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Resumen: Introducción: Los tumores pulmonares congénitos son patologías poco frecuentes; asimismo, cuando requieren intervención quirúrgica, el médico anestesiólogo se enfrenta a un reto en el manejo de estos pacientes. Presentación del caso: En este artículo describimos el caso y el manejo anestésico de un recién nacido de 37.5 semanas de gestación (SDG) y 26 días de vida extrauterina, programado para toracotomía posterolateral izquierda más lobectomía inferior izquierda y colocación de catéter venoso central bajo anestesia combinada (anestesia general balanceada más bloqueo caudal con bupivacaína y morfina). Conclusiones: Las consideraciones anestésicas para los procedimientos quirúrgicos en neonatos y/o pacientes pediátricos se convierten en un reto para el anestesiólogo, debido a la inmadurez de algunos de los sistemas, se considera que la técnica anestésica idónea para el adecuado manejo de los pacientes neonatales sigue siendo la técnica combinada. El anestesiólogo debe mantener en mente dicha técnica así como los eventos y/o efectos secundarios que se puedan derivar de la misma y de este modo instaurar de manera oportuna el tratamiento pertinente.
Abstract: Introduction: Congenital lung tumors are rare pathologies, likewise when surgical intervention is required, the anesthesiologist faces a challenge in the anesthetic management of these patients. Presentation of the case: The following article describes the case of a 26-day-old newborn child scheduled for left posterolateral thoracotomy plus lower left lobectomy and central venous catheter placement under combined anesthesia (balanced general anesthesia plus caudal block with bupivacaine and morphine). Conclusions: Anesthetic considerations for surgical procedures in neonates and/or pediatric patients become a challenge for the anesthesiologist, due to the immaturity of some of the systems, thus considering that the ideal anesthetic technique for the proper management of in neonatal patients, the combined technique continues, with epidural blocks for the management of peri- and postoperative pain. The anesthesiologist must keep in mind this technique as well as the events and/or side effects that may derive from it, thus establishing the pertinent treatment in a timely manner.
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<p><b>OBJECTIVE</b>To observe the analgesic and sedative effects of acupuncture combined with local anesthesia for percutaneous vertebroplasty (PVP).</p><p><b>METHODS</b>Sixty patients of single segmental osteoporotic vertebral compression fractures who were prepared to receive PVP were randomly divided into an observation group, a control 1 group, a control 2 group, 20 cases in each group. The patients in the observation group were treated with electroacupuncture (EA) at Hegu (LI 4), Neiguan (PC 6) and Zusanli (ST 36) 20 min before operation; during operation, EA was given combined with regular anesthesia. The patients in the control 1 group were treated with intramuscular injection of parecoxib sodium (40 mg), combined with regular anesthesia. The patients in the control 2 group were treated with intravenous injection of dezocine (5 mg), combined with regular anesthesia. Visual analogue scale (VAS) and Ramesy sedation score were compared among the three groups.</p><p><b>RESULTS</b>In the observation group and control 2 group, the VAS during puncture and bone cement placement was higher than that before acupuncture (all <0.01); the VAS during bone cement placement was higher than that before puncture (<0.05, <0.01); the VAS after operation was lower than that during puncture and bone cement placement (<0.05, <0.01). In the control 1 group, the VAS during puncture and bone cement placement and after operation was higher than that before acupuncture (<0.01, <0.05), the VAS after operation was lower than that during puncture and bone cement placement (<0.05, <0.01). There was no significant difference in VAS and Ramesy score among three groups at all time points (all >0.05).</p><p><b>CONCLUSION</b>Compared with local anesthesia and analgesics, acupuncture combined with local anesthesia has similar analgesic and sedative effect for PVP, which could be considered a better method for PVP anesthesia.</p>
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Objective To compare the early cognitive function of elderly patients underwent sevoflurane static inhalation combined anesthesia and total intravenous anesthesia after total hip replace-ment.Methods A total of 80 cases with femoral neck fractures were randomly divided into two groups with 40 cases in each group.The A group was given sevoflurane static inhalation combined anesthesia and the B group was given total intravenous anesthesia.The cognitive function score of patients before and after anesthesia,the incidence of postoperative cognitive dysfunction(POCD)and the postoperative recovery were recorded and analyzed.Results The mini-mental state examination(MMSE)score at 2 h(23.08 ± 2.10)and 6 h(24.86 ± 1.51)after surgery in the A group were significantly higher than that at 2 h (21.34 ± 1.61)and 6 h(22.12 ± 1.56)in the B group.There were significant differences between the two groups(P<0.05).The incidence of POCD in the A group(20.0%)was significantly lower than that in the B group(32.5%).There were significant differences between the two groups(P<0.05).The MoCA score at 2 h(23.88 ± 1.32),6 h(24.56 ± 0.88)and 1 d(26.12 ± 1.03)after surgery in the A group were significantly higher than that at 2 h(21.78 ± 0.88),6 h(22.98 ± 1.21)and 1 d(24.48 ± 1.13)in the B group.There were significant differences between the two groups(P<0.05).Conclusion The ap-plication of sevoflurane static inhalation combined anesthesia can decrease the incidence of early POCD and effectively improve the cognitive ability of elderly patients after total hip replacement.
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Objective To investigate the effect of ultrasound-guided oblique subcostal trans versus abdominis plane (OSTAP) block with different concentration of ropivacaine in combined anesthesia for upper abdominal surgery.Methods One hundred forty-seven patients underwent upper abdominal surgery,85 males and 62 females,aged 18-80 years,ASA physical status Ⅰ or Ⅱ,were recruited and randomly divided into four groups.Bilateral ultrasound-guided OSTAP block were performed in each group.Ropivacaine hydrochloride injection of 2.5 mg/kg were performed in each of group A (n =41),B (n =55),C (n =37) while concentration was 0.375％,0.5％,0.75％,respectively.Group D (n =14) was received 20 ml of saline solution for each side.Intravenous-inhalation combined anesthesia was conducted during the surgery,with sevoflurane 0.8-1.0 MAC,dexmedetomidine 0.5 μg/kg iv,remifentanil 0.1μg·kg-1 ·min-1 iv.Each group was received patient-controlled intravenous analgesia (PCIA) after surgery which contained butorphanol tartrate and flurbiprofen axetil.The consumption of opioids and vasoactive drugs,hemodynamic parameters in operation were recorded.The visual analogue scale (VAS) scores were evaluated at 12 and 24 h after operation,the location and degree of abdominal pain,fentanyl used for acute pain during the first 12 h after operation,the postoperative intestinal exhaust time and hospitalization time were also recorded.Results There was no difference in basic states,duration of operation or blood loss in each group.The consumption of sufentanil in operation in groups A,B and C was (30.5±9.4)μg,(27.4±7.4) μg,(30.9±8.8) μg,respectively,which were significantly lower than that in group D [(47.1±9.3) μg] (P＜0.05).There was no difference in vasoactive drugs between the four groups.There was no difference in hemodynamic indexes in the TAP block groups.There was no significant difference in intraoperative blood loss between the four groups the VAS scores.There was no difference in the location and degree of abdominal pain,fentanyl used for acute pain,the postoperative intestinal exhaust time and hospitalization time.Conclusion Intraoperative opioids consumption in combined general anesthesia was reduced by ultrasound-guided OSTAP block.There is no difference between the effect of OSTAP block with different concentration of ropivacaine in combined anesthesia for upper abdominal surgery.
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Objective To explore the effect of general anesthesia on Wuzhishan miniature pigs induced by a mixture of ketamine, Sumianxin II and midazolam, and maintained by ketamine and propofol in surgery lasting up to 8 hours. Methods A total of 18 Wuzhishan miniature pigs (body weight (20. 3 ± 1. 9) kg, 14 male and 4 female) were used in this study. The induction of anesthesia was performed with intramuscular injection of ketamine (8 -10 mg/kg) Sumianxin II (1. 5 mL) and midazolam (10 mg) behind the ear, and the general anesthesia was maintained with a mixture containing 0. 9％ sodium chloride 8 mL, ketamine 100 mg/2 mL and propofol 200 mg/40 mL, continuously injected through the marginal ear vein through a syringe infusion pump. The time spent for anesthesia induction and the duration time of anesthesia were recorded. Physiological indexes including body temperature, blood pressure, heart rate and respiratory rate, the reflex activities, and the effects of analgesia, sedation and muscular relaxation of the miniature pigs under anesthesia at 0, 0. 5, 1, 1. 5, 2, 4, 6, 8 h were observed. Results All the 18 pigs were successfully anaesthetized, but 4 pigs died during surgery due to hypovolemic shock, anesthesia accident, left main coronary thrombosis and reperfusion arrhythmia, respectively. During anesthesia, the analgesia, sedation and muscular relaxation effects on the pigs were obvious. The average time spent for anesthesia induction was (4. 8 ± 1. 2) min and the duration time of anesthesia was (54. 1 ± 5. 8) min. The eyelid reflex, corneal reflex and anal reflex in the pigs were weak or disappeared during 1 -8 h after the anesthesia was induced. The body temperature of the pigs was decreased gradually, with a significant difference between 1 h and 0 h (P＜ 0. 05), reaching the lowest point at 4 h, and then maintained stable. The blood pressure was gradually decreased, reaching the lowest level at 2 h (P ＜ 0. 05), then somehow increased, and maintained at a stable level until the end of surgery. The respiratory rate fluctuated during the anesthesia, with no significant difference. Conclusions The anesthesia induced by a combination of ketamine, Sumianxin II and midazolam and maintained with a combination of ketamine and propofol is simple to operate, shows effects fast, and has good effects of analgesia, sedation and muscular relaxation, keeping the circulatory system and respiratory system relatively stable throughout the anesthesia. Thus it is suitable for general anesthesia for miniature pigs.
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Objective To investigate the effects of sevoflurane combined anesthesia on the early cognitive function of the elderly patients.Methods 120 patients underwent laparoscopic surgery in our hospital from August 2014 to August 2016 were selected and randomly divided into two groups:sevoflurane group 60 cases, sevoflurane anesthesia during operation and propofol anesthesia 60 cases, propofol anesthesia during operation.MMSE was used to detect the cognitive function at one day before operation, one day, three days and seven days after surgery respectively.The blood samples were taken from the patients of the two groups at the time of one day before operation, one hour after operation and one day after operation, the levels of serum TNF-αand IL-6 were measured by enzyme-linked immunosorbent assay ( ELISA ) . The recovery time and adverse reactions were observed after operation.Results The average recovery time was (18.94 ±3.32) min in the propofol group and (10.62 ±2.31) min in the sevoflurane group, the sevoflurane group was better than the propofol group, the difference was statistically significant (P<0.05).The scores of MMSE were significantly lower in the sevoflurane group one day after operation than those in the one day before operation, the difference was statistically significant (P<0.05).The scores returned to the preoperative level three days and seven days after operation.In the propofol group, the MMSE score was significantly lower at one day after operation than that before operation, the difference was statistically significant (P<0.05), but increased three days after operation but did not reach the preoperative level, and sevoflurane group, the difference was statistically significant.After treatment, the levels of TNF-and IL-6 in serum of two groups increased, the level of TNF-αand IL-6 in the propofol group one hour after operation and one day after operation were significantly higher than those in the sevoflurane group, the difference between the two groups was statistically significant ( P <0.05 ).Conclusion The sevoflurane compound anesthesia in patients after surgery, the recovery of cognitive ability faster, fewer side effects in patients.
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A safe and effective anesthesia technique is necessary in ensuring a successful surgical operation in rabbit experiments.A variety of anesthesiamethod have been reported, yet, no one matured and widely accepted anesthesiamethod is available so far.This article aims to provide an information basis for further research on general anesthesia in rabbits by reviewing the literature on single and combined anesthesia techniques in rabbits reported in the last decade.
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Objective To study the physiological indicators and arterial blood gas values,and create a reliable data for researchers using beagle dogs.Methods Beagle were sampled before and after Zoletil anesthesia (10 mg/kg) via intramuscular injection.Then aterial blood gas was detected by blood gas analyzer.Then the physiological indicators,including heart rate,blood pressure and body temperature were measured via large animal ECG.Results For blood gas values,the pH value decreased significantly (P ＜ 0.01).pCO2 increased significantly and pO2 decreased significantly,the differences were significantly (P ＜ 0.05).In contrast,levels of Lac and HCO3-remained unaltered,indicating a typical respiratory acidosis.For physiological indicators,blood pressure increased slightly,but not significant.The heart rate increased significantly (P ＜ 0.01) and body temperature decreased significantly (P ＜ 0.01).There was no difference between sexes.Conclusion Zoletil anesthesia causes respiratory arrest and respiratory congestion,which further induced respiratory acidosis.Meanwhile,anesthesia also results in elevated heart rhythm and lower body temperature.These data indicate that warming and airway clear are necessary during anesthesia in Beagles.Moreover,it should be considered about the effects of anaesthetics when comparing differents in animals before and after treatment.
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<p><b>OBJECTIVE</b>To observe the effect of electroacupuncture (EA) combined with general anesthesia for the immune function of patients treated with laparoscopic radical rectectomy for rectal cancer.</p><p><b>METHODS</b>Fifty patients who would receive selective laparoscopic radical rectectomy for rectal cancer with general anesthesia were randomly divided into an observation group and a control group,25 cases in each one. Fifteen minutes before anesthesia induction,patients in the observation group were treated with EA at Zusanli (ST 36) and Sanyinjiao (SP 6) until the end of operation. Sham acupuncture without piercing the skin was applied at the same acupoints in the control group, and electrodes were connected without stimulation. Interferon-γ (IFN-γ), interleukin-4 (IL-4), interleukin-6 (IL-6) were quantitatively tested before anesthesia (T), at the time of abdomen closing (T) and one hour after anesthesia anabiosis (T). And serum procalcitonin (PCT) level, leucocyte count and the number of cases with increasing leucocyte (the standard number>10×10/L) were measured on the first day after operation.</p><p><b>RESULTS</b>The levels of IL-4 and IL-6 were increased apparently and the ratio of IFN-γ/IL-4 was decreased at Tcompared with those before treatment in the control group (all<0.05), but obvious change did not appear in the observation group (all>0.05). The ratio of IFN-γ/IL-4 was enhanced (<0.05),and the levels of IL-4 and IL-6 were reduced (both<0.05) at Tin the observation group compared with those in the control group. The level of PCT of the observation group was markedly lower than that of the control group on the first day after operation (<0.05). There was no statistical significance about leucocyte count and the number of cases with increasing leucocyte between the two groups (both>0.05).</p><p><b>CONCLUSIONS</b>EA at Zusanli (ST 36) and Sanyinjiao (SP 6) could alleviate the depressing immune function and inflammatory reaction of patients after laparoscopic radical rectectomy for rectal cancer.</p>
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Objective To analysis the effect of dezocine combined anesthesia on serum levels of IL-6,MDA and SOD in patients after laparoscopic surgery for colon cancer.Methods 48 patients who were undergoing laparoscopic radical resection of colon cancer in our hospital were collected.All patients were randomly divided into experimental group and control group, 24 cases in each group, the control group was given remifentanil combined anesthesia, the experimental group received dezocine combined anesthesia, after surgery, the serum levels of interleukin-6 (IL-6), tumor necrosis factor-α( TNF-α) , malondialdehyde ( MDA ) , superoxide dismutase ( SOD ) and incidence of adverse reactions were detected in all patients. Results After surgery, compared with control group, the serum levels of IL-6 and TNF-αwere lower in the experimental group (P<0.05);the serum level of MDA was lower, and the serum level of SOD was higher in the experimental group(P<0.05);the incidence of adverse reactions was lower in the experimental group(P<0.05).Conclusion The dezocine combined anesthesia can significantly reduce the serum levels of IL-6,TNF-αand MDA in patients after laparoscopic surgery for colon cancer,improve serum SOD level, effectively reduce inflammation and oxidative stress reaction, and have high security.
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Objective To compare the clinical effects of combined anesthesia of lumbar plexus-sciatic nerve and superior clunial nerve versus spinal-epidural analgesia in total hip replacement. Methods Fifty cases of total hip replacement were randomly divided into two groups. Patients in group A received combined anesthesia of lumbar plexus-sciatic nerve and superior clunial nerve,while patients in group B received spinal-epidural analgesia. Results There were no significant differences in preoperative HR, SBP,DBP and SpO2 between the groups(P > 0. 05). Compared with pre-anesthesia data,HR,SBP,DBP in group A were significantly lower during the anesthesia(P 0. 05). Patients′ heart rate in group A showed significant changes compared with that in group B. The differences in HR,SBP and DBP between group A and B at the same time points were significant(P < 0. 05). Superior rate of anesthesia in group B is higher than that in group A(P < 0. 05). Conclusion Combined anesthesia of lumbar plexus-sciatic nerve and superior clunial nerve has limited influence on the circulatory and respiratory systems,which can be used for total hip replacement.
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Objective To observe the efficacy ,safety and patient acceptance of the artificial airway with the oro‐pharyngo‐laryn‐gead airway cap(OPLAC) for hip replacement surgery in patients with intravenous‐inhalation combined anesthesia .Methods Sev‐enty eight cases of patients receiving the hip replacement surgery were included ,42 patients were to be adopted to establish artificial airway with the OPLAC for intravenous‐inhalation combined anesthesia ,another 36 patients treated with heath side‐lying position hypobaric spinal‐epidural anesthesia .There are two groups ,the oro‐pharyngo‐laryngead airway cap group(OPLAC ,n=42) and hy‐pobaric combined spinal‐epidural anesthesia group (CESA ,n=36) .Monitor the changes of respiratory and circulatory parameters of the two groups before the start of anesthesia ,anesthetic after 10 min ,30 min ,1 h ,and handling marrow ,observing occurrence of complications (delirium ,sore throat ,nausea ,vomiting ,deep vein thrombosis) ,following up the degree of satisfaction of patients and surgeons for anesthesia .Results The respiratory and circulatory parameters of the OPLAC group during anesthesia induction and maintenance were relatively stable ,on the other hand ,significant cyclic inhibition (blood pressure and heart rate decresing ) and re‐spiratory rate declining were observed in the CESA group after anesthesia ,cases with the use of atropine and dopamine significantly more than OPLAC group .The circulation and breath in the OPLAC group were relatively stable when handling marrow ,while cir‐culation fluctuating Significantly in the CESA group (blood pressure decreasing and heart rate increasing ) .The incidence of delirium in the CESA group was significantly higher than OPLAC group .The patient satisfaction of the OPLAC group was significantly bet‐ter than the CESA group .Conclusion The artificial airway with OPLAC for hip replacement surgery in patients with intravenous‐inhalation combined anesthesia is safe ,effective ,and satisfactory .
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Background and purpose:Many patients may suffer from acute pain after radical mastectomy un-der general anesthesia. This article aimed to investigate the effect of intercostal nerve block coupled with general anes-thesia on analgesia after radical mastectomy for breast cancer.Methods:Ninety-six patients underwent modiifed radical mastectomy for breast cancer were randomized with random number into group C (intercostal nerve block coupled with general anesthesia) and group G (general anesthesia), with 48 patients in each group. Group C received intercostal nerve block by ultrasound before general anesthesia. Group G received only general anesthesia. The induction of general an-esthesia was the same between the two groups. During the surgery, 10 μg sufentanil was given to the patient if heart rate or blood pressure were 20% higher than baseline. After surgery, sufentanil was given if VAS score exceeded 0 point. The perioperative amount of sufentanil was recorded. VAS scores were recorded respectively on 2 (T1), 12 (T2) and 24 h (T3) after surgery. The incidence of postoperative nausea and vomiting was also observed.Results:Sufentanil amount used intra- and post- operation were signiifcantly lower in group C [(25.2±3.5) and (3.3±1.2) μg] than that in group G [(40.5±4.3) and (8.4±2.2) μg] (P<0.01). The VAS scores on 2, 12 and 24 h after surgery in group C(0.45±0.15,1.75±0.08 and 2.05±0.12), were signiifcantly lower than those in group G (4.32±0.21, 4.88±0.13 and 4.78±0.16) (P<0.01). The incidences of nausea and vomiting on 2 and 24 h after surgery in group C (6.25% and 16.66%) were signiifcantly lower than those in group G (20.8% and 41.66%). There was no adverse complication related with intercostal nerve block in group C.Conclusion:Intercostal nerve block coupled with general anesthesia plays an important role in preemptive analgesia for patients undergoing modiifed radical mastectomy for breast cancer, which may improve postoperative pain control and reduce the usage of opioids and incidence of nausea and vomiting. Intercostal nerve block under ultrasound is quite safe and effective for patients.
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Objective To compare the effects of total intravenous anesthesia or Intravenous-in-halation combined anesthesia on intraoperative somatosensory evoked potential (SSEP)and motor evoked potential (MEP)in spinal surgery.Methods Sixty patients scheduled for spinal surgery under general anesthesia were divided randomly and equally into 2 groups.The anesthesia was maintained with TCI propofol (plasma target concentration 3.0-3.5 μg/ml)and 1% sevoflurane+propofol in group T or group I respectively.BIS was monitored and maintained at 40-50.SSEP and MEP was re-corded before induction of anaesthesia (T0 ),5 minutes after tracheal intubation (T1 ),during skin in-cision (T2 )and at the time of decompressing spinal canal (T3 ).Results The latency of P38 and N45 prolonged,and the amplitudes of P38 and N45 was significantly depressed at T1-T3 compared to those at T0 (P <0.05).No statistically significant differences in cortical SSEP amplitudes or latency was observed in each time point.There was no case who could not detect the wave of MEP intraoperative-ly in this study.Conclusion The data from these cases indicates that 1% sevoflurane can be used in conjunction with SSEP and MEP monitoring for some adult patients undergoing spinal surgery.
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Objective To investigate the clinical application of acupuncture combined with general anesthe -sia in gynecologic laparoscopic surgery .Methods 60 ASA( the American society of anesthesiologists )Ⅰ-Ⅱpatients undergoing elective gynecologic laparoscopic surgery were randomly divided into the acupuncture group and control group.Patients in the acupuncture group were chosen Hegu (LI 4),Neiguan(PC 6) on both sides.After acupuncture, the two acupoints,electroacupuncture stimulated 20-30min,then administered general anesthesia ,electroacupuncture until surgery finished ,the control group received general anesthesia only .The drug dosages of the two groups was regu-lated,maintained anesthesia depth bispectral index ( BIS) between 40 and 60.The changes of the blood pressure ( BP) ,heart rate and BIS of the two groups at the same time points were observed;the propofol and remifentanil dos-age after the surgery ,the awaken time and extubation time ,OAA/S score and pain score after wake ,the happening of restlessness,chills,nausea and vomiting ,the usage of narcotic analgesics postoperation ,and the intraoperative aware-ness were recorded .The effect of acupuncture combined with general anesthesia was evaluated .Results Anesthetic dosage propofol of the acupuncture group [(7.44 ±1.30)μg· kg-1· h-1] was less than [(8.66 ±1.24)μg· kg-1· h-1] of the control group (t=3.720,P=0.001),remifentanil dosage was also less than the control group [acupunc-ture group (10.59 ±2.58)μg· kg-1· h-1,control group (11.93 ±2.27)μg· kg-1· h-1,t=2.168,P=0.034]. Compared with the basic value ,the BP values were higher at the time of intraoperation ,waking,extubation and 10 min after extubation (all P<0.05),the acupuncture group had more stable BP .Compared with the acupuncture group , heart rates in the control group were faster at extubation and 10min after extubation .Recovery time and extubation time of the acupuncture group were (9.05 ±2.36)min and (1.61 ±2.40)min,which were shorter than (12.50 ± 3.20)min and (15.90 ±3.37)min of the control group (P<0.05).Pain score(VAS) in the acupuncture group was lower than that of the control group .Consciousness score was higher in the acupuncture group ,the incidence rates of restlessness,chills were less.Conclusion The use of acupuncture combined with general anesthesia in gynecologic laparoscopic surgery can reduce the dosage of general anesthetics ,shorten the awaken time and extubation time ,increase the OAA/S score of the patients ,relieve pain ,and the recovery quality is higher .
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Objective To compare the effects of total intravenous anesthesia(TITA) by using remifentanil combined with propofol and intravenous-inhaled anesthesia by using propofol combined with sevoflurane on emergence agitation(EA) in children undergoing surgery of obstruction sleep apnea syndrome(OSAS). Methods Forty children of 3 to 7 years old scheduled for elective surgery of OSAS were randomly divided into TITA group(group T,n=20) and combined anesthesia group(group C,n=20).Patients in group T were induced with remifentanil 1 ?g/kg,midazolam 0.2 mg/kg,propofol 2.5 mg/kg and rocurolnium 0.6 mg/kg and maintained with remifentanil(0.4-0.5 ?g?kg-1?min-1) and propofol(4-6 mg?kg-1?h-1) until the end of the operation.Patients in group C were induced with midazolam 0.2 mg/kg,propofol 2.5 mg/kg and rocurolnium 0.6 mg/kg and maintained with propofol 4-6 mg?kg-1?h-1 and sevoflurane inhalation(1.2-1.4 MAC) until the end of the operation.EA was evaluated by 5-point scoring scale. Results The score of EA was significantly lower in group T than that in group C(P
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Spinal anesthesia in preterm infants offers a safe alternative to general anesthesia, especially if general anesthesia is not preferred because of coexisting diseases, such as bronchopulmonary dysplasia and recurring of apnea. But the single-shot technique of spinal anesthesia has some limitations because the duration of surgical anesthesia is approximately 60 min. Since some procedures may require more time, alternative regional techniques which provide more prolonged surgical anesthesia are needed. We present our experience with a combined spinal caudal anesthesia in a preterm infant.
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Humans , Infant, Newborn , Anesthesia , Anesthesia, Caudal , Anesthesia, General , Anesthesia, Spinal , Apnea , Bronchopulmonary Dysplasia , Infant, PrematureABSTRACT
Objective To compare the effects of propofol intravenous balanced anesthesia with infusion of remifentanil combined with fentanyl to simple infusion of remifentanil or fentanyl during laparoscopic cholecystectomy(LC).Methods Sixty patients scheduled for LC were randomly divided into three groups(n=20): simple remifentanil group(R),remifentanil combined with fentanyl group(RF) and simple fentanyl group(F).Mean arterial pressure(MAP),heart rate(HR) and SpO2 during the anesthesia induction phage,maintenance phage and analepsia phage,the recovery time of spontaneously breathing and consciousness from withdrawal,extubation time,pain score(verbral report score,VRS) and conscious state score(observers assessment of alertness/sedation scale,OAAS) at instant,1 h,3 h,7 h,12 h after extubation and complications of analepsia phage were recorded.Results As compared with the RF Group,the F Group and pre-induction intro-group,the R Group showed lower MAP and quicker HR when induction intubation,higher MPA and quicker HR after operation,and no obvious difference in maintenance phage was found.MAP and HR showed no obvious difference between the RF and F Group as well as within groups in induction and maintenance phage.MAP increased and HR became quicker in the RF Group when extubating and leaving operating room.All observed index at every time showed no significant differences between the R and RF Group after operation,but it prolonged significantly in the F Group.Complications of the three groups showed no statistical difference.VRS of the R Group was significantly higher than that of RF and F groups after operation(P
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Objective:To investigate the anesthetic management of thymectomy for the patients with myasthenia gravis.Methods:Sixty-two patients with myasthenia gravis who underwent thymectomy in our hospital from 1984 to 2003 were retrospectively studied.Of these patients,21 cases received peroral endotracheal intubation and 41 cases pernasal intubation.Intravenous-inhalation combined anesthesia was taken during operation.All of 62 patients with endobronchial tube were transferred to ICU and received mechanical ventilation.Results:Twenty-one patients with perora endotracheal intubation were extubated at 4h-6h after operation.Of these 21 patients,five cases had to be intubated again because of repeated occurrence of myasthenia crisis.Forty-one patients with pernasal intubation did not extubated until mechanical ventilation for 6 hrs to 5 days,and none needed for intubation again,pernasal intubation cases were significantly different with peroral endotracheal intubation cases.The statistics have no difference betwen the trachea incisioned and the dead cases.Conclusion:In anesthetic management of thymectomy for the patients with myasthenia gravis,pernasal endotracheal intubation is convenient for prolonged mechanical ventilation,it can effectively prevent the occurrence of postoperative myasthenia crisis.The perioperative safety precautions,intravenous-inhalation combined anesthesia during operation and strengthening management of respriratory tract are very important.
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0.05).Conclusions Combined spinal and epidural anesthesia combined with target controlled infusion of midazolam has slight side effects and serum cortisol changes,suitable for gynecological operations.