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BACKGROUND@#Patients with lung cancer are often accompanied by anxiety, which affects postoperative recovery. The aim of this study is to explore the effects of preoperative anxiety on early prognosis in patients after thoracoscopic lung cancer resection.@*METHODS@#A total of 100 patients undergoing thoracoscopic resection of lung cancer were divided into 2 groups by hospital anxiety and depression scale (HADS): 44 in anxiety group (anxiety score>8) and 56 in control group (anxiety score<8). The primary endpoint: length of postoperative hospital stay. The secondary endpoint: length of hospital stay, visual analogue scale (VAS), the incidence of nausea and vomiting as well as postoperative new arrhythmia and the consumption of postoperative analgesic and rescue antiemetic.@*RESULTS@#Compared with the control group, the length of postoperative hospital stay and hospital stay in the anxiety group were both significantly longer [(5.1±2.5) d vs (4.0±1.3) d, P<0.01; (10.9±4.0) d vs (9.1±4.1) d, P<0.05)], the VAS score and the incidence of nausea as well as arrhythmia were significantly increased [(4.7±1.9) vs (2.6±1.8), P<0.001; 40.9% vs 16.1%, P<0.01; 36.4% vs 20.7%, P<0.05], and the consumption of postoperative analgesic and rescue antiemetic were also significantly increased [(72.5±8.9) mL vs (68.2±9.4) mL, P<0.05; (2.1±2.9) mg vs (0.9±1.9) mg, P<0.05].@*CONCLUSIONS@#Preoperative anxiety can affect the early prognosis of patients after thoracoscopic lung cancer resection, prolong hospitalization time, increase the postoperative pain score and the incidence of postoperative nausea and new arrhythmia as well as the consumption of postoperative analgesic and rescue antiemetic.
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Objective To investigate the effect of transcutaneous electric acupoint stimulation (TEAS)of Hegu-Neiguan-Houxi-Zhigou for preventing postoperative nausea and vomiting (PONV) in patients undergoing thoracoscopic lobectomy.Methods Sixty-four ASA physical status Ⅰ-Ⅲ pa-tients,aged 18-75 years,scheduled for elective thoracoscopic lobectomy were enrolled.Patients were randomly allocated into two groups (n =32):TEAS group (group E)and sham TEAS group (group C).TEAS at Hegu,Neiguan,Houxi and Zhigou was applied to patients before,during and after sur-gery in group E.The frequency was 2/100 Hz and the intensity was 2 times the threshold of sensation before and after surgery,and 30 mA during surgery.While sham TEAS with the intensity of sensory threshold was given to patients before and after surgery in group C.Patients in both groups received sufentanil,propofol and rocuronium for induction of anesthesia.Target controlled infusion of propofol and remifentanil was administered for maintenance of anesthesia.Patient-controlled intravenous anal-gesia (PCIA)was applied in both groups.No antiemetic was given to patients before and during sur-gery.Frequency of nausea or vomiting and any use of antiemetic for remediation were recorded after surgery.The postoperative Visual Analogue Scale (VAS)score and analgesic dosage were also docu-mented.Results Compared to group C,the incidence of nausea immediately after surgery,6 h after surgery,24 h after surgery and 48 h after surgery were significantly lower in group E.The incidence of vomiting 24 h after surgery was significantly lower in group E.The VAS score 6h and 24 h after surgery were significantly lower in group E.The analgesic dosage 48 h after surgery were reduced in group E.There were no significant differences regarding the use of antiemetic for remediation between the two groups.Conclusion TEAS at Hegu-Neiguan-Houxi-Zhigou is effective for preventing PONV in patients undergoing thoracoscopic lobectomy.
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Objective To compare the risk of tumor invasion and metastasis under paravertebral block (PVB) combined with general anesthesia versus general anesthesia in the patients undergoing radical resection for lung cancer performed via video-assisted thoracoscope in terms of plasma concentrations of vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9).Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 30-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective radical resection for lung cancer performed via video-assisted thoracoscope,were randomly divided into 2 groups (n =20 each) using a random number table:general anesthesia group (group G) and PVB combined with general anesthesia (group PG).PVB of T4-7 was performed successfully with local injection of 0.375％ ropivacaine 5 ml before induction of anesthesia.Double-lumen endotracheal tube was placed after induction of anesthesia,and the patients were mechanically ventilated.Anesthesia was maintained with inhalation of sevoflurane (end-tidal concentration 1％-2％),and intravenous infusion of remifentanil 0.2-0.3 μg · kg-1 · min-1,and intermittent intravenous boluses of atracurium.Before anesthesia and at 24 h after surgery,the venous blood samples were collected for measurement of plasma concentrations of VEGF and MMP-9.Results The plasma VEGF and MMP-9 concentrations were significantly lower after surgery in group PG than in group G.Conclusion PVB combined with general anesthesia significantly decreases the risk of tumor invasion and metastasis in the patients undergoing radical lung cancer resection performed via video-assisted thoracoscope in comparison to general anesthesia.
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Objective To compare the efficacy of oxycodone versus sufentanil for intravenous analgesia after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope.Methods One hundred fifty-four patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg/m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective radical resection of pulmonary carcinoma performed via video-assisted thoracoscope, were randomly divided into either sufentanil group (group S, n=76) or oxycodone group (group O, n =78) using a random number table.The 2 groups received combined intravenous-inhalational anesthesia.When postoperative visual analogue scale (VAS) score ≥ 4, sufentanil 5 μg or oxycodone 2 mg was injected intravenously, and the administration was repeated when necessary until VAS score ≤ 3.Patient-controlled intravenous analgesia (PCIA) was then used for postoperative analgesia (lasting for 48 h).PCIA solution contained tropisetron 20 mg and sufentanil 200 μg in 100 ml of normal saline in group S.PCIA solution contained tropisetron 20 mg and oxycodone 50 mg in 100 ml of normal saline in group O.The PCIA pump was set up to deliver a 2 ml bolus dose with a 10 min lockout interval and background infusion at a rate of 1 ml/h.VAS score was maintained ≤3.When VAS scores ≥4, morphine 10 mg injected intramuscularly was used as rescue analgesic.The requirement for rescue analgesic, level of patient's satisfaction with analgesia,and analgesia-related adverse events were recorded.Results The incidence of nausea and vomiting was significantly lower in group O than in group S (P＜0.05).There was no significant difference in the requirement for rescue analgesic, level of patient's satisfaction, and incidence of dizziness and over-sedation between the two groups (P＞0.05).No patients developed respiratory depression and pruritus in the two groups.Conclusion Compared with sufentanil, oxycodone can produce similar analgesic efficacy when used for PCIA after radical resection of pulmonary carcinoma performed via video-assisted thoracoscope, with lower incidence of nausea and vomiting.
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BACKGROUND: Based on previous technique prepared for encapsulating living cells with alginate-polysine- alginate (APA) microcapsules, it has been confirmed that microencapsulated chromaffin cells have good analgesic effects. The immunoisolated effects of such microcapsule materials need to be evaluated. OBJECTIVE: This study aimed to investigate the immunological rejections of APA microencapsulated chromaffin cells transplanted into rat anterior chamber of eyes and tendon of feet, and to evaluate the immunoisolated effect of microencapsulation.DESIGN: A randomized controlled animal experiment. SETTING: Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology.MATERIALS: Forty-eight female SD rats, with the age of 3 months, were provided by the Laboratory Animal Center, Tongji Medical College, Huazhong University of Science and Technology. The protocol was carried out in accordance with ethical guidelines for the use and care of animals. Alginate and polylysine used in the experiment were the products of Sigma Company, USA. Microcapsule generator was gifted by Germany. METHODS: This study was performed at the Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology from September 2002 to September 2003. Suprarenal medulla was taken from 6 healthy adult cadavers of brain death. After isolated, digested and cultured, suprarenal medulla was prepared into chromaffin cell suspension. Written informed consents were obtained from the family members of donors, and the protocol was given approval by the Ethics Committee of the hospital. Empty microcapsules and microencapsulated cells were prepared by APA. The 48 rats were randomly divided into the human chromaffin cell (HCC) group, the empty microcapsule group and the microencapsulated HCC (ME-HCC) group. In each group, there were two transplanted regions of anterior chamber of eyes and tendon of feet, with 8 rats used for each region. Each rat in the HCC group was perfused 2×1010 L-1 cell suspension into the anterior chamber of eyes and tendon of feet. Those in the empty microcapsule group and the ME-HCC group were perfused 100 empty capsules and ME-HCCs (100 microcapsules, 400-500 HCCs per microcapsule) into the same regions, respectively. MAIN OUTCOME MEASURES: On day 7 after transplantation, serum interleukin (IL)-2 level was determined by ELISA. Serum IgG and IgM levels were determined with a laser turbidimeter. On day 28 after transplantation, rat right eyeball and left feet were harvested, routinely sliced and stained by haematoxylin-eosin (HE). Histo-morphological structure was observed under a 40×light microscope. RESULTS: Forty-eight rats were included in the final analysis. Serum IL-2, IgG and IgM levels were significantly lower in the empty microcapsule group and ME-HCC group than in the HCC group (t=8.544-21.64, P < 0.01). A lot of lymphocyte and neutrophile infiltration could be found in the anterior chamber of eyes and tendon of feet of rats in the HCC group, but a little seen in that of the empty microcapsule group and ME-HCC group. CONCLUSION: APA microencapsulation has an effective immunoisolated effect on immunological rejection due to its good biocompatibility and mechanical stability.
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Objective To investigate the effects of mediastinal block(MB)on coronary atherogenesis and hemodynamics in rabbits with hyperlipoidemia.Methods Forty-eight male New Zealand white rabbits were randomly divided into 4 groups(n=12 each):control group received normal diet 150 g/d for 16 weeks,hypercholesterol group received hypercholesterol diet 150 g/d for 16 weeks,thoracic epidurial block(TEB)group received hypercholesterol diet 150 g/d for 16 weeks and TEB was performed from 13th to 16th week with 2% lidocaine 2 mg/kg twice a day,and MB group received hypercholesterol diet 150 g/d for 16 weeks and MB was performed from 13th to 16th week with 2% lidocaine 2 mg/kg twice a day.MAP was measured before and after 1st block was performed.The serum levels of total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C)were measured on 1st day,and on4th,6th,8th and 16th week during the experiment.At the end of 16 th week,all rabbits were killed by air embolism.Heart was removed and kept in 10% formalin for a week.The ventricles were transversely sectioned at the level of papillary muscle and slices from the cross section of the ventricles were obtained for determination of the degree of atherosclerosis by microscopy.Results MAP was decreased significandy after TEB in TEB group,while there was no significant changes in MAP after MB in MB group(P＜0.05).The serum levels of TC,TG and LDL-C were significandy higher in hypercholesterol.TEB and MB groups than in control group(P＜0.05 or 0.01).The ratios of atherogenesis and intimal thickening were significantly lower in TEB and MB groups than in hyperoholesterol group(P＜0.01),there was no significant difference between TEB and MB groups.Conclusion Mediastinal block can inhibit the development of coronary atherogenesis in rabbits with hyperlipoidemia to a great degree similar to that of thoracic epidural block,but has no effect on hemodynamics.
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Objective To investigate the immunoisolation effect of xenografts of microencapsulated human chromaffin cells (HCCs) .Methods HCCs were microencapsulated with APA microcapsules. Forty-eight SD rats were randomly divided into 3 groups ( n = 16 each) . HCCs (group I ) , empty APA microcapsules (group II ) and microencapsulated HCCs (group III ) were implanted into the anterior chamber of the eyes and the sole of the feet. Seven days after transplantation blood samples were collected for determination of serum IL-2, IgG and IgM concentration. The right eye-balls and left feet were obtained for microscopic examination. Results The serum IL-2, IgG and IgM concentrations were significantly lower in group II and group III than in group I ( P