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OBJECTIVE: To compare the effects of general anesthesia combined with epidural preemptive analgesia with general anesthesia on stress reaction in the retroperitoneal laparoscopic surgery. METHODS: Forty patients with adrenal tumors undergoing retroperitoneal laparoscopic surgeries were randomly assigned into general anesthesia combined with epidural preemptive analgesia group (GE) and general anesthesia group (G). Each group had 20 cases. In the GE group, before the induction of general anesthesia, T10-T11 epidural puncture was performed and 0.2% bupivacaine 5-10 ml was injected to maintain the anesthesia level at T4. In the G group, normal saline was injected as control. After entry into the operation room (X0), before surgery (X1), 30 min after pneumoperitoneum (X2), 60 min after pneumoperitoneum (X3), 10 min after extubation (X4), the mean arterial pressure (MAP) and heart rate (HR) were recorded. The concentration of plasma endothelin (ET) and calcitonin gene-related peptide (CGRP) were detected. Meanwhile, isoflurane inhalation MAC and intervention situations were recorded. RESULTS: At X1-X3, MAP in the GE group was significantly lower than that in the G group (P < 0.05). At X2-X4 HR in two groups was significantly faster than at X1 (P < 0.05). At X4 HR in the GE group was significantly lower than that in the G group (P < 0.05). At X3 and X4, ET and CGRP were significantly lower than those in the G group (P < 0.05). At X2 and X3, ET in the GE group was significantly higher than that at X1 (P < 0.05). At X3, CGRP in the GE group was significantly higher than that at X1 (P < 0.05). At X2, X3 and before pneumoperitoneum, isoflurane MAC in the GE group was significantly lower than that in the G group (P < 0.05). At X2 and X3, isoflurane MAC in two groups was significantly higher than that during pneumoperitoneum (P < 0.05). CONCLUSION: Compared with general anesthesia, general anesthesia combined with epidural preemptive analgesia can effectively alleviate patients' stress reaction under retroperitoneal laparoscopic surgery.
RESUMO
Tracheostomy tube might cause tracheoesophageal fistula (TEF) due to high cuff pressure or direct mechanical trauma. Surgical repair provides the ideal way to deal with TEF but it necessitates the weaning the patient from mechanical ventilation. Here we report a spontaneous closure of TEF by managing it with improved tracheal catheters in a patient who is dependent on mechanical ventilation.
RESUMO
OBJECTIVE: Our objective was to examine whether prior tetanic stimulation of cranial nerves enhances the amplitudes of transcranial motor-evoked potentials (MEPs). METHODS: Thirty patients undergoing elective craniotomy under propofol-fentanyl anesthesia with partial neuromuscular blockade were enrolled. Both control and posttetanic MEPs (c-MEPs and p-MEPs) monitoring were performed with a train of five pulses delivered to C3 or C4. c-MEPs were recorded from target muscles and p-MEPs were obtained 1 s after tetanic stimulation to the ulnar nerves and facial nerves. The amplitudes of paired MEPs were compared with Wilcoxon's signed rank test. RESULTS: When tetanic stimulation was separately applied to the facial nerves, amplitudes of p-MEPs from abductor pollicis brevis, orbicularis oculi or oris were similar with those of c-MEPs. When tetanic stimulations were separately applied to the ulnar nerves, the amplitudes of p-MEPs from the abductor pollicis brevis but not orbicularis oculi or oris were significantly enlarged compared with c-MEP. CONCLUSIONS: We found that only prior tetanic stimulation of ulnar nerve but not facial nerve could enlarge the amplitudes of trancranial hand MEPs. Augmentation of MEP amplitude via prior tetanic stimulation of peripheral nerve seems to originate from the subcortical level but not motor cortex.