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BACKGROUND@#No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects.@*METHODS@#Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported.@*RESULTS@#A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001).@*CONCLUSIONS@#The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.
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Pregnancy , Female , Humans , Post-Dural Puncture Headache/epidemiology , Anesthesia, Obstetrical/adverse effects , Retrospective Studies , Punctures , Starch , Blood Patch, EpiduralABSTRACT
Objective:To evaluate the relationship between the development of postoperative delirium and sleep quality in elderly patients undergoing non-cardiac surgery.Methods:The medical records of elderly patients who underwent elective non-cardiac surgery from May 2011 to November 2013, aged ≥ 65 yr, with American Society of Anesthesiologists physical status Ⅱ or Ⅲ, were collected. The patient′s age, gender, body mass index, years of education, preoperative comorbidities, and results of the last preoperative laboratory examination; sedatives given at the night before surgery, anesthesia methods, intraoperative medication, anesthesia time, surgical time, surgical type, whether it was a malignant tumor, and intraoperative intake and output; postoperative analgesia methods, subjective sleep quality scores and postoperative delirium were collected.The patients were divided into delirium group and non-delirium group according to whether delirium occurred on the morning of 1st postoperative day and later. Multivariable logistic regression analysis was used to determine the risk factors for postoperative delirium and evaluate the relationship between postoperative delirium and sleep quality.Results:A total of 700 patients were ultimately enrolled, and 111 patients developed delirium, with an incidence of 15.9%.The results of multivariable logistic regression analysis showed that poor sleep quality on the night of surgery, advanced age, previous stroke history and postoperative intensive care unit admission of patients with catheters were risk factors for postoperative delirium ( P<0.05). Conclusions:Poor sleep quality on the night of surgery, advanced age, previous stroke history and postoperative intensive care unit admission of patients with catheters are the risk factors for postoperative delirium.
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We report two women with massive hemoptysis during late pregnancy, who gave birth to two live neonates by cesarean section under a rigid bronchoscopy-guided high-frequency jet ventilation combined with general anesthesia at 33 and 28 gestational weeks, respectively. Bronchoscopy- guided hemostasis was achieved during the operation. Postoperative bronchial arteriography and bronchial artery embolization confirmed the diagnosis of pulmonary vascular malformations. During the 12-month follow-up, no relapse of hemoptysis was observed and the two babies were healthy.
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Objective:To compare the tropism of different adeno-associated virus (AAV) serotypes in retinal cells.Methods:The plasmids pFastBacDual-inCap and pFastBacDual-ITR-CMV-EGFP were constructed for AAV packaging with the baculovirus expression system.Recombinant adeno-associated virus type 2(rAAV2), 6, 8 and 9 serotypes were packaged, and the infectivity of rAAV was evaluated by infecting HEK293T cells at multiplicity of infection(MOI)2000.Twenty-five C57BL/6 mice were divided into five groups, with five mice per group.In the three experimental groups, both eyes of each mouse were injected 1 μl rAAV intravitreally, and 1 μl phosphate buffered saline (PBS) for the eyes of the control group.Two weeks after injection, the retinal tissues were collected for preparing flat mounts and cryosections.Enhanced green fluorescent protein (EGFP) gene expression was observed via fluorescence microscopy and laser scanning confocal microscopy.The study protocol was approved by the Ethics Committee of Suzhou Institute of Biomedical Engineering and Technology.Results:The infection efficiency of the recombinant virus to HEK293T cells was rAAV2>rAAV6>rAAV8>rAAV9, and the transduction efficiency was 39.5%, 18.4%, 8.7% and 4.6%, respectively.In mouse retinal transduction, rAAV2 and rAAV6 were highly expressed in the ganglion cells, and rAAV8 and rAAV9 were highly expressed in the retinal pigment epithelium (RPE) and photoreceptor cells.rAAV2-mediated EGFP expression in retinas was stable within three months after injection.Conclusions:Different rAAV serotypes have varying tropism and transduction efficiencies in retinal cells through intravitreal injection, rAAV2 has a high transduction efficiency and it can be stably expressed in retinas within three months after injection.
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During the epidemic of coronavirus disease 2019 (COVID-19), the infection of the elderly population will bring great challenges to clinical diagnosis and treatment, outcome and management.Combined with the characteristics of anesthesia and the pathophysiological characteristics of COVID-19 on lung function impairment in elderly patients, Chinese Society of Anesthesiology formulated the " Recommendations for anesthesia management and infection control in elderly patients with COVID-19″. This recommendation expounds preoperative visit and infection control, anesthesia management protocol, anesthesia monitoring, anesthesia induction/endotracheal intubation, anesthesia maintenance and infection control, intraoperative lung protection strategy, anti-stress and anti-inflammatory management, hemodynamic optimization, infection control during emergence from anesthesia, and postoperative analgesia in elderly patients with COVID-19, and provides the reference for the safe and effective implementation of anesthesia management in elderly patients during the prevention and control of COVID-19 epidemic.
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Objective To evaluate the risk factors for intraoperative hemodynamic instability (HI) in patients with adrenal incident pheochromocytoma.Methods Perioperative clinical parameters of patients undergoing surgery for adrenal incident pheochromocytoma at the First Hospital of Peking University from January 2001 to July 2018 were analyzed.There were 39 males and 41 females,with mean age of 45.1 years (13-76 years old).The median tumor length was 5.1 cm (1.5-14.0 cm),with 25 cases (31.3％) on the left side,55 cases (68.8％) on the right side.There were 37 cases combined with coronary heart disease or diabetes or BMI≥24 kg/m2.Patients were divided into hemodynamic instability (HI group) and hemodynamic stability group (HS group) by whether intraoperative hemodynamic instability occurred.The differences of demographic characteristics and clinical parameters between the two groups were compared.Logistic regression analysis was done for seeking the risk factors for hemodynamic instability during surgery.Results There were 54 cases (67.5％) in the HS group and 26 cases (32.5％) in the HI group.Univariate analysis showed that there was no significant difference in age [(44.06 ± 13.58) years old vs.(47.35 ± 16.11) years old],combined with coronary heart disease or diabetes or BMI≥24 kg/m2 [50.0％(27/54) vs.38.5％ (10/26)],tumor long diameter [median 5.0 cm(1.5-14.0 cm) vs.6.0cm(1.5-13.5 cm)],tumor location [left:29.6％ (16/54) vs.34.6％ (9/26)],preoperative catecholamine test positive [44.4％ (20/45) vs.50.0％ (10/20)],open surgery [27.8％ (15/54) vs.34.6％ (9/26)]and preoperative non-alpha blockers[13.0％ (7/54) vs.30.8％ (8/26)] between HS group and HI group (P ＞ 0.05).Further logistic regression analysis was used to analyze the risk factors of intraoperative hemodynamic instability.Multivariate analysis found that patients who preoperative non-alpha blockers before surgery were independent risk factor for HI (OR =4.574,95 ％ CI 1.273-16.432,P =0.020).Conclusions Preoperative non-alpha blocker in patients with adrenal incidental pheochromocytoma could be independent risk factor for intraoperative hemodynamic instability.Therefore,it is recommended that patients with adrenal incidental tumors,especially those who fail to rule out pheochromocytoma,take preoperative alpha blockers.
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We reported a case of rhabdomyolysis following hemorrhagic shock caused by intractable postpartum hemorrhage. During the resuscitation, the patient was clearly diagnosed with the following manifestations, including dark urine, oliguria, significantly increased creatine kinase and positive myoglobin in both serum and urine. Acute kidney injury occurred after emergent abdominal hysterectomy. The patient was fully recovered after active anti-shock management, including a successful resuscitation, aggressive hydration, urine alkalinization, diuresis, treatment on acidosis, hyperpotassemia and hypocalcemia.
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Objective To evaluate the effect of early postoperative delirium on prognosis in the pa-tients undergoing coronary artery bypass graft in a nested case control study. Methods A total of 308 pa-tients scheduled for elective coronary artery bypass graft were divided into delirium group or non-delirium group according to whether early postoperative delirium occurred. Type of surgery (on-pump or off-pump) and difference of EuroSCORE between two cases ≤2 were considered as criteria, and patients in two groups were matched with a ratio of 1 : 1. The development of complications was observed within 28 days after op-eration. The development of complications developed after delirium was recorded in delirium group. Results The incidence of delirium was 46. 4％. The total incidence of complications, postoperative cardiac insuf-ficiency and incidence of arrhythmia were significantly higher in delirium group than in non-delirium group (P<0. 05). Conclusion Early postoperative delirium is not helpful for the prognosis in the patients under-going coronary artery bypass graft.
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Objective To evaluate the effect of early postoperative delirium on outcomes in elderly patients undergoing joint replacement.Methods Elderly patients,aged ≥ 60 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective hip or knee joint replacement,were divided into delirium group and non-delirium group according to whether the patients developed postoperative delirium.The case-matching criteria was set up with difference in age less than 5 yr and difference in Charlson comorbidity index less than 2 and with a ratio of 1 ∶ 4 for match.The development of complications was recorded within 28 days after operation.Complications happened after delirium was recorded in delirium group.Results There were 53 cases in delirium group and 212 cases in non-delirium group.There was no significant difference in preoperative baseline data or intraoperative variables between two groups (P ＞0.05).Compared with non-delirium group,the total incidence of postoperative complications was significantly increased,the incidence of postoperative cognitive dysfunction,cardiovascular complications,pulmonary complications and deep venous thrombosis was increased,and the length of hospitalization was prolonged in delirium group (P＜0.05).Conclusion Early postoperative delirium is not helpful for outcomes in elderly patients undergoing joint replacement.
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Objective To explore the risks and its influencing factors of patients with psychotic disorders in communities.Methods A total of 457 patients with psychotic disorders in communities were investigated by use of the multistage stratified cluster random sampling method.Results Totally 257 patients with psychotic disorders in communities were with risks,which accounted for 56.2％.Among them,200 patients (43.8％) were with level-0 risk,113 patients (24.7％) were level-1 risk,85 patients (18.6％) were level-2 risk,43 patients (9.4％) were level-3 risk,11 patients (2.4％) were level-4 risk,while 5 patients (1.1％) were level-5 risk.There were significant differences in risks among patients with different gender,family income,duration,type of disease,medication and the history of violent behavior.Logistic regression analysis showed that low family income (OR=0.515,95％ CI=0.386-0.689,P＜0.01),long course of disease (OR=1.378,95％CI=1.179-1.609,P＜0.01),patients with schizophrenia (OR=6.285,95％CI=2.456-16.086,P＜ 0.01) and patients with a history of violence history (OR=28.988,95％CI=10.692-78.592,P＜0.01) were the risk factors of the influencing of patients with psychotic disorders in communities.Conclusions Low family income,long course of disease,patients with schizophrenia and a history of violence history are the influencing factors of patients with psychotic disorders in communities,and the management of follow-up and the strength of supervision among these patients should be reinforced.
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Objective To investigate whether preset epidural catheter and individualized onset time could improve the effect of epidural labor analgesia.Methods This was an open-label,random-ized,controlled trial.The nulliparae aged from 18 to 35 years,with single cephalic term pregnancy, were randomized into two groups.In the individualized group,epidural catheterization was performed at the beginning of labor (emergence of regular contractions and nearly disappearance of cervix),and epidural analgesia was initiated when asked by parturients and the numeric rating scale (NRS,a verbal rating score from 0 to 10 for pain,in which 0 represented no pain and 10 the worst pain imagi-nable)pain score ≥ 5 .In the control group,epidural analgesia was initiated at cervical dilation of≥ 1 cm.The primary outcome measures were the most severe NRS pain score during labor and the pro-portion of the most severe NRS pain score ≥ 7 evaluated at 24 hours after delivery.Results A total of 194 parturients completed the study,among whom 97 were in the individualized group and 97 in the control group.The most severe labor pain score during labor [median 9 (IQR 8-10)in the individ-ualized group vs 9 (8-10)in the control group,P=0.201]and the proportion having the most severe pain score ≥ 7 [94 cases (96.9%)in the individualized group vs 89 cases (91.8%)in the control group,P=0.1 2 1 ]did not differ significantly between the two groups.There were no significant differences of adverse events between the two groups.Conclusion For the nulliparae with single ce-phalic term pregnancy suitable for vaginal delivery, the effects of individualized epidural labor analgesia are comparable to that of traditional analgesia (beginning at cervical dilation of ≥ 1 cm). The individualized analgesia is safe.
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Objective To investigate the value of CT taking WO3-x@BSA nanoparticles as contrast agents.Methods CT values of WO3-x@BSA nanoparticles and the iohexol contrast agents at different concentrations were measured.When the tube voltage was the same,CT values of the tungsten at different concentrations were measured,and the relationship curve of CT values and the concentrations,the tube voltages and CT values were plotted.The animal models were performed to observe CT imaging in vivo and in vitro.WO3-x@BSA nanoparticles were injected through tail vein and intraperitoneally of rats in vivo.In fresh pig liver,WO3-x@BSA nanoparticles were injected by portal vein.Results CT value of the tungsten was higher than the iodine at the same concentration,and the imaging signal of the tungsten was more significant than the iodine.The amount of WO3-x@BSA was less than the iohexol contrast agent reaching to the same CT value.WO3-x@BSA nanoparticles could reach the organs of various tissues in SD rats through different ways and showing the high density sig nal.WO3-x@BSA nanoparticles were also injected into the fresh in-vitro liver of pig,and could diffuse and distribute along with the blood vessels with good CT imaging.Conclusion As a novel CT contrast agent,WO3-x@BSA nanoparticles can be used to get good CT imaging.
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Objective To investigate the value of CT taking WO3-x@BSA nanoparticles as contrast agents.Methods CT values of WO3-x@BSA nanoparticles and the iohexol contrast agents at different concentrations were measured.When the tube voltage was the same,CT values of the tungsten at different concentrations were measured,and the relationship curve of CT values and the concentrations,the tube voltages and CT values were plotted.The animal models were performed to observe CT imaging in vivo and in vitro.WO3-x@BSA nanoparticles were injected through tail vein and intraperitoneally of rats in vivo.In fresh pig liver,WO3-x@BSA nanoparticles were injected by portal vein.Results CT value of the tungsten was higher than the iodine at the same concentration,and the imaging signal of the tungsten was more significant than the iodine.The amount of WO3-x@BSA was less than the iohexol contrast agent reaching to the same CT value.WO3-x@BSA nanoparticles could reach the organs of various tissues in SD rats through different ways and showing the high density sig nal.WO3-x@BSA nanoparticles were also injected into the fresh in-vitro liver of pig,and could diffuse and distribute along with the blood vessels with good CT imaging.Conclusion As a novel CT contrast agent,WO3-x@BSA nanoparticles can be used to get good CT imaging.
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Objective To investigate the effect of the different phases of menstrual cycle on the incidence of post-operative nausea and vomiting (PONV)after laparoscopic gynecological surger-ies.Methods A total of 228 women undergoing laparoscopic gynecological surgeries were enrolled from Mar 2016 to Feb 2017 in our hospital.They were classified into three groups according to the different phases of menstrual cycle at the time of surgeries:group follicular phase (n =98),group o-vulatory phase (n =79),and group luteal phase (n =59).The incidence of PONV and the use of res-cue antiemetic drugs were recorded within 0-2 h,0-24 h periods after surgeries.Multivariate Logistic regression analysis was applied to identify independent risk factors of PONV.Results The incidence of 0-2 h PONV and 0-24 h PONV were 23.2% (53/228)and 54.8% (125/228)respectively.Univa-riate analysis showed that the incidence of PONV in the different phases of menstrual cycle was not statistically significant,as well as 0-24 h.Multivariate logistic regression analysis showed that the risk of 0-2 h PONV in group luteal phase might be higher than that in group follicular phase,however, the difference was not statistically significant (OR =2.289,95%CI 0.979-5.355,P =0.056).And two independent risk factors of 0-2 h PONV were identified:duration of operation > 1 h (OR =3.176,95% CI 1.567-6.436,P = 0.001 )and history of PONV (OR = 5.711,95% CI 1.710-19.080,P =0.005).Three independent risk factors of 0-24 h PONV were identified:duration of op-eration>1 h (OR = 2.714,95%CI 1.525-4.829,P = 0.001 ),postoperative PCA (OR = 2.717, 95%CI 1.233-5.986,P = 0.013 )and application of metronidazole (OR = 3.926,95%CI 1.808-8.527,P =0.001).Conclusion There was no significant effect of different phases of menstrual cycle on the incidence of nausea and vomiting after gynecologic laparoscopic surgeries.
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Objective:To estimate the safety and feasibility of flexible laryngeal mask airway (FLMA) for lumbar vertebral surgery in prone position.Methods: In the study,120 adult patients scheduled for lumbar vertebral surgery under intravenous general anesthesia were divided into group FLMA and reinforced tracheal tube (RTT) group at random.Heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at the beginning of anesthesia induction (T0) and on the time of artificial airway intubation (T1),1 min after intubation (T2),extubation (T3),1 min after extubation (T4) as well.The number and time required for intubation were recorded.Peak airway pressure (PPEAK),airway sealing pressure (PAS) in group FLMA and fiberoptic bronchoscopy scale (FBS) were recorded after artificial airway intubation,turned over into prone position and after the operation started,as well as on the time of 1 hour after the operation started,2 hours after operation started and when the operation stopped.Finally,respiratory complications after extubation,including hypoxemia,laryngospasm,coughing,vomiting,hoarseness,and pharyngalgia,were observed and whether there was blood or sewage inside and outside the artificial airway was recorded.Results: There was no difference in the number and time required for intubation between the two groups (P>0.05).There was no difference in PPEAK and FBS between the two groups,and also the same at the different time points in each group (P>0.05).PAS in group FLMA was the same at the diverse time points during anesthesia (P>0.05) and always higher than PPEAK in the perioperative period.In group FLMA,there was no difference in HR,SBP and DBP between the time points of T2 and T1,also of T4 and T3 (P>0.05).In group RTT,HR,SBP and DBP were significantly higher between the time points of T2 and T1 (P0.05) while no laryngospasm and sewage seen outside the artificial airway in each group.Conclusion: For suitable patients,FLMA can be used in mechanical ventilation forlumbar vertebral surgery in prone position with more stable circulation and less respiratory complications than RTT.Further clinical validation is needed for the safety of FLMA.
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Objective To investigate the relationship between preoperative albumin level and postoperative acute kidney injury(AKI)following off-pump coronary artery bypass(OPCAB)surgery;to confirm albumin cut-off value associated with AKI. Method This was a retrospective cohort study. data from patients who accepted OPCAB surgery in last two years in our hospital and AKI was diagnosed according to KIDGO-AKI criteria. Results Generalized additive model and multivariable logistic regression analysis have shown that the higher preoperative albumin level is related with the lower the incidence of AKI after OPCAB surgery. By generalized additive model,multivariable logistic regression analysis and ROC curve,we confirmed the albumin cut-off value associated with AKI between 39~40 g/L. Conclusion For patients undergoing OPCAB surgery,the higher preoperative albumin level ,the lower the incidence of AKI. In order to reduce the incidence of AKI in OPCAB surgery patients,preoperative albumin level higher than 40 g/L should be maintained.
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Objective To investigate the effect of small dose of dexmedetomidine on the development of postoperative nausea and vomiting in the patients undergoing laparoscopic gynecologic surgery.Methods A total of 207 patients,aged 18-60 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic gynecologic surgery under general anesthesia,were randomly divided into either dexmedetomidine group (group D,n=103) or control group (group C,n=104) using a random number table.Before induction of anesthesia,dexmedetomidine 0.1 μg/kg was injected intravenously over 1 min in group D,while the equal volume of normal saline was given instead in group C.At 20 min before the end of surgery,dexmedetomidine 0.04 μg/kg was injected intravenously over 30 s in group D.For the patients requiring patient-controlled analgesia (PCA),PCA solution contained sufentanil 125 μg in 125 ml of normal saline.The PCA pump was set up with a 2 ml bolus dose,a 8 min lockout interval and background infusion at a rate of 1 ml/h.Pethidine was used for PCA after surgery in the patients who did not require PCA.Numeric rating scale scores were maintained ＜4 after surgery.Sufentanil 3 μg was injected intravenously as rescue analgesic in postanaesthesia care unit (PACU).The occurrence of nausea and vomiting was recorded within 0-1 h,1-6 h,6-12 h,and 12-24 h periods after surgery.The occurrence of hypotension and bradycardia during surgery,emergence time,Ramsay sedation score on admission to PACU,requirement for sufentanil as rescue analgesic in PACU,requirement for PCA and antiemetics,and occurrence of somnolence and shivering were recorded.Results Pethidine was not given in the patients who did not require PCA in the two groups.Somnolence and shivering were not found in the two groups.Compared with group C,the incidence of bradycardia was significantly increased,the requirement for antiemetics in PACU and incidence of nausea and vomiting within 1 h after surgery were significantly decreased (P＜0.05),and no significant change was found in the emergence time,Ramsay sedation score,requirement for sufentanil as rescue analgesic,requirement for PCA and total incidence of postsurgical nausea and vomiting in group D (P＞0.05).Conclusion For the patients undergoing laparoscopic gynecologic surgery,small dose of dexmedetomedine can only decrease the development of nausea and vomiting in the early postsurgical period (in PACU),and does not influence the recovery from anesthesia.
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Objective:To evaluate the effect of intraoperative dexmedetomidine (DEX)infusion during propofol intravenous anesthesia on postoperative recovery after major spinal surgery.Methods:Sixty pa-tients aged 1 8 to 65 (American Society of Anesthesiologists,ASA Ⅰ -Ⅱ),scheduled for spinal surgery from January 201 4 to May 201 4 were randomized into two groups.The DEX group (n =30)received 0.5 μg/kg of DEX ten minutes before anesthesic induction,followed by an infusion of DEX at 0.2 μg/(kg·h)intraoperatively and the control group (n =30)was given identical amounts of normal saline. At the end of surgery,the patients of both groups received patient-controlled intravenous analgesia (PCIA)with morphine 0.5 mg/h (1 mg demand dose and 8 min lockout).Heart rate and mean arterial pressure (MAP) were continually monitored during operation and in the post-anesthesia care unit (PACU).The propofol and sufentanil consumptions during operation and the morphine consumption 48 h after surgery were recorded.The time for recovery and extubation were recorded.The followed-up evalua-tions were performed to assess Ramsay scores,visual analogue scale (VAS)pain scores as well as side effects in PACU and 48 h after surgery.Results:Heart rate of DEX group was lower than that of control group after intubation and extubation and in PACU 1 0 min (P <0.05).MAP was lower in DEX group than that in control group after extubation and in PACU (P <0.05).Compared with control group,the propofol consumption during anesthesic induction,the sufentanil consumption during operation and the cumulative consumption of morphine 2 h and 6 h after surgery were decreased (P <0.05).There were no differences between the two groups as to the time for recovery or extubation.Compared with control group,the VAS pain scores were significantly decreased (P <0.01 ),the incidence of postoperative nau-sea and vomiting in DEX group were significantly decreased (P <0.05)48 h after surgery.Conclusion:Intraoperative infusion of DEX improved quality of recovery,provided good analgesia,and decreased morphine use and the incidence of postoperative nausea and vomiting after major spinal surgery.
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The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: ① the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; ② light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; ③ light sedation strategies and pain, agitation, delirium control bundles; ④ the problems and prospects of light sedation. Light sedation is the main principle of currently ICU sedation strategy in critically ill adult patients. Goal-directed light sedation should be considered as a routine therapy in most clinical situation, and its goal should be achieved as early as possible in the early stage of sedation. Routine use of benzodiazepines should be avoided, especially in patients with or at a risk of delirium. Prevention and treatment of agitation with a combination of non-pharmacologic or pharmacologic methods; ICU specification rules for pain, agitation and delirium prevention and treatment should be made. Light sedation is the main ICU sedation strategy in adult patients now, but must be individualized for each patient.
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Objective To identify the association between body temperature and neurological outcome in post-arrest patients.Methods This was a multicenter,retrospective cohort study.In the period 1990-2011,a total of 184 patients resuscitated from IHCA with ROSC for more than 20 min were included.Data were collected according to Utstein style.The primary endpoint was hospital dis-charge with good neurological function (Cerebral Performance Category,CPC,1-2).Multivariate Lo-gistic regression was performed to determine the association between body temperature and neurologi-cal outcome.Results Among the 184 enrolled patients,37.0% (68/184)survived to hospital dis-charge,19.6% (36/184)survived to discharge with favorable neurological outcome(CPC,1-2).Mul-tivariate Logistic regression revealed that maximal body temperature between 35.5℃ and 38.4℃ was associated with favorable neurological outcomes (OR=8.986,95% CI 1.156-69.882;P =0.036). Conclusion For IHCA patients achieving spontaneous circulation, maximal body temperature between 35.5℃ and 38.4℃ in the initial 24 h following admission to ICU was associated with favora-ble neurological outcome.