Expert Recommendations for Tracheal Intubation in Critically ill Patients with Noval Coronavirus Disease 2019 / 中国医学科学杂志(英文版)

Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus (SARS-CoV-2), is a highly contagious disease. It firstly appeared in Wuhan, Hubei province of China in December 2019. During the next two months, it moved rapidly throughout China and spread to multiple countries through infected persons travelling by air. Most of the infected patients have mild symptoms including fever, fatigue and cough. But in severe cases, patients can progress rapidly and develop to the acute respiratory distress syndrome, septic shock, metabolic acidosis and coagulopathy. The new coronavirus was reported to spread via droplets, contact and natural aerosols from human-to-human. Therefore, high-risk aerosol-producing procedures such as endotracheal intubation may put the anesthesiologists at high risk of nosocomial infections. In fact, SARS-CoV-2 infection of anesthesiologists after endotracheal intubation for confirmed COVID-19 patients have been reported in hospitals in Wuhan. The expert panel of airway management in Chinese Society of Anaesthesiology has deliberated and drafted this recommendation, by which we hope to guide the performance of endotracheal intubation by frontline anesthesiologists and critical care physicians. During the airway management, enhanced droplet/airborne PPE should be applied to the health care providers. A good airway assessment before airway intervention is of vital importance. For patients with normal airway, awake intubation should be avoided and modified rapid sequence induction is strongly recommended. Sufficient muscle relaxant should be assured before intubation. For patients with difficult airway, good preparation of airway devices and detailed intubation plans should be made.

Protective effect of melatonin on reexpansion pulmonary edema in rats model / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Rapid reexpansion of collapsed lungs leads to reexpansion pulmonary edema (RPE). We aimed to investigate the effect of melatonin in the prevention of RPE formation.</p><p><b>METHODS</b>We used a Wistar rat model in which the left lung was collapsed by ligating the left bronchus for 48 hours and then reexpanded and ventilated for an additional 2 hours. Thirty minutes before reexpansion, we injected melatonin (10 mg/kg) or vehicle intraperitoneally. We compared the wet/dry ratio, oxygenation index, myeloperoxidase (MPO) activity, nitric oxide (NO), malondialdehyde (MDA) and interleukin 8 (IL-8) levels in the reexpanded lungs between untreated and treated animals.</p><p><b>RESULTS</b>We found that the wet/dry ratio of the melatonin group was significantly lower than that of the vehicle group, and the oxygenation index was higher in the melatonin group. Compared with the control, melatonin pretreatment significantly decreased the activities of IL-8, NO, MDA levels and MPO in lung tissues. Histopathology of reexpanded lungs showed that the melatonin pretreatment group had less pulmonary edema and less inflammatory cell infiltration.</p><p><b>CONCLUSION</b>Melatonin decreases pulmonary edema and improves oxygenation after reexpansion by attenuating oxidative stress and inhibiting pro-inflammatory cytokines.</p>

Anesthesia allows a step forward in endoscopic treatment for gastrointestinal diseases / 中华胃肠外科杂志

Over the past 10 years, endoscopic diagnosis and treatment of gastrointestinal disesses has become one of the most commonly performed invasive procedures in China. Recently, China is considered the international leader in some new endoscopic technologies. In this paper, we discuss anesthesia support for new endoscopic technologies, including endoscopic submucosal dissection (ESD) and peroral endoscopic myotomy (POEM), in terms of selection such as operative procedure, complications, preoperative evaluation, anesthesia management, and intraoperative monitoring.

Predictive value of N-terminal pro-brain natriuretic peptide in combination with the sequential organ failure assessment score in sepsis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prognostic power of n-terminal pro-brain natriuretic peptide (NT-proBNP) in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment (SOFA) score in sepsis.</p><p><b>METHODS</b>In this retrospective study, 100 consecutive sepsis patients were enrolled. Clinical data such as admission SOFA, the Acute Physiologic and Chronic Health Evaluation score, shock prevalence, use of lung protective ventilation, vasopressors, and glucocorticoids were recorded. Additionally, serum creatinine (Scr1 and Scr3) and NT-proBNP (NT-proBNP1 and NT-proBNP3) were assayed and evaluated at admission and on day 3 respectively.</p><p><b>RESULTS</b>DNT-proBNP (NT-proBNP3 minus NT-proBNP1) (P < 0.001, Hazard ratio (HR) = 1.245, 95% confidence interval (CI), 1.137 - 1.362) and admission SOFA (P < 0.001, HR = 1.197, 95%CI, 1.106 - 1.295) were independently related to in-hospital mortality. Their combination was a more robust predictor for in-hospital mortality than either of them individually. Patients with high DNT-proBNP and SOFA had the poorest prognosis.</p><p><b>CONCLUSIONS</b>In our study, both DNT-proBNP and SOFA were independent predictors of septic patients' prognosis. Moreover, the combination of DNT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity.</p>

Application of enhanced recovery program after surgery(ERAS) in patients undergoing radical resection for colorectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the enhanced recovery program after surgery (ERAS) with conventional perioperative management in patients undergoing radical resection for colorectal cancer.</p><p><b>METHODS</b>The ERAS protocol included a combination of evidence-based and consensus methodology. A total of 597 consecutive patients undergoing elective colorectal resection were randomized to either the ERAS(n=299) or the control group(n=298). Outcomes related to nutrition and metabolism index, stress index, and recovery index were measured and recorded.</p><p><b>RESULTS</b>Demographics and operative parameters were similar between the two groups(P>0.05). The nutritional status of patients in the ERAS group was improved after surgery compared with that of the control group. On postoperative day (POD) 1, the HOMA-IR in the ERAS group was significantly lower than that in the control group(P<0.01). The cortisol level in the control group was elevated on both POD 1(P<0.01) and POD 5(P<0.01) compared to the preoperative level. However, the cortisol level was not increased until POD 5(P<0.01) in the ERAS group. The levels of TNF-α, IL-1β, IL-6, and IFN-γ were reduced in the ERAS group, indicating less postoperative stress responses compared with the control group. In addition, ERAS group was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay [(5.7±1.6) d vs. (6.6±2.4) d, P<0.01] and expense[(15 998±2655) RMB vs. (17 763±3059) RMB, P<0.01] were reduced in the ERAS group. Twenty-eight patients(9.4%) in the control group and 29(9.7%) in the ERAS group developed complications, while the difference was not statistically significant(P>0.05).</p><p><b>CONCLUSION</b>ERAS protocol alleviates surgical stress response and accelerates postoperative recovery without compromising patient safety.</p>

Application of the protocol of enhanced recovery after surgery in colorectal surgery / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate enhanced recovery after surgery(ERAS) protocol in colorectal surgery.</p><p><b>METHODS</b>From september 2006 to February 2007, 74 patients with colorectal cancer were randomly assigned to ERAS group and control group. The stress index, nutrition and metabolism index, intraoperative index and postoperative index were evaluated.</p><p><b>RESULTS</b>Six patients were excluded, 3 in ERAS group (2 cases received hepatectomy concomitantly and 1 case received partial ileum resection), and 3 in control group (1 case received hepatectomy and 1 case received colorectomy concomitantly, another presented asthma paroxysm). So there were 34 cases in ERAS group and 34 cases in control, with no statistical differences in sex, age, BMI index and operation types. Deviation of HOMA-IR index of ERAS was lower than the control (P>0.05), the same as plasma cortisol at the 1st day after operation (P<0.05), but plasma glucagons in the operation of ERAS group was higher than that of control (P<0.05). Plasma glucose 1st day after operation of ERAS group was lower than control (P<0.05), while plasma triglyceride intraoperation, at 1st day, 2nd day after operation of ERAS was higher than control (P<0.05). Nitrogen negative balance of ERAS group was higher than control at 2nd day after surgery, but is lower intraoperation and at 6th day after operation (P<0.05). The time of exhaust gas and stool, time to eat fluidity and semi-fluidity, out-of-bed time and exercise time per-day, residual time and complication rate in ERAS group were better than those of control (P<0.05). Post-operative expenses of ERAS was lower than that of control (P<0.05).</p><p><b>CONCLUSION</b>ERAS can decrease surgical stress, increase functional recovery and reduce complication rate.</p>

Clinical study on effect of electro-acupuncture combined with different anesthetics on auditory-evoked potential index / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the effect of electro-acupuncture (EA) on auto regressive with exogenous input model (ARX-model) auditory evoked index (AAI) in patients anesthetized with different anesthetics.</p><p><b>METHODS</b>Forty-eight adult patients undergoing scheduled surgical operation were enrolled and divided into two groups (24 in each group) according to the anesthetics applied, Group A was anesthetized with propofol sedation and Group B with Isoflurane-epidural anesthesia. Group A was subdivided into three groups of low, middle and high concentration of target effect-site of 1.0 microg/ml, 1.5 microg/ml and 2.0 microg/ml through target controlled infusion (TCI) and Group B into 3 subgroups of minimum alveolar effective concentration of isoflurane (0.4 MAC, 0.6 MAC and 0.8 MAC for B1, B2 and B3 subgroups) respectively, with 8 patients in every subgroup. EA on acupoints of Hegu (LI4) and Neiguan (P6) was applied on all the patients during anesthesia, and the change of AAI at various time points was recorded.</p><p><b>RESULTS</b>In the three subgroups of Group A, levels of AAI were significantly elevated in the first few minutes after EA, and significantly lowered 20 min after EA in subgroup A2. While in the subgroups of Group B, except the elevating in Group B1 1-2 min after EA, levels of AAI remained unchanged at other time points.</p><p><b>CONCLUSION</b>Pain response could be reflected by AAI during EA. EA could enhance the sedative effect of propofol in middle concentration, but its effect on isoflurane epidural anesthesia is insignificant.</p>

Application of lornoxicam to patient-controlled analgesia in patients undergoing abdominal surgeries / 中国医学科学杂志(英文版)

<p><b>OBJECTIVE</b>To assess the efficacy and safety of lornoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patient-controlled analgesia (PCA) in patients undergoing abdominal surgeries.</p><p><b>METHODS</b>Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lornoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period.</p><p><b>RESULTS</b>The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058, respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05).</p><p><b>CONCLUSION</b>In clinic, we can use lornoxicam to treat postoperative pain effectively and with less adverse reactions compared with fentanyl.</p>

Effect of midazolam pretreatment on propofol sedation by closed-loop TCI during epidural anesthesia / 中华麻醉学杂志

Objective To compare the effect of midazolam pretreatment on propofol sedation using closed-loop target-controlled infusion (TCI) between two age groups - the adult and the aged. Methods Forty-eight ASA Ⅰ-Ⅱ patients of both sexes weighing 45-81 kg undergoing elective lower abdominal or lower extremity operation under epidural anesthesia were divided into two age groups : (A) the adult group (18-39 yrs) and (B) the aged group (66-79 yrs). The two groups were further divided randomly into 2 subgroups : midazolam subgroup ( n=12) received midazolam 0.04 mg?kg-1 10 min before propofol TCI and placebo subgroup ( n = 12) received normal saline instead of midazolam 10 min before propofol TCI. The patients were unpremedicated. An intravenous line was established before operation, which was connected to a TCI system comprising a Graseby 3500 infusion pump and a closed-loop TCI automatic control system. BP, HR, SpO2 and BIS were continuously monitored during operation. During epidural anesthesia the patients were sedated with propofol administered by TCI. The initial target blood concentration of propofol was set at 1.5?g?ml-1 . The level of sedation was assessed by OAA/S scale (5 = alert,0 = no response to prodding). The target blood propofol concentration was then increased or decreased in 0.5?g?ml-1 increment to maintain OAA/S score at 3. The BIS value at this level of sedation (OAA/S=3) was used as feedback in controlling TCI of propofol. The induction dose and the total dose of propofol, induction time and emergence time (OAA/S=5) were recorded. Results Midazolam premeditation significantly reduced the induction dose and total dose of propofol, shorten the induction time and prolonged the emergence time compared with placebo in both groups, especially in the aged group (P