Effects of dexmedetomidine on cognitive function in elderly patients after laparoscopic cholecystectomy: A protocol for systematic review and meta-analysis.

BACKGROUND: Although many studies have reported the effects of dexmedetomidine on cognitive function (CF) in elderly patients after laparoscopic cholecystectomy (LCT), to this date, its effects are still not well understood. The aim of this study is to produce a qualitative synthesis of assessing the effects of dexmedetomidine on CF in elderly patients after LCT. METHODS: We will conduct a comprehensive search in Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, VIP Database, WANGFANG Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from the commencement to March 31, 2020 without restrictions of language and publication status. In addition, we will also search grey literature, including conference abstracts, dissertations, reference lists of included studies and relevant reviews. All potential studies will be identified independently by 2 authors to determine their inclusion against previously defined eligibility criteria. The quality of selected papers will be assessed using Cochrane risk of bias tool. All statistical analysis will be performed using RevMan 5.3 software. RESULTS: This study will provide a synthesis of the current available data on assessing the effects of dexmedetomidine on CF in elderly patients after LCT. CONCLUSIONS: Its findings will provide qualitative evidence to better understand the effects of dexmedetomidine on CF in elderly patients after LCT.INPLASY Registration Number: INPLASY202040030.

[Effect of Epidural Volume Extension on Combined Spinal-anesthesia of Parturients in Women Undergoing Cesarean Delivery].

OBJECTIVE: To evaluate the blocking characteristics of epidural volume extension on combined spinal-anesthesia of parturients undergoing cesarean delivery. METHODS: Eighty parturients were randomly allocated to one of four groups, receiving 0, 5, 10 or 15 mL normal saline, respectively, through epidural catheter at a rate of 0.5 mL/s (n = 20 in each group) after combined spinal-anesthesia with 11 mg intrathecally isobaric bupivacaine. Peak sensory block height, time for sensory block to sixth thoracicdermatome level, time for highest modified Bromage motor score, time for sensory regression to tenth thoracicdermatome level, and motor block recovery to Modified Bromage 0 were recorded. RESULTS: The groups with 10 mL and 15 mL epidural extension had a higher level of peak sensory and shorter time for the sensory block to sixth thoracicdermatome level compared with the control group (P< 0.05). There were no significant group differences in the time for sensory regression to tenth thoracicdermatome level (P > 0.05). The saline epidural extension groups had significant shorter time for highest modified Bromage motor score and motor block recovery to Modified Bromage 0 compared with the control group (P < 0.05). The use of phenylephrine was significantly higher in the 15 mL treatment group (P < 0.05). CONCLUSION: 10 mL of epidural saline volume extension is optimal for combined spinal-epidural anaesthesia of parturients undergoing caesarean delivery.

[ED50 of Intrathecal Isobaric Bupivacaine with Epidural Volume Extension for Cesarean Delivery].

OBJECTIVE: To determine the 50% effective dose (ED50) of intrathecal isobaric bupivacaine in combined spinal-epidural anaesthesia with epidural volume extension for caesarean surgery. METHODS: Eighty-four women undergoing elective caesarean sections were randomly assigned to seven groups, receiving intrathecally isobaric bupivacaine in a dosage of 6, 7, 8, 9, 10, 11 or 12 mg (n=12 per group), respectively. Ten mL normal saline was injected through an epidural catheter at a rate of 0.5 mL/s. Successful induction was defined as Hollmen pinprick block grade 2 at a height equal to or higher than T6. Success (surgery) was defined as success (induction) plus no requirement for epidural supplementation throughout surgery. The ED50 values were determined using a logistic regression model. RESULTS: The EDs for success (induction) and success (surgery) were 8.121 mg (95% confidence interval: 7.421-8.821) and 9.012 mg (95% confidence interval: 7.747-10.280), respectively. With increase in amount of intrathecal bupivacaine, time to success (induction) was shortened (P<0.05), resulting in increased successful numbers for both induction and surgery. No differences were found in the use of phenylephrine, haemodynamic stability and the occurrence of nausea and vomiting among groups. CONCLUSION: When combined with epidural volume extension, intrathecal bupivacaine has an ED50 of 8.121 mg and 9.012 mg for success (induction) and success (surgery), respectively, in women undergoing caesarean sections.

[Appling the color Doppler in abdominal aortic balloon occlusion for pelvic and sacral surgery].

OBJECTIVE: To apply the color Doppler in abdominal aortic balloon occlusion for pelvic or sacral surgery, and to evaluate its effectiveness in controlling blood loss. METHODS: A Philips 4500 color Doppler was used to place abdominal aortic balloons in 20 patients with pelvic or sacral tumors who underwent surgery. The temporary abdominal aortic balloons were used for controlling blood loss in the surgery. Transesophageal echocardiography was performed to detect the renal blood flow. RESULTS: Abdominal aortic balloons were successfully placed to the 20 patients, with a water injection rate of 10-18 (13.8 +/- 2.6) mL and a total of 45-180 min occlusion during the 70-450 (265 +/- 102) min surgery. The intraoperative blood loss ranged from 250 to 4000 (1357 +/- 997) mL. The water injection rate of abdominal aortic-balloons (Y) was correlated with the diameter of abdominal aorta (X): Y = 7.1602X + 2. 9968 (R2 = 0.7371, P < 0.05). Renal blood flow was not affected. The patients stayed in hospital for 7-13 (9.8 +/- 11.9) days after operation. One patient developed complications. The one year recurrence rate of tumors was 10%. CONCLUSION: The color Doppler provides a simple and accurate instrument for abdominal aortic-balloon occlusion, with reliable blood loss control.