Comparison of oxycodone and sufentanil in patient-controlled intravenous analgesia for postoperative patients: a meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

BACKGROUND@#Managing acute postoperative pain is challenging for anesthesiologists, surgeons, and patients, leading to adverse events despite making significant progress. Patient-controlled intravenous analgesia (PCIA) is a recommended solution, where oxycodone has depicted unique advantages in recent years. However, controversy still exists in clinical practice and this study aimed to compare two drugs in PCIA.@*METHODS@#We performed a literature search in PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, Chinese National Knowledge Infrastructure, Wanfang, and VIP databases up to December 2020 to select specific randomized controlled trials (RCTs) comparing the efficacy of oxycodone with sufentanil in PCIA. The analgesic effect was the primary outcome and the secondary outcome included PCIA consumption, the Ramsay sedation scale, patients' satisfaction and side effects.@*RESULTS@#Fifteen RCTs were included in the meta-analysis. Compared with sufentanil, oxycodone showed lower Numerical Rating Scale scores (mean difference [MD] = -0.71, 95% confidence interval [CI]: -1.01 to -0.41; P < 0.001; I2 = 93%), demonstrated better relief from visceral pain (MD = -1.22, 95% CI: -1.58 to -0.85; P < 0.001; I2 = 90%), promoted a deeper sedative level as confirmed by the Ramsay Score (MD = 0.77, 95% CI: 0.35-1.19; P < 0.001; I2 = 97%), and resulted in fewer side effects (odds ratio [OR] = 0.46, 95% CI: 0.35-0.60; P < 0.001; I2 = 11%). There was no statistical difference in the degree of patients' satisfaction (OR = 1.13, 95% CI: 0.88-1.44; P = 0.33; I2 = 72%) and drug consumption (MD = -5.55, 95% CI: -14.18 to 3.08; P = 0.21; I2 = 93%).@*CONCLUSION@#Oxycodone improves postoperative analgesia and causes fewer adverse effects, and could be recommended for PCIA, especially after abdominal surgeries.@*REGISTRATION@#PROSPERO; https://www.crd.york.ac.uk/PROSPERO/; CRD42021229973.

Effects of different doses of dexmedetomidine in patients undergoing heart valve replacement / 中国医师进修杂志

Objective:To investigate the effects of different doses of dexmedetomidine on intestinal mucosal barrier function, cognitive function and brain protection in patients undergoing heart valve replacement.Methods:The clinical data of 135 patients with heart valve replacement from April 2019 to April 2020 in the First Affiliated Hospital of Chengdu Medical College were retrospectively analyzed. Among them, 54 patients received low-dose of dexmedetomidine after induction of anesthesia (low-dose group), 38 patients received high-dose of dexmedetomidine (high-dose group), and 43 patients did not use dexmedetomidine (control group). Before surgery (T 1), 1 h after surgery (T 2), end of surgery (T 3) and 72 h after surgery (T 4), the levels of intestinal mucosal barrier function indexes D-lactate and diamine oxidase (DAO) were detected by spectrophotometry, the levels of brain injury indexes central nervous system specific protein (S100β) and neuron-specific enolase (NSE) were detected by double antibody sandwich enzyme-linked immunosorbent assay; before surgery and 3 d after surgery, the cognitive function was assessed by the mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scale before and 3 days after surgery. Result:There was no statistical difference in T 1, T 2 and T 4 D-lactic acid among 3 groups ( P>0.05); the T 3 D-lactic acid in low-dose group was significantly lower than that in high-dose group and the control group: (7.87 ± 1.59) mg/L vs. (8.99 ± 1.82) and (9.32 ± 1.74) mg/L, the high-dose group was significantly lower than the control group, and there were statistical differences ( P<0.05). There was no statistical difference in T 1 and T 2 DAO among 3 groups ( P>0.05); the T 3 and T 4 DAO in low-dose group was significantly lower than that in high-dose group and control group: (2.77 ± 0.23) kU/L vs. (3.58 ± 0.25) and (4.30 ± 0.26) kU/L, (2.08 ± 0.25) kU/L vs. (2.40 ± 0.20) and (2.71 ± 0.23) kU/L, the high-dose group was significantly lower than the control group, and there were statistical differences ( P<0.05). There were no statistical differences in MMSE score and MoCA score before surgery among 3 groups ( P>0.05); the MMSE score and MoCA score 3 d after surgery in low-dose group were significantly higher than those in high-dose group and control group: (22.76 ± 0.54) scores vs. (21.41 ± 0.47) and (20.21 ± 0.43) scores, (24.90 ± 0.51) scores vs. (24.01 ± 0.48) and (23.12 ± 0.49) scores, the high-dose group was significantly higher than the control group, and there were statistical differences ( P<0.05). There was no statistical difference in T 1, T 2 and T 4 S100β among 3 groups ( P>0.05); the T 3 S100β in low-dose group was significantly lower than that in high-dose group and control group: (4.09 ± 2.01) μg/L vs. (5.48 ± 1.10) and (6.10 ± 1.58) μg/L, and there were statistical differences ( P<0.05). There was no statistical difference in T 1 and T 4 NSE among 3 groups ( P>0.05); the T 2 and T 3 NSE in low-dose group was significantly lower than that in high-dose group and control group: (17.20 ± 4.13) μg/L vs. (20.29 ± 3.77) and (22.35 ± 3.80) μg/L, (19.40 ± 3.92) μg/L vs. (23.46 ± 5.26) and (25.18 ± 5.32) μg/L, and there were statistical differences ( P<0.05). Conclusions:Administration of 0.5 μg/(kg·h) dexmedetomidine during heart valve replacement under cardiopulmonary bypass can reduce intestinal mucosal damage, protect brain against injury in a certain degree, and improve cognitive function.

Changes in renal blood flow during laparoscopic cholecystectomy / 中华麻醉学杂志

Objective To investigate the changes in renal blood flow during laparoscopic cholecystectomy.Methods Thirty-two ASA Ⅰ patients (10 male, 22 female) aged 18-64 yr, weighing 45-81 kg undergoing laparoscopic cholecystectomy were included in this study. Anesthesia was induced with midazolam, fentanyl,propofol and vecuronium and maintained with isoflurane inhalation, continuous infusion of propofol and remifentanil and intermittent iv boluses of vecuronium. The patients were intubated and mechanically ventilated. PET CO2 was maintained at 30-40 mm Hg. The probe of transesophageal echocardiography (TEE) was inserted into esophagus after tracheal intubation. The internal diameter and blood flow velocity and time integral of left renal artery and descending aorta were measured by TEE before (baseline) and at 1, 5, 10, 15, 20 and 30 min of pneumoperitoneum and 1 and 5 min after deflation. The blood flow of left renal artery (LRAF) and decending aorta (DAF) were calculated. The maximal decrease in LRAF and DAF and LRAF/DAF were analyzed. Results LRAF and DAF decreased significantly during pneumoperitoneum compared to the baseline and recovered after deflation. LRAF and DAF decreased maximally by 40% (95% confidence interval (95% CI) 31%-49% ) and 38% (95% CI 31%-44% ) at 8.9 min (95% CI 5.5-12.4 min) and 6.7 min (95% CI 4.0-9.5 min) of pneumoperitoneum respectively. There was no significant change in LRAF/DAF ratio during pneumoperitoneum. Conclusion The renal blood flow decreases at 1-30 min of pneumoperitoneum with the maximum degree of decrease about 40% at about 9 min of pneumoperitoneum and the reason is related to the decrease in the cardiac output.

Accuracy of renal blood flow assessment by transesophageal echocardiography during carbon dioxide pneumoperitoneum / 中华麻醉学杂志

Objective To determine the accuracy of renal blood flow assessment by transesophageal echocardiography (TEE) during carbon dioxide (CO2) pneumoperitoneum.Methods The left renal arterial diameter (RAD) and the Doppler velocity time integral (VTI) were measured by TEE before peumoperitoneum (T0, baseline), at 1, 5, 10, 15, 20 and 30 min of pneumoperitoneum and 1 and 5 min after deflation in 35 patients undergoing elective laparoscopic cholecystectomy. The left renal blood flow (LRBF) and the left renal blood perfusion resistance (LRPR) were calculated according to the following formulae: LRBF = 1/4π x RAD2 x VTI x HR, LRPR = MAP/LRBF.Three months later, the TEE images of 10 cases were randomly selected and reviewed by the same and another research team member to check the repeatability and consistency of the LRBF determination during operation, respectively. The quality of the TEE images was evaluated by another specialist.Results Before pneumoperitoneum, 94% of the TEE images were rated as satisfactory. There was no significant difference between the qualities of the TEE images obtained before and during pneumoperitoneum. The variabilities between the RADs measured by TEE during and 3 months after operation were 9.28% by the same team member and 8.71% by another team member. The variabilities between the VTIs measured by TEE during and 3 months after operation were 5.61% by the same team member and 6.25% by another team member. The linear regression analysis of the LRBF showed that the slope and the intercept were 1.05 and 31.4 ml/min respectively by the same member and 0.92 and 47.3 ml/min respectively by another member. The LRBF was decreased during pneumoperitoneum and the LRPR was increased.Conclusion TEE can be used to accurately monitor the changes in renal blood flow during CO2 pneumoperitoneum.