Is pre-oxygenation with high-flow nasal oxygen safe? randomized control trial of 56 cases of elderly patients during induction of general anesthesia with endotracheal intubation / 南方医科大学学报

OBJECTIVE@#To evaluate the safety of preoxygenation with high-flow nasal oxygenation in elderly patients during induction of general anesthesia with endotracheal intubation.@*METHODS@#Fifty-six elderly patients without difficult airway were randomized equally into high-flow nasal oxygen group (HF group) and conventional mask oxygen group (M group). Preoxygenation was performed for 5 min before induction of general anesthesia and endotracheal intubation. Oxygenation was maintained during laryngoscopy in HF group, and ventilation lasted until laryngoscopy in M group. For all the patients, the general data, cross-sectional area (CSA) of the gastric antrum measured by ultrasonography, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (cSO2) were recorded before preoxygenation (T1), at 5 min of preoxygenation (T2) and immediately after intubation (T3). The safety time of asphyxia, intubation time, times of mask ventilation and postoperative complications were compared between the two groups.@*RESULTS@#The general data were comparable between the two groups. After 5 min of preoxygenation, PaO2 and cSO2 were significantly increased in both groups, and PaO2 was significantly higher in HF group than in M group (F=118.108 vs 9.511, P < 0.05). Both PaO2 and cSO2 decreased after intubation, but PaO2 decreased more slowly in HF group and still remained higher than that at T1; cSO2 decreased significantly in M group to a lower level than that at T1. Compared with those in M group, the patients in HF group showed a significantly longer safety time of asphyxia (t=5.305, P < 0.05) with fewer times of mask ventilation (χ2= 6.720, P < 0.05). PaCO2 increased after intubation in both groups but was comparable between the two groups (F=3.138, P > 0.05).@*CONCLUSION@#High-flow nasal oxygen is safe, simple and effective for pre-oxygenation, which, as compared with the conventional oxygen mask, improves arterial oxygen partial pressure and prolongs the safety time of asphyxia to ensure the safety of airway management during induction of general anesthesia in elderly patients with endotracheal intubation.

Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019 / 中国医学科学杂志(英文版)

Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China and spread to multiple countries through infected persons travelling by air. Most of the infected patients have mild symptoms including fever, fatigue and cough. But in severe cases, patients can progress rapidly and develop to the acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. The new coronavirus was reported to spread via droplets, contact and natural aerosols from human-to-human. Therefore, high-risk aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections. In fact, SARS-CoV-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan. The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation, by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians. During the airway management, enhanced droplet/airborne PPE should be applied to the health care providers. A good airway assessment before airway intervention is of vital importance. For patients with normal airway, awake intubation should be avoided and modified rapid sequence induction is strongly recommended. Sufficient muscle relaxant should be assured before intubation. For patients with difficult airway, good preparation of airway devices and detailed intubation plans should be made.

Comparison of effects of acupuncture-assisted anesthesia with different acupoint combination in gynecologic laparoscopy operation / 中国针灸

<p><b>OBJECTIVE</b>To explore the best acupoint combination of acupuncture-assisted anesthesia in gynecologic laparoscopy operation.</p><p><b>METHODS</b>Ninety patients, with American Society of Anesthesiologists (ASA) physical status I - II, and scheduled for elective gynecologic laparoscopy operation, were randomly divided into 3 groups, 30 cases in each group. Group I received only general anesthesia, group II and group III received general anesthesia after Han's acupoint nerve stimulator (HANS) administered for 30 min, bilateral Zusanli (ST 36) and Sanyinjiao (SP 6) were selected for group II, and bilateral Hegu (LI 4) and Taichong (LR 3) were selected for group III. During operation, the concentration of Seveflurine was adjusted to maintain NTS at D1-D2. The change of ETsev value was recorded, the heart rate (HR) and blood pressure (BP) were observed, and the time from the end of operation to extubation, awake time were recorded adverse events such as restlessness, shivering, postoperative pain, nausea and vomiting, cases of respiratory depression, the analepsia quality, the time of first anus exhaust, the awaking of patient in operation and satisfactory of patients after surgery were recorded so as to evaluate the effect of acupuncture anesthesia.</p><p><b>RESULTS</b>Compared with group I, the ETsev in group II was decreased 35% (P < 0.05), group ifi was decreased 25% (P < 0.05), with a significant difference between group II and group III (P < 0.05). BP and HR had more stability in group II and group III, the best in group II. As for the time from the end of operation to extubation and the time from the end of operation to open the eye on command, group I was the longest (all P < 0.05), group III was longer, group II was the shortest. The score of restlessness, postoperative pain, vomiting and in analepsia were the highest in group I (all P < 0.05), higher in group III and the lowest in group II. Consciousness score was lowest in group I (P < 0.05). As for the satisfactory of patient after operation, it was higher in group II and group IIII (both P < 0.05 ) than group I. The time of first anus exhaust in group II and group III were significantly shorter than that in group I (both P < 0.05).</p><p><b>CONCLUSION</b>Han's acupoint nerve stimulator has a certain adjuvant action for general anesthesia and analgesia and acupuncture point combination with both Zusanli (ST 36)and Sanyinjiao (SP 6) have the best effect in gynecologic laparoscopy operation. It can decrease the dosage of anaesthetic, has a stable effect on HR and BP during the surgery and has a better quality of analepsia.</p>

Effects of ligustrazine injection on IL-2, IL-10, and IFN-gamma in patients undergoing spinal operation after autologous blood transfusion / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the regulatory effect of Ligustrazine Injection (LI) on the cellular immune function in patients undergoing autologous blood transfusion (ABT).</p><p><b>METHODS</b>Enrolled were 60 patients scheduled for receiving selective lumbar surgery at the Department of Spinal Orthopedics, First Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine during October 2009 to June 2010. They were equally randomized into two groups, the trial group and the control group. LI was given to patients in the trial group by intravenous dripping at the dose of 2 mg/kg 30 min before autologous blood collection. The LI (at the final concentration of 0.005%) was added in the heparin saline solution and the washing saline for recycle blood. No LI was given to patients in the control group. They received the same treatment of the trial group. The operation time, the amount of blood loss and blood transfusion were recorded. Patients' venous blood samples were collected for determining cytokines including interleukin-2 (IL-2), interleukin-10 (IL-10), interferon-gamma (IFN-gamma) by ELISA and calculating IL-2/IL-10 ratio before surgery (T1), 1 h (T2), 1 day (T3), and 5 days (T4) after ABT.</p><p><b>RESULTS</b>There was no statistical difference in the amount of blood loss and blood transfusion, the levels of IL-2, IL-10, IFN-gamma, or IL-2/IL-10 at T1 between the two groups (P>0.05). Compared with T1 of the same group, the level of IL-2 decreased at T(2-4), IL-10 increased and IL-2/IL-10 decreased at T(2-3) in the two groups. The level of IFN-gamma decreased at T(2-4), IL-2/IL-10 increased at T4, the level of IL-10 decreased at T4 in the control group (P<0.05, P<0.01). The level of IL-10 decreased at T4 in the trial group with statistical difference (P<0.05, P<0.01). Compared with the control group, the level of IL-2, IFN-gamma, and IL-2/IL-10 at T(2-4) were obviously higher in the trial group. But the IL-10 level was lower in the trial group than in the control group at T(2-4) (P<0.05, P<0.01).</p><p><b>CONCLUSION</b>The application of LI in ABT had regulatory effects on the balance of cytokines.</p>

Effects of electroacupuncture assistant general anesthesia on postoperative cognitive dysfunction of aged patients / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effects of electroacupuncture (EA) assistant general anesthesia on postoperative cognitive dysfunction (POCD) of aged patients.</p><p><b>METHODS</b>One hundred and twenty senile American Society of Anesthesiology (ASA) grade I - III patients (more than 65 years old) with non-cardiac surgery were randomly assigned to two groups, Group A and Group B, 60 cases in each group. Patients in Group A received general anesthesia, while those in Group B received EA assistant general anesthesia. Patients in Group B received EA at Baihui (DU20), Hegu (LI4), Neiguan (PC6), Zusanli (ST36) 30 min before anesthesia induction to the end of operation. Anesthesia was induced by etomidate 0.2 - 0.3 mg/kg, fentanyl 3-5 microg/kg, cisatracurium 0.15 mg/kg in the two groups. Anesthesia maintenance was provided by sevoflurane and continuous pumping of remifentanil. Tramadol 50 mg was given 30 min before ending the operation. The scores of mini-mental state examination (MMSE), nausea and vomiting were recorded in the two groups one day before anesthesia, the 2nd, 4th, and 6th day after operation. The occurrence of postoperative cognitive dysfunction (POCD) on day 2, 4, and 6 was compared.</p><p><b>RESULTS</b>The occurrence of POCD on day 2 and 4 was obviously lower in Group B than in Group A at the same time period (40.0% vs 66.7%, 13.3% vs 43.3%), showing statistical difference (P < 0.05). There was no significant difference in the pre-anesthesia scores of MMSE between the two groups. The scores of MMSE on the 2nd and the 4th day were higher in Group B than in Group A (21.3 +/- 3.9 vs 18.3 +/- 3.8, 26.4 +/- 2.9 vs 22.9 +/- 3.9, P < 0.05). Compared with one day before anesthesia in the same group, the scores of MMSE were significantly different on the 2nd and the 4th day (Group A: 18.3 +/- 3.8, 22.9 +/- 3.9 vs 27.9 +/- 2.1; Group B: 21.3 +/- 3.9 vs 27.5 +/- 2.5; P < 0.05). The occurrence of post-aesthesia nausea and vomiting was lower in Group B (23.3%, 14/60) than in Group A (46.7%, 28/60) with statistical difference (P < 0.05).</p><p><b>CONCLUSION</b>EA assistant general anesthesia could reduce the occurrence of POCD in aged patients.</p>

Effect of ligustrazine on T-lymphocyte immunity in patients undergoing autologous blood transfusion / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the protective effect of ligustrazine on T-lymphocyte immunity of patients undergoing autologous blood transfusion (ABT).</p><p><b>METHODS</b>Forty American Society of Anesthesiologist (ASA) I - II patients scheduled for receiving selective lumbar surgery, with pre-operational anticipatory blood loss > 400 mL and without any diseases of blood or endocrinal system were enrolled. They were equally randomized into two groups, the trial group and the control group. Ligustrazine was given to patients in the trial group by intravenous dripping at the dose of 2 mg/kg, 30 min before auto-blood collection, also by mixed in the washing saline and heparinized saline solution to make the final concentration of ligustrazine 0.005%. No ligustrazine was given to patients in the control group. The amount of blood loss and autotransfused were measured and recorded; and patients' venous blood samples for T-lymphocyte subsets (CD3, CD4, CD8) determination and CD4/CD8 ratio calculation were collected at different time points, i. e. before surgery (T0) and at 1 h (T1), 1st day (T2) and 5th day (T3) after ABT.</p><p><b>RESULTS</b>CD3 decreased obviously at T1 and T2 in both groups (P < 0.05 or P < 0.01), while at T3, it restored to baseline in the trial group, but remained at the low level in the control group (P < 0.05). Moreover, levels of CD3 at T1-T3 were lower in the control group than those in the trial group respectively (P < 0.05 or P < 0.01). CD4 decreased obviously at T1 (P < 0.01) in both groups, it recovered at T2 in the trial group, but the recovering in the control group was T3, so comparison of CD4 level between groups showed significant difference at T1 and T2 (P < 0.05 or P < 0.01). As for CD4/CD8 ratio, it decreased obviously at T2 and T3 in the control group (P < 0.05), but unchanged in the trial group, showing statistical difference between groups (P < 0.05).</p><p><b>CONCLUSION</b>Ligustrazine had definite protective effect on T-lymphocyte immunity in patients undergoing ABT, which was presented by the milder inhibition and quicker recovery of immunity.</p>

Effects of electroacupuncture anesthesia of different frequencies on stress reaction in thyroid surgery / 中国针灸

<p><b>OBJECTIVE</b>To probe into the optimal frequency of electroacupuncture for the access to the best anesthesia.</p><p><b>METHODS</b>Sixty cases of optional thyroid surgery were randomly divided into group A, group B and group C, 20 cases in each group. In group A, 2 Hz/100 Hz disperse-dense wave was selected in stimulation. In group B, 2 Hz/15 Hz disperse-dense wave was selected. Group C was the control group without electric stimulation applied. Hegu (LI 4) and Neiguan (PC 6) were stimulated bilaterally. Cervical plexus block was produced after 15 min acupuncture. The concentration changes in plasma cortisone (COR) and beta-endorphin (beta-EP) were compared among 4 time-points, named before anesthesia (T1), before skin incision after induction (T2), thyroid traction in surgery (T3) and the end of surgery (T4).</p><p><b>RESULTS</b>Group B achieved the highest significant rate of analgesia (50.0%, 10/20) and that in group C was the lowest (10.0%, 2/20). COR content was the highest at T2 in group A and that was the lowest at T3 in group B. At the end of surgery, COR content was up the maximum in 3 groups, but still COR content was the lowest in group B in comparison. The plasma beta-EP content decreased apparently at T3 and T4 in group B as compared with the value before (both P < 0.05).</p><p><b>CONCLUSION</b>In electroacupuncture-assisted anesthesia, 2 Hz/15 Hz disperse-dense wave achieves the optimal anesthesia compared with 2 Hz/100 Hz disperse-dense wave, and moreover inhibits stress reaction induced by anesthesia surgery.</p>

Effect of shenfu injection on the stability of circulation during induction of general anesthesia for aged people / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the intervention of Shenfu Injection (SFI) on the hemodynamics and circulatory function during induction of general anesthesia for aged people, in order to optimize the medication of anesthesia inductive phase in aged people.</p><p><b>METHODS</b>Sixty aged patients scheduled to receive general anesthesia were equally randomized into 2 groups, the SFI group and the control group. SFI via intravenous drip (1 mL/kg diluted with 5 mL/kg saline) was administered to the SFI group 15 min before anesthesia induction and to the control group, normal saline was administered instead. Then the induction and intubation were implemented. The systolic blood pressure (SBP), diastolic pressure (DBP), heart rate (HR), central venous pressure (CVP), pulse saturation oxygen (SpO2), and the ST segment of ECG were observed at the different time points of induction, i.e. at the time of entry into the operating room (T1), ending the medication (T2), before the induction (T3), showing the lowest SBP in induction (T4), before and after intubation (T5 and T5). The dose and frequency of atropine and ephedrine applied in the inductive phase were observed as well.</p><p><b>RESULTS</b>As compared with the baseline values measured at T1, CVP elevated at T2, T3, and T6 (P < 0.05), SBP and DBP descended at T4, T5, T6 in both groups; HR accelerated at T2, T3, and T6 in the control group; and HR at T4, T5 and T6 in both groups were significantly different (P < 0.05 or P < 0.01). Inter-group comparisons showed significant difference between groups in CVP at T2 (P < 0.05); so did SBP, DBP and HR at T4, T5 and T6 (P < 0.05 or P < 0.01).</p><p><b>CONCLUSION</b>Application of SFI in the inductive phase of general anesthesia in aged people could evidently reduce the fluctuation of hemodynamics to prevent the occurrence of myocardial ischemia and improve it definitely.</p>