Résumé
@#Objective To explore the relationship between post-operative cognitive dysfunction (POCD) and the dose of general anesthetic propofol in the elderly. Methods 96 patients undergoing thoracic operation were selected and randomly assigned to high bispectral index (BIS) value (HIBIS 50~60, low dose of propofol) and low BIS value (LOBIS 30~40, high dose of propofol). Remifentanyl was infused in both group with the dose of 0.2 μg/kg ⋅ min. The dose of propofol was adjusted with target-controlled infuse (TCI) according to the different ranges of BIS value in different groups. The mean arterial pressure was maintained in a certain level. The dose of propofol was recorded during the operation. Cognitive function was assessed by 12 neurophysiological tests recommended by International Study of Post Operative Cognitive Dysfunction (ISPOCD) on the day before operation and the 7th day after operation. And the D-value of the tests before and after the operation was calculated. Results 47 cases in the HIBIS group and 45 cases in the LOBIS group were included in the end. The incidences of POCD were 6.3%(3 cases) and 2.2%(1 case) respectively in HIBIS group and LOBIS group according to Mini-Mental State Examination (MMSE) score, and 12.8% (6 cases) and 6.7% (3 cases) according to combination judgment, but there was no significantly difference (P>0.05). The post-operative scores were significantly lower than pre-operative scores (P<0.01) on Hopkins Verbal Learning Test-Revised (HVLT-R) in HIBIS group. and HVLT-R dealyed Recall Test, Hvlt- r Recognition Discrimination Index and Verbal Fluency Test in both groups (P<0.01), including verbal and words. The D-values of 4 neurophysiological tests were higher in the HIBIS group than in the LOBIS group. The dose of propofol was significantly lower in the HIBIS group than in the LOBIS group (P<0.01). Conclusion As the same level of analgisia and hemodynamics, the more the dose of propofol is, the better the post-operative function is in the elderly.
Résumé
Objective To assess the accuracy of mixed venous oxygen saturation ( S(-v)O2 ) in reflecting the change in CO during off-pump coronary artery bypass grafting (OPCABG) .Methods Twenty-five NYHA Ⅰ -Ⅲ patients of both sexes, aged 50-75 yr, weighing 55-85 kg, undergoing OPCABG, were studied. Anesthesia was induced with midazolam, fentanyl, etomidate and pipecuronium and maintained with propofol infusion and intermittent iv boluses of fentanyl and pipecuronium supplemented with isoflurane if necessary. The patients were mechanically ventilated (VT 8-10 ml/kg, RR 8-10 bpm, I:E 1:2). PETCO2 was maintained at 35-45 mm Hg.Radial artery was cannulated and pulmonary catheter was placed. CI, S(-v)O2 and Hb were monitored and recorded before skin incision, during anastomosis with left anterior descending artery (LAD), right coronary artery (RCA)and left circumflex coronary artery (LCX), when the chest was closed, when the patients' body position was changed and the heart was manipulated. S(-v)O2 and CI were scaled immediately after the pulmonary artery catheter was placed and before anastomosing LAD. Results The CO change in S(-v)O2 was real-time and accurate in reflecting the body positioning and elevation of hearts. There was no simultaneous significant change in CI.Conclusion The CO change in S(-v)O2 is real-time and accurate in reflecting the body positioning and elevation of hearts during OPCABG.
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Objective Investgate the anesthetic management of patients with brachiocephaliic arteritis.Methods Review and analysis the clinic data of eleven cases of brachiocephaliic arteritis.Results The process of anesthesia is smooth,and haemodynamics is stable during peri-operation.Two patients was dead of MODS.Conclusion The keys of anesthstic management of brachiocephaliic arteritis are maintaining the haemodynamics steady and the blood supply to the brain,and the protection of the brain function.
Résumé
Objective To approach the hemodynamic effects of combined spinal-epidural anesthesia in 65 years or older patients. Methods In a prospective study, 60 American Society of Anesthesiologists Ⅱ～Ⅲ patients (aged 65 yr or older), undergoing elective TKR surgery were randomLy assigned to either CSE an-esthesia (CSEA, n=30) or epidurai anesthesia alone (CEA, n=30). The age, sex, duration of surgery, blood loss, fluid infusion during the surgery and main complications were recorded. Hemodynamic measure-ments included invasive or non-invasive mean arterial blood pressure (MAP), heart rate (HR) before an-aesthesiaufe, 15 wins after anaesthesia and the end of surgery. Our primary endpoint (outcome) was the number of hypotension and bradycardic episodes (defined as MAP<70 mmHg and HR<50 beats per mi-nute). Cases of blood bandage were also recorded. Results There was no significant difference between two groups in the age, sex, duration of surgery, blood loss, fluid infusion and main complications. Using univariate analysis, we found no significant differences between the groups in regards to MAP, HR during the perioperative period. The incidence of hypotension was similar in both groups (7 patients in CSEA and 6 in CEA group, P=0.704), as of bradycardia (3 patients in CSE, 5 in epidural, P=0.754). The inci-dance of blood bandage pain of CSE group was higher than CSEA group. Conclusion Combined spinal-epi-dural anesthesia and epidural anesthesia alone during TKB surgery are associated with the same incidence of hypotension with statistically and clinically similar hemodynamic responses.