ABSTRACT
Objective:To retrospectively review the efficacy of enhanced epidural anesthesia in the patients undergoing cesarean section.Methods:The data from patients who underwent cesarean section in our hospital from August 2008 to December 2021 were retrospectively collected. The method of epidural anesthesia, drug dosage, onset time, blocking level, anesthesia effect, remedial medication, and complications related to the method were recorded. The main points of enhanced epidural anesthesia included: ① test negative pressure by rotating the epidural puncture needle in situ to determine the position of the needle tip; ② catheterization after administering local anesthetic through epidural puncture needle to assess the clinical application of this technique. A questionnaire survey was conducted in 134 anesthesiologists with qualifications for epidural procedures. The questionnaire addressed whether to perform routine needle rotation during epidural procedures, direction of needle rotation, and the percentage of the dosage of local anesthetic administered through puncture needle. Results:A total of 10 054 patients received epidural anesthesia (10 016 cases) and switched to general anesthesia because of poor epidural effect or intraoperative emergencies (38 cases) were enrolled. The consumption of local anesthetics for epidural anesthesia was 18 (15, 20) ml.There were 7 287 cases with block plane records, of which the ratio of the block level reached T 6-8 was 86.84%. The time from the beginning of anesthesia to skin incision was 25 (20, 30) min. Sixteen patients (0.159%) switched to general anesthesia because of poor epidural effect.Among 10 016 patients underwent epidural anesthesia, 925 patients (9.235%) received intravenous adjunctive drugs.No patients experienced total spinal anesthesia, 25 patients (0.248%) had epidural perforation due to puncture or needle rotation, and 4 cases (0.039%) local anesthetic intoxication, 3 cases (0.030%) postoperative nerve injury, and 142 patients (1.412%) requiring intervention with vasoactive drugs due to hemodynamic instability within 30 min after epidural administration. Questionnaire survey: The proportion of anesthesiologists rotating epidural puncture needles was 85.1%, and the proportion of anesthesiologists using epidural puncture needles to inject local anesthesia drugs with a dose greater than 50% of the total dose before catheterization was 84.2%. Conclusions:Enhanced epidural anesthesia can provide effective anesthesia for the patients undergoing cesarean section without increasing the risk of complications related to epidural procedures.
ABSTRACT
Objective To investigate the effect of electroacupuncture at points Xiaohai and Xiajuxu on the expressions of tumour necrosis factor-α (TNF-α) and choline acetyltransferase (ChAT) in serum and nicotinic acetylcholine receptorα 7 (α 7 nAchR) in duodenal tissues in a rat model of duodenal ulcer (DU) and preliminarily explore the relative specificity of He-Sea point in “treating visceral diseases with He-Sea point”.Methods Forty healthy SD rats were randomized into blank (A), model (B), Xiaohai (C) and Xiajuxu (D) groups, 10 rats each. A rat model of DU was made by subcutaneous injection of 10% cysteamine hydrochloride at the right buttock. After successful model making, group C was given electroacupuncture at point Xiaohai and group D, at point Xiajuxu. Duodenal tissue ulcer was macroscopically observed and scored in every group of rats. Rat serum expression of TNF-α was determined by double antibody sandwich enzyme-linked immunosorbent assay (ELISA); rat serum expression of ChAT, by ultraviolet spectrophotometry & colorimetry; rat duodenal expression ofα7 nAchR, by Western blot.Results After model making, the duodenal ulcer score was significantly higher in groups B, C and D than in group A (allP0.05) and was significantly higher in group D than in group B (P<0.01) or C (P<0.05).α7 nAchR expression was significantly higher in groups C and D than in group B (bothP<0.01). There was a positive correlation between ChAT andα7 nAchR expressions in every group (r=0.444,P=0.007).Conclusions Electroacupuncture at both points Xiaohai and Xiajuxu can reduce the duodenal ulcer score and serum TNF-α expression and increase serum ChAT and duodenalα7 nAchR expressions in DU rats. The results show that the therapeutic effect of electroacupuncture on duodenal ulcer may be produced by regulating TNF-α. Its mechanism may be activating cholinergic anti-inflammatory pathway to produce an anti-inflammatory effect. The effect being better in group D than in group C suggests that Xiajuxu has the relative specificity.