ABSTRACT
BACKGROUND: Mechanical ventilation during general anesthesia may impair airway mucosal function. This study aimed to investigate the effect of pressure-controlled ventilation-volume guaranteed (PCV-VG) on bronchial mucus transport velocity (BTV) in patients during laparoscopic surgery for gynecological oncology compared with volume controlled ventilation (VCV). METHODS: 66 patients undergoing elective a laparoscopic surgery for gynecological oncology. The patients were randomized into two group receiving either PCV-VG or VCV. a drop of methylene blue was placed on the surface of the airway mucosa under the bronchoscopeand, then the distance the dye movement was measured after 2, 4, and 6 min. Outcomes were assessed at T0 (5 min after endotracheal intubation and before initiation of pneumoperitoneum), T1 and T2 (1 and 2 h after stabilization of pneumoperitoneum respectively). BTV at T0, T1 and T2 was the primary outcome. Secondary outcomes included heart rate (HR), mean arterial pressure (MAP), body temperature, end-tidal CO2 pressure (PETCO2), tidal volume(VT), peak inspiratory pressure (PIP), mean inspiratory pressure (Pmean), respiratory rate (RR), and dynamic compliance (CDyn) at T0, T1, and T2. RESULTS: 64 patients were included in the analysis. The median [interquartile range] BTV was significantly lower in VCV group at T1 and T2 that at T0 (P < 0.05). Furthermore, BTV was slightly reduced in PCV-VG compared with VCV. BTV in PCV-VG was significantly decreased at T2 compared with BTV at T0 (P < 0.05) and slightly decreased at T1 compared with T0(P > 0.05). Compared with the PCV-VG group, BTV in VCV group significantly decreased at T2 (P < 0.05). No participants experienced respiratory complications. CONCLUSIONS: PCV-VG is more suitable for patients undergoing laparoscopic surgery for gynecological oncology than VCV since it can protect mucociliary clearance function. TRIAL REGISTRATION: This trial is registered on https://www.chictr.org.cn/ in Chinese Clinical Trial Registry (ChiCTR.2200064564: Date of registration 11/10/2022).
Subject(s)
Laparoscopy , Pneumoperitoneum , Humans , Respiration, Artificial , Tidal Volume , MucusABSTRACT
Objective: This study investigates the effect of the Pain Sensitivity Questionnaire (PSQ) in guiding patient controlled intravenous analgesia (PCIA) on postoperative analgesia in women undergoing cesarean section. Methods: A total of 160 women who were to undergo a cesarean section under combined spinal and epidural anaesthesia were included in this study. Women with a preoperative PSQ <4 were randomly divided into a low pain-sensitive control group (LC group), and a low pain-sensitive observation group (LO group), and women with preoperative PSQ >6 were randomly divided into a high pain-sensitive control group (HC group) and a high pain-sensitive observation group (HO group). After the surgery, patients received the pump butorphanol concentration was 3.5 µg·kg-1·h-1 in the LC and HC groups, 3.0 µg·kg-1·h-1 in the LO group and 4.0 µg·kg-1·h-1 in the HO group.To compare the analgesic effects of postoperative PCIA and postoperative recovery in women. Results: Wound pain and uterine contraction pain VAS scores at rest and activity were significantly lower in the LC group than in the LO group at 4 and 8 h postoperatively (P<0.05). Similarly, wound pain and uterine contraction pain VAS scores at rest and activity were significantly lower in the HO group than in the HC group at 8, 12, and 24 h postoperatively (P<0.05). The Ramsay scores were significantly higher in the LC than in the LO groups at 4, 8, 12, 24, and 48 h postoperatively (P<0.05), but there was no statistically significant difference between the Ramsay scores in the HC group and the HO group. There was no statistical difference in any of the post-operative recoveries (P>0.05). Conclusion: Compared to the weight-based postoperative PCIA, the PSQ-based postoperative PCIA has better analgesic effects and can improve maternal satisfaction with postoperative analgesia.
ABSTRACT
BACKGROUND: For the past few years, preventive interventional therapy has been widely used domestically and overseas, bringing great benefits to pregnant women at high-risk for complications, such as pernicious placenta previa (PPP) and placenta accreta. Nevertheless, there are still few reports on surgical complications related to interventional therapy, and its safety should be a concern. CASE SUMMARY: We report a 36-year-old pregnant woman with PPP who underwent balloon implantation in the lower segment of the abdominal aorta before caesarean section. However, the balloon shifted during the operation, which damaged the arterial vessels after filling, resulting in severe postpartum haemorrhage in the patient. Fortunately, after emergency interventional stent implantation, the patient was successfully relieved of the massive haemorrhage crisis. CONCLUSION: It seems that massive postoperative bleeding has been largely avoided in preventive interventional therapy in high-risk pregnant women with placenta-related diseases, but surgical complications related to intervention therapy can also cause adverse consequences. It is equally important for clinical doctors to learn how to promptly identify and effectively treat these rare complications.
ABSTRACT
DNA vaccination is useful for generating immune responses, particularly the cell-mediated immune response, in a wide variety of species. However, DNA vaccination generally induces only relatively weak responses; hence, various approaches have been developed recently in order to improve its efficacy or immunopotency. The use of a chemical adjuvant is one of them. Previously we have shown that Bupivacaine or Marcaine can modulate immune responses induced by DNA vaccines [Proc. Natl. Acad. Sci. 90 (1993) 4156]. Following that lead, we have recently tested several additional chemicals for their usefulness as adjuvants in DNA inoculation. Of a total of five chemicals tested, levamisole exhibited strongest Th1 stimulatory activity whereas Tween 80 showed weakest Th1 activity, as determined by IgG2a production, and saline formulation induced weak T cell proliferation and DTH, in animals inoculated with a DNA construct expressing the foot-mouth disease viral capsule protein VP1. Furthermore, co-inoculation of levamisole increased the production of IFN-gamma by more than 100-fold as compared to that by DNA inoculation formulated in saline. In contrast, a previously reported chemical adjuvant, bupivacaine, stimulated only modest levels of overall antibody production, with relatively low level of Ig2a. These results demonstrate the usefulness of various chemicals, particularly levamisole, for modulating the outcome of DNA vaccination, in both the intensity of the immune response and the polarity of such response (toward Th1).
