Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendici...Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups.The study group received combined spinal-epidural anesthesia,while the control group received epidural anesthesia.Anesthesia indicators,vital signs,and complication indicators were compared between the two groups.Results:The onset time of anesthesia in the study group was shorter than that in the control group,the visual analog scale(VAS)score was lower than that in the control group,and the highest plane of anesthesia block was lower than that in the control group(P<0.05).At 15 minutes after anesthesia induction and at the end of surgery,the heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SPO2)in the study group were significantly different from those in the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).Conclusion:Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs,shorten the onset time of anesthesia,and is highly effective and feasible.展开更多
Objective： To investigate the dynamics of vascular volume and the plasma dilution of lactated Ringer＇s solution in patients during the induction of general and epidural anesthesia. Methods： The hemodilution of i.v....Objective： To investigate the dynamics of vascular volume and the plasma dilution of lactated Ringer＇s solution in patients during the induction of general and epidural anesthesia. Methods： The hemodilution of i.v. infusion of 1000 ml of lactated Ringer＇s solution over 60 min was studied in patients undergoing general （n=31） and epidural （n= 22） anesthesia. Heart rate, arterial blood pressure and hemoglobin （Hb） concentration were measured every 5 rain during the study. Surgery was not started until the study period had been completed. Results： General anesthesia caused the greater decrease of mean arterial blood pressure （MAP） （mean 15% versus 9%; P〈0.01） and thereby followed by a more pronounced plasma dilution, blood volume expansion （VE） and blood volume expansion efficiency （VEE）. A strong linear correlation between hemodilution and the reduction in MAP （r=-0.50;P〈0.01） was found. At the end of infusion, patients undergoing general anesthesia retained 47% （SD 19%） of the infused fluid in the circulation, while epidural anesthesia retained 29% （SD 13%） （P〈0.001）. Correspondingly, a fewer urine output （mean 89 ml versus 156 ml; P〈0.05） and extravascular expansion （454 ml versus 551 ml; P〈0.05） were found during general anesthesia. Conclusion： We concluded that the induction of general anesthesia caused more hemodilution, volume expansion and volume expansion efficiency than epidural anesthesia, which was triggered only by the lower MAP.展开更多
Nonintubated video-assisted thoracic surgery （VATS） that is also defined awake VATS entails thoracoscopic procedures performed by regional anesthesia in spontaneously ventilating,mildly sedated or fully awake patients.
Thoracoscopic surgeries usually require single-lung ventilation under general anesthesia because of the need to obtain a sufficient working space.In patients with impaired pulmonary function,if the patient can undergo...Thoracoscopic surgeries usually require single-lung ventilation under general anesthesia because of the need to obtain a sufficient working space.In patients with impaired pulmonary function,if the patient can undergo general anesthesia,a more selected collapse of the lung is considered to be beneficial for intraoperative oxygenation.The selective bronchial blockade of the lobe to be resected has been reported by several investigators （1-3）.Mukaida and coworkers first reported thoracoscopic surgery for pnenmothorax under local and epidural anesthesia in 1998 in high-risk patients contraindicated for general anesthesia （4）.展开更多
Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. ...Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.展开更多
Objective: to investigate the effect of general anesthesia + epidural anesthesia on postoperative analgesia of gastric cancer. Methods: 78 patients with gastric cancer were randomly divided into control group (39 case...Objective: to investigate the effect of general anesthesia + epidural anesthesia on postoperative analgesia of gastric cancer. Methods: 78 patients with gastric cancer were randomly divided into control group (39 cases under general anesthesia) and observation group (39 cases under general anesthesia combined with epidural anesthesia). The pain score and the incidence of adverse reactions were compared between the two groups. Results: the pain score of the observation group at 6h, 12h and 24h was lower than that of the control group (P<0.05). The incidence of adverse reactions in observation group (7.69%) was lower than that in control group (30.77%) (P<0.05). Conclusion: general anesthesia + epidural anesthesia has better effect on postoperative analgesia of gastric cancer and fewer adverse reactions.展开更多
Objective: to study and analyze the application value of posture management in caesarean section of obese parturients under combined spinal epidural anesthesia. Methods: 60 obese cesarean section parturients admitted ...Objective: to study and analyze the application value of posture management in caesarean section of obese parturients under combined spinal epidural anesthesia. Methods: 60 obese cesarean section parturients admitted to our hospital from May 2019 to February 2022 were included;Randomized number table method was used to divide into study group and control group;30 cases each;All patients underwent elective caesarean section under combined spinal and epidural anesthesia;The control group carried out routine perinatal management;The research group also carried out posture management;The perioperative vital signs, blood pressure at different stages of anesthesia, stress status and nursing satisfaction of the two groups were evaluated and compared. Results: the temperature of patients in the study group was higher than that in the control group 2 hours after operation;Heart rate was lower than that of control group;The systolic and diastolic blood pressure in the study group were higher than those in the control group 10 minutes after anesthesia injection;IR index and NR level were lower than those of control group;The scores of SERVQUAL were higher than those of the control group;The difference was statistically significant (P0.05). Conclusion: the application of posture management in caesarean section for obese parturients under combined spinal epidural anesthesia can stabilize the perioperative vital signs, relieve the decrease of blood pressure after anesthesia, improve the early postoperative stress, and improve nursing satisfaction.展开更多
Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our...Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.展开更多
Objective: to investigate the effect of general anesthesia combined with epidural anesthesia during laparoscopic gynecological surgery on hemodynamic indexes of patients. Methods: a total of 180 patients treated with ...Objective: to investigate the effect of general anesthesia combined with epidural anesthesia during laparoscopic gynecological surgery on hemodynamic indexes of patients. Methods: a total of 180 patients treated with gynecological laparoscopic surgery in Xinzhou Peoples Hospital from January to December 2022 were extracted The observation objects, according to the hospital group specifications, were divided into control group and observation group, each group was extracted according to the number of 90 cases, and laparoscopic treatment was carried out, in terms of anesthesia selection, the control group selected single general anesthesia for surgery, the observation group combined with epidural anesthesia on the basis of the anesthesia of the previous group, and the 6 index observations during anesthesia in the two groups were included in statistical data analysis, namely hemodynamic indexes, clinical medical index and scores, adverse reactions after medication, muscle relaxation, traction reactions, and actual effects of anesthesia. Results: before the application of narcotic drugs, no significant difference in hemodynamic indexes between the two groups was detected (P>0.05). After the administration of narcotic drugs, the ratio of the measured index values in the observation group to the control group was statistically significant (P<0.05). After anesthesia administration in the two groups, the observation group had shorter onset time, longer analgesic time and exercise recovery time, and higher Bromage exercise score, but there was no significant difference between the observation group and the control group (P>0.05). The prevalence of various adverse reactions after anesthesia in the observation group showed a lower level (P<0.05). After the observation group, the rate of muscle relaxation was higher (P<0.05). After anesthesia administration in the observation group, the proportion of 0 samples of traction reaction was higher (P<0.05). The overall excellent rate of the anesthesiologists in the observation group evaluated the actual effect of this anesthesia medication was higher than that of the control group (P<0.05). Conclusion: the synergy of general anesthesia and epidural anesthesia in the treatment of gynecological laparoscopic surgery can improve the actual effect of anesthesia, reduce the adverse reactions of patients after anesthesia, improve muscle relaxation and traction response, and ensure the smooth completion of surgery.展开更多
Objective: to study and analyze the clinical effect of ropivacaine combined with spinal epidural anesthesia in elderly patients undergoing lower limb surgery. Methods: the time range of this study was 2019.12-2020.12,...Objective: to study and analyze the clinical effect of ropivacaine combined with spinal epidural anesthesia in elderly patients undergoing lower limb surgery. Methods: the time range of this study was 2019.12-2020.12, and the subjects were 92 elderly patients who were admitted to hospital for lower limb surgery during this period. Patients were randomly assigned to the control group and the study group on average, the former was given bupivacaine and the latter was given ropivacaine, and the effects of application were compared. Results: the onset time of sensory block, the recovery time of exercise and the incidence of adverse reactions in the study group were lower than those in the control group, P < 0.05, which was statistically significant. There was no significant difference in the onset time of motion block arrest between the two groups (P > 0.05). Conclusion: the use of ropivacaine combined with spinal epidural anesthesia can bring positive anesthesia effect in the lower limb surgery of elderly patients, its application effect is outstanding, should be vigorously promoted.展开更多
To investigate the application of combined spinal and epidural anesthesia combined with volume therapy in high-risk elderly patients undergoing orthopedic surgery. Methods: a total of 50 patients were included in this...To investigate the application of combined spinal and epidural anesthesia combined with volume therapy in high-risk elderly patients undergoing orthopedic surgery. Methods: a total of 50 patients were included in this study, all of whom were high-risk elderly orthopedic surgery patients admitted to our hospital from January, 2019 to December, 2019. According to the principle of odd-even distribution, the patients were divided into control group (25 cases) and experimental group (25 cases). Patients in the former group received epidural anesthesia, and patients in the latter group received combined lumbar epidural anesthesia combined with volume therapy. The anesthetic effect of the two groups was observed. Results: compared with the incidence of adverse reactions in the two groups, the anesthetic effect of the experimental group was better than that of the control group, and the incidence of adverse reactions was 12.00% lower than that of the control group 28.00% (P<0.05). Conclusion: lumboid epidural anesthesia combined with volume therapy is helpful to improve anesthesia effect, reduce the risk of perioperative adverse reactions, and help patients recover.展开更多
Objective: to explore the clinical significance of general anesthesia combined with epidural anesthesia in the treatment of hysteromyoma. Methods: 100 patients who underwent hysteromyomectomy in our hospital from Janu...Objective: to explore the clinical significance of general anesthesia combined with epidural anesthesia in the treatment of hysteromyoma. Methods: 100 patients who underwent hysteromyomectomy in our hospital from January 2019 to December 2020 were randomly allocated, 50 patients in each group. The general anesthesia group was all under general anesthesia, while the compound anesthesia group was under general anesthesia combined with epidural anesthesia. The vital signs of the two groups before tracheal intubation, immediately after tracheal intubation, at the time of skin incision, at the end of surgery and at the time of tracheal extubation were compared, and the incidence of postoperative complications was compared. Results: there was no significant difference in vital signs immediately before tracheal intubation between compound anesthesia group and general anesthesia group (P > 0.05). The vital signs of the compound anesthesia group were lower than those of the general anesthesia group immediately after tracheal intubation, at the time of skin incision, at the end of operation and at the time of tracheal extubation (P < 0.05). The incidence of postoperative complications in compound anesthesia group was lower than that in general anesthesia group (P < 0.05). Conclusion: compared with total anesthesia, general anesthesia combined with epidural anesthesia is effective in hysteromyoma surgery, which can effectively maintain good anesthetic effect and reduce the occurrence of complications. It is worthy of promotion and application.展开更多
As a means of pain relief, anesthesia is becoming more and more recognized and used by the medical community. Epidural anesthesia is the injection of a local anesthetic into the epidural cavity to block the spinal ner...As a means of pain relief, anesthesia is becoming more and more recognized and used by the medical community. Epidural anesthesia is the injection of a local anesthetic into the epidural cavity to block the spinal nerve root and temporarily paralyze the innervated area. Combined lumbar anesthetic-epidural block anesthesia is the injection of a local anesthetic into the cerebrospinal fluid. Blocking is produced by acting directly on the anterior and posterior roots of the spinal nerve and spinal cord. Waist anesthesia-epidural combined block anesthesia is effective in maintaining normal cardiopulmonary function and works quickly. In this study, 100 patients treated from April 2018 to June 2021 were randomly divided into observation and control groups, with 50 patients in each group. The control group underwent epidural anesthesia, and the observation group performed both lumbar anesthesia and epidural anesthesia to analyze the anesthesia effect. The results are reported as follows.展开更多
Objective: TO study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of small dose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystecto...Objective: TO study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of small dose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia group (group A, n = 66), acupoint-skin electrical stimulation combined with epidural anesthesia group (group B, n = 63) and simple epidural anesthesia group (group C, n=65). Observations were conducted using single-bland method. Bilateral Neiguan (PC 6) and Zusanli (ST 36) were punctured and stimulated electrically in group A and only stimulated electrically via cutaneous electrodes in group B. Epidural anesthetic used was 1.5% Lidocaine and the anesthetic level was controlled to reach T4-11 . Results: The class-I (excellent) rates of group A, B and C were 75.76%, 60.32% and 13.85% respectively, showing significant differences between group A and C and group B and C (P <0.001). The initial dose, doses of every hour and every case of group A and B were lower than those of group C. The dose of every hour of group C was 36.23% and 3. 75% higher then group A and B respectively (P < 0. 001), suggesting that acupuncture or acupoint-skin electrical stimulation could strengthen anesthetic effect and reduce the dose of epidural anesthetic. During operation, indexes of the life signs as HR, MAP, RR, TV, MV, SpO2 and ECG kept basically stable and all patients in group A passed surgical operation safely. Conclusion: Acupuncture or acupoint-skin electrical stimulation combined with epidural anesthesia can be used as one of the anesthetic methods for cholecystectomy.展开更多
Objective： To investigate the effects of acupuncture on the morphine-related side effects （nausea, vomiting, itchiness and gastrointestinal disorders） in patients undergoing anesthesia and analgesia and try to find...Objective： To investigate the effects of acupuncture on the morphine-related side effects （nausea, vomiting, itchiness and gastrointestinal disorders） in patients undergoing anesthesia and analgesia and try to find the clinical mechanism of acupuncture. Methods： Patients scheduled to have transurethral prostatic resection enrolled in the study （69 patients）, characterized as Grade Ⅱ or Ⅲ by the American Society of Anesthesiologists physical status classification, were randomly assigned to three groups, 23 patients in each group： the placebo group （control group）, non-anesthesia area （NAA） group, and the anesthesia area （AA） group. After spinal anesthesia, all patients received Patients Controlled Epidural Analgesia. The vital signs, bowel sounds, visual analogue scales, itchiness, nausea and vomiting, and time for first exhaust post operation were observed. Results： Altogether, nine cases were eliminated, three in each group. Finally, sixty cases completed this study, twenty in each group. There was a significant decrease of bowel sounds after morphine spinal anesthesia in the three groups. Compared with the control or AA group, the bowel sound recovered after acupuncture, the incidences of nausea and vomiting, itchiness, and time for first exhaust after operation decreased in the NAA group （P〈0.05）. There was a significant decrease of the incidence for itchiness in the NAA group compared with the control group （P〈0.05）. Conclusions： On the basis of this study, it is obviously seen that acupuncture could decrease the incidence of morphine-related side effects （nausea and vomiting, itchiness and gastrointestinal disorders） when the spinal cord conduct is normal. However, it decreases only the incidence of itchiness but not for gastrointestinal dysfunction when the spinal cord is blocked.展开更多
Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods: 33 ch...Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods: 33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n=11), acupoint skin electrical stimulation combined with epidural anesthesia (B) group (n=11) and simple epidural anesthesia (C) group (n=11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2～3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before, during and 3 days after operation for detecting plasma NE, E and DA contents. Results: ① During operation, plasma NE of group A and B lowered in comparison with pre operation, particularly group A (P<0.01), while in group C, plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre operation (P< 0.01). Plasma DA in the 3 groups all raised during operation. ② Three days after operation, plasma NE, E and DA levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effect has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. Conclusion: Acupuncture or acupoint surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy.展开更多
In the present paper, the authors make a review on the progresses of acupuncture anesthesia (AA) from ① historical development, ② research on acupuncture combined with local anesthesia; ③ research on acupuncture co...In the present paper, the authors make a review on the progresses of acupuncture anesthesia (AA) from ① historical development, ② research on acupuncture combined with local anesthesia; ③ research on acupuncture combined with epidural anesthesia; and ④ research on acupuncture combined with general anesthesia. Compound acupuncture anesthesia provides a new anesthetic measure for surgical operations and has a definite analgesic effect and many advantages, and should be investigated further.展开更多
Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the...Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (p<.05). The probability of making an accidental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.展开更多
Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate ...Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate if there were improvements in the performance of anesthesia novice trainees when executing the epidural technique after an EMME of epidural block procedure. Methods: We developed an eye movement modeling example (EMME) from eye tracking recordings made by experienced anesthesiologists with more than 20 years of experience. Forty-two PGY3 anesthesia trainees who had never previously performed an epidural block were randomized to receive (study group) or not receive (control group) the EMME video before their institutional training. All the trainees were evaluated every 10 epidural blocks until the end of the rotation period, by an independent, blinded observer using the Global Rating Scale for Epidural Anesthesia (GRS). Results: Trainees who received the EMME training exhibited more respect for the patient’s tissues (P Discussion: This is the first study that has used the EMME for a practical, clinical teaching purpose on real patients and that has used it as an aid in teaching epidural anesthesia. We demonstrated that inexperienced trainees who received the EMME training improved their proficiency at epidural blocks as compared to those who had no EMME training beforehand. Given this result, we welcome further studies to investigate the impact and the role of EMME on clinical teaching in the field of anesthesia.展开更多
文摘Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia in patients undergoing appendicitis surgery.Methods:Seventy-eight patients who underwent surgical treatment for appendicitis from February 2022 to February 2025 were selected as samples and randomly divided into two groups.The study group received combined spinal-epidural anesthesia,while the control group received epidural anesthesia.Anesthesia indicators,vital signs,and complication indicators were compared between the two groups.Results:The onset time of anesthesia in the study group was shorter than that in the control group,the visual analog scale(VAS)score was lower than that in the control group,and the highest plane of anesthesia block was lower than that in the control group(P<0.05).At 15 minutes after anesthesia induction and at the end of surgery,the heart rate(HR),mean arterial pressure(MAP),and blood oxygen saturation(SPO2)in the study group were significantly different from those in the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).Conclusion:Combined spinal-epidural anesthesia for appendicitis surgery can reduce the impact of anesthesia on vital signs,shorten the onset time of anesthesia,and is highly effective and feasible.
基金Project (No. 20051899) supported by Office of Education of Zheji-ang Province, China
文摘Objective： To investigate the dynamics of vascular volume and the plasma dilution of lactated Ringer＇s solution in patients during the induction of general and epidural anesthesia. Methods： The hemodilution of i.v. infusion of 1000 ml of lactated Ringer＇s solution over 60 min was studied in patients undergoing general （n=31） and epidural （n= 22） anesthesia. Heart rate, arterial blood pressure and hemoglobin （Hb） concentration were measured every 5 rain during the study. Surgery was not started until the study period had been completed. Results： General anesthesia caused the greater decrease of mean arterial blood pressure （MAP） （mean 15% versus 9%; P〈0.01） and thereby followed by a more pronounced plasma dilution, blood volume expansion （VE） and blood volume expansion efficiency （VEE）. A strong linear correlation between hemodilution and the reduction in MAP （r=-0.50;P〈0.01） was found. At the end of infusion, patients undergoing general anesthesia retained 47% （SD 19%） of the infused fluid in the circulation, while epidural anesthesia retained 29% （SD 13%） （P〈0.001）. Correspondingly, a fewer urine output （mean 89 ml versus 156 ml; P〈0.05） and extravascular expansion （454 ml versus 551 ml; P〈0.05） were found during general anesthesia. Conclusion： We concluded that the induction of general anesthesia caused more hemodilution, volume expansion and volume expansion efficiency than epidural anesthesia, which was triggered only by the lower MAP.
文摘Nonintubated video-assisted thoracic surgery （VATS） that is also defined awake VATS entails thoracoscopic procedures performed by regional anesthesia in spontaneously ventilating,mildly sedated or fully awake patients.
文摘Thoracoscopic surgeries usually require single-lung ventilation under general anesthesia because of the need to obtain a sufficient working space.In patients with impaired pulmonary function,if the patient can undergo general anesthesia,a more selected collapse of the lung is considered to be beneficial for intraoperative oxygenation.The selective bronchial blockade of the lobe to be resected has been reported by several investigators （1-3）.Mukaida and coworkers first reported thoracoscopic surgery for pnenmothorax under local and epidural anesthesia in 1998 in high-risk patients contraindicated for general anesthesia （4）.
文摘Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.
文摘Objective: to investigate the effect of general anesthesia + epidural anesthesia on postoperative analgesia of gastric cancer. Methods: 78 patients with gastric cancer were randomly divided into control group (39 cases under general anesthesia) and observation group (39 cases under general anesthesia combined with epidural anesthesia). The pain score and the incidence of adverse reactions were compared between the two groups. Results: the pain score of the observation group at 6h, 12h and 24h was lower than that of the control group (P<0.05). The incidence of adverse reactions in observation group (7.69%) was lower than that in control group (30.77%) (P<0.05). Conclusion: general anesthesia + epidural anesthesia has better effect on postoperative analgesia of gastric cancer and fewer adverse reactions.
文摘Objective: to study and analyze the application value of posture management in caesarean section of obese parturients under combined spinal epidural anesthesia. Methods: 60 obese cesarean section parturients admitted to our hospital from May 2019 to February 2022 were included;Randomized number table method was used to divide into study group and control group;30 cases each;All patients underwent elective caesarean section under combined spinal and epidural anesthesia;The control group carried out routine perinatal management;The research group also carried out posture management;The perioperative vital signs, blood pressure at different stages of anesthesia, stress status and nursing satisfaction of the two groups were evaluated and compared. Results: the temperature of patients in the study group was higher than that in the control group 2 hours after operation;Heart rate was lower than that of control group;The systolic and diastolic blood pressure in the study group were higher than those in the control group 10 minutes after anesthesia injection;IR index and NR level were lower than those of control group;The scores of SERVQUAL were higher than those of the control group;The difference was statistically significant (P0.05). Conclusion: the application of posture management in caesarean section for obese parturients under combined spinal epidural anesthesia can stabilize the perioperative vital signs, relieve the decrease of blood pressure after anesthesia, improve the early postoperative stress, and improve nursing satisfaction.
基金Weifang Municipal Science and Technology Bureau(Medical)Project“Effects and Mechanisms of Oxycodone and Alfentanil on IgFs in Mouse Ovarian Granulosa Cells”(2021YX035)。
文摘Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.
文摘Objective: to investigate the effect of general anesthesia combined with epidural anesthesia during laparoscopic gynecological surgery on hemodynamic indexes of patients. Methods: a total of 180 patients treated with gynecological laparoscopic surgery in Xinzhou Peoples Hospital from January to December 2022 were extracted The observation objects, according to the hospital group specifications, were divided into control group and observation group, each group was extracted according to the number of 90 cases, and laparoscopic treatment was carried out, in terms of anesthesia selection, the control group selected single general anesthesia for surgery, the observation group combined with epidural anesthesia on the basis of the anesthesia of the previous group, and the 6 index observations during anesthesia in the two groups were included in statistical data analysis, namely hemodynamic indexes, clinical medical index and scores, adverse reactions after medication, muscle relaxation, traction reactions, and actual effects of anesthesia. Results: before the application of narcotic drugs, no significant difference in hemodynamic indexes between the two groups was detected (P>0.05). After the administration of narcotic drugs, the ratio of the measured index values in the observation group to the control group was statistically significant (P<0.05). After anesthesia administration in the two groups, the observation group had shorter onset time, longer analgesic time and exercise recovery time, and higher Bromage exercise score, but there was no significant difference between the observation group and the control group (P>0.05). The prevalence of various adverse reactions after anesthesia in the observation group showed a lower level (P<0.05). After the observation group, the rate of muscle relaxation was higher (P<0.05). After anesthesia administration in the observation group, the proportion of 0 samples of traction reaction was higher (P<0.05). The overall excellent rate of the anesthesiologists in the observation group evaluated the actual effect of this anesthesia medication was higher than that of the control group (P<0.05). Conclusion: the synergy of general anesthesia and epidural anesthesia in the treatment of gynecological laparoscopic surgery can improve the actual effect of anesthesia, reduce the adverse reactions of patients after anesthesia, improve muscle relaxation and traction response, and ensure the smooth completion of surgery.
文摘Objective: to study and analyze the clinical effect of ropivacaine combined with spinal epidural anesthesia in elderly patients undergoing lower limb surgery. Methods: the time range of this study was 2019.12-2020.12, and the subjects were 92 elderly patients who were admitted to hospital for lower limb surgery during this period. Patients were randomly assigned to the control group and the study group on average, the former was given bupivacaine and the latter was given ropivacaine, and the effects of application were compared. Results: the onset time of sensory block, the recovery time of exercise and the incidence of adverse reactions in the study group were lower than those in the control group, P < 0.05, which was statistically significant. There was no significant difference in the onset time of motion block arrest between the two groups (P > 0.05). Conclusion: the use of ropivacaine combined with spinal epidural anesthesia can bring positive anesthesia effect in the lower limb surgery of elderly patients, its application effect is outstanding, should be vigorously promoted.
文摘To investigate the application of combined spinal and epidural anesthesia combined with volume therapy in high-risk elderly patients undergoing orthopedic surgery. Methods: a total of 50 patients were included in this study, all of whom were high-risk elderly orthopedic surgery patients admitted to our hospital from January, 2019 to December, 2019. According to the principle of odd-even distribution, the patients were divided into control group (25 cases) and experimental group (25 cases). Patients in the former group received epidural anesthesia, and patients in the latter group received combined lumbar epidural anesthesia combined with volume therapy. The anesthetic effect of the two groups was observed. Results: compared with the incidence of adverse reactions in the two groups, the anesthetic effect of the experimental group was better than that of the control group, and the incidence of adverse reactions was 12.00% lower than that of the control group 28.00% (P<0.05). Conclusion: lumboid epidural anesthesia combined with volume therapy is helpful to improve anesthesia effect, reduce the risk of perioperative adverse reactions, and help patients recover.
文摘Objective: to explore the clinical significance of general anesthesia combined with epidural anesthesia in the treatment of hysteromyoma. Methods: 100 patients who underwent hysteromyomectomy in our hospital from January 2019 to December 2020 were randomly allocated, 50 patients in each group. The general anesthesia group was all under general anesthesia, while the compound anesthesia group was under general anesthesia combined with epidural anesthesia. The vital signs of the two groups before tracheal intubation, immediately after tracheal intubation, at the time of skin incision, at the end of surgery and at the time of tracheal extubation were compared, and the incidence of postoperative complications was compared. Results: there was no significant difference in vital signs immediately before tracheal intubation between compound anesthesia group and general anesthesia group (P > 0.05). The vital signs of the compound anesthesia group were lower than those of the general anesthesia group immediately after tracheal intubation, at the time of skin incision, at the end of operation and at the time of tracheal extubation (P < 0.05). The incidence of postoperative complications in compound anesthesia group was lower than that in general anesthesia group (P < 0.05). Conclusion: compared with total anesthesia, general anesthesia combined with epidural anesthesia is effective in hysteromyoma surgery, which can effectively maintain good anesthetic effect and reduce the occurrence of complications. It is worthy of promotion and application.
文摘As a means of pain relief, anesthesia is becoming more and more recognized and used by the medical community. Epidural anesthesia is the injection of a local anesthetic into the epidural cavity to block the spinal nerve root and temporarily paralyze the innervated area. Combined lumbar anesthetic-epidural block anesthesia is the injection of a local anesthetic into the cerebrospinal fluid. Blocking is produced by acting directly on the anterior and posterior roots of the spinal nerve and spinal cord. Waist anesthesia-epidural combined block anesthesia is effective in maintaining normal cardiopulmonary function and works quickly. In this study, 100 patients treated from April 2018 to June 2021 were randomly divided into observation and control groups, with 50 patients in each group. The control group underwent epidural anesthesia, and the observation group performed both lumbar anesthesia and epidural anesthesia to analyze the anesthesia effect. The results are reported as follows.
基金Chinese State "9th 5-years" Key Projects of Science and Technology Grant.
文摘Objective: TO study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of small dose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia group (group A, n = 66), acupoint-skin electrical stimulation combined with epidural anesthesia group (group B, n = 63) and simple epidural anesthesia group (group C, n=65). Observations were conducted using single-bland method. Bilateral Neiguan (PC 6) and Zusanli (ST 36) were punctured and stimulated electrically in group A and only stimulated electrically via cutaneous electrodes in group B. Epidural anesthetic used was 1.5% Lidocaine and the anesthetic level was controlled to reach T4-11 . Results: The class-I (excellent) rates of group A, B and C were 75.76%, 60.32% and 13.85% respectively, showing significant differences between group A and C and group B and C (P <0.001). The initial dose, doses of every hour and every case of group A and B were lower than those of group C. The dose of every hour of group C was 36.23% and 3. 75% higher then group A and B respectively (P < 0. 001), suggesting that acupuncture or acupoint-skin electrical stimulation could strengthen anesthetic effect and reduce the dose of epidural anesthetic. During operation, indexes of the life signs as HR, MAP, RR, TV, MV, SpO2 and ECG kept basically stable and all patients in group A passed surgical operation safely. Conclusion: Acupuncture or acupoint-skin electrical stimulation combined with epidural anesthesia can be used as one of the anesthetic methods for cholecystectomy.
基金Supported by the Research Item of Guangxi Science and Technology Committee(No.0848013)Research Item of Guangxi Medicine Committee(No.2008256)
文摘Objective： To investigate the effects of acupuncture on the morphine-related side effects （nausea, vomiting, itchiness and gastrointestinal disorders） in patients undergoing anesthesia and analgesia and try to find the clinical mechanism of acupuncture. Methods： Patients scheduled to have transurethral prostatic resection enrolled in the study （69 patients）, characterized as Grade Ⅱ or Ⅲ by the American Society of Anesthesiologists physical status classification, were randomly assigned to three groups, 23 patients in each group： the placebo group （control group）, non-anesthesia area （NAA） group, and the anesthesia area （AA） group. After spinal anesthesia, all patients received Patients Controlled Epidural Analgesia. The vital signs, bowel sounds, visual analogue scales, itchiness, nausea and vomiting, and time for first exhaust post operation were observed. Results： Altogether, nine cases were eliminated, three in each group. Finally, sixty cases completed this study, twenty in each group. There was a significant decrease of bowel sounds after morphine spinal anesthesia in the three groups. Compared with the control or AA group, the bowel sound recovered after acupuncture, the incidences of nausea and vomiting, itchiness, and time for first exhaust after operation decreased in the NAA group （P〈0.05）. There was a significant decrease of the incidence for itchiness in the NAA group compared with the control group （P〈0.05）. Conclusions： On the basis of this study, it is obviously seen that acupuncture could decrease the incidence of morphine-related side effects （nausea and vomiting, itchiness and gastrointestinal disorders） when the spinal cord conduct is normal. However, it decreases only the incidence of itchiness but not for gastrointestinal dysfunction when the spinal cord is blocked.
文摘Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods: 33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n=11), acupoint skin electrical stimulation combined with epidural anesthesia (B) group (n=11) and simple epidural anesthesia (C) group (n=11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2～3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before, during and 3 days after operation for detecting plasma NE, E and DA contents. Results: ① During operation, plasma NE of group A and B lowered in comparison with pre operation, particularly group A (P<0.01), while in group C, plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre operation (P< 0.01). Plasma DA in the 3 groups all raised during operation. ② Three days after operation, plasma NE, E and DA levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effect has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. Conclusion: Acupuncture or acupoint surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy.
文摘In the present paper, the authors make a review on the progresses of acupuncture anesthesia (AA) from ① historical development, ② research on acupuncture combined with local anesthesia; ③ research on acupuncture combined with epidural anesthesia; and ④ research on acupuncture combined with general anesthesia. Compound acupuncture anesthesia provides a new anesthetic measure for surgical operations and has a definite analgesic effect and many advantages, and should be investigated further.
文摘Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (p<.05). The probability of making an accidental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.
文摘Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate if there were improvements in the performance of anesthesia novice trainees when executing the epidural technique after an EMME of epidural block procedure. Methods: We developed an eye movement modeling example (EMME) from eye tracking recordings made by experienced anesthesiologists with more than 20 years of experience. Forty-two PGY3 anesthesia trainees who had never previously performed an epidural block were randomized to receive (study group) or not receive (control group) the EMME video before their institutional training. All the trainees were evaluated every 10 epidural blocks until the end of the rotation period, by an independent, blinded observer using the Global Rating Scale for Epidural Anesthesia (GRS). Results: Trainees who received the EMME training exhibited more respect for the patient’s tissues (P Discussion: This is the first study that has used the EMME for a practical, clinical teaching purpose on real patients and that has used it as an aid in teaching epidural anesthesia. We demonstrated that inexperienced trainees who received the EMME training improved their proficiency at epidural blocks as compared to those who had no EMME training beforehand. Given this result, we welcome further studies to investigate the impact and the role of EMME on clinical teaching in the field of anesthesia.
