Ultrasonography in examining the position of gastric tube in patients undergoing gastrectomy / 中华全科医师杂志

Thirty patients with gastric cancer,ASA Ⅱ or Ⅲ,scheduled for selective radical gastrectomy under tracheal intubation general anesthesia in Zhejiang Provincial People's Hospital from November 2016 to February 2017 were enrolled in the study.The gastric tubes were placed by a nurse before operation.The position of gastric tube was judged under gastric ultrasonography by a sonographer and anesthesiologist respectively;and confirmed by the surgeon during the operation.With the position judged by the surgeon as gold standard,the sensitivity,specificity,positive predictive value,negative predictive value of the judgment of ultrasonographer were 96％,80％,96％,50％,respectively with the Kappa value 0.760 of (P ＜0.001),those of the judgment of anesthesiologist were 92％,40％,92％ and 60％,respectively with a Kappa value of 0.280 (P =0.125);those of the judgment of nurse were 92％,0％,100％ and 71.4％,with a Kappa value of-0.105 (P =0.513).The results suggest that ultrasound examination is a simple,reliable and sensitive method for confirming correct gastric tube placement.

Risk factors for perioperative acute kidney injury in adult cardiac valve surgery with cardiopulmonary bypass / 临床麻醉学杂志

Objective To investigate the risk factors of acute kidney injury (AKI) in patients undergoing cardiac valve surgery with cardiopulmonary bypass (CPB).Methods A retrospective cohort database study was conducted, involving 1 349 patients undergoing heart valve surgery with CPB technique.Logistic regression was used to screen out the risk factors of AKI after the surgery.Results Of the 1 349 patients, the incidence of AKI in valve surgery was 28.4%.One year older (OR=1.05, 95%CI 1.03-1.06, P<0.001), diabetes (OR=2.11, 95%CI 1.22-3.68, P=0.008), anemia (OR=1.50, 95%CI 1.05-2.21, P=0.026), each additional basic serum creatinine of 1 mg/dl (OR=1.01, 95%CI 1.01-1.02, P=0.001), each additional operation time of 1 hour (OR=1.28, 95%CI 1.15-1.41, P<0.001), plasma transfusion during surgery (OR=1.50, 95%CI 1.14-1.97, P=0.004) were the independent risk factors for AKI in multivariate logistic regression model.Conclusion AKI is a common and serious complication following cardiac valve surgery.More attention should be paid to the patients with elder age, anemia, prolonged operation time, diabetes, increased basic serum creatinine and requirement of plasma transfusion during surgery.

Effect of dexmedetomidine on prognosis after cardiac surgery with cardiopulmonary bypass / 中华麻醉学杂志

To evaluate the effect of dexmedetomidine on prognosis after cardiac surgery with cardiopulmonary bypass (CPB) in the patients.For this retrospective study,753 patients of both sexes,aged 18-84 yr,who underwent cardiac surgery with CPB from September 2013 to May 2015,were divided into 2 groups depending on whether or not dexmedetomidine was used during surgical procedures:control group (group C,n=548) and dexmedetomidine group (group D,n =205).Propensity score matching analysis with preset caliper width was used.A total of 197 matched pairs were selected from the patients.The development of postoperative arrhythmia,in-hospital mortality,pulmonary infection after operation,and acute renal injury,length of intensive care unit stay,length of hospital stay and 30-day readmission to the hospital were collected.Compared with group C,the incidence of postoperative tachyarrhythmia and inhospital mortality rate were significantly decreased (P＜0.05),and no significant changes were found in the incidence of postoperative bradyarrhythmia,pulmonary infection after operation and postoperative acute renal injury,length of intensive care unit stay,length of hospital stay and rate of 30-day readmission to the hospital in group D (P＞0.05).Dexmedetomidine can effectively improve prognosis after cardiac surgery with CPB in the patients.

Efficacy of ultrasound for placement of laryngeal mask airway in adult patients: a comparison with fiberoptic bronchoscopy / 中华麻醉学杂志

Objective To evaluate the efficacy of ultrasound for placement of laryngeal mask airway (LMA) in comparison with fiberoptic bronchoscope in adult patients.Methods Fifty-eight ASA physical status Ⅰ or Ⅱ patients,aged 18-57 yr,weighing 50-70 kg,with body mass index 20-30 kg/m2,scheduled for gynecological operation under general anesthesia,underwent standard general anesthetic technique with 4 # LMA-ClassicTM.After clinical assessment of correct placement of LMA,the position of the LMA was confirmed by transverse neck ultrasound,and reconfirmed using fiberoptic bronchoscopy.The peak airway pressure and oropharyngeal leak pressure were recorded.Results When the outcome of clinical assessment of correct placement of LMA was considered as satisfactory,the rate of ideal anatomic placement assessed by ultrasound evaluation was 69 %,and the rate of ideal anatomic placement assessed by fiberoptic bronchoscopy was 59 %,and it showed that there was no significant difference in detecting the ideal placement of the LMA (P ＞ 0.05).The oropharyngeal leak pressure was significantly higher when ultrasound was used for confirmation of the correct placement of LMA than that when fiberoptic bronchoscope was used (P ＜ 0.05).Conclusion Ultrasound provides better efficacy for placement of LMA in indicating sealing of LMA than fiberoptic bronchoscope and is helpful in improving ventilation conditions in adult patients.