A Retrospective Analysis for Risk Factors and Early Prognosis of Delayed Withdrawal Extracorporeal Membrane Oxygenation After Lung Transplantation.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is widely used for cardiopulmonary assistance during lung transplantation (LTx). However, the optimal timing for ECMO removal remains controversial. This study aimed to evaluate the risk factors and early prognosis of delayed withdrawal ECMO after LTx. METHODS: Two hundred sixty-seven patients who underwent LTx supported by ECMO were included in this study. Based on whether or not ECMO was completely stopped in the operating room, patients were divided into early ECMO withdrawal group (group E, 107 cases) and delayed withdrawal group (group D, 160 cases). Perioperative data of the donors and recipients, including the suspected risk factors for delayed removal of ECMO, postoperative complications, and hospital survival rate, were retrospectively analyzed. RESULTS: Preoperative New York Heart Association cardiac function for recipients and mechanical ventilation time for donors were independent risk factors for delayed weaning of ECMO in veno-arterial ECMO patients. Compared with group E, the odds of postoperative pulmonary infection, primary graft dysfunction, renal dysfunction, blood transfusion volume, and mechanical ventilation time were significantly higher in group D (all P < 0.05). Delayed withdrawal ECMO was decisive factor for early postoperative death, as the risk of early postoperative death in group D was 1.99 (95% confidence interval, 1.13-3.54) times as that in the group E. CONCLUSIONS: During the period of LTx, New York Heart Association grade III/IV for recipients and mechanical ventilation time ≥5 days for donors are suggestive of delayed veno-arterial ECMO removal, and clinicians should minimize the postoperative bypass time of ECMO when conditions permit.

Application of disposable syringe of low resistance in epidural puncture / 中国医师进修杂志

Objective To assess the application value of disposable syringe of low resistance (SLR) in epidural puncture.Methods One hundred and thirty-two patients scheduled to undergoing selective operation under epidural or combined epidural-spinal anesthesia were divided into glass syringe (GS) group and SLR group with 66 cases each by random digits table method.GS was applied in local anesthesia and epidural puncture with loss of resistance in GS group.While SLR was used in SLR group.The defect of the syringes' appearance was evaluated.The fastness between each sub-unit during the procedure was observed.The rupture,dropping,leakage,air leakage and blockage were also estimated.The heart rate,blood pressure,oxygen saturation and other adverse events were also observed.Results In SLR group,syringe excepted 1 case of slight resistance but did not affect the use,the rest of the components connected firmly,surface without defects,clear scale uniform color,not observed rupture,air leakage,leakage and blockage phenomenon,pump liquid and air resistance was small.In GS group,syringe surface without defects,clear scale uniform color,3 cases had loose connection,1 case with rupture when using,5 cases with air leakage and leakage,3 cases of pumping liquid or dry air resistance to 0.9％ sodium chloride and moist after use.There was significant difference in appearance and usage between two groups (x2 =10.324 5,P =0.001 3).There was no significant difference in a puncture success,first three puncture success and inject air negative pressure sensitivity between two groups (P ＞ 0.05).Conclusion SLR is worth to be applied in epidural puncture.

Comparison of oxygen saturation between the blood of superior vena cava and mixed venous in lung transplantation / 实用医学杂志

Objective To compare the oxygen saturation between the blood of superior vena cava and mixed venous in lung transplantation and provide reference for monitoring method in anesthesia. Methods 30 patients who received lung transplantation were placed central venous catheter into superior vena cava and flotation catheter into the pulmonary artery in turn. The blood samples were collected from the superior vena cava and pulmonary artery for blood gas analysis simultaneously at the time of just followed the catheter placement (T1), before the resection of the first bad lung (T2), after the reperfusion of the first donor lung (T3), before the resection of the second bad lung (T4), after the reperfusion of the second donor lung (T5), before the end of the operation (T6). The oxygen saturation were compared between the blood of the superior vena cava and mixed venous. Results From T1 to T6, Bland-Altman analysis showed that the mean of deviation between the SpO2 measured in blood of superior vena cava and mixed venous were 0.5, 3.4, 2.3, 0.5, 0.27,-2.9, respectively, and the incidence beyond the upper and lowed limits of consistency zone was 3.3%, 0%, 0%, 3.3%, 3.3%, 0%respectively. The incidence of SpO2 within the consistent limits was 96.7%, 100%, 100%, 96.7%, 96.7%, 100% respectively. Conclusions The SpO2 of superior vena cava may be approximately reference as SpO2 of mixed venous during lung transplantation.

The effect of intranasal dexmedetomidine on preventing myoclonus induced by etomidate / 中国医师进修杂志

Objective To observe the effect of intranasal dexmedetomidine on preventing myoclonus induced by etomidate.Methods One hundred patients who ASA classification Ⅰ-Ⅱ grades were divided into two groups by random digits table method with 50 cases each.Before anesthesia induction with dexmedetomidine 1 μ g/kg (dexmedetomidine group) or equivalent 0.9％ sodium chloride (control group) intranasal,30 min after two groups were injected etomidate 0.3 mg/kg.Mean artery pressure(MAP),heart rate (HR),oxygen saturation with pulse oximetry (SpO2) and respiratary rate were recorded before intranasal instillation of dexmedetomidine (T0),at l5 min (T1) and 30 min (T2) after intranasal dexmedetomidine,myoclonus was observed and graded.Results The MAP,HR at T2 was lower than that at T0 in dexmedetomidine group [(75.9 ± 8.1) mm Hg (1 mm Hg =0.133 kPa) vs.(81.4 ± 10.4) mm Hg,(80.9 ± 7.6) times/min vs.(85.9 ± 9.1) times/min],there was significant difference (P ＜ 0.05),but all within the normal range; other within the group at each time point had no statistical significance between two groups (P ＞ 0.05).The incidence of myoclonus was significantly reduced in dexmedetomidine group compared with that in control group [42％(21/50) vs.70％(35/50)],there was significant difference (P ＜ 0.01).Conclusion Intranasal instillation of dexmedetomidine can safely prevent myoclonus induced by etomidate.

Effect of Pleurotus Eryngii Polysaccharide on Learning and Memory Ability and Antioxidant of Aging Mice Induced by D-galactose / 中国康复理论与实践

@#Objective To study the effect of Pleurotus eryngii polysaccharide on aging mice induced by D-galactose (D-gal). Methods 72 ICR mice were divided into high, moderate, and low dosages (of polysaccharide) groups, piracetam group, model group, and control group, 12 in each group. The model of aging mice was induced with D-gal. They were tested with Y-maze, and the contents of superoxide dismutase (SOD), malondialdehyde (MDA), lipofuscin and L-glutamate in cerebrum were determined 6 weeks after model. Results Compared with the model group, the achievement of Y-maze improved, the activities of SOD increased and the content of MDA and lipofuscin decreasd in high and moderate dosage groups (P<0.05), while the mass of brain and kidney increased and the L-glutamate decreased in the high dosage group (P<0.05). Conclusion Pleurotus eryngii polysaccharide can ameliorate aging of mice induced by D-gal.

Application of Supreme laryngeal mask airway to the anesthesia of poster laparoscopic surgery with lateral position / 中国医师进修杂志

Objective To study the application of Supreme laryngeal mask airway (SLMA) with new type to the general anesthesia of lateral position. Methods Sixty patients with ASA Ⅰ - Ⅱ who planned to receive selective poster laparoscopic surgery were divided into SLMA group and general tracheal tuber (GTT) group with 30 cases of each by random digits table. After fast intravenous induction SLMA and GTT were intubated respectively to obtain artificial airway in each group. The time of intubation, efficiency of success,heart rate(HR), invasive blood pressure(IVBP),airway pressure,side effects were observed and recorded. Results The intubation time in SLMA group [(15.1 ±4.0) s] was shorter than that in GTT group [(30.5 ±: 16.2) s] (t' =-5.05,P ＜0.05); there was no significant difference in efficiency of success between two groups [96.7%(29/30) vs. 76.7%(23/30),P＞ 0.05]. There was no significant difference in HR and IVBP during the time of intubation and extubation in SLMA group(P＞ 0.05), but not in GTT group(P＜0.05). There was no significant difference in the change of the airway pressure between two groups during the ventilation. There were no complications in two groups. Conclusions The time of SLMA intubation in the general anesthesia with lateral position is short. The effect of intubation and extubation to HR and blood pressure is light. The SLMA intubation is another way to set up safely artificial airway.