ABSTRACT
Objective:To investigate the effects of ultrasound-guided lumbar erector spinae plane block (L-ESPB) combined with general anesthesia using a laryngeal mask airway on postoperative delirium and early outcome in older adult patients undergoing hip arthroplasty.Methods:Sixty older adult patients who underwent unilateral total hip arthroplasty under general anesthesia using a laryngeal mask airway from August 2020 to May 2021 were included in this study. They were randomly assigned to observation and control groups, with 30 patients in each group. All patients underwent general anesthesia using a laryngeal mask airway. In the observation group, L-ESPB with 30 mL 0.375% ropivacaine was performed before induction of general anesthesia. Patient-controlled intravenous analgesia was performed in all patients after surgery. The Visual Analogue Scale score was > 4 points, and dezocine was intravenously injected for rescue analgesia. The amount of general anesthetics, the rate of use of vasoactive drugs, the time to pull out the laryngeal mask airway, length of stay in postanesthesia care unit, and the incidence of restlessness during the recovery period were recorded. Resting-state VAS score and Bruggrmann comfort scale score at 4, 8, 12, 24 and 48 hours after surgery, effective times of pressing the analgesia pump, the rate of rescue analgesia, the incidence of anesthesia-related adverse reactions at 48 hours after surgery, Pittsburgh Sleep Quality Index (PSQI) score at 1 day before and 1, 3 and 5 days after surgery, the incidence of postoperative delirium within 5 days after surgery, the time to get out of bed the first time, and the incidence of pulmonary infection were recorded.Results:The amount of remifentanil and propofol used during surgery were significantly lower in the observation group than those in the control group ( t = -6.80, -5.23, both P < 0.05). The rate of use of urapidil and esmolol were significantly lower in the observation group than those in the control group ( χ2 = 4.32, 5.46, both P < 0.05). The time to pull out the laryngeal mask airway, length of stay in postanesthesia care unit, and the time to get out of bed the first time in the observation group were (14 ± 2) minutes, (21 ± 2) minutes and (2.4 ± 0.5) days respectively, which were significantly shorter than those in the control group [(18 ± 2) minutes, (26 ± 3) minutes and (2.8 ± 0.7) days, t = -6.64, -7.18, -2.51, all P < 0.05]. The incidence of restlessness during the recovery period, postoperative delirium, and pulmonary infection in the observation group were 0.0%, 3.3% and 0.0% respectively, which were significantly lower than those in the control group [20.0%, 26.7%, 20.0%, all P < 0.05]. Resting-state VAS score at each time point was significantly lower in the observation group than that in the control group ( t = 3.32, 2.97, 4.33, 3.81, 3.10, all P < 0.05). Bruggrmann comfort scale score at each time point was significantly higher in the observation group than that in the control group ( t = 9.20, 8.62, 5.73, 5.72, 6.28, all P < 0.05). The effective times of pressing the analgesia pump, the rate of rescue analgesia, and the incidence of nausea and vomiting at 48 hours after surgery in the observation group were 0 (0, 0), 10.0% and 6.7% respectively, which were significantly lower than those in the control group [1(0, 2), 33.3% and 30.0%, Z = -3.41, χ2 = 4.81, 5.46, all P < 0.05]. PSQI score measured at 1, 3, and 5 days after surgery were significantly increased compared with those measured 1 day before surgery in each group ( F = 116.80, 325.64, both P < 0.001). PSQI measured at 1, 3 and 5 days after surgery was significantly lower than those in the control group ( t = -7.26, -6.41, -11.17, all P < 0.001). There were no significant differences in the incidence of dizziness, drowsiness, urinary retention and atelectasis between the two groups ( P > 0.05). Conclusion:Ultrasound-guided L-ESPB combined with general anesthesia using a laryngeal mask airway for hip arthroplasty in older adult patients can decrease the incidences of postoperative delirium and complications, which are conducive to early postoperative outcomes.
ABSTRACT
Objective To investigate the efficacy of high frequency jet ventilation via the nasopha?ryngeal catheter in assissting ventilation in patients with obstructive sleep apnea hypopnea syndrome ( OS?AHS) undergoing gastroscopy. Methods Eighty patients with OSAHS of both sexes, aged 40-64 yr, weighing 65-99 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, with an apnea?hy?popnea index 20-40 events∕h, scheduled for elective painless gastroscopy, were divided into control group and test group using a random number table, with 40 patients in each group. In control group, a nasopha?ryngeal catheter 6.0-7.0 mm in internal diameter was inserted, and oxygen was inhaled at 4 L∕min through the catheter. In test group, a nasopharyngeal catheter 4.0 mm in internal diameter was inserted, and a high frequency jet ventilator was connected ( inspiratory∕expiratory ratio 1. 0 ∶ 1. 5, frequency 150 bpm, peak pressure 0.4 kPa, tidal volume 180 ml) . Anesthesia was maintained with propofol in both groups. The oc?currence of hypoxemia during ventilation, and peak value of partial pressure of end?tidal CO2 before induc?tion of anesthesia and during ventilation, and occurrence of chin lift, mask ventilation, and epistaxis after insertion of the catheter during operation were recorded. Results Compared with control group, the inci?dence of hypoxemia, peak value of partial pressure of end?tidal CO2 during ventilation, and incidence of chin lift, mask ventilation and epistaxis during operation were significantly decreased in test group ( P<0.05) . Conclusion High frequency jet ventilation via the nasopharyngeal catheter can be safely and effec?tively used to assisst ventilation in patients with OSAHS undergoing gastroscopy.
ABSTRACT
Objective To investigate the effects of two different doses of fentanyl given by target-controlled infusion (TCI) on stress responses during operation under general anesthesia and evaluate the accuracy of TCI of fentanyl.Methods Thirty ASA Ⅰ-Ⅱ patients (14 males, 16 females) aged 24-69 yr, weighing 48-77 kg scheduled for elective abdominal surgery under general anesthesia were randomly divided into three groups with 10 patients in each group : group Ⅰ and Ⅱ received fentanyl by TCI with the target effect-site concentration set at 2 ng Ⅲ ml 1 (Ⅰ) and 4 ng ? ml-1 ( Ⅱ ) during induction and maintenance of anesthesia, while group Ⅲ received a bolus of fentanyl 3 ?g?kg-1 during induction of anesthesia. In addition to fentanyl, anesthesia was induced with propofol 2mg?kg-1 and vecuromum 0.1 mg?kg-1 and maintained with propofol infusion at 6 mg?kg-1?h-1 and intermittent i. v. doses of vecuronium BP (SBP, DBP, MAP ) , HR, SpO2 and PET CO2 were recorded before induction of anesthesia (T0 ,baseline), at the loss of consciousness (T1), immediately after tracheal intubation (T2), 5 and 10 rnin after intubation (T3 , T4), during skin incision (T5) and exploration of abdominal cavity (T6). Blood samples were obtained for determination of plasma norepinephrine (NE) and epinephrine (E) concentrations and blood glucose ( BG) and fentanyl concentrations at T0, T2, T4 and T5 by HPLC. Results There were no significant differences in sex, age and body weight among the three groups. There were no significant changes in plasma NE, E and BG concentrations, which were all within normal range in the three groups. The SBP and MAP in group Ⅲ were significantly lower than those in group Ⅰ and Ⅱ at T1 ( P