Effect and safety of intraoperative cell salvage during cesarean section / 中华围产医学杂志

Objective To assess the safety and effect of intraoperative cell salvage (ICS) during cesarean section.Methods This was a case-control study in which 60 gravidas who received ICS (ICS group) and 60 gravidas who received allogenic transfusion (control group) during caesarean section in Obstetrics and Gynecology Hospital of Fudan University during January 2014 to December 2016 were enrolled.Subjects in the two groups were matched in age,gestational age,gestational complications (placenta increta,placenta previa,scarred uterine,leiomyomas and anemia) and hemorrhagic volume during cesarean section.Several indicators including complications of transfusion,postoperative recovery,expense of transfusion,as well as the complete blood count and body temperature before and after operation were compared between the two groups.T,rank-sum or Chi-square test was used for statistical analysis.Results (1) No significant difference in age,gestational age,twin gestation,complications,preoperative body temperature,or the volume of hemorrhage or transfusion was observed between the two groups (all P＞0.05).(2) The autotransfusion volume was 385 (161-583) ml in the ICS group.Fifteen cases (20.0％) in the ICS group also received additional transfusions of leukocyte-reduced red blood cell (RBC) suspension,fresh frozen plasma and cryoprecipitate and two cases (3.3％) received additional transfusions of leukocyte reduced RBC suspension and fresh frozen plasma.The two groups showed no significant difference in the cost of transfusion or per-capita transfusion volume of fresh frozen plasma or cryoprecipitate.However,the transfusion volume of leukocyte-reduced RBC suspension was lower in the ICS group as compared with that in the control group [M(P25-P75),1.9 (1.5-4.5) vs 4.1 (2.8-6.2) U,Z=-2.800,P=0.005].(3) There was no significant difference in complete blood count or coagulation function between the two groups before the operation.White blood cell (WBC) counts in the two groups were elevated following operation.Postoperative WBC count in the control group was higher than that in the ICS group,while the levels of RBC and hemoglobin were lower than those in the ICS group following operation (all P＜0.05).(4) No amniotic fluid embolism was reported in the two groups.Only one case of rash was reported in the ICS group,which was fewer than the transfusion reactions occurred in the control group [1.7％ (1/60) vs 13.3％ (8/60),x2=5.886,P=0.016].(5) The two groups showed no significant difference in preoperative temperature,the highest temperature within three days after operation or incision healing.Compared with the patients in the control group,those in the ICS group had shorter hospital stay [(4.7± 1.1) vs (6.3 ±1.8) d,t=3.341,P＜0.05].Conclusion ICS is a safe and effective measure for gravidas at higher risk of hemorrhage during cesarean section.

Efficacy of different doses of dexmedetomidine for prevention of shivering after combined spinal-epidural anesthesia in patients undergoing caesarean section / 中华麻醉学杂志

Objective To evaluate the efficacy of different doses of dexmedetomidine for prevention of shivering after combined spinal-epidural anesthesia in the patients undergoing caesarean section.Methods A total of 120 patients,of ASA physical status Ⅱ or Ⅱ,aged 20-40 yr,with body mass index≤ 35 kg/m2,scheduled for elective caesarean section under combined spinal-epidural anesthesia,were randomly divided into 4 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine 0.1,0.3 and 0.5 μg/kg groups (D1,D2 and D3 groups).Combined spinal-epidural anesthesia was performed at L3,4 interspace with isobaric 0.5％ bupivacaine 2 ml.In D1,D2 and D3 groups,dexmedetomidine 0.1,0.3 and 0.5 μg/kg (in 50 ml of normal saline) were infused intravenously,respectively.In group C,normal saline 50 ml was infused at a rate of 5 ml/min.The development of shivering,bradycardia,hypotension,nausea and vomiting was recorded during the period from the end of dexmedetomidine infusion to PACU discharge time.Results Compared with group C,the incidence and degree of shivering and incidence of nausea and vomiting were significantly decreased in D2 and D3 groups,and no significant change was found in the parameters mentioned above in group D1.Compared with group D2,the incidence and degree of shivering and incidence of nausea and vomiting were significantly decreased in D3 group.Conclusion Dexmedetomidine 0.3 and 0.5 μg/kg can prevent shivering after combined spinal-epidural anesthesia in the patients undergoing caesarean section,and 0.5 μg/kg provides better efficacy.

Effect of chronic anemia on duration of non-hypoxic apnea during tracheal intubation after induction of general anesthesia in female patients / 中华麻醉学杂志

Objective To evaluate the effect of chronic anemia on duration of non-hypoxic apnea during tracheal intubation after induction of general anesthesia in female patients.Methods Seventy-five ASA physical status Ⅰ or Ⅱ patients,aged 20-40 yr,of Mallampati class Ⅰ or Ⅱ,with body mass index ＜ 25 kg/m2,were enrolled in the study.According to the test results of hemoglobin (Hb),the patients were allocated into 3 groups (n =25 each):Hb ＞ 110 g/L group (group A),Hb 90-110 g/L group (group B),and 70 g/L ＜ Hb ＜ 90 g/L group (group C).Each patient inhaled 100％ oxygen through a mask with oxygen flow of 8 L/min and 3 min later anesthesia was induced with general anesthesia.Assisted ventilation was not performed during induction.After tracheal intubation,artificial ventilation was performed with pure oxygen when SpO2 decreased to 90％.The time from beginning of apnea to SpO2 of 90％ (duration of non-hypoxic apnea),and the minimum SpO2 and the maximum PET CO2 during the period of observation were recorded.Immediately before oxygen inhalation via a mask,immediately after beginning of apnea,and at the time for SpO2 decreasing to 90％,arterial blood samples were taken from 10 patients randomly chosen from each group for blood gas analysis.Results Compared with group A,the duration of non-hypoxic apnea was significantly shortened,and no significant change was found in the minimum SpO2 in B and C groups,and the maximum PET CO2 and PaCO2 while SpO2 decreasing to 90％ were decreased in group C.Compared with group B,the duration of non-hypoxic apnea was signifi.cantly shortened,PaCO2 while SpO2 decreasing to 90％ was decreased,and no significant change was found in the minimum SpO2 and the maximum PET CO2 in group C.Conclusion Mild and moderate chronic anemia shortens the duration of non-hypoxic apnoea to about 6.0 and 3.5 min,respectively,during tracheal intubation after induction of general anesthesia in female patients.

Investigation of the anaesthetic effect of propofol combined with remifentanil by target-controlled infusion during gynecological laparoscopic myomectomy / 中国综合临床

Objective To investigate the anaesthetic effect of propofol combined with remifentanil by target-controlled infusion (TCI) used in gynecological laparoscopic myomectomy.Methods Fifty cases,who were scheduled for gynecological laparoscopic myomectomy in our hospital from June 2010 to June 2011,was randomly divided into propofol combined with remifentanil group (n =25) and inhalation anesthesia (remifentanil combined with sevoflurane) group (n =25).The heart rate and blood pressure were recorded at the time of before induction of anesthesia (T0),30 min after carbon dioxide pneumoperitoneum,the end of operation and 3 min after extubation.The awake time,time of extubation and surgery time were also recorded.Results The hemodynamics were kept stable in propofol combined with remifentanil group,and there were no significant difference with respect to SABP,DABP and heart rate at all time points compared with baseline (P ＞0.05) in propofol group.However,in inhalation anesthesia group,SABP,DABP and heart rate were increased significantly at 30 min after carbon dioxide pneumoperitoneum and 3 min after extubation when compared with baseline (P ＜ 0.05) and were higher than those of propofol group (P ＜ 0.05) at counterpart time points.In inhalation anesthesia group,the awake time ((9.3 ± 1.5) min vs (4.9 ± 1.1) min,t =10.56,P =0.017) and time of extubation ((12.9 ± 2.4) min vs.(6.8 ± 1.2) min,t =12.36,P =0.01) were significantlv longer than that of propofol group (P ＜ 0.05).Conclusion Propofol combined with remifentanil TCI-based anesthesia could achieve the optimal hemdynamic stability during anesthesia maintance and better recovery profile from anesthesia in gynecological laparoscopic myomectomy.

Effects of fraction of inspired oxygen and positive end-expiratory pressure on gradient between arterial and end-tidal carbon dioxide in patients undergoing gynecological laparoscopic surgery / 中华麻醉学杂志

Objective To evaluate the effects of fraction of inspired oxygen (FiO2) and positive end-expiratory pressure (PEEP) on the gradient between arterial and end-tidal carbon dioxide (D(a-ET)CO2).Methods Sixty ASA Ⅰ or Ⅱ patients (body mass index ＜ 30 kg/m2),aged 25-50 yr,weighing 45-75 kg,scheduled for elective gynecological laparoscopic surgery,were randomized into A,B and C groups (n =20 each).The patients were mechanically ventilated with pure oxygen in group A,and with air and O2 (FiO2 =50％) in groups B (PEEP =0) and C (PEEP =5 cm H2O).PETCO2 was monitored during mechanically ventilation.Blood samples were obtained from the radial artery immediately after tracheal intubation (T1) and at 1 h of pneumoperitoneum (T2) for blood gas analysis.D(a-ET) CO2 and Qs/Qt were calculated.Results D(a-ET) CO2 and Qs/Qt were significantly lower at T2 in groups B and C than in group A (P ＜ 0.05).Compared with group B,D(a-ET)CO2 was significantly decreased at T2 (P ＜ 0.05),and no significant change was found in Qs/Qt in group C (P ＞ 0.05).Conclusion Decreased FiO2 and PEEP of 5 cm H2O can decrease D(a-ET)CO2 and increase the accuracy of PErCO2 for reflection of PaCO2,which is due to reduced intrapulmonary shunt.

Effect of ropivacaine administered intrathecally on pulmonary function after caesarean section / 中华麻醉学杂志

ObjectiveTo investigate the effect of ropivacaine administered intrathecally on the pulmonary function after caesarean section.MethodsThirty-six ASA Ⅰ or Ⅱ parturients,aged 22-34 yr,with body mass index ≤35 kg/m2,undergoing elective cesarean section,were randomly divided into 2 groups (n=18 each):bupivacaine group (group B) and ropivacaine group (group R).Spinal anesthesia was performed at L3,4 interspace and 0.5％ bupivacaine 1.8 ml (in cerebrospinal fluid 3 ml) and 1.0％ ropivacaine 1.4 ml (in cerebrospinal fluid 3 ml) were injected into the subarachnoid space over 10 s in groups B and R respectively.Forced vital capacity (FVC),forced expiratory volume first second (FEV1) and peak expiratory flow (PEF) were measured by spirometry before surgery (T0),and at 1,1.5 and 2 h after intrathecal injection (T1-3).The motor block score was recorded at T1-3.It is regarded as the criteria for respiratory dysfunction that the measured values of FVC and FEV1 are lower than their 80 ％ and 70 ％ predicted levels respectively.ResultsFVC and FEV1 were significantly decreased at T1 compared with the baseline value at T0 in both groups (P＜0.05).Compared with that at T1,PEF was significantly increased at T2,3 in group R (P ＜0.05).Compared with group B,PEF at T1 and motor block score atT3 were significantly decreased in group R (P＜0.05).The respiratory dysfunction was not found in both groups.ConclusionSpinal anesthesia with ropivacaine and bupivacaine can inhibit the parameter level of carly pulmonary function afrer caesarean section in parturient without respiratory complications,but the pulmonary function still remains normal.

The effect of hypophysin on QT interval of gynecology patients during surgery / 复旦学报（医学版）

Objective To evaluate the effect of hypophysin and oxytocin on QT interval of the patients undergoing myomectomy. Methods Forty ASAⅠ-Ⅱ female patients scheduled for laparoscopic operation were enrolled. All patients were randomized into hypophysin or oxytocin group, with 20 patients in each group. The blood pressure, heart rate and QT interval were recorded at following time points: before anesthesia (T_1), before injection of hypophysin or oxytocin (T_2), 2 min (T_3), 5 min (T_4), 10 min (T_5), 20 min (T_6), and 30 min (T_7) after injection of hypophysin or oxytocin. Results The QT interval at 2, 5 and 10 min post injection of hypophysin were significantly longer compared to oxytocin group (P<0.01). No significant changes of QT interval were detected in oxytocin group, though the trend of QT interval prolongation were recorded. Conclusions In hysteromyoma operation, injection of hypophysin could prolong the QT interval of patients.

Accuracy of predicting acute postoperative pain by assessment of intravenous propofol injection-induced pain / 中华麻醉学杂志

Objective To investigate the accuracy of predicting acute postoperative pain by assessment of intravenous propofol injection-induced pain.Methods Seventy-one ASA I or Ⅱ patients aged 20-40 yr scheduled for induced abortion operation were enrolled in this study. The patients were unpremedicated. ECG, HR, BP and SpO_2 were continuously monitored before and during anesthesia. Anesthesia was induced with 2 mg/kg propofol. A third of the induction dose was injected via a dorsal hand vein. Pain induced by iv propofol injection was assessed with verbal rating scale (VRS) (0 = no pain, 3 = severe pain) . Postoperative abdominal pain was assessed with visual analog scale (VAS) (0 = no pain, 100 = most severe pain) at 20 min after operation. Results The propofol injection pain occurred in 66% of patients. Postoperative VAS scores at rest and during activity and intravenous propofol injection-induced pain were significantly correlated (r = 0.561, P<0.01; r = 0.608, P<0.01). The sensitivity and specificity of iv propofol injection-induced pain (VRS > 1) in predicting clinically significant acute postoperative pain (VAS > 30) were 96% and 52% respectively. Conclusion Preoperative iv propofol injection induced pain is a reliable factor in predicting acute postoperative pain and is useful in identifying those women who will experience greater pain after operation.