ABSTRACT
Objective:To evaluate the efficacy of scalp nerve block combined with general anesthesia in optimizing anesthesia in the patients with moyamoya disease undergoing revascularization.Methods:A total of 154 patients with moyamoya disease, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective revascularization, were divided into 2 groups ( n=77 each) using a random nunber table method: scalp nerve block combined with general anesthesia group (GN group) and general anaesthesia group (G group). Anesthesia was induced with intravenous midazolam 0.05 mg/kg, sufentanil 0.5-1.0 μg/kg, rocuronium 0.6 mg/kg and etomidate 0.2-0.3 mg/kg.After the patients were tracheally intubated after anesthesia induction, ipsilateral scalp nerve block (2 ml for supraorbital nerve block, 2 ml for supratrochlear nerve block; 3 ml for auriculotemporal nerve block, 3 ml for greater occipital nerve block, 3 ml for less occipital nerve block) was performed with 0.5% ropivacaine in GN group.The equal volume of normal saline was locally injected in G group.Anesthesia was maintained by inhalation of sevoflurane and intravenous infusion of remifentanil 0.05-0.10 μg·kg -1·min -1 and cisatracurium 0.1 mg·kg -1·h -1.The consumption of intraoperative remifentanil, requirement for postoperative rescue analgesia, nausea and vomiting, length of postoperative hospital stay, and early neurological complications were recorded.The modified Rankin Scale scores were evaluated before operation, at discharge and at 6 months after operation. Results:Compared with G group, the consumption of intraoperative remifentanil and requirement for postoperative rescue analgesia were significantly decreased ( P<0.05), and no significant change was found in the incidence of postoperative nausea and vomiting, incidence of neurological complications, length of postoperative hospital stay, and modified Rankin Scale scores at each time point in GN group ( P>0.05). Conclusions:Scalp nerve block combined with general anesthesia can increase the perioperative analgesic efficacy and is helpful in achieving a low-opioid anesthesia mode when used in the patients with moyamoya disease undergoing revascularization.
ABSTRACT
Stroke rescue features strong time sensitivity and high complexity. Minimizing the time of consumption in pre-hospital and in-hospital stroke rescue is key to improve stroke rescue efficiency and reduce the disability rate. In December 2017, a tertiary hospital launched the construction of a one-stop stroke rescue platform. This platform was centered on " multi-mode image fusion operating room" , operating as a one-stop rescue mode integrating emergency admission, imaging examination, intravenous thrombolytic therapy, mechanical thrombolytic therapy, postoperative evaluation, and so on. The seamless convergence workflow of pre-hospital, in-hospital and post-hospital could effectively optimize the physical rescue pathway. In order to ensure the efficient and orderly operation of the platform, the hospital adopted such measures as multidisciplinary integration, pre-hospital and in-hospital integration construction, and regional stroke care network. Since its operation in September 2019, the platform has treated more than 1 000 patients by December 2021. The application of the platform had effectively improved the efficiency of stroke rescue, led the development of regional stroke rescue system, and provided the reference for raising the stroke rescue capacity and management level in China.
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Objective To analyze the clinical features and prognosis of patients with acute epidural hematoma in the whirlpool sign.Methods 36 cases of CT scan showed a whirlpool sign of acute subdural hematoma patients were selected as the observation group.During the same time period,50 acute epidural hematoma patients without the whirlpool sign were selected as the control group.All patients received operation treatment.The Glasgow coma score (GCS),amount of hemorrhage and prognosis were compared between the two groups.Results The preoperative GCS score of the observation group was significantly lower than that of the control group (P ＜ 0.05).In the operation,the blood loss of the observation group was significantly increased compared with the control group (t =3.232,3.164,P ＜ 0.05).Control group CT evaluation of preoperative and intraoperative measurement had no significant difference(P ＞0.05).In the observation group,11 patients died,the mortality rate was 30.5％ (11/36).In the control group,6 patients died,the mortality rate was 12.0％ (6/50),the difference between the two groups was statistically significant (x2 =4.134,P ＜ 0.05).The patients were followed up for 6 months,the excellent and good rate of ADL score in observation group was 64.0％,which was significantly lower than 84.1％ in the control group (x2 =3.989,P ＜ 0.05).Conclusion Acute epidural hematoma patients with thewhirlpool signshowed progressive disease,high mortality,poor prognosis,and active countermeasures should be taken.
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Objective To investigate the feasibility and effectiveness of fast track surgery (FTS) in neurosurgery. Methods One hundred fifteen patients who underwent neurosurgery surgery in Henan Province People's Hospital from June 2012 to March 2014 were enrolled in this study. All the patients were divided into FTS group (62 cases) and the tra?ditional operation group (53 cases). The clinical index, postoperative hospital stay and hospitalization cost were compared between the two groups. Results The clinical index were significantly lower in FTS group than in traditional operation group (P<0.05). Length of hospital stay (days) and hospitalization cost of FTS group were significantly shorter and lower in FTS group compared with traditonal operation group (8±1 vs. 11±2 days and RMB 4.58 ±0.75 vs. 5.78 ±0.64 ten thou?sand, respectively) (P<0.05). Conclusion FTS in neurosurgery operation is an all-new concept for surgery which can ef?fectively reduce postoperative complications, shorten length of hospital stay, decrease hospitalization cost and promote postoperative recovery.