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Objective To observe the influence of subarachnoid space associated with epidural anesthesia at different posture on the hemodynamics during cesarean section.Methods One hundred and twenty uterine-incision delivery patients were chosen,the patients were separated into the left lateral decubitus group(LL group) and right lateral decubitus group(RL group) with 60 cases each by random digits table method,all the patients were blocked by subarachnoid space associated with epidural anesthesia after puncturation 2 ml 0.5％ ropivacaine was given.Then the head end epidural catheter insertion in 3-4 cm,asked maternal supine after fixed catheter enjoin.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate were recorded before anesthesia and at 3,5,10,15 min after anesthesia.Apgar scores of 1 and 5 min were observed as well.Results SBP and DBP at 3,5 min after anesthesia were significantly lower than those before anesthesia in RL group,SBP was (120.1 ± 11.2),(106.7 ± 17.2),(127.3 ± 13.6)mmHg (1 mmHg =0.133 kPa) respectively,DBP was (77.5 ± 6.3),(55.2 ± 21.2),(80.3 ± 10.5) mmHg,respectively,and there were significant differences (P ＜0.05).And SBP,DBP in RL group were also significantly lower than those in LL group,SBP was (123.2 ± 12.4),(110.3 ± 16.3) mmHg,DBP was (80.1 ± 9.9),(63.1 ± 13.2) mmHg,and there was significant difference (P ＜ 0.05).There was no significant difference in Apgar scores of 1 and 5 min between two groups.Conclusion The left lateral decubitus position could effectively reduce the incidence of hypotension during caesarean section under subarachnoid space associated with epidural anesthesia.
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Objective To explore the clinical characteristics of patients during recovery period in low flow and circulation closed pattern anesthesia by ZEUS with isoflurane.Methods During elective gynecologic surgery,35 ASA Ⅰ or Ⅱ patients were anesthetized with isoflurane under general anesthesia with tracheal intubation.The ventilation was used with the closed circuit breathing mode (Autocontrol) of ZEUS anesthesia machine.The time of inhale drug,exhale drug and eyes-opend,consumption of drug and complication were recorded during the process.The values of NT stage (NTS),NT index (NTI),the final endexpiratory concentration of isoflurane (EXP),MAC and hemodynamic parameters were recorded during the time of isoflurane stopping inhale,recovery of spontaneous respiration,eyes opening.Results The values of NTI (50±7,74±12,86±10,t =-9.382,t =-16.682,P ＜ 0.01),the EXP [(0.9±0.0)％,(0.1±0.1)％,0,z =-7.262,z =-7.835],MAC [(1.2±0.1)％,(0.2±0.2)％,0,z =-7.186,z =-7.728,P ＜ 0.01] and hemodynamic parameters (SBP,DBP,MAP,HR) [(108.1±13.4) mm Hg (1 mm Hg =0.133 kPa),(66.3±12.1) mm Hg,(84.3± 12.5) mm Hg,(69.8±12.5) /min and (124.6±17.9) mm Hg,(75.7±14.5) mm Hg,(96.0±14.6) mm Hg,(82.8±15.0)/min and (128.0±16.3) mm Hg,(77.1±15.0) mm Hg,(99.8±15.3) mm Hg,(85.2±18.5) bpm] (t =-4.365,t =-2.951,t =-3.574,t =-3.921; t =-5.554,t =-3.309,t =-4.642,t =-4.085,P ＜0.01) during the time of recovery of spontaneous respiration and tracheal extubation were statistically significant compared to the time of isoflurane stopping (P＜ 0.01).None of patients experienced intraoperative was awareness.Conclusion Isoflurane can be used for closed circuit breathing mode of ZEUS anesthesia machine,but consciousness recovery need a long time.
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Objective To evaluate the predictive effects of Narcotrend(NT) monitor on laryngeal mask intubation and consciousness recovery in propofol-laryngeal mask total intravenous anesthesia of gynecilogical surgery.Methods Thirty ASA I patients undergoing elective gynecilogical surgery under general anesthesia with laryngeal mask intubation were anesthetized with propofol by target-controlled infusion (TCI).NT monitor was used to monitor the anesthesia depth.The ventilation was used on the closed circuit breathing mode of ZEUS anesthesia machine.The values of NT stage (NTS),NT index (NTI),the effect compartment concentration (Ce) and hemodynamic parameters were recorded during the time of sleeping,laryngeal mask intubation,propofol stopping pumping,recovery of spontaneous respiration and eyes opening.The incidence rate of intraoperative awareness was recorded.Results The NTI (77±23,30±9) (Z =5.561,P =0.001),Ce [(1.1±0.4) μg/ml vs (2.2±0.4) μg/ml] (Z=6.38,P=0.006),MAP [(92±14) mm Hg (1 mm Hg =0.133 kPa)vs (83±14) mm Hg] (t =2.490,P =0.016) and HR [(74±15) bpm vs (65±10) bpm] (t =2.688,P =0.009) of the time of intubation were significantly decreased compared to the time of sleeping.The NTI (37±7 vs 71±14)of the time of recovery of spontaneous respiration was significantly increased compared to the time of propofol stopping pumping (Z =6.34,P =0.005).The NTI (37±7 vs 83±13) (Z =6.668,P =0.003),Ce [(3.1±0.4) μg/ml vs (1.6±0.2) μg/ml] (Z =6.414,P =0.002) and HR[(59±7) bpm vs (64±8) bpm] (t =-2.825,P =0.006) of the time of eyes opening were statistically significant compared to the time of propofol stopping pumping.None of patients experienced intraoperative awareness.Conclusion NT monitor can effectively guide the intubation and extubation of laryngeal mask in total intravenous anesthesia of gynecilogical surgery.
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Objective To investigate the influence of intraoperative thermostasis over respiratory burst of polymorphonuclear neutrophils (PMNs) in patients undergoing radical operation for lung cancer.Methods Thirty-two ASA Ⅱ or Ⅲ patients scheduled for radical operation for lung cancer under general anesthesia were randomized into two groups ( n = 16 each): control group (Group C) and warming group (Group W). The patients in Group C were kept warm by routine measures such as using woollen blankets, while the patients in Group W were kept warm by force-air warming system and fluid warming device as soon as the patients were admitted to the operation room. Rectal and axillary temperatures were continuously monitored as the core and surface temperature, respectively. The core temperature was maintained at the preoperative level (baseline). Anesthesia was induced with midazolam, fentanyl and propofol. Tracheal intubation was facilitated with rocuronium. Anesthesia was maintained with isoflurane and nitrous oxide and intermittent i.v. boluses of fentanyl, midazolam and vecuronium. Venous blood samples were obtained before, during and at the end of surgery for normal blood analysis and respiratory burst of PMNs which included activated PMNs count and reactive oxygen species (ROS) production.Results (1) WBC and PMN counts were significantly increased during and after operation as compared with the baseline values before operation in both groups and there was no significant difference in WBC and PMN counts between the two groups. (2)Phorbol-12-myristate-13-acetate (PMA) stimulation resulted in higher intraoperative and postoperative activated PMN counts in both groups and higher postoperative ROS production in Group W. Postoperative ROS production was significantly higher in Group W than in Group C. (3) The PMN counts without stimulation activation during operation and intra- and post-operative ROS production were significantly decreased as compared with the baseline values before operation in Group C, while in Group W there was no significant difference in pre-, intra- and post-operative activated PMN counts and ROS production. The intraoperative PMN counts and intra- and post-operative ROS productions were significantly higher in Group W than in Group C.Conclusion Intraoperative thermostasis can effectively maintain activated PMN count and ROS production without stimulation and enhance ROS production with stimulation in patients undergoing radical operation for lung cancer.
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Objective To discuss the mechanism,procedures and effect of implantable intrathecal infusion system for intractable pain therapy. Methods Among the 4 patients with intractable pain,2 had cancer pain,2 had failed back syndrome.Before operation,Visual Analogy Scale(VAS) were 8～10.Three had bolus intrathecal injection screening trial,1 had bolus epidural injection screening trial.In the clinical trail,VAS all decreased to 75%～90%.(Results) They all had intrathecal infusion system implantation.After operation,Morphine was prescribed(intrathecally.) The dose was 1～(8 mg).They all had satisfied pain relief without serious drug adverse effects.Conclusion The effect of implantable intrathecal system for intractable pain was satisfied.The drug adverse effects were obviously alleviated.
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0.05). Lornoxicam caused less side effects than morphine (10.2% vs 17.9%) Conclusions The study suggests that lornoxicam provide an alternative to morphine for the treatment of postoperative pain.
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0.05) . The sensory block reached T7 in levobupivacaine group and T6 in bupivacaine group respectively. The motor blocked was somewhat more intense in bupivacaine group. Conclusion The efficacy and safety of epidural anesthesia with levobupivacaine and bupivacaine are comparable.
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Objective In a randomized double blind study, we have compared the analgesic efficacy and safety of PCA with buprenorphine and PCA with morphine after abdominal hysterectomy. Methods One hundred and fifty-four patients aged 25-55 yr undergoing abdominal hysterectomy were included in this study. Patients with severe cardiac, cerebral, hepatic and renal disease and those who had recently taken monoamine oxidase inhibitor were excluded. Anesthesia was induced with propofol 1.5-2.0 mg?kg-1 and intubation was facilitated with succinylcholine 1.5 mg?kg-1 or vecuronium 0.1 mg?kg-1 . Anesthesia was maintained with inhalation of l%-2% isoflurane and 50% nitrous oxide in oxygen supplemented with intermittent iv boluses of vecuronium 1-2 mg, fentanyl 2?g?kg-1 and droperidol 1-2 mg. The patients were randomly divided into 2 groups: 1 buprenorphine group (B, n = 77 ) and 2 morphine group (M, n = 77) . In group B, patients received PCA with buprenorphine (bolus dose 0.03 mg, lockout interval 14 min, 24 h dose limit 1.2 mg); in group M patients received PCA with morphine (bolus dose 1 mg, lockout interval 5 min, 24 h dose limit 40 mg). Intensity of pain was assessed using VAS with 0 representing no pain and 10 representing the worst pain. Pain intensity difference before and after PCA and pain relief (PAR) (0 = not relieved, 4 = completely relieved) , patient satisfaction and adverse effects were recorded. Results The two groups were comparable with regard to age, body weight, duration of operation, the time when postoperative pain started and PCA was commenced, and the intensity of postoperative pain. There was no significant difference in pain intensity before and after PCA and PAR between the two groups. The incidence of nausea and vomiting was significantly higher in group B than in group M ( P