ABSTRACT
Objective To observe the effect of body temperature protection on enhanced recovery after surgery of patients undergoing laparotomy radical gastrectomy.Methods Sixty of patients ASA physical status Ⅰ or Ⅱ,aged 45-76 years,scheduled for elective radical gastrectomy were ran domly divided into 2 groups (n=30 each):heating blanket group and control group.In the heating blanket group,patients were warmed up during the whole perioperative period using the warmblanket until discharge from PACU;exposed skin as covered with clean surgical dressing;infusion,irrigation fluids and blood transfusions were warmed to 40℃;the bacteriological and viral filters were placed between the Y-piece of the breathing circuit and the tracheal tube.In the control group,patients were not given special heat preservation measures.For temperature measurements,an infrared tympanic ear thermometer was used.The core temperature of two groups were recorded at the pre-operative period (T1),before induction (T2),1 h after induction (T3),closing (T4),extubation （T5),discharging from PACU (T6).The dosage of anesthetic drug,volume of fluids infused,peritoneal fluid flushing volume,operation time,anesthesia time,ambient temperature,amount of bleeding,intrao perative blood transfusion,shivering,extubation time,incision infection and hospitalization time were recorded.Results There was no statistical difference in terms of temperature at T1 between the two groups.Compared with the T1,the core temperature of two groups of patients in T2-T6 were signifi cantly decreased (P ＜0.05).The perioperative core body temperature at T2-T6 was significantly higher in the heating blanket group than in the control group.The amount of bleeding and blood transfusion in perioperative period was significantly less that in the heating blanket group (P＜0.05).The incidence of shivering and surgical-wound infection were significantly lower in the heating blanket group (P＜0.05).The extubation time and hospitalization time were shorter in the heating blanket group (P＜0.05).Conclusion Combined body temperature protection measures can significantly reduce the incidence of inadvertent perioperative hypothermia (IPH) and improve postoperative outcomes for patients undergoing laparotomy radical gastrectomy.
ABSTRACT
Objective To evaluate the efficacy and safety of postoperative analgesia in continuous Interscalene brachial plexus block by different strength ropivacaine mesylate combined with sufentanil.Methods Ninety cases of upper limb surgery in continuous peripheral nerve block (CPNB) were selected.The patients after the operation were divided randomly into three groups (A,B,and C):A group was treated with 0.158％ ropivacaine mesylate + 0.5 μg/ml sufentanil,B group with 0.238％ ropivacaine mesylate + 0.5 μg/ml sufentanil,and C group with 0.238％ ropivacaine mesylate.20 minutes before the end of surgery,controlled analgesia device was connected with infusion rate 0.05 ml/(kg · h),PCA 1 ml,and lock time 15 min.The pain visual analog score (VAS),Ramesay sedation score,and postoperative motor nerve block recovery ratings (modified Bromage classification) were recorded at the 4,8,16,32,48 h time point postoperatively.The times of using PCA and the frequency of the adverse reaction were also recorded.Results Three groups all got good analgesic effect at 4,8,16,32,48 h time point postoperatively (VAS 1.58 ± 9 ; 1.90 ± 0.8 ; 1.62 ± 0.6 ; 1.59 ± 0.7 ; 1.53 ± 0.7) (P ＞ 0.05) ; There were no significant difference among the three groups in Ramesay score,modified Bromage score,limb discomfort,nausea,vomiting,lethargy,pruritus and respiratory depression (P ＞ 0.05),but the time of using PCA in A group were significantly more than that in B or C group (P ＜ 0.05).Conclusions Sufentanil can enhance the analgesic effect significantly when the ropivacaine mesylate is in low concentrations (0.158％ ～0.238％),but when the ropivacaine mesylate concentration get up 0.238％,there will be similar analgesic efficacy and safety between ropivacaine mesylate only and ropivacaine mesylate combined with sufentanil.