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1.
Article in Chinese | WPRIM | ID: wpr-933340

ABSTRACT

Objective:To determine the median effective dose (ED 50) of esketamine for preoperative sedation in different aged pediatric patients. Methods:Pediatric patients, aged 1-6 yr, of American Society of Anaesthesiologists physical status Ⅰ, with the preoperative parental Separation Anxiety Scale (PSAS) score ≥3, undergoing elective surgery under general anesthesia, were selected.According to the age, the children were divided into 1 yr≤age<4 yr low-age group (group L) and 4 yr≤age< 6 yr high-age group (group H). Esketamine 0.5 mg/kg was intravenously injected in the first child in each group.The dose in the next child was determined according to PSAS scores, and the two consecutive dose gradient was 0.1 mg/kg; when the PSAS score in the previous child was ≥3, the dose in the next child was increased; when the PSAS score in the previous child was< 3, the dose in the next child was decreased until appearance of 7 turning points, and then the experiment was terminated.The ED 50 and 95% confidence interval of esketamine for preoperative sedation were calculated by probit analysis. Results:A total of 54 children were enrolled in this study, including 26 cases in group L and 28 cases in group H. The ED 50 and 95% confidence interval of esketamine were 0.413 (0.314-0.530) mg/kg and 0.282 (0.252-0.318) mg/kg in group L and group H, respectively.Compared with group L, ED 50 of esketamine was significantly decreased in group H ( P<0.05). Conclusions:The ED 50 of esketamine for preoperative sedation is 0.413 mg/kg in pediatric patients of 1 yr≤age<4 yr old and 0.282 mg/kg in those of 4 yr≤age<6 yr old, and the efficacy of esketamine for preoperative sedation increases with age.

2.
Article in Chinese | WPRIM | ID: wpr-933331

ABSTRACT

Objective:To investigate the mechanism of dexmedetomidine preventing sevoflurane-indued neurotoxicity to neonatal mice and the relationship with Tau phosphorylation.Methods:Seventy-two SPF healthy newly born C57BL/6 wild-type mice of both sexes, aged 6 days, were divided into 4 groups ( n=18 each) using a random number table method: normal control group (C group), dexmedetomidine control group (D group), sevoflurane-induced neurotoxicity group (S group), and dexmedetomidine prevention group (SD group). Mice inhaled 2.1%-3.3% sevoflurane 2 h daily on postnatal days 6, 9 and 12, and dexmedetomidine 10 μg/kg was intraperitoneally injected at 30 min before anesthesia in group SD.Six mice were randomly selected after the end of injection, and the hippocampus tissues were removed for determination of the expression of phosphorylated Tau protein (AT8) and Tau46 protein at Tau-PS202 and Tau-PT205 sites by Western blot.The new object recognition test was performed on postnatal days 29-30 (the discrimination ratio of new objects was observed), and the Morris water maze test was performed from postnatal day 31 to 37 (the escape latency and the times of crossing the platform were observed). The hippocampi were harvested under anesthesia to detect the expression of postsynapatic density-95 by Western blot. Results:Compared with group C, the expression of AT8 was significantly up-regulated, the expression of PSD-95 was down-regulated, the number of crossing the platform and new object discrimination ratio were decreased ( P<0.05), and no significant change was found in Tau46 protein expression or escape latency in group S ( P>0.05). There was no significant difference in the indexes mentioned above between group D and group SD ( P>0.05). Compared with group S, the expression of AT8 was significantly down-regulated, the expression of postsynapatic density-95 was up-regulated, the number of crossing the platform and new object discrimination ratio were increased ( P<0.05), and no significant change was found in Tau46 protein expression and escape latency in group SD ( P>0.05). Conclusions:The mechanism of dexmedetomidine preventing sevoflurane-induced neurotoxicity to neonatal mice is related to the inhibition of Tau phosphorylation.

3.
Article in Chinese | WPRIM | ID: wpr-933307

ABSTRACT

Objective:To identify the risk factors for postoperative nausea and vomiting (PONV) in the patients undergoing thoracic surgery.Methods:The medical records of patients of either sex, aged 18-80 yr, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, underwent elective thoracic surgery from January 2018 to January 2020, were collected retrospectively.The age, gender, educational background, American Society of Anesthesiologists physical status, motion sickness, history of smoking, history of drinking, history of heart disease, history of hypertension, history of diabetes, preoperative blood routine, liver function, parameters of electrolytes; operation method, type of operation, operation time, intraoperative nerve block, consumption of dexamethasone before anesthesia induction and intraoperative sufentanil and dexmedetomidine, use of postoperative patient-controlled intravenous analgesia (PCIA), and postoperative rescue opioid analgesics and antiemetics were recorded.The patients were divided into PONV group and non-PONV group depending on the occurrence of nausea and vomiting within 24 h after operation.PONV group was further divided into nausea group (PON group) and vomiting group (POV group) according to whether vomiting occurred.Logistic regression analysis was used to identify the risk factors for PONV.Results:A total of 3 791 patients were enrolled in this study, with 144 cases in PONV group and 3 647 cases in non-PONV group.The incidence of PONV was 3.80%.There were 38 patients in POV group, and the incidence was 26.4%.The results of logistic regression analysis showed that motion sickness, female, pulmonary wedge resection, postoperative PCIA and increased use of postoperative rescue opioid analgesics were risk factors for PONV in the patients undergoing thoracic surgery, intraoperative use of dexmedetomidine was a protective factor for PONV; motion sickness, female and history of hypertension were risk factors for postoperative vomiting in the patients at risk for PONV ( P<0.05). Conclusions:Motion sickness, female, pulmonary wedge resection, postoperative PCIA, and increased use of postoperative rescue opioid analgesics are risk factors and intraoperative use of dexmedetomidine is a protective factor for PONV in the patients undergoing thoracic surgery; motion sickness, female and history of hypertension are risk factors for postoperative vomiting in the patients at risk for PONV.

4.
Article in Chinese | WPRIM | ID: wpr-933292

ABSTRACT

Objective:To evaluate the effect of thoracic paravertebral block (TPVB) combined with general anesthesia on the postoperative brain injury in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods:A total of 100 patients of either sex, aged ≥65 yr, with body mass index of 20-24 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective thoracoscopic radical resection of lung cancer, were divided into 2 groups ( n=50 each) by using a random number table method: general anesthesia group (G group) and TPVB combined with general anesthesia group (TG group). TPVB was performed before induction of anesthesia in group TG.Anesthesia was induced with IV midazolam, etomidate, rocuronium and sufentanil and maintained with infusion of propofol and remifentanil and intermittent IV boluses of cis-atracurium.Patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia after surgery.Venous blood samples were taken at 5 min after entering the operating room and 24 and 72 h after surgery to determine the concentrations of S100β, neuron-specific enolase, Tau protein, β amyloid and interleukin-6 in plasma.The cognitive function was assessed by using the Mini Mental State Examination Scale and Montreal Cognitive Assessment Scale at 1 day before surgery and 24 and 72 h after surgery, and cognitive dysfunction was recorded.The quality of night sleep was assessed using Numerical Rating Scale at 1 day before surgery, on the day of surgery and on day 3 after surgery.The occurrence of nausea and vomiting within 72 h after operation, perioperative consumption of sufentanil, effective pressing times of PCA within 24 h after operation and requirement for postoperative rescue analgesia were recorded. Results:No postoperative nausea and vomiting was found and no patients required rescue analgesia in either group.Compared with group G, the concentrations of S100β, neuron-specific enolase and interleukin-6 in plasma, Montreal Cognitive Assessment scale score, and incidence of cognitive dysfunction were significantly decreased at 24 h after surgery, sleep quality score was increased, and the perioperative sufentanil consumption and effective pressing times of PCA were reduced ( P<0.05), and no significant change was found in plasma Tau protein and β amyloid concentrations in group TG ( P>0.05). Conclusions:TPVB combined with general anesthesia is helpful in reducing postoperative brain injury in elderly patients undergoing thoracoscopic radical resection of lung cancer.

5.
Article in Chinese | WPRIM | ID: wpr-933290

ABSTRACT

Objective:To evaluate the optimization strategy of anesthesia for liver cancer resection using serratus anterior plane block-posterior rectus sheath block-general anesthesia.Methods:One hundred patients, aged 30-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with liver function Child-Pugh grade A or B, scheduled for elective liver cancer resection under general anesthesia, were divided into serratus anterior plane block combined with posterior rectus sheath block group (group S, n=50) and thoracic paravertebral block group (group T, n=50) using a random number table method.Ultrasound-guided serratus anterior plane block (20 ml) combined with posterior rectus sheath block (10 ml) was performed using 0.375% ropivacaine in group S. Ultrasound-guided paravertebral block was performed at T 7 and T 9(15 ml for each site) with 0.375% ropivacaine in group T. Anesthesia was induced with intravenous midazolam, propofol, sufentanil and cisatracurium and maintained with intravenous infusion of propofol and remifentanil and intermittent intravenous boluses of cisatracurium.BIS value was maintained at 40-60 during operation.Patient-controlled intravenous analgesia (PCIA) was performed with sufentanil and flurbiprofen at the end of operation, and oxycodone 5 mg was intravenously injected as rescue analgesic when the VAS score>3.The onset time and operation time of nerve block were recorded.The intraoperative consumption of sufentanil and remifentanil and occurrence of cardiovascular events within 30 min after skin incision were recorded.The effective pressing times of PCA and requirement for rescue analgesia within 48 h after operation were recorded.The recovery quality was measured using the 40-item quality of recovery questionnaire at 24 h before surgery and 24 and 48 h after surgery.Peripheral venous blood samples were collected at 24 h before surgery and 24 h and 7 days after surgery to determine the concentrations of interleukin-17 and interferon-gamma in serum.The postoperative time to first flatus, first ambulation time, and length of hospital stay were recorded.The nausea and vomiting, respiratory depression, skin itching, puncture site infection, pneumothorax and other adverse reactions were recorded within 48 h after operation. Results:Compared with group T, the operation time of nerve block was significantly shortened, the incidence of intraoperative hypotension was decreased ( P<0.05), and no significant change was found in the onset time of nerve block, intraoperative consumption of sufentanil and remifentanil, postoperative requirement for rescue analgesia, effective pressing times of PCA, time to first flatus, first ambulation time, and length of hospital stay, and 40-item quality of recovery scores and serum concentrations of interleukin-17 and interferon-gamma at each time point in group S ( P>0.05). No postoperative adverse reactions were found in either group. Conclusions:Compared with thoracic paravertebral nerve block combined with general anesthesia, serratus anterior plane block-posterior rectus sheath block-general anesthesia has shorter operation time and lower incidence of intraoperative hypotension when used for liver cancer resection.

6.
Chinese Journal of Anesthesiology ; (12): 1105-1108, 2021.
Article in Chinese | WPRIM | ID: wpr-911326

ABSTRACT

Objective:To summarize the efficacy of general anesthesia for percutaneous pulmonary valve implantation (PPVI).Methods:The clinical data of 6 patients underwent PPVI under general anesthesia in Children′s Heart Center of Henan Provincial People′s Hospital from December 2017 to January 2020 were retrospectively analyzed.Systolic blood pressure, diastolic blood pressure, heart rate, central venous pressure, SpO 2 and regional cerebral oxygen saturation were recorded before anesthesia induction (T 1), after anesthesia induction (T 2), before beginning of surgery (T 3), before pulmonary valve implantation (T 4), during pulmonary valve implantation (T 5), immediately after pulmonary valve implantation (T 6) and when the patients left the operating room (T 7). Right ventricular systolic pressure, diastolic pressure, pulmonary artery systolic pressure and diastolic pressure were recorded at T 4 and T 6.The development of related complications during operation and the cardiac, liver and kidney functions before and after operation were recorded.The postoperative extubation time, intensive care unit stay time and hospital stay time were recorded. Results:Six patients (3 males, 3 females), aged (16±4) yr, weighing (41±12) kg, were analyzed.Compared with the value at T 1-4 and T 6, 7, systolic blood pressure, diastolic blood pressure, heart rate, regional cerebral oxygen saturation and SpO 2 were significantly decreased at T 5 ( P<0.05). Compared with the value at T 1-5, central venous pressure was significantly decreased at T 6, 7 ( P<0.05). Compared with the value at T 4, right ventricular diastolic pressure was significantly decreased, and pulmonary artery diastolic pressure was increased at T 6 ( P<0.05). No anesthesia- and surgery-related serious complications occurred among the patients.One patient was transferred to the ward after extubation in the operating room, and 5 patients were transferred to the intensive care unit after operation.All 6 patients were discharged successfully and entered the follow-up stage. Conclusion:General anesthesia provides better efficacy when used for PPVI, and hemodynamic monitoring of pulmonary circulation and systemic circulation should be strengthened during pulmonary valve implantation to maintain circulation stable.

7.
Article in Chinese | WPRIM | ID: wpr-911240

ABSTRACT

Objective:To evaluate the effects of intraoperative fluid therapy guided by different stroke volume variation (SVV)s on bleeding during laparoscopic hepatolobectomy and postoperative renal function.Methods:A total of 135 American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 25-64 yr, scheduled for elective laparoscopic hepatolobectomy under general anesthesia, were divided into 3 groups ( n=45 each) using a random number table method: low SVV group (group L), medium SVV group (group M) and high SVV group (group H). In group L, group M and group H, SVVs were maintained at 10%-15%, 16%-20% and more than 21%, respectively.Before surgery and at 1, 3 and 5 days after the surgery, blood samples from the peripheral vein were taken for determination of serum blood urea nitrogen, creatinine and procalcitonin (PCT) concentrations.The occurrence of conversion to laparotomy, intraoperative volume of blood loss, volume of blood transfused, urine volume, operation duration, length of hospital stay and time to first flatus were recorded.On admission to the operating room (T 0), at skin incision (T 1), at the beginning of resection of the liver (T 2), after resection of the lobes of the liver (T 3) and at the end of the surgery (T 4), mean arterial pressure (MAP), heart rate (HR) and lactic acid (Lac) were recorded.The consumption of intraoperative norepinephrine, hypotension, arrhythmia and postoperative adverse reactions were recorded. Results:Compared with group L, the intraoperative volume of blood loss and consumption of intraoperative norepinephrine in group M and intraoperative volume of blood loss, the total amount of fluid infused and urine volume in group H were significantly decreased, consumption of furosemide and nitroglycerin in group H and the total amount of red blood cells infused in M and H groups were increased, length of hospital stay and time to first flatus in group M were shortened, concentration of serum PCT at 1 day after surgery was decreased in group M, MAP at T 3, 4 was increased in group M, and Lac at T 2-4 was increased in group H ( P<0.05). Compared with group M, the intraoperative volume of blood loss, consumption of intraoperative norepinephrine and consumption of furosemide and nitroglycerin were significantly increased, the total amount of fluid infused and urine volume were decreased, length of hospital stay and time to first flatus in group M were prolonged, concentration of serum PCT at 1 day after surgery was increased, MAP at T 3, 4 was decreased in group M, and Lac at T 2-4 was increased in group H ( P<0.05). There was no significant difference in the incidence of postoperative adverse reactions and intraoperative hypotension and arrhythmia among the 3 groups ( P>0.05). Conclusion:Intraoperative fluid therapy guided by SVV at 16%-20% during laparoscopic hepatolobectomy can decrease the intraoperative volume of blood loss and has less effect on renal function, which is helpful for postoperative outcomes.

8.
Article in Chinese | WPRIM | ID: wpr-911226

ABSTRACT

Objective:To evaluate the effect of sevoflurane-dexmedetomidine combined anesthesia on inflammatory responses in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods:A total of 96 American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 45-60 yr, weighing 60-75 kg, with New York Heart Association Ⅱ or Ⅲ, scheduled for elective CABG with CPB, were divided into 4 groups ( n=24 each) using a random number table method: routine general anesthesia (group C), sevoflurane-based general anesthesia group (group S), dexmedetomidine-based general anesthesia group (group D) and sevoflurane combined with dexmedetomidine-based general anesthesia group (group SD). In D and SD groups, dexmedetomidine was intravenously infused in a loading dose of 1μg/kg over 10 min at the beginning of induction anesthesia, followed by an infusion at 0.4 μg·kg -1·h -1 until the end of the surgery.After tracheal intubation, 1%-2% sevofluran was inhaled in S and SD group.Before anesthesia induction, before the CPB, immediately at the end of CPB, at 6 h after the end of CPB and 24 h after surgery, central venous blood samples were collected for determination of plasma interleukin-6 (IL-6), IL-10 and tumor necrosis factor-alpha (TNF-α) concentrations by enzyme linked immunosorbent assay.The restoration of spontaneous heart beat, the occurrence of serious adverse events during surgery and within 24 h after surgery, the retention time of intubation and duration of intensive care unit (ICU) stay after surgery were recorded. Results:Compared with group C, the plasma concentrations of IL-6, IL-10 and TNF-α were significantly decreased in the other 3 groups, and the postoperative retention time of tracheal intubation was shortened in group SD ( P<0.05). Compared with group S or group D, the plasma concentrations of IL-6, IL-10 and TNF-α were significantly decreased ( P<0.05), and no significant change was found in the postoperative retention time of tracheal intubation in group SD ( P>0.05). There was no significant difference in the duration of ICU and restoration of spontaneous heart beat ( P>0.05), and no serious adverse events occurred during surgery and within 24 h after surgery among the groups. Conclusion:Sevoflurane combined with dexmedetomidine anesthesia is helpful in reducing the inflammatory responses in patients undergoing CABG with CPB, but provides no value in clinical outcomes.

9.
Article in Chinese | WPRIM | ID: wpr-911183

ABSTRACT

Objective:To identify the risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.Methods:A total of 200 elderly patients of both sexes, aged>65 yr, of American Society of Anesthesiology physical status Ⅱ or Ⅲ, scheduled for elective thoracic surgery, were enrolled in the study.Data regarding patient age, gender, body mass index (BMI), American Society of Anesthesiologists physical status, history of hypertension, history of diabetes mellitus, operation method, type of operation, operation time, intraoperative blood loss, use of intraoperative nerve block and use of dexmedetomidine in patient-controlled intravenous analgesia (PCIA) were collected.The patients were followed up after operation, the occurrence of postoperative pain at 48 h after operation was recorded, and patients′ subjective sleep quality at 48 h after operation was assessed using the Pittsburgh Sleep Quality Index Questionnaire (PSQI). Patients were divided into 2 groups according to PSQI score: non-postoperative sleep disturbances group (PSQI score<5) and postoperative sleep disturbances group (PSQI score≥5). A multivariate logistic regression was used to identify the risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.Results:A total of 169 patients were included in this study, and the incidence of postoperative sleep disturbances was 45%.The results of logistic regression analysis showed that history of preoperative insomnia, BMI≥24 kg/m 2, diabetes mellitus, thoracic surgery, radical resection of lung cancer, radical resection of esophageal cancer, operation time≥120 min and moderate and severe postoperative pain were risk factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery, and use of intraoperative nerve block and use of dexmedetomidine during PCIA were protective factors for postoperative sleep disturbances in elderly patients ( P<0.05). Conclusion:History of preoperative insomnia, BMI≥24 kg/m 2, diabetes mellitus, thoracic surgery, radical resection of lung cancer, radical resection of esophageal cancer, operation time≥120 min, moderate and severe postoperative pain are risk factors and use of intraoperative nerve block and use of dexmedetomidine during PCIA are protective factors for postoperative sleep disturbances in elderly patients undergoing thoracic surgery.

10.
Chinese Critical Care Medicine ; (12): 1080-1083, 2021.
Article in Chinese | WPRIM | ID: wpr-909456

ABSTRACT

Objective:To compare the curative effects of different venous cannulas and drainage to improve patient's whole body oxygenation during the auxiliary process of venous-arterial extracorporeal membrane oxygenation (VA-ECMO) in lung transplantation.Methods:From December 2016 to December 2019, 12 patients who were assisted by VA-ECMO in one lung transplantation in People's Hospital of Henan Province were selected as the research objects. According to the number of side holes of venous cannulas, they were divided into two groups: one group with few side holes and other group with multiple side holes. The differences in blood gas indexes among the right radial artery, left radial artery, and right internal jugular vein before and after assistance were compared, and the assistance effect was evaluated.Results:The arterial partial pressure of oxygen (PaO 2) of blood gas indexes of the right and left radial arteries in both groups were significantly higher than that before assistance [mmHg (1 mmHg = 0.133 kPa): right and left radial artery in few side holes group: 79.5±4.2 vs. 48.3±3.8 and 88.1±3.5 vs. 48.3±3.8; right and left radial artery in multiple side holes group: 67.7±5.9 vs. 48.7±3.2 and 84.0±3.8 vs. 48.7±3.2, all P < 0.05]. The arterial partial pressure of carbon dioxide (PaCO 2) of blood gas index was significantly lower than that before assistance (mmHg: 44.2±2.6 vs. 71.7±4.4 for the right radial artery and 44.7±1.4 vs. 71.7±4.4 for the left radial artery in the group with few side holes; 46.2±2.1 vs. 71.2±3.5 for the right radial artery and 44.1±1.9 vs. 71.2±3.5 for the left radial artery in the group with multiple side holes, all P < 0.05). The partial pressure of oxygen in venous blood (PvO 2) of blood gas index of ECMO system in the group with few side holes was significantly lower than that of the multiport side holes group (mmHg: 56.4±3.2 vs. 88.7±1.5, P < 0.01), and the partial pressure of carbon dioxide in venous blood (PvCO 2) was significantly higher than that of multiport side holes group (mmHg: 63.6±3.7 vs. 44.2±1.7, P < 0.01). Conclusions:When VA-ECMO is used in lung transplantation, the superior vena cava blood flow can be fully drained by using intravenous cannula with few side holes. It can effectively improve the oxygenation of the upper body of lung transplant patients, avoid the dilemma of hypoxemia in the upper body and hyperxemia in the lower body, provide more effective assistance to patients undergoing single lung transplantation, and is more meaningful for improving the oxygenation status of the whole body in patients undergoing single lung transplantation.

11.
Article in Chinese | WPRIM | ID: wpr-885045

ABSTRACT

Objective:To evaluate the accuracy of ultrasonography in determining the laryngeal mask airway position using three-dimensional CT reconstruction (3D-CTR) images as the standard.Methods:One hundred and thirty-four patients, aged 18-64 yr, weighing 30-100 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective cerebral vascular interventional stent surgery in our hospital, were selected.Cervical ultrasonography was performed before and after laryngeal mask airway placement, and digital subtraction angiography was performed during operation to obtain 3D-CTR images.Neck ultrasound and 3D-CTR images were analyzed and graded.Results:A total of 125 patients completed the study.At the vertical position of the laryngeal mask airway, ultrasonic grading was positively correlated to 3D-CTR grading ( r=0.742, P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound in determining the rotation of the laryngeal mask airway was 73.0% (95% CI: 62.0%-84.4%), 92.8% (95% CI: 86.9%-98.7%), 89.1% (95% CI: 80.5%-97.7%), 81.0% (95% CI: 72.6%-89.4%), and 74.2% (95% CI 65.2%-81.1%), respectively.In terms of laryngeal mask airway depth grading, the correlation between ultrasonic grading was positively correlated to 3D-CT grading ( r=0.332, P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound in determining the depth of the laryngeal mask airway was 58.5% (95% CI: 46.9%-70.1%), 93.3% (95% CI: 87.2%-99.4%), and 90.5% (95% CI: 82.0%-99.0%), 67.5% (95% CI: 57.7%-77.3%), and 33.2% (95% CI: 16.8%-47.8%), respectively.The positive predictive value of ultrasound in determining the optimal placement of the laryngeal mask airway was 61.1% (95% CI: 48.6%-73.6%). Conclusion:Although ultrasound cannot measure the depth of the tip of the laryngeal mask airway into the esophagus, it has higher accuracy in determining the rotation and can be used as a reliable tool for clinical detection of the position of the laryngeal mask airway, especially the rotation.

12.
Article in Chinese | WPRIM | ID: wpr-885035

ABSTRACT

Objective:To identify the risk factors for moderate-to-severe pain in postanesthesia care unit (PACU) in the patients undergoing thoracic surgery.Methods:The medical records of patients of both sexes, aged 18-80 yr, of American Society of Anesthesiologists(ASA) physical status Ⅰ-Ⅲ, transferred to PACU with tracheal intubation from January 2019 to January 2020, were retrospectively collected.Combined intravenous-inhalational anesthesia was used during surgery.The patient′s age, gender, ASA physical status, smoking history, drinking history, history of non-thoracic surgery, history of hypertension, history of diabetes mellitus, and history of immune system disease were collected.The operation method, type of operation, operation time, intraoperative nerve block and use of opioids and dexmedetomidine were also collected.The consumption of rescue analgesics during PACU, occurrence of nausea and vomiting, and length of stay in PACU were also collected.Patients were divided into moderate-to-severe pain group (VAS score>3 points) and non-moderate-to-severe pain group (VAS score≤3 points) according to the VAS scores at rest and during activity at 10 min after extubation in PACU.Logistic regression analysis was used to identity the risk factors for moderate-to-severe pain in PACU.Results:A total of 1 698 patients were included in this study, the incidence of moderate-to-severe pain at rest was 46.70%, and the incidence of moderate-to-severe pain during activity was 54.12%.The results of logistic regression analysis showed that female, radical resection of esophageal cancer, mediastinal surgery, internal fixation for rib/sternal surgery were risk factors for moderate-to-severe pain in PACU, and increasing age, endoscopic surgery, intraoperative use of nerve block and dexmedetomidine were protective factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery ( P<0.05). Conclusion:Female, radical resection of esophageal cancer, mediastinal surgery, and rib/sternal surgery are risk factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery; increasing age, endoscopic surgery, intraoperative use of nerve block and dexmedetomidine are protective factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery.

13.
Article in Chinese | WPRIM | ID: wpr-883191

ABSTRACT

Objective:To summarize the clinical experience of changing the membranous pulmonary system during extracorporeal membrane oxygenation(ECMO) in infants after congenital heart disease opration with cardiopulmonary bypass.Methods:From January to September in 2019, 6 cases of congenital heart disease with cardio-pulmonary bypass in our hospital were analyzed retrospectively, whose membrane obstruction occurred during ECMO treatment and replaced successfully.The hemodynamics and blood gas before and after replacement of ECMO system were observed, and the experience was summarized.Results:Six patients(3 males and 3 females), aging from 1 to 3 months and weighing from 3.0 to 4.9 kg, were received VA-ECMO adjuvant therapy.The ECMO system replacement process was smooth and took 175-209 s. The hemodynamic of the children was stable.The ECMO support time was 134-249 h. After the improvement of cardiac systolic function, all children were successfully withdrawn and survived.Conclusion:The improved method of liquid replacement in ECMO system can make full use of the blood components in the original system and avoid the loss of blood tangible components.According to the plan of rapid replacement, the risk of replacement will not be increased.

14.
Chinese Journal of Anesthesiology ; (12): 1475-1479, 2021.
Article in Chinese | WPRIM | ID: wpr-933276

ABSTRACT

Objective:To evaluate the effects of thoracic paravertebral block (TPVB) on graft patency in off-pump coronary artery bypass grafting.Methods:Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-75 yr, weighing 50-80 kg, undergoing elective off-pump coronary artery bypass grafting under combined intravenous-inhalational anesthesia, were divided into 2 groups using a random number table method: control group (group C, n=30) and TPVB group (group T, n=20). In group T, TPVB was performed at T 4, 5 interspace under the guidance of ultrasound, a test dose of 1% lidocaine 5 ml was injected on both sides, and 2 min later 0.375% ropivacaine 15 ml was injected.According to the anatomy of coronary artery, the graft was divided into 4 parts: left internal thoracic artery-anterior descending branch (arterial graft), the middle branch or the first diagonal branch, blunt marginal branche, and right posterior descending branch or left ventricular posterior branch.The blood flow was measured and pulsatility index was calculated after graft transplantation.Central venous pressure, mean pulmonary artery pressure, cardiac output, systemic resistance index and pulmonary resistance index were recorded immediately after placement of floating catheter (T 1), immediately after sawing sternum (T 2), immediately after anastomosis of all grafts (T 3) and 5 min before leaving the room (T 4). The intraoperative cardiovascular adverse events and consumption of sufentanil were recorded. Results:Compared with group G, central venous pressure, systemic resistance index and pulmonary resistance index were significantly decreased, cardiac output were increased, the incidence of intraoperative tachycardia was decreased, the incidence of hypotension was increased, the consumption of sufentanil was reduced, the flow of left internal thoracic artery-anterior descending branch was increased, and the pulsatility index was decreased at T 3 and T 4 in group T ( P<0.05). Conclusion:TPVB can improve the patency of left internal thoracic artery-anterior descending branch in off-pump coronary artery bypass grafting.

15.
Chinese Journal of Anesthesiology ; (12): 1451-1453, 2021.
Article in Chinese | WPRIM | ID: wpr-933270

ABSTRACT

Objective:To determine the potency of remimazolam in inhibiting ventilatory function during sedation in the patients undergoing internal jugular vein puncture.Methods:American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index<30 kg/m 2, undergoing elective internal jugular vein puncture under local anesthesia, were enrolled in this study.Remimazolam was intravenously injected, and the dose was determined by up-and-down sequential allocation.The initial dose was 0.07 mg/kg and was increased/decreased in the next patient depending on whether the patients showed inhibition of ventilatory function, and the ratio between the 2 successive doses was 1.2.The criterion for inhibition of ventilatory function was defined as Integrated Pulmonary Index < 5.The median effective dose (ED 50) and 95% confidence interval of remimazolam in inhibiting ventilatory function were calculated by Dixon-Massey method. Results:Thirty-six patients were enrolled in this study.The ED 50 (95% confidence interval) was 0.106 (0.097-0.115) mg/kg. Conclusion:The ED 50 of remimazolam in inhibiting ventilatory function during sedation in internal jugular vein puncture is 0.106 mg/kg.

16.
Article in Chinese | WPRIM | ID: wpr-869958

ABSTRACT

Objective:To evaluate the role of hypothalamic aromatase in sevoflurane anesthesia-induced epileptic waves in neonatal rats.Methods:Thirty clean-grade healthy neonatal Sprague-Dawley rats of both sexes, aged 5 days, weighing 10-15 g, were divided into 3 groups ( n=10 each) according to a random number table method: control group (group C), sevoflurane group (group S), and aromatase inhibitor formestane plus sevoflurane group (group F). The electroencephalogram (EEG) in the neonatal rat cortex was monitored, 30 min later formestane 2 mg/kg was subcutaneously injected in F group, while the equal volume of normal saline was given instead in C and S groups.At 30 min after subcutaneous administration, 6% sevoflurane was inhaled to induce anesthesia for 3 min, and then the concentration was adjusted to 2.1% to maintain anesthesia for 57 min in S and F groups.The total duration and single duration of epileptic waves and the number of seizure during sevoflurane anesthesia were recorded.After the end of EEG recording, the laparotomy was performed, the left ventricular puncture was performed, and blood samples were collected for blood gas analysis and for determination of corticosterone levels (by enzyme-linked immunosorbent assay). Brain tissues were obtained, and then the hypothalamus was rapidly isolated for determination of the expression of aromatase mRNA, Na + -K + -2Cl - cotransporter-1 (NKCC1) mRNA and K + -Cl - cotransporter-2 (KCC2) mRNA (by polymerase chain reaction). Results:No epileptic waves were found in group C. Compared with group C, the total duration and single duration of cortical epileptic waves were significantly prolonged, and the number of seizures was increased, the serum corticosterone concentration was increased, the expression of aromatase mRNA was up-regulated, and NKCC1/KCC2 mRNA ratios were increased in S and F groups ( P<0.05). Compared with group S, the total duration and single duration of cortical epileptic waves were significantly shortened, and the number of seizures was decreased, the serum corticosterone concentration was decreased, the expression of aromatase mRNA was down-regulated, and NKCC1/KCC2 mRNA ratios were decreased in group F ( P<0.05). Conclusion:Up-regulation of hypothalamic aromatase expression is involved in the development of sevoflurane anesthesia-induced epileptic waves in newborn rats.

17.
Article in Chinese | WPRIM | ID: wpr-869856

ABSTRACT

Objective:To evaluate the effect of esmolol on the expression of phosphorylated extracellular signal-regulated kinase 1/2 (p-ERK1/2) during cerebral ischemia-reperfusion (I/R) in rats.Methods:Forty-eight clean-grade healthy adult male Sprague-Dawley rats, were allocated into 3 groups ( n=16 each) using a random number table method: sham operation group (Sham group), cerebral I/R group (I/R group) and esmolol group (E group). Cerebral I/R was induced by 3 cycles of 20-min occlusion of bilateral common carotid arteries followed by 10-min reperfusion in anesthetized rats.Esmolol 200 g·kg -1·min -1 was intravenously infused for 1 h starting from 30 min before ischemia, and the model was established after 30-min infusion in E group.The equal volume of normal saline was given at 30 min before ischemia in I/R group.Bilateral common carotid arteries were only isolated but not clamped, and the equal volume of normal saline was given after isolating bilateral common carotid arteries in Sham group.Learning and memory function was tested by Morris water maze test before ischemia and at 1, 3 and 7 days of reperfusion.Rats were sacrificed after Morris water maze test, and the hippocampus was excised for determination of wet to dry weight ratio (W/D ratio), permeability of blood-brain barrier (using Evans blue method), expression of ERK1/2 mRNA (by real-time polymerase chain reaction ), and expression of p-ERK1/2 (by Western blot). Results:Compared with Sham group, the escape latency and swimming distance were significantly prolonged at 1, 3 and 7 days of reperfusion, the W/D ratio and EB content in brain tissues were increased, and the expression of ERK1/2 mRNA and p-ERK1/2 was up-regulated in I/R and E groups ( P<0.05). Compared with I/R group, the escape latency and swimming distance were significantly shortened at 1, 3 and 7 days of reperfusion, the W/D ratio and EB content in brain tissues were decreased, and the expression of ERK1/2 mRNA and p-ERK1/2 was down-regulated in E group ( P<0.05). Conclusion:The mechanism by which esmolol alleviates cerebral I/R injury and improves cognitive function is related to inhibiting the up-regulated expression of ERK1/2 in rats.

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Article in Chinese | WPRIM | ID: wpr-869804

ABSTRACT

Objective:To evaluate the analgesic efficacy of pericapsular nerve group (PENG) block in elderly patients undergoing hip replacement under subarachnoid block.Methods:Fifty patients of both sexes, aged 65-89 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index 20-30 kg/m 2, undergoing unilateral hip arthroplasty, were divided into 2 groups ( n=25 each) by a random number table method: PENG group and fascia iliaca compartment block (FICB) group.In PENG group, 0.4% ropivacaine hydrochloride 20 ml was injected around the nerve innervating the hip joint capsule under ultrasound guidance.In FICB group, 0.4% ropivacaine 30 ml was injected around the nerve innervating the fascia iliaca compartment under ultrasound guidance.Subarachnoid block was performed in both groups.Visual analog scale scores and scores for satisfaction with analgesia at rest and during activity were recorded before blockade (T 0), at 10, 20 and 30 min after blockade (T 1-3) and when placed in the position for spinal anesthesia (T 4). The cumulative consumption of sufentanil, effective pressing times of analgesic pump, and development of related complications were recorded at 6, 12, 24 and 48 h after operation (T 5-8). Results:Compared with FICB group, the VAS scores at rest and during activity were significantly decreased at T 1-4, and scores for satisfaction with analgesia during activity were increased in PENG group ( P<0.05). There was no significant difference between the two groups in the cumulative consumption of sufentanil and effective pressing times of analgesic pump ( P>0.05). One patient developed postoperative delirium in group FICB, and no patients developed puncture site infection and nerve damage after operation in two groups. Conclusion:PENG block produces better analgesic efficacy than FICB when used for elderly patients undergoing hip replacement under subarachnoid block.

19.
Article in Chinese | WPRIM | ID: wpr-867144

ABSTRACT

Objective:To investigate the effects of bumetanide on changes of NKCC1 and KCC2 mRNA expression in hypothalamus and anxiety in adulthood induced by multiple sevoflurane exposure in neonatal rats.Methods:Eighty-one healthy male Sprague-Dawley rats, at postnatal 5 days (P5), were randomly divided into 3 groups ( n=27 in each group): control group (group C), multiple sevoflurane group (group MS) and bumetanide group (group B). The rats were commonly reared in the cage and received no anesthesia in group C. Animals were exposed to 2.1% sevoflurane for 2 h on P5, P7, P9 in group MS and group B. In group B, animals received intraperitoneal injection of 1.82 mg/kg bumetanide(Na + -K + -2Cl - cotransporter 1 blocker, NKCC1 blocker)at 30 min before every anesthesia.The animals in group C and group MS received the same dose of dimethyl sulfoxide subcutaneously at the same time as group B. The rats were observed for 30 minutes after recovery from anesthesia, and then breastfed normally.On the 9th day after birth, six rats were taken from each group immediately at the end of anesthesia and the blood was collected by left ventricular puncture for blood gas analysis.At 30 min after anesthesia, 6 animals in each group were decapitated and the hypothalamus part of brain tissue was collected.Then the expression level of IL-6 mRNA, NKCC1 mRNA and KCC2 mRNA were detected by RT-PCR.The other rats in each group were raised to 60 days for the elevated plus maze (EPM) test. Results:Compared with group C, the expression of IL-6 mRNA and NKCC1 mRNA in hypothalamus of MS group was up-regulated (IL-6: (1.000±0.207) vs (1.782±0.231); t=6.899, P<0.01; NKCC1: (1.000±0.255) vs (1.639±0.290); t=3.518, P<0.01), the KCC2 mRNA expression was down-regulated ((1.000±0.140) vs (0.733±0.115); t=3.017, P<0.001) and the NKCC1/KCC2 mRNA ratio increased ((1.000±0.276) vs (2.054±0.521); t=5.078, P<0.001) and the differences were statistically significant.Compared with MS group, the expression of IL-6 mRNA and NKCC1 mRNA in hypothalamus of group B was down-regulated (IL-6: (1.147±0.140); t=5.635, P<0.01; NKCC1: (1.038±0.385); t=3.310, P=0.01), KCC2 mRNA expression was up-regulated((0.988±0.194); t=2.880, P<0.05), NKCC1 / KCC2 mRNA ratio was decreased((1.027±0.200); t=4.950, P<0.001), and the differences were statistically significant.EPM behavioral test showed that compared with group C, the open arm residence time in MS group was significantly shorter than that in group C ((18.4±10.1)s vs (4.3±3.1)s; P<0.01); compared with group MS, the open arm residence time in group B was significantly prolonged((16.6±7.6)s, P<0.05). Conclusion:Bumetanide can reduce the up-regulation of NKCC1 level and the down-regulation of KCC2 level in neonatal rats after sevoflurane anesthesia, and alleviate the anxiety state of adult rats.

20.
Article in Chinese | WPRIM | ID: wpr-867055

ABSTRACT

Objective:To investigate the effect of sevoflurane anesthesia on electroencephalographic (EEG) seizures and long-term behavior and possible mechanism in neonatal rats.Methods:A total of 141 postnatal days 4-6 Sprague-Dawley rats (66 male, 75 female) were divided into 3 groups ( n=47 in each group) according to random number table method: control group, sevoflurane group, and NKCC1 inhibitor group, with 22 males and 25 females in each group. Rats in the control group were fed in normal cage without anesthesia; rats in the sevoflurane group were anesthetized with 2.1% sevoflurane for 6 hours; rats in the NKCC1 blocker group received intraperitoneal injection of 1.82 mg / kg bumetanide 30 minutes before anesthesia with 2.1% sevoflurane. The rats in the control group and sevoflurane group were injected subcutaneously with the same dose of DMSO at the same time when the NKCC1 blocker group received the drug intervention, so as to eliminate the influence caused by the solvent. The rats were observed for 30 minutes after recovery from anesthesia and then continued to breastfeed normally. Some of the new born rats received EEG monitoring from 9 to 11 days after being raised; the other rats received EPM and PPI respectively at 60 and 70 days after being raised. Results:The results of EEG showed that, compared with the control group, the number of epileptic waves((0.429±0.787), (1.571±0.787), t=2.753, P<0.01), the average duration of single epileptic wave ((1.575±2.349), (6.392±3.374), t=3.880, P< 0.01), the total duration increased significantly ((1.800±3.617), (10.957±6.028), t= 3.929, P<0.01) were all increased, the differences were statistically significant. Compared with sevoflurane group, the number of epileptic waves in EEG of male rats in NKCC1 blocker group decreased, the average duration of single epileptic wave decreased, and the total duration of epileptic wave shortened significantly, with statistical significance ((0.286±0.756), (0.925±1.733), (1.043±2.759), t=3.097, 4.404, 4.254, all P<0.01). There were no significant differences in female rat among the three groups (all P>0.05). Compared with male rats, the average duration of female rats in sevoflurane group decreased ((6.392±3.374), (2.515±2.992), t=3.044, P<0.01), the total duration shortened ((10.957±6.028), (3.270±5.883), t=2.626, P<0.01), the difference was statistically significant.The behavioral results showed that, compared with the control group, the open arm dwell time of male rats in sevoflurane group was significantly shorter ( P<0.05), and the panic response in PPI group was significantly lower ( P<0.05), the difference was statistically significant.Compared with the sevoflurane group, the open arm dwell time in NKCC1 blocker group was significantly longer ( P<0.05), and the panic response in PPI group was significantly increased.The difference was statistically significant ( P<0.05). The change trend in female rats of each group was similar to that of male rats, but there was no significant difference (all P>0.05). Comparison between male and female rats: compared with male rats in sevoflurane group, the female rats in sevoflurane group had a longer open arm stay time in EPM experiment ( P<0.05), the difference was statistically significant. Conclusion:Sevoflurane anesthesia for 6 hours can significantly increase the generation of epileptic waves in EEG of male newborn rats, and cause behavioral abnormalities in adult male rats, which may be related to NKCC1.And male rats are more vulnerable to the negative effects of sevoflurane anesthesia on brain nerve development.

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