ABSTRACT
Objective:To evaluate the effect of general anesthesia under the guidance of bispectral index (BIS) on postoperative fatigue syndrome (POFS) in elderly patients undergoing laparoscopic resection of gastrointestinal tumor.Methods:A total of 90 patients of both sexes, aged 65-80 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiology physical status Ⅰ-Ⅲ, undergoing elective laparoscopic resection of gastrointestinal tumor, were divided into 3 groups ( n=30 each) using a random number table method: control group (C group), BIS value 40-49 group (B1 group), and BIS value 50-60 group (B2 group). Combined intravenous-inhalational anesthesia was used.The intraoperative BIS value was maintained at 40-49 in group B1, the intraoperative BIS value was maintained at 50-60 in group B2, and the fluctuation range of heart rate and mean arterial pressure was maintained within 20% of the baseline value during operation, and vasoactive drugs were given when necessary in group C. Patient-controlled intravenous analgesia was performed with sufentanil plus dezocine plus palonosetron after surgery, when the VAS score > 3 points, oxycodone/acetaminophen tablets 5 mg were administered orally or flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.The Christensen′s Fatigue Scale (CFS) scores were recorded at 1 day before operation and 1, 3, 7 and 30 days after operation, and the development of POFS (CFS score ≥ 6) was recorded.The intraoperative consumption of propofol, remifentanil and sufentanil was recorded.The serum C-reactive protein concentration was determined by immunoturbidimetry at 1 day before operation and 1 day after operation.The requirement for rescue analgesia within 48 h after operation was recorded.The time to the first flatus, the first ambulation time, length of hospital stay, and occurrence of fever, vomiting and delirium within 3 days after operation were recorded.The Quality of Recovery-15 (QoR-15) scores were measured at 1, 3 and 7 days after operation. Results:Compared with group C, CFS scores were significantly decreased at 1, 3 and 7 days after surgery, the incidence of POFS was decreased at 7 days after surgery, QoR-15 scores were increased at each time point after operation, the length of hospital stay was shortened, and the intraoperative consumption of propofol was reduced in B1 and B2 groups ( P<0.05). Compared with group B1, the intraoperative consumption of propofol was significantly reduced, QoR-15 scores were increased at each time point after operation ( P<0.05), and no significant change was found in CFS scores, incidence of POFS at each time point after operation, or length of hospital stay in group B2 ( P>0.05). There were no significant differences in serum C-reactive protein concentration, postoperative requirement for rescue analgesia, time to first flatus, first ambulation time, and incidence of fever, vomiting and delirium at each time point among the three groups ( P>0.05). Conclusions:General anesthesia under BIS guidance can reduce POFS and promote early postoperative recovery in elderly patients undergoing laparoscopic resection of gastrointestinal tumor.
ABSTRACT
OBJECTIVE：To investigate the effects of dexmedetomidine on regional cerebral oxygen saturation and cerebral function in patients undergoing intracranial aneurysm embolization. METHODS ：Totally 44 patients undergoing intracranial aneurysm embolization in the First Affiliated Hospital of Hunan University of TCM during Jun. 2017-Aug. 2019 were collected and randomly divided into group D （22 cases）and group C （22 cases）. Ten minutes before anesthesia induction ，group D was given intravenous injection of Dexmedetomidine hydrochloride injection 1 μg/kg；group C was given buffered normal saline 20 μL. Both groups were induced with Propofol emulsion injection+Midazolam injection+Fentanyl citrate injection+Cisatracurium besylate for injection. During the operation ，group D was given Dexmedetomidine hydrochloride injection 0.5 μg（/ kg·h）+Fentanyl citrate injection+Benzsulfosum atracurium for injection+Propofol emulsion injection to maintain anesthesia ；group C was continuously pumped with buffered normal saline 0.5 μg（/ kg·h）+Fentanyl citrate injection + Benzsulfosum aratracurium for injection Propofol emulsion injection to maintain anesthesia. Before anesthesia induction （T0）， immediately after anesthesia。induction （T1）， 1 min after tracheal intubation （T2）， immediately after operation finished （T3），immediately afte extubation（T4），the mean arterial pressure（MAP），heart rate 中国药房 2021年第32卷第7期 China Pharmacy 2021Vol. 32 No. 7 ·865· （HR），regional cerebral oxygen satur ation（rSO2）were observed in 2 groups. The levels of neuron specific enolase （NSE）and S100 β protein in serum were measured at T1，T3，6 h after operation （T6）. The recovery time ，intraoperative blood loss ， nitroglycerin amount and the occurrence of ADR were recorded. RESULTS ：MAP and HR of group D at T 2-T4 were significantly lower than those at T 0；MAP and HR of group C at T 2-T4 were significantly higher than those at T 0；the group D were significantly lower than the group C at the same period （P＜0.05）；there was no statistical significance in rSO 2 between 2 groups at T 0-T4（P＞ 0.05）. The levels of serum NSE and S 100β protein in 2 groups at T 3 were significantly higher than at T 1；those in 2 groups at T 6 were significantly lower than at T 3，but those of group D were significantly lower than the group C at T 3（P＜0.05）；there was no statistical significance in the levels of serum NSE or S 100β protein between 2 groups at T 1（P＞0.05）. The recovery time of anesthesia，the amount of nitroglycerin ，the incidence of tachycardia ，nausea and vomiting ，restlessness，shivering and cough in group D were significantly shorter or lower than group C （P＜0.05）；there was no statistical significance in the intraoperative blood loss between 2 groups（P＞0.05）. CONCLUSIONS ：Dexmedetomidine can maintain the hemodynamic stability of patients with intracranial aneurysm embolization during the perioperative period ，has little effect on rSO 2 and brain function ，and has good safety.
ABSTRACT
Objective To explore the influence of perioperative immune function and postoperative nausea and vomiting (PONV) of different intervention time of general anesthesia acupuncture intervention in the patients with laparoscopic surgery. Methods According to random number table method, 104 patients with laparoscopic surgery using general anesthesia from October 2015 to December 2016 in our hospital were divided into A, B, C, D group with 26 patients in each group. All patients were treated with tracheal intubation anesthesia. Patients in group A (acupuncture half an hour before anesthesia), group B (acupuncture in the surgery), group C (acupuncture after the end of the surgery) and group D (without acupuncture). The levels of T lymphocyte subsets, including total T lymphocytes (CD3+), T helper cells (CD4+) and T suppressor cell (CD8+), and the CD4+/CD8+, were detected at half an hour before anesthesia induction (T0), the end of surgery (T1), postoperative day 1 (T2) and postoperative day 3 (T3). At the same time, the levels of IgA, IgM and IgG were calculated by suspension method. In addition, the occurrence and score of PONV were observed in postoperative 6h (T4), 12h after surgery (T5) and 48h after surgery (T6). The occurrence of adverse reactions was observed postoperative 1 week. Results The various immune index at T3 CD3+ (62.12% ± 8.37% vs. 58.15% ± 3.92%,57.15% ± 7.83%,55.32% ± 7.66%,F=132.238),CD4+(37.99% ± 6.92% vs.34.03% ± 6.32%, 34.00% ± 6.49%,33.85% ± 6.73%,F=2.794),CD8+(25.07% ± 5.06% vs.22.89% ± 1.32%,22.91% ± 1.24%, 22.78% ± 1.75%,F=2.849),CD4+/CD8+(1.30 ± 0.34 vs.1.27 ± 0.34,1.29 ± 0.31,1.25 ± 0.27,F=5.413),IgA (151.15 ± 36.83 IU/ml vs.135.24 ± 15.17 IU/ml,135.16 ± 16.09 IU/ml,132.05 ± 17.37 IU/ml,F=3.044),IgM (169.35 ± 53.69 IU/ml vs.146.26 ± 23.06 IU/ml,145.73 ± 24.66 IU/ml,143.12 ± 21.43 IU/ml,F=2.839),IgG 131.89 ± 28.13 IU/ml vs.118.88 ± 15.35 IU/ml,116.92 ± 20.25 IU/ml,115.06 ± 20.55 IU/ml,F=3.165)]in the group A were significantly higher than those in the other three groups (P<0.05); Meanwhile the PONV score of patients in group A at T5 (1.76 ± 0.24 vs. 1.98 ± 0.31, 1.96 ± 0.37, 2.09 ± 0.33, F=4.918) were significantly lower than that in the other three groups(P<0.05);the PONV score of patients in group A at T6(1.33 ± 0.36 vs. 1.52 ± 0.26, 1.54 ± 0.28, 1.73 ± 0.35 , F=6.984) were significantly lower than that in the other three groups (P<0.05);The incidence of adverse events in group A[11.5%(3/26)vs.38.5%(10/26),χ2=5.026]was lower than that in group D (P<0.05). Conclusions Preoperative acupuncture can effectively improve immunosuppressive state of patients with laparoscopic surgery during general anesthesia perioperative, and reduce the incidence of PONV and PONV score.
ABSTRACT
Objective To study the effects of the multi-model analgesia for the old patients who received total hip replacement surgery.Methods Thiry-four patients who would received total hip replacement surgery were randomly divided into 2 group:Group E was the epidural analgesia group and Group M was the multi-model analgesia group.15min before the end of surgery,the load doses were given to the patients in both groups and the electric pumps for postoperative analgesia were connected.The multi-model analgesia was used for Group M:30min before the end of surgery,ropivacaine 7.5mg and morphine 1mg were given via epidural catheter,and at the end of surgery the catheter was pulled out.Intravenous analgesic pumb were used for Group M.Record the following data at different time point (T1 to T5):(1)the pain scores.(2)the scores of sedation and HR,MAP,RR and SpO2.(3)the numbers of the patients who suffered from adverse effects,such as nausea and vomiting and the numbers of patients who needed the rescue medicine were recorded in 48h after surgery.Results Compared to Group E,the scores of pain when the patients turned over in Group M,were lower significantly at T2.At T1 and T2 time point,the sedation scores of Group M were higher than those of Group E significantly.There was significant difference in the SpO2 change between groups at T1.Conclusion The multi-model analgesia of using long-acting local anesthetics and opioids for epidural analgesia once,then using sufentanil and tramadal for intravenous analgesia continuously,was safe and sufficient for the old patients.