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Objective To investigate the accurancy of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) in estimation of the occurrence of intraoperative cerebral ischemia in patients undergoing carotid endarterectomy (CEA).Methods Ninety patients (71 males, 19 females, aged 18-80 years, ASA physical status grade Ⅱ or Ⅲ) undergoing CEA using general anesthesia were studied.Bilateral SSEP and MEP were monitored during CEA and the intraoperative changes of SSEP and MEP amplitude and latency were analyzed before, during and after ICA cross-clamping until CEA ended.Neurological dysfunction was investigated within 5 days after operation and the gold standard of cerebral ischemia was defined as the occurrence of neurological dysfunction.Results Fourteen cases (15.6%) were diagnosed as post-operative neurological dysfunction.The sensitivity, specificity of SSEP in detecting the occurrence of intraoperative brain ischemia were 79%, 92%, respectively.The sensitivity, specificity of MEP was 86%, 89% respectively.The sensitivity, specificity, of SSEP+MEP was 79%, 99% respectively.Conclusion During the carotid endarter ectomy,SSEP predicts the occurrence of cerebral ischemia with a high specificity.MEP has a high sensitivity.The combination monitoring of SSEP+MEP can improve the specificity, make up for the shortcomings of single monitoring.
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Objective To compare the accuracy of somatosensory evoked potentials(SSEPs), motor evoked potentials(MEPs), regional cerebral oxygen saturation(rSO2)and multimodal monitoring in monitoring cerebral ischemia in patients undergoing carotid endarterectomy(CEA). Methods Eighty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 46-76 yr, scheduled for elective CEA, were enrolled in the study. SSEPs, MEPs and rSO2were monitored during CEA. The event of intraoperative cerebral ischemia was defined as:(1)SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%;(2)disappearance of MEP amplitude;(3)decrease in rSO2>20% of the baseline value;(4)When multimodal monitoring was applied, the event of intraopera-tive cerebral ischemia could be defined as long as one variable previously described met the condition. The gold standard of perioperative cerebral ischemia was defined as:(1)the National Institutes of Health Stroke Scale score≥4 at 1, 3 and 5 days after operation than before operation was considered as neurologi-cal dysfunction;(2)cranial CT showed a new ipsilateral cerebral focal ischemia, and postoperative in-tracranial hemorrhage diseases were excluded. Results Five cases developed cerebral ischemia after opera-tion. The sensitivity and specificity of SSEPs in predicting cerebral ischemia were 80% and 83%, respec-tively;MEPs 80% and 80%, respectively; SSEPs+MEPs 100% and 79%, respectively; rSO260% and 93%, respectively;SSEPs+MEPs+rSO2100% and 7%, respectively. Decrease in rSO2> 20% of the base-line value was consistent with SSEP escape latency prolongation of 10% and∕or amplitude decrease of 50%in diagnosis of cerebral ischemia(Kappa value 0.67, P<0.01); decrease in rSO2>20% of the baseline value was consistent with disappearance of MEP amplitude in diagnosis of cerebral ischemia(Kappa value 0.54, P<0.01). Conclusion rSO2has a good agreement with SSEPs and MEPs in diagnosis of cerebral ischemia during CEA; combination of SSEPs and MEPs produces better accuracy in monitoring cerebral is-chemia.
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Objective: To evaluate the efficiency and safety of endoscopic trans-fistula drainage (ETFD) for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy. Methods: Among 456 esophageal cancer patients receiving esophagectomy between February 2012 and February 2017 in Sir Run Run Shaw Hospital, 15 cases were diagnosed as gastroesophageal anastomotic fistula with para-fistula abscess after surgery. Seven cases received ETFD treatment (ETFD group), and 8 cases received conventional treatment (control group). Recovery of inflammatory markers and fistula, length of hospital stay after esophagectomy and total medical expenses were compared between ETFD group and control group. Results: All patients recovered in ETFD group. Time of white cell count returning to normal and decline of C-reactive protein, time of fistula healing and length of hospital stay after esophagectomy in ETFD group were significantly shorter than those of control group (all PPConclusion: ETFD is effective and safe for gastroesophageal anastomotic fistula with para-fistula abscess after esophagectomy.
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Humans , Abscess , Anastomotic Leak , Drainage , Esophageal Neoplasms , General Surgery , Esophagectomy , Fistula , General Surgery , Retrospective StudiesABSTRACT
Objective To explore the feasibility and safety of dexmedetomidine sedation in interventional neuroradiology operations.Methods Eighty-five cases ASA grade Ⅱ-Ⅲ grade patients undergoing cerebral angiography according to age divided into two groups:old group(more than 60 years old,35 cases) and young group (18-59 years old,50 cases).The loading dose of dexmedetomidine were dexmedetomidine 0.5 μ g/kg in old group and 1.0 μ g/kg in young group,respectively.The loading dose was administered for 10 min followed by continuous infusion dexmedetomidine 0.5 μ g/ (kg· h).Blood pressure,heart rate (HR),peripheral oxygen saturation (SpO2) and respiratory rate (RR),Ramsay score and bispectral index(BIS) were monitored and recorded during the study.Results The BIS,Ramsay score after administration 10,15,30,45 min in two groups was significantly longer than that before administration [old group:84 ±22,83 ±22,85 ± 15,75 ±23 vs.94 ±5; (2.0 ±0.4),(2.3 ±0.6),(2.8 ±0.7),(3.0 ±0.7)scores vs.(1.7 ± 0.5) scores; young group:91 ± 8,89 ± 11,86 ± 12,81 ± 13 vs.96 ± 2; (1.9 ± 0.6),(2.3 ±0.7),(2.7 ± 0.9),(3.0 ± 0.9) scores vs.(1.6 ± 0.5) scores,P ＜ 0.05].The systolic blood pressure,diastolic blood pressure,mean arterial pressure (MAP) after administration 10,15,30,45 min in two groups was significantly longer than that before administration [old group:(152 ± 23),(144 ± 23),(140 ± 21),(135 ±21) mm Hg(1 mm Hg =0.133 kPa) vs.(165 ± 25) mm Hg; (87 ± 11),(83 ± 11),(78 ± 8),(75 ± 8) mm Hg vs.(89± 13)mm Hg;(106±14),(100±13),(99±12),(95±12)mm Hg vs.(113±16)mm Hg;young group:(131 ± 24),(127 ± 23),(124 ± 25),(124 ± 26) mm Hg vs.(142 ± 23) mm Hg; (81 ± 13),(79±13),(77±13),(76±13)mmHgvs.(86± 14) mmHg;(97±16),(94±16),(91±19),(92±20) mm Hg vs.(104 ± 19) mm Hg,P ＜0.05],but the decreases in blood pressure were ＜20％ from baseline.The HR,RR and SpO2 was no significant difference (P ＞ 0.05).Conclusions Continuous infusion of dexmedetomidine sedation during cerebral angiography has little effect on hemodynamics,no significant respiratory depression,is safe and effective.
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@#Objective To evaluate the efficacy of pregabalin combined with nerve block on postherpetic neuralgia (PHN). Methods 60patients were assigned into group A (n=30), who received pregabalin orally, and group B (n=30), who received nerve block (trigeminalnerve, intercostal nerve, lumbar nerve block) in addition. They were assessed with visual analogue scale (VAS) of pain, sleep score fromHamilton Rating Scale for Depression before and 3 d, 1 week, 2 weeks, 3 weeks, 4 weeks, 5 weeks, 6 weeks, 7 weeks, and 8 weeks aftertreatment. The incidence of pain decreased >50% and >30% were compared. Results The scores of VAS and sleep significantly reduced inboth groups 1~8 weeks after treatment (P<0.01), and decreased significantly 3 d after treatment in group B than in group A (P<0.05). The incidenceof pain decreased >50% and >30% were more in group B than in group A (P<0.05). Conclusion Nerve block combined with oralpregabalin is more effective on PHN.
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@#Objective To observe clinical efficacy of intra-articular injection of sodium hyaluronate(SH) and betamethasone accompanied with Bulleyaconitin A or diclofenac sodium administration for severe knee osteoarthritis(KOA).Methods60 patients with severe KOA from 580 subjects with KOA were selected as observational subjects in the experiment. All patients were treated by intra-articular injection of sodium hyaluronate 2.5 ml and betamethasone administration once a week for five consecutive weeks as a therapeutic course, betamethasone only once. Bulleyaconitin A group was accompanied with Bulleyaconitin A 0.4 mg, t.i.d, p.o.; diclofenac sodium group was accompanied with diclofenac sodium 75 mg, b.i.d, p.o. According to knee joint comprehensive score table (Tegner rating systems), the function comprehensive scores for all the patients pre-treatment and post-treatment knee joints were assessed.ResultsThe function comprehensive scores improved significantly after treatment in two groups(P＜0.001). The side effects in Bulleyaconitin A group decreased significantly than in diclofenac sodium group(P＜0.01).ConclusionThe intra-articular injection of SH and betamethasone accompanied with Bulleyaconitin A administration was an effective and less side-effect therapeutic measure for the treatment of knee osteoarthritis, especially for the old patients with severe knee osteoarthritis.
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@#Objective To evaluate the efficacy of nerve block combined with oral administration drugs on postherpetic neuralgia (PHN). Methods 40 patients were assigned into 2 groups: group A (n=20) accepted carbamazepine, doxepin, diclofenac sodium, and vitamin B compound; while group B (n=20) combined with intercostal nerve block. The pain was assessed with visual analogue scale (VAS) before, 3 weeks and 6 months after treatment. Results The scores of VAS decreased significantly after treatment compared with the baseline in groups B (P<0.01), but only 3 weeks after treatment in group A, and it decreased more in group B than in group A (P<0.01) at any time after treatment. Conclusion Nerve block combined with oral administration drugs is effective on PHN.
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@#Up to now,the researches of postoperative headache have been focused on the pain of the incision of scalp,however,other kinds of headache have not been thought highly of.To find and determine the reasons of postoperative headache and treat depending on the pathogenesis of the pain are the main goal in the future.The authors investigated and reviewed the pathogenesis of cervicogenic headache after craniotomy and proposed the therapeutic strategy in this article.
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@#Objective To compare the effects of nerve block using diprospan, triamcinolone and lysinipirium on cervicogenic headache (CEH).Methods Sixty CEH patients were randomly divided into three groups (20 cases in each group), treated by occipital nerve block and C2 neural blockade with diprospan, triamcinolone and lysinipirium respectively, combined with a mixture of 0.4% lidocaine. All patients in three groups were evaluated by numeric rating scales (NRS) for pain degree and range of motion of the neck (ROM) before and after the nerve block.Results The scores of NRS decreased significantly and ROM improved in all groups after treatment ( P<0.01). There were no significant differences between diprospan group and triamcinolone group, but these two groups had a better effect than lysinipirium group ( P<0.01).Conclusion Nerve block using diprospan and triamcinolone can obtain a significant effect in the treatment of CEH.