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Objective: Goal-directed fluid therapy [GDFT] was associated with improved outcomes after surgery. Noninvasive Cardiac Output Monitoring [NICOM] has proved to be a good choice for guiding GDFT. This study evaluated the effect of GDFT based on NICOM on prognosis in elderly patients undergoing resection of gastrointestinal tumor
Methods: Fifty patients scheduled for elective laparoscopic radical resection for stomach, colon or rectal cancer in Yongchuan Hospital of Chongqing Medical University between November 2014 and December 2015 were included and randomly divided into two groups: conventional fluid therapy [group C, n=25] and goal-directed fluid therapy [group G, n=25]. The primary outcome was moderate or severe postoperative complications within 30 days
Results: Finally, 45 patients successfully completed the study [group G, n=22; group C, n=23]. There were no difference of the duration of surgery, the requirement of vasoactive agents and the bleeding volume between two groups [P>0.05]. Total fluids infused were 2956 +/- 629 ml [group C] and 2259 +/- 454 ml [group G] [P<0.05], while the requirement of colloid was increased in group G [1103 +/- 285ml vs 855 +/- 226ml] [P<0.05]. The MAP and the mean CI were higher in group G [P<0.05]. Compared with group C, the time when the patients passed the flatus and the length of hospital stay after operation were shortened in group G [12.6 +/- 2.4 day vs17.2 +/- 2.6 day], the incidence of postoperative complications were significantly lower in group G [P<0.05]
Conclusions: Goal-directed fluid therapy based on NICOM was significantly associated with improvement of prognosis in elderly patients undergoing resection of gastrointestinal tumor which reduced postoperative complications
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Objective: To investigate the effect of epidural anesthesia combined with inhalation or intravenous anesthesia on intrapulmonary shunt and oxygenation in patients undergoing long term single lung ventilation
Methods: Eighty patients, aged 35-75, American Society of Anesthesiology [ASA] classification of I-III, undergoing thoracic surgery with one lung ventilation more than three hour, were randomly divided into propofol group [group Pro], propofol combined with epidural anesthesia group [group Pro+Epi], isoflurane group [group Iso] and isoflurane combined with epidural anesthesia group [group Iso+ Epi], 20 patients in each group. Arterial blood and mixed venous blood were taken for blood gas analysis, and hemodynamic data were recorded at following time points: before induction in supine position [T1], 30min after bilateral lung ventilation [T2], 15min after one lung ventilation [T3], 30min after one lung ventilation [T4], 60min after one lung ventilation [T5], 180min after one lung ventilation [T6], intrapulmonary shunt [Qs/Qt] was calculated according to the correlation formula
Results: Qs/Qt values at T2-6 in four groups were significantly higher than that of T1, and Qs/Qt values at T3-6 was significantly higher than that of T2 [P< 0.05]; PaO2 at T2-6 were significantly higher than that of T1, with PaO2 at T3-6 were significantly lower than T2 [P< 0.05]. Between groups, Qs/Qt values in group Iso were significantly higher than that of group Pro, Pro+Epi and Iso+Epi at T3-5 [P< 0.05]. There was no significant difference in PaO2 between groups [P> 0.05]. CI at T3-6 in group Iso and Iso+Epi were significantly higher than that of T1 [P<0.05], and were significantly higher than that of propofol group [P<0.05]. MAP at T3-6 in group Pro+Epi and Iso+Epi were significantly lower than that at T1 [P <0.05]. Heart rate at T4-6 in group Iso were significantly higher than T1, and higher than group Pro and group Iso+Epi [P <0.05]
Conclusion: One lung ventilation may predispose to increase of intrapulmonary shunt and decrease in arterial partial pressure of oxygen; isoflurane inhalation anesthesia is more likely to cause intrapulmonary shunt, but no changes in arterial partial pressure of oxygen
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Objective To observe the anesthesia related effect of dexmedetomidine conscious sedation on Laryngeal mask airway general anesthesia in Parkinson patients with deep brain electric stimulus implantation.Methods Forty patients (72 males, 8 females, aged 18-75 years, ASA physical status Ⅰ or Ⅱ) of Parkinson disease with selective operated bilateral subthalamic nucleus deep brain electric stimulus implantation were selected and randomly divided into dexmedetomidine group (group D) and contrast group (group C), 20 cases in each group.The operation divided into two stages: in the first stage, the electrode was put under the local anesthesia, CT examination proof of electrode placement satisfaction was the end of the first stage.The second stage needed to bury the pulse generator under of the chest skin under general anesthesia.For group D, dexmedetomidine 0.5 μg/kg was pumped venously within 15 min after entering the operating room, the speed of 0.1-0.3 μg·kg-1·h-1 was kept subsequently until the end of the first period.For group C, the same dosage of normal saline was pumped.The times of micro-electrode interference, tremor relief were recorded.Ramsay scores of two groups of patients were recorded at the entry of operating room (T0), partial infiltration anesthesia (T1), unilateral electrode implantation (T2), contralateral electrode implantation (T3), the end of the first period (T4);the time needed to vanish consciousness, implant laryngeal mask airway, recover the spontaneous breathing and extubation were recorded;the propofol, remifentanil dosage from the beginning of general anesthesia induction to the end of the surgery were recorded.Results The micro-electrode was intervened and tremble was relieved in both two groups.Compared with group C, the ramsay scores of T1-T4 were obviously increased in group D (P<0.05), the time needed to vanish consciousness, implant laryngeal mask airway, recover the autonomous respiration, extubation were significantly shortened in group D (P<0.05), the dosage of propofol, remifentanil from the beginning of the general anesthesia starts to the end of the surgery were significantly reduced in group D (P<0.05).Conclusion Dexmedetomidine provided the excellent sedation to the first period of Parkinson patients with deep brain electric stimulus implantation;it can shorten the time of the anesthesia induction and awakening time, as well as decreases propofol and remifentanil dosage.
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The study aimed to investigate if the dynamic changes in cerebral electrical impedance [CEI] values could be used to monitor brain edema during cardiopulmonary bypass [CPB] in infants. Forty infants [mean age: 1.4+/-0.38y] with acyanotic congenital heart disease who underwent CPB open-heart surgery between September 2009 and March 2010 were prospectively enrolled, and divided into 2 groups based on aortic cross-clamping [ACC] time: CPB-A [ACC<50 min] and CPB-B [ACC>/=50 min]. During the same period, twenty infants [aged 1-3y] who underwent surgery for indirect inguinal hernias were selected as controls. Serum astrocyte S100 protein [S100] and neuron-specific enolase [NSE] levels were determined before and after CPB. Changes in CEI were detected using the BORN-BE system. No intraoperative death occurred. Compared with controls, left and right side CEI values, serum S100 and NSE levels in the CPB groups significantly increased from surgery beginning to end [P<0.05]. After surgery, these levels decreased [P<0.05]. Detection rates of cerebral edema in the CPB-B group 24h post-operative were significantly higher than in the CPB-A group [P<0.05]. CEI value can be used to dynamically monitor brain edema in infants undergoing CPB, and is an index reflecting brain damage during CPB in infants
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Objective To explore the effect of the unilateral lumbar anesthesia by hypobaric bupivacaine and general anesthe‐sia in elderly hip replacement and their influence on the stress response .Methods Forty elderly patients undergoing hip replace‐ment in our hospital from December 2013 to November 2014 were selected and randomly divided into the unilateral lumbar anesthe‐sia group and general anesthesia group according to the random number table ,20 cases in each group .Venous blood was collected to determine the levels of blood sugar ,serum catecholamine(CA) and cortisol(CORT ) at 10 min before anesthesia(T0 ) ,end of surgery (T1 ) and at postoperative 24 h(T2 ) .MAP ,HR ,SpO2 ,intraoperative adverse reactions and postoperative related complications were recorded at each time point ,and the comparative analysis was performed .Results All patients successfully completed surgery and the anesthetic effect was satisfied .The occurrence rates of intraoperative hypotension ,hypertension and bradycardia in the unilateral lumbar anesthesia group were lower than those in the general anesthesia group ,the differences had statistical significances (P>0 .05) .HR and MAP at T1 in the two groups were reduced ,but the differences between the two groups were no statistical signifi‐cance(P>0 .05);the levels of GLU ,CORT and CA were increased ,moreover the differences between the two groups were statisti‐cally significant(P<0 .05) .SpO2 at T2 in the general anesthesia group was obviously lower than that in the unilateral lumbar anes‐thesia group ,while CORT was higher than that in the unilateral lumbar anesthesia group ,the differences were statistically signifi‐cant(P<0 .05) .The occurrence rates of postoperative nausea and vomiting ,sore throat ,dizziness ,drowsiness and pulmonary infec‐tion in the unilateral lumbar anesthesia group were lower than those in the general anesthesia group ,the differences were statistical‐ly significant(P<0 .05) .Conclusion The unilateral lumbar anesthesia by using hypobaric bupivacaine and general anesthesia all could offer better anesthetic effect .The unilateral lumbar anesthesia by using hypobaric bupivacaine can effectively regulate the stress response in elderly patients with hip replacement .
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Expression and regulation of the P-glycoprotein (P-gp) is associated with the development of multidrug resistance in cancer.Cancer cells are exposed in endogenous damages from its own micro-environments and inflicted stimulated damages.These harmful micro-environments could trigger cellular stress response and regulated the expression of P-gp through various activated signal transduction pathways.Researches of the cellular endogenous micro-environments and exogenous stimulation damages on the expression and regulation of P-gp would have important significance for exploring the multidrug resistance of cancer cell.
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Objective:To discuss the anesthetic management of remedy operation for coarctation of aorta in infants and children.Methods:The anesthetic data of thirty-two patients undergoing remedy operation for coarctation of aorta in infants and children from Jan,2000 to Nov,2006 were reviewed retrospectively.Results:All cases underwent remedy operation for coarctation of aorta under general anaesthesia,controlled hypotension with nitroprusside sodium or glycerol trinitrate,and at low temperature,with the different blood pressure of upper limbs and lower limbs maintained during the operation.When anaesthesia was induction and the aorta blocked,the difference in blood pressure of upper limbs and lower limbs is statistically remarkable(P0.05).The complication such as acute heart failure,arrhythmia and kidney function failure did not happen except in 3 cases with high blood pressure and 12 cases with hypotension.Conclusions:The key of anesthetic treatment for coarctation of aorta in infants and children should be anesthetic selection,controlled hypotension,low temperature during operation and prevention of complications
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In order to train the high-quality clinical anaesthesia specialized personnel with comprehensive ability,we have a lot of researching and improvement on clinical anaesthesia educational concepts,contents and methods according to the special condition,The focal point has been located in the development of autonomous learning,and lifelong learning ability.
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0.05).42 children were anesthetized perfectly except 3 cases with Horner syndrome and 2 failure cases.The complication such as hematoma and infection did not happen.Conclusion:Continuous brachial plexus block is a simple,feasible and safe method in complex and prolonged operation of upper limb.