ABSTRACT
Thirty-six puerperas who underwent emergency cesarean section at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 24, 2020 to February 9, 2020, who all wore medical surgical masks, were retrospectively included in this study. Anesthesia management was performed under tertiary medical protection measures. A dedicated anesthesia equipment was separately sterilized. Narcotic drugs were used for one patient only, and disposable medical supplies were used for anesthetic supplies. Contact transmission should be avoided when a neonate required resuscitation, and early isolation and nucleic acid testing were provided for the neonates. The rate of suspected cases of novel coronavirus (2019-nCoV) was 11% , and the rate of clinically diagnosed cases was 17% before surgery. The rate of clinically diagnosed cases of 2019-nCoV was 22%, the rate of confirmed cases was 8%, and the total positive rate of diagnosis was 31% after surgery. The rate of neuraxial anesthesia was 86%, the rate of general anesthesia was 14%, the time of spinal puncture was (15±7) min, the time of tracheal intubation under general anesthesia was (2.1±1.3) min, the operation time was (95±36) min, and blood loss was (276±166) ml. The Apgar score of newborns was 8.8 ± 0.5. There was 1 neonate whose mother was diagnosed as having 2019 novel coronavirous disease after operation, an oropharyngeal swab specimen was obtained at 36 h of birth, and the swab was tested positive for 2019-nCoV by nucleic acid testing. As of February 10, 2020, an anesthesiologist involved in the operation was diagnosed to have infection by 2019-nCoV. In conclusion, diagnosis of 2019 novel coronavirous disease during pregnancy is more difficult, it is necessary to perform anesthesia management for cesarean section under tertiary medical protection. Although the difficulty in anesthesia operation is increased under tertiary medical protection, anesthesiologists can carry out standardized anesthesia management and guarantee the safety of maternal and infants and anesthesiologists themselves as long as they are rigorously trained and adhere to protective protocols.
ABSTRACT
Thirty-six puerperas who underwent emergency cesarean section at Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 24, 2020 to February 9, 2020, who all wore medical surgical masks, were retrospectively included in this study.Anesthesia management was performed under tertiary medical protection measures.A dedicated anesthesia equipment was separately sterilized.Narcotic drugs were used for one patient only, and disposable medical supplies were used for anesthetic supplies.Contact transmission should be avoided when a neonate required resuscitation, and early isolation and nucleic acid testing were provided for the neonates.The rate of suspected cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 11% , and the rate of clinically diagnosed cases was 17% before surgery.The rate of clinically diagnosed cases of SARS-CoV-2 was 22%, the rate of confirmed cases was 8%, and the total positive rate of diagnosis was 31% after surgery.The rate of neuraxial anesthesia was 86%, the rate of general anesthesia was 14%, the time of spinal puncture was (15±7) min, the time of tracheal intubation under general anesthesia was (2.1±1.3) min, the operation time was (95±36) min, and blood loss was (276±166) ml.The Apgar score of newborns was 8.8±0.5.There was 1 neonate whose mother was diagnosed as having coronavirus disease 2019 after operation, an oropharyngeal swab specimen was obtained at 36 h of birth, and the swab was tested positive for SARS-CoV-2 by nucleic acid testing.As of February 10, 2020, an anesthesiologist involved in the operation was diagnosed to have infection by SARS-CoV-2.In conclusion, diagnosis of coronavirus disease 2019 during pregnancy is more difficult, it is necessary to perform anesthesia management for cesarean section under tertiary medical protection.Although the difficulty in anesthesia operation is increased under tertiary medical protection, anesthesiologists can carry out standardized anesthesia management and guarantee the safety of maternal and infants and anesthesiologists themselves as long as they are rigorously trained and adhere to protective protocols.
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Objective To summarize the experience in anesthesia management for cesarean section(CS) after failed labor in women with combined spinal and epidural analgesia and to provide evidence for more effective and safer clinical practice.Methods We included 58 singleton pregnant women who received spinal and epidural analgesia during labor but converted to CS at Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology from October 2017 to October 2018.When CS was indicated,10 ml of 0.125％ ropivacaine was given through the epidural catheter immediately,and 5 ml of 1％ lidocaine was given when arriving at the operating room.Five minutes later,10 ml of 1％ ropivacaine was administered.General anesthesia would be required when epidural anesthesia was considered to be failed 10 min after the usage of ropivacaine.Clinical datas were retrospectively reviewed.The management and effects of anesthesia for CS,maternal and neonatal outcomes were described.Results Of the 58 patients when CS was indicated during labor,5.2％(3/58) received general anesthesia immediately.Among the other 94.8％ (55/58) who received epidural anesthesia,3.6％(2/55) converted to general anesthesia later.Adverse effects of epidural anesthesia included reduced mean artery pressure (8/53,15.1％),nausea and vomiting (3/53,5.7％).For the neonatal Apgar score at 1 min,one out of the 58 babies (1.7％) was between 0 and 3,ten (17.2％) between 4 and 7,and 47 (81.0％) between 8 and 10.The two babies (3.4％) with Apgar score between 4 and 7 at 5 min were both referred to the department of Neonatology,and the rest 56 neonates (96.6％) scored 8-10.Conclusions Spinal and epidural analgesia in labor can be safely and effectively adjusted to anesthesia for CS.
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Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression.Methods In this study,we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology,Tongji Medical College,Huazhong University of Science and Technology from May to September,2018.The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150),and those who were not to the control group (n=150).Labor duration and delivery outcomes were analyzed by Student's t test,Mann-Whitney U test,Chi-square test and Fisher's exact test.Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration.Results The median durations of first-and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min,respectively,which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273,P＜0.001;Z=-3.210,P=0.001).Quantile regression analysis showed that,for the first stage of labor,epidural analgesia was associated with labor prolongation,and had significant effects on all the percentiles (all P＜0.05).The regression coefficients increased (95.630-285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased.For the second stage of labor,epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients:10.000～18.143;all P＜0.05).Although the epidural group had a significant higher episiotomy rate [46.8％(65/139) vs 33.3％(48/144),x2=5.318,P=0.021],more times of urine catheterization during labor [1(0-1) vs 0(0-1),Z=-0.974,P=0.001]and higher rate of oxytocin administration during labor [48.7％(73/150) vs 30.0％(45/150),x2=10.952,P=0.001],when compared with the control group,there was no significant difference in cesarean section rate,assisted vaginal delivery rate and neonatal outcomes between the two groups (all P＞0.05).Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor,especially with the first stage of labor,but has no adverse effects on maternal and neonatal outcomes.
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Objective To explore the related factors on sore throat and pharyngeal xeransis during thyroid surgery.Methods Twenty-nine female patients, aged 24-67 years, BMI 18-30 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were scheduled for thyroid surgery.After anesthesia induction and tracheal intubation, the endotracheal intracuff was inflated to 20 mm Hg.Intracuff pressure was monitored every 5 minutes by a pressure transducer.At the time of 24 hours after tracheal intubation, the patients were asked about their throat complaints such as sore throat and pharyngeal xeransis.Results Endotracheal intracuff pressure during thyroid surgery was in a discrete distribution.Multiple linear regression model analysis found that age, BMI, anesthesia time and intracuff pressure had no obvious effects on sore throat.Decision tree model analysis found that patients undergoing thyroid surgery had higher probability of pharyngeal xeransis grade Ⅳ, when the average intracuff pressure was higher than 29 mm Hg.Conclusion Excessive endotracheal intracuff pressure during thyroid surgery due to operation causes pharyngeal xeransis.
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Objective To investigate the effects of compound lidocaine cream applied to tracheal tube on the recovery of tonsil with adenoidectomy in general anesthesia. Methods 120 patients undergoing elective tonsillectomy with adenoidectomy were randomly divided into the experimental group and the control group. In the experimental group, the surface of the tracheal tube was uniformly coated with compound lidocaine cream before anesthesia. In the control group, paraffin oil was given evenly to the surface of the tracheal tube. The changes of hemodynamics and the incidence of complications in the two groups were observed and recorded. Results The indexes of hemodynamics in the experimental group were more stable than those in the control group, and the control group had poor tube resistance, and the incidence of complications such as cough, irritability and sore throat was increased (P<0.05). Conclusion Application of compound lidocaine cream on tracheal tube surface can effectively reduce the cough and other stress response during the general anesthesia recovery period, decrease postoperative irritability and improve the safety of children after surgery.
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Objective To investigate the median effective dose (ED50) of cisatracurium priming accelerating the onset of neuromuscular block in patients of different genders. Methods Ninety ASA Ⅰ or Ⅱ patients aged 18-55 yr undergoing elective abdominal operation under general anesthesia were divided into 2 groups ( n = 45 each): male group (group M) and female group (group F). Neuromuscular block was monitored with accelerograph F (TOF-Watch SX). A single twitch stimulation of ulnar nerve was used to monitor neuromuscular function.Anesthesia was induced with midazolam 0.04 mg/kg and fentanyl 1 μg/kg. Accelerograph F was opened after the patients lost consciousness. The priming dose of cisatracurium was injected intravenously, then fentanyl 5 μg/kg and propofol 2 mg/kg were injected intravenously 3 min later and the left dose of cisatracurium for intubation was injected intravenously 4 min later. Tracheal intubation was performed when the ratio of the single twitch stimulation value to control value (T/Tc). decreased to 10%. Anesthesia was maintained with iv infusion of propofol and remifentanil and inhalation of isoflurane. The priming dose of cisatracurium was determined by up-and-down sequential trial. The initial priming dose was set at 5 μg/kg. The ratio of two successive doses was 1.2. T/Tc, time to 90% block, onset time, maximal neuromuscular block and clinical duration were recorded 4 min after the administration of the priming dose. The ED50 and 95% confidence interval (CI) of cisatracurium priming required to accelerate the onset were caculated. Results Time to 90% block was significantly longer-in group M than in group F (P ＜0.05). No significant difference was found in the other parameters among the groups. The ED50 and 95% CI of cisatracurium priming required to accelerate the onset were 21.36 μg/kg (95% CI 20.52-22.23 μg/kg)in group M and 14.53 μg/kg (95% CI 13.77-15.33 μg/kg) in group F. The ED50 was significantly higher in group M than in group F ( P ＜ 0.05). Conclusion The ED50 of cisatracurium priming accelerating thd onset is 21.36 and 14.53 μg/kg in male and female respectively and it is significantly higher in male than in female.
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Objective To investigate the effects of on-pump and off-pump coronary revascularization on renal function.Methods Twenty four patients underwent elective coronary revascularization were divided into 2 groups: group A with cardiopulmonary bypass(CPB)(n=12) and group B without CPB(n=12).Markers of glomerular and tubular function were evaluated before anesthesia(T_0),at the end of operation(T_1),2 hours after operation(T_2) and 24 hours after operation(T_3).Results The ratio of urinary microalbumin to creatinine and NAG levels increased significantly at T_1 as compared with that at T_0 in on-pump coronary revascularization(P