Effects of different levels of stroke volume variation directed fluid therapy on short term of prognosis in elderly surgery patients / 中国医师进修杂志

Objective To observe the effects of different levels of stroke volume variation(SVV) directed fluid therapy on prognosis in elderly surgery patients. Methods One hundred and fifty-six patients (ASA gradeⅠorⅡ) having underwent abdominal surgery were selected, and the patients were divided into 3 groups according to the level of SVV with 52 cases each:low SVV group (SVV 3%-6%), middle SVV group (SVV 7% - 10%) and high SVV group (SVV 11% - 14%). Each group accepted different fluid therapy strategy. The intraoperative index, postoperative recovery index and complications were compared. Results The volume of crystalloid and volume of colloform in low SVV group and middle SVV group were significantly higher than those in high SVV group: (2 365 ± 517) and (2 080 ± 378) ml vs. (1 820 ± 579) ml, (1 105 ± 220) and (898 ± 239) ml vs. (559 ± 166) ml, and those in low SVV group were significantly higher than those in middle SVV group, and there were statistical differences (P<0.05). The urine volume in low SVV group was significantly higher than that in high SVV group:(717.4 ± 289.0) ml vs. (511.8 ± 326.3) ml, and there was statistical difference (P<0.05). The first exhaust time in high SVV group was significantly shorter than that in low SVV group:(81.2 ± 27.5) h vs. (98.9 ± 32.5) h, and there was statistical difference (P<0.05). The first level and above nursing time, postoperative hospital stay and total length of hospital stay in middle SVV group were significantly shorter than those in high SVV group and low SVV group: (4.4 ± 2.8) d vs. (5.3 ± 3.2) and (6.4 ± 3.7) d, (13.8 ± 5.2) d vs. (17.7 ± 8.4) and (19.5 ± 8.9 ) d, (22.7 ± 10.4) d vs. (26.8 ± 13.1) and (30.6 ± 10.3) d, and there were statistical differences (P<0.05). The incidence of stomal leak in high SVV group was significantly higher than that in low SVV group: 17.3% (9/52) vs. 3.8% (2/52), the incidences of postoperative infection in high SVV group and middle SVV group were significantly lower than that in low SVV group: 5.8% (3/52) and 5.8% (3/52) vs. 26.9% (14/52), and there was statistical difference (P<0.05). Conclusions The SVV 3% - 6% in elderly surgery patients may increase the risk of postoperative infection and prolong the time of hospitalization. But the SVV 7% - 10% may have a better postoperative recovery, and this level could be a better goal of perioperative fluid therapy in elderly surgery patients.

Evaluation on cardiac index measured with arterial pressure-based cardiac output and pulmonary artery catheter during cesarean section in parturients with congenital heart disease combined with severe pulmonary hypertension / 中国医师进修杂志

Objective To evaluate the concordance on cardiac index (CI) measured with arterial pressure based cardiac output (APCO) and pulmonary artery catheter (PAC) during cesarean section in parturients with congenital heart disease combined with severe pulmonary hypertension.Methods Forty-five congenital heart disease combined with severe pulmonary hypertension parturient who scheduled for cesarean section were selected,APCO and PAC were used for cardiac output and other parameters of hemodynamics monitoring during operation in all patients.Continuous epidural anesthesia was performed.CI was recorded immediately before epidural administration (T1),at 5 and 10 min after epidural administration (T2,T3),immediately before delivery (T4),and at 2 and 5 min after delivery (T5,T6).The correlation of CI between APCO and PAC (A-CI and P-CI,respectively) was tested by Pearson correlation analysis and agreement test.Results The P-CI was significantly higher than A-CI,there was statistical difference (P ＜ 0.05).Compared with T1,no significant differences between A-CI and P-CI were found at T2-T4 and T6 (P ＞ 0.05),The A-CI at T5 [(4.5 ± 1.1) L/(min·m2) vs.(4.2 ± 0.8) L/(min ·m2)] and P-CI [(6.2 ± 1.5) L/(min·m2) vs.(5.4 ± 1.2) L/ (min· m2)] were significantly higher,there were statistical differences (P ＜ 0.05).The correlation analysis showed that there was positive correlation between A-CI and P-CI at T1-6 (r =0.931,0.955,0.945,0.892,0.960,0.913 ; P ＜ 0.05).Bland-Altman analysis showed poor agreement between CI measured with the two methods.Conclusion CI value obtained with APCO agrees poorly with that obtained with PAC during cesarean section in parents with congenital heart disease combined with severe pulmonary hypertension,but agrees well in monitoring the changing trend of CI.

Teaching reform on practice in the course of anesthesiology for college students not majoring in anesthesiology / 中华医学教育探索杂志

Teaching in the course of anesthesiology for college students not majoring in anesthesiology was reformed and optimized by inducing various approaches such as development of interest,heuristic teaching,multimedia teaching,clinical simulation teaching and anesthesia experience in the First Affiliated Hospital,Sun Yat-sen University.Students' fundamental knowledge of clinical anesthesiology and abilities of clinical thinking and active learning were improved.Based on the summary of teaching practice,teachers should cultivate students' interest in anesthesiology,emphasize interactive teaching and learning and take fundamental knowledge of clinical anesthesiology as main teaching objectives in the clinical practice course of anesthesiology.

The potencies for motor block after intrathecal ropivacaine and bupivacaine / 中华麻醉学杂志

Objective To determine the median effective doae (ED50) for motor block after intrathecal ropivacaine and bupivacaine. Methods Sixty ASA Ⅰ or Ⅱ patients, aged 18-64, weighing 46-75 kg, undergoing elective urological surgery under combined spinal-epidural anesthesia, were randomized into 2 groups ( n = 30each) receiving intrathecal 0.5% ropivacaine and 0.5% bupivacaine respectively. The ED50 was determined by up-down sequential allocation. The initial dose was 4 mg. Each time the dose increased/decreased by 1 mg. Efficacy was determined by the occurrence of any motor block in either lower extremity (modified Bromage scale > 0)within 5 or 10 min after the spinal injection. Results The intrathecal ED50 for motor block was 6.68 mg for ropivacaine (95% confidence interval 6.27-7.13 mg) and 4.07 mg for bupivacaine (95% confidence interval 3.56-4.47mg) . The relative motor blocking potency ratio was ropivacaine/bupivacaine 0.61. Conclusion The potency of intrathecal ropivacaine is lower than that of bupivacaine for motor block.

Improving the quality of acute pain services: experiences of treatment of 5212 patients.

BACKGROUND: In a retrospective, non-randomized, observational study, we compared methods of postoperative analgesia in 5212 cases treated in 2003 and 2004. METHODS: Patients were allocated to two groups: Group A included 2,796 patients treated in 2004; Group B included 2,419 treated in 2003.The acute pain team was staffed by anaesthesiologists who performed daily visits to patients receiving the APS. They dealt with complaints and complications, evaluated the effectiveness of analgesia, and kept records. The visiting anaesthesiologists rotated weekly in group A, and daily in group B. RESULTS: Analgesic effects, VAS, patient satisfaction, and the incidence of complications were compared between the two groups. The number of patients with an analgesic effect evaluated as "bad" was significantly lower in group A than in group B (p < 0.05). The proportion of patients in whom satisfaction was evaluated as"good"was significantly higher in group A compared to group B (p < 0.05);"moderate" and "bad"satisfaction scores were significantly lower in group A than in group B (p < 0.05). There was no significant difference in the incidence of complications between the two groups (p > 0.05).The number of cases in which analgesia was no longer required was lower in group A than in group B (p < 0.05). CONCLUSION: During postoperative management of analgesia by an acute pain service, a weekly rotation of anaesthesiologist staffing is more effective in improving patient satisfaction than a daily rotation.

Effect of lipid emulsion on cardiac arrest induced by Bupivacain intoxication / 中国基层医药

Objective To investigate effect of lipid emulsion on cardiac arrest induced by bupivacain intoxication.Methods Forty SD rats were randomly devided into 2 groups.Group A applied epinephrine (n=20);Group L applied lipid emulsion combinding epinephring(n=20).The rats were administered Lupivacaine 20 mg/kg.Cardiopulmonary resuscitation(CPR) was started. Epinephrine 10 μg/kg were repeated three times followed by epinephrine 10 μg/kg every 5 minutes.Normal saline 5 ml/kg and 1 ml·kg-1·min-1 were administered in group A.20% Lipid emulsion 5 ml/kg and 0.25 ml·kg-1·min-1 were administered in group L.Heart rate,blood pressure, temperature were monitored.Blood gas analysiswere checked at 5 min,30 min after restoration of spontaneous circulation(ROSC).To record the number of successful CPR,time of ROSC and epinephrine dose.Results 11 rats(55%) and 16 rats(80%) were successful resuscitated.The success rate was higher in group L than in group A.Epinephrine dose was higher in group A than in group L.There was no difference in heart rate between the two groups.Systolic blood pressure and PaO2 was higher in group L than in group A(P<0.05).Conclusion There was better effect in lipid emulsion combined epinephrine than soly epinephrine when applied in cardiac arrest induced by bupivacaine intoxication.

Effects of ulinastatin on lung function after cardiopulmonary bypass / 中华胸心血管外科杂志

Objective: To study the effects of ulinastatin (UTI) on lung function after cardiopulmonary bypass. Methods: 60 patients, ASA score II～III, scheduled for elective cardiac valvular replacement, were randomly allocated into three groups. Study group (group I, n=20), UTI 10?000 U/kg group (group II, n=20), and UTI 20?000 U/kg group (group III, n=20). OI, V_D/V_T, P(A-a)O_2, CaO_2 , SaO_2 and PaO_2 were studied respectively. Ventilation time, simultaneous breath frequency within 24 hours after extubation and respiratory changes were also observed. Results: Compared with pre-CPB, in group I, postoperative OI, V_D/V_T, P_ (A-a) O_2 increased and CaO_2, SaO_2, PaO_2 decreased, respectively (P

The lung inflammatory response to cardiopulmonary bypass / 中华麻醉学杂志

Objective To assess the lung inflammatory response to cardiopulmonary bypass (CPB). Methods Twenty ASAⅡ-Ⅲ patients of either sex (9 male, 11 female) aged (43 ? 12)yr, undergoing elective cardiac valve replacement were studied. Patients with liver or kidney dysfunction and lung inflammatory diseases were excluded. Premedication included intramuscular morphine 5mg and atropine 0.1mg. Anesthesia was induced with propofol 1.5-2.0mg? kg-1, fentanyl 5?g?kg-1 and vecuronium 0. 1mg?kg-1 and maintained with isoflurane (