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Objective To evaluate the effect of low-flow sevoflurane anesthesia on the early postoperative renal function in patients.Methods Sixty patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,scheduled for elective non-urological surgery with general anesthesia,with an expected surgical duration＞4 h,were divided into 2 groups (n =30 each) using a random number table method:middle-flow anesthesia group (group Ⅰ) and low-flow anesthesia group (group Ⅱ).Anesthesia was induced with Ⅳ midazolam,sufentanil,propofol and cisatracurium besylate.Mechanical ventilation was performed after tracheal intubation.Pure oxygen served as carrier,the fresh gas flow of oxygen was set at 4-5 L/min,sevoflurane was inhaled for 10-15 min,and then fresh gas flow was decreased to 2 L/min (group Ⅰ) and 0.5 L/min (group Ⅱ).End-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.The end-tidal concentration of sevoflurane was set at 2.0％-2.4％,remifentanil and cisatracurium besylate were infused intravenously,and sufentanill or propofol was injected intermittently to maintain anesthesia.Bispectral index value was maintained at 40-60 during operation.Before anesthesia induction (T0),at 1,2,3 and 4 h after anesthesia induction (T1-4),immediately after operation (T5) and at 24 h after operation (T6),peripheral venous blood samples were collected for determination of serum fluoride ion concentrations.Peripheral venous blood samples and urine specimens were collected at T0,T5,T6,48 h after operation (T7) and 72 h after operation (T8) for determination of creatinine (Cr),blood urea nitrogen (BUN) and cystatin C (Cys C) and serum and urine β2-microglobulin (β2-MG) concentrations.Results Compared with the baseline at T0,serum fluoride ion concentrations were significantly increased at T1-6 in two groups,the serum Cys C concentration was increased at T5,and serum and urine β2-MG concentrations were increased at T5 and T6 in group Ⅰ,serum Cr and BUN concentrations and serum and urine β2-MG concentrations were increased at T5 and T6,and the serum Cys C concentration was increased at T5-T7 in group Ⅱ (P＜0.05).Compared with group Ⅰ,serum fluoride concentrations were significantly increased at T1-6,serum Cr and BUN concentrations and serum and urine β2-MG concentrations were increased at T5,and serum Cys C concentrations at T5-T7 and urine β2-MG concentrations at T5 and T6 were increased in group Ⅱ (P＜0.05).Conclusion Low-flow sevoflurane anesthesia produces no marked effect on early postoperative renal function in patients.
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[Objective] To observe the muscle relaxation clinical effect and the occurrence of intraoperative and postoperative complications,and the postoperative extubation and muscle strength recovery of Rocuronium and Succinylcholine in children during airway foreign body removal operation.[Methods] 80 cases of children (ASA I) with airway foreign body,among them,30 cases were older than 3 years old,were agreed to be on electively airway foreign body removal surgery.According to anesthesia induction,intravenous injection muscle relaxants were randomly divided into two groups (n =40):Rocuronium group (Group R) 0.9 mg/kg,Succinylcholine group (Group S) 1.5 mg/kg.According to the degree of muscle relaxation and operation time,if necessary,patients in Group R were added intravenous injection with Rocuronium 0.3 mg/kg,patients in Group S were added intravenous injection with Succinylcholine 0.5 mg/kg,the other drugs were consistent.Observation items included:the bronchoscopy conditions,the degree of muscle relaxation during operation,the numbers of intravenous injection muscle relaxant and atropine,the times of tracheal extubation,the dynamic observation about vital sign and hemodynamic intraoperative and postoperative,and the occurrence situation of complications,the incidence rate of muscle soreness in children older than 3 years old 24 h after operation.[Results] (1) There was no significant statistics difference between the two groups in the condition of bronchoscopy (P ＞ 0.05).(2)The patients in Group R were not required to add muscle relaxants and atropine,but all patients in Group S were required to add muscle relaxants and atropine (P ＜ 0.01).(3)The complications such as body movement,hypoxemia,restlessness during recovery period were happened in Group S,and in Group R,there were only 1 case of laryngeal spasm and restlessness during recovery period,there was statistically significant difference between the two groups (P ＜ 0.05).(4)The muscle strength recovery of 15 min in Group S was significantly higher than the Group R (P ＜ 0.01).(5) The time of tracheal cannula extubation was extended after the operation in Group R,there was statistically significant difference between the two groups (P ＜ 0.05).(6)30 cases patients older than 3 years old were followed up 24 h after operation,14 cases in Group S were found with the muscle soreness of trunk and limb,but none was found in 16 cases in Group R,there was statistically significant difference between the two groups (P ＜ 0.01).[Conclusions] The muscle relaxant effect was well during the removal of forcign body in children with Rocuronium and Succinylcholine,but the former provided a more security anesthesia condition,the muscle soreness of trunk and limb was not found in patient 24 h after operation;and the latter must continue to add drugs in operation,and the complications were found during and after the operation,the muscle soreness of trunk and limb was found in patient 24 h after operation.
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Objective To compare the bleeding volume during endoscopic sinus surgery in pa-tients with hypertension under total intravenous anesthesia or combination of intravenous with inhaled anesthesia.Methods Forty adult patients with hypertension (ASA Ⅰ or Ⅱ),male 25 and female 1 5,aged 35-54 years,agreed to be on electively endoscopic sinus surgery,were divided randomly into two groups(group A and group B,n =20 each).All patients were injected intravenously with fenta-nyl,propofol and cisatracurium during the induction of general anesthesia.During the maintenance stage of the general anesthesia,patients in group A were injected intravenously with propofol,and patients in group B were inhaled with sevoflurane until 5 minutes before the end of the operation.BIS was 40-60 during the operation in the two groups.After induction of anesthesia and tracheal intubation,ni-troglycerin and esmolol were given to adjust blood pressure and hypervolemic hemodilution was performed.. Bleeding volume and operation duration were recorded at the end of the operation.The arterial blood gas, blood lactate and coagulation function were monitored 30 minutes before the operation (T0 ),30 minutes (T1 )and 90 minutes after the operation beginning (T2 )and 30 minutes after the end of the operation (T3 ). Results Bleeding volume in group A was significantly less than that in group B (P <0.05).Fifteen minutes before the operation,the MAP of all the patients in two groups was controlled slowly to 60 mm Hg.Com-pare to those at T0 ,there was no significant difference in the arterial blood pressure,blood lactate and coag-ulation function at T1 ,T2 and T3 .Conclusion During the endoscopic sinus surgery with intravenous anes-thesia for patients with hypertension,the bleeding volume was less than that with inhalation anesthesia.
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Objective To compare the muscular relaxation effect and side effects of Cisatracuri-um and Succinylcholine for children on tracheal foreign body removal.Methods Forty ASA Ⅰ pediat-ric patients,undergoing electivetracheal foreign body removal,were randomly divided into two groups:group C,received cisatracurium 0.2 mg/kg for induction,0.05 mg/kg for maintenance,n=20;group S,received succinycholine 2 mg/kg for induction,0.4 mg/kg for maintenance,n=20.All patients were performed with controlled ventilation assisted by high-frequency jet ventilation (HFJV).We recorded bronchoscope condition,muscle relaxant supplements,extubation time and the incidence of muscle soreness in postoperative 24 h.Results There was no significant difference in bronchoscope condition between these two groups.The extubation time were significantly longer in group C than in group S (P<0.05).The incidence of muscle soreness in postoperative 24 h were sig-nificantly higher after the operation in group S than that in group C (P<0.01).All patients in group S needed muscle relaxant supplements,but none in group C (P <0.01).Conclusion Both Cisatra-curium and succinylcholine can provide good muscle relaxation effect on tracheal foreign body remov-al,but cisatracurium prolong the extubation time,and succinylcholine increase the incidence of muscle soreness.
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Objective To compare the effects oflightwand(LW) and direct laryngoscope(DL) in elderly patients undergoing surgery on hemodynamics and stress responses.Methods Forty elderly patients with ASA grade Ⅰ-Ⅱ grade who selective surgery were divided into LW group and DL group by random digits table method,each group with 20 cases.Systolic blood pressure (SBP),diastolic blood pressure (DBP),heart rate(HR) were recorded respectively before intubation,30 seconds and 5 minutes after intubation.Extracted patients with peripheral arterial 3 ml at the same time,measured by radioimmunoassay epinephrine and norepinephrine levels.Results The SBP,DBP,HR,epinephrine,norepinephrine 30 seconds after intubation in LW group were significantly lower than those in DL group [(140.50 ± 21.91) mm Hg(1 mm Hg =0.133 kPa) vs.(167.95 ± 17.85) mm Hg,(67.80 ± 6.76) mm Hg vs.(84.15 ±9.89) mm Hg,(85.10 ± 11.76) times/min vs.(96.30 ± 13.72) times/min,(49.47 ± 8.09) ng/L vs.(61.25 ± 9.43) ng/L,(171.27 ± 17.11) ng/L vs.(187.40 ± 16.13) ng/L,P ＜ 0.01].The SBP,epinephrine,norepinephrine 5 minutes after intubation in LW group were significantly lower than those in DL group [(120.75 ± 17.12) mm Hg vs.(136.65 ± 15.43) mm Hg,(39.80 ±7.38) ng/L vs.(47.63 ±8.48) ng/L,(155.93 ± 17.11) ng/L vs.(172.76 ± 13.45) ng/L,P ＜ 0.01].Conclusion Both LW and DL can be well done in elderly patients intubation,but LW can reduce stress responses during the intubation.