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Objective To evaluate the median effective anesthetic dose of ropivacaine in ultrasound-guided transversus abdominis plane ( TAP ) block for analgesia in patients undergoing appendectomy. Methods Twenty-eight cases of appendectomy under general anesthesia were analyzed.After standardized general anaesthesia,a bilateral ultrasound-guided TAP block was performed on patients undergoing appendectomy using ropivacaine. Sequential method was applied. The initial dose of ropivacaine in first patient was 1.6 mg·kg-1,the dose adjustment interval was 0.2 mg·kg-1.Numerical Rating Scale was used to estimate the level of pain postoperatively. If NRS≤3, dosage of ropivacaine was decreased by 0. 2 mg·kg-1. The transversus abdominis plane block analgesia duration and incidences of postoperative adverse reactions were analyzed. Results Median effective dose (ED50) of ropivacaine in ultrasound-guided transversus abdominis plane block was 2.73 mg·kg-1.95%CI (1.94, 3.84) mg·kg-1. Conclusion The determination of ED50of ropivacaine in ultrasound-guided transversus abdominis plane block improved the anesthesia efficacy and safety.
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Objective To systematically review the efficacy of dexmedetomidine mixed with ropivacaine for brachial plexus block in the patients undergoing upper limb surgery.Methods Medline,PubMed,Embase,Web of Science,Weipu,Wanfang,Zhiwang databases were searched for randomized controlled trials involving the efficacy of dexmedetomidine mixed with ropivacaine for brachial plexus block in patients undergoing upper limb surgery from the date of database establishment up to July 2017,and the trials were published in Chinese or in English.Evaluation indexes included onset time and duration of sensory and motor blocks and analgesia time when used for brachial plexus block.Trials were selected and data were extracted independently by 2 investigators,and meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.3 software.Results Twelve randomized controlled trials were included in our metaanalysis.Compared with control group,the onset time of sensory and motor blocks was significantly shortened,the duration of sensory and motor blocks was prolonged,and analgesia time when used for brachial plexus block was prolonged in dexmedetomidine group (P＜0.01).Conclusion Dexmedetomidine mixed with ropivacaine can be effectively used for brachial plexus block in the patients undergoing upper limb surgery.
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Objective To investigate the effect of different operation positions on cardiac index (CI) and stroke volume variation (SVV) in the patients monitored by FloTrac/Vigileo system to provide some references for the hemodynamic management and liquid treatment of the patients.Methods Sixty patients scheduled for elective TV auxiliary thoracoscope radical operation of esophageal cancer.The CI and SVV changes were observed by using the FloTrac/Vigileo system.CI,SVV and CVP were recorded at 5 min after anesthesia induction (T0),5 min after converting to the position of head low feet high (T1),5 min after converting to the position of head high feet low (T2).Results Compared with T0,CI at T1 and T2 was decreased(P＜0.05);compared with T0,SVV at T1 was decreased and CVP was increased;SVV at T2 was increased and CVP was decreased(P＜0.05).Conclusion The operation position change may have a significant impact on the patient's CI,SVV and CVP.Focusing on the corresponding change can provide some references for the intraoperative hemodynamic management and liquid treatment.
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Objective To investigate the effects of different values of PEEP on cardiac index (CI), stroke volume variation (SVV) and oxygen transport index (DO2I) in patients monitored by FloTrac/Vigileo system, and to provide some references for the hemodynamic management and improvement of oxygenation for patients. Methods Sixty patients scheduled for elective television (TV) auxiliary thoracoscope radical operation for esophageal cancer were included in this study. Data of CI, SVV and DO2I were observed by the FloTrac/Vigileo system. Changes of CI, SVV and DO2I were recorded after anesthesia induction and turn left side (T0), artificial pneumothorax with 0 PEEP after 5 minutes (T1), artificial pneumothorax with 5 PEEP after 5 minutes (T2), artificial pneumothorax with 10 PEEP after 5 minutes (T3), and artificial pneumothorax with 15 PEEP after 5 minutes (T4). Results Compared with T0, CI decreased and SVV increased significantly at T1, T2, T3 and T4(P<0.05). Compared with T1, CI decreased and SVV increased at T4. DO2I increased at T2 and T3 compared with that of T1(P<0.05). Conclusion PEEP may have a certain influence on CI and SVV in the process of operation. The values of 5-10 PEEP can significantly improve oxygenation and have a less influence on hemodynamics, which can be appropriately used in clinical care.
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Objective To investigate the effect of remote ischemic preconditioning (RIPC) on the lung injury during one-lung ventilation (OLV) in the patients undergoing thoracic surgery.Methods Eighty patients scheduled for elective radical operation for esophageal cancer,were randomly divided into 2 groups (n=40 each) using a random number table.control group (group C) and group RIPC.At 0 (T1),30 min (T2),1 h (T3) and 2 h (T4) of OLV,blood samples were obtained from the radial artery for blood gas analysis and determination of plasma concentrations of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-1ββ) and IL-10.Oxygenation index(OI),respiratory index(RI) and PaO2/PAO2 were calculated.Exhaled breath condensate was collected and the pH value was measured.Results Compared with group C,Oxygenation index was significantly increased,and respiratory index was decreased at T2-T4,the plasma concentrations of TNF-α and IL-1β were decreased,and the pH value of exhaled breath condensate was increased at T3-T4,and the plasma concentration of IL-10 was increased at T4 in group RIPC.Conclusion RIPC can inhibit inflammatory responses and reduce airway acidification,thus attenuating the lung injury during OLV in the patients undergoing thoracic surgery.
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Objective To evaluate the effect of dexmedetomidine on the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.Methods Forty-two patients of either sex with intracranial aneurysm,aged 57-78 yr,weighing 53-86 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective balloon occlusion test of the internal carotid artery under general anesthesia,were assigned into 2 groups (n =21 each) using a random number table:propofol conbined with remifentanil group (group PR) and dexmedetomidine combined with propofol and remifentanil group (group DPR).In group DPR,dexmedetomidine was intravenously infused over 15 min in a loading dose of 0.5 μg · kg-1 before induction of anesthesia,followed by an infusion of 0.3 μg · kg-1 · h-1 throughout surgery.Propofol and remifentanil were given by target-controlled infusion (TCI) after infusion of the loading dose.The patients were mechanically ventilated after placement of the laryngeal mask airway.Maintenance of anesthesia was as follows:propofol and remifentanil were given by TCI with the target plasma concentrations of 0.5-1.0 μg/ml and 1-3 ng/ml,respectively,in group DPR;propofol and remifentanil were given by TCI with the target plasma concentrations of 3-5 μg/ml and 3-6 ng/ml,respectively,in group PR.Bispectral index (BIS) value was maintained at 40-60.Before wakeup test,propofol infusion was stopped and the target plasma concentration of remifentanil was decreased to 0.5 ng/ml in two groups,and the infusion rate of dexmedetomidine was decreased to 0.1 pg · kg-1 · h-1 in group DPR.The wake-up time was recorded and the wake-up quality was assessed.After admission to the operating room (T0,baseline),at 10 min before wake-up test (T1),immediately after patients were wakened (T2),at 10 min after patients were wakened (T3) and at the end of wake-up test (T4),the mean blood pressure (MAP),heart rate,respiratory rate (RR),SpO2 and BIS values were recorded.The development of intraoperative awareness,emergence time,postoperative agitation,nausea and vomiting,regurgitation and aspiration and severe pain was recorded.Results MAP,heart rate,SpO2 and RR were all within the normal range during wake-up period in two groups.Compared with the baseline at To,MAP was significantly decreased at Ti,3,4 in group PR,and BIS value was decreased at T1-4 in DPR and PR groups (P＜0.05).Compared with group PR,MAP was significantly increased at T1.3,BIS value was decreased at T24,the wake-up time was shortened,Ramsay sedation score and wake-up quality were increased,the emergence time was shortened,and the incidence of agitation was deceased (P＜0.05),and no significant change was found in verbal rating scale scores assessed after extubation in group DPR (P ＞ 0.05).No cardiovascular events,respiratory depression,intraoperative awareness,postoperative nausea and voniting,regurgitation and aspiration or severe pain was found in two groups.Conclusion Dexmedetomidine can raise the quality of intraoperative wake-up test in the patients undergoing balloon occlusion test of the internal carotid artery.
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After the current situation of knowledge service in aviation medicine was analyzed, the major problems in restrict security systems, few information access approaches, and difficulties in team construction for the knowledge service in aviation medicine were pointed out, with measures that should be taken in knowledge service put for-ward, such as keeping abreast of the key task in research of aviation medicine, making use of open access re-sources, digitalizing paper-type resources, organizing and revealing the knowledge in resources by making use of information technologies.
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Objective To evaluate the optimum ratio of medicine dosage for dexmedetomidine mixed with sufentanil used for patient?controlled intravenous analgesia ( PCIA) after Nuss procedure in pedi?atric patients with pectus excavatum. Methods Sixty pediatric patients diagnosed with pectus excavatum, aged 5-12 yr, weighing 18-50 kg, of ASA physical statusⅠorⅡ, scheduled for elective Nuss procedure under general anesthesia, were randomly divided into 3 equal groups using a random number table:different ratios of medicine dosage while dexmedetomidine was added to sufentanil groups ( SD1-3 groups) . Postopera?tive analgesia was as follows: group SD1 received sufentanil 1 μg∕kg + dexmedetomidine 2 μg∕kg; group SD2 received sufentanil 1 μg∕kg + dexmedetomidine 3 μg∕kg; group SD3 received sufentanil 1 μg∕kg +dexmedetomidine 4 μg∕kg. A mixture of tropisetron 0?1 mg∕kg and dexamethasone 0?1 mg∕kg ( in 100 ml of normal saline) was added in each group. The PCA pump was programmed to deliver 0?5 ml with a lockout interval of 15 min and background infusion at 2 ml∕h. The PCA pump was connected immediately after the end of operation, and sufentanil with a dosage of 0?1μg∕kg was used as a rescue analgesic within 48 h post?operatively. The VAS score was maintained below 4. The requirement for rescue analgesics was recorded. The Ramsay sedation scores was recorded at 4, 8, 12, 24 and 48 h postoperatively, and the occurrence of adverse reactions such as nausea and vomiting, bradycardia, over?sedation, respiratory depression, agitation and shivering was recorded within 48 h after surgery. Results No pediatric patients developed nausea and vomiting, respiratory depression, bradycardia, over?sedation, and shivering. No pediatric patients required rescue analgesics in SD2 and SD3 groups. Compared with group SD1 , the requirement for rescue analgesics and incidence of agitation were significantly decreased, and Ramsay sedation scores were increased at 4 and 8 h after operation in SD2 and SD3 groups. Ramsay sedation scores were significantly higher at 4 h after oper?ation in SD3 group than in SD2 group. Conclusion Dexmedetomidine 3 μg∕kg mixed with sufentanil 1μg∕kg is the optimum ratio of medicine dosage when used for PCIA after Nuss procedure in pediatric patients with pectus excavatum.
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Objective To investigate the influence of different respiratory parameter setting during gynecological laparoscopic surgery on early postoperative cognitive function.Methods Eighty patients undergoing elective ovarian cancer or cervical cancer were grouped randomly into groups A, B,C and D.In group A patients were ventilated with respiratory parameters of VT 8 ml/kg,RR 12 times/min.While patients in groups B,C and D with identical minute volume 105 ml/kg though with respective RR of 12,1 5 and 18 times/min respectively.Patients in four groups were all graded by the MMSE at time points of preoperation(T0 ),postoperative 1 h(T1 ),6 h(T2 ),24 h(T3 ),48 h(T4 ), 72 h(T5 ).PaCO2 of arterial blood gas were tested before pneumoperitoneum(Ta)and immediately af-ter pneumoperitoneum(Tb).Results PaCO2 at Tb was higher in each group than that at Ta(P <0.05).Patients in group A showed the highest PaCO2 at Tb while PaCO2 in group C were lowest. The MMSE scores in group C were significantly higher than those in other groups at T1-T3 (P <0.05).The values at T4 in group A were lower (P <0.05)than those in other groups.Values at T1-T4 in group A were lower than that at T0 (P <0.05).In groups B and D at T1-T3 MMSE scores were lower than those at T0 and patients in group C showed lower MMSE scores at T1 and T2 (P <0.05).Conclusion Early postoperative cognitive function can be improved by regulating intraoperative respiratory parameters properly and increasing minute volume adequately in gynecological laparoscopic surgery.
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Objective To discuss the clinical epidemiology features and change trend of aortic dissection (AD) in Henan Province.Methods Retrospective analysis of consecutive 906 patients with AD over 10 years in Henan Provincial People' s Hospital,the First Affiliated Hospital of Zhengzhou University and Henan Provincial Chest Hospital.Hospital records and prognosis were compared between two five-year periods.Results 906 cases with AD were hospitalized during the past 10years.The mean age was (50.2 ± 9.8) years.The male/female ratio was 3.49 ∶ 1.Hypertension was present in 60.3 ％ of all patients.Heavy smoking history was elicited in 32.2％ of all patients.Type A dissection were identified in 57.8％ of all the cases,and type B in 42.2％.In-hospital mortality of acute type A dissection was 21.8％,acute type B dissection 6.8％.In two five-year periods,the total number of cases increased by 216％,among which type A was the fastest,increased by 294％,Changes of mean age and male/female ratio were not significant.For acute AD,changes of prognosis in one year improved,and reach statistical significance (P ＜ 0.05).Conclusion This study provides insight into current regional profiles of AD.The number of hospitalized patients with AD is increasing dramatically.The mean age of the first-attack is much younger and the male ration is much higher than that reported by other regional researchers.These data support the urgent need for further improvement in prevention and treatment of AD.
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Sixty gynecological patients undergoing laparoscopic surgery during October 2010 to June 2011were randomly divided into 2 groups:laryngeal mask airway proseal ( PLMA group,n =30 ) and laryngeal mask airway classic (CLMA group,n =30).Laryngeal mask was inserted after induction.The heart rate (HR),mean arterial pressure (MAP),airway sealing pressure,the average time of placement,the pulmonary satisfaction and complications were recorded.There was no significant difference in heart rate and MAP between the two groups(P＞0.05).The airway sealing pressure [ (26 ±6) cm H2O ( 1cm H2O =0.098 kPa) vs.(16±5) cm H2O],the average time of placement [(36±5) vs.(24±6) s)] and the excellent lung ventilation(90％ vs.73％ ) in the PLMA group were more significantly increased than those in the CLMA group(P ＜0.05).PLMA can assure good airway sealing and is more suitable for gynecological patients undergoing laparoscopic surgery.
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Objective To determine the risk factors for acute kidney injury following type Stanford A Aortic Dissection surgeryies.Methods It's a restrospective study.The clinical data of 176 patients undergoing type Stanford A Aortic Dissection surgery from Septerary 2009 to December 2011 were retrospectively analyzed.There were 115 males and 61 females with mean ages(43.20 ± 10.14)years old.The patients were divided into two groups according to whether AKI occurred after operation.Univariate and multivariate analyses were used to evaluate possible pre-,intra-,and post-operative parameters associated with AKI according to AKI Network.Results Among all the patients,AKI occurred in 78 (44.32％),21 (11.93％) of whom underwent continuous renal replacement therapy (CRRT).In hospital mortality was 3.41％ in all discharges while 6.45％ in AKI patients (P ＜ 0.01).Conclusion Multivariate Logistic regression analysis revealed that increased age,pre-operative left ventricular insufficiency,pre-operative renal insufficiency and long extracorpeal circulation (CPB) time ＞ 140 min were risk factors for the development of AKI.AKI is the most common complication of type Stanford A Aortic Dissection surgery,and is the risk factor of mortality after the surgery.It is important to enhance peri-operative protection of the renal function.
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Pain in the cervical region of air force pilots, who are exposed to high G-forces, is a specifically occupational health problem. To minimize neck problems, the cervical muscles need specific strength exercise. It is important that the training for the neck must be carried out with optimal resistance in exercises. The model NSE-1 neck training machine for pilots was designed for neck strengthening exercises under safe and effective conditions. In order to realize the functions of changeable velocity and resistant (CVR) training and neck isometric contractive exercises, the techniques of adaptive hydraulics, sensor, optic and auditory biological feedback, and signal processing were applied to this machine. The training system mainly consists of mechanical parts (including the chair of flexion and extension, the chair of right and left lateral flexion, the components of hydraulics and torque transformer, etc.), and the software of signal processing and biological feedback. Eleven volunteers were selected for the experiments of neck isometric contractive exercises, three times a week for 6 weeks, where CVR training (flexion, extension, right, left lateral flexion) one time a week. The increase in relative strength of the neck (flexion, extension, left and right lateral flexion) was 70.8%, 83.7%, 78.6% and 75.2%, respectively after training. Results show that the strength of the neck can be increased safely, effectively and rapidly with NSE-1 neck training machine to perform neck training.
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Humanos , Medicina Aeroespacial , Aeronaves , Diseño de Equipo , Ejercicio Físico , Fisiología , Personal Militar , Músculos del Cuello , Heridas y Lesiones , Fisiología , Dolor de Cuello , Educación y Entrenamiento Físico , PosturaRESUMEN
Twelve ASA Ⅳ or Ⅴ patients with severe airway stenosis, aged 34-87 yr, weighing 50-80 kg,were enrolled in the study. The guidewire and endotracheal tube were inserted through the oral cavity under the guidance of the method of interventional radiology. The expandor was then exchanged and the endotracheal tube was placed in the suitable position within the trachea along the expandor under X-ray guidance. Endotracheal intubation was technically successful in all patients, without serious complications in the process. The intubation time was 1-5 min.
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Objective To develop a new ambulance aid on airport rescue of pilot and solve the difficult problems on medical staff, which carry the wounded from high aircraft cabin to the ground. Methods The device owned QG 0.85 trailer chassis. On the basis of it, self-made manual flexible extension-jib, flexible extension ladders and safety board were designed. The safety board was used to fix wounded pilots to protect secondary injury of backbone and C-spine. Results The maximal speed of equipment was 80km/h and spreading time is 3～7min, operating time is 4min and lifting height is 6 000mm. Conclusion The ambulance aid can be used in the location of flight accident quickly and rescued the pilots rapidly, adapted to any type fighters and met the needs of medical support in flight.
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Objective To demonstrate medical aid techniques and ways of rescue helicopter,explore the variety and quantity of equipped medicines and instruments,develop medical aid equipment on board and solve the problems of lacking standard medical aid equipment in the rescue helicopter of our army.Methods The service demand of medical aid equipment in rescue helicopter was demonstrated by means of investigating and material analyzing.The medical aid equipment was developed.Results The technical specifications of technical methods,treatment principles and drugs,the volume of equipment goods and equipment were formed.The medical aid helicopter has features of small size and light weight,and has a fully furnished on fixation and spread of medical equipment.The helicopter of vibration,noise,jolt,low pressure has no effect on job status of the equipment,which performance stability and reached the design requirements.Conclusion The medical aid technique,method and equipment of rescue helicopter are researched to meet the needs of curing the wounded pilots who had to parachute in emergency situation and solve the problem of training demand in the army.