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Objective:To summarize the experience of respiratory management in 20 cases of fetuses diagnosed with prenatal malformations undergoing ex utero intrapartum treatment (EXIT) surgery.Methods:From 2016 to 2018, 20 cases of fetuses undergoing EXIT surgery were admitted to our hospital, including five cases of maxillofacial lymphangioma, four cases of cervical teratoma, three cases of lung cystadenoma, five cases of pleural effusion, and three cases of isolated lung.The fetal anesthesia was through maternal anesthesia.After the fetal head was delivered, the placental circulation was maintained.All cases were established with artificial laryngoscopy by visual laryngoscopy and tracheal intubation.The blood oxygen saturation and heart rate of the fetuses were recorded before and after intubation.After successful intubation, the umbilical cord was broken and the fetal arterial blood gas was drawn.Immediately, the neonatal surgery was performed in the delivery room, with 3 to 5 cmH 2O(1 cmH 2O=0.098 kPa) PEEP for respiratory support, and blood gas analysis during the operation were collected.After surgery, newborns were transferred to NICU. Results:(1) The 20 cases of fetal anesthesia under placenta maintenance, maternal 1.5 MAC sevoflurane inhalation anesthesia with remifentanil pumping, fetal oxygen saturation can be maintained at (51.5±4.7)%, fetal heart rate (155.3± 11.34) times/min; (2) The completion time of tracheal intubation of 20 fetuses was (24.20±3.43)s, the time of glottal exposure was (3.20 ±1.12)s, and the success rate of one intubation was 90% (18/20), of which two cases were exposed to glottis difficult, successful after two tracheal intubation; (3) The use of 3 to 5 cmH 2O PEEP to support the high-frequency positive pressure ventilation mode can provide good oxygenation[SpO 2 (92.10±3.34)%] during the neonatal surgery, the length of hospital stay of the fetus was (15.0±3.2) d, and ventilator duration time was (3.0±1.2) d. Postoperative complications included four cases of pneumonia and two cases of atelectasis. Conclusion:(1) Avoiding excessive deep anesthesia of mother, maintain the placental circulation effectively, providing good oxygenation before artificial airway establishment and providing effective anesthesia for the fetus are important in EXIT; (2) The visual laryngoscope shortens the intubation time, and the glottis is well exposed, which can increase the oxygenation index of the newborn after the umbilical cord is broken; (3) The high-frequency ventilation mode supported by PEEP can provide good oxygenation for newborns during surgery.
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Objective To investigate the effect of bilateral cervical vagotomy on microglial activation in spinal cord in a rat model of persistent postoperative pain evoked by skin/muscle incision and retraction (SMIR).Methods Thirty six male Sprague-Dawley rats were randomly divided into three groups (n =12 each group):group sham operation,group SMIR,and group SMIR + bilateral cervical vagotomy (SV).The rat model of persistent postoperative pain evoked by SMIR was established according to the method described by Flatter.Pain behavior was assessed by paw mechanical withdrawalthreshold (MWT) to yon Frey filament stimulation at 1,3,and 5 days after operation.Four animals were sacrificed at each time point in each group to detect the expression of Iba-I (a specific marker of microglia) in the spinal dorsal horn with immunofluorescence and the microglia was counted.Results MWT was significantly decreased atT1-5 in SMIR and SV (10.3 ±0.6,9.7 ±0.8,9.6 ±0.5; 8.0 ±0.7,7.7 ±0.4,7.6 ± 0.3),while the expression of Iba-1 and microglia counts in the spinal dorsal horn were significantly in-creased at T1-5 in SMIR and SV (1428 ± 134,1245 ± 129,and 1001 ± 117 ;8.0 ± 0.7,7.7 ± 0.4,and 7.6 ±0.3; 187 ± 13,164 ± 11,and 142 ± 14;and 241 ±21,230 ±21,and 202 ± 19).In group SV as compared to group SMIR,MWT was significantly decreased at T1-5,while the expression of Iba-1 and microglia counts in the spinal dorsal horn were significantly increased at T1-5.Conclusions Vagus nerve plays an important role in microglial activation in spinal cord in a rat model of persistent postoperative pain evoked by skin/muscle incision and retraction.
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Objective To investigate effects of two doses of dexmedetomidine (Dex) on the recovery quality from general anesthesia undergoing thyroidectomy.Methods A prospective randomized controlled double-blind trial was conducted in 90 patients admitted to Shengjing Hospital of China Medical University who were scheduled for thyroidectomy.They were randomly divided into three groups:group D0.4 received Dex 0.4 μg/kg intravenously,group D0.8 received Dex 0.8 μg/kg intravenously,and control group with same volume of normal saline.There were 30 patients in each group,and all the patients received the above drug or saline 30 minutes after intubation.The heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded before Dex administration,at the end of surgery,time of eye opening and extubation,and 10 minutes after extubation.Time of eye opening after surgery and time of extubation after eye opening were recorded.End-tidal partial pressure of carbon dioxide (PETCO2) before and after operation as well as restlessness score (RS),Ramsay sedative score,and visual analogue pain scale (VAS) scores at 10 minutes after extubation were recorded.Events during extubation including cough,nausea and vomiting,respiratory depression were also recorded.Results ① Compared with control group,in D0.4 and D0.8 groups incidence of lowering of HR,SBP and DBP was lower at time of eye opening and extubation,and 10 minutes after extubation.Compared with D0.4 group,D0.8 group had lower HR at the time of extubation and 10 minutes after extubation,SBP was lower at the time of eye opening and extubation,and lower DBP at the time of eye opening.② D0.4 and D0.8 groups showed lower RS and VAS scores than those of control group,Ramsay sedative score in groups D0.4 and D0.8 was higher than that in control group (RS:1.40±0.51,1.20±0.42 vs.1.90±0.56; VAS:1.50±0.52,0.80±0.63 vs.2.50 ± 0.52; Ramsay:2.10 ± 0.56,2.40 ± 0.51 vs.1.60 ± 0.51,P＜0.05 or P＜0.01),and VAS score in group D0.8 was lower than that in D0.4 group (P＜0.01).The time of eye opening and extubation were longer in group D0.8 as compared with those in control and D0.4 groups (minutes:12.50 ± 1.08 vs.10.50 ± 1.58,10.40 ± 1.26; 15.00 ± 0.94 vs.13.00 ± 1.63,12.80 ± 1.13,P＜0.05 or P＜0.01),but there was no significant difference between the latter two groups.No significant difference in PETCO2 was found among three groups before and after surgery.③ The incidence rate of cough,nausea and vomiting in control group (16.7％,13.3％) were significantly higher than those in groups D0.4 (3.3％,0) and D0.8 (0,0).There was no respiratory depression in the three groups.Conclusion Adjunctive infusion of Dex 0.4 μg/kg at 30 minutes after anesthesia induction was recommended as it may result in more steady hemodynamics,with shorter recovery time and extubation time after thyroidectomy.
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Objective To explore the regulatory roles of butorphanol on isolated rabbit pulmonary arteries by lipopolysaccharide(LPS)pre-incubation and assay the protective effect of ketamine on clinic sep tic shock patients.Methods Vascular ring tension detection technique was applied to observe the effect of butorphanol on the normal or lipopolysaccharide incubated pulmonaryvascular.Results In normal group, the final concentration of butorphanol(0.1 μmol,1μmol,10μmol,100μmol)were used to make pretreat ment- phenylephrine(PE)pulmonary artery relaxation.In LPS group,the effect of vasodilation of butor phanol was enhanced.Conclusions LPS can enhance the effect of butorphanol on pulmonary artery relaxa tion reaction.And the direct effect of butorphanol on pulmonary arteries was vasodilation.
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Objective To investigate the effect and mechanism of low-dose remifentanil(RF)on systemic artery tension of baby rabbit with septic shock.Methods Thirty-six systemic artery strips were prepared from 12 baby rabbits and randomly divided into 6 groups:control group,lipopoly-saccharide(LPS)group,RF group,LPS + RF group,NG-nitro-L-arginine(L-NNA)pretreated group,LPS + L-NNA pretreated group.Each group had six rings(n =6).The effect of low-dose RF on the systemic artery tension of baby rabbit with septic shock was observed with isolated vascular ring technique.The change was also obversed after L-NNA pretreatment.Results In control group:the relaxant rates after low-dose RF at the time point of 5 min,10 min,20 min were(18.48±3.96)％,(23.63±4.42)％,(28.33±3.73)％(P＜0.05),compared with NS group.After pretreatment with L-NNA,RF-related relaxant rates of systemic arteries decreased significantly to(8.15 ± 1.01)％,(13.08 ± 1.46)％,(18.54 ±2.94)％(P ＜ 0.05).In LPS group,low dose RF(4 μg/L)did not bring out any response to systemic arteries(P ＞0.05).The tension was not affected with pretreatment of L-NNA(P ＞ 0.05).Conclusion These results suggest that low dose RF has relaxant effect on systemic arteries of baby rabbits,and NO may be involved.Low dose RF has no relaxant effect on LPS-pretreated systemic arteries of baby rabbits,and it has no association with NO.