Effect of intraoperative wake-up test on postoperative delirium in patients undergoing scoliosis surgery under analgesia with sufentanil / 中华麻醉学杂志

Objective To investigate the effect of the intraoperative wake-up test on the postoperative delirium in patients undergoing scoliosis operation under analgesia with sufentanil. Methods Sixty ASA Ⅰ or Ⅱ patients , aged 12-60 yr, scheduled for scoliosis surgery, were randomly divided into 2 groups ( n = 30 each) : control group (group C) and intraoperative wake-up test group (group W) . The intraoperative wake-up test was not performed during operation in group C. Anesthesia was induced with target-controlled infusion of sufentanil with the target effect-site concentration set at 0.5 ng/ml and iv injection of propofol 1-2 nig/kg. As soon as the patients lost consciousness, tracheal intubation was facilitated with 0.15 mg/kg cisatracurium besylate. The patients were mechanically ventilated. Anesthesia was maintained with target-controlled inhalation of sevoflurane (target end-tidal concentration 0. 8%-1. 5%), target-controlled infusion of sufentanil (target effect-site concentration 0.2-0.3 ng/ml) and iv infusion of cisatracurium besylate 0.1 mg- kg-1·h-1 . In group W, the patients underwent the intraoperative wake-up test. Postoperative analgesia was provided with sufentanil. The occurrence of intraoperative awareness and postoperative delirium was recorded. Results No significant difference was found in the incidences of intraoperative awareness and postoperative delirium between the two groups. Conclusion The intraoperative wake-up test is not the risk factor for postoperative delirium in patients undergoing scoliosis surgery under analgesia with sufentanil, and inhibition of perioperative pain and intraoperative awareness by analgesia with sufentanil may be involved in the mechanism.

Clinical research of low resection of rectal carcinoma in pull-through anus operation / 中国医师进修杂志

Objective To explore the value of low resection of rectal carcinoma in pull-through anus operation and its influence factor with rectal carcinoma distant metastases along intestine wall.Method Clinical pathological and visited data of 43 patients with rectal carcinoma were analyzed prospectively.Resuits Forty--one cases were successfully accepted resection in pull-through anus (95.3%).No patient suffered from stoma leak,3 cases appeared recurrence after operation.Compared between high differentiation patients and mid differentiation patients,there was no significant difference, while the difference of comparing between high or mid differentiation patients and low differentiation patients respectively,there was significant difference.The difference of comparison among Dukes stage A,B or C was significant.Conclusions The right length of incising distant intestine tube is more than 2.0,3.0,4.0 cm respectively for rectal careinoma of high,mid and low differentiation or that of Dukes stage A,B or C.low resection of rectal carcinoma in puB-through anus should be considered as a regular operation.

The hemodynamic and spinal cord protective effects of captopril during suprarenal aortic crossclamping in rabbits / 中华麻醉学杂志

Objective Crossclamping of aorta causes a sudden increase in systemic vascular resistance. Spinal cord may suffer ischemic injury during aortic aneurysm surgery. This study was designed to evaluate the hemodynamic and and spinal cord protective effects of captopril during suprarenal aortic crossclamping in rabbits.Methods Twenty-four albino rabbits were randomly divided into three groups :sham operation group (A),control group (B) and captopril group (C). The descending aorta was crossclamped above the level of renal artery for 30 min and then declamped.In group C a bolus of captopril 2 mg?kg -1 was given intravenously 10 min before crossclamping followed by a 0.5mg?kg -1?min -1 infusion for 30 min. The same volume of normal saline was given in other 2 groups. The carotid artery pressure(BP 1) and femoral artery pressure(BP 2) were recorded before injection, 5, 20,30min after crossclamping and 5,60,180min after declamping. Spinal cord was examined at the level of T 10 and L 3 for morphological changes and MDA content 180 min after declamping.Results 1. BP 1 increased significantly after crossclamping in group B. In group C there was no significant change in BP 1 after crossclamping. In group C there was no significant change in BP 1 after crossclamping. In group B BP after declamping was significantly lower than that before crossclamping. In group C BP at 60 and 180 min after declamping was significantly higher than that at the same intervals in group B(P