ABSTRACT
Objective To evaluate the intraoperative opioid?sparing effect of different duration transcutaneous electrical acupoint stimulation ( TEAS ) in video?assisted thoracoscopic lobectomy. Methods Seventy?five patients, aged 18-64 yr, weighing 40-96 kg, of ASA physical status Ⅰ or Ⅱ, scheduled for elective video?assisted thoracoscopic lobectomy under general anesthesia, were randomly divided into 3 groups (n=25 each) using a random number table: control group (group C), 30 min of stimulation before induction of anesthesia group ( group B) , and stimulation throughout surgery ( group T) . In group B, the patients received TEAS ( frequency 2∕100 Hz ) on acupoints Xinshu ( BL15 ) , Feishu (BL13), Neiguan (PC6), Hegu (LI4) on the operated side starting from 30 min before induction of anesthesia until the beginning of induction, and the intensity was the maximum current that could be tolerated. The intensity for Neiguan ( PC6) and Hegu ( LI4) was 6-12 mA, and for Xinshu ( BL15) and Feishu ( BL13 ) was 9-18 mA. In group T, the patients received TEAS on the four acupoints mentioned above starting from 30 min before induction of anesthesia until the end of surgery. The patients had the electrodes applied, but received no stimulation in group C. After anesthesia was induced with propofol?sufentanil?cisatracurium, double lumen endotracheal tube was inserted. Propofol was given by target?controlled infusion to maintain BIS value within the range of 40-60. Cisatracurium was infused continuously to facilitate muscle relaxation. The infusion rate of remifentanil was adjusted to maintain analgesia nociception index value within the range of 50-70. The intraoperative consumption of remifentanil ( the intraoperative consumption of sufentanil was converted to the consumption of remifentanil producing the equivalent effect by 1∶ 10) was recorded. Results Compared with group C, the intraoperative consumption of remifentanil was significantly decreased in B and T groups. The intraoperative consumption of remifentanil was significantly lower in group T than in group B. Conclusion TEAS on Xinshu ( BL15 ) , Feishu (BL13), Neiguan ( PC6) and Hegu acupoints throughout surgery and for 30 min before induction of anesthesia significantly reduces intraoperative opioid consumption in the patients undergoing video?assisted thoracoscopic lobectomy, while TEAS throughout surgery provides better effect.
ABSTRACT
BACKGROUND AND PURPOSE: Whether or not migraine can cause cumulative brain alterations due to frequent migraine-related nociceptive input in patients is largely unclear. The aim of this study was to characterize longitudinal changes in brain activity between repeated observations within a short time interval in a group of female migraine patients, using resting-state functional magnetic resonance imaging. METHODS: Nineteen patients and 20 healthy controls (HC) participated in the study. Regional homogeneity (ReHo) and functional interregional connectivity were assessed to determine the focal and global features of brain dysfunction in migraine. The relationship between changes in headache parameters and longitudinal brain alterations were also investigated. RESULTS: All patients reported that their headache activity increased over time. Abnormal ReHo changes in the patient group relative to the HC were found in the putamen, orbitofrontal cortex, secondary somatosensory cortex, brainstem, and thalamus. Moreover, these brain regions exhibited longitudinal ReHo changes at the 6-week follow-up examination. These headache activity changes were accompanied by disproportionately dysfunctional connectivity in the putamen in the migraine patients, as revealed by functional connectivity analysis, suggesting that the putamen plays an important role in integrating diverse information among other migraine-related brain regions. CONCLUSIONS: The results obtained in this study suggest that progressive brain aberrations in migraine progress as a result of increased headache attacks.
Subject(s)
Female , Humans , Brain Stem , Brain , Follow-Up Studies , Headache , Longitudinal Studies , Magnetic Resonance Imaging , Migraine Disorders , Putamen , Somatosensory Cortex , ThalamusABSTRACT
Objective To primarily investigate the clinical value of analgesia/nociception index (ANI) in evaluating the analgesic effect during lobectomy performed via video-assisted thoracoscope.Methods Forty ASA physical status Ⅰ or Ⅱ patients,aged 25-64 yr,weighing 45-80 kg,undergoing elective lobectomy performed via video-assisted thoracoscope,were enrolled in this study.After induction of anesthesia with propofol,sufentanil and cisatracurium,patients received double lumen endotracheal intubation.Anesthesia was maintained with targetcontrolled infusion of propofol,and iv infusion of remifentanil and cisatracurium.The concentration of propofol was adjusted to maintain the bispectral index (BIS) value in the range of 40-60.ANI,HR,systolic blood pressure (SBP),diastolic blood pressure (DBP) and BIS value were recorded within 5 min before and after the predefined time points including posture change between lateral and supine position,ventilatory pattern change between onelung and double-lung ventilation,skin incision and trocars insertion,lymph node dissection and pleural lavage.At skin incision and during trocars insertion,lymph node dissection and pleural lavage,the development of hemodynamic responses (increase in HR and SBP ＞ 20％ of baseline value) were recorded.Results The incidence of hemodynamic responses was 100％ at skin incision and trocars insertion,and 84 ％ during No.4,7,10 groups of lymph node dissection and after pleural lavage and difference was found in ANI during these stimuli.ANI was significantly decreased within 5 min after skin incision,trocars insertion,No.4,7,10 groups of lymph node dissection and pleural lavage than that before the procedures (P ＜ 0.05).The BIS value was maintained at 40-60,and no significant changes were found between before and after the procedures (P ＞ 0.05).No significant changes were found in ANI,HR,SBP,and DBP between before and after the changes of posture and respiratory pattern (P ＞ 0.05).Conclusion ANI can be used to evaluate the analgesic effect during lobectomy performed via video-assisted thoracoscope in patients and is unaffected by the changes of posture and ventilatory pattern.