ABSTRACT
Objective:To compare the effects of dexmedetomidine and nicardipine in the induction of controlled hypotension in the pa-tients during orthognathic surgery.Methods:60 patients were randomly divided into 2 groups(n =30).The patients in group D were intravenously pumped with 1 μg/kg dexmedetomidine for 10 min followed by 0.2 ~0.7 μg/(kg·h).Those in group N were pumped with nicardipine for an initial dose of 0.75 μg/(kg·min)followed by 0.2 ~0.5 μg/(kg·min).HR,MAP were recorded before in-duction (T0 ),start of hypotension(T1 ),10 min(T2 ),20 min (T3 ),30 min(T4 )and 60 min(T5 )after hypotension,10 min(T6 ), 30 min(T7 )after stop of hypotension,and at the end of surgery(T8 ).The remifentanil dosage was recorded.Riker sedation-agitation score (RSAS)before extubation and Ramsay score 5 min after extubation were observed.Results:Comparing with T0 ,MAP at T2 -T7 in the 2 groups were significantly decreased(P <0.05).The intraoperative remifentanil consumption in group D was significantly lower than that in group N (P <0.05).The Ramsay score in group D was significantly higher than that in group N(P <0.05).The RSAS in group D was significantly lower than that in group N(P <0.05).Conclusion:Both dexmedetomidine and nicardipine are safe for con-trolled hypotension in providing ideal surgical field during orthognathic surgery.Dexmedetomidine can produce more stable hemdynamic indexes and offer more advantage in postoperative sedation.
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Objective:To analyse pros and cons of Shikani laryngoscope anatomically during nasal intubation.Methods:60 pa-tients,with ASAⅠ -Ⅱ,aged 1 9 to 29 years old,undergoing titanium plate and titanium screw removal surgery after orthognathia, were randomly divided into Shikani group (S group,n =30)and HC video laryngoscope group (V group,n =30).Successful intuba-tion rate of the first attempt,total time cost,nasal bleeding rate and the incidence of postoperative airway complications were compared. Results:Compared with group V,the time cost of group S was significantly lower(P 0.05).Conclusion:Shikani la-ryngoscope is faster,less invasive with easy maintenance in nasal intubation.
ABSTRACT
Objective:To investigate the efficacy of HC-videolaryngoscopy in nasotracheal intubation for patients with predicted diffi-cult airway undergoing oral maxillofacial surgery.Methods:70 patients undergoing oral maxillofacial surgery with predicted difficult airway were enroled and randomly divided into 2 groups(n =35).Nasotacheal intubation was performed with HC-videolaryngoscopy (group VL)and Macintosh laryngoscopy(group ML)respectively.The duration and success rate of intubation,degree of glottis expo-sure,hemodynamic response as well as intubation related complications were evaluated.Results:There was higher success rate of first attempt(P <0.05),shorter intubation duration(P <0.05)and fewer frequency of multiple intubation(P <0.05)in group VL than in group ML.During intubation,the first and the best Cormack-Lehane laryngeal view was better in group VL(P <0.05)and less intuba-tion assistance was required in group VL(P <0.05).1 3 patients in group ML were intubated with VL after failure of the first attempt with ML.Conclusion:HC-videolaryngoscopy is safe and effective in the nasotracheal intubation for the patients with predicted difficult airway undergoing oral maxillofacial surgery.
ABSTRACT
Objective To investigate the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.Methods Two hundred and sixteen ASA Ⅰ-Ⅲ patients aged 18-80 yr undergoing vascular free flap reconstruction surgery were enrolled in this study.Patient characteristics before and during operation were recorded.The patients were followed up for 5 days after operation.Their level of consciousness,severity of pain and sleep quality were evaluated daily.The patients were divided into 2 groups according to the occurrence of delirium during the 5 days after operation:delirium group and non-delirium group.The method of CAM-ICU was reed in the diagnosis of postoperative delirium.Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results logistic regression analysis showed that old age,history of alcohol abuse and sleep diacrder after operation were risk factors for delirium developed after free flap surgery.Conclusion Old age,history of alcohol abuse and sleep disorder after operation were the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.