Comparison of three methods for the confirmation of laryngeal mask airway placement in female patients undergoing gynecologic surgery.

The laryngeal mask airway (LMA) is a supraglottic device that is commonly used to provide lung ventilation during general anesthesia. LMA placement needs to be confirmed to provide adequate lung ventilation. To investigate the feasibility of using ultrasound examination, compared with clinical tests and fiberoptic laryngoscopy, to confirm LMA placement, we performed a clinical study of 64 female patients classified as American Society of Anesthesiologists Physical Status I or II who were scheduled for gynecologic surgery with LMA insertion for airway management. After insertion, placement of the LMA was confirmed by clinical tests, ultrasound examination and fiberoptic laryngoscopy. Of the 64 women, placement was confirmed as acceptable in 89.1% by clinical tests, in 59.4% by fiberoptic laryngoscope assessment and in 67.2% by ultrasound examination. With respect to patients with oropharyngeal leaks classified as high, there were no differences in confirmation of acceptable placement between clinical tests and ultrasound examinations (p = 0.092), but the number of patients determined to have acceptable placement by ultrasound examination was greater than that determined by fiberoptic laryngoscopy (p = 0.034). Thus, ultrasound examination is a superior technique for confirming the seal on the LMA.

[Effect of transcutaneous acupoint electrical stimulation on lipid peroxidation and cognitive function in patients experiencing craniotomy].

OBJECTIVE: To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on serum superoxide dismutase (SOD) activity, malondialdehyde (MDA) and S100beta contents in craniotomy patients for studying its cerebral protection mechanism. METHODS: Fifty patients scheduled for neurosurgery were randomly divided into TAES group (n = 25) and control group (n=25) with randomized block method. For patients of TAES group, TAES was applied to bilateral Hegu (LI 4) and Quchi (LI 11), Zusanli (ST 36) and Sanyinjiao (SP 6) from 30 minutes on before anesthesia to the end of operation. Patients of control group were anesthetized with sevoflurane inhalation and intermittent (i.v.) of sulfenany and vecurnium bromide. Blood samples were taken for assaying serum SOD activity, MDA and S100beta contents with purinase oxydasis, biochemiluminescence and enzyme linked immunosorbent assay separately. Scores of cognitive ability were given by using Mini Mental State Examination (MMSE). RESULTS: In comparison with pre-anesthesia, serum SOD activity decreased significantly 1 h after craniotomy in control group, at the end of operation in both control and TAES groups (P<0.05, P<0.01), and increased markedly 48 h after operation in control group (P<0.05). Serum MDA in control group increased significantly 48 h after operation, while that in TAES group reduced apparently 24 h after operation (P<0.01). Serum S100beta content in TAES group decreased remarkably 48 h after operation (P<0.01). Serum SOD activity of TAES group was significantly higher than that of control group 24 h after operation (P<0.05). Compared with control group, serum MDA contents of 24 h and 48 h after operation and serum S100beta levels at 1 h after craniotomy and 48 h after operation were markedly lower in TAES group (P<0.01, P<0.05). No significant differences were found between two groups in the cognitive function scores (P>0.05). CONCLUSION: TAES can increase serum SOD activity and reduce MDA and S100beta levels in patients undergoing craniotomy, which may contribute to its effect in reducing lipid peroxidation induced cerebral injury. But its impact on the patient's cognitive function needs study further.

[Effect of transcutaneous acupoint electrical stimulation on brain oxygen and glucose metabolism in the perioperative period of the craniocerebral operation].

OBJECTIVE: To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on brain tissue oxygen and glucose metabolism of the brain tissue in peri-operative period of the craniocerebral operation. METHODS: Fifty patients scheduled for neuro-surgery were randomly assigned to the treatment group and the control group equally. Anesthesia applied after induction on all patients was continuous sevoflurane inhalation and intermittent intravenous injection of sulfenany and vecurnium bromide, but to the treatment group TASE was applied additionally from 30 min before anesthesia to the end of operation. Blood samples were taken from artery and jugular venous bulb at different time points, i. e. before induction (T0) , before skin incision (T1) , at the end of operation (T2) , and 10 min after extubation (T3) , for blood-gas analysis. The difference of oxygen, glucose and lactate contents between blood samples of arterial and jugular bulb (Da-jvO2, Da-jvGlu and Da-jvLac) at respective time point were determined and calculated. RESULTS: Da-jvO2 decreased in both group at T1, T2 and T3, and all lower than that at T0 (P < 0.05 or P < 0.01), but significant difference was shown in comparison of the index at T2 and T3 with the same time points in the control group in the treatment group (P < 0.05 or P < 0.01) , and that between groups at T2 and T3 (P < 0.01). Da-jvGlu in the treatment group decreased at T2 and T3 (P < 0.05), but keep unchanged relatively in the control group before and after anesthesia, inter-group comparison showed it was lower at T2 and T3 in the treatment group than that in the control group respectively (P < 0.05). Da-jvGlu in the treatment group at T1, T2, and T3 were all lower than that at the same time points (P < 0. 01). CONCLUSION: TAES can significantly decrease the oxygen and glucose metabolism of the brain tissue in the perioperative period of the craniocerebral operation.

[Effect of transcutaneous acupoint electrical stimulation on blood bioactive compounds involving cerebral injury during craniotomy].

OBJECTIVE: To observe the effect of transcutaneous acupoint electrical stimulation (TAES) on plasma ET, CGRP and serum IL-6, S100beta during craniotomy. METHODS: Fifty patients scheduled for neurosurgery were randomly divided into TAES group (n=25) and control group (n=25). TAES (2/100 Hz, 8-12 mA) of bilateral Hegu (LI 4)-Quchi (LI 11), Zusanli (ST 36)-Sanyinjiao (SP 6) was administrated for patients of TAES group starting 30 min before anesthesia till the end of the operation. Anesthesia of the patients was maintained with sevoflurane inhalation and intermittent intravenous injection of boluses of sulfenany and vecurnium bromide. Jugular venous blood samples were taken at preanesthesia (T0), 1 hour after craniotomy (T1), closure complete (T2), 24 hours (T3) and 48 hours (T4) after operation respectively for detecting contents of plasma endothelin (ET), calcitonin gene-related peptide (CGRP) and serum interleukin (IL)-6, S100beta with radioimmunoassay and enzyme linked immunosorbent assay separately. RESULTS: Compared with control group, plasma ET at T2, serum IL-6 at T1 S100beta at T1 and T4 in TAES group all decreased significantly (P < 0.01, 0.05), while serum IL-6 at T3 increased remarkably (P < 0.05). It suggests that after TAES, CGRP/ET was improved, favoring cerebral microcirculation to reduce surgery-induced cerebral injury. There were no significant differences between two groups at different time courses in plasma CGRP concentrations (P > 0.05). CONCLUSION: TAES can regulate plasma CGRP/ET and serum IL-6, lower serum S100beta level, which may contribute to its effect in relieving craniotomy-induced brain injury.