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Teaching ward round is an important guarantee to improve the training quality. The purpose and content of anesthesiology teaching ward round are different from clinical surgical teaching ward round, and it has its own characteristics. According to the rule of perioperative medicine, we can complete the teaching ward round with small plate and multi-segment teaching mode on the clinical anesthesia management related issues of various surgical patients involved in anesthesia major or sub specialty. In this paper, the methods of anesthesiology teaching ward round, including the formulation of teaching plan, teacher arrangement, preparation before ward round, ward round process and teaching methods, quality control, and teaching experiences were briefly introduced.
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In order to better match the teaching hours of clinical anesthesiology with the teaching content of modem anesthesia, the teachers must take full advantage of various supplementary teaching methods in the limited teaching hours to help enhance the students' enthusiasm in active learning, help the students concentrate on the crucial points and apply their knowledge and ultimately improve the teaching quality.
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Objective To investigate the preventive effect of low molecular weight heparin or tranexamic acid in the rabbits with hypercoagulation induced by impact injury and intravenous infusion of the endotoxin. Methods Combination of impact injury and endotoxin was created by strike on rabbit chest with type BIM-Ⅱ biological impact machine and injection of endotoxin via vein.Thirty-two male New Zealand rabbits were divided into four groups in a completely random design as follows:impact injury combined with endotoxin without treatment group(control group),treatment with low molecular weight heparin(L group),treatment with tranexamic acid(TA group),and treatment with low molecular weight heparin and tranexamie acid(L+TA group).The changes of interleukin-1β(IL-1β)and interleukin-6(IL-6)were observed by using the enzyme-linked immunosorbent assay;changes of antithrombin-Ⅲ(AT-Ⅲ)activity,tissue factor(TF)and tissue factor pathway inhibitors(TFPI)were detected by the chromogenic substrate method chromozym P:the content of fibrinogen was observed by coagulation analyzer.The lung and kidney were removed from the experimental animals at 24 hours post impact injury forhistopathologic observation. Results In the control group,the activity of AT-Ⅲ was decreased obviously.while the content of fibrinogen and the activity of TF and TFPl were increased,with formation of the thrombosis in the kidney after injection of PLS.Compared with control group,the activity of TF and the content of IL-1β and IL-6 were reduced but the TFPI was increased in the L group,which resulted in a decrease of TF/TFPI ratio.with decrease of formation of the micro-thrombosis in the organs.The content of IL-1β and IL-6 in the TA group were reduced,which was still higher than that in tIle L group.In the TA group.the activity of IF and TFPI Was lower than that in the L group and control group,with higher TF/TFPI ratio than the L group.The frequency of thrombosis increased in pulmonary artery and other important organs.The content of IL-1β and IL-6 in the L+TA group wag lower than that in the L group.In the L+TA group.the activity ofTF was lower than that inthe L group and control group,but the activity of TFPI was higher than that in the L group and control group.with lower TF/TFPI ratio than the L group.There found no increase of thrombus in the pulmonary arterial and other important organs. Conclusions Besides anticoagulation function,the low molecular weight heparin can inhibit the inflanunation reaction,reduce the release of TF and attenuate the coagulation reaction.On the basis of treatment with low molecular weight heparin,application of the tranexamic acid will not lead to the formation of thrombus,but the only use of the tranexamic acid would have the contrary results.The rtsults of the study provide a theoretical and experimental basis for clinical diagnosis and prevention of hypercoagulation induced by injury and infection.
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Objective To analyze the anesthetic methods and surgical procedures in the treatment of inpatients in N 2 People' s Hospital of Deyang after Wenchuan earthquake. Methods More than 900 patients were sorted for injury triage, among whom 83 patients received emergency surgery within 72 hours after earthquake, and 21 received surgery after 72 hours. After 10 days of the earthquake, the hospitalized patients needing further surgery have been transferred to hospitals in safe regions. Of all patients, 89 (85.58%) were with injuries of extremities, 11 (10.6%) with cerebral trauma, 3 with thoracic injury, and 1 (1.0%) with abdominal trauma. Perioperative noninvasive blood pressure, electrocardiogram, pulse and oxygen saturation were detected during the surgery. All patients were cured except that one patient with traumatic flail chest died 12 hours after the surgery. Results Of all patients undergone surgeries, 35 patients (33.7%) received combined spinal-epidural anesthesia (CSEA), 33 (31.7%) received nerve plexus block (NPB), 5 (4.8%) had CSEA plus NPB, 28 were under general anesthesia (GA) [17 (16.3%) were intubated and 11(10.6%) were non-intubated] and 3 (2.8%) received monitored anesthesia care (MAC). The average ratios of operation time to time for patients stayed in operation room were (51.29±12.38)% in GA group, (53.24±11.39)% in NPB group, (58.43±9.26)% in CSEA group and (77.15±9.27)% in CSEA plus NPB group. There was a significant difference between CSEA + NPB group and the other three groups (P<0.01), and there was no significant difference among GA group, NPB group and CSEA group (P > 0.05). Conclusions During the initial period of rescue, the most common type of injuries are fractures. CSEA plus NPB is encouraged to use as they have the advantages of shorter operation time, higher operation throughput, safety and faster convalescence of the victims.
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0 01) in the two groups were significantly different Conclusion After CPR in non hemorrhagic CA, quick infusion of polyglucose and sodium chloride solution is beneficial to the recovery of erythrocyte rheological parameters before CPR
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Objective To study the influence and mechanism of seawater immersion on endothelial cell injury sustained by burn firearm combined injury to improve the early therapeutic efficacy. Methods The dogs with burn firearm combined injury were randomly divided into two groups: immersion group and control group. In immersion group, the dogs were immersed in seawater for 4 hours, then taken out from seawater. Blood samples were collected from central vein at 4 h, 7 h, 10 h, 20 h and 28 h following wound for the detection of changes of the circulating endothelial cells (CEC) and von Willebrand Factor (vWF). The same procedures except immersion were performed in the control group. Results The levels of CEC and vWF elevated at 4 h and 7 h following wound in control group( P
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Objective To study the correlation between early cognitive function and severity of pain in elderly patients after operation. Methods Selective open abdominal operation was performed in 30 elderly patients admitted to our department from January 2009 to June 2009. Severity of pain was assessed using visual analogue scale ( VAS) and cognitive function was scored with Mini-Mental State Examination ( MMSE) ,animal fluency test ( AFT) and clock drawing test ( CDT) ,respectively,in 24 and 48 h after operation. Cognitive function of the patients was assessed from the view of neurophysiology. Pain was scored after operation with VAS. Variables were analyzed with the linear correlation analysis. Correlation between early cognitive function and severity of pain in elderly patients was observed after operation. Results No linear correlation was observed between scores on MMSE,VAS and AFT scales in 24 and 48 h after operation ( r = -0. 053,P = 0. 786; and r = -0. 052,P = 0. 783; and r = -0. 323,P = 0. 082; and r = -0. 038,P = 0. 841). A negative linear correlation was found between scores on CDT and VAS scales in 24 and 48 h after operation ( r = -0. 731,P =0. 000; and r = -0. 636,P = 0. 001). Conclusion Cognitive function including visual space structure function and implementing function in elderly patients after operation is correlated with the pain scores on VAS scale.
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Objective To investigate the effect of ondansetron on the development of neuropathic pain in rats following chronic constriction injury (CCI) on sciatic nerve. Methods This research consisted of 3 parts. ①A single bolus of ondansetron was given intraperitoneally 2 h before nerve injury; ②A single bolus of ondansetron was given intraperitoneally on the 7th day after nerve injury; ③Continuous administration of ondansetron was given daily for 35 d; In each part, male SD rats were randomly divided into ondansetron group (0.5, 2, 8 mg/kg), saline group and sham operated group. The paw withdrawal response to thermal stimulation was tested throughout the 35 d following nerve injury. Results Ondansetron administration before nerve injury had no effect on thermal pain threshold in rats of experimental neuropathic pain. ondansetron administration on the 7th day after nerve injury attenuated the descending of thermal pain threshold but did not alter its descending trend in subsequent time period. Daily administration of ondansetron for 35 d attenuated and further delayed the descending of thermal pain threshold significantly in a dose-dependent manner. Conclusion Continuous administration of ondansetron can prevent or at least delay the descending of thermal pain threshold of rats with experimental neuropathic pain after constriction injury.
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Objective To study the coagulation of patients with lung cancer or esophagus cancer in thoracotomy during perioperative period.Methods Variables [reaction time(R),clotting time(K),? angle,maximum amplitude(MA)]detected by thrombelastography were measured in 10 cases of lung cancer and 10 cases of upper or median esophagus cancer before anesthesia(T0),at the end of 1 h after operation beginning(T1)and 30 min after operation(T2).The control group consisted of 10 healthy volunteers.Results In lung cancer group and esophagus cancer group,R was shorter than control group(P
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Objective To investigate whether preemptive intrathecal administration of CRH has an antinociceptive efficacy on inflammatory pain model rats. Methods The antinociceptive efficacy of preemptive intrathecal administration of CRH was evaluated by the flinch-licking time and the tail flicking latency in formalin-subjected pain model rats. The c-fos gene expression in spinal cord dorsal horn was analyzed by immunohistochemical technique and computer image technique. Results Comparing with NS control group, preemptive intrathecal administration of 0.5 ?g CRH could markedly inhibit the phase Ⅱpain reaction and meanwhile decrease c-fos gene expression by 25.02% in the superficial lamella of spinal cord dorsal horn of the model rats. The antinociceptive efficacy could be counteracted by preemptive intraperitoneal injection of CP-154526 (the specific antibody of CRHR1, 10 mg/kg). Conclusion CRH could significantly inhibit pain reaction and spinal cord c-fos gene expression, and thereby preemptive intrathecal administration of CRH will contribute to the antinociceptive efficacy because of its potency of inhibiting hyperalgesia.
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Objective To assess the changes of coagulation and fibinolysis in patients undergoing thoracotomy. Methods Forty patients undergoing thoracotomy were enrolled into this trial. The venous blood were collected for normal coagulable function test at the following time points: before surgery, at 3 h after the beginning of surgery, at 1 d and 3 d after surgery. Results PT, APTT levels had no obvious change. Compared with before and during surgery, FG levels decreased obviously at 1 d and 3 d after surgery. TEG showed the value of R and K increased during and after surgery and value of MA decreased during and 1 d after surgery, but they had no significance in statistics. CI decreased significantly during and after surgery as compared with before surgery(P
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Objective To investigate the effect of cardiopulmonary bypass (CPB) on vascular endothelial cell injury and plasma endothelin-1 and nitric oxide equilibrium in patients undergoing cardiovascular operation with CPB. Methods A total of 20 patients with congenital heart disease (Group Ⅰ) and 20 with valvular problem (group Ⅱ) were operated on under CPB respectively. Blood samples were collected from central vein before skin incision, before CPB, 30 min after CPB, at the end of CPB, and end of operation, the first morning and third morning after operation. The levels of plasma thrombomodulin(TM), endothelin-1(ET-1) and nitric oxide(NO) were measured. Results The plasma TM level was significantly elevated during CPB (P<0.01, P<0.05) and 1 d after operation, reached its peak as (4.88±1.12) ng/ml in Group Ⅰand (8.34±1.84) ng/ml in group Ⅱ at the end of surgery and came back to the level as before operation. The plasma level of ET-1 was also increased significantly after CPB and reached peak as (129.04±22.29) in Group Ⅰ and (156.62±29.66) in Group Ⅱ at the end of operation. And the level was still higher than before operation in 2 groups 3 d after operation. No change was found on the level of NO in 2 groups. Conclusion CPB may cause extensive acute endothelial cells damage for about 24-48 h and recovered about 72 h and it may also cause an imbalance of ET-1 and NO.
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Objective To investigate the effect of hydroxyl starch (HES 200/0 5) infusion on blood rheology during operation Methods Forty adult ASA Ⅰ Ⅱ patients (male 28, female 12) scheduled for elective operation on spine (26 patients) and lower extremities (14 patients) were enrolled in this study The age ranged from 18 56 yr and weight from 40 85kg Preoperative heart, lung, liver and kidney function tests, blood routine exam, bleeding and coagulation time were all normal No patients had any history of abnormal bleeding The patients were randomly divided into two equal groups: control group(C) receiving lactated Ringer solution 1 000ml during operation and HES group receiving 6% HES 1 000ml No patient received any plasma or whole blood during operation The patients were premedicated with intramuscular atropine 0 5mg and sodium luminal 0 1g The operations were all performed under continuous epidural block (1 6% lidocaine with adrenaline 1:200 000) BP,ECG,and SpO 2 were continuously monitored during operation Blood pressure was maintained with range and SpO 2 above 97% Venuos blood samples were taken before anesthesia , 30min and 4h after the fluid had been infused and 24h after operation for determination of blood viscosity, plasma viscosity, hematocrit(HCT) index of red blood cell (RBC) aggregation and deformation and index of fibrinogen Results Blood viscosity, Hct, index of RBC aggregation and fibrinogen decreased significantly (P
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Objective To investigate the changes in counts of T-lymphocyte subsets, natural killer cell (NK cell) and the levels of serum soluble interleukin-2 receptor(sIL-2R) after perioperative allogeneic whole-blood transfusion or erythrocyte suspention (SAG-M blood) blood transfusion. Methods Thirty patients undergoing elective refection for rectal cancer, were randomly allocated to receiving 400 ml of allogeneic whole-blood (n = 15 ) or 400 ml of SAG-M blood (n = 15 ) during perioperative period, respectively. Indirect immunofluorescence technique and enzyme-linked immunosorbent assay were used to determine the counts of T--lymphocyte subsets, NK cells and to detect levels of serum sIL-2R 1 day and 5 day after operation.Results The counts of CD3 +, CD. + and NK cells in both groups decreased significantly after operation (P
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Objective: To observe the influences of infusing small volume of 7.5% NaCl solution (HS) in vivo,and the different volume ratio of plasm of rich platelets (PRP) to HS or sucrose in vitro on the function of platelet. Method:Twenty-nine patients undergoing middle or small operation were divided randomly into HS group and normal saline group(NS). Blood samples were taken before infusion and,5,30,60 and 120 min after infusion,to measure hematocrit (HCT),platelets (PLT) count, maximum aggression rate (MAR),thromboxance B_2(TXB_2),granule membrane protein-140(GMP-140) and platelet factor 3 activety (PF_(3a)T). In addition,fifteen blood samples of blood donors were taken,and divided control group,HS group,sucrose group and NS group. The volume ratio in each group were arranged in 1/25,2/25,4/25 and 8/25. Osmotic concentration of 1/25 was equivalent to that induced with small volume hypertonic saline infusion. Result: Compare with NS group,the HCT and PLT count were decreased after infusion of small volume of HS. When the volume ratio ≥2/25, all measure values of the MAR, TXB_2, GMP-140 and PF_(3a)T were decreased in vitro,and profoundly inhibited following osmolarity increase of HS. Conclusion;Small volume of HS may be safely used,but severe inhibition of functions of platelet may occur when the infusing volume of HS exceeded more than twice of small volume of HS.
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Objective To study the influence of seawater immersion on hemostatic function after burn in dogs. Methods Twenty healthy adult mongrel dogs of beth sexes weighing 12-15 kg were randomly divided into two groups: immersion group(n=10) and control group(n=10). The animals were anesthestized with 3% pentobarbital 30 mg?kg~(-1) i.v., intubated and mechanically ventilated. 5F Swan-Ganz catheter was placed via right internal jugular vein. 10% of the skin on the back was burnt(second degree). In immersion group the animals were immersed in seawater containing salt 25.3 g?L~(-1)(pH8.1, T21-23℃) with head and neck kept above water for 4h. In control group the animals suffered second degree burn of same area without being immersed in seawater. Blood samples were taken from Swan-Ganz catheter before burn(baseline)and 4,7,10,20,28 h after burn for determination of(1) circulating endothelial cell(CEC) count, (2)tissue-type plasminogen activator(t-PA), (3) plasminogen activator inhibitor(PAI) and (4) thromboxane B_2/6-keto-prostaglandin F_(1?)(TXB_2/6-k-PGF_(1?)). At the end of the experiment lung tissue was obtained for microscopic examination. Results The blood CEC count, PAI-1 level and TXB_2/6-k-PGF_(1?) ratio significantly increased while t-PA level significantly decreased at 4 h after burn in control group but at 4-28 h after burn in immersion group. The differences between the two groups were significant. Microscopic examination of the lung showed some thrombi in immersion group. Conclusion Burn causes acute damage to the endothelial cells of the whole body and disorder of hemostasis. They are more severe and last longer after seawater immersion.
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Objective To investigate the effects of verapamil on hyperalgesia and spinal cord dorsal horn c fos expression after trauma in rats Methods Forty Wistar rats weighing 160 220g were randomly divided into five groups with eight animals in each group Traumatic pain model was made by amputation of right hind limb 0 5cm below ankle joint In group A animals received intraperitoneal verapamil 10mg/kg after trauma; in group B fentanyl 30 ?g/kg; in group C verapamil 10mg/kg plus fentanyl 30?g/kg; in group D normal saline; in group E animals received neither trauma nor verapamil or fentanyl The pain threshold of the skin surrounding the site of trauma was measured at 15 min, 30 min,1h and 2h after trauma and the interval between the radiation heat applied to the skin over ankle and the withdrawal of the hind limb was taken as pain threshold Fos like immunoreactive (FLI) neurons were determined in 1 2 luminal of ipsilateral lumber spinal cord dorsal horn with FOS immunohistochemistry technique 2h after trauma Results The pain threshold of the skin surrounding trauma site decreased significantly at 15 min, 30 min, 1h and 2h after trauma (P
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Objective To study vascular endothelial cell injury/activation associated with CPB in order to understand the pathophysiology of the complications of patients undergoing cardiovascular operationsMethods Twenty-six patients scheduled for cardiac operations with CPB, were divided into two grourps, group Ⅰ: 14 patients with acyanotic congenital heart diseases undergoing corrective surgical procedures; group Ⅱ: 12 patients undergoing selective cardiac operation for valvular replacement Blood samples were withdrawn from central vein before skin incision,before CPB, 30 min following CPB, at end of CPB, at end of operation, on the first postoperative day and the third postoperative day to measure the levels of circulating endothelial cells(CEC), thrombomodulin(TM) and von Willebrand Factor(vWF).Results The levels of CEC,TM and vWF significantly elevated during CPB and on the first postoperative day in the two groups,as compared with those before operation (P
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OBJECTIVE:To survey the dosage range,clinical effect and safety of hypertonic sodium chloride hydroxylethyl starch 40 injection(HSS40) on anti-hemorrhagic shock METHODS:The changes of blood pressure and laboratory examination indices were detected after HSS40 was infused into the patients who suffered from hemorrhagic shock RESULTS:HSS40 could rapidly raise the blood pressure in a dose below 500ml and the effective rate could reach 100% In part of patients,the levels of serum Cl- and Na+ increased temporarily and restored after 24 hours CONCLUSION:HSS40 was safe and effective in doses of 80ml～500ml The clinical doses of 300ml～500ml are recommended
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Objective To investigate the effect of seawater immersion on the hemostatic function of endothelial cells in dogs sustained burn firearm combined injury and the mechanisms. Methods Dogs with burn firearm combined injury were randomly divided into two groups: immersion group and control group. Dogs in immersion group were immersed in seawater for 4 h, and then taken out from seawater. Blood samples were collected from central vein before wound, immediately after immersion, at 4, 7, 10, 20, and 28 h after immersion to detect the changes in circulating endothelial cells (CEC), tissue type plasminogen activator (t PA), plasminogen activator inhibitor (PAI), and thromboxane B 2/6 keto prostaglandin F 1? (TXB 2/6 K PGF 1? ). Dogs were sacrificed at 28 h after wound for the purpose of pathological examination of the lung tissue. The indices detected except seawater immersion in the control group were the same as those in the immersion group. Results In the control group, the levels of CEC, PAI 1, and TXB 2/6 K PGF 1? increased, but the level of t PA decreased at 4 and 7 h after wound. However, in immersion group, the levels of CEC, PAI 1 and TXB2/6 K PGF1? kept increasing, but the level of t PA kept decreasing at 4, 7, 10, 20, and 28 h. Each index in immersion group from 4 h to 28 h after wound was significantly different from that in the control group ( P