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Objective:To evaluate the development of hypothermia after spinal anesthesia and risk factors.Methods:Patients undergoing spinal anesthesia in the anesthesia preparation room of our hospital from April 2020 to April 2021 were included. The temperature of the tympanic membrane was measured before spinal anesthesia and immediately after anesthesia and at 5, 10 and 15 min after anesthesia. Patients with tympanic membrane temperature<36 ℃ at any time point were considered as having hypothermia and included in hypothermia group and patients with membrane temperature ≥ 36 ℃ were considered as having no hypothermia and included in non-hypothermia group. The patients′ demographic data, highest anesthesia plane, puncture space of spinal anesthesia, types of anesthetics, preoperative fasting time, and surgical sites were recorded. The multivariate logistic regression analysis was performed to identify the risk factors for hypothermia.Results:A total of 196 patients were finally enrolled. The body temperature was significantly decreased at 5 and 10 min after anesthesia compared with the baseline body temperature before anesthesia and immediately after anesthesia ( P<0.001), and the incidence of hypothermia was 10.2%. The multivariate logistic regression analysis showed that female and high anesthesia plane were independent risk factors for hypothermia, and higher baseline body temperature was an independent protective factor for hypothermia ( P<0.05). Conclusions:Body temperature decreases at 5-10 min after spinal anesthesia, and the occurrence of hypothermia is not a small probability event in the patients undergoing spinal anesthesia; female and higher anesthesia plane are risk factors and higher baseline body temperature is the protective factor.
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The damage caused by space microgravity environment to the body systems of astronauts directly affects their work efficiency.This paper reviewed previous studies on the effects of space microgravity environment and ground simulated microgravity environment on cognition and emotion, potential mechanisms and interventions. It was found that a microgravity environment led to dysfunction in learning, memory, spatial orientation and other aspects, and caused anxiety and depression. The mechanisms of cognitive and emotional impairment associated with microgravity environment are complex, including neuronal damage, brain structure changes, neurotransmitter disorders, synaptic dysfunction, oxidative stress injury, and energy metabolism disorders. Pharmacological approaches such as natural extracts, physical interventions such as repetitive transcranial magnetic stimulation, and new therapies such as probiotics were expected to reduce cognitive impairment and mood disorders caused by microgravity exposure. With the development of aerospace medicine in China, the potential mechanism and interventions of microgravity environment on cognitive and emotional impairment remain to be further studied.
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Objective:To investigate and analyze the awareness of malignant hyperthermia (MH) in anesthesiology nurses in mainland China.Methods:From November 2021 to January 2022, anesthesiology nurses of secondary hospitals or above in Chinese mainland were enrolled by convenience sampling and investigated by a self-designed questionnaire on the awareness of MH.The system automatically recorded the situation of questionnaires.Results:A total of 2 058 anesthesiology nurses participated in the survey, distributed in 21 provinces, 2 autonomous regions (Ningxia Hui Autonomous Region, Guangxi Zhuang Autonomous Region) and 4 municipalities directly under the central government, and 2 049 questionnaires were effectively received with effective recovery of 99.56%.The correct answers to questions related to the treatment of MH, characteristics of the disease, classification, susceptible population, screening method of the susceptible population, genetic mode, inducing factors, the first symptoms and the best infusion time of dantrolene, preparation method of domestic dantrolene and the first dose were 86.58%, 82.33%, 58.18%, 50.90%, 50.76%, 50.42%, 45.73%, 32.89%, 51.25%, 48.32% and 46.51%, respectively.Only 27.13% of anesthesiology nurses expressed that dantrolene was available in their hospital.The scores of knowledge about MH among anesthesiology nurses in hospitals of province-level municipalities and provincial capital cities were significantly higher than those in other cities ( P<0.001). The scores of knowledge about MH among the anesthesiology nurses in secondary hospitals were significantly higher than those in tertiary hospitals ( P<0.05). There was no significant difference in the scores of knowledge about MH among anesthesiology nurses with different professional titles, educational backgrounds, and working years ( P>0.05). Conclusions:Anesthesiology nurses in mainland China have insufficient awareness of MH.Popularizing the knowledge about MH and strengthening the awareness of MH in medical staff in the department of anesthesiology throughout the country may be of great significance in improving the diagnosis and treatment of MH in China.
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A 14-year-old male pediatric patient was admitted to the hospital mainly because of neck and back deformity, with limited activity for 7 yr, dysphagia and short of breath for more than 10 months.He was diagnosed with cervical lordosis deformity, RyR1 gene-related myopathy, high possibility of multi-minicore disease and being susceptible to malignant hyperthermia.Posterior cervical orthopedic internal fixation surgery was successfully performed under total intravenous anesthesia with propofol.The vital signs were stable during anesthesia and operation which lasted for 10 h. The patient was admitted to intensive care unit after the uneventful operation.When emerging from general anesthesia, the patient suddenly presented with symptoms of muscular fasciculation in the head, face, trunk and limbs, along with elevated body temperature as high as 39.4℃, severe acidosis and hypercapnia, meanwhile, the blood creatine kinase, blood myoglobin and urinary myoglobin gradually increased.The patient was diagnosed with malignant hyperthermia based on the clinical grading scale score of 63.Dantrolene sodium was infused intravenously, combined with multiple treatments such as physical cooling, correction of acidosis and electrolyte disturbance, alkalization of urine, intermittent hemofiltration and plasma exchange.The arrhythmia and delirium were treated symptomatically.The pediatric patient was fully recovered and discharged with good outcomes.
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The original version of this article unfortunately contained some mistakes.
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Objective To evaluate the effect of isoflurane preconditioning on cell apoptosis during renal ischemia-reperfusion (I/R) in rats.Methods Thirty male Sprague-Dawley rats, aged 12-14 weeks, weighing 300-320 g, were randomly divided into 3 groups (n =10 each) using a random number table: sham operation group (group S);I/R group;isoflurane preconditioning plus I/R group (group Iso+I/R).The rats were anesthetized with intraperitoneal pentobarbital sodium 30 mg/kg.To establish the model of renal I/R injury, the right kidney was removed, and the left renal pedicle was occluded for 30 min with atraumatic mini-clamp for 30 min, followed by 2 h reperfusion.In Iso+I/R group, 1.5％ isoflurane was inhaled for 1 h, followed by 30 min of washout before I/R.In S and I/R groups only oxygen 2 L/min was inhaled for 1 h.Arterial blood samples were taken at 2 h of reperfusion to determine the concentrations of serum creatinine (Cr), blood urea nitrogen (BUN) and cystatin C (CysC).The animals were then sacrificed, and left kidneys were sampled for determination of the cell apoptosis (by TUNEL), expression of p53, Bax and Bcl-2 mRNA (using real-time fluorescent quantitative PCR), and expression of Bax, Bcl-2, and caspase-3 (by Western blot analysis).The Bcl-2/Bax ratio was calculated.Results Compared with group S, the serum Cr, BUN, and CysC concentrations were significantly increased, the Bcl-2/Bax ratio was decreased, Bcl-2 mRNA, Bax mRNA, Bcl-2, Bax and caspase-3 expression was up-regulated, and AI was increased in group I/R.Compared with group I/R, the serum Cr, BUN, and CysC concentrations were significantly decreased, the Bcl-2/Bax ratio was increased, Bcl-2 mRNA, Bax mRNA, Bax and caspase-3 expression was down-regulated, and AI was decreased in group Iso+I/R.There was no significant difference in p53 mRNA expression among the three groups.Conclusion Regulating the balance between Bcl-2 and Bax and inhibiting apoptosis in kidney cells are involved in the mechanism by which isoflurane preconditioning reduces renal I/R injury in rats.