ABSTRACT
The abuse of opioids in the perioperative period has made the side effects of opioids increasingly prominent. So many anesthesiologists have proposed the concept of opioid-free anesthesia. Immunomodulation is an important field of modern medical research. With the introduction of the concept of enhanced recovery after surgery, the immunomodulatory effects of opioids have received increasing attention. Currently, the fentanyl family is commonly used opioid analgesics in clinical practice. This article reviews the research progress of the fentanyl family and immunomodulation, in order to provide guidance for clinicians to choose analgesic drugs.
ABSTRACT
Objective:To investigate the effects of dexmedetomidine on short-term prognosis in elderly patients with gastric cancer after laparoscopic radical gastrectomy.Methods:A total of 60 elderly patients with gastric cancer admitted to Shanxi Provincial Cancer Hospital from June 2018 to September 2019 were selected as the research objects. The patients were randomly divided into the observation group and the control group according to random number method, 30 cases in each group. All patients underwent laparoscopic radical gastrectomy. The patients in the control group received routine intravenous anesthesia, and the patients in the observation group were assisted with intravenous infusion of dexmedetomidine on the basis of anesthesia in the control group. The general situation during and after surgery, hemodynamics and postoperative delirium of patients in the two groups were observed and compared.Results:The anal exhaust time and hospitalization time in the observation group was shorter than that in the control group [(72±10) h vs. (79±13) h, t = 8.384, P = 0.031; (11.0±1.7) d vs. (12.9±1.9) d, t = 7.404, P = 0.022]. While the time of abdominal drainage was (8.4±2.8) d and (8.6±1.6) d, respectively in the observation group and the control group, and the difference was not statistically significant ( t = 0.958, P = 1.092); the volume of abdominal drainage was (534±50) ml and (545± 55) ml, respectively, and the difference was not statistically significant ( t = 0.847, P = 1.202). Compared with the preoperative baseline, the mean arterial pressure (MAP) in the two groups was stable during the operation. At extubation, the MAP in the control group [(104±5) mmHg, 1 mmHg = 0.133 kPa] was higher than that in the observation group [(92±7) mmHg] ( t = 7.383, P < 0.01); in the control group, the MAP at extubation was also higher compared with the preoperative MAP [(92±9) mmHg] ( P < 0.05). The heart rate in the observation group was lower than that before surgery and the same period in the control group.The incidence rate of delirium and suspicious delirium was 3% (1/30) and 7% (2/30) in the observation group, 10% (3/30) and 13% (4/30) in the control group within 7 d after surgery, and there were statistically significant differences in delirium and suspicious delirium between the two groups ( χ2 = 9.394, 7.485, all P < 0.05). Conclusion:Dexmedetomidine can reduce the incidence of delirium in elderly patients with gastric cancer after laparoscopic radical gastrectomy, and make the hemodynamics more stable and recovery faster.
ABSTRACT
Objective:To analyze the anesthesia effect of closed-loop target-controlled infusion system in esophageal cancer surgery.Methods:A total of 78 patients with esophageal cancer who underwent surgery in Shanxi Provincial Cancer Hospital from February to October 2019 were selected and divided into observation group and control group by random number table method, with 39 cases in each group. The patients in the observation group were anesthetized by closed-loop target-controlled infusion of propofol, while the propofol target-controlled infusion concentration of patients in the control group was manually controlled by anesthesiologists. The dosage of propofol, the time from drug discontinuation to recovery, the time of stay in post-anesthesia care unit (PACU), the incidence of hypoxemia after entering PACU and the incidence of anesthesia related complications were analyzed and compared between the two groups.Results:The dosage of propofol in the observation group was lower than that in the control group [(978±163) mg vs. (1 307±278) mg], and the difference was statistically significant ( t = 9.234, P = 0.028). The time from drug discontinuation to recovery in the observation group was shorter than that in the control group [(9.7±1.2) min vs. (13.2±2.6) min], and the difference was statistically significant ( t = 9.895, P = 0.025). The time of stay in PACU in the observation group was shorter than that in the control group [(15.6±2.4) min vs. (19.5±3.0) min], and the difference was statistically significant ( t = 9.536, P = 0.026). The incidence of hypoxemia after entering the PACU in the observation group was lower than that in the control group [7.69% (3/39) vs. 23.08% (9/39)], and the difference was statistically significant ( χ2 = 10.271, P = 0.016). The total incidence of postoperative anesthesia-related complications in the observation group was lower than that in the control group [10.26% (4/39) vs. 23.08% (9/39)], and the difference was statistically significant ( χ2 = 8.353, P = 0.021). Conclusion:The application of closed-loop target-controlled infusion system can effectively reduce the dosage of propofol, shorten the recovery time of patients and the time of stay in PACU, reduce the incidence of hypoxemia after entering PACU and the incidence of postoperative anesthesia related complications, which is worthy of clinical application.