ABSTRACT
Objective To compare the effect of three kinds of reverse trendelenburg position angle in block plane of prone position after subarachnoid anesthesia, in order to acquire the conformable reverse trendelenburg position angle of prolapse and hemorrhoids (PPH). Methods Sixty patients having underwent the selective PPH were divided into 10° group, 20° group and 30° group by random digits table method with 20 cases each. Subarachnoid puncture was performed in the L3 - 4 processus spinosus gap, then 0.5%heavy density ropivacaine 2 ml was injected. After anesthesia, the operation bed was adjusted to reverse trendelenburg position 10° (10° group), 20° (20° group) and 30° (30° group). At the same time the patients changed to prone position, and the operation bed was changed to horizontal position before operation. The patients changed to jackknife position 10 min after drug injection of subarachnoid anesthesia. The sensory blockade after drug infusion, circulation function change, anesthetic effect and perioperative adverse reaction were observed. Results There were no statistical differences in operation start time and fixed time of anesthesia plane among 3 groups (P>0.05). The upper bound of sensory nerve block before horizontal position, upper bound of sensory nerve block before jackknife position, highest plane of sensory nerve block in 10° group were significantly higher than those in 20° group and 30° group: T(10.47 ± 0.65) vs. T(12.36 ± 0.72) and T(12.50 ± 0.54), T(10.12 ± 0.56) vs. T(11.82 ± 0.66) and T(11.99 ± 0.72), T(9.53 ± 0.71) vs. T(11.32 ± 0.78) and T(11.54 ± 0.83), and there were statistical differences (P0.05). The systolic blood pressure and diastolic blood pressure levels 15 and 20 min after drug infusion in 10° group were significantly lower than those in 20° group and 30° group, systolic blood pressure:(120.40 ± 7.38) mmHg (1 mmHg=0.133 kPa) vs. (131.82 ± 7.88) and (130.47 ± 7.57) mmHg, (119.55 ± 7.65) mmHg vs. (131.25 ± 9.67) and (130.23 ± 8.69) mmHg, diastolic blood pressure: (63.74 ± 6.54) mmHg vs. (71.36 ± 8.49) and (74.32 ± 7.54) mmHg, (61.59 ± 6.23) mmHg vs. (72.98 ± 7.39) and (73.75 ± 6.34) mmHg, and there were statistical differences (P0.05). No patients′ anesthesia effect was poor in 3 groups, but 4 cases in 30° group were good. Hypotension and tachycardia occurred in 2 cases in 10° group, respectively. Conclusions Immediately prone position after subarachnoid anesthesia can be adjusted by reverse trendelenburg position angle to get the appropriate level of anesthesia, and conformable reverse trendelenburg position angle of PPH is 20°.
ABSTRACT
Objective To explore the safety and applicability of a temporary protective ileostomy that closes itself in the prevention of anastomotic leakage following anterior resection after chemoradiation for rectal cancer.Methods From Oct 2010 to Oct 2013,54 cases of middle or low rectal carcinoma were admitted.Protective ileostomy was created to prevent anastomotic leakage.Patients were divided into two groups receiving respectively intubation ileostomy (group A,28 cases),and conventional ileostomy (group B,26 cases).Results The mean time for anus to restore defecation was identical in the two groups.The period of protection of the anastomosis,was 21 d (15 ～ 35 d) in group A.The rate of spontaneous closure of the stoma after removal of the tube was 100％.The stoma was reduced after 3 to 6 months in group B and major complication developed in one case in this group.Conclusions Temporary ileostomy prevents anastomotic leakage of anterior resection in patients of rectal carcinoma receiving preoperative neoadjuvant chemoradiotherapy.Intubation ileostomy is effective and safe in prevention of anastomotic leakage saving stoma reduction procedures.