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Objective:To investigate the relationship between the timing of pulmonary surgery and postoperative pulmonary complications (PPCs) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Methods:Sixty-eight American Society of Anesthesiologists Physical Status classification Ⅰor Ⅱ patients of either sex, with body mass index of 18-30 kg/m 2, who were first infected with SARS-CoV-2 after December 2022, undergoing elective thoracoscopic partial pneumonectomy from January to May 2023, were included in this prospective cohort study. The patients were divided into 2 groups ( n=34 each) according to the time between the date of surgery and SARS-CoV-2 infection: 5-10 weeks group and 11-16 weeks group. The preoperative persistent symptoms and dyspnea before operation were recorded. The serum concentrations of interleukin-6 and tumor necrosis factor-alpha were determined by enzyme-linked immunosorbent assay at 1 day before operation and 2 h and 1 and 2 days after operation. The white blood cell count and serum C-reactive protein concentration were measured at 1 day before operation and 1 and 2 days after operation. The occurrence of PPCs and length of postoperative hospital stay were recorded. Logistic regression was used to analyze the relationship between PPCs and timing of pulmonary surgery after SARS-CoV-2 infection. Results:Two patients in each group were excluded from the study because of conversion to thoracotomy. Thirty-two patients were finally included in each group. Compared with 5-10 weeks group, the ratio of preoperative persistent symptoms and dyspnea was significantly decreased, the serum concentrations of interleukin-6, tumor necrosis factor-alpha and C-reactive protein and white blood cell count were decreased at each time point after operation, the incidence of PPCs and postoperative pulmonary infection was decreased, and the length of postoperative hospital stay was shortened in 11-16 weeks group ( P<0.05). Multivariate logistic regression analysis showed that short time from the date of surgery to infection ( OR=1.754, 95% confidence interval[ CI] 1.509-2.038, P<0.001), preoperative persistent symptoms ( OR=2.523, 95% CI 2.047-3.110, P<0.001), preoperative dyspnea ( OR=1.875, 95% CI 1.406-2.500, P<0.001) and high white blood cell count at 1 day after surgery ( OR=0.676, 95% CI 0.651-0.701, P<0.001) were independent risk factors for PPCs. Conclusions:The risk of PPCs is lower in the patients undergoing pulmonary surgery at 11-16 weeks after SARS-CoV-2 infection than at 5-10 weeks after infection. Short time from the date of surgery to infection is an independent risk factor for PPCs.
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Objective:To evaluate the efficacy of perioperative analgesia with esketamine in the patients undergoing thoracoscopic surgery.Methods:A total of 90 patients of either sex, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy under general anesthesia, were divided into 3 groups ( n=30 each) by a random number table method: control group (C group) and different doses of esketamine groups (S 1 group, S 2 group). Before induction of anesthesia, esketamine 0.1 and 0.2 mg/kg were intravenously injected in S 1 group and S 2 group, respectively, while esketamine was not given in group C. Anesthesia was routinely induced in all the three groups. During anesthesia maintenance, esketamine 0.1 and 0.2 mg·kg -1·h -1 were intravenously infused in group S 1 and group S 2, respectively, and the remaining drugs used for anesthesia maintenance were the same in the three groups. Patient-controlled intravenous analgesia (PCIA) was used after operation, and PCIA solution contained sufentanil 2 μg/kg in group C, and esketamine 1 mg/kg was mixed on the basis as previously described in S 1 and S 2 groups. Aminotriol ketorolac was given as rescue analgesia to maintain numeric rating scale score at rest ≤3. The total amount of propofol and remifentanil during operation, effective pressing times of PCIA in postoperative 0-24 h and >24-48 h periods, and requirement for rescue analgesia were recorded. The occurrence of adverse reactions such as respiratory depression, nausea and vomiting, dizziness and salivation, and emergence time were recorded after surgery. The serum interleukin-6 (IL-6) concentration was measured by enzyme-linked immunosorbent assay at 30 min before and after surgery, and the malondialdehyde (MDA) concentration in serum was measured by thiobarbituric acid colorimetric analysis. The postoperative recovery was assessed using the 50-item quality of recovery scale at 1 and 2 days after surgery. The development of chronic pain was followed up by telephone within 1-3 months after surgery. Results:Compared with group C, the intraoperative consumption of remifentanil, effective pressing times of PCIA in postoperative 0-24 h and >24-48 h periods, rate of rescue analgesia, and postoperative serum IL-6 concentration were significantly decreased, and the 50-item quality of recovery scale score was increased in S 1 and S 2 groups, and the postoperative serum MDA concentration was significantly decreased in group S 2 ( P<0.05). Compared with group S 1, the consumption of intraoperative remifentanil was significantly decreased ( P<0.05), and no significant change was found in postoperative serum IL-6 and MDA concentrations in group S 2 ( P>0.05). Compared with group S 2, the postoperative emergence time was significantly shortened in S 1 and C groups ( P<0.05). There was no statistically significant difference in the intraoperative consumption of propofol, incidence of adverse effects and incidence of chronic pain among the three groups ( P>0.05). Conclusions:Esketamine for perioperative analgesia (dose before anesthesia induction 0.1 mg/kg, dose for maintenance of anesthesia 0.1 mg·kg -1·h -1, dose for postoperative PCIA 1 mg/kg) can raise the quality of analgesia and improve the quality of early postoperative recovery in the patients undergoing thoracoscopic lobectomy.
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Objective:To evaluate the optimization efficacy of pressure-volume (P-V) curve-based individualized lung-protective ventilation strategy combined with pressure-controlled ventilation-volume guaranteed (PCV-VG) mode (LPVS+ PCV-VG) for one-lung ventilation (OLV) in elderly patients undergoing radical resection of lung cancer.Methods:Seventy American Society of Anesthesiologists Physical Status classificationⅡ-Ⅲ patients, aged 65-74 yr, with body mass index of 18-24 kg/m 2, undergoing elective thoracoscopic radical resection of lung cancer, were divided into 2 groups ( n=35 each) using a random number table method: PCV-VG group and LPVS+ PCV-VG group. Blood samples were collected from the radial artery for blood gas analysis before induction of general anesthesia (T 0), at 5 min of two lung ventilation after endotracheal intubation (T 1), at 30 min of OLV (T 2), at the end of OLV (T 3), and at 5 min of two lung ventilation in supine position (T 4). Ppeak, mean airway pressure (Pmean) and dynamic lung compliance (Cdyn) were recorded. The use of antibiotics, lung-related complications and rehabilitation were recorded within 7 days after operation. Results:Compared with PCV-VG group, PaO 2, PaCO 2 and Cdyn were significantly increased at T 2-4, Ppeak was decreased at T 2, 3, Pmean was increased at T 3, the requirement for antibiotics within 7 days after operation was decreased, the incidence of 1 grade lung-related complications was decreased, and the thoracic drainage tube indwelling time and length of hospital stay were shortened in LPVS+ PCV-VG group ( P<0.05). Conclusions:Individualized LPVS based on P-V curve combined with PCV-VG mode provides better efficacy for OLV in elderly patients undergoing radical resection of lung cancer.
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Objective:To evaluate the efficacy of pecto-intercostal fascial block (PIFB)-pectoral nerve block type Ⅱ (PECS Ⅱ block)-general anesthesia for modified radical mastectomy.Methods:Forty-six patients, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, aged 40-65 yr, scheduled for elective modified radical mastectomy, were divided into 2 groups ( n=23 each) using a random number table method: PECS Ⅱ block-general anesthesia group (group P+ G) and PIFB-PECS Ⅱ block-general anesthesia group (group P+ P+ G). The patients received ultrasound-guided PECS Ⅱ block (P+ G group) or PIFB combined with PECS Ⅱ block (P+ P+ G group) in the pre-anesthesia room. Then the patients were admitted to the operating room, and midazolam, propofol, sufentanil and cisatracurium were used for anesthesia induction, and sevoflurane, remifentanil and cisatracurium were used for anesthesia maintenance. The intraoperative consumption of remifentanil, emergence time and extubation time were recorded. Flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic after operation, and visual analog scale score was maintained ≤3 at rest. The requirement for rescue analgesia and occurrence of nausea and vomiting within 24 h after operation were recorded. Results:Compared with group P+ G, the intraoperative consumption of remifentanil was significantly decreased, the emergence time and extubation time were shortened, the rate of rescue analgesia within 24 h after operation was decreased, the time of first rescue analgesia was prolonged ( P<0.05), and no significant change was found in the incidence of nausea and vomiting in group P+ P+ G ( P>0.05). Conclusions:Compared with PECS Ⅱ block-general anesthesia, PIFB-PECS Ⅱ block-general anesthesia can reduce the amount of intraoperative opioids, inhibit postoperative hyperalgesia and promote early postoperative recovery when used for modified radical mastectomy.
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Enhanced recovery after surgery (ERAS)is a new concept of accelerating the recovery of patients through a series of multi-mode strategies based on evidence-based medicine date in perioperative period. The perioperative fluid therapy is an important part of ERAS, including three phases of preoperative、intraoperative and postoperative. Its aim is to maintain the circulation volume to ensure circulation stability and effective perfusion of tissues, to avoid tissue ischemia and hypoxia, and to reduce surgical stress, maintain internal environment stability, reduce postoperative respiratory and circulatory complications, thus accelerating recovery. Fluid therapy has been controversial, Goal-directed Fluid Therapy is a recognized method.This article reviews the latest advances in preoperative, intraoperative and postoperative fluid therapy on the guidance of ERAS and its influence on postoperative outcomes.
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Objective:To evaluate the effect of remimazolam combined with remifentanil used for painless gastroscopy.Methods:A total of 150 patients of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 18-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective painless gastroscopy, were divided into 3 groups ( n=50 each) using a random number table method: propofol combined with remifentanil group (group P), remimazolam 0.3 mg/kg combined with remifentanil group (group R1) and remimazolam 12 mg combined with remifentanil group (group R2). Drugs were administrated according to body weight, and calculation was carried out according to ideal body weight.Remifentanil 0.25 μg/kg was injected intravenously, propofol 1.5 mg/kg was then injected intravenously in group P, remimazolam 0.3 mg/kg was injected intravenously in group R1, and remimazolam 12 mg was injected intravenously in group R2.When Modified Observer′s Assessment/Alertness and Sedation (MOAA/S) score was≤3, gastroscopy was performed.It was defined as sedation failure when MOAA/S score was still ≥4 at 3 min after administration of propofol or remimazolam.When intraoperative body movement occurred, 1/4 of the initial dose of propofol was injected intravenously in group P, 1/4 of the initial dose of remimazolam was injected intravenously in group R1, and remimazolam 2.5 mg was injected intravenously in group R2 to maintain MOAA/S score ≤3.It was defined as sedation failure when sufficient sedation was not maintained after the additional drugs were given more than 3 times within 15 min.The success of sedation, time for gastroscopy, emergence time and discharge time were recorded.The occurrence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was recorded. Results:Compared with group P, no significant change was found in the success rate of sedation ( P>0.05), and the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, hiccup, coughing and injection pain was decreased in group R1, and the success rate of sedation was significantly decreased, the incidence of intraoperative body movement, bradyeardia, hypotension, respiratory depression, coughing and injection pain was decreased, and the incidence of hiccup was increased in group R2 ( P<0.05). Compared with group R2, the success rate of sedation was significantly increased, and the incidence of intraoperative body movement, coughing and hiccup was decreased in group R1 ( P<0.05). Conclusion:Remimazolam 0.3 mg/kg combined with remifentanil can be safely and effectively used for painless gastroscopy.
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Objective To evaluate the efficacy of transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia when used for modified radical mastectomy. Methods Sixty female patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 45-63 yr, weighing 48-72 kg, scheduled for elective modified radical mastectomy, were divided into 3 groups ( n=20 each) using a random number table method: thoracic nerve block-general anesthesia group ( group P+G ) , transverse thoracic muscle plane-thoracic nerve block-general anesthesia group ( group T+P+G) and general anesthesia group ( group G ) . Anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium and maintained with sevoflurane, fentanyl and cisatracurium. Thoracic nerve block typeⅠ and Ⅱ was per-formed after implanting laryngeal mask airway in group P+G. Transverse thoracic muscle plane block was performed after performing thoracic nerve block typeⅠandⅡin group T+P+G. Flurbiprofen 50 mg was in-travenously injected after operation as a rescue analgesic to maintain the Visual Analogue Scale score≤3. The consumption of opioids, emergence time and time for removal of the laryngeal mask airway were recor-ded. Ramsay sedation score was recorded at 10 min after removal of the laryngeal mask airway. The require-ment for rescue analgesia, time of passing flatus and development of nausea and vomiting within 24 h after operation were recorded. Results Compared with group G, the emergence time, time for removal of the laryngeal mask airway and time of passing flatus were significantly shortened, and the Ramsay sedation score, consumption of fentanyl and requirement for rescue analgesia were decreased in P+G and T+P+G groups ( P<0. 05) , and the incidence of nausea and vomiting was significantly decreased in group T+P+G ( P<0. 05) . Compared with group P+G, the time for removal of the laryngeal mask airway and time of pass-ing flatus were significantly shortened, the consumption of fentanyl was decreased ( P<0. 05) , and no sig-nificant change was found in the requirement for rescue analgesia or incidence of nausea and vomiting in group T+P+G ( P>0. 05) . Conclusion Transverse thoracic muscle plane-thoracic nerve block combined with general anesthesia can provide satisfactory perioperative analgesia and is helpful in improving prognosis for the patients undergoing modified radical mastectomy.
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Objective To evaluate the effects of acute peritonitis on rocuronium?induced neuromus?cular blockade in abdominal muscles and function of the sarcoplasmic reticulum of rats. Methods Thirty?six pathogen?free male Sprague?Dawley rats, weighing 220-250 g, were divided into 2 groups using a ran?dom number table: control group (group C, n=12) and acute peritonitis group (group P, n=24). After the rats were anesthetized with pentobarbital sodium, acute peritonitis was induced by artificial gastric per?foration in group P. At 1 and 2 h after operation, the changes in the intra?abdominal pressure (IAP) with different volumes were detected, and blood samples were collected from the orbital veins for determination of serum levels of interleukin?6, tumor necrosis factor?alpha and interleukin?13. Rocuronium 3. 5 mg∕kg was then injected via the caudal vein. The IAP was recorded at 1, 5 and 10 min after administration. The intra?cellular free Ca2+ concentration was assessed using fura?2, and the maximal Ca2+ uptake and release rate in the sarcoplasmic reticulum were calculated. Results Compared with group C, the serum levels of interleu?kin?6 and tumor necrosis factor?alpha at 2 h after operation and IAP at 1 and 2 h after operation were signifi?cantly increased, the IAP was increased at 1, 5 and 10 min after administration of rocuronium, and the maximal Ca2+ uptake rate and amount of calcium uptake in the sarcoplasmic reticulum were decreased in group P ( P<0.01) . Conclusion Acute peritonitis decreases rocuronium?induced neuromuscular blockade in abdominal muscles, which may be related to the impaired Ca2+uptake function of the sarcoplasmic reticu?lum of rats.
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Objective To observe the oxygenation and heartbeat duration effect of peritoneal ventilation with oxygen on a rabbit asphyxia model so as to provide a basis for treatment of severe respiratory damage with peritoneal oxygenation technique. Methods Twenty-four New Zealand rabbits were randomized into control group,air group and oxygen group,eight rabbits per group.Trachea dissection and intubation,carotid artery and vein catheter and placement of peritoneal cavity in and out of air duct were performed.An asphyxia model was built by clamping the tracheal catheter and was administered with peritoneal ventilation (with air in air group and oxygen in oxygen group).Indices including blood gas and mean arterial pressure (MAP) before and at an interval of one minute after asphyxia and heartbeat duration were observed,and their differences between groups were compared. Results The arterial partial pressure of oxygen ( PaO2 ) in the oxygen group was higher than that in the control group within four minutes after asphyxia.The partial pressure of carbon dioxide ( PaCO2 ) [ (77.6 ± 11.2) mm Hg] in the oxygen group was significantly lower than (89.1 ± 10.1 )mm Hg in the control group at four minutes after asphyxia.The heartbeat duration [ (6.48 ± 0.89 ) minutes ] in the oxygen group was longer than (5.03 ± 0.51 ) minutes in the control group.MAP had no obvious changes in the three groups. Conclusion The transperitoneal ventilation with gaseous oxygen can alleviate the decrease of PaO2,increase of PaCO2 and prolong the duration of heartbeat in an asphyxia rabbit model.
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Starter is one of the most important factors in the yoghourt producing.The using of vacuum freeze-drying starter can greatly improve the quality of products and avoid some technical problems.The best combination of S.t and L.b were mushroom juice 14mL、carrot juice 10mL、maize liquid 0.6mL、Vc 0.2g and beer 10mL、tomato 10mL、carrot juice 15mL、mushroom juice 16mL respectively,the best cultivate time was also determined.