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Objective To evaluate the effect of ultrasound-guided transverse abdominal plane block (TAPB) on postoperative analgesia in patients undergoing orthotopic liver transplantation under general anesthesia.Methods Forty American Society of Anesthesiologists physical status Ⅲ-V patients,with body mass index of 18-24 kg/m2,aged 18-64 yr,undergoing elective modified piggy-back orthotopic liver transplantation,were divided into 2 groups (n =20 each) by a random number table method:TAPB combined with general anesthesia group (TAPB-GA group) and general anesthesia group (GA group).In TAPB-GA group,two-point TAPB was performed below bilateral costal margins under ultrasound guidance after induction of general anesthesia,and a mixture of 0.33％ ropivacaine 15 ml plus 0.5％ dexamethasone 0.5 ml was injected into each point.The equal volume of normal saline was injected into each point instead in group GA.Patient-controlled intravenous analgesia was performed with sufentanil 2 μg/kg after operation in both groups.Sufentanil 5 μg was intravenously injected as rescue analgesic,and the visual analog scale score was mainrained ≤3 within 48 h after operation.The intraoperative consumption of remifentanil and extubation time after operation were recorded.The requirement for sufentanil as rescue analgesic and development of nausea and vomiting,itching and respiratory depression were recorded within 48 h after surgery.Results Compared with group GA,the intraoperative consumption of remifentanil and requirement for sufentanil as rescue analgesic within 48 h after surgery were significantly reduced,the time of extubation was shortened,and the incidence of nausea and vomiting,itching and respiratory depression was decreased in group TAPB-GA (P＜ 0.05).Conclusion Ultrasound-guided TAPB can provide better efficacy of postoperative analgesia with fewer adverse reactions in patients undergoing orthotopic liver transplantation under general anesthesia.
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Objective To observe the effect of acute normovolemic hemodilution(ANH)combined with enhanced recovery after surgery(ERAS)on immune function in patients undergoing hepatic lobectomy. Methods 80 patients were divided into two groups:ERAS group(group E),ANH combined with ERAS group(group AE). bleeding volume,blood transfusion,infused fluid volume,urine output during operation and clinical index after surgery were recorded. Exhaust and defecation time ,fluid intake time and hospitalization duration were also record-ed. Blood samples were obtained from the patients at 30 min before anesthesia induction(T1),immediately(T2), 24 h(T3),3 d(T4)and 7 d(T5)after the end of operation for determination of the expression of CD3+,CD4+, CD8+ on T cells and natural killer cell. Results In group E ,CD3+,CD4+ T-lymphocytes and NK cells at T2-3 decreased as compared with T0. Compared with group E ,no allogeneic blood transfusion cases were found and clinical index duration was shorter in group AE. CD3+,CD4+T-lymphocytes and NK cells at T2-3 increased in group AE as compared with those in Group E. The difference is significant (P < 0.05). Conclusion ANH combined with ERAS can decrease allogenic blood transfusion and increase post-operation immunologic function ,shorten the postoperative hospitalization time.
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0.05); and there was no significant difference between two groups in variance of renal function 24h after lobectomy. Conclusion WT LCVP is able to obviously reduce patients' blood loss and blood transfusion in lobectomy of liver under ventroscope and has no significant effects on renal function.
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Objective To evaluate the effectiveness of EEG bispectral index (BIS) as the feedback control variable of target-controlled infusion (TCI) of propofol for sedation in patients undergoing laparoscopic hysterectomy under epidural anesthesia. Methods A total of 60 patients for selective operation of laparoscopic hysterectomy under epidural anesthesia were randomly divided into two groups: the feedback TCI group (FTCI) and the TCI group (TCI),with 30 patients in each group.The target blood concentration of propofol was set up at a level of 2 mg/L.It was maintained unchanged in the TCI group throughout the surgery.The BIS value,as the control variable,was set up at 70 in the FTCI group.The highest and lowest BIS values,mean arterial pressure (MAP) and HR during the operation,the standardized unit dose of propofol,time for orientation recovery,the degree of amnesia during the operation and patient's satisfaction were recorded and compared between the two groups. Results Of the two groups: the maximum of BIS values were 76 1?6 4 and 86 0?8 6,respectively,with statistically significant difference ( t = -5 058, P =0 000),and the minimal values were 69 0?4 5 and 60 9?11 8,respectively,with significant difference ( t =-3 513, P =0 000); the highest MAPs were (90 9?14 2) mm Hg and (100 4?11 6) mm Hg,respectively,with significant difference ( t =-2 838, P =0 006),and the lowest,(74 2?12 5) mm Hg and (63 8?13 8) mm Hg,respectively,with statistical significance ( t =-3 059, P = 0 003); the time for orientation recovery was (440 8?141 0)s and (576 4?120 5)s,respectively,with significant difference ( t = -4 004, P =0 000).Total dose of propofol in the FTCI group [(510 48?82 75)mg] was statistically lower than that in the TCI group [(620 65?76 79)mg; t =-5 345, P =0 000],the same was the standardized unit dose of propofol [FTCI: (5 08?1 26)mg,TCI:(6 02?0 86)mg; t =-3 375, P =0 001].No significant differences were seen between the two groups in the degree of amnesia during the operation and patient's satisfaction. Conclusions BIS is feasible to be used as a feedback control variable in propofol anesthesia.It offers less propofol consumption,appropriate sedation,rapid recovery of orientation and more stable blood pressure.