour, there were no statistically signiifcant differences in the temperature and thermal comfort among the three groups (P>0.05). Conclusion:The rewarming effect of infusion of mixed amino acid is better than that of the forced-air warming system. It is the more effective and convenient method to rewarm the postoperative hypothermia.
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Background and purpose:Previous researches have shown that intravenous amino acid infusion during general anaesthesia prevents the decreases in core temperature. This study aimed to investigate the effect of amino acid infusion on postoperative liver and renal function in elderly patients undergoing gastrointestinal surgery. Methods:Forty ASAⅠ orⅡ patients (33 males, 7 females) aged 65-75 years undergoing elective gastrointestinal can-cer operation under epidural block combined with general anesthesia were randomly divided into 2 groups (n=20 each). GroupⅠ received intravenous infusion of mixed amino acids at a rate of 2 mL·(kg·h) -1 from induction of anesthesia to the end of operation (AA group); GroupⅡ received infusion of equal volume of normal saline (NS group). Snuff temperature was monitored for induction of anesthesia immediately, after 90 min and at closed abdomen. Renal and hepatic function was performed regularly before operation and on the 1st and 7th postoperative day.Results:The naso-pharyngeal temperatures at 90 min after the beginning of surgery and the time when the peritoneum was closed in AA group were signiifcantly higher than those in NS group (P0.05).Conclusion:Intraoperative amino acid infusion has no signiifcant effects on the renal or hepatic function in elderly patients undergoing gastrointestinal surgery.
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Objective To study the best multiple concentration of target controlled infusion of propofol and remifentanil in elderly patients during the induction of general anesthesia. Methods Fifty elderly patients were randomized into five groups, according to the effect site concentration of remifentanil (0, 2, 4, 6, 8 ng/mL). We started the effect site concentration of propofol (PEC) at 2 μg/mL, and added 1 μg/mL every 2 min until bispectral index (BIS) was stable at 40±5. During the induction,we recorded the effect site concentration of remifentanil (REC) and propofol (PEC), heart rate (HR), arterial blood pressure (ABP), BIS, AAI, and isolated forearm technique (IFT). After statistic analysis, the best multiple concentration was judged. Results There was no significant difference (P<0.05) in the changes of hypertension and hypotension among these five groups during intubation. The most smooth hemodynamic conditions were found in group B, i.e. 20% and 10%, respectively. When consciousness was lost, there was a negative correlation between PEC and REC. Group B was the minimum on the change of IFT and the cardiovascular system among these five groups at tracheal intubation. Conclusions It is safe and stable to use REC 2 μg/mL for TCI, combined with propofol in elderly patients under general anesthesia. PEC is (3.5±0.8)μg/mL when the patients' consciousness is lost. And PEC is 5.3 μg/mL at tracheal intubation.
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Objective To investigate the effects of β_2 agonist salbutamol aerosol on the uptake of sevoflurane in elderly patients with chronic obstructive pulmonary disease (COPD). Methods A randomized, placebo-controlled and double-blinded trial was designed. Twenty-six patients were recruited and randomly allocated to salbutamol group (group E, n=13) and placebo group (group C, n=13). Eligible patients were elderly patients with ASA physical status Ⅱ-Ⅲ, a body mass index (BMI) between 18 and 30 kg/m~2, well-defined clinical diagnosis of COPD. Routine monitoring (consists of a three-lead ECG, pulse oximetry, noninvasive blood pressure and expired gas analysis) was instituted and 500 mL Ringer's lactate solution was administered. Bispectral index (BIS) monitoring was initiated prior to induction. All subjects were received inhaled aerosol 200 μg according to manufacturers' recommendations 30 minutes before induction of anesthesia. Controlled ventilation was applied after the trachea was intubated. When stable hemodynamics was maintained for 5 minutes, fresh gas flow was set to 2 L/min with 2% sevoflurane in admixture, then HR, invasive arterial blood pressure (IABP), SpO_2, P_(ET)CO_2, bispectral index (BIS), minimum alveolar concentration (MAC), concentrations of inhaled sevoflurane (F_I) and end-tidal (F_E) were recorded at 1, 2, 3, 4, 5, 7,10, and 15 minutes after inhalation of sevoflurne. The P_(peak) and P_(plat) were also measured in 1, 5, and 10 minutes after the successful endotracheal intubation. Results Compared to the placebo group, the F_E was significantly higher at 2, 3, 4, and 5 minutes in experiment group. Peak airway pressure and plateau pressure in experiment group were strikingly lower than control group (P<0.05). There was no statistical significance about BIS variations between these groups in respective time in spite of increased MAC (P>0.05). Conclusions The increasing rate of alveolar concentration of sevoflurane was accelerated after the administration of inhaled salbutamol aerosol (200 μg) 30 minutes before induction of anesthesia, it might increase the uptake of sevoflurane.
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Objective To study the effect of intraoperative glucose and insulin infusion on the metabolism in patients undergoing esophageal cancer surgery under combined general anesthesia with epidural block. Methods Twenty ASA physical status Ⅰ-Ⅱ adult patients undergoing esophageal cancer surgery were studied. Ten patients received an iv glucose infusion at 0.5 g·kg~(-1)·h~(-1) and insulin infusion (1-1.5 IU ∶ 1 g glucose) throughout the anesthesia. Ten control subjects received isovolumic nutrient-free saline solution. Rectal temperature, plasma glucose concentrations, plasma free fatty acid (FFA) concentrations, plasma potassium concentrations and 24 hour urea nitrogen were measured perioperatively. Results No statistical difference was observed in rectal temperature and 24 hour urea nitrogen between the two groups. The plasma glucose concentrations continued to increase perioperatively in the control group. The glucose concentration increased during the operation in the glucose/insulin group, but the glucose concentrations at 1 and 2 hours after the operation were not statistically different from that before operation. Significant difference in plasma FFA concentration was found perioperatively (30, 90, 120, 150 min during the operation compared with 1 h after operation) between the two groups. In the glucose/insulin group, there was a significant decrease in the concentration of plasma potassium at 1 and 2 h during and after the operation. Conclusions Intraoperative glucose and insulin infusion cannot prevent hypothermia in patients undergoing esophageal cancer surgery under combined general anesthesia with epidural block, however, it may reduce lipoclasis.
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Objective To investigate the effect of intraoperative amino acid infusion on perioperative glucose metabolism. Methods Thirty-six adult mongrel dogs of both sexes weighing 12-16 kg undergoing partially small intestine resection under general anesthesia were randomly allocated to one of 4 groups (n=9 each): Ⅰ control group received normal saline (C);Ⅱ,Ⅲ,Ⅳ amino acid group (A1, A2, A3) received iv infusion of 2.85%, 5.70% and 11.4% 18-amino acid respectively at 12 ml·kg-1·h-1 during operation starting from skin incision until the end of operation. The animals were premedicated with ketamine and diazepam. Anesthesia was induced with propofol 5-10 mg/kg, fentanyl 2 μg/kg and vecuronium 0.2 mg/kg and maintained with 1%-3% isoflurane and intermittent iv boluses of fentanyl and vecuronium. The animals were intubated and mechanically ventilated. PET CO2 was maintained at 30-40 mm Hg. ECG, MAP, HR, PET CO2 and esophageal T0 were continuously monitored. Venous blood samples were collected before anesthesia (T1), 15 min after induction of anesthesia (T2), 15, 30 min and 1 h after skin incision (T3-5), when abdomen was closed (T6) and 1,2,4,8 and 24 h after operation (T7-11) for determination of plasma glucose, lactate, insulin and glucagon. Liver biopsy was performed at T6-11 and muscle biopsy at T2,6,11 for measurement of hepatic and muscle glucagon. Homa index was used to estimate the degree of insulin resistance. Results The plasma glucose and insulin concentrations were significantly increased at T3-11 as compared with the baseline at T1 in all 4 groups (P<0.05). The plasma insulin concentrations were significantly higher in group A1 (at T6), group A2 (at T3,6) and group A3 (at T3-11) than in group C (P<0.05). Homa index was significantly higher in group A3(at T3-8) than in group C. Conclusion Intraoperative amino acid infusion increases plasma insulin concentration but does not prevent glycogenolysis especially high dose amino acid infusion.
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Objective:To investigate the influence of electroacupuncture on auditory evoked potential index (AAI) during propofol sedation.Methods: According to propofol effect site concentration, 24 patients for operation were randomly allocated to group 1 (1.0 μg/mL), group 2 (1.5 μg/mL) and group 3 (2.0 μg/mL). Propofol was administered intravenously, points Hegu (LI4) and Neiguan (PC6) were electro-acupunctured, and changes in AAI were recorded.Results:AAI significantly rose in all groups during the initial several minutes after electro-acupuncture and significantly fell in group 2 at 20 min after electro-acupuncture(P＜0.05).Conclusion:AAI can sensitively reflect pain response during electro-acupuncture and electro-acupuncture can strengthen propofol sedation at its medium concentration.
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Objective To evaluate the feasibility of using auditory evoked potential index(AAI) to monitor the depth of nitrous oxide anesthesia. Methods Sixteen ASAⅠ-Ⅱpatients aged 23-64 years, weighing 51-86 kg scheduled for elective surgery under general anesthesia were studied. Patients with psychoneural diseases and hearing disturbances were excluded. The patients were premedicated with phenobarbital sodium 0.1g and atropine 0.5mg. AAI, BIS, 95% SEF, BP, HR, SpO2 monitoring were started before induction of anesthesia. The patients were preoxygenated for 5 min using a close-fitting face mask and 100% O2 at l0L?min-1 . Inhalation of nitrous oxide was then started. Nitrous oxide concentration was gradually increased in increments of 10% from 0% to 70% . AAI, BIS and 95%SEF were recorded and observer's assessment of alertness/sedation (OAA/S) scores were measured at each 10% increment of end-tidal nitrous oxide concentration which was maintained for 5 min. The correlation between AAI, BIS, 95% SEF and OAA/S scores was analyzed. Results OAA/S scores and AAI decreased as the nitrous oxide concentration increased. AAI correlated closely with OAA/S scores and end-tidal nitrous oxide concentration (the coefficients of Spearman' s rank correlation ? = - 0.739, 0.837, P