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Objective:To evaluate the dose-effect relationship of compound lidocaine hydrochloride for transverse abdominal plane-rectus abdominis sheath block (TAP-RSB) for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.Methods:Elderly patients of either sex, aged≥65 yr, with body mass index <30 kg/m 2, of American Society Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic radical colon cancer surgery with general anesthesia, were selected.After induction of general anesthesia, compound lidocaine hydrochloride was given under ultrasound guidance for bilateral TAP block (20 ml on each side) and for bilateral RSB (10 ml on each side), with the initial concentration of 0.4%.Each time the concentration increased/decreased in the next patient depending on whether or not the analgesia was effective.The ratio between the two successive concentrations was 1.00∶1.15.The analgesic effects were evaluated by the Numerical Rating Scale at 1 h intervals from the time of postoperative admission to the post-anesthesia care unit until 8 h after TAP-RSB (Numerical Rating Scale ≤ 3 was considered as effective analgesia). The probit method was used to calculate the half effective concentration (EC 50) and 95% effective concentration (EC 95) and 95% confidence interval of compound lidocaine hydrochloride. Results:The EC 50 and EC 95(95% confidence interval)of compound lidocaine hydrochloride for TAP-RSB were 0.289% (0.232%-0.352%) and 0.404% (0.345%-0.970%), respectively, when used for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia. Conclusions:The EC 50 and EC 95 of compound lidocaine hydrochloride for TAP-RSB are 0.289% and 0.404%, respectively, when used for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.
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Objective:To evaluate the optimization efficacy of transversus thoracic muscle plane block (TTPB)-pectoral nerve block (PECS) with compound lidocaine-general anesthesia for modified radical mastectomy for breast cancer.Methods:Ninety female patients, aged 40-64 yr, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ and body mass index <30 kg/m 2, undergoing elective modified radical mastectomy for breast cancer, were divided into 3 groups ( n=30 each) using the random number table method: general anesthesia group (group C), TTPB-PECS with compound lidocaine-general anesthesia group (group L), and TTPB-PECS with ropivacaine-general anesthesia group (group R). The laryngeal mask was used for total intravenous anesthesia.PECS I, PECS II and TTPB were performed sequentially after laryngeal mask placement in L and R groups, and 0.4% compound lidocaine 15, 15 and 10 ml (group L) and 0.375% ropivacaine 15, 15 and 10 ml (group R) were injected at the above three points, respectively.Patient-controlled intravenous analgesia (PCIA) was performed with sufentanil at patient-controlled analgesia (PCA) dose of 2 ml/dose and a lockout time of 15 min at the end of operation, and when visual analog scale (VAS) score ≥ 3 points, sufentanil 5 μg was given intravenously for rescue analgesia.The intraoperative consumption of propofol and remifentanil, emergence time, and laryngeal mask removal time were recorded.The Ramsay sedation score and duration of postoperative analgesia were recorded at 10 min after removal of the laryngeal mask.The consumption of sufentanil, ratio of the effective pressing times to the total pressing times of PCA (D 1/D 2 ratio), requirement for rescue analgesia, and occurrence of adverse effects such as nausea and vomiting, skin pruritus, bradycardia, and respiratory depression within 48 h after surgery were recorded. Results:Compared with C group, the intraoperative consumption of propofol and remifentanil was significantly reduced, the emergence time and laryngeal mask removal time were shortened, Ramsay sedation scores was decreased, postoperative VAS scores were decreased, duration of postoperative analgesia was prolonged, D 1/D 2 ratios were increased, the consumption of sufentanil was reduced, and the requirement for rescue analgesia and incidence of postoperative nausea and vomiting were decreased in R and L groups ( P<0.05). Compared with R group, the duration of postoperative analgesia was significantly prolonged, D 1/D 2 ratio was increased, the consumption of sufentanil was decreased, and the requirement for rescue analgesia was decreased in L group ( P<0.05). Conclusions:Compared with general anesthesia, TTPB-PECS with compound lidocaine-general anesthesia used in modified radical mastectomy for breast cancer is helpful in achieving a low-opioid anesthetic mode, which is more conducive to suppressing postoperative hyperalgesia and promoting early postoperative recovery, and the optimization efficacy is more significant than that of ropivacaine.
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Objective To determine the median effective dose (ED50) of 0.375 ％ ropivacaine for ultrasound-guided subgluteus approach to the sciatic nerve block in the elderly patients.Methods Thirty ASA Ⅰ-Ⅲ patients of both sexes,aged 65-85 yr,scheduled for foot or ankle surgery under the sciatic nerve block,were enrolled in this study.The patients were placed in the Sim's position and received the sciatic nerve block using the posterior subgluteus approach guided by ultrasound.The initial dose of 0.375％ ropivacaine was 14.5 ml in the first patient and the ratio between the 2 successive doses was 1.2.The ED50 and 95 ％ confidence interval of ropivacaine were calculated by up-and-down technique.Results The ED50 and 95％ confidence interval of 0.375％ ropivacaine resulting in complete block of the sciatic nerve by using the ultrasound-guided subgluteus approach were 13.4 and 11.5-16.2 ml,respectively.Conclusion The ED50 of 0.375 ％ ropivacaine for ultrasound-guided subgluteus approach to the sciatic nerve block is 13.4 ml in the elderly patients.
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Objective To investigate the influence of different head and neck positions on airway sealing pressure (OLP) with i-gel laryngeal mask airway (LMA) in patients undergoing elective surgery under general anesthesia with mechanical ventilation.Methods Thirty ASA Ⅰ or Ⅱ patients of both sexes aged 32-64 yr with a body mass index of 18-30 kg/m2 undergoing elective surgery under general anesthesia with LMA were studied.Size 4 i-gel LMA was placed blindly after induction of anesthesia and connected to anesthetic circuit.The criteria for successful placement were easy inflation with small leak,peak inspiratory pressure (PPeak) within normal range and normal PETCO2 wave form.Fiberoptic bronchoscopy was performed to check the position of LMA.OLP,expiratory tidal volume ( VTE ),PPeak and efficiency of mechanical ventilation were measured in different head and neck positions.OLP was measured by gradually increasing airway pressure until PPeak was reached.The measurement was stopped when there was large leak or OLP ＞ 35 cm H2 O.The efficacy of ventilation was evaluated by manually inflating the lungs (perfect:easy inflation,no audible leak; satisfactory:easy inflation,small leak; poor:difficult inflation,large leak).Results Flexion of the head significantly increased OLP and PPeak and decreased VTE,while hyperextension significantly decreased OLP and PPeak and increased VTE as compared with middle position of the head.Lung ventilation was less satisfactory when the head was flexed.Turning the head to either side did not affect ventilation.Conclusion Flexion of the head should be avoided when i-gel LMA is used during anesthesia.
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Objective To evaluate the efficacy of fiberoptic bronchoscope (FOB)-guided tracheal intubation with laryngeal mask airway i-gel (LMA i-gel) in patients undergoing cervical spine surgery. Methods Forty ASA Ⅰ or Ⅱ patients, aged 36-62 yr, weighing 57-78 kg, scheduled for cervical spine surgery under general anesthesia, were randomly divided into 2 groups (n = 20 each): FOB-guided tracheal intubation with oropharynx ventilation tube group (group O) and FOB-guided tracheal intubation with LMA i-gel (group I). Anesthesia was induced with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 2-3 μg/kg and rocuronium 0.9 mg/kg. The intubation time, fiberoptic bronchoscope score, the number of successful intubation, hypertension, tachycardia and hypoxemia were recorded. All the patients were followed up postoperatively for adverse effects like sore throat or hoarseness, etc. Results The rate of successful LMA i-gel placement at first attempt was 100%, placement time was (10 + 3) s, and the rate of successful intubation in the two groups was 100%. The intubation time was significantly shorter, the rate of successful intubation at first attempt and fiberoptic bronchoscope score were significantly higher in group I than in group O (P ＜ 0.05). Hypertension, tachycardia and hypoxemia were not found in the two groups. There was no significant difference in the incidence of adverse effects between the two groups (P ＞0.05). Conclusion FOB-guided tracheal intubation with LMA i-gel can provide adequate ventilation during operation, improve the success rate of FOB-guided intubation and shorten the intubation time in patients undergoing cervical spine surgery.
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Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing gynecological laparoscopic surgery. Methods Eighty ASA Ⅰ or Ⅱ patients, aged 40-64 yr,weighing 50-70 kg, undergoing elective gynecological laparoscopic surgery, were randomized into 2 groups ( n = 40 each): LMA Supreme group (group S) and LMA ProSeal group (group P). Mallampati test was performed before operation in both groups. The patients were classified as Ⅰ or Ⅱ . LMA Supreme and LMA ProSeal were inserted in group S and P respectively after induction of anesthesia with midazolam 0.05 mg/kg, propofol 2 mg/kg, fentanyl 3 μg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA. The number of attempt, success rate, LMA placement time, success rate of gastric tube placement, cuff volume, peak airway pressure, and airway seal pressure, BP, HR, ECG, SpO2, PET CO2 and complications were recorded. The duration of surgery and pneumoperitoneum, and emergence time were also recorded. The fiberoptic bronchoscope scores were assessed after successful LMA placement. Results There were no significant differences in the duration of operation and pneumoperitoneum, emergence time between the two groups (P ＞ 0.05). The BP, HR,SpO2, PET CO2 and peak pressure were within the normal range during operation in both groups. The first attempt success rates of LMA placement and gastric tube placement were significantly higher, the LMA placement time was significantly shorter, and the fiberoptic bronchoscopic scores were significantly higher in group S than in group P ( P ＜ 0.05). Conclusion LMA Supreme is helpful for ventilation during operation with less complications and can be used effectively for gynecological laparoscopic surgery.