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Objective:To investigate the effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery.Methods:The clinical data of 136 patients who underwent lung cancer surgery in the Second People's Hospital of Liaocheng from June 2020 to May 2022 were retrospectively analyzed. According to anesthesia methods, these patients were divided into an observation group ( n = 89) and a control group ( n = 47). The observation group was given thoracic segment epidural anesthesia, while the control group was given remifentanil infusion anesthesia. The tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels in the epithelial lining fluid collected from the non-dependent lung, the plasma levels of TNF-α, IL-6, and malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, the incidence of complications, the incidence of re-operations, numeric rating scale score, and the length of hospital stay were compared between the two groups. The effects of different anesthesia methods on lung cancer surgery were evaluated. Results:In each group, TNF-α, IL-6, and IL-10 levels in the epithelial lining fluid were significantly increased 30 minutes after termination of one-lung ventilation (T2) compared with those measured before one-lung ventilation (T1) ( t = 7.71, 77.10, 7.59, 3.41, 57.51, 5.74, all P < 0.05). In the observation group, TNF- α [(1.59 ± 0.53) ng/L, (1.89 ± 0.64) ng/L] measured at T1 and T2, IL-6 [(2.96 ± 0.82) ng/L] and IL-10 [(1.99 ± 0.53) ng/L] measured at T1 were significantly higher compared with those measured at the corresponding time points in the control group ( t = 10.45, 2.59, 2.00, 7.19, all P < 0.05). In the observation group, IL-6 measured at T2 [(38.91 ± 5.84) ng/L] was significantly lower than that in the control group ( t = 33.25, P < 0.001), and IL-10 measured at T2 [(2.51 ± 0.67) ng/L] was slightly, but not significantly higher than that in the control group ( P > 0.05). There was no significant difference in the plasma level of TNF- α measured at T1 and T2 between the two groups (both P > 0.05). Plasma levels of IL-6 in the two groups [(42.98 ± 5.29) ng/L, (27.93 ± 4.17) ng/L] measured at T2 were significantly increased compared with those measured at T1 ( t = 54.14, 61.06, both P < 0.001). In the observation group, TNF-α measured at T2 [(1.60 ± 0.56) ng/L] and IL-6 measured at T1 and T2 [(0.92 ± 0.16) ng/L, (27.93 ± 4.17) ng/L] were significantly lower compared with the control group ( t = 3.39, 6.96, 18.20, all P < 0.05). There were no significant differences in plasma level of malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, numeric rating scale score, the incidence of complications, the incidence of re-operation, and the length of hospital stay between the two groups (all P > 0.05). Conclusion:Thoracic segment epidural anesthesia can reduce the local inflammatory response of the lung during lung cancer surgery.
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Objective:To investigate the clinical efficacy of combined spinal and epidural anesthesia with isobaric bupivacaine in older adult patients undergoing artificial femoral head replacement.Methods:The clinical data of 50 older adult patients who underwent artificial femoral head replacement in Zhuji Third People's Hospital between January 2016 and January 2020 were retrospectively analyzed. The patients were divided into a control group ( n = 22) and a combined anesthesia group ( n = 28) according to different anesthesia methods. The control group was subjected to epidural anesthesia with bupivacaine. The combined anesthesia group underwent combined spinal and epidural anesthesia with isobaric bupivacaine. The excellent and good rate of anesthesia as well as heart rate and mean arterial pressure measured before and 10 minutes after anesthesia, at 1 hour of surgery and at the end of surgery were compared between the two groups. Time to anesthesia onset and time to block completion were recorded in each group. Results:The excellent and good rate of clinical efficacy in the combined anesthesia group was significantly higher than that in the control group [85.71% (24/28) vs. 59.09% (13/22), χ2 = 4.54, P < 0.05]. There were no significant differences in heart rate and mean arterial pressure between the two groups before and 10 minutes after anesthesia, at 1 hour of surgery and at the end of surgery ( t = 0.83, 0.60, 1.13, 1.21; 0.98, 0.60, 0.85, 0.88, P > 0.05). The time to anesthesia onset and the time to block completion in the combined anesthesia group were shorter than those in the control group ( t = 4.99, 2.29, both P < 0.05). Conclusion:Combined spinal and epidural anesthesia with isobaric bupivacaine can increase the excellent and good rate of anesthesia effects and has no obvious effect on hemodynamics in patients undergoing artificial femoral head replacement. Combined spinal and epidural anesthesia takes a shorter time to anesthesia onset and a shorter time to block completion than spinal or epidural anesthesia.
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Abstract Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.
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Humans , Acute Pain/etiology , Peripheral Nerve Injuries/etiology , Anesthesia, Conduction/adverse effects , Anesthesia, Epidural/adverse effects , Tertiary Healthcare , Retrospective Studies , Abscess/complications , Hematoma/etiology , HospitalsABSTRACT
Objective:To evaluate the effect of general anesthesia combined with epidural block on postoperative sleep in the frail elderly patients undergoing gastrointestinal tumor surgery.Methods:Ninety frail patients of either sex, aged 65-80 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiology physical status Ⅱ-Ⅲ, scheduled for elective open gastrointestinal tumor surgery (FRAIL score >2), were divided into 2 groups ( n=45 each) using a random number table method: general anesthesia group (GA group) and general anesthesia combined with epidural block group (GE group). Combined intravenous-inhalational anesthesia was carried out in group GA.Epidural block was performed before induction of anesthesia, and the method of general anesthesia was the same as that described in group GA, and the consumption of propofol and remifentanil was adjusted according to the BIS value, sweat and tears, heart rate and blood pressure during operation in group GE.Postoperative intravenous analgesia was performed to maintain VAS score ≤3.Wearable devices were used to monitor sleep parameters at 1 day before surgery and 1, 3 and 7 days after surgery.Sleep quality was assessed using Pittsburgh Sleep Quality Index and Quality of Recovery-15 questionnaire at 1 day before surgery and 1, 3, 7 and 30 days after surgery.The intraoperative consumption of propofol, sufentanil and remifentanil were recorded.The requirement for postoperative rescue analgesia and total pressing times of patient-controlled analgesia (PCA) within 48 h after surgery were recorded.Serum C-reactive protein concentrations were determined by immunoturbidimetry at 1 day before surgery and 1 day after surgery, and the adverse reactions at 7 days after surgery were recorded. Results:Compared with group GA, the consumption of remifentanil was significantly reduced, the total sleep score, deep sleep ratio, rapid eye movement ratio and Quality of Recovery-15 score were increased, the Pittsburgh Sleep Quality Index was decreased, and the incidence of postoperative nausea and vomiting was decreased on 1st and 3rd days after operation ( P<0.05), and no significant change was found in the serum C-reactive protein concentration and postoperative requirement for rescue analgesia, and total pressing times of PCA in group GE ( P>0.05). Conclusions:General anesthesia combined with epidural block can improve short-term sleep quality and recovery quality after gastrointestinal tumor surgery in elderly frail patients.
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Objective:To compare the perioperative plasma high-mobility group box 1 protein (HMGB1) concentrations in the patients undergoing laparoscopic radical resection of cervical cancer using different anesthetic regimens.Methods:Sixty-eight American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 34-68 yr, with body mass index of 19-24 kg/m 2, undergoing elective laparoscopic radical resection of cervical cancer, were divided into 2 groups ( n=34 each) using a random number table method: general anesthesia group (G group) and general anesthesia combined with epidural anesthesia group (GE group). In group G, anesthesia was induced with midazolam, etomidate and cisatracurium and maintained with remifentanil, propofol and cisatracurium.In group GE, an epidural catheter was placed at L 1, 2 interspace before induction of anesthesia, general anesthesia was performed after the anesthesia level reached T 6, and the method was similar to those previously described in group G. Patient-controlled intravenous analgesia was used after operation to maintain visual analog scale score ≤ 3 points.Peripheral venous blood samples were collected at 10 min before anesthesia (T 0), at the end of operation, and at 1, 24 and 48 h after operation (T 1-4) for determination of plasma concentrations of HMGB1, interferon-gamma (IFN-γ) and interleukin-4 (IL-4) (by enzyme-linked immunosorbent assay) levels of T lymphocyte subsets CD3 + , CD4 + and CD8 + and CD4 + /CD8 + ratio (by flow cytometry). Results:Compared with group G, the plasma concentrations of IFN-γ and IL-4 were significantly decreased at T 2, 4, the plasma concentration of HMGB1 was decreased at T 2-4, and the levels of CD3 + at T 2-4, CD4 + at T 2 and CD8 + at T 2, 3 and CD4 + /CD8 + ratio were increased in group GE ( P<0.05). Conclusion:The plasma HMGB1 concentration is lower, which has less impact on immune function of the patients undergoing laparoscopic radical resection of cervical cancer with the combination of general anesthesia and epidural anesthesia than that with general anesthesia alone.
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Abstract Purpose To develop a 3D anatomical model for teaching canine epidural anesthesia (3DMEA) and to assess its efficacy for teaching and learning prior to the use of live animals. Methods The creation of 3DMEA was based on 3D optical scanning and 3D printing of canine bone pieces of the fifth to the seventh lumbar vertebrae, sacrum and pelvis. A total of 20 male dogs were scheduled for castration. 20 veterinary students watched a video showing epidural anesthesia in dogs before the clinical attempt and were assigned to control or 3DMEA groups. Students in the 3DMEA group trained in the model after the video. For the clinical trial, the epidural procedure was performed by students under the veterinary supervision. When observed the absence of response to nociceptive stimuli, the epidural was considered successful. Then, all students answered a questionnaire evaluating the main difficulty founded in the technique and its degree of difficulty. Results The 3DMEA group reported a lower degree of difficulty to perform the epidural anesthesia technique when compared with the control group (p=0.0037). The 3DMEA reproduced the anatomical structures, allowing the perception of the distance of needle in relation to the iliac prominences during epidural anesthesia. Its mobility allowed simulation of the animal in standing position and sternal recumbency. Conclusion The use of 3DMEA demonstrated greater efficacy in the execution of the technique, being effective in the teaching and learning process before the epidural anesthesia in live animals.
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Animals , Male , Dogs , Anesthesia, Epidural , Epidural Space , Models, Anatomic , NeedlesABSTRACT
Objective@#To observe the clinical effect of continuous epidural anesthesia on labor analgesia and its effect on pregnancy outcome.@*Methods@#From July 2017 to June 2018, 110 hospitalized women giving birth in the Maternal and Child Health Care Hospital of Zhuji were selected and randomly divided into two groups according to the digital table, with 55 cases in each group.The control group was given conventional treatment.The observation group was treated with continuous epidural anesthesia for labor analgesia.The duration of labor, analgesic effect, delivery outcome, adverse reactions and neonatal status were compared between the two groups.@*Results@#The active time [(231.76±82.08)min], the second stage of labor [(63.94±22.56)min], and the total stage of labor [(309.42±120.15)min] in the observation group were all shorter than those in the control group[(275.62±85.31)min, (91.05±26.27)min, (380.84±121.63)min], and the differences were statistically significant(t=2.748, 5.806, 3.098, P=0.007, 0.001, 0.003). The analgesia satisfaction of the observation group was 100.00%(55/55), which was higher than 83.64%(46/55) of the control group, and the difference was statistically significant(χ2=9.802, P=0.002). In the observation group, the amount of vaginal bleeding [(241.62±30.54)mL], analgesic effect time [(62.80±11.96)s] were better than those in the control group[(270.55±40.83)mL, (135.18±20.73)s], and the differences were statistically significant(t=4.208, 22.429, P=0.001, 0.001). The rate of natural birth in the observation group was 87.27%(48/55), which was higher than that in the control group[70.91%(39/55)], and the difference was statistically significant(χ2=4.453, P=0.035). The incidence of neonatal distress in the observation group was 1.82%(1/55), and the incidence of asphyxia was 3.64%(2/55), which were lower than those in the control group [12.73%(7/55), 16.36%(9/55)], the differences were statistically significant(χ2=4.853, 4.950, P=0.028, 0.026).@*Conclusion@#Continuous epidural anesthesia in parturient analgesia can shorten the labor process and achieve satisfactory analgesic effect, which is helpful to improve the outcome of labor and neonatal condition.
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Objective@#To investigate the clinical effect of epidural anesthesia combined with general anesthesia on the expression of serum interleukin 6(IL-6), interleukin 8(IL-8) and C-reactive protein (CRP) in patients undergoing hip replacement.@*Methods@#From February 2017 to February 2018, 82 patients who underwent hip replacement in Zhuji People's Hospital were selected in the research.According to the random table method, the patients were divided into two groups, with 41 patients in each group.The observation group was given epidural anesthesia combined with general anesthesia, while the control group was given general anesthesia.The extubation time and recovery time, the scores of MMSE and the changes of inflammatory factors at preoperation, postoperative 3h and postoperative 24h were compared between the two groups.@*Results@#The extubation time and recovery time of the observation group [(10.93±2.41)min and (17.85±3.24)min] were shorter than those of the control group [(16.29±2.73)min and (23.94±2.46)min] (t=9.425, 9.586, all P<0.05). The scores of MMSE in the observation group at postoperative 3h[(25.48±1.43)points] and postoperative 24h [(26.83±1.09)points] were higher than those in the control group [(23.09±1.60)poinrts and (25.32±1.42)points] (t=7.132, 5.401, all P<0.05). The serum levels of IL-6, IL-8 and CRP in the observation group at postoperative 3h [(28.93±3.54)ng/L, (37.92±6.73)ng/L, (18.93±3.25)mg/L] and postoperative 24h [(21.09±1.76)ng/L, (28.76±3.25)ng/L, (10.39±2.67)mg/L] were lower than those in the control group [3h after operation: (49.97±5.46)ng/L, (64.32±8.98)ng/L, (29.90±4.36)mg/L; 24h after operation: (34.52±3.49)ng/L, (43.65±5.61)ng/L, (18.89±2.34)mg/L] (3h after operation: t=20.704, 15.064, 12.917; 24h after operation: t=22.001, 14.706, 15.330, all P<0.05).@*Conclusion@#Epidural anesthesia combined with general anesthesia has better clinical effect than general anesthesia alone in patients with hip replacement, and can reduce the occurrence of cognitive dysfunction and inhibit the release of inflammatory reaction after operation, which is worthy of clinical reference.
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Objective To investigate the clinical effect of epidural anesthesia combined with general anesthesia on the expression of serum interleukin 6(IL-6),interleukin 8(IL-8) and C-reactive protein (CRP) in patients undergoing hip replacement.Methods From February 2017 to February 2018,82 patients who underwent hip replacement in Zhuji People's Hospital were selected in the research.According to the random table method ,the patients were divided into two groups , with 41 patients in each group.The observation group was given epidural anesthesia combined with general anesthesia ,while the control group was given general anesthesia.The extubation time and recovery time,the scores of MMSE and the changes of inflammatory factors at preoperation ,postoperative 3h and postoperative 24h were compared between the two groups.Results The extubation time and recovery time of the observation group [( 10.93 ±2.41) min and (17.85 ±3.24) min] were shorter than those of the control group [(16.29 ±2.73)min and (23.94 ±2.46)min] (t＝9.425,9.586,all P＜0.05).The scores of MMSE in the obser-vation group at postoperative 3h[(25.48 ±1.43)points] and postoperative 24h [(26.83 ±1.09)points] were higher than those in the control group [(23.09 ±1.60) poinrts and (25.32 ±1.42) points] ( t＝7.132,5.401,all P＜0.05).The serum levels of IL-6,IL-8 and CRP in the observation group at postoperative 3h [(28.93 ±3.54)ng／L, (37.92 ±6.73)ng／L,(18.93 ±3.25)mg／L] and postoperative 24h [(21.09 ±1.76)ng／L,(28.76 ±3.25)ng／L, (10.39 ±2.67) mg／L] were lower than those in the control group [3h after operation:( 49.97 ±5.46) ng／L, (64.32 ±8.98)ng／L,(29.90 ±4.36) mg／L;24h after operation:(34.52 ±3.49) ng／L,(43.65 ±5.61) ng／L, (18.89 ±2.34)mg／L] (3h after operation:t＝20.704,15.064,12.917;24h after operation:t＝22.001,14.706, 15.330,all P＜0.05).Conclusion Epidural anesthesia combined with general anesthesia has better clinical effect than general anesthesia alone in patients with hip replacement ,and can reduce the occurrence of cognitive dysfunction and inhibit the release of inflammatory reaction after operation ,which is worthy of clinical reference.
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Objective@#To observe the clinical effect of ultrasound-guided thoracic paravertebral nerve block on anesthesia and postoperative analgesia in patients undergoing radical resection of lung cancer.@*Methods@#From August 2016 to August 2018, 88 patients who had undergone selective radical resection of lung cancer in the Traditional Chinese Medicine Hospital of Jinhua were divided into study group and control group according to random number table, with 44 cases in each group.The patients in the control group were given epidural block combined with general anesthesia.The patients in the study group were given ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia.The hemodynamic parameters such as SpO2, MAP and HR were monitored before and after anesthesia(T0), after blocking anesthesia administration(T1), after induction and extubation(T2), after skin incision(T3) and extubation(T4). The serum levels of NE, Cro, hs-CRP and TNF-α were measured before and after operation.The VAS scores were scored at different time points after operation.The adverse reactions after anesthesia were observed.@*Results@#The values of MAP and HR at each time point of T1-T4 in the control group were significantly lower than those at T0(t=5.067-14.839, all P<0.05), while there were no statistically significant differences in the study group between the values of MAP and HR at each time point of T1-T4 and those at T0(t=0.241-0.619, all P>0.05). At 6h, 12h, 24h and 48h after operation, the levels of serum NE, Cro, hs-CRP and TNF-α in both two groups were significantly higher than those before operation(t=16.289-38.520, all P<0.05), and the levels of serum NE, Cro, hs-CRP and TNF-α in the study group were significantly lower than those in the control group at all time points after operation(t=4.925-12.162, all P<0.05). The VAS scores of resting state and cough state at different time points in the study group were significantly lower than those in the control group(t=6.593-8.424, all P<0.05). The overall incidence of adverse reactions in the study group[18.18%(8/44)] was significantly lower than that in the control group[38.64%(17/44)](χ2=4.526, P=0.033).@*Conclusion@#Compared with epidural anesthesia, ultrasound-guided thoracic paravertebral nerve block combined with general anesthesia can effectively maintain the stability of blood flow, reduce the level of post-operative stress and inflammatory reaction, alleviate the degree of post-operative pain response, and prevent the occurrence of adverse reactions after anesthesia, which is worthy of clinical application.
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Objective@#To investigate the effects of epidural analgesia on puerpera and neonatal.@*Methods@#A total of 150 puerpera were continuously enrolled from May 2017 to May 2018 in Zhoushan Maternal and Child Health Care Hospital, and were divided into analgesia group (102 cases) and non-analgesia group (48 cases) according to their prenatal wishes.The analgesia group was given epidural anesthesia for analgesic delivery, while the control group had no analgesia intervention.Differences in the expression of serum pain and stress hormones were compared between two groups at the time of prenatal, postpartum 1h and 24h.At the same time, differences in neonatal NACS scores were compared between two groups at the time of postpartum 1h, 8h and 24h.@*Results@#No statistically significant differences were found between the two groups in prenatal serum pain and stress hormones, but at the time of postpartum 1h and 24h, serum pain media neuropeptide Y (NPY) (t=5.041, P=0.000; t=4.984, P=0.000), 5-hydroxytryptamine (5-HT) (t=3.083, P=0.002; t=4.203, P=0.000), prostate E2 (PGE2) (t=6.764, P=0.000; t=4.364, P=0.000) and stress hormone angiotensin Ⅱ (AngⅡ) (t=3.670, P=0.000; t=2.911, P=0.004), adrenocorticotropic hormone (ACTH)[(212.54±38.65) ng/mL vs.(231.43±34.82)ng/mL, t=3.510, P=0.001; (163.82±33.21) ng/mL vs.(175.21±32.48) ng/mL, t=2.105, P=0.045)]and cortisol (Cor)[(344.56±57.39) μg/L vs.(381.81±59.23)μg/L, t=3.670, P=0.000; (241.27±43.44) μg/L vs.(262.56±37.97) μg/L, t=2.911, P=0.004)] in the analgesia group were significantly lower than those in the non-analgesia group.There were no statistically significant differences in NACS score, complications and Apgar score between the two groups (all P>0.05).@*Conclusion@#The analgesic effect of full-course epidural delivery in analgesic delivery is remarkable, which can effectively reduce maternal stress reaction, and it is safe and has less adverse effect on neonates.
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Objective@#To compare the anesthetic effects of subarachnoid anesthesia(SA)and epidural anesthesia(EA)for the procedure for prolapse and hemorrhoids(PPH)in elderly patients with benign anorectal diseases.@*Methods@#A retrospective analysis was conducted in 60 patients with benign anorectal diseases admitted to Peking University Third Hospital from March to August 2018 and undergoing PPH.According to anesthesia methods, patients were divided into the SA group and the EA group (n=30 each). The level of sensory block was tested by acupuncture, and the degree of motor block was assessed by revised Bromage score.The anesthesia effect, operation time, blood loss, adverse events and hospitalization time were compared between the two groups.@*Results@#The highest level of sensory block was similar between the two groups without significant difference(P>0.05). The median onset time of sensory block was longer in the EA group [270.0 s(interquartile range, 66.3 s)] than in the SA group [25.5 s(interquartile range, 14.3 s)]. The revised Bromage score was lower in the EA group than in the SA group [1.0(interquartile range, 1.0)vs.2.0 (interquartile range, 1.0), Z=6.657, -1.685, both P=0.000]. The risks of hypotension, nausea and vomiting, and urinary retention were lower in the EA group than in the SA group (χ2=6.405, 4.286 and 4.403, P=0.011, 0.038 and 0.044). There were no significant differences in anesthetic effect, operation time, blood loss and hospitalization time between the two groups(all P>0.05).@*Conclusions@#EA can provide a perfect anesthesia and analgesic effect for elderly patients receiving PPH, with the advantages of rapid recovery of limb movement and low adverse events.As a substitute for SA, EA is a suitable anesthesia method for promoting the enhanced recovery after surgery(ERAS)in patients with benign anorectal diseases.
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Objective@#To observe the analgesic and sedative effect of epidural dexmedetomidine injection in patients undergoing transurethral resection of prostate (TURP) and its effect on postoperative cognitive function.@*Methods@#A total of 60 patients undergoing TURP under combined spinal-epidural anesthesia (CSEA) were randomly divided into dexmedetomidine group and normal saline group. Patients in the dexmedetomidine group were given 0.1 μg/kg of dexmedetomidine injection after epidural anesthesia, and 0.9 μg/kg of dexmedetomidine was added into epidural analgesia pump after operation; patients in the normal saline group were given the same dose of normal saline. The vital signs, visual analogue scale (VAS) and Ramsay sedation score of patients in the two groups at different time points[before intervention (T0), after intervention for 15 min (T1), after intervention for 30 min (T2), after intervention for 45 min (T3), after intervention for 60 min (T4), after surgery for 12 h (T5), after surgery for 36 h (T6)] were recorded. The mini mental state examination (MMSE) of patients in the two groups 1 d before operation and 3 d after operation were recorded.@*Results@#Compared with normal saline group, the VAS scores of patients in dexmedetomidine group were significantly lower at T1-T6 (P < 0.05), and the Ramsay scores were significantly higher (P < 0.05). There was no significant difference of MMSE total score [25.00(23.50, 27.50) scores] in the patients of dexmedetomidine group 3 d after operation but the memory ability score [4.00(3.00, 5.00) scores] was significantly decreased (P < 0.05), and the language ability score [9.00(8.00, 9.00) scores] was significantly increased (P < 0.05). There was no significant difference in MMSE score between the two groups in comparison with that 1 d before operation.@*Conclusions@#Epidural dexmedetomidine injection (1 μg/kg) enhancesd the analgesic effect of ropivacaine and producesd sedative effect. Although there was is no significant effect on the overall cognitive function, it might have some effect on memory function.
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Objective To compare the anesthetic effects of subarachnoid anesthesia(SA)and epidural anesthesia(EA)for the procedure for prolapse and hemorrhoids(PPH)in elderly patients with benign anorectal diseases.Methods A retrospective analysis was conducted in 60 patients with benign anorectal diseases admitted to Peking University Third Hospital from March to August 2018 and undergoing PPH.According to anesthesia methods,patients were divided into the SA group and the EA group (n=30 each).The level of sensory block was tested by acupuncture,and the degree of motor block was assessed by revised Bromage score.The anesthesia effect,operation time,blood loss,adverse events and hospitalization time were compared between the two groups.Results The highest level of sensory block was similar between the two groups without significant difference(P ＞0.05).The median onset time of sensory block was longer in the EA group [270.0 s(interquartile range,66.3 s)] than in the SA group [25.5 s(interquartile range,14.3 s)].The revised Bromage score was lower in the EA group than in the SA group [1.0(interquartile range,1.0)vs.2.0 (interquartile range,1.0),Z =6.657,-1.685,both P =0.000].The risks of hypotension,nausea and vomiting,and urinary retention were lower in the EA group than in the SA group (x2 =6.405,4.286 and 4.403,P=0.011,0.038 and 0.044).There were no significant differences in anesthetic effect,operation time,blood loss and hospitalization time between the two groups (all P ＞ 0.05).Conclusions EA can provide a perfect anesthesia and analgesic effect for elderly patients receiving PPH,with the advantages of rapid recovery of limb movement and low adverse events.As a substitute for SA,EA is a suitable anesthesia method for promoting the enhanced recovery after surgery(ERAS) in patients with benign anorectal diseases.
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Objective To observe the analgesic and sedative effect of epidural dexmedetomidine injection in patients undergoing transurethral resection of prostate (TURP) and its effect on postoperative cognitive function. Methods A total of 60 patients undergoing TURP under combined spinal-epidural anesthesia (CSEA) were randomly divided into dexmedetomidine group and normal saline group. Patients in the dexmedetomidine group were given 0.1 μg/kg of dexmedetomidine injection after epidural anesthesia, and 0.9 μg/kg of dexmedetomidine was added into epidural analgesia pump after operation;patients in the normal saline group were given the same dose of normal saline. The vital signs, visual analogue scale (VAS) and Ramsay sedation score of patients in the two groups at different time points [before intervention (T0), after intervention for 15 min (T1), after intervention for 30 min (T2), after intervention for 45 min (T3), after intervention for 60 min (T4), after surgery for 12 h (T5), after surgery for 36 h (T6)] were recorded. The mini mental state examination (MMSE) of patients in the two groups 1 d before operation and 3 d after operation were recorded. Results Compared with normal saline group, the VAS scores of patients in dexmedetomidine group were significantly lower at T1-T6 (P<0.05), and the Ramsay scores were significantly higher (P<0.05). There was no significant difference of MMSE total score [25.00(23.50, 27.50) scores] in the patients of dexmedetomidine group 3 d after operation but the memory ability score [4.00(3.00, 5.00) scores] was significantly decreased (P<0.05), and the language ability score [9.00(8.00, 9.00) scores] was significantly increased (P < 0.05). There was no significant difference in MMSE score between the two groups in comparison with that 1 d before operation. Conclusions Epidural dexmedetomidine injection (1 μg/kg) enhancesd the analgesic effect of ropivacaine and producesd sedative effect. Although there was is no significant effect on the overall cognitive function, it might have some effect on memory function.
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Objective To investigate the effects of epidural analgesia on puerpera and neonatal.Methods A total of 150 puerpera were continuously enrolled from May 2017 to May 2018 in Zhoushan Maternal and Child Health Care Hospital,and were divided into analgesia group (102 cases) and non-analgesia group (48 cases) according to their prenatal wishes.The analgesia group was given epidural anesthesia for analgesic delivery,while the control group had no analgesia intervention.Differences in the expression of serum pain and stress hormones were compared between two groups at the time of prenatal,postpartum 1h and 24h.At the same time,differences in neonatal NACS scores were compared between two groups at the time of postpartum 1h,8h and 24h.Results No statistically significant differ-ences were found between the two groups in prenatal serum pain and stress hormones,but at the time of postpartum 1h and 24h,serum pain media neuropeptide Y ( NPY) ( t = 5. 041, P = 0. 000; t = 4. 984, P = 0. 000 ), 5 -hydroxytryptamine (5-HT) (t=3.083,P=0.002;t=4.203,P=0.000),prostate E2 ( PGE2) ( t=6.764,P=0.000;t=4.364,P=0.000) and stress hormone angiotensin Ⅱ(AngⅡ) (t=3.670,P=0.000;t=2.911,P=0.004),adrenocorticotropic hormone (ACTH)[(212.54 ± 38.65) ng/mL vs.(231.43 ± 34.82)ng/mL,t=3.510, P=0.001; (163.82 ± 33.21) ng/mL vs.(175.21 ± 32.48) ng/mL,t=2.105,P=0.045)] and cortisol (Cor) [(344.56 ± 57.39) μg/L vs.(381.81 ± 59.23)μg/L,t=3.670,P=0.000; (241.27 ± 43.44) μg/L vs.(262.56 ± 37.97) μg/L,t=2.911,P=0.004)] in the analgesia group were significantly lower than those in the non-analge-sia group.There were no statistically significant differences in NACS score,complications and Apgar score between the two groups (all P>0.05).Conclusion The analgesic effect of full-course epidural delivery in analgesic delivery is remarkable,which can effectively reduce maternal stress reaction, and it is safe and has less adverse effect on neonates.
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Objective To investigate the influence of epidural analgesia on labor duration under the new partogram recommendations using quantile regression.Methods In this study,we recruited 300 nulliparous women at full term who were hospitalized in Department of Obstetrics and Gynecology,Tongji Medical College,Huazhong University of Science and Technology from May to September,2018.The participants who were willing to receive epidural analgesia during labor were assigned to the epidural group (n=150),and those who were not to the control group (n=150).Labor duration and delivery outcomes were analyzed by Student's t test,Mann-Whitney U test,Chi-square test and Fisher's exact test.Quantile regression models were also used to investigate the effect of epidural analgesia on labor duration.Results The median durations of first-and second-stage labor in the epidural group were 600(400-840) and 66(45-98) min,respectively,which were significantly longer than those of the control group [420(320-610) and 52(33-87) min] (Z=-4.273,P＜0.001;Z=-3.210,P=0.001).Quantile regression analysis showed that,for the first stage of labor,epidural analgesia was associated with labor prolongation,and had significant effects on all the percentiles (all P＜0.05).The regression coefficients increased (95.630-285.000) correspondingly as the percentiles of the labor duration (from 10th to 90th percentiles) increased.For the second stage of labor,epidural analgesia showed a significant impact on prolongation only between the 25th and 75th percentiles (coefficients:10.000～18.143;all P＜0.05).Although the epidural group had a significant higher episiotomy rate [46.8％(65/139) vs 33.3％(48/144),x2=5.318,P=0.021],more times of urine catheterization during labor [1(0-1) vs 0(0-1),Z=-0.974,P=0.001]and higher rate of oxytocin administration during labor [48.7％(73/150) vs 30.0％(45/150),x2=10.952,P=0.001],when compared with the control group,there was no significant difference in cesarean section rate,assisted vaginal delivery rate and neonatal outcomes between the two groups (all P＞0.05).Conclusions Epidural analgesia may associated with the prolongation of the first and second stage of labor,especially with the first stage of labor,but has no adverse effects on maternal and neonatal outcomes.
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Objective To explore the effects of different anesthesia methods on cognitive function and serum interleukin-6 ( IL -6), interleukin -8 ( IL -8) levels in elderly patients with lung cancer during perioperative period.Methods From March 2015 to March 2017, ninety elderly patients undergoing radical resection of lung cancer treated in Heji Hospital Affiliated to Changzhi Medical College were selected in the research.According to the different anesthesia methods,they were divided into inhalation anesthesia group( A group),general intravenous anes-thesia group(B group) and epidural block anesthesia group(C group),with 30 cases in each group.The minimum mental state examination(MMSE) scores,cognitive dysfunction rate,serum IL-6 and IL-8 levels of the three groups before operation,one day after operation and three days after operation were compared.Results One day and three days after operation,the MMSE scores of C group were (25.62 ± 2.11) points,(27.12 ± 2.04) points,respectively, which were higher than those of group A[(22.61 ± 2.75) points,(25.78 ± 2.68)points] and B group[(22.34 ± 2.01)points,(25.81 ± 2.42) points],the differences were statistically significant(tA group =4.756,2.179,tB group =6.165,2.267,all P<0.05).One day and three days after operation,the cognitive dysfunction rates of C group were 26.67% (8/30),6.67% (2/30),respectively,which were lower than those of A group[50.00% (15/30),26.67% (8/30)] and B group[66.67% (20/30),30.00% (9/30)],the differences were statistically significant(χ2A group =3.455,4.320,χ2B group =9.643,5.455,all P<0.05).One day and three days after operation,the serum IL-6 and IL-8 levels of C group[IL-6:(99.53 ± 16.82)ng/mL,(83.24 ± 8.34) ng/mL,IL-8:(50.43 ± 7.84)ng/mL, (42.15 ± 5.25)ng/mL] were lower than those of A group[IL-6:(122.43 ± 18.41)ng/mL,(88.51 ± 10.42)ng/mL, IL-8:(64.53 ± 8.94)ng/mL,(55.62 ± 6.78) ng/mL] and B group[IL-6:(124.52 ± 20.10) ng/mL,(87.95 ± 9.34)ng/mL,IL-8:(63.27 ± 9.03)ng/mL,(54.62 ± 6.30) ng/mL],the differences were statistically significant (IL-6:tA group =5.030,2.163,tB group =5.222,2.060,all P<0.05;IL-8:tA group =6.495,8.604,tB group =5.881, 8.329,all P<0.05).Conclusion The influence of epidural block anesthesia on postoperative cognitive dysfunction in elderly patients with radical resection of lung cancer is minimal,which can inhibit the expression of inflammatory factors.It is better than the other two anesthesia methods,and it is worthy of radical operation for elderly patients with lung cancer.
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Abstract Amyotrophic lateral sclerosis is characterized by the progressive degeneration of motor neurons, causing a constellation of symptoms that include muscle weakness, atrophy, fasciculations, spasticity, and hyperreflexia. Currently, Rulizol is the only treatment that has been shown to delay its progression, though to a very small extent. Disease prognosis is grim, with death caused mainly by respiratory failure secondary to muscle weakness, making anesthetic management of these patients a true challenge. The use of muscle relaxants must be avoided as much as possible because of the high risk of ventilatory depression, considering that these patients have an abnormal unpredictable response as a result of heightened sensitivity related to the lower number of acetylcholine receptors. If muscle relaxants are required during the surgery, rocuronium, among nondepolarizing muscle relaxants, is the drug of choice because of its short half-life, while depolarizing relaxants such as succinylcholine are contraindicated because of the risk of lethal hyperkalemia. In terms of intraoperative hypnotics and analgesics, propofol and remifentanil are ideal because of their short half-life. Regarding neuroaxial anesthesia, despite widespread reluctancy to use it, its benefits and rather uncommon adverse effects lead many anesthetists to consider it as an important alternative when it comes to deciding between general or neuroaxial anesthesia, because it reduces airway manipulation significantly, thus reducing respiratory complications as described in this clinical case.
Resumen La esclerosis lateral amiotrófica se caracteriza por la degeneración progresiva de las neuronas motoras provocando una constelación de síntomas que incluyen debilidad muscular, atrofia, fasciculaciones, espasticidad e hiperreflexia. Actualmente, el unico tratamiento que ha demostrado retrasar mínimamente su progresión ha sido el Rulizol. Su pronóstico es infausto, falleciendo mayoritariamente por insuficiencia respiratoria secundaria a la debilidad de su musculatura, siendo el manejo anestésico de estos pacientes, un importante desafío. El uso de relajantes neuromusculares deberá evitarse en la medida de lo posible por el riesgo elevado de depresión ventilatoria, ya que estos pacientes tienen una respuesta anormal e impredecible a ellos al presentar una sensibilidad aumentada por el menor número de receptores de acetilcolina; Si la cirugía requiere de ellos, es de elección dentro de los relajantes neuromusculares no despolarizantes, el rocuronio por su vida media corta, contraindicándose el uso de los despolarizantes como la succinilcolina, por el riesgo de hiperkaliemia letal. En cuanto a los hipnóticos y analgésicos que deberemos de usar intraoperatoriamente, el propofol y remifentanilo serían los más ideales por su vida media corta. En cuanto a la anestesia neuroaxial, a pesar de la reticencia extendida a su uso, su beneficio y sus no tan frecuentes efectos adversos, hacen a muchos anestesistas, considerarla como una alternativa de peso a la hora de decidir entre anestesia general o neuroaxial, pues reduce considerablemente la manipulación de la vía aérea, disminuyendo por tanto complicaciones respiratorias posteriores, como referimos en el caso clínico que describiremos a continuación.