Study of infusion methods of postoperative enteral nutrition in patients with gastric cancer / 中国现代普通外科进展

Objective:To investigate the infusion methods of postoperative enteral nutrition in patients with gastric cancer.Methods:86 patients with gastric cancer received radical operationin our hospital from January 2014 and December 2015 were enrolled for the study and randomly divided into continuous infusion group and periodic infusion group,each group with 43 cases.Patients in continuous infusion group were given postoperative continuous enteral nutrition for 24 h in one day,while cases in periodic infusion group were given postoperative continuous enteral nutrition for 15-17 h in one day.Results of enteral nutrition,physical indicators including upper arm skinfold,diameter of midpoint of upper arm and grip strength,nutritional indexes including total protein (TP),hemoglobin (Hb),albumin (AIb),prealbumin (PA) and transferrin(TF),immune indicators including immunoglobulin G(IgG),immunoglobulin M (IgM),immunoglobulin A (IgA),CD4+,CD8+ and CD4+/CD8+were compared between two groups before and after operation.Results:Intolerance of enteral nutrition occurred in 1 case(2.3％) of continuous infusion group and 3 cases(7.0％) of periodic infusiongroup,and there was no significant difference between them (P＞0.05).Time of transition to full enteral nutrition and taking off the tube to self-feeding incontinuous infusion group were significantly smaller than that in periodic infusion group (P＜0.05).There were no significant difference in baseline data,physical indicators,nutritional indexes and immune indicators between them before operation (P＞0.05).PA level at 5 d,10 d after operation in continuous infusion group were significantly higher than that in periodic infusion group (P＜0.05),and there were no significant difference in physical indicators,other nutritional indexes and immune indicators between them after operation(P＞0.05).Conclusion:Compared with periodic infusion,continuous infusion method could shorten the time of transition to full enteral nutrition and taking off the tube to self-feeding in patients after radical operation of gastric cancer,and had more significant effect of improvement of nutritional status,worthy of clinical popularization and application.

Comparison of intermittent versus continuous interscalene brachial plexus block for postoperative analgesia

BACKGROUND: Interscalene brachial plexus block (IBPB) is an effective method of postoperative analgesia after shoulder surgery. This study evaluates the effects and complications of IBPB with two different infusion methods (using intermittent bolus infusion versus automated continuous infusion). METHODS: Thirty six patients who were scheduled for shoulder surgery were randomly assigned into two groups (the continuous vs. intermittent groups). All the patients received preoperative IBPB using 15 ml of 0.25% ropivacaine followed by insertion of a 20 gauge catheter. This catheter was connected to a patient controlled analgesia (PCA) pump after the operation. The intermittent group (n = 18) received IBPB with 0.2% ropivacaine 100 ml (bolus 15 ml, lock time 4 h) without basal infusion. The continuous group (n = 18) received IBPB with 0.2% ropivacaine 100 ml (basal rate 4 ml/h) without bolus injection. All the patients were given meperidine 25 mg when the postoperative visual analogue score (VAS) >40 mm. The VAS, heart rate, noninvasive blood pressure, respiratory rate, consumption of meperidine and complications were measured during the 64 h following surgery at intervals of 8 h. RESULTS: The VAS was higher in the intermittent group than that in the continuous group at 24 h after surgery (P < 0.01).However, there was no significant difference for the VAS between the groups for the other assessment periods.There was no significant difference for the amount of meperidine consumed and the incidence of complications between the groups. CONCLUSIONS: Intermittent IBPB's analgesic effects and complications for treating pain after shoulder surgery are similar to those of continuous IBPB. Therefore, intermittent IBPB could be used for the management of pain after shoulder surgery.

Drip infusion method as a useful indicator for identification of the epidural space / 대한마취과학회지

BACKGROUND: Cervical epidural anesthesia (CEA) is used for pain control and surgical procedures of the head and neck or upper arm areas. However, the failure rate of CEA is reported to be high, is the failure rate being quite higher than other sites, because of the anatomical differences of the cervical spine. We hypothesized that the loss of resistance (LOR) method combined with the drip infusion method for confirmation of the cervical epidural space can reduce the failure rate. This study investigated the usefulness of the drip infusion method. METHODS: One hundred chronic renal failure patients undergoing arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. In the cervical epidural puncture, we identified the cervical epidural space using a combination of the LOR method with the drip infusion method. After confirmation of the epidural space with LOR method, we decided it was the true epidural space when fluid dripping to the space was present. Otherwise, if fluid dripping was not present, we designated it was pseudo LOR, and we found the true epidural space using the drip infusion method only. RESULTS: In all cases, the combined LOR with drip infusion method, identify the epidural space. CONCLUSIONS: Combined LOR with drip infusion method is an efficacious method for the confirmation of the cervical epidural space.

Comparison of Methods to Confirm the Cervical Epidural Space

BACKGROUND: The loss of resistance (LOR) method is most commonly used to identify the epidural space. This method is thought to rely on the penetration of the ligamentum flavum. Unfortunately the exact morphology of the ligamentum flavum is variable at different vertebral levels. Especially, it has been pointed out that the lower cervical ligamentum flavum may be discontinuous in the midline in up to 50% of patients. Thus, the LOR method may be inaccurate to confirm the cervical epidural space. The aim of this study is to determine which method is the safest and most exact for confirming the cervical epidural space. METHODS: 100 adult, chronic renal failure patients who were undergoing an arteriovenous bridge graft for hemodialysis at the upper arm under cervical epidural anesthesia were recruited for this study. During the cervical epidural puncture, we identified the cervical epidural space by subjectively feeling the resistance with using a finger just through the ligamentum flavum, and we also used the drip infusion method, the loss of resistance method using air, and the hanging drop method. By using 5 grades, we classified the extent of whether or not the techniques were effective. RESULTS: Using the drip infusion method, we identify the epidural space in all the patients as +/++ grade. The catheter insertion method was also successful in identifying those epidural spaces over a +/- grade. The pseudo LOR was over micro grade in 47 patients. CONCLUSIONS: The combined LOR/hanging drop with drip infusion method is useful for confirming the cervical epidural space.

The Effect of Increased Dilution Volume and Prolonged Infusion Time of Vancomycin on Incidence of Adverse Reactions through Peripheral Venous Cannulae / 성인간호학회지

The purpose of the study was to explore the effect of 2 hour infusion of vancomycin(1g) in 200ml of isotonic saline every 12 hour on the frequency of "red man syndrome", phlebitis and length of peripheral catheter placement of infected patients, in order to provide safe infusion method for reducing vancomycin-induced RMS and phlebitis. The subjects of the study consisted of 16 hospitalized patients; 3 oncology and gastro-intestinal patients, 1 neurological patient, 6 thoracic surgical patients and 6 orthopedic patients, who had received vancomycin from July to October in 1999 at S-hospital. The dependent variables were the incidence of RMS, phlebitis and the length of peripheral catheter placement. The incidence of RMS was checked by an inspector at the first night whenever the infusion method of vancomycin was changed. RMS was observed every 15 minutes during an hour for symptoms of RMS such as itching, erythema, chest pain and systolic blood pressure. Incidence of phlebitis was assessed by inspector twice a day from the insertion of peripheral catheter to the removal of the catheter. The data were analyzed by percentage, mean, X2-test, t-test, repeated ANOVA, and logistic regression analysis using the SPSSWIN program. The results are summarized as follows; 1. No significant difference was identified in frequency of RMS between the experimental group and control group. 2. There was no significant difference in the change of systolic blood pressure as the time goes on between the experimental group and control group. 3. The incidence of phlebitis was significantly lower in the experimental group than in the control group. 4. The length of peripheral catheter placement was significantly longer in the experimental group than in the control group. 5. Other drugs administrated with vancomycin didn't influence the occurrence of phlebitis. However, the infusion method of vancomycin influenced the occurrence of phlebitis. The results suggest that 2 hour infusion of vancomycin(1g) in 200ml of isotonic saline every 12 hours may decrease the incidence of phlebitis and increase the length of peripheral catheter placement compared to 1 hour infusion of vancomycin(1g) in 100ml of isotonic saline every 12 hours. However, it does not reduce the incidence of RMS.

Comparison of Graded and Bolus Infusion Methods in Baroreflex Measurements in Rabbits

Graded infusion and bolus injection methods of vasoactive drugs have both been used to measure baroreflex sensitivity. To determine whether the two methods produce the same values of baroreceptor sensitivity, phenylephrine and nitroglycerin was administered intravenously by both graded infusion and bolus injection methods to 11 rabbits. To evaluate the baroreflex control of heart rate(HR), a logistic sigmoid function model was used. The range of HR and baroreflex gain by the bolus method(100.53+/-0.62, 0.113+/-0.011) were significantly(p<0.05) larger than those measured by the graded infusion method(108.49+/-1.66, 0.126+/-0.013). However, there were no significant changes in the pressure at the midrange of the baroreflex curve. Thus my results indicate that baroreflex control of HR by the graded infusion and bolus injection methods is not equivalent and that baroreflex-induced HR response to a gradual change in pressure is less than that seen with a repid change.