Comparison of Two Dexmedetomidine Administration Strategies on the Incidence of Postoperative Respiratory Complications: A Retrospective, Inverse Probability of Treatment Weighted Study.

Randomized controlled trials have shown a higher risk of postoperative hypoxemia and delayed extubation with opioid-free anesthesia (OFA), compared with opioid anesthesia. The practice of OFA is not standardized. The objective of this study is to investigate the association between the dexmedetomidine administration protocol used and the occurrence of postoperative respiratory complications. This work is a retrospective, propensity score-adjusted study (inverse probability of treatment weighting) conducted between January 2019 and September 2021 in a French tertiary care university hospital, including 180 adult patients undergoing major digestive surgery. Comparison of 2 anesthesia protocols: with a continuous intravenous maintenance dose of dexmedetomidine following a bolus (group B+M, n = 105) or with a bolus dose alone (group B, n = 75). The main outcome measure was a composite respiratory end point within 24 hours of surgery. There was no significant difference in the incidence of overall respiratory complications, as assessed by the primary end point. Nevertheless, there were more patients with postoperative hypercapnia in group B+M than in group B (16% vs 2.5%, P = .004). Patients in group B+M were extubated later than patients in group B (group B+M, median 40 minutes, IQR 20-74 minutes; group B, median 20 minutes, IQR 10-50 minutes; P = .004). Our study showed negative results for the primary end point. However, data on the increased risk of postoperative hypercapnia in patients receiving a maintenance dose of dexmedetomidine are new. Other prospective randomized studies with greater power are necessary to confirm these data and to make OFA safer, by reducing the prescribed doses of dexmedetomidine.

Effect of sevoflurane-remifentanil and propofol-remifentanil anesthesia on glycocalyx shedding during deep inferior epigastric perforator flap breast reconstruction: a prospective randomized, controlled trial.

BACKGROUND: The endothelial glycocalyx (EG) is an important structure that regulates vascular homeostasis. Deep inferior epigastric perforator (DIEP) flap is expected to cause substantial EG breakdown owing to the long procedural duration and ischemia- reperfusion injury. This prospective, randomized, controlled study aimed to compare syndecan-1 levels during sevoflurane-remifentanil and propofol-remifentanil anesthesia in patients who underwent DIEP flap breast reconstruction. METHODS: Fifty-one patients were randomized to either sevoflurane (n = 26) or propofol (n = 25) groups. Anesthesia was maintained with remifentanil in combination with either sevoflurane or propofol. The primary endpoint was the concentration of serum syndecan-1 measured at 1 h after surgery. RESULTS: Fifty patients (98.0%) completed the study. Patients in the propofol group had significantly lower levels of syndecan-1 than patients in the sevoflurane group at 1 h after operation (23.8 ± 1.6 vs. 30.9 ± 1.7 ng/ml, respectively; Bonferroni corrected P = 0.012). There were no significant differences between groups in postoperative complications. The postoperative hospital stay was 8.4 ± 2.5 days in the sevoflurane group and 7.4 ± 1.0 days in the propofol group (P = 0.077). CONCLUSIONS: Propofol-remifentanil anesthesia resulted in lesser increases in syndecan-1 levels compared to increases with sevoflurane-remifentanil anesthesia in patients who underwent DIEP flap reconstruction. Our results suggest that propofol-remifentanil anesthesia shows protective effects against EG damage during DIEP flap breast reconstruction in contrast to sevoflurane-remifentanil anesthesia.

The effect of intravenous anesthesia on the detection rate of lesions in diagnostic gastroscopy: a retrospective study based on propensity score matching / 中国医师杂志

Objective:To investigate the effect of intravenous anesthesia on the detection rate of lesions in diagnostic gastroscopy.Methods:A total of 9 071 subjects who underwent diagnostic gastroscopy at the Digestive Endoscopy Center of Yangzhou University Affiliated Hospital from March 2021 to February 2022 were selected. Data were collected from the gastroscopy quality control system, including age, gender, examination physician, Helicobacter pylori infection, examination method, withdrawal time, number of images left, number of biopsies, biopsy site, gastroscopy diagnosis, pathological diagnosis, etc. They were divided into anesthesia group and general group based on the examination method, and propensity score matching (PSM) was performed on the two groups of subjects. Excluding confounding factors, the detection of lesion location and lesion type in two groups of subjects was analyzed; Simultaneously, univariate and multivariate logistic regression analysis was used to analyze the influencing factors of the detection rate of precancerous lesions and malignant tumors in the upper gastrointestinal tract.Results:After PSM, 1 655 subjects were included in both groups. In terms of lesion location, the detection rate of gastric body lesions in the anesthesia group was higher than that in the general group ( P<0.05), and the detection rate of esophageal lesions in the anesthesia group was lower than that in the general group ( P<0.05); In terms of lesion types, the detection rate of precancerous lesions such as gastric polyps, mucosal protrusions, mucosal atrophy, and intestinal metaplasia in the anesthesia group was higher than that in the general group (all P<0.05). The results of logistic regression analysis showed that intravenous anesthesia was an independent influencing factor for the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy ( OR=1.338, 95% CI: 1.070-1.674, P<0.05). Conclusions:Intravenous anesthesia is an independent influencing factor for the detection rate of precancerous lesions and malignant tumors in diagnostic gastroscopy, and can improve the detection rate of upper gastrointestinal lesions.

Effects of dyclonine hydrochloride mucilage on gag reflex in patients with chronic pharyngitis undergoing gastroscopy / 中国基层医药

Objective:To investigate the effects of dyclonine hydrochloride mucilage administered for oropharyngeal anesthesia on gag reflex in patients with chronic pharyngitis during gastroscopy.Methods:A total of 100 patients with chronic pharyngitis who met American Society of Anesthesiologists Classification I-II and received treatment in The First Affiliated Hospital of Ximen University from January to December 2020 were included in this study. Using the principle of voluntariness, these patients were divided into dyclonine hydrochloride mucilage (D) and control (C) groups, with 50 patients in each group. Ten minutes before anesthesia induction, patients in Group D took 10 mL of dyclonine hydrochloride mucilage in the mouth, but did not swallow it, and those in Group C were identically given equal volume of placebo. Ten minutes later, dyclonine hydrochloride mucilage or placebo was swallowed. For anesthesia induction, 20 μg Fentanyl and 2-4 mg/kg Propofol were intravenously administered. A gastroscopy examination was performed after the patient's consciousness disappeared. The patient's cough and body movement response scores during gastroscopy were recorded. Before anesthesia induction (T0), before endoscope insertion (T1), after endoscope insertion (T2), and after endoscope withdrawal (T3), mean arterial pressure and heart rate were recorded.Results:The incidence rate of cough and body movement in Group D were 20% (10/50) and 24% (12/50), which were significantly lower than 72% (36/50) and 68% (34/50) in Group C ( χ2 = 27.21, 19.49, both P < 0.001). At T1, mean arterial pressure in Group D and Group C was (62.21 ± 10.32) mmHg and (63.82 ± 10.51) mmHg(1 mmHg=0.133 kPa), respectively, which were significantly lower than (70.21 ± 13.13) mmHg and (70.91 ± 14.02) mmHg at T0 ( t = 3.15, 5.82, both P < 0.05). At T2, mean arterial pressure and heart rate in Group C were (80.13 ± 11.92) mmHg and (90.02 ± 15.63) beats/minute, respectively, which were significantly higher than (70.91 ± 14.02) mmHg and (78.75 ± 14.93) beats/minute at T0 in the same group ( t = 5.99, 4.03, both P < 0.05) and were also significantly higher than (66.21 ± 12.33) mmHg and (76.53 ± 10.31) beats/minute] at T2 in Group D ( t = 2.07, 2.67, both P < 0.05). Conclusion:Dyclonine hydrochloride mucilage administered for oropharyngeal anesthesia can effectively suppress gag reflex in patients with chronic pharyngitis and increase hemodynamic stability during gastroscopy.

Comparison of direct costs associated with the use of balanced general anesthesia and total intravenous anesthesia (TIVA) techniques / Comparación de los costos directos asociados al uso de técnicas de anestesia general balanceada y anestesia total intravenosa (TIVA)

Abstract Introduction: Healthcare costs are increasing against the backdrop of scarce resources. Surgical procedures are an important part of healthcare spending, and the cost of anesthetic techniques is relevant as part of the total cost of care and it is a potential target for expenditure optimization. Although important economic differences have been reported internationally for general anesthesia options, there are no publications in Colombia that compare current costs and allow for informed and financially responsible decision-making. Objective: To quantify and compare direct costs associated with the various general anesthesia options most frequently used at the present time. Methods: Cost minimization analysis based on a theoretical model of balanced general anesthesia using isoflurane, sevoflurane, desflurane in combination with remifentanil, and TIVA (propofol and remifentanil). Initial results were obtained using a deterministic simulation method and a sensitivity analysis was performed using a Monte Carlo simulation. Results: The average total cost per case for the different anesthetic techniques was COP 126381 for sevoflurane, COP 97706 for isoflurane, COP 288605 for desflurane and COP 222 960 for TIVA. Conclusions: Balanced general anesthesia with desflurane is the most costly alternative, 1.2 times more expensive than TIVA, and 2 and 3 times more costly than balanced anesthesia with sevoflurane and isoflurane, respectively. TIVA ranks second with a cost 1.8 times higher than balanced anesthesia with sevoflurane and 2.5 times higher than balanced anesthesia with isoflurane.

Resumen Introducción: Los costos de la atención en salud son crecientes y se enfrentan a un escenario de recursos escasos. La realización de procedimientos quirúrgicos hace parte importante de la atención y del gasto en salud, el costo de las técnicas anestésicas utilizadas es relevante en el costo total de la atención y es un objetivo potencial para la optimización del gasto. Aunque a escala internacional se han reportado diferencias económicas importantes entre las alternativas para anestesia general, en Colombia no se cuenta con publicaciones que comparen los costos actuales y permitan una toma de decisiones informada y responsable económicamente. Objetivo: Cuantificar y comparar los costos directos para Colombia de las diferentes alternativas para anestesia general usadas con más frecuencia en la actualidad. Métodos: Análisis de minimización de costos basado en un modelo teórico de anestesia general balanceada con isoflurano, sevoflurano, desflurano en combinación con remifentanilo y TIVA (propofol y remifentanilo). Se obtuvieron resultados iniciales utilizando una simulación con un método determinista y se realizó un análisis de sensibilidad con una simulación de Montecarlo. Resultados: El costo total promedio por caso para las diferentes técnicas anestésicas fue de COP 126.381 para sevoflurano, COP 97.706 para isoflurano, COP 288.605 para desflurano y COP 222.960 para TIVA. Conclusiones: La anestesia general balanceada con desflurano es la alternativa de mayor costo, es 1,2 veces más costosa que la TIVA, y 2 y 3 veces más que la balanceada con sevoflurano e isoflurano, respectivamente. La TIVA ocupa el segundo lugar con un costo 1,8 veces superior a la balanceada con sevoflurano y 2,5 veces a la balanceada con isoflurano.

Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report.

Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.

Manejo anestésico en neurocirugía de paciente con síndrome de Eisenmenger y síndrome de Down. Reporte de un caso / Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report

El número de pacientes con patología cardíaca congénita que se intervienen de cirugía no cardíaca está en aumento. El manejo de este tipo de pacientes en neurocirugía requiere de una planificación anestésico-quirúrgica minuciosa. La necesidad de intervención urgente junto con la presencia de una cardiopatía congénita evolucionada a síndrome de Eisenmenger, asociadas a una vía aérea difícil, van a suponer un reto para el anestesiólogo. La utilización de dexmedetomidina puede ser una alternativa. Presentamos el caso de una paciente con síndrome de Down y síndrome de Eisenmenger que fue sometida a un drenaje de absceso cerebral de urgencias siendo posteriormente reintervenida de forma programada. Se comparan las diferentes técnicas anestésicas empleadas en ambos procedimientos, analizando las implicaciones que tuvieron sobre las principales alteraciones fisiopatológicas que presentaba la paciente.(AU)

Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger Syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.(AU)

Blood pressure nomograms for children undergoing general anesthesia, stratified by age and anesthetic type, using data from a retrospective cohort at a tertiary pediatric center.

Reference values for non-invasive blood pressure (NIBP) are available for children undergoing general anesthesia, but have not been analyzed by type of anesthetic. This study establishes age-specific pediatric NIBP reference values, stratified by anesthetic type: inhalational anesthesia (IHA), total intravenous anesthesia (TIVA), and mostly intravenous anesthesia (MIVA, an inhalational induction followed by intravenous maintenance of anesthesia). NIBP measurements were extracted from a de-identified vital signs database for children < 19 years undergoing anesthesia between Jan/2013-Dec/2016, excluding cardiac surgery. We automatically rejected artifacts and randomly sampled 20 NIBP values per case. Anesthetic phase (induction/maintenance) was identified using operating room booking times for procedure start, and anesthetic types were identified based on intraoperative minimum alveolar concentration values in the different phases of the anesthetic. From 36,347 cases in our operating room booking system, we matched 24,457 cases with available vital signs. Of these, 20,613 (84%) had valid NIBP data and could be assigned to one anesthetic type: TIVA 11,819 [57%], IHA 4,752 [23%], and MIVA 4,042 [20%]. Mean NIBP during anesthesia increased with age, from median values of 48 mmHg (TIVA), 45 mmHg (IHA), and 41 mmHg (MIVA) in neonates, to 70 mmHg (TIVA), 68 mmHg (IHA), and 64 mmHg (MIVA) in 18-year-olds, respectively. In children < 1 year, mean NIBP values were 4 mmHg higher with TIVA than IHA (p < 0.001). These pediatric NIBP reference values contribute to ongoing debate about alarm limits based on age and anesthetic type, and may motivate prospective studies into the effects of different anesthesia regimes on vital signs.

Comparison of different flow rates of transnasal humidified rapid-insufflation ventilatory exchange for prevention of hypoxemia in painless gastroscopy / 中华消化内镜杂志

Objective:To explore the clinical effect of different flow rates of transnasal humidified rapid-insufflation ventilatory exchange (Thrive) on hypoxic events during painless gastroscopy.Methods:Patients who underwent painless gastroscopy in Nanjing First Hospital from April to July 2020 were randomly selected by random number table method and assigned to Thrive groups of 30 L/min ( n=52), 50 L/min ( n=55) and 70 L/min ( n=54). The incidences of different degree of hypoxic events (including subclinical respiratory depression, hypoxia and severe hypoxia) and adverse events related to Thrive were recorded. Results:The total incidence of hypoxic events in the 70 L/min group was 0 (0/54), which was significantly lower than that in the 30 L/min group (21.3%, 11/52, χ2=12.75, P<0.001) and 50 L/min group (12.7%, 7/55, P=0.007). There were no significant differences in subclinical respiratory depression [13.5% (7/52) VS 5.5% (3/55), χ2=1.19, P=0.194] or hypoxia [7.7% (4/52) VS 7.3% (4/55), P=0.610] between 30 L/min group and 50 L/min group. No severe hypoxia occurred in any group. The oxygenation of patients with hypoxemia in 30 L/min and 50 L/min groups was improved (SpO 2>95%) after opening the airway by mandibular support. In addition, there were no significant differences in the incidence of adverse events except hypoxemia among the three groups ( P>0.05). Conclusion:The flow rates of Thrive of 30 L/min, 50 L/min, and 70 L/min can prevent the occurrence of severe hypoxia during painless gastroscopy, and the flow rate of 70 L/min can further reduce the incidence of subclinical respiratory depression.

Anesthetic efficacy of remiazolam combined with alfentanil in patients undergoing painless gastroscopy / 中华麻醉学杂志

Objective:To evaluate the anesthetic efficacy of remiazolam combined with alfentanil in the patients undergoing painless gastroscopy.Methods:A total of 400 patients of both sexes, aged 20-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective painless gastroscopy, were divided into 2 groups ( n=200 each) using the computer-generated random numbers: remimazolam combined with alfentanil group (group RA) and propofol combined with alfentanil group (group PA).All subjects inhaled oxygen and were denitrogenated by deep inhalation.Alfentanil 7 μg/kg and remimazolam 0.2 mg/kg were intravenously injected in group RA, and alfentanil 7 μg/kg and propofol 1.5 mg/kg were intravenously injected in group PA.When body movement occurred during operation, remimazolam 2.5 mg was intravenously injected in group RA, propofol 0.5 mg/kg was intravenously injected in group PA, and anesthesia was defined as failure when there was still body movement after 3 times of additional injection within 15 min.The success of anesthesia, effective time of sedatives, time of gastroscopy, emergence time, perioperative adverse reactions, and satisfaction score of endoscopic surgeons-anesthesiologists-patients were assessed using visual analog scale score. Results:Compared with group PA, the incidence of hypotension (6.2%/14.0%), bradycardia (6.2%/19.0%), respiratory depression (3.1%/8.0%), injection pain (2.1%/30.0%), postoperative nausea (6.3%/25.0%), fatigue (7.8%/14.0%) was significantly decreased, and the incidence of hiccup (8.3%/1.0%) and patient′ s satisfaction score were increased in group RA ( P<0.05).There was no significant difference between the two groups in the success rate of sedation, effective time of sedatives, time of gastroscopic examination, emergence time, satisfaction scores of anesthesiologists-endoscopic surgeons, and incidence of postoperative vomiting, dizziness, and lethargy ( P>0.05). Conclusions:Compared with conventional anesthesia for painless gastroscopy, remiazolam (0.2 mg/kg) combined with alfentanil (7 μg/kg) has a certain optimization effect in anesthesia for gastroscopy.

Analgesic effect of intravenous anesthesia induction combined anterior lumbar quadratus block and related hemodynamic changes in patients undergoing partial nephrectomy via retroperitoneal approach / 中华全科医师杂志

Objective:To investigate the analgesic effect of intravenous anesthesia induction combined with anterior quadratus lumborum block (AQLB)and related hemodynamic changes in patients undergoing laparoscopic retroperitoneal partial nephrectomy (RPN).Methods:A total of 116 patients undergoing elective laparoscopic partial nephrectomy for renal tumors in Jinhua Central Hospital from August 2021 to February 2022 were randomly divided into two groups with 58 cases in each group. Patients in control group received intravenous anesthesia , while those in study group received intravenous anesthesia induction with AQLB. The analgesic effect was evaluated at 1, 6, 12, 24, and 48 h after the operation. The hemodynamics were monitored at the time of entering the operating room (T 0), 3 min after induction of anesthesia (T 1), at the beginning of the operation (T 2), after the operation (T 3), and leaving the operating room (T 4). Microcirculation was assessed at 1, 6, 12, 24, and 48 h after operation. Cognitive function was assessed 30min before anesthesia, 6 h, 24 h, and 72 h after operation. Results:At 1, 6, 12, 24 and 48 h after operation, the visual analogue scale (VAS) of the resting (quiet state) pain in the study group were 3.2±1.2, 2.6±0.3,2.0±0.4, 1.5±0.4 and 0.8±0.2, which were significantly lower than those in control group (4.0±1.7, 3.4±0.7, 2.9±0.5, 1.7±0.5 and 1.2±0.3) ( t=2.93, P=0.004; t=8.00, P<0.001; t=10.07, P<0.001; t=2.38, P=0.019; t=8.45, P<0.001). There was no significant difference in heart rate and mean arterial pressure (MAP) at T 0 between two groups ; no significant difference in the heart rate at T 1, T 2, T 3 and T 4. There were significant differences in MAP levels at T 1, T 2, T 3 and T 4 between study group [(80.0±8.0)mmHg (1 mmHg=0.133 kPa), (84.4±8.4)mmHg, (80.4±5.7)mmHg, (86.4±4.7)mmHg and control group (77.1±7.5)mmHg, (88.0±8.6)mmHg, (83.0±7.7)mmHg, (92.2±6.2) mmHg; t=2.01, P=0.046; t=2.28, P=0.024; t=2.07, P=0.041; t=5.68, P<0.001]. At 6, 12, 24 and 48 h after operation, the morphological scores of tube loops in the study group were 1.0±0.2, 0.8±0.2, 0.7±0.1 and 0.7±0.1, which were lower than those in the control group (1.1 ±0.2, 0.9±0.2, 0.8±0.2 and 0.8±0.1; t=2.69, P=0.008; t=2.69, P=0.008; t=3.41, P=0.001; t=5.39 , P < 0.001). The blood flow status scores of the study group were 1.1±0.2, 0.9±0.2, 0.8±0.2 and 0.6±0.1, which were lower than those of the control group (1.2±0.2, 1.0±0.2, 0.9±0.2 and 0.7±0.1; t=2.69, P=0.008; t=2.69, P=0.008; t=2.69, P=0.008; t=5.39, P<0.001). The cognitive function scores of the study group and the control group were 24.4±1.0, 27.1±0.9 and 23.5±0.9, 26.7±0.9 at 6 h and 24 h after operation ( t=5.10, P<0.001; t=2.39, P=0.018); while there were no significant at 72 h after operation between two groups (28.2±0.9 vs. 28.1±0.8, t=0.63, P=0.529). Conclusion:Intravenous anesthesia induction combined with anterior quadratus lumborum block has a good analgesic effect in patients undergoing RPN, with stable hemodynamics and microcirculation, and not affecting cognitive function of patients.

Relationship between early postoperative recovery and frailty after digestive endoscopy-assisted minimally invasive surgery under intravenous anesthesia in the elderly / 中华麻醉学杂志

Objective:To evaluate the relationship between early postoperative recovery and frailty after digestive endoscopy-assisted minimally invasive surgery under intravenous anesthesia in the elderly.Methods:This study retrospectively selected hospitalized patients, aged ≥65 yr, scheduled for elective gastrointestinal endoscopic treatment.Early postoperative recovery time was defined as the period from the end of propofol administration to the achievement of a modified Aldrete score of 9.All the patients were divided into 2 groups according to whether the early recovery time after operation was less than 75%: normal early postoperative recovery time group and delayed early postoperative recovery time group.Frailty was assessed using the frailty phenotype (FP score 0-5), and the patient was diagnosed as frail (FP ≥3) or non-frail (FP 0-2). The age, sex, height, weight, smoking history, American Society of Anesthesiologists (ASA) Physical Status classification, type of operation, and baseline mean arterial pressure and heart rate were recorded.Logistic regression analysis was used to identify the risk factors for delayed early postoperative recovery time after minimally invasive digestive endoscopy under intravenous anesthesia in elderly patients.Results:A total of 214 patients were enrolled and divided into normal early postoperative recovery time group ( n=169) and delayed early postoperative recovery time group ( n=45). There were significant differences in frailty, age, drinking history of more than 10 yr, preoperative ASA Physical Status classification and propofol administration time between delayed early postoperative recovery time group and normal early postoperative recovery time group ( P<0.05). The results of logistic regression analysis indicated that frailty, age, ASA Physical Status classification Ⅲ, and propofol administration time were independent risk factors for the occurrence of delayed early postoperative recovery ( P<0.05). Conclusions:Frailty, age, ASA Physical Status classification Ⅲ and propofol administration time are independent risk factors for delayed early postoperative recovery time following digestive endoscopy-assisted minimally invasive surgery under intravenous anesthesia in elderly patients.

Anaesthetic management in neurosurgery in a patient with Eisenmenger syndrome and Down syndrome. A case report. / Manejo anestésico en neurocirugía de paciente con síndrome de Eisenmenger y síndrome de Down. Reporte de un caso.

Adults patients with congenital heart disease increasingly present for non cardiac surgery. The anesthetic management this type of patients in neurosurgery requires a meticulous surgical anesthetic planning. The need for urgent intervention, with the presence of a congenital heart disease evolved to Eisenmenger Syndrome, associated to a difficult airway, is a challenge for the anesthesiologist. The use of dexmedetomidine may be a valid alternative. We present the case of a patient with Down syndrome, and Eisenmenger syndrome who underwent drainage of brain abscess from the emergency department and was subsequently scheduled for reintervention. We compare the different anesthetic techniques used in both procedures, analyzing the implications they had on the main physiopathological alterations presented by the patient.

Anesthetic considerations of Joubert syndrome in patients with mitochondrial disease - A case report.

BACKGROUND: Joubert syndrome and mitochondrial disease are rare congenital diseases in which a wide range of symptoms affects multiple organs. Patients with these diseases present characteristic symptoms related to the musculoskeletal, respiratory, and neurological systems, which make it difficult for anesthesiologists to manage the patient's airway and choose appropriate anesthetic drugs. CASE: A 13-year-old male patient with Joubert syndrome and mitochondrial disease underwent elective surgery to insert a continuous ambulatory peritoneal dialysis catheter. Anesthesia was induced and maintained with propofol, remifentanil, and rocuronium. An I-gel was inserted to secure the airway; however, the fitting did not work properly, so the patient was intubated. The operation was completed without any major problems, and the intubated patient was transferred to the intensive care unit. CONCLUSIONS: Anesthesiologists should determine the method of anesthesia and prepare for unintended complications based on a full understanding of these congenital diseases.

Efficacy and safety of naborphine versus dizocine in painless visual anesthetics induced abortion / 中国基层医药

Objective:To investigate the efficacy and safety of naborphine versus dezocine in painless visual anesthetics induced abortion. Methods:A total of 120 patients who underwent painless visual anesthetics induced abortion in Zhongshan City People's Hospital and Zhongshan Shaxi Longdu Hospital, China during January to September in 2020. They were randomly assigned to receive intravenous naborphine hydrochloride injection (0.15 mg/kg, naborphine group) or dezocine injection (5 mg, dezocine group), followed by intravenous propofol (2 mg/kg). When the eyelash reflex disappeared, surgery was initiated. If there were body movements, 30-50 mg propofol was added as appropriate. Systolic blood pressure, diastolic blood pressure, blood oxygen saturation, and heart rate before anesthesia (T 0), at 3 minutes after the beginning of surgery (T 1), and during recovery (T 2) were compared between the two groups. The time to regain consciousness, postoperative visual analogue pain score, propofol dose, operative time, and adverse reactions were determined in each group. Results:There were slight, but not significant, differences in systolic blood pressure and heart rate between the two groups at T 0, T 1 and T2 (all P > 0.05). There were no significant differences in time to regain consciousness, postoperative visual analogue pain score, propofol dose and operative time between the two groups (all P > 0.05). The incidence of nausea and vertigo in the naborphine group was 8.3% (5/60) and 11.6% (7/60), respectively, which was significantly lower than that in the dezocine group [30.0% (18/60), 31.6% (19/60), χ2 = 9.09, 7.07, both P < 0.05). Conclusion:Naborphine combined with propofol for painless visual anesthetics induced abortion exhibits good anesthetic effects and safety, with fewer intraoperative and postoperative adverse reactions than dezocine combined with propofol.

Effects of dexmedetomidine on hemodynamics, quality of recovery from anesthesia and postoperative analgesia in children patients with hernia subjected to laparoscopic hernia repair / 中国基层医药

Objective:To investigate the effects of dexmedetomidine on hemodynamics, quality of recovery from anesthesia and postoperative analgesia in children patients with hernia subjected to laparoscopic hernia repair.Methods:A total of 120 children patients who received laparoscopic hernia repair in Shangyu Maternal and Child Health Hospital from March 2019 to March 2020 were included in this study. They were randomly assigned to receive anesthesia maintenance with either inhaled sevoflurane (control group, n = 60) or intravenous dexmedetomidine hydrochloride (observation group, n = 60). The hemodynamic changes at different time points [5 minutes before skin incision (T0), 5 minutes after skin incision (T1) and 15 minutes after skin incision (T2)] were compared between the control and observation groups. Time to extubation, time to recovery from anesthesia, time to wake up, occurrence of agitation, and duration of agitation were compared between the two groups. Visual Analogue Scale score at 3, 12 and 24 hours after surgery were compared between the control and observation groups. Results:Mean arterial pressure and heart rate measured at T1 in the observation group were (72.01 ± 1.64) mmHg and (136.42 ± 3.20) beats/minute, respectively, which were significantly lower than those in the control group [(76.31 ± 1.89) mmHg and (143.21 ± 3.45) beats/minute, t = 13.311, 11.177, both P < 0.05]. Mean arterial pressure and heart rate measured at T2 in the observation group were (69.32 ± 1.36) mmHg and (130.02 ± 2.61) beats/minute, respectively, which were significantly lower than those in the control group [(72.02 ± 1.86) mmHg, (134.09 ± 3.26) beats/minute, t = 9.077, 7.549, both P < 0.05]. Time to extubation, time to recovery from anesthesia, and time to wake up in the observation group were (7.15 ± 0.89) minutes, (10.36 ± 1.74) minutes, (26.76 ± 8.32) minutes, respectively, which were significantly shorter than those in the control group [(9.20 ± 1.43) minutes, (8.23 ± 1.56) minutes, (39.42 ± 12.15) minutes, t = 9.428, 7.060, 6.659, P < 0.05]. The incidence of agitation in the observation group was significantly lower than that in the control group [10.00% (6/15) vs. 25.00% (15/60), χ2= 4.675, P < 0.05)]. Duration of agitation in the observation group was significantly shorter than that in the control group [(6.75 ± 1.32) minutes vs. (10.85 ± 2.14) minutes, t = 12.631, P < 0.05]. At 3, 12 and 24 hours after surgery, Visual Analogue Scale score in the observation group was (2.15 ± 0.34) points, (1.45 ± 0.38) points and (1.08 ± 0.26) points, respectively, which were significantly lower than that in the control group [(3.24 ± 0.53) points, (2.16 ± 0.39) points, (1.54 ± 0.32) points, t = 13.409, 10.100, 8.642, all P < 0.05]. Conclusion:Dexmedetomidine hydrochloride has little effect on hemodynamics during surgery in children patients with hernia subjected to laparoscopic hernia repair, with fast recovery from anesthesia, a low incidence of agitation, and obvious postoperative analgesia.

Anesthetic effects of inhalational sevoflurane versus intravenous ketamine in pediatric surgical anesthesia / 中国基层医药

Objective:To investigate the anesthetic effects of inhalational sevoflurane versus intravenous ketamine in pediatric surgical anesthesia. Methods:A total of 100 patients with appendicitis who underwent appendectomy in Ningbo Ninth Hospital between June 2017 and August 2018 were included in this study. They were randomly assigned to receive either inhalational anesthesia with sevoflurane (observation group, n = 50) or intravenous anesthesia with ketamine (control group, n = 50). Hemodynamic indexes at different time periods (T1: 5 minutes after entering the room, T2: after anesthesia induction, T3: immediately after skin incision, T4: operation completion), anesthesia induction, duration for anesthesia induction and recovery from anesthesia, liver function, and adverse reactions were compared between the observation and control groups. Results:There was no significant difference in peripheral oxygen saturation (SpO 2) level at different time periods between the observation and control groups (all P > 0.05). At T1, there were no significant differences in mean arterial pressure and heart rate between the two groups (both P > 0.05). At T2, T3 and T4, mean arterial pressure in the observation group was (67.25 ± 1.32) mmHg, (67.52 ± 1.32) mmHg, and (66.28 ± 1.31) mmHg, respectively, and heart rate was (115.21 ± 2.32) beats/minute, (112.21 ± 1.34) beats/minute and (111.25 ± 1.32) beats/minute, respectively. There were significant differences in mean arterial pressure and heart rate measured at T2, T3 and T4 between the observation and control groups ( t = 19.176, 16.817, 30.015, 58.797, 51.649, 2.617, all P < 0.05). The time to pain reflex disappearance and the time to eyelash reflex disappearance in the observation group were (2.32 ± 0.21) minutes and (1.26 ± 0.32) minutes, respectively, which were significantly longer than those in the control group ( t = 9.247, 4.251, both P < 0.05). The time to eye opening or body movement and the time to getting out of operation room were (3.21 ± 1.32) minutes and (5.52 ± 1.13) minutes respectively, which were significantly shorter than those in the control group ( t = 91.851, 109.641, both P < 0.05). After surgery, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and bilirubin levels in the observation group were (26.01 ± 1.32) U/L, (22.02 ± 1.32) U/L, (486.32 ± 2.74) U/L, (0.66 ± 0.02) U/L, respectively. There were significant differences in these indexes between observation and control groups ( t = 6.036, 6.798, 23.741, 3.500, all P < 0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group ( χ2 = 9.470, P < 0.05). Conclusion:Inhalational sevoflurane is advantageous over and safer than intravenous ketamine in pediatric surgical anesthesia.

Effect of different withdrawal sequences on quality of recovery in patients undergoing endoscopic sinus surgery under combined intravenous and inhalation anesthesia / 中国基层医药

Objective:To investigate the effect of two different withdrawal sequences on the quality of recovery in patients undergoing nasal endoscopic surgery under combined intravenous and inhalation anesthesia.Methods:Seventy patients scheduled for endoscopic sinus surgery in The First Affiliated Hospital of Xiamen University, China from January to June 2019 were included in this study and randomly assigned to undergo intravenous anesthesia alone (Group A, n = 35) or combined intravenous and inhalation anesthesia (Group B, n = 35). Propofol 2-4 mg/kg, fentanyl 3-4 μg/kg, cisatracurium besylate 0.2 mg/kg were used to induce anesthesia. Propofol 4-6 mg/kg/h, remifentanil 6.5-13.0 mg/kg/h, sevoflurane ≥ 0.30 minimum alveolar concentration were used to maintain anesthesia. At 30 minutes before the end of surgery, inhalational sevoflurane administration and pump propofol administration were stopped in the groups A and B respectively. At 10 minutes before the end of surgery, pump propofol administration and inhalational sevoflurane administration were stopped in the groups A and B respectively. At the end of surgery, pump remifentanil administration was stopped in both groups A and B. The time to spontaneous breathing recovery, the time to consciousness recovery, and the time to tracheal extubation were recorded. Mean arterial pressure and heart rate were recorded at the time of entering the operation room (T0), at the end of anesthesia (T1), at the time of spontaneous breathing recovery (T2), consciousness recovery (T3) and tracheal extubation (T4), 5 minutes (T5) and 10 minutes after tracheal extubation (T6). Agitation score was recorded at T2-T6 and at 20 minutes after tracheal extubation (T7). Cough score was recorded at T4. Results:The time to spontaneous breathing recovery, the time to consciousness recovery, and the time to tracheal extubation in group A were (16.0 ± 4.6) minutes, (18.0 ± 5.3) minutes, (19.0 ± 5.5) minutes, respectively, which were significantly longer than (8.8 ± 3.5) minutes, (9.5 ± 4.1) minutes, (10.7 ± 4.5) minutes, respectively in the group B ( t = 9.554, 8.881, 9.011, all P < 0.05). There were no significant differences in mean arterial pressure and heart rate recorded at T0-T6 between groups A and B (all P > 0.05). There was no significant difference in agitation score measured at T3-T6 between groups A and B (all P > 0.05). There was no significant difference in cough score recorded at T4 between groups A and B ( P > 0.05). Conclusion:Two different withdrawal sequences can maintain stable hemodynamics and reduce agitation during recovery period and cough during extubation. The recovery time of remifentanil combined with propofol is longer than that of remifentanil combined with sevoflurane.

Comparison of intravenous anesthesia between propofol and etomidate in patients undergoing laparoscopic surgery and their effects on plasma nitric oxide and endothelin-1 / 中国医师进修杂志

Objective:To compare the effects of intravenous anesthesia between propofol and etomidate in patients undergoing laparoscopic surgery and their effects on plasma nitric oxide (NO) and endothelin-1 (ET-1).Methods:The clinical data of 80 patients with laparoscopic surgery in Guangrao People′s Hospital from March 2017 to March 2019 were retrospectively analyzed. Among them, 40 cases were given propofol intravenous anesthesia (propofol group), and 40 cases were given etomidate intravenous anesthesia (etomidate group). The anesthetic effect, plasma NO and ET-1 levels, hemodynamic indexes and adverse reactions (muscle spasm, nausea and vomiting, injection site pain, body movement and respiratory depression) were compared between the two groups.Results:The time of consciousness disappearance, tracheal intubation, eye opening, spontaneous breathing and speech response in etomidate group were significantly shorter than those in propofol group: (57.48 ± 2.63) s vs. (86.17 ± 7.41) s, (4.39 ± 2.56) min vs. (6.42 ± 2.58) min, (5.39 ± 2.56) min vs. (9.42 ± 2.58) min, (5.21 ± 1.99) min vs. (8.75 ± 2.54) min and (8.39 ± 2.56) min vs. (8.39 ± 2.56) min, and the differences were statistically significant ( P<0.05). The levels of NO and ET-1 in the etomidate group were significantly lower than those in the propofol group at 0.5, 1.0 and 1.5 h after pneumoperitoneum ( P< 0.05). The levels of systolic blood pressure, diastolic blood pressure and oxygen saturation (SpO 2) in the etomidate group were significantly higher than those in the propofol group: (78.42 ± 4.68) mmHg (1 mmHg = 0.133 kPa) vs. (74.11 ± 6.63) mmHg, (132.86 ± 8.71) mmHg vs. (111.24 ± 3.56) mmHg and 0.982 ± 0.032 vs. 0.953 ± 0.043, and the differences were statistically significant ( P<0.05). The incidence of adverse reactions in the etomidate group was significantly lower than that in the propofol group: 17.5% (7/40) vs. 47.5% (19/40), P<0.05. Conclusions:Compared with propofol intravenous anesthesia, etomidate intravenous anesthesia in laparoscopic surgery patients has more stable hemodynamics and better anesthetic effect. It can effectively inhibit the release of NO and ET-1, and has higher safety.

Meta-analysis of the effects of total intravenous anesthesia and inhalation anesthesia on early postoperative immune function, recurrence and metastasis in patients with malignant tumors / 中国医师进修杂志

Objective:To compare the effects of total intravenous anesthesia and inhalation anesthesia on early postoperative immune function, recurrence and metastasis by Meta-analysis in patients with malignant tumors.Methods:The PubMed, Embase and Cochrane Library were searched by computer from January 2010 to January 2020. The randomized controlled trials of surgical treatment using total intravenous anesthesia or inhalation anesthesia in patients with malignant tumors were collected. The RevMan 5.3 and STATA 15.0 softwares were used to analyze the impact of 2 anesthesia methods on early postoperative immune function indexes and tumor recurrence and metastasis in patients with malignant tumors. The immune function indexes included interleukin (IL)-6, IL-10, transforming growth factor (TGF)-β, vascular endothelial growth factor (VEGF)-C and natural killer (NK) cell.Results:A total of 8 articles were included, with a total of 665 patients. Meta analysis results show that, compared with inhalation anesthesia, total intravenous anesthesia could significantly reduce the levels of IL-6, TGF-β and VEGF-C in patients with malignant tumors after surgery ( SMD = - 0.35, - 0.26 and - 0.64; 95% CI - 0.58 to - 0.12, - 0.49 to - 0.02 and - 0.99 to - 0.28; P<0.01 or <0.05); the 2 anesthesia methods had no significant effect on IL-10 and NK cell in patients with malignant tumors after surgery ( SMD = 0.16 and 0.18, 95% CI - 0.07 to 0.39 and - 0.23 to 0.60, P>0.05); and the 2 anesthesia methods had no significant effect on tumor recurrence and metastasis in patients with malignant tumors ( RR = 0.70, 95% CI 0.47 to 1.03, P = 0.07). Conclusions:Total intravenous anesthesia may improve the early postoperative immune function in patients with malignant tumor by reducing the levels of pro-cancer factors IL-6, TGF-β and VEGF-C, but total intravenous anesthesia has no obvious effect on reducing postoperative tumor recurrence and metastasis in patients with malignant tumor.