ABSTRACT
Objective:To investigate the application value of ultrasound-guided selective pudendal nerve block during vestibular gland resection.Methods:Ninety patients who underwent vestibular gland resection in Lishui Maternal and Child Health Hospital from January 2017 to January 2020 were included in this study. These patients were divided into a control group and an observation group ( n = 45/group) according to the order of admission. Patients in the control group underwent blind nerve block and those in the observation group underwent ultrasound-guided selective pudendal nerve block. Hemodynamics before and after anesthesia, anesthetic effects, pain severity, and the incidence of complications were compared between the control and observation groups. Results:There were no significant differences in hemodynamics and pain severity between the control and observation groups (both P > 0.05). Systolic blood pressure [(124.37 ± 8.12) mmHg], diastolic blood pressure [(91.68 ± 5.44) mmHg] and heart rate [(74.62 ± 3.56) beats/min] were significantly lower than those in the control group [(128.62 ± 9.27) mmHg, (95.24 ± 6.17) mmHg, (76.12 ± 3.32) beats/min, t = 2.248, 2.903, 2.067, all P < 0.05]. In the observation group, pain scores at 2 and 24 hours after surgery were (3.06 ± 0.25) points and (4.21 ± 0.52) points, respectively, which were significantly lower than those in the control group [(3.28 ± 0.24) points and (4.54 ± 0.48) points, t = 2.618, 3.128, both P < 0.05). Anesthetic effect in the observation group was superior to that in the control group, and incidence of complications in the observation group was significantly lower than that in the control group ( χ2 = 12.869, 4.285, 4.864, 3.920, all P < 0.05). Conclusion:Ultrasound-guided selective pudendal nerve block in vestibular gland resection exhibits better anesthetic effect, has no obvious effect on hemodynamics, and has good analgesic effect with low incidence of complications. Therefore, it deserves clinical popularization.
ABSTRACT
Objective:To determine the dose-effect relationship of norepinephrine in the treatment of hypotension after spinal anesthesia in cesarean section.Methods:Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients who were at full term with a singleton fetus, body mass index of 20-35 kg/m 2, blood pressure 100-140 mmHg, heart rate 60-100 beats/min, scheduled for elective cesarean section, were divided into 6 different doses of norepinephrine groups (NE2, NE4, NE6, NE8, NE10 and NE12 groups) using a random number table method, with 15 cases in each group.The maternal basal systolic blood pressure was measured after entering the operating room.Anesthesia was performed by injecting hyperbaric bupivacaine 9 mg into the subarachnoid space over 45 s. When hypotension occurred for the first time after anesthesia (systolic blood pressure was lower than 80% of the baseline value), norepinephrine 2, 4, 6, 8, 10 and 12 μg (diluted to 5 ml in normal saline) were intravenously injected in NE2, NE4, NE6, NE8, NE10 and NE12 groups, respectively.Systolic blood pressure was measured at 60 s after completion of injection.The effective treatment of hypotension was defined as the recovery of systolic blood pressure to more than 80% of the baseline value.The logistic regression analysis method was used to draw the dose-effect curve of norepinephrine in treating hypotension after spinal anesthesia in cesarean section.The median effective dose (ED 50), 95% effective dose (ED 95) and 95% confidence interval (CI) were calculated.The time to first hypotension, effective treatment of hypotension, and occurrence of bradycardia and nausea and vomiting after intravenous injection of norepinephrine were recorded.The Apgar scores of the neonates at 1 and 5 min after birth were recorded.The umbilical artery blood samples of neonates were collected immediately after cutting the cord for blood gas analysis. Results:There was no significant difference in the incidence of maternal basal systolic blood pressure, time to first hypotension, bradycardia, and nausea and vomiting among the six groups ( P>0.05). The rate of effective treatment of hypotension increased with the increase of the dose in the six groups ( P<0.05). There was no significant difference in Apgar score and indexes of umbilical artery blood gas analysis at 1 and 5 min after birth among the six groups ( P>0.05). The ED 50 (95% CI) of norepinephrine in the treatment of hypotension after spinal anesthesia in cesarean section was 4.0 (3.0 to 5.0) μg, and the ED 95 (95% CI) was 11.8 (8.9-20.4) μg. Conclusion:The ED 50 and ED 95 of norepinephrine are 4.0 and 11.8 μg, respectively, when used for treating hypotension after spinal anesthesia in cesarean section.
ABSTRACT
Objective To investigate the agitation effect of dexmedetomidine in the operation of radical hysterectomy by general anesthesia in patients.Methods 68 cases in this study who were under the operation of radical hysterectomy by general anesthesia in our hospital were selected, and randomly divided into the group A and the group B, 34 cases in each group.Group A received dexmedetomidine after tracheal intubation, and group B received physiological saline as the measurement of group A, hemodynamic and inflammatory factors were measured at different time points in anesthesia, the corresponding indexes and the degree of emergence delirium were compared.Results Compared with T1 , levels of HR and MAP increased, levels of SpO2 decreased at T3 and T4 in group B, levels of CRP, TNF-αincreased at T2 , T3 , T4 , T5 in group B, levels of CRP, TNF-αincreased at T3 , T4 , T5 in group A(P<0.05), and compared with the group A, levels of HR and MAP were higher at T3 and T4, levels of SpO2 were lower,levels of CRP, TNF-αwere higher at T2, T3, T4, T5in group B(P<0.05).The cough response score and agitation score in group B were higher than group A, and sedation score was lower than group A ( P <0.05 ) , the grade of emergence delirium in group A was better than group B ( P <0.05 ) . Conclusion Dexmedetomidine in the operation of radical hysterectomy by general anesthesia could reduce the emergence of agitation occurred, inhibit extubation reaction, but would not extend the anesthesia recovery time.