Perioperative transfusion analysis and blood ordering schedule update for total knee arthroplasty / 中国输血杂志

【Objective】 To investigate the perioperative rate of allogeneic red blood cell (RBC) transfusion in patients who underwent total knee arthroplasty (TKA) and its risk factors, and to identify its cross-match to transfusion ratio (C∶T ratio). 【Methods】 Anesthetic data of patients who underwent TKA from January 2014 to October 2019 in Peking Union Medical College Hospital were collected and analyzed retrospectively. Perioperative allogeneic RBC transfusion rate was calculated, and binary Logistic regression analysis was performed to identify its risk factors in these patients. The overall C∶T ratio was calculated and divided into subgroups based on surgery type and age group. 【Results】 The study enrolled 2 903 patients. The perioperative rate of allogeneic RBC transfusion in TKA patients was 10.9% (95% CI 9.8%~12.0%) and overall C∶T ratio was 5.6∶1. The independent risk factors leading to perioperative allogeneic RBC transfusion included advanced age(OR=1.025, 95% CI 1.009~1.042, P<0.01), preoperative hemoglobin level(OR=0.966, 95% CI 0.954~0.978, P<0.001), preoperative anemia(OR=3.543, 95% CI 2.052~6.119, P<0.001), hematological diseases(OR=6.462, 95% CI 2.479~16.841, P<0.001), bilateral surgery(OR=7.681, 95% CI 5.759~10.245, P<0.01) and revision surgery(OR=9.584, 95% CI 4.360~21.065, P<0.001). 【Conclusion】 The risk factors for perioperative allogeneic RBC transfusion in TKA patients included advanced age, preoperative low hemoglobin level, preoperative anemia, hematological diseases, bilateral surgery and revision surgery. Only type and screen tests are recommended if patients receiving unilateral primary TKA surgery are less than 75 years old without anemia and hematological diseases, while at least one to four units of blood should be cross-matched if patients are with preoperative anemia and hematological diseases or will receive bilateral and revision arthroplasty.

Investigation and analysis of cognition and clinical practice status of ERAS among anesthesiologists in secondary hospitals in China / 中华麻醉学杂志

Objective:To investigate the cognition and clinical practice status of Enhanced Recovery After Surgery (ERAS) among anesthesiologists in secondary hospitals in China using a questionnaire, trying to provide some references for the promotion and popularization of ERAS across China.Methods:From April to November 2021, anesthesiologists in secondary public hospitals across the country were enrolled by convenience sampling and investigated by a self-designed questionnaire on the cognition, clinical practice status and their teaching needs about ERAS.Influencing factors of ERAS cognition were then analyzed.Results:Totally 879 questionnaires were sent out, 864 were effectively received with effective recovery of 98.3%.The anesthesiologists in this survey were distributed in 31 provincial administrative regions across the country.The score of the ERAS cognition (total score of 18) was 12.00 (3.75), and 563 participants (65.2%) were qualified on cognitive status (score ≥ 12). Geographic region, age, educational qualification, professional title and length of occupation were found to have significant influence on ERAS cognition ( P<0.05). Among the anesthesiologists who participated in the survey, 817 participants (94.6%) recognized that ERAS management was beneficial to patients, and 778 (90.0%) of them agreed that ERAS management should be carried out as much as possible in secondary hospitals.Two hundred and fifty-five (29.5%) participants had never implemented ERAS management in clinic anesthesia.There were significant differences in the ERAS practice status among participants from different geographical regions in China ( P<0.05). Eight hundred and forty-eight (98.1%) anesthesiologists who participated in the survey expressed their willingness to receive further systematic training on ERAS, and taking online courses and reading books were the current main ways to obtain related knowledge. Conclusions:The cognition and clinical practice status of ERAS need to be improved among anesthesiologists in secondary hospitals in our country.Sustained ERAS education programs with various forms should be carried out in subgrade medical care centers in order to continuously promote the extensive practice of ERAS across China.

Comparison of patient-centered doctor-patient communication skills in anesthesiologists with different working experience and genders / 中华麻醉学杂志

Objective:To compare the patient-centered doctor-patient communication skills in anesthesiologists with different working experience and genders.Methods:The second and third year residents who had been trained as residents in the Department of Anesthesiology in our hospital from September 2017 and September 2018 and senior physicians who had worked for 10-15 yr in our hospital, were recruited to perform a preoperative interview in a standardized patient counter.Consultation and Relational Empathy (CARE) measure was used to assess the communication skills among senior physicians, residents, and anesthesiologists of different genders.The residents also took the objective structured clinical examination (OSCE) and theory examination.Results:Thirty-six residents and 20 senior physicians were included.There was no significant difference in the CARE measure score between residents and senior physicians and in the total CARE measure score between residents who received doctor-patient communication training at the stage of medical students and those who did not ( P>0.05). Compared with the residents in the second year, the listening ability score and decision-making ability score were significantly decreased ( P<0.05), and no significant change was found in the scores for the other items in the residents in the third year ( P>0.05). Compared with residents, the listening ability scores were significantly increased, and the caring ability scores were decreased ( P<0.05), and no significant change was found in the scores for the other items in senior physicians ( P>0.05). There was no difference in CARE measure scores between the male and female anesthesiologists.The resident′s CARE measure score was positively correlated with the annual OSCE score ( r=0.486, P<0.05), and there was no correlation between the resident′s CARE measure score and annual theoretical examination grade ( r=0.308, P>0.05). Conclusion:Senior anesthesiologists with more clinical experience are not superior to the junior residents in patient-centered communication skills, and the doctor-patient communication skills of residents are not related to their medical theoretical grade.Moreover, there is no significant difference between male and female anesthesiologists in terms of doctor-patient communication skills before surgery.Therefore, training of patient-centered doctor-patient communication skills should be strengthened at all levels of anesthesiologists.

Comparison of effects of different anesthetic methods on prognosis in patients with stage Ⅲ breast cancer / 中华麻醉学杂志

Objective:To compare the effects of different anesthetic methods on the prognosis in the patients with stage Ⅲ breast cancer.Methods:Based on a multicenter randomized controlled trial (NCT00418457), 274 patients with untreated stage Ⅲ breast cancer, aged 18-85 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, were enrolled in the study and assigned to thoracic paravertebral block (TPVB) combined with total intravenous anesthesia group (TPVB+ TIVA group, n=141) and general anesthesia group (GA group, n=133) by computer-generated randomization stratified by study site.The primary outcome parameter of this study was postoperative recurrence rate.The secondary outcome parameters were the degree of postoperative acute pain (assessed using visual analogue scale score), the incidence of postoperative nausea and vomiting (PONV), postoperative hospital stay time, and the incidence of persistent pain after breast cancer surgery (PPBCS) at 6 and 12 months after surgery (assessed using the modified Brief Pain Inventory). Results:Compared with group GA, no significant change was found in the postoperative recurrence rate ( HR=0.711, 95% confidence interval (CI) 0.418-1.210, P=0.209), the degree of postoperative acute pain and the incidence of PONV were decreased (mean difference ( MD) of visual analogue scale score -0.890, 95% CI -1.344--0.436, P<0.001; OR=0.236, 95% CI 0.083-0.674, P=0.007), and no significant change was found in postoperative hospital stay time and the incidence of PPBCS ( HR=1.000, 95% CI 0.778-1.286, P=1.000; OR=2.100, 95% CI 0.599-7.362, P=0.246) in group TPVB+ TIVA. Conclusion:Compared with general anesthesia alone, TPVB combined with total intravenous anesthesia can provide lower degree of postoperative acute pain and lower incidence of PONV, and exert no effects on postoperative recurrence, postoperative hospital stay time and PPBCS in patients with stage Ⅲ breast cancer.

Effects of N-methyl-D-aspartate Receptor in Keratinocyte on TypeⅠComplex Regional Pain Syndrome / 中国医学科学院学报

To observe the cell origin of N-methyl-D-aspartic acid(NMDA)receptor expression in skin after chronic ischemic pain modeling in rats and explore the role of NMDA receptor in type Ⅰ complex regional pain syndrome. Forty-two adult male Sprague-Dawley rats were randomly divided into five groups:sham operation group(=12),chronic post ischemia pain(CPIP)group(=12),CPIP+normal saline(NS)group(=6),CPIP+NMDA group(=6),and CPIP+MK801 group(=6).Six rats in the sham operation group and CPIP group were sacrificed under deep anesthesia one day after modeling.The plantar skin and L3-L5 spinal cord tissue were used for NR1(NMDA receptor)subunit immunofluorescence detection and for Western blotting of NR1,interleukin(IL)-1β,and tumor necrosis factor(TNF)-α.For the remaining rats,the mechanical withdrawal threshold(MWT)values on the 2nd,6th,10th and 14th day after ischemia were recorded,and the corresponding drugs were injected subcutaneously from the 6th day after ischemia.The skin and L3-L5 spinal cords were collected on the 14th day,and the same detection methods were applied. Compared with the sham operation group,the CPIP group had significantly higher expressions of NR1(1.708±0.064;=12.120, <0.001),IL-1β(2.575±0.305;=5.158, =0.003),and TNF-α(2.691±0.217;=7.786, <0.001)in the skin on the first day after modeling.After intervention with NMDA and MK801,the MWT value was [(20.37±0.95)g] in the CPIP+NS group,which was significantly higher than that in CPIP+NMDA group [(15.85±1.09)g;=10.920, <0.001] but significantly lower than that in CPIP+MK801 group[(22.95±0.96)g;=6.421, <0.001] 10 days after modeling.On the 14th day,compared with the MWT of the CPIP+NS group [(21.57±0.96)g],the CPIP+NMDA group had significantly decreased MWT value [(16.53±1.63)g;=12.190, <0.001],and the CPIP+MK801 group had significantly increased MWT value [(23.27±1.28)g;=4.094, =0.025].Compared with the sham operation group,the CPIP group had significantly increased NR1 expression(1.708±0.064;=10.910, <0.001)and the CPIP+NS group had significantly increased expressions of IL-1β(2.518±0.147;=11.010, <0.001)and TNF-α(1.949±0.184;=10.870, <0.001).Compared with the CPIP+NS group,the CPIP+NMDA group had significantly increased expressions of IL-1β(4.816±0.607;=16.670, =0.003)and TNF-α(2.629±0.349;=7.790, <0.001)and the CPIP+MK801 group had significantly decreased expressions of IL-1β(1.048±0.257;=10.660, =0.003)and TNF-α(0.790±0.165;=13.280, <0.001). NMDA receptor activation in skin keratinocytes after chronic ischemia in rats hinders the expression of inflammatory cytokines such as IL-1β and TNF-α,which may be involved in central sensitization and pain conduction of type Ⅰ complex regional pain syndrome.

Effect of dexmedetomidine on excitability of fast-spiking interneurons in primary somatosensory cortex of mouse brain / 中华麻醉学杂志

Objective:To evaluate the effect of dexmedetomidine on the excitability of fast-spiking interneurons in the primary somatosensory cortex of mouse brain.Methods:Eleven healthy C57BL/6 mice of either sex, at postnatal days 15-21, were used.The acute brain slices of primary somatosensory cortex were prepared and incubated in artificial cerebrospinal fluid.The whole-cell patch-clamp was established on fast-spiking interneurons and excitatory neurons in primary somatosensory cortex layer 4 separately.The membrane potential and action potential threshold from fast-spiking interneurons and spontaneous inhibitory postsynaptic currents from excitatory neurons were recorded before application of dexmedetomidine (10 μmol/L)and at 5 min after application of dexmedetomidine.Results:Compared with that before application of dexmedetomidine, no significant change was found in the membrane potential and action potential threshold of fast-spiking interneurons and frequency and amplitude of spontaneous inhibitory postsynaptic currents at 5 min after application of dexmedetomidine( P>0.05). Conclusion:The analgesic mechanism of dexmedetomidine may not be related to the excitability of fast-spiking interneurons in the primary somatosensory cortex of the mouse brain.

Recommendations for anesthesia management and infection control in elderly patients with COVID-19 / 中华麻醉学杂志

During the epidemic of coronavirus disease 2019 (COVID-19), the infection of the elderly population will bring great challenges to clinical diagnosis and treatment, outcome and management.Combined with the characteristics of anesthesia and the pathophysiological characteristics of COVID-19 on lung function impairment in elderly patients, Chinese Society of Anesthesiology formulated the " Recommendations for anesthesia management and infection control in elderly patients with COVID-19″. This recommendation expounds preoperative visit and infection control, anesthesia management protocol, anesthesia monitoring, anesthesia induction/endotracheal intubation, anesthesia maintenance and infection control, intraoperative lung protection strategy, anti-stress and anti-inflammatory management, hemodynamic optimization, infection control during emergence from anesthesia, and postoperative analgesia in elderly patients with COVID-19, and provides the reference for the safe and effective implementation of anesthesia management in elderly patients during the prevention and control of COVID-19 epidemic.

A survey of the ten-year implementation of WHO surgical safety checklist in China / 中华麻醉学杂志

Objective@#To investigate the current status of the ten-year implementation of the World Health Organization (WHO) surgical safety checklist (SSC) in China.@*Methods@#A questionnaire was designed based on the three phases described by the checklist — the period before induction of anaesthesia, the period before skin incision, and the period before patient leaves operating room, taking into account some hotspots and disputes.The questionnaire was sent to the members of the Chinese-based online New Youth Anesthesia Forum through the WeChat platform.Answers were completed by mobile phones or desktop computers.Each WeChat ID number allowed only one answer for each individual participant.@*Results@#A total of 3 943 members red the questionnaire invitation, of which 2 121 members completed the questionnaire with an overall completion rate of 53.79%.For checks completed before induction of anesthesia, the percentage of members who routinely practiced checks before induction of anesthesia was 93.35%, the percentage of members who completed each and every element of the checklist was 60.16%, and the percentage of members who selected the element of the checklist the surgeon was not involved in the check was 14.05%.For checks practiced before skin incision, the percentage of members who routinely completed checks before skin incision was 78.22%, the percentage of members who completed each and every element of the checklist was 51.91%, and the percentage of members who selected the element of the checklist surgeons and anesthesiologists routinely stated their own professional key information was 18.24% and 18.81%, respectively.For checks practiced before the patient leaved the operating room, the percentage of members who routinely completed checks before removing the patient from the operating room was 64.26%, and the percentage of members who completed each and every element of the checklist was 44.18%.The percentage of members who was really serious about practicing the checklist was 56.20%.The percentage of members who believed that surgeons should participated in checks practiced before induction of anesthesia was 81.47%.If the member himself or a member of his family needed a surgery, the percentage of members who hoped to implement the checklist was 98.35%.The percentage of members who believed that practicing WHO SSC could reduce the complications of surgery and improve the anesthetic safety of patients was 94.34%.@*Conclusion@#The implementing rate of checks practiced before induction of anesthesia is high, while the implementing rates of checks completed before skin incision and before patient leaves operating room are sequentially reduced in China.Although there are some problems with the implementation of WHO SSC, most respondents believe that implementing SSC can improve the anesthetic safety of patients undergoing surgery.

A survey of the ten-year implementation of WHO surgical safety checklist in China / 中华麻醉学杂志

Objective To investigate the current status of the ten-year implementation of the World Health Organization (WHO) surgical safety checklist (SSC) in China.Methods A questionnaire was designed based on the three phases described by the checklist — the period before induction of anaesthesia,the period before skin incision,and the period before patient leaves operating room,taking into account some hotspots and disputes.The questionnaire was sent to the members of the Chinese-based online New Youth Anesthesia Forum through the WeChat platform.Answers were completed by mobile phones or desktop computers.Each WeChat ID number allowed only one answer for each individual participant.Results A total of 3 943 members red the questionnaire invitation,of which 2 121 members completed the questionnaire with an overall completion rate of 53.79％.For checks completed before induction of anesthesia,the percentage of members who routinely practiced checks before induction of anesthesia was 93.35％,the percentage of members who completed each and every element of the checklist was 60.16％,and the percentage of members who selected the element of the checklist the surgeon was not involved in the check was 14.05％.For checks practiced before skin incision,the percentage of members who routinely completed checks before skin incision was 78.22％,the percentage of members who completed each and every element of the checklist was 51.91％,and the percentage of members who selected the element of the checklist surgeons and anesthesiologists routinely stated their own professional key information was 18.24％ and 18.81％,respectively.For checks practiced before the patient leaved the operating room,the percentage of members who routinely completed checks before removing the patient from the operating room was 64.26％,and the percentage of members who completed each and every element of the checklist was 44.18％.The percentage of members who was really serious about practicing the checklist was 56.20％.The percentage of members who believed that surgeons should participated in checks practiced before induction of anesthesia was 81.47％.If the member himself or a member of his family needed a surgery,the percentage of members who hoped to implement the checklist was 98.35％.The percentage of members who believed that practicing WHO SSC could reduce the complications of surgery and improve the anesthetic safety of patients was 94.34％.Conclusion The implementing rate of checks practiced before induction of anesthesia is high,while the implementing rates of checks completed before skin incision and before patient leaves operating room are sequentially reduced in China.Although there are some problems with the implementation of WHO SSC,most respondents believe that implementing SSC can improve the anesthetic safety of patients undergoing surgery.

A survey of anesthesia residents' proficiency in epidural puncture and training needs in China / 中华麻醉学杂志

Objective To investigate the anesthesia residents' proficiency in the epidural puncture and training needs using questionnaire survey in China.Methods A questionnaire designed by ourselves was sent to anesthesia residents via the WeChat platform within 1 month.The data were recorded by the system automatically.Results A total of 795 anesthesia residents involved in the investigation,and the number of valid questionnaires was 753 (94.7％).There were 233 (30.9％) junior residents (0-2 yr of training),279 (37.1％) semi-senior residents (3-5 yr of training),and 241 (32.0％) senior residents (＞5yr of training).Compared with junior group,the difficulty score for epidural puncture was significantly decreased,and the confidence scores for performing normal middle lumbar,difficult lumbar,lateral lumbar and thoracic epidural puncture were increased in semi-senior and senior groups (P＜0.05).Compared with semi-senior group,the difficulty score for epidural puncture was significantly decreased,and the confidence scores for performing normal middle lumbar,difficult lumbar,lateral lumbar and thoracic epidural puncture were increased in senior group (P＜0.05).The self-evaluated difficulty of epidural puncture was lower as the number of prior epidural cases was more (r=-0.719,P＜0.01).There were 46.6％ of the residents who had received simulation-based training before performing epidural puncture on the patient,among which most residents considered the simulation-based training is effective in helping to familiarize with procedure (77.2％),familiarize with anatomy (70.4％),simulate the texture of different layers (47.9％),and enhance success rate of epidural puncture (56.7％).There were 75.0％ residents who considered visualization technology is helpful in enhancing the success rate and confidence of epidural puncture.Conclusion Currently,the proficiency of junior anesthesia residents in epidural puncture needs to be strengthened.The simulation-based training has not been widely applied in the epidural training,while residents think high of simulation-based training and are looking forward to visualization technique training.

Application of the saphenous nerve emerging site through the adductor canal in ultrasound-guided adductor canal block / 临床麻醉学杂志

Objective To study clinical data retrospectively and demonstrate the optimal injection site of adductor canal block by performing a cadaveric study.Methods Clinical part:clinical data from 19 patients,11 males and 8 females,aged 21 85 years,ASA physical status Ⅰ-Ⅲ,who received ultrasound guided adductor canal block were retrospectively collected.Among whom 9 received a mid-distance injection of 10 ml of 0.5％ ropivacaine and 10 received an injection of the same medication at the outlet of adductor canal.The primary endpoint was complete absence of cold sensation to ice cube on the medial side of calf at 30 minutes and 24 hours after injection.Cadaveric part:40 lower limbs,20 males and 20 females,were finally analyzed in the study.The distances from the anterior superior iliac spine (ASIS) to the medial tibial condyle,from ASIS to the entrance of the adductor canal,from ASIS to the exit of the canal (adductor tendinous opening),from ASIS to the site where sa phenous nerve emerges through the aponeurotic covering were measured respectively.The length of adductor canal,the relative location of adductor canal and the site where saphenous nerve pierces in the lower limbs were calculated.Results Clinical part:all 19 cases were successfully recorded with complete absence of cold sensation at 30 minutes after injection of local anesthetic and complete sensory recovery at 24 hours after injection.Cadaveric part:in all specimens,saphenous nerve enters adductor canal and coursed down until emerging at very close to the distal end of the canal with the saphenous branch of descending genicular artery.The length of the adductor canal was (10.0±2.1) cm.The entrance and the exit of adductor canal and the emerging site of the saphenous nerve located along the (54.7±3.0) ％,(76.0％±3.8) ％ and (74.1±3.2) ％ of sartorius muscle,respectively.Conclusion Performing ultrasound-guided adductor canal block at either the outlet of adductor canal or mid-distance of thigh can achieve comparable blockade of saphenous nerve.Cadaveric study implicated that the optimal injection site for adductor canal block should be the lower one-third of sartorius muscle.Ultrasound-guided injection of local anesthetics next to the descending genicular artery may possibly become a promising new method of saphenous nerve block.

Effect of thoracic paravertebral block combined with general anesthesia on long-term quality of life in patients undergoing breast cancer surgery / 中华麻醉学杂志

Objective To evaluate the effect of thoracic paravertebral block ( TPVB) combined with general anesthesia on the long-term quality of life in the patients undergoing breast cancer surgery. Methods A total of 156 patients, aged 18-64 yr, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, undergoing breast cancer surgery, were randomly assigned to TPVB combined with general anes-thesia group (TPVB+GA group, n= 78) and general anesthesia group (GA group, n = 78), and the pa-tients in two groups were matched with a ratio of 1 : 1. In group TPVB+GA, propofol (target effect-site concentration 2. 5-4. 0 μg∕ml) was given by target-controlled infusion, and patients received either single or multiple injections (T1-T5 ) of TPVB under ultrasound guidance at 30 min before induction of general an-esthesia. Group GA inhaled 2. 0％-2. 5％ sevoflurane. The patients were followed up at 6 and 12 months after operation, postoperative chronic pain and chronic pain affecting daily life were assessed using the mod-ified Brief Pain Inventory, the development of neuropathic pain using neuropathic pain questionnaire-short form, and the development of long-term health-related quality of life by using the 12-item short-form scale. Results There was no significant difference in the incidence of chronic pain and chronic pain affecting dai-ly life, incidence of neuropathic pain or quality of life scale score at 6 and 12 months postoperatively be-tween the two groups (P>0. 05). Conclusion TPVB combined with general anesthesia exerts no effect on the long-term quality of life in the patients undergoing breast cancer surgery.

Effect of thoracic paravertebral block combined with general anesthesia on early postoperative re-covery in patients undergoing breast cancer surgery / 中华麻醉学杂志

Objective To evaluate the effect of thoracic paravertebral block ( TPVB) combined with general anesthesia on early postoperative recovery in patients undergoing breast cancer surgery. Meth-ods A total of 201 patients with untreated primary breast cancer, aged 18-69 yr, with body mass in-dex <35 kg∕m2 , of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective surgery for treatment, were enrolled and randomly assigned to general anesthesia group (group GA, n =102) and TPVB combined with general anesthesia group (group TGA, n= 99). In group TGA, TPVB was performed under ultrasound guidance at 30 min before surgery, and 0. 75％ ropivacaine 5 ml was injected at each puncture site of T1-5 . In group GA, local infiltration anesthesia was performed with 1％ lidocaine 0. 2 ml at each puncture site. Anesthesia was induced with IV fentanyl, propofol and rocuronium in both groups. Anesthesia was maintained by inhaling sevoflurane ( group GA), target-controlled infusion of propofol (group TGA) and intermittent IV boluses of fentanyl or rocuronium. Bispectral index value was maintained at 40-60 during surgery. Verbal Rating Scale score was used to assess the severity of pain after surgery. Parecoxib sodium 40 mg, pethidine 50 mg, tramadol 50 mg or fentanyl 50 μg was selected and intrave-nously injected as rescue analgesics when Verbal Rating Scale pain score>4. The requirement for rescue analgesia and development of nausea and retching∕vomiting were recorded within 2 days after surgery. Chinese quality of recovery score was used to assess the early postoperative quality of recovery on days 1 and 2 after surgery. Results Compared with group GA, the quality of recovery score was significantly increased on days 1 and 2 after surgery, the incidence of postoperative nausea was decreased (P<0. 05), and no signifi-cant change was found in the requirement for rescue analgesia or incidence of retching∕vomiting after surgery in group TGA (P>0. 05). Conclusion TPVB combined with general anesthesia is more helpful than gen-eral anesthesia alone for early postoperative recovery in the patients undergoing breast cancer surgery.

Risk factors for anxiety status of patients undergoing breast surgery in waiting area / 中华麻醉学杂志

Objective To determine the risk factors for the anxiety status of the patients undergoing breast surgery in the waiting area. Methods A total of 214 female patients scheduled for elective breast surgery, underwent biopsy under local anesthesia, were selected. When the patients were waiting for the pathological results in the waiting area, they filled in the questionnaire independently, read and understood the questionnaire of this study, showed cooperation and voluntarily received investigation including State-Trait Anxiety Inventory (STAI), self-evaluation questionnaire, etc. Anxiety was assessed and scored by the patients themselves. The patients were divided into state anxiety group and non-state anxiety group ac-cording to State-Anxiety scale. The variables were compared, and the variables of which P values less than 0. 05 would enter the logistic regression analysis to stratify the risk factors for the anxiety status of the pa-tients undergoing breast surgery in the waiting area. Results The incidence of state anxiety in the wait-ing area was 62. 6％. Compared with non-state anxiety group, significant change was found in the larger possibility of malignant breast lesions in preoperative conversation, preoperative anxiety, self anxiety score, STAI score and no understanding of disease prognosis in state anxiety group (P<0. 05). Logistic regression analysis showed that the larger possibility of malignant breast lesions in preoperative conversation, preoperative anxiety, self anxiety score and STAI score were all independent risk factors for the anxiety status of the patients undergoing breast surgery in the waiting area. Among all the patients involved in the investigation, 144 patients felt anxiety before surgery, 100％ patients expected help from the doctor in charge, and 60. 4％ patients expected the company of family in the waiting area. Conclusion Larger possibility of ma-lignant breast lesions in preoperative conversation, preoperative anxiety, self anxiety score and STAI score are independent risk factors for the anxiety status of the patients undergoing breast surgery while waiting for the pathological results in the waiting area after biopsy under local anesthesia.

Anesthetic management of patients with active infective endocarditis undergoing cardiac valve surgery under cardiopulmonary bypass / 中华麻醉学杂志

Objective To summarize experience and characteristics of the perioperative anesthetic management of patients with active infective endocarditis (AIE) undergoing cardiac valve surgery under cardiopulmonary bypass (CPB).Methods A total of 117 patients of both sexes,aged 18-70 yr,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,undergoing cardiac valve surgery under CPB from January 2014 to June 2015 in Peking Union Medical College Hospital,were enrolled in the study and divided into AIE group (n =57) and non-AIE group (n =60).Anesthesia was induced by Ⅳ injection of midazolam 1-2 mg,etomidate 0.15-0.30 mg/kg,sufentanil 0.3-0.5 μg/kg and rocuronium 0.6-1.0 mg/kg.After orotracheal intubation,the patients underwent high-frequency volume-controlled ventilation with low tidal volume,and positive end-expiratory pressure was increased appropriately.Esophageal echocardiography was used for evaluation.Anesthesia was maintained by inhalation of 1.0％-1.5％ sevoflurane,intermittent Ⅳ boluses of sufentanil 0.2-0.3 μg/kg and Ⅳ infusion of piperium bromide 2 mg/h,and the bispectral index value was maintained between 40-60 during surgeDy.Sensitive antibiotics were given during surgery according to the results of preoperative blood culture in AIE group.The following data were collected:baseline patient characteristics,preoperative blood routine,erythrocyte sedimentation rate,concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide,operation time,CPB time,intraoperative consumption of vasoactive drugs,fluid intake and output,use of antibiotics,length of postoperative intensive care unit stay,extubation time,new invasive operation (intra-aortic balloon counterpulsation was performed),time for use of vasoactive drugs,postoperative 24 h drainage,length of hosptial stay,serious complications (postoperative bleeding,pericardial tamponade,severe arrhythmia,heart failure,acute lung injury,renal failure and other organ function failure,etc.) and development of death.Results Compared with non-AIE group,age,body mass index and preoperative Hb,Hct,systolic blood pressure and diastolic blood pressure were significantly decreased,the rate of preoperative hypertension,neutrophil count,erythrocyte sedimentation rate,concentrations of hypersensitive c-reactive protein and amino-terminal pro-brain natriuretic peptide,body temperature and heart rate were increased,the intraoperative volume of allogeneic blood transfused and consumption of norepinephrine,phenylephrine and ephedrine after CPB were increased,the time for postoperative use of vasoactive drugs,extubation time and length of postoperative intensive care unit stay were shortened,and the length of hospital stay was prolonged in AIE group (P＜0.05).Conclusion For the patients with AIE undergoing cardiac valve surgery under CPB,comprehensive evaluation should be performed and heart failure be corrected actively before surgery;esophageal echocardiography should be used for evaluation,the application of vasoactive drugs could be increased appropriately and anesthetists should pay attention to respiratory management during surgery;cardiotonic and anti-shock therapy should be maintained,arrhythmia prevented and anti-infective therapy strengthened after surgery.

Effects of dexmedetomidine on the emergence of patients undergoing transnasal transsphenoidal pituitary tumor resection / 临床麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on the tolerance to endotracheal tube, on agitation and other complications of patients undergoing transnasal transsphenoidal pituitary tumor resection.Methods One hundred and twenty-four patients aged 18-65 years, ASA physical status Ⅰ or Ⅱ) were randomly assigned to dexmedetomidine group (group D, n=60) and control group (group C, n=62).Group D were given intravenous infusion of dexmedetomidine during the operation and group C with saline.The extubation time, observation time in the post-anesthesia care unit (PACU), the incidence of emergence agitation, cough, postoperative sore throat and hoarseness were analyzed.Results The extubation time [(29.7±11.5) min vs (22.2±8.5) min] and the length of stay in PACU [(41.5±11.8) min vs (35.3±10.0) min] were significantly longer in group D than those in group C (P<0.05).There was no significant difference of the incidence of emergence agitation (26.3% vs 32.3%), cough (49.1% vs 53.2%), postoperative sore throat (14.0% vs 24.2%) and hoarseness (10.5% vs 19.4%) between two groups.Conclusion Intraoperative intravenous administration of dexmedetomidine can prolong the extubation time and the length of stay in PACU.The incidence of agitation, cough, postoperative sore throat and hoarseness was not affected by dexmedetomidine.

Perioperative regional pain management of TKA / 基础医学与临床

Perioperative pain management play a critical role in rapid recovery and long term outcome in patient undergoing total knee arthroplasty.With the advancement of peripheral nerve block, technique such as femoral nerve block, sciatic nerve block, abductor canal block have play an important role in perioperative pain management.Local infiltration analgesia have also gained popularity.The ultimate goal of perioperative pain management is to ensure analgesia effect and maintain good motor function of lower extremity.We are still in searching of a safe, effective, analgesia without motor block.Currently multimodal analgesia seems to be the most favorable choice.

Effects of forced-air prewarming combined with fluid warmingon body temperature and thermal comfort in patients undergoing lobectomy / 基础医学与临床

Objective To investigate the effects of forced-air prewarming combined with fluid warming on body temperature and thermal comfort in patients undergoing lobectomy.Methods Forty six patients scheduled for video-assisted thoracoscopic surgery (VATS) of lobectomy were randomized into two groups (n=23 each):warming group (group T) and the control group (group C).Forced-air prewarming combined with infusion heating was applied in the warming group,while only conventional passive warming was used in control group.The tympanic membrane temperatures were recorded before prewarming,after prewarming, during the anesthesia, the end of operation, the moment in and out of the postanesthesia care unit (PACU).Incidence of postoperative shivering, thermal comfort and the time in the PACU were recorded.Results The warming group had a slower temperature decrease at 1,2, 3 hours after operation and end of operation(P< 0.01), warming group had significantly lower incidence of hypothermia and shivering than control group(8.7% vs 56.5%, 4.3% vs 34.8%,P<0.05),and the thermalcomfort score was higher in warming group than in control group(8.52±0.94 vs 7.65±0.83,P<0.05).Conclusions Forced-air prewarming combined with fluid warming has significant clinical effects to stabilize patients` body temperature during operations,to reduce the incidence of hypothermia and shivering and to improve the thermal comfort, which provides a simple and effective temperature protection strategy for patients undergoing lobectomy.

Perioperative anesthetic management of patients undergoing resection of huge mediastinal mass and recommendations for enhanced recovery after surgery protocol pathway / 中华麻醉学杂志

Objective The mediastinal mass usually posed higher risk of anesthesia and surgery due to its especial anatomical position,and this study aimed to analyze the perioperative anesthetic management of 3 patients undergoing resection of huge mediastinal mass,to identify the potential risks for this type of surgery and to summarize the corresponding perioperative anesthetic management protocol.Methods Three cases recently underwent resection of huge mediastinal mass in our hospital were reviewed.Their preoperative assessment and preparation,intraoperative anesthetic management,postoperative pain management and special interventions needed in the perioperative period were summarized and analyzed retrospectively.The enhanced recovery after surgery (ERAS) protocol was established for this type of surgery based on the analysis mentioned above,evidence reported at home and abroad and currently available ERAS protocols for other surgeries.Results Pleural malignant solitary fibrous tumor,thymus squamous cell carcinoma and malignant mixed germ cell tumor were the three mediastinal masses.The preoperative assessment focused on the impact of tumor on other vital organs within the mediastinum;anesthesiologists focused on massive hemorrhage and severe complications such as cardiac insufficiency and respiratory insufficiency;all the three patients were sent to the intensive care unit after surgery for further treatment,successfully recovered and were discharged;improving postoperative analgesia was helpful for recovery after resection of huge mediastinal mass.Conclusion Perioperative anesthetic management of patients undergoing resection of huge mediastinal mass is related to high risk,and establishing specific ERAS protocol is helpful in reducing complications and in promoting recovery after surgery based on the currently available evidence and characteristics of this type of surgery.

A survey of perioperative pain treatment and management in China / 中华麻醉学杂志

Objective To investigate the current situation of perioperative pain treatment and management using questionnaire survey.Methods A questionnaire was designed by ourselves and sent to anesthesiologists in each hospital all over China via the WeChat platform within 1 month.The system automatically recorded the situation of questionnaires.Results A total of 8 447 anesthesiologists involved in the investigation,the number of valid questionnaires retrieved was 6 778,anesthesiologists in the survey came from 847 hospitals in China,distributing across China 31 provinces and cities,and there were 526 tertiary hospitals (62.1％) and 321 hospitals under tertiary grade (37.9％).Among the medication for perioperative analgesia (not including medication for anesthesia),the following analgesics (applied alone or in combination) were used by anesthesiologists,and the application rate was as follows:opioids 79.74％,nonsteroidal anti-inflammatory drugs 53.78％,paracetamol 25.76％,local analgesics for analgesia (for nerve blockade) 25.44％,other drugs (such as ketamine,gabapentin) 12.39％;combination of two or more drugs 63.65％.Six hundred forty-nine hospitals (76.6％) carried out therapy with analgesic pump after operation,and the constituent ratio of hospitals using patient-controlled analgesia (PCA) pump was 43.8％.Four hundred seventy-five hospitals (56.1％) established Acute Pain Service (APS),the organizing rate of APS was significantly higher in tertiary hospitals than in hospitals under tertiary grade (P＜ 0.01),and the majority of APS personnel was anesthesiologists (72.4％).Conclusion Multimodal analgesia and PCA technique are not widely adopted and the requirement for non-steroidal anti-inflammatory drugs and nerve blockade is lower in perioperative pain treatment in China;analgesic pump is widely used after operation,but the application rate of PCA technique is not high;APS establishment is relatively weak in pain management and anesthesiologists play a leading role in APS.