[Clinical Trials for Thyroidectomy Under Acupuncture-aided Anesthesia by Using Electroacupuncture or Transcutaneous Acupoint Electrical Stimulation of Different Acupoints].

OBJECTIVE: To observe the effectiveness of transcutaneous acupoint electrical stimulation (TAES) or electroacupuncture (EA) stimulation of different acupoints in combination with anesthetics in the management of thyroidectomy patients, so as to choose a better stimulating method and most effective acupoints for thyroidectomy. METHODS: A total of 216 thyroidectomy patients (ASA Ⅰ-Ⅱ grades) with thyroid gland adenoma, thyroid cyst or thyroid nodules from 3 hospitals (3 research centers) were randomized into 6 groups, i.e., local anesthesia (LA, n=34), Futu (LI 18)-EA (n=36), Hegu (LI 4)-Neiguan (PC 6)-TAES (n=34), LI 4-PC 6-EA (n=36), Yanglingquan (GB 34)-EA (n=36) and non-acupoint (NA, about 1.5 cm latero-posterior to KI 9)-EA (n=34) groups according to the hospitalizition sequence. For patients of the LI 18-EA, LI 4-PC 6-TAES/EA, GB 34 and non-acupoint-EA groups, EA or TAES (2 Hz/100 Hz) was applied to the abovementioned bilateral acupoints or non-acupoint till the termination of the surgical operation. The surgery was conducted under anesthesia by local injection of 0.5% lidocaine and midazolam, and intravenous injection of fentanyl (for severe pain cases) 20 min after beginning of TAES or EA. The patients' scores of visual analogue scale (VAS),mean arterial pressure (MAP) and heart rate (HR) at the time-points of pre-anesthesia (T 0), skin-incision (T 1), skin flap-freeing (T 2), anterior cervical muscle traction (T 3), thyroid upper/lower-pole-sectioning (T 4/T 5), and thyroidectomy (T 6), and the dosages of the administered fentanyl and lidocaine were recorded. RESULTS: Compared with the corresponding time-points of the non-acupoint group, the VAS scores at T 1 and T 4 time-points in the LI 18-EA group and LI 4-PC 6-EA group, at T 1, T 5 and T 6 time-points in the LI 4-PC 6-TAES group were significantly lower (P<0.05). Compared with the corresponding time-points of the LA group, the VAS scores at T 2, T 3, T 5 and T 6 time-points in the LI 18-EA group and LI 4-PC 6-EA group, at T 3, T 5 and T 6 in the LI 4-PC 6-TAES group, and the MAP levels at T 2, T 3, T 4 and T 6 time-points in the LI 18-EA group, at T 3, T 4 in the LI 4-PC 6-EA group, at T 3, T 4, T 6 in the LI 4-PC 6 TAES group, as well as the HR levels at T 4, T 5 and T 6 in the LI 18-EA group, and at T 5, T 6 in the LI 4-PC 6-TAES group were significantly lower (P<0.05). The dosages of fentanyl in the LI 18-EA and LI 4-PC 6-TAES groups, and those of lidocaine in the LI 18-EA, LI 4-PC 6-EA and TAES groups were significantly lower relevant to the LA group and non-acupoint group (P<0.05). No significant differences were found between the LA and GB 34-EA groups, and between the LA and non-acupoint groups, as well as between the LI 4-PC 6-EA and LI 4-PC 6-TAES groups in the VAS scores, the MAP and HR levels, the dosages of lidocaine and fentanyl consumption (P>0.05). CONCLUSIONS: EA stimulation of both LI 18 and LI 4-PC 6 and TAES of LI 4-PC 6 combined with anesthetics have a better effect in inducing analgesia and controlling MAP and HR, and need lower dosages of anesthetics for patients undergoing thyroidectomy, for which LI 18 and LI 4-PC 6 are evidently superior to GB 34 and non-acupoint. Hence, combined EA or TAES and anesthetics is highly recommended for thyroidectomy.

[The feasibility of training anesthesiologists with hemodynamic models of miniature pigs].

OBJECTIVE: To investigate the feasibility of training anesthesiologists with hemodynamic models of miniature pigs. METHODS: Eight miniature experimental pigs were chosen; ECG, SpO2, PetCO2, ABP, CVP, SV, SVV and PAP were monitored after anesthesia. The research was divided into two parts. Part one: the blood of pig was taken from its artery, air was injected into its body thought jugular vein, 15%KCl and 0.75% bupivacaine were given by peripheral vein respectively. The resuscitation would not be implemented unless the monitoring data changes were significantly and were recorded. Trainees looked on only during that time. Part two: Trainees were trained for placement of Swan-Ganz catheter after the sheath had been success- fully intubated into pig's right jugular vein. Trainees were trained for placement of femoral artery guided by ultrasound.Scores related to trainees' performance were written down. RESULTS: (1) Monitoring data (ABP, SV, SVV, CVP, PetCO2, PAP, SpO2 , ECG) changes were significantly ( P < 0.05 or P < 0.01), which indicated that the models had been successfully established. The evaluation scale displays: 81.3% of trainees thought this research improved their under- standing of hemodynamic changes; 78.2% thought that it helped them know how to deal with these circumstances; 71.9% thought this training was meaningful. (2) It was improved for students' skill to place Swan-Ganz catheter (P < 0.05), whereas the skill for placement of artery catheter by ultrasound was not significantly improved (P > 0.05). CONCLUSION: It was feasible to use a hemodynamic model of miniature pigs as an assisted teaching method to improve resident anesthesiologists' ability to understand and cope with clinical hemodynamic changes.

The utility of using the bispectral index-Vista for detecting cross-clamping decline in cerebral blood flow velocity.

BACKGROUND: Patients undergoing carotid endarterectomy for extracranial internal carotid artery stenosis are at risk of cerebral ischemia/hypoperfusion. Criterion recommended by European and American committees to determine whether to place a shunt consisted of a decline in transcranial Doppler ultrasonography-measured middle cerebral artery blood flow velocity (MCBFV) to < 30% to 40% of intraoperative preclamp value. OBJECTIVE: To assess the discriminative power of the bispectral index (BIS)-Vista monitor for detecting a 40% decline in MCBFV with cross-clamping. METHODS: In 20 patients undergoing carotid endarterectomy under remifentanil/propofol anesthesia, BIS-Vista data, MCBFV, and pulsatility index from bilaterally mounted BIS-Vista and transcranial Doppler monitors were continuously recorded. RESULTS: Coefficient of determination revealed good correlation (r = 0.763) between ipsilateral BIS-Vista and MCBFV after cross-clamping. BIS-Vista exhibited a high discriminative power of 0.850 (95% confidence interval, 0.455-0.966) area under the receiver-operating characteristic curve in detecting an ipsilateral 40% MCBFV decline. Two-way analysis of variance (location by time) suggests that BIS-Vista exhibited a global decline; ie, both BIS-Vistas declined when 1 carotid on either side was clamped because there was no significant interhemispheric difference (P = .112) in mean BIS-Vista values over time. CONCLUSION: Although we demonstrated good correlation and high discriminative power of the BIS-Vista monitor in depicting a MCBFV decline that could serve as indicator of decline in cerebral activity, BIS-Vista cannot be considered a reliable indicator of cerebral ischemia/hypoperfusion that could replace transcranial Doppler monitoring to determine whether a shunt is to be placed.

[Investigation and analysis of status in simulation education of anesthesiology of China].

OBJECTIVE: To investigate the status of simulation education of anesthesiology in China. METHODS: Five hundreds questionnaires were mailed to chairmen of department of anesthesiology in teaching hospitals in 29 provinces and autonomous regions in China. The retrieved questionnaires and data were processed and analyzed with statistics. RESULTS: Sixty one questionnaires were retrieved, and retrieved rate is 12.2%. The result indicated that the theory and knowledge of anesthesiology was adopted for the training of medical students and residents in 2% teaching hospitals, theory and knowledge of anesthesiology combined with problem-based learning discussion in 52% teaching hospitals, theory and knowledge of anesthesiology combined with problem-based learning discussion and simulation training in 46% teaching hospitals. The order of simulation devices possessed was as follows: Basic Life Support (BLS) (79.6%), training model for clinical anesthesia techniques (53.1%) and Advances Life Support (ALS) (51.0%). There were only six teaching hospitals utilized Human Patient Simulator for anesthesia training. The result of evaluation of simulation education showed that 91.2% anesthesiologists recognized it as applicable, 90.1% anesthesiologists recognized it as medical ethic requirement and 86.0% anesthesiologists recognized it as partly close to clinical situation. The degree of cognition of anesthesiologists to simulation education was ordered as follows: manipulation correcting ability (92.6%), procedure controllability (87.0%), training adjustability (76.0%) and patients safety (68.5%). CONCLUSION: The simulation education of anesthesiology in China is still in the preliminary period. The executive departments of education should enhance supports to the simulation education in both hard ware and in soft ware.

BIS-vista occipital montage in patients undergoing neurosurgical procedures during propofol-remifentanil anesthesia.

BACKGROUND: Neurosurgical procedures that require a frontal approach could be an impediment for a successful Bispectral Index (BIS) frontal sensor placement. The aim of this study was to explore the utility of using the new BIS-Vista monitor (Aspect Medical Systems, Newton, MA) for occipital sensor placement in the patients undergoing brain neurosurgical procedures during propofol-remifentanil anesthesia. METHODS: Two BIS Quatro sensors (Aspect Medical Systems, Newton, MA) mounted on the occipital and frontal regions were connected to two BIS-Vista monitors at three anesthesia states: before induction, during anesthesia maintenance, and recovery. RESULTS: There were significant differences before induction (P = 0.0002) and at anesthesia maintenance (P = 0.0014) between mean +/- SD occipital (83.4 +/- 4.8, 66.7 +/- 7.2) and frontal (93.1 +/- 3.4, 56.9 +/- 9.1) BIS-Vista values. During anesthesia recovery, there was no difference (P = 0.7421) between occipital (54.6 +/- 9.3) and frontal (53.1 +/- 7.3) BIS-Vista values. Bland and Altman analysis revealed a BIS-Vista negative-bias (limits of agreement) of -9.7 (+1.1, -20.5) before anesthesia induction, +9.8 positive-bias (+22.8, -1.7) during anesthesia maintenance, and -0.9 bias (+10.9, -12.8) during anesthesia recovery. CONCLUSION: We demonstrated that not only the regional limits of agreement are too wide to allow data of the two montages to be used interchangeably but also the variation is a function of anesthetic depth. However, keeping in mind a relatively consistent BIS-Vista -10 bias before induction and +10 bias during anesthesia maintenance with limits of agreement of approximately +/-11 BIS units, approximately double the clinically acceptable less than 10 BIS units level of agreement, BIS-Vista off-label occipital montage might be helpful in following a trend of propofol-remifentanil anesthesia in individual cases where frontal access is particularly difficult.

[Exploration and application by combining human patient simulator drivers of critical and emergency events with micro-division teaching during training primary residents].

OBJECTIVE: To explore the feasibility of combining human patient simulator (HPS) drivers with micro-division teaching during primary resident training by George Miller' medical education step-wised principle of goal and competence. METHOD: The 20 residents from department of anesthesia who are less than 3 years in clinical training were randomized into two Groups. The all residents in Group T received HPS training, and no HPS training in Group N. In simulation system, we designed 8 programmed critical and emergency events. We disassembled and quantified the programmed design and training process with Micro-division teaching principle. The training mode was run by test-feedback-self-analysis-instructor guide-summarize-re-practice-retest. The feedback assessment from all residents were collected after finishing HPS training. RESULTS: The training score in Group T was much higher than Group N (P < 0.05). CONCLUSIONS: The training mode with HPS is an accessory teaching means because it can improve clinical thinking and skill training of primary resident.

Bispectral index monitoring of a narcolepsy-cataplexy episode during regional anesthesia.

Narcolepsy or Gélineau syndrome is an extremely incapacitating chronic sleep disorder of unknown etiology that is characterized by uncontrollable attacks of deep sleep and is typically associated with cataplexy sudden loss of muscle tone. The Bispectral Index (BIS), an electroencephalographic-derived cerebral monitor, used for monitoring the effects of anesthetic/hypnotic drugs was shown to correlate to various conditions that could influence the eletroencephalogram. We assessed the utility of using BIS for monitoring a possible narcolepsy-cataplexy episode and whether a distinctive BIS profile might offer an early warning of an impending narcoleptic/cataplectic spell. We recorded both hemispheres, using two synchronized BIS-XP monitors, during a narcolepsy-cataplexy episode in a 57-yr-old male patient undergoing lower limb surgery under femoral nerve block regional anesthesia. The patient went through three stages: first a prodromal "intermittent low-vigilance" phase interrupted by high electromyographic activity. This was followed by a second "continuous low-vigilance" phase of BIS around 75 with low electromyographic activity, ending with a third "nonresponsive vigilance" phase of a full-blown narcolepsy-cataplexy episode of BIS around 45 with complete loss of muscle power. The purpose of presenting this report is to emphasize the fact that narcoleptic patients can still run the risk of loss of consciousness with atonia under regional anesthesia, and such an undesirable complication cannot be under-estimated. BIS monitoring is a simple method that could offer an early warning of an imminent episode, with its associated hazards, in patients with narcolepsy-cataplexy undergoing surgery under regional anesthesia.