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Objective:To evaluate the improved efficacy of ultrasonography-guided superior laryngeal nerve block (SLNB) in elderly patients undergoing short surgery with general anesthesia.Methods:Sixty-four patients of both sexes, aged≥65 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective percutaneous balloon compression under general anesthesia, were divided into 2 groups ( n=32 each) using a random number table method: control group (group C) and ultrasound-guided SLNB group (group S). The patients received bilateral SLNB under ultrasound guidance, and 1% lidocaine 3 ml was injected on each side in group S, while the equal volume of normal saline was given instead in group C. Anesthesia was induced with midazolam, sufentanil, etomidate and mivacurium, and then the patients were mechanically ventilated after endotracheal intubation.Anesthesia was maintained with propofol, remifentanil, and sevoflurane.Cardiovascular response to endotracheal intubation was defined as SBP or HR increased by more than 30% of baseline from the time point immediately after intubation to 2 min after intubation, and the occurrence was recorded.Venous blood samples were collected to detect the plasma concentrations of norepinephrine and cortisol before anesthesia induction and at 5 min after intubation.The development of bucking was recorded during emergence, and the time of tracheal extubation and occurrence of sore throat, throat numbness and hoarseness after tracheal extubation were recorded. Results:Compared with group C, the incidence of cardiovascular response to endotracheal intubation was significantly decreased, the plasma concentrations of norepinephrine and cortisol were decreased at 5 min after intubation, and the incidence of bucking during emergence and sore throat after tracheal extubation was decreased in group S ( P<0.05). Conclusions:Ultrasound-guided SLNB can inhibit the stress response during endotracheal intubation and reduce the occurrence of adverse events during emergence in elderly patients undergoing short surgery with general anesthesia.
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Objective:To evaluate the effect of low-dose esketamine on postoperative delirium (POD) in elderly frail patients undergoing laparoscopic radical resection of the gastrointestinal tumor.Methods:Ninety-four American Society of Anesthesiologists physical status Ⅱ or Ⅲ frail patients of both sexes, aged 65-80 yr, with body mass index of 18.5-30.0 kg/m 2 and preoperative Fried frailty phenotype scale score≥3, scheduled for elective laparoscopic radical resection of the gastrointestinal tumor under general anesthesia, were divided into 2 groups ( n=47 each) using a random number table method: control group (group C) and low-dose esketamine group (group K). In group K, esketamine 0.5 mg/kg was given during induction of anesthesia, and esketamine 0.25 mg·kg -1·h -1 was continuously infused during operation until the end of operation.In group C, the equal volume of normal saline was given at the corresponding time point.After induction of anesthesia and before skin incision (T 1), at 1 day after operation (T 2) and at 3 days after operation (T 3), blood samples from the internal jugular vein were collected for determination of the concentrations of S100β protein and neuron-specific enolase (NSE) in serum by enzyme-linked immunosorbent assay.The intraoperative consumption of propofol, remifentanil and sufentanil and use of vasoactive drugs were recorded.POD was evaluated by Confusion Assessment Method within 3 days after operation. Results:Compared with the baseline at T 1, the concentrations of serum S100β and NSE were significantly increased at T 2, 3 in both groups ( P<0.05). Compared with group C, the incidence of POD was significantly decreased (30% vs.13%), the intraoperative consumption of propofol and remifentanil was decreased, and concentrations of serum S100β protein and NSE were decreased at T 2, 3 in group K ( P<0.05). Conclusions:Low-dose esketamine can decrease the occurrence of POD in elderly frail patients undergoing laparoscopic radical resection of gastrointestinal tumor.
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Objective:To evaluate the optimization efficacy of dexmedetomidine-based balanced anesthesia for laparoscopic radical resection of colorectal cancer in elderly patients from the perspective of postoperative outcomes.Methods:A total of 112 patients of both sexes, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic radical resection of colorectal cancer under general anesthesia, were divided into 2 groups ( n=56 each) using a random number table method: conventional general anesthesia group (group C) and dexmedetomidine-based balanced anesthesia group (group D). In D group, dexmedetomidine was intravenously infused with a loading dose of 0.5 μg/kg over 10 min starting from the beginning of anesthesia induction, and then midazolam, sufentanil, etomidate and cis-atracurium were injected sequentially, and anesthesia was maintained with sevoflurane, remifentanil and propofol, and dexmedetomidine 0.5 μg·kg -1·h -1 was continuously infused until 30 min before the end of surgery.In group C, the equal volume of normal saline was given instead of dexmedetomidine, and the other anesthetics were similar to those previously described in group D. Venous blood samples were collected on 1 day before surgery and 2 and 7 days after surgery for routine blood test to determine the neutrophil-to-lymphocyte ratio.The consumption of intraoperative anesthetics, anesthesia-related postoperative complications, and time to postoperative first flatus and first feces were recorded. Results:Compared with group C, the consumption of intraoperative propofol and remifentanil was significantly reduced, neutrophil-to-lymphocyte ratio was decreased on 2 and 7 days after surgery, the incidence of postoperative delirium, nausea and vomiting was decreased, and the time to postoperative first flatus and first feces was shortened in group D ( P<0.05). Conclusions:Dexmedetomidine-based balanced anesthesia has a certain improvement in the efficacy and is more helpful for early postoperative outcomes than conventional general anesthesia when used in elderly patients undergoing laparoscopic radical resection of colorectal cancer.
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Objective:To evaluate the effect of nimodipine on postoperative cognitive function in elderly patients undergoing carotid endarterectomy.Methods:Eighty-two American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 65-80 yr, scheduled for elective carotid endarterectomy under general anesthesia, were divided into 2 groups ( n=41 each) using a random number table method: control group (group C) and nimodipine group (group N). Nimodipine 7.5 μg·kg -1·h -1 was intravenously infused starting from the beginning of surgery until the end of surgery in group N, while the equal volume of normal saline was given in group C. Before infusing nimodipine (T 1), before placing the the shunt (T 2), at 10 min after placing the the shunt (T 3) and at 10 min after releasing carotid artery (T 4), blood samples were taken from the radial artery and jugular bulb for blood gas analysis.Jugular venous blood oxygen content, arterio-jugular difference of oxygen content, and cerebral oxygen extraction ratio were calculated.The concentrations of S100β protein in serum of the jugular bulb were measured by enzyme-linked immunosorbent assay.Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) Scale (Chinese version) at 1 day before surgery and 1, 3 and 7 days after surgery, and the occurrence of cognitive dysfunction (MoCA score<26) was recorded within 7 days after operation. Results:Compared with group C, MoCA scores were significantly increased at each time point after surgery, and the incidence of cognitive dysfunction was decreased (27% vs.17%), and the jugular venous blood oxygen content was increased, and arterio-jugular difference of oxygen content, cerebral oxygen extraction ratio, and concentrations of serum S100β protein were decreased at T 2-4 in group N ( P<0.05). Conclusions:Nimodipine can improve the cognitive function after carotid endarterectomy, which may be related to the improvement in intraoperative cerebral oxygen metabolism and reduction of brain injury in elderly patients.
