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BACKGROUND@#Post-operative pneumonia (POP) is a common complication of lung cancer surgery, and muscular tissue oxygenation is a root cause of post-operative complications. However, the association between muscular tissue desaturation and POP in patients receiving lung cancer surgery has not been specifically studied. This study aimed to investigate the potential use of intra-operative muscular tissue desaturation as a predictor of POP in patients undergoing lung cancer surgery.@*METHODS@#This cohort study enrolled patients (≥55 years) who had undergone lobectomy with one-lung ventilation. Muscular tissue oxygen saturation (SmtO 2 ) was monitored in the forearm (over the brachioradialis muscle) and upper thigh (over the quadriceps) using a tissue oximeter. The minimum SmtO 2 was the lowest intra-operative measurement at any time point. Muscular tissue desaturation was defined as a minimum baseline SmtO 2 of <80% for >15 s. The area under or above the threshold was the product of the magnitude and time of desaturation. The primary outcome was the association between intra-operative muscular tissue desaturation and POP within seven post-operative days using multivariable logistic regression. The secondary outcome was the correlation between SmtO 2 in the forearm and that in the thigh.@*RESULTS@#We enrolled 174 patients. The overall incidence of muscular desaturation (defined as SmtO 2 < 80% in the forearm at baseline) was approximately 47.1% (82/174). The patients with muscular desaturation had a higher incidence of pneumonia than those without desaturation (28.0% [23/82] vs. 12.0% [11/92]; P = 0.008). The multivariable analysis revealed that muscular desaturation was associated with an increased risk of pneumonia (odds ratio: 2.995, 95% confidence interval: 1.080-8.310, P = 0.035) after adjusting for age, American Society of Anesthesiologists status, Assess Respiratory Risk in Surgical Patients in Catalonia score, smoking, use of peripheral nerve block, propofol, and study center.@*CONCLUSION@#Muscular tissue desaturation, defined as a baseline SmtO 2 < 80% in the forearm, may be associated with an increased risk of POP.@*TRIAL REGISTRATION@#No. ChiCTR-ROC-17012627.
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Humanos , Estudios de Cohortes , Neumonía/epidemiología , Complicaciones Posoperatorias/epidemiología , Oxígeno , Músculos , Neoplasias Pulmonares/cirugíaRESUMEN
Objective:To evaluate the relationship between postoperative delirium and preoperative modified frailty index (mFI) score in elderly patients undergoing colorectal cancer surgery.Methods:The medical records of elderly patients of either sex, aged 65-90 yr, with primary tumor, without radiotherapy and chemotherapy before operation, with the expected operating time ≥ 2 h, undergoing colorectal cancer surgery under general anesthesia, were collected.The patients′ preoperative frailty was assessed using mFI scale.Primary outcome was the incidence of delirium within 7 days after operation, and delirium was assessed using Confusion Assessment Method.The preoperative baseline characteristics, BI score, mFI score and Mini-Mental State Examination were recorded; anesthesia-related information, surgery-related information, intraoperative adverse events, total volume of intraoperative fluid infused, blood loss, and urine output were recorded.The patients were divided into delirium group (D group) and non-delirium group (N group) according to whether delirium occurred or not, and logistic regression analysis was used to screen the risk factors for postoperative delirium in elderly patients with colorectal cancer.Results:A total of 370 patients were enrolled in this study, and the incidence of delirium was 10.8%.There were significant differences in age, ASA grading ratio, mFI score, anesthetic time and total volume of intraoperative fluid infused between group N and group D ( P<0.05). The results of multivariate logistic regression analysis showed that increased age and mFI were independent risk factors for the occurrence of postoperative delirium ( P<0.05). Conclusions:Increased mFI score and age are independent risk factors for postoperative delirium in elderly patients undergoing colorectal cancer.
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Objective:To evaluate the effect of paravertebral nerve block (PVNB) combined with general anesthesia on intraoperative regional cerebral oxygen saturation (rScO 2) in elderly patients undergoing thoracoscopic lobectomy. Methods:Seventy American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 60-85 yr, with body mass index of 18-25 kg/m 2, were divided into 2 groups ( n=35 each) using a random number table method: general anesthesia group (group G) and PVNB combined with general anesthesia group (group PG). PVNB was performed at T 4 and T 6 with 0.5% ropivocaine 10 ml for each site under ultrasound guidance before induction of anesthesia in group PG.After induction of anesthesia, anesthesia was maintained with IV propofol and remifentanil, and a patient-controlled intravenous analgesia pump was connected at the end of operation.The maximum and minimum rScO 2 and cumulative time of rScO 2 below the baseline value were recorded.The rScO 2 was recorded before anesthesia (T 0), at 5 min before one-lung ventilation (T 1), at 5 min after one-lung ventilation (T 2) and at tracheal extubation (T 3). The length of postoperative hospital stay and complications within 30 days after operation were recorded. Results:Compared with group G, the minimum rScO 2 and rScO 2 at T 2 and T 3 were significantly increased, the incidence of postoperative cognitive dysfunction was reduced ( P<0.05), and no significant change was found in the other parameters mentioned above in group PG ( P>0.05). Conclusion:PVNB combined with general anesthesia can improve intraoperative rScO 2 and reduce the development of postoperative cognitive dysfunction in elderly patients undergoing thoracoscopic lobectomy.
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Objective:To evaluate the accuracy of surgical pleth index (SPI) in monitoring the depth of anesthesia in elderly patients undergoing general anesthesia.Methods:Thirty-five patients, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 65-80 yr, with body mass index of 18-30 kg/m 2, scheduled for elective gynecological laparoscopic surgery, were studied.Combined intravenous-inhalational anesthesia was used to maintain bispectral index value at 45-60.SPI was recorded within 2 min before and after skin incision, before and after pneumoperitoneum, and before and after the most intense stimulation of skin incision.The maximum value (SPI max) within 2 min after noxious stimulation was recorded, and the difference between SPI max and baseline value (ΔSPI) was calculated.The receiver operating characteristic curve (ROC) was used to evaluate the accuracy of the above indicators in monitoring the depth of anesthesia. Results:Thirty patients were finally included in this study.The area under the curve of SPI max was 0.887, the diagnostic threshold was 57, the sensitivity was 68.9%, and the specificity was 92.9%.The area under the curve of ΔSPI was 0.988, diagnostic threshold was 12, the sensitivity was 88.0%, and the specificity was 98.7%. Conclusion:SPI can accurately determine the depth of anesthesia in elderly patients with general anesthesia, and using ΔSPI has more clinical significance.
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Objective:To identify the risk factors for decrease in regional cerebral oxygen saturation (rScO 2) during one-lung ventilation (OLV) in the patients undergoing thoracic surgery. Methods:A total of 175 patients of both sexes, aged ≥55 yr, with expected operation time≥2 h, scheduled for elective thoracic surgery with OLV, were selected in the Fourth Hospital of Hebei Medical University from August 2017 to September 2018.The rScO 2 was continuously monitored from the beginning of anesthesia induction until removal of tracheal intubation.General anesthesia, general anesthesia combined with epidural block or general anesthesia combined with local nerve block were used.The baseline characteristics, previous medical history and history of anesthesia surgery, type of surgery, method of anesthesia, duration of anesthesia, duration of OLV, duration of surgery, and intraoperative adverse events (hypoxemia, hypotension, bradycardia, etc.) were recorded.According to whether a decrease in rScO 2 occurred during OLV (absolute value of rScO 2 was less than 65% or a decrease of more than 20% of the baseline value), the patients were divided into 2 groups: low rScO 2 group and normal rScO 2 group.Multivariate logistic regression analysis was used to identify the risk factors for decrease in rScO 2 during OLV. Results:One hundred and seven patients developed decrease in rScO 2 during OLV, with an incidence of 61.1%.The results of logistic regression analysis showed that hypoxemia was an independent risk factor for decrease in rScO 2, and general anesthesia combined with epidural block was a protective factor for decrease in rScO 2 during OLV. Conclusion:Hypoxemia is an independent risk factor for decrease in rScO 2 during OLV, while general anesthesia combined with epidural block is a protective factor for decrease in rScO 2 in the patients undergoing thoracic surgery.
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Objective To evaluate the effect of neoadjuvant chemotherapy for ovarian cancer on the sedative potency of propofol and oxycodone for anesthesia induction.Methods Sixty-eight American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 40-64 yr,with body mass index of 20-30 kg/m2,scheduled for elective radical resection of ovarian cancer with general anesthesia,were divided into into 2 groups (n =34 each) according to whether the patients received neoadjuvant chemotherapy before surgery:neoadjuvant chemotherapy group (group Ⅰ) and non-chemotherapy group (group Ⅱ).Patients received 3 cycles of chemotherapy (21 days for 1 cycle),chemotherapy regimen was paclitaxel and carboplatin,and patients underwent surgery after 3 weeks of chemotherapy in group Ⅰ.Anesthesia was induced with Ⅳ oxycodone 0.2 mg/kg.Propofol was given by target-controlled infusion 4 min later,and the effectsite concentration (Ce) of propofol was determined by up-and-down technique,with the initial Ce 1.0 μg/ml and the ratio between the two successive Ces 1.09.The median-effective target plasma concentration (EC50) and 95％ confidence interval of propofol causing loss of consciousness were calculated using Probit analysis.Results The EC50 and 95％ confidence interval of propofol causing loss of consciousness were 1.22 μg/ml (1.14-1.30 μg/ml) and 1.74 μg/ml (1.57-3.19 μg/ml) in group Ⅰ and group Ⅱ,respectively.Compared with group Ⅱ,the EC50 of propofol causing loss of consciousness was significantly decreased in group Ⅰ (P＜0.05).Conclusion Neoadjuvant chemotherapy for ovarian cancer can enhance the sedative potency of propofol and oxycodone for anesthesia induction.
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Objective To study the distribution of the regions of ultrasound-guided erector spinae plane block (ESPB) at the level of T5 transverse process.Methods Thirty male patients,aged 18-64 yr,with body mass index of 18-24 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective thoracotomy,were enrolled in this study.ESPB was conducted with 0.5％ ropivacaine hydrochloride 0.4 ml/kg at the level of T5 transverse process under ultrasound guidance before induction of general anesthesia.Blocks in each thorax and back region (the left side of the body was divided into 18 different regions based on the anatomical "landmarks" on the body surface,No.1-18) were assessed by cold stimulation.Effective block in each region was recorded at 10,15,20,25,30,40 and 50 min after administration.The adverse reactions such as pneumothorax,puncture hematoma and local anesthetic intoxication were recorded.Results The blocking range was basically fixed at 30 min after a single ESPB injection at the level of T5 transverse process,and the regions covered from the sternal angle to the level of the rib arch.The regions of effective block were No.1-3 and 5-7 in ≥95％ patients,and the regions of effective block were No.1-15 and 17 in patients ≥90％ and ＜ 95％.No patients developed adverse reactions such as pneumothorax,puncture hematoma or local anesthetic intoxication.Conclusion The regions of effective ultrasound-guided ESPB at the level of T5 transverse process are mainly distributed in T2-T8 thoracodorsal skin areas.
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Objective To compare the cost-effectiveness of closed-loop versus open-loop infusion of propofol guided by bispectral index (BIS) in elderly patients undergoing abdominal surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅱ patients of either sex,aged 65-75 yr,with body mass index of 18 25 kg/m2,undergoing elective open gastrointestinal tumor resection with general anesthesia,were allocated into closed-loop target-controlled infusion (TCI) group (group C) and open-loop TCI group (group O) using a random number table.Propofol was given using closed-loop TCI,and the target BIS value was set at 45-55 in group C.In group O,the target plasma concentration (2.0-3.5 μg/ml)of propofol was adjusted to maintain the BIS value at 45-55.Remifentanil was given by TCI with the target plasma concentration of 2-8 ng/ml in both groups.The total consumption of propofol and remifentanil,time rate of maintaining BIS value within the target range,development of intraoperative hypertension and hypotension,emergence time,tracheal extubation time,time for recovery of orientation,first ambulation time,time to first flatus and length of postoperative hospital stay were recorded.The development of nausea and vomiting and delirium within 3 days after operation and intraoperative awareness was recorded.The cost of anesthetics and total cost of anesthesia were calculated.Results Compared with group O,the total consumption of propofol was significantly decreased,the total consumption of remifentanil was increased,the time rate of maintaining BIS value within the target range was increased,the emergence time,tracheal extubation time and time for recovery of orientation were shortened,the cost of propofol and total cost of anesthesia were decreased (P＜0.05),and no significant change was found in the cost of remifentanil,incidence of postoperative delirium and nausea and vomiting,first ambulation time,time to first flatus or length of postoperative hospital stay in group C (P＞0.05).Intraoperative awareness was not found in two groups.Conclusion Compared with open-loop infusion of propofol guided by BIS,closed-loop infusion of propofol guided by BIS is a cost-effective method of anesthesia in elderly patients undergoing abdominal surgery.
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Objective To determine the optimal dose of oxycodone for patient-controlled intravenous analgesia (PCIA) after gastrointestinal surgery when combined with dexmedetomidine in elderly patients.Methods Sixty patients of both sexes,aged 65-80 yr,weighing 50-75 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,undergoing elective open gastrointestinal surgery,were divided into 3 different doses of oxycodone groups (group O1,group O2 and group O3,n=20 each) using a random number table.At 15 min before the end of surgery,oxycodone 0.1 mg/kg was intravenously injected,and PCIA pump was connected simultaneously.In O1,O2 and O3 groups,the PCIA solution contained dexmedetomidine 2.0 μg/kg and oxycodone 0.3,0.5 and 0.7 mg/kg in 100 ml of 0.9％ normal saline,respectively.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Oxycodone 0.05 mg/kg was intravenously injected as a rescue analgesic after surgery,postoperative pain was assessed using a verbal rating scale,and the verbal rating scale score was maintained ≤4.The number of successfully delivered doses and requirement for rescue analgesics were recorded within 48 h after surgery,and the rate of rescue analgesia was calculated.The occurrence of adverse reactions such as nausea,vomiting,dizziness,respiratory depression,somnolence,bradycardia,hypotension and over-sedation was recorded.Patients' satisfaction with analgesia at postoperative 72 h and the length of postoperative hospital stay were also recorded.Results Compared with group O1,the rate of rescue analgesia after surgery and the number of successfully delivered doses were significantly decreased,and the degree of patients' satisfaction with analgesia was increased in O2 and O3 groups,and the incidence of nausea and somnolence was significantly increased in group O3 (P＜0.05).Compared with group O2,no significant change was found in the rate of rescue analgesia after surgery or the number of successfully delivered doses (P＞0.05),and the incidence of nausea and somnolence was increased in group O3 (P＜0.05).Conclusion When combined with dexmedetomidine 2.0 μg/kg,the optimal dose of oxycodone for PCIA is 0.5 mg/kg after gastrointestinal surgery in elderly patients.
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Objective To evaluate the effects of different doses of dexmedetomidine on stress responses of the hypertensive patients undergoing thoracic surgery and find the uptimal infusion rate of dexmedetomidine in decreasing stress responses.Methods Sixty hypertensive patients of both sexes,aged 45-64 yr,weighing 65-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 4 groups (n =15 each) using a random number table:control group (group C) and 3 different doses of dexmedetomidine groups (D1-3 groups).In D1,D2 and D3 groups,dexmedetomidine 0.2,0.3 and 0.4 μg · kg 1 · h 1 were intravenously infused until 30 min before the end of surgery,respectively,starting from 15 min before induction of anesthesia.The equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration of dexmedetomidine (T0),at 1 min after endotracheal intubation (T1),at skin incision (T2) and immediately after extubation (T3),venous blood samples were collected for determination of epinephrine and norepinephrine concentrations in plasma (using high-performance liquid chronatography) and blood glucose concentrations.The development of adverse effects such as bradycardia,hypotension and respiratory depression was recorded.Results Compared with group C,epinephrine and norepinephrine concentrations in plasma and blood glucose concentrations were significantly decreased at T1-3 in D1,D2 and D3 groups,the incidence of bradycardia and hypotension was significantly increased in group D3 (P＜0.05),and no significant change was found in the incidence of bradycardia or hypotension in D1 and D2 groups (P＞0.05).There were no significant differences in epinephrine and norepinephrine and concentrations in plasma and blood glucose concentrations at each time point between group D1,group D2 and group D3 (P ＞ 0.05).Conclusion The optimal infusion rates of dexmedetoinidine are 0.2 and 0.3μg · kg-1 · h-1 in decreasing stress responses of the hypertensive patients undergoing thoracic surgery.
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Objectives To investigate the ameliorative effect of cannabinoid 2 receptor(CB2R)agonist JWH-015 on the cog-nitive impairment of Alzheimer' s disease(AD)model mice and to assess the correlation with microglial phenotype transformation. Methods Twenty adult male C57BL/6J mice were randomly divided into four groups:C57BL/6J solvent group,JWH-015 control group,AD model group,and AD model treated with JWH-015 group. Amyloidβ1-42 oligomers of 4μg and the same volume of saline were intraventricularly administered to construct the AD mouse model and the solvent groups. CB2R agonist JWH-015 or the corre-sponding vehicle at a dose of 0.5 mg/(kg·d)was administered by intraperitoneal injection for 3 weeks. Non-spatial learning and memo-ry was measured using novel object recognition task. Furthermore,the mRNA expression levels of M1 microglia marker inducible ni-tric oxide synthase(iNOS)and M2 microglia marker chitinase-3 like protein(Ym1/2)in brain samples of cortex and hippocampus were evaluated using real-time quantitative PCR(qPCR). In the meantime,fifteen CB2R knockout(CB2RKO)mice and five CB2R wild-type(CB2RWT)littermates were assigned to identify the specificity of CB2R in the research. Based on the genotype and different treatment,the animals were divided into four groups:CB2RKO solvent group,CB2RKO AD model group,CB2RKO AD model treat-ed with JWH-015 group and CB2RWT solvent group. Results Compared with solvent group,there was a significant decrease in nov-el object recognition index in C57BL/6J AD model group(P<0.01). The mRNA expression levels of M1 phenotype microglia marker iNOS in cortex and hippocampus were significantly up-regulated(both P<0.05)and the mRNA expression levels of M2 phenotype mi-croglia marker Ym1/2 were significantly down-regulated(both P<0.01). Interestingly,administration of JWH-015 could reverse the impairment of novel object recognition index(P<0.05);compared with C57BL/6J AD model group,administration of JWH-015 also decreased the iNOS mRNA expression levels(both P<0.05)and increased the Ym1/2 mRNA expression levels(both P<0.05)in cortex and hippocampus;compared with CB2RKO solvent group,the novel object recognition index of CB2RKO AD model group was decreased(P<0.05);the mRNA expression levels of iNOS in cortex and hippocampus were significantly up-regulated(both P<0.05),the mRNA expression level of Ym1/2 in cortex was significantly down-regulated in cortex(P<0.05);compared with CB2RKO AD model group,administration of JWH-015 had no effect on novel object recognition index and the mRNA expression level of M1/M2 in cortex and hippocampus,respectively. Conclusion JWH-015 improves the cognitive impairment of Aβ-induced AD mice by the specific activation of CB2R,the mechanism of which is related to the direct regulation of CB2R on the M1/M2 microglial phenotype transformation and microglia-mediated neuroinflammation in brain.
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Objective To evaluate the role of mitochondrial ATP-sensitive potassium(mito-KATP) channels in dexmedetomidine-induced attenuation of myocardial ischemia-reperfusion(I∕R)injury in rats. Methods Forty pathogen-free healthy male Sprague-Dawley rats, aged 8-12 weeks, weighing 200-350 g, were divided into 5 groups(n=8 each)using a random number table: sham operation group(group S), I∕R group, dexmedetomidine group(group DEX), a specific mito-KATPchannel blocker 5-hydroxyde-canoate(5-HD)group(group 5-HD)and dexmedetomidine plus 5-HD group(group DEX+5-HD). Myo-cardial I∕R was produced by occlusion of the anterior descending branch of the left coronary artery for 30 min followed by 120 min reperfusion in pentobarbital sodium-anesthetized rats. Dexmedetomidine 5 μg∕kg was intraperitoneally injected at 15 min prior to reperfusion in group DEX.5-HD 40 mg∕kg was intraperitoneally injected at 30 min prior to reperfusion in group 5-HD. In group DEX+5-HD, 5-HD 40 mg∕kg and dexme-detomidine 5 μg∕kg were intraperitoneally injected at 30 and 15 min prior to reperfusion, respectively. The parameters of cardiac function such as left ventricular systolic pressure(LVSP), left ventricular end-dias-tolic pressure(LVEDP)and the maximum rate of increase or decrease in left ventricular pressure(±dp∕dtmax)were recorded before ischemia(T0)and at 60 and 120 min of reperfusion(T1,2). Blood samples were collected from the carotid artery at the end of reperfusion for determination of the concentrations of cre-atine kinase-MB(CK-MB)and cardiac troponin I(cTnI)in serum. The animals were then sacrificed, and hearts were removed for determination of the myocardial infarct size in the left ventricular myocardial tissues. Results Compared with group S, the LVSP and ±dp∕dtmaxwere significantly decreased, and the LVEDP was increased at T1-2, and the concentrations of CK-MB and cTnI in serum and myocardial infarct size were increased in the other groups(P<0.05). Compared with group I∕R, the LVSP and ±dp∕dtmaxwere signifi-cantly increased, and the LVEDP was decreased at T1-2, and the concentrations of CK-MB and cTnI in ser-um and myocardial infarct size were decreased in group DEX, and the LVSP and ±dp∕dtmaxwere significant-ly increased at T1-2, the concentrations of CK-MB and cTnI in serum and myocardial infarct size were de-creased(P<0.05), and no significant change was found in LVEDP in group DEX+5-HD, and no signifi-cont change was found in the parameters mentioned above in group 5-HD(P>0.05). Compared with group DEX, the LVSP and ±dp∕dtmaxwere significantly decreased, and the LVEDP was increased at T1-2, and the concentrations of CK-MB and cTnI in serum and myocardial infarct size were increased in DEX+5-HD group(P<0.05). Conclusion The mechanism by which dexmedetomidine attenuates myocardial I∕R inju-ry is partially related to promotion of mito-KATPchannel opening in rats.
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Objective To evaluate the effect of obesity on the potency of propofol for sedation.Methods Sixty patients of both sexes, aged 35-55 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective operation under general anesthesia, were enrolled in the study.The patients were divided into 2 groups (n=30 each) according to the body mass index (BMI) : normal body weight (BMI ＜ 25 kg/m2) group (group C) and obesity (BMI 30-40 kg/m2) group (group O).No patients received premedication.Propofol was given by target-controlled infusion.The initial target plasma concentration of propofol was set at 1.2 μg/ml.After the target concentration was steadily maintained for 30 s, it was increased in 0.3 μg/ml increment until the patients lost consciousness (OAA/S score =1).The target plasma concentration of propofol was recorded during each period.The median effective concentration (EC50) and 95％ confidence interval of propofol for loss of consciousness was calculated using probit analysis.Results The EC50 and 95％ confidence interval of propofol for loss of consciousness were 3.82 (3.73-3.90) and 3.29 (3.20-3.37) μg/ml in group C and group O, respectively.Compared with group C, the EC50 was significantly decreased in group O (P＜0.05).Conclusion Obesity can enhance the potency of propofol for sedation.
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Objective To investigate the optimum ratio of medicine dosage for dexmedetomidine mixed with oxycodone used for patient-controlled intravenous analgesia (PCIA) after gastrointestinal surgery.Methods Eighty patients of both sexes, aged 35-64 yr, weighing 55-75 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective gastrointestinal surgery, were randomly divided into 4 groups (n=20 each) using a random number table: oxycodone group (group O), and different ratios of medicine dosage when dexmedetomidine was added to sufentanil groups (OD1-3 groups).At 15 min before the end of surgery, oxycodone 0.1 mg/kg was injected intravenously, and PCIA pump was connected simultaneously.In group O, the PCIA solution contained oxycodone 1.00 mg/kg in 100 ml of normal saline.In group OD1, the PCIA solution contained oxycodone 1.00 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.In group OD2 , the PCIA solution contained oxycodone 0.75 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.In group OD3, the PCIA solution contained oxycodone 0.50 mg/kg and dexmedetomidine 2.5 μg/kg in 100 ml of normal saline.The PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Oxycodone 0.05 mg/kg was injected intravenously as a rescue analgesic, and visual analogue scale score was maintained ≤ 4.The requirement for rescue analgesics was recorded.The requirement for the rescue analgesic was recorded within 48 h after surgery.The number of successfully delivered doses, and occurrence of adverse reactions such as bradyeardia, hypotension, nausea, vomiting, over-sedation, somnolence, pruritus, and respiratory depression were recorded.Patient's satisfaction with analgesia was recorded at 72 h after surgery.Results No patients required the rescue analgesic or developed over-sedation, vomiting, respiratory depression and hypotension in the four groups.Compared with group O, the incidence of somnolence was significantly increased in group OD1, the incidence of nausea, somnolence, bradycardia and pruritus was decreased in OD2 and OD3 groups, and the degree of patient's satisfaction with analgesia was increased in OD1-3 groups (P＜0.05).Compared with group OD1, the incidence of nausea, somnolence, bradycardia and pruritus was significantly decreased in OD2 and OD3 groups, the degree of patient's satisfaction with analgesia was increased in group OD3 (P＜0.05) , and no significant was found in the degree of patient's satisfaction with analgesia in group OD2 (P＞0.05).Compared with group OD2, no significant was found in the incidence of adverse reactions (P＞0.05) , and the degree of patient's satisfaction with analgesia was significantly decreased in group OD3 (P＜0.05).The number of successfully delivered doses was significantly larger in group OD3 than in O, OD1 and OD2 groups (P＜0.05).Conclusion Dexmedetomidine 2.5 μg/kg added to oxycodone 0.75 mg/kg is the optimum ratio of medicine dosage when used for PCIA after gastrointestinal surgery.
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Objective To evaluate the accuracy of stroke volume variation (SVV) in monitoring the changes in blood volume during laparoscopic surgery.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,with body mass index ranged from 20 to 25 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were studied.After induction of general anesthesia,baseline registrations of variables were obtained.After establishing pneumoperitoneum,6％ hydroxyethyl starch (HES 130/0.4) 500 ml was infused over 30 min.Before pneumoperitoneum (T1),at 5 min after pneumoperitoneum (T2),immediately before volume expansion (T3) and at 3 min after volume expansion (T4),cardiac output (CO),cardiac index (CI),SV,stroke volume index (SVI) and SVV were monitored and recorded.The changing rate of CI (△CI) was calculated.The criterion for effective volume expansion was △CI ≥ 15％.The ROC curve for SVV in determining the volume expansion responsiveness was plotted,and the diagnostic threshold was determined.The area under the curve and 95％ confidence interval were calculated.Results SVV was significantly lower at T2 than at T1.CO,CI,SV and SVI were significantly higher,and SVV was lower at T4 than at T3.The results of ROC curve analysis showed that a 9.2％ SVV threshold discriminated between responders and non-responders with a sensitivity of 61％ and a specificity of 50％,and the area under the curve (95％ confidence interval) was 0.567 (0.378-0.757).Conclusion SVV is not a suitable index in monitoring the changes in blood volume during laparoscopic surgery.
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Objective To compare the postoperative analgesic effect of the single dose of oxycodone and dezocine in patients who underwent gynecological laparoscopic operation. Methods Sixty patients who underwent elective gynecological laparoscopic operation were randomly divided into two groups (n=30): oxycodone group (group O) and dezocine group (group D). Fifteen minutes before the end of surgery, oxycodone 0.1 mg/kg was given in O group, and dezocine 5 mg was given to D group. Twenty minutes before the end of surgery, tropisetron 5 mg was given to both groups. Analgesia was maintained by propofol-remifentanil with TCI. The mean arterial pressure (MAP) and heart rate (HR) of T1, T2, T3 and T4 were recorded respectively in both two groups. After the operation, pain of visual analogue scale (VAS) was assessed in 2 h ,4 h , 6 h and 24 h, respectively. Results There were no significant differences in MAP and HR between two groups at T1, T2, T3 and T4 (P＞0.05). The VAS score was significantly lower in group O than that of group D (P＜0.05). There was significant difference in the incidence of nausea between the two groups (P＜0.05). Conclusion Single dose of oxycodone 0.1 mg/kg can be used for postoperative analgesia after gynecological laparoscopic operation, and which has better analgesia than that of dezocine, except for the adverse reaction of nausea.
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Clinical practice is a special learning phase. Interns, as both students and doctors are confronted with multiple pressures from studies, employment and examination. Their ideology tends to fluctuate due to the influence of the society. Therefore, it's very important to strengthen the ideo-logical and political education. It is relatively difficult in managing interns due to their dispersed loca-tion and unfixed daily schedule. Internet not only expands the space and time of the ideological edu-cation, but also it has the features of vivid, interesting, timely, open and resource conservation. On the basis of analyzing the characteristics and difficulties of the clinical ideological education and the pros and cons of the network, we proposed the methods to utilize the advantages of network informa-tion technology to enhance the ideological and political education of clinical interns.
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Objective To evaluate the protective effects of different modes of ventilation on the lungs on the operated side during one-lung ventilation (OLV ) in patients undergoing thoracic surgery .Methods Forty-five ASA physical status Ⅰ or Ⅱ patients of both sexes ,aged 45-64 yr ,weighing 65-80 kg ,were randomly divided into 3 groups (n=15 each) using a random number table :group A ,group B and group C .After induction of anesthesia ,the patients were intubated with double-lumen tube and OLV was performed .During OLV ,the lung on the operated side was collapsed naturally in group A ,positive pressure ventilation (FGF 2 L/min) was applied in the lung on the operated side in group B ,and high-frequency jet ventilation (frequency 100 beats/min ,driving pressure 0.5 kg/cm2 ) was used in the lung on the operated side in group C .Immediately after intubation (T0 ) , and at 1.5 h (T1 ) and 2 h (T2 ) of OLV ,blood samples were taken from the central vein and radial artery for determination of the serum interleukin-6 (IL-6 ) and IL-8 concentrations .The net release of IL-6 and IL-8 was calculated .Blood samples were taken from the radial artery at T0-2 for blood gas analysis and for determination of surfactant protein A (SP-A) concentration in the serum .Respiratory index (RI) was calculated .The non-cancer tissues 1.0 cm × 1.0 cm × 1.0 cm which were extracted from the lung cancer specimens were used for microscopic examination of the pathological changes of lungs which were scored .Results Compared with group A ,the net release of IL-6 and IL-8 ,serum SP-A concentration ,RI and pathological scores were significantly decreased at T1 ,2 in B and C groups ( P<0.05) .Compared with group B ,the serum SP-A concentration and RI were significantly decreased at T1 ,2 , and the net release of IL-6 was increased at T2 in group C ( P< 0.05 ) .Conclusion Continuous positive ventilation and high-frequency jet ventilation both can effectively protect the lungs on the operated side during OLV in patients undergoing thoracic surgery ,and the efficacy of high-frequency jet ventilation is better .
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Objective To investigate the effect of carbon dioxide ( CO2 ) pneumoperitoneum on the neuromuscular block of cisatracurium in patients undergoing laparoscopic operation.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 35-60 yr,with body mass index of 18-24 kg/m2,scheduled for elective hysterectomy,were randomly divided into 2 groups ( n =30 each ):pneumoperitoneum group ( group P) and control group ( group C ).Each group was further divided into 2 subgroups according to the use of the antagonist of neuromuscular block ( n =15 each):no neostigmine group ( group P0 or C0 ) and neostigmine group (group P1 or C1 ).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with target-controlled infusion of propofol and remifentanil.Tracheal intubation was performed and the patients were mechanically ventilated.Neuromuscular function was monitored by TOF-Watch SX accelerography (Organon Co.,Organon).A train of four (TOF) stimulation of the ulnar nerve was used.When T,returned to 5％ of control height after CO2 pneumoperitoneum was established,cisatracurium 0.05 mg/kg was injected intravenously in group P.When T1 returned to 25％ of control height after the end of operation,neostigmine was injected intravenously in groups P1 andC1.The clinical duration and recovery index were recorded after CO2 pneumoperitoneum was established.Arterial blood samples were obtained immediately before induction,at 30 and 60 min of pneumoperitoneum,and at the end of operation for blood gas analysis.Results The clinical duration and recovery index were significantly longer in group P0 than in group C0,and in group P1 than in group C1 ( P ＜ 0.05).Compared with group C0,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P0 ( P ＜ 0.05).Compared with group C1,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P1 ( P ＜ 0.05).Conclusion CO2 pneumoperitoneum can strengthen the neuromuscular block induced by cisatracurium and prolong the recovery time following antangonism by neostigmine administration in patients undergoing laparoscopic operation.
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Objective To investigate the effects of different methods of volume therapy on the inflammatory response in patients undergoing liver cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients,aged 40-60 yr,with body mass index 20-25 kg/m2,undergoing liver cancer resection,were randomly divided into 2 groups ( n =20 each):routine fluid replacement group (group Ⅰ ) and goal-directed fluid replacement group (group Ⅱ ).The fluid replacement regime in group Ⅰ =compensatory volume expansion (CVE) + physiological requirements + cumulative loss + confinued loss + the third space losses.CVE was replaced with lactated Ringer's (LR) solution 5 mg/kg before anesthesia induction.The physiological requirements and cumulative loss were replaced with LR solution according to the principle of 4-2-1.The continued loss equal to the intraoperative blood loss was replaced with the equal volume of 6％ hydroxyethyl s tarch ( HES 130/0.4).The 3rd space losses were replaced with LR solution 5 ml·kg-1 ·h-1.In group Ⅱ,CVE was replaced with LR sol6ution as in group Ⅰ.LR solution was infused after anesthesia induction at 5 ml·kg-1 ·h-1.6％ HES was infused to maintain left ventricular ejection time (LVETc) between 350-400 ms.When 350 ms ＜ LVETc ＜ 400 ms and the amplitude of stroke volume ( SV ) increased by ＞ 10％,6％ HES was infused continuously until the amplitude of SV increased by ≤ 10％.Blood samples were taken before anesthesia induction and at the end of operation for measurement of serum TNF-α,IL-2,IL-4,IL-6 and IL-8 concentrations.The adverse cardiovascular reactions were recorded.Results Compared with group Ⅰ,the serum TNF-α,IL-6,IL-8 concentrations were significantly decreased,the serum IL-2 and IL-4 concentrations were significantly increase,and the incidence of hypotension and tachycardia was significantly decreased in group Ⅱ ( P ＜ 0.05).No adverse cardiovascular reactions were found in both groups.Conclusion LVETc and SV-guided volume therapy can maintain the blood volume and inhibit the inflammatory response and is suitable for the patients undergoing liver cancer resection.