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Major hepatectomy (MH) is a common treatment for benign and malignant liver diseases. Controlled low central venous pressure (CLCVP) is an important measure to reduce the intraoperative blood loss and transfusion requirement during MH. In this paper, the application standard of CLCVP at MH is discussed, and the specific measures to achieve CLCVP including fluid restriction, drug application, body gesture adjustment, reduction of tidal volume, suspension of respiratory ventilation, and infrahepatic inferior vena cava clamping (complete and partial) are systematically summarized.
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@#Contracture and spasticity of ankle joints were major sources of disability in neurological impairment including stroke and cerebral palsy, etc. The manual stretching used in physical therapy might be laborious and time-consuming to the therapists and the outcome was dependent on the experience and the subjectiveend feelingof the therapists. A device was developed that could safely stretch the an-kle joint to its extreme positions with quantitative control of the resistance torque and stretching velocity. Furthermore, it could satisfy a strong need for quantitative and objective measures of the impairment and rehabilitation outcome. This was just the meaning intelligent stretching referred to. This article described the origin of the concept of intelligent stretching and its definition, operational principle, and su-periority and weakness, as well as its application in ankle joint spasticity and contracture in patients with stroke and cerebral palsy.
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Objective To investigate the discriminatory power of Auditory Evoked Potential and Bispectral Index devices on consciousness or consciousless state of patients during intraoperative wake-up test and recovery from scoliosis surgery with sevoflurane-remifentanil anesthesia.Methods Thirty ASA Class I or II adolescents undergoing scoliosis surgery under sevoflurane-remifentanil anesthesia were randomly divided into three groups: standard clinical practice (control), AEP-guided, and BIS-guided. After induction of general anesthesia remifentanil was infused at the rate of 0.3 ?g/(kg?min). At the beginning of wake-up test, the circuit was opened while the vaporizer was turned off , and the rate of remifentanil infusion was decreased to 0.05 ?g/(kg?min). Anesthesia was started again as soon as the patients had movements to command. The AAI, BIS, and end-tidal sevoflurane concentration at the time of before induction (T0), circuit opened(T1), spontaneously breathing recovered (T2), patients movement to command (T3), tracheal extubation (T4) and emergence from anesthesia (T5), as well as the time of spontaneously breathing recovered, patients movement to command during wake-up test, tracheal extubation and emergence from anesthesia were recorded.Results Comparing with control group, AAI and BIS increased at T1 both in AEP-guided and BIS-guided group (P
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Objective To observe the changes of heart rate variability(HRV) following intravenous esmolol and surface anesthesia during tracheal intubation Methods One hundred and twenty adult patients were randomly divided into three groups (n=40), group Ⅰ (Esmolol), group Ⅱ (laryngotracheal surface anesthesia), group Ⅲ (oropharynx and laryngotracheal surface anesthesia group) Tracheal intubation was induced with fentanyl 2?g kg -1 , propforl 2mg kg -1 and vecuronium 0 1 mg kg -1 Group Ⅰ : intravenous administration of esmolol 2mg kg -1 2min before endotracheal intubation Group Ⅱ: laryngotracheal spray with 1% tetracaine 2 5ml 2min before endotracheal intubation Group Ⅲ : spraying the back of tongue, soft palate, pharynx and larynx with 1% tetracaine 0 5ml, with other manipulation being similar to group Ⅱ In each group BP,HR, HRV, LF, HF and LF/HF and BIS parameters were recorded before induction, during intubation and 1,3,5 and 10min after intubation respectively Results In three groups BP remained unchanged Compared with that in group Ⅱ and Ⅲ, HR in group Ⅰ decreased significantly(P
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Objective To evaluate the right ventricular function using volumetric pulmonary artery catheter (VPAC) in patients undergoing off-pump coronary artery bypass grafting (CABG) .Methods Thirty-two patients (18 males, 14 females) aged 45-63 yrs weighing 58-74 kg undergoing CABG were studied. Their cardiac functions were graded according to NYHA classification as Ⅰ or Ⅱ. Radial artery was cannulated before induction of anesthesia for BP monitoring. Anesthesia was induced with midazolam 0.03-0.05 mg?kg-1, fentanyl 10-15 ?g?kg-1 and pipecuronium 0.1-0.15 mg?kg-1 and maintained with 1.0-1.5% isoflurane. The probe (7 MHz) of the transesophageal echocardiography (TEE, Sonos 2500, HP) was placed in esophagus after tracheal intubation for measurement of both right and left ventricular end-diastolic, end-systolic volume and ejection fraction (LVEDV, LVESV, LVEF, RVEDV, RVESV, RVEF). VPAC (type 774HF75, Edwards Life Science Co) was placed via right internal jugular vein for measurement of RVEDV, RVESV and RVEF. 6% HAES 10 ml?kg-1 was infused over 10 min. The cardiovascular parameters mentioned above were measured before and immediately after 6% HAES infusion using both TEE and VPAC, and compared.Results The RVEDV and RVESV (measured by TEE and VPAC) and LVEDV, LVESV (by TEE) were significantly increased after HAES infusion as compared with the baseline values (P
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Objective To study the changes in cerebral cortex glutamate (G) content induced by isoflurane inhalation alone or combined with 2-amino-5-phosphonovalerate (AP5),a NMDA receptor competitive antagonist.Methods Six adult male SD rats were anesthetized with isoflurane. Dialysis probe (internal diameter=0.05mm) which was connected to a micro-infusion pump filled with artifical cerebrospinal fluid(ACSF) was inserted into cerebral cortex. The dialysate was collected for determination of G concentration. After the baseline MAC for isoflurane was measured, the study was carried out in 4 groups based on the concentration of isoflurane inhalation: group Ⅰ:1%; group Ⅱ:1MAC; group Ⅲ:2% and group Ⅳ: the effect of AP5 on isoflurane MAC value. In group Ⅳ AP5 was continuously infused at a rate of 100 ?g?kg -1?h -1 via the vein in the tail and the MAC for isoflurane was measured again. G concentration of dialysate was measured and EEG and SEP were monitored in every group.Results G concentration of cerebral cortex dialysate was decreasing with increasing concentration of isoflurane from group Ⅰ to group Ⅲ. Concentration of isoflurane was negatively correlated with cerebral G content (r=-0.839,P
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Objective To assess the changes in heart geometry and function during off-pump coronary artery bypass grafting(CABG).Methods Thirty ASAⅡorⅢpatients(24 males,6 females)aged 50-78 undergoing elective off-pump CABG were studied.After induction of anesthesia and tracheal intubation a catheter which was connected to the monitor measuring continuous cardiac output(CCO),mixed venous blood oxygen saturation(S(?)O_2)and CEDV was placed via right internal jugular vein and the probe of multi-phase transesophageal echocardiograph(TEE)(Sonos HP 2500)was inserted in the esophagus.The distance between the probe and the incisors was between 34-45 cm.The hemodynamic variables and TEE parameters were recorded when epicardium was opened(T_1,baseline)when the octopus tissue stabilizer was placed during anastomosis between the graft vessel and left anterior descending artery(LAD)(T_2)left circumflex artery(LCX)(T_3)and right coronary artery(RCA)(T_4)and when the anastomoses between the vessel grafts and aorta was completed (T_5).Results At T_2 the mitral valve deceleration time(DT_1)and the blood flow through the mitral valve(Q_1) were decreased significantly as compared with the baseline(T_1);MAP was significantly decreased while HR and CVP were increased(P＜0.05).At T_3 the left and right ventricular end-diastolic diameter(LVEDD,RVEDD), tricuspid valve diameter(TVD)and the blood flow through Q_1 and tricuspid valve(Q_2)were significantly decreased as compared to the baseline values at T_1.The mitral valve E/A ratio was increased while the tricuspid valve E/A ratio was decreased(P＜0.05).The MAP,S(?)O_2,right ventricular end-systolic and end-diastolic volume(RVESV,RVEDV)and right ventricular ejection fraction were significantly decreased while HR and CVP were increased at T_3 as compared to the baseline at T_1.At T_4 LVESD,LVEDD,MVD,tricuspid valve E/A ratio and Q_1 were significantly decreased as compared to the baseline at T_1(P＜0.05).MAP,MPAP,SV,S(?)O_2, RVEF,RVESV and RVEDV were significantly decreased while HR and CVP were increased(P＜0.05).At T_5 all the TEE and hemodynamic parameters returned to the baseline valves at T_1.Conclusion During anastomoses between graft vessels and LAD,LCX and RCA,both left and right ventricles are compared to some extent and the heart function is impaired temporarily but returns to the baseline after the anastomoses are completed.