BACKGROUND Surgery is a common treatment for gastrointestinal tumors.General anesthesia(GA),while effective,can cause oxidative stress reactions and neuroinflammation,potentially leading to postoperative cognitive dys...BACKGROUND Surgery is a common treatment for gastrointestinal tumors.General anesthesia(GA),while effective,can cause oxidative stress reactions and neuroinflammation,potentially leading to postoperative cognitive dysfunction and gastrointestinal dysfunction.The stellate ganglion block(SGB)can reduce sympathetic excitability and stress responses.This study aims to investigate whether combining SGB with GA can mitigate these adverse effects in patients undergoing gastrointestinal surgery.AIM To analyze the effects of SGB plus GA on hemodynamic stability,oxidative stress,neuroinflammation,cognitive function,and gastrointestinal function in patients undergoing gastrointestinal surgery.METHODS Patients undergoing gastrointestinal surgery between October 2022 and December 2024 were divided into two groups:A single GA group and an SGB combined with GA group(40 patients each).Hemodynamics,oxidative stress response,laboratory indices,cognitive function,and gastrointestinal function were compared preoperatively and 24 hours postoperatively between the two groups.Pain levels and complications were also recorded.RESULTS Before anesthesia induction,no significant differences were found in various indexes(including hemodynamics,oxidative stress indicators,laboratory indices,cognitive function scores,and gastrointestinal function indicators)between the two groups(P>0.05).At tracheal intubation,3 minutes after,and extubation,the GA-only group had significantly higher mean arterial pressure and heart rate postoperatively than preoperatively and compared to the SGB-GA combined group(P<0.05).Twentyfour hours postoperatively,oxidative stress indicators(malondialdehyde and nitric oxide)were significantly higher and superoxide dismutase was significantly lower in the GA group than in the SGB-GA combined group(P<0.05).Cognitive function scores[Mini-Mental State Examination and Montreal Cognitive Assessment(MoCA)]and gastrointestinal function indicators(motilin)were also significantly better in the SGB-GA combined group(P<0.05).The 24-hour postoperative MoCA score was 0.98 points higher in the SGB-GA combined group.No significant differences were found in the time of first postoperative ambulation,catheter removal time,and 24-hour postoperative pain between groups(P>0.05).CONCLUSION Combining SGB with GA can maintain perioperative hemodynamic stability,reduce oxidative stress and neuroinflammatory injury,and attenuate postoperative cognitive decline and gastrointestinal dysfunction in patients undergoing gastrointestinal surgery.展开更多
BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluat...BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia,in combination with general anesthesia,for thoracic surgery for lung cancer.The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020.Patients were randomly allocated to the peripheral+general anesthesia(observation)group(n=74)or to the general anesthesia(control)group(n=66).Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia,with those in the control group receiving an epidural block combined with general anesthesia.Measured outcomes included the operative and anesthesia times,as well as the mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO;)measured before surgery,15 min after anesthesia(T1),after intubation,5 min after skin incision,and before extubation(T4).RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group(1.48±0.43 mg,760.50±92.28 mg,and 72.50±16.62 mg,respectively)than control group(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).Postoperative levels of epinephrine,norepinephrine,and dopamine used were significantly lower in the observation than control group(210.20±40.41 pg/mL,230.30±65.58 pg/mL,and 54.49±13.32 pg/mL,respectively;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer,with no increase in the rate of adverse events.展开更多
BACKGROUND Laparoscopic hernia repair is a minimally invasive surgery,but patients may experience emergence agitation(EA)during the post-anesthesia recovery period,which can increase pain and lead to complications suc...BACKGROUND Laparoscopic hernia repair is a minimally invasive surgery,but patients may experience emergence agitation(EA)during the post-anesthesia recovery period,which can increase pain and lead to complications such as wound reopening and bleeding.There is limited research on the risk factors for this agitation,and few effective tools exist to predict it.Therefore,by integrating clinical data,we have developed nomograms and random forest predictive models to help clinicians predict and potentially prevent EA.AIM To establish a risk nomogram prediction model for EA in patients undergoing laparoscopic hernia surgery under total inhalation combined with sacral block anesthesia.METHODS Based on the clinical information of 300 patients who underwent laparoscopic hernia surgery in the Nanning Tenth People’s Hospital,Guangxi,from January 2020 to June 2023,the patients were divided into two groups according to their sedation-agitation scale score,i.e.,the EA group(≥5 points)and the non-EA group(≤4 points),during anesthesia recovery.Least absolute shrinkage and selection operator regression was used to select the key features that predict EA,and incorporating them into logistic regression analysis to obtain potential pre-dictive factors and establish EA nomogram and random forest risk prediction models through R software.RESULTS Out of the 300 patients,72 had agitation during anesthesia recovery,with an incidence of 24.0%.American Society of Anesthesiologists classification,preoperative anxiety,solid food fasting time,clear liquid fasting time,indwelling catheter,and pain level upon awakening are key predictors of EA in patients undergoing laparoscopic hernia surgery with total intravenous anesthesia and caudal block anesthesia.The nomogram predicts EA with an area under the receiver operating characteristic curve(AUC)of 0.947,a sensi-tivity of 0.917,and a specificity of 0.877,whereas the random forest model has an AUC of 0.923,a sensitivity of 0.912,and a specificity of 0.877.Delong’s test shows no significant difference in AUC between the two models.Clinical decision curve analysis indicates that both models have good net benefits in predicting EA,with the nomogram effective within the threshold of 0.02 to 0.96 and the random forest model within 0.03 to 0.90.In the external model validation of 50 cases of laparoscopic hernia surgery,both models predicted EA.The nomogram model had a sensitivity of 83.33%,specificity of 86.84%,and accuracy of 86.00%,while the random forest model had a sensitivity of 75.00%,specificity of 78.95%,and accuracy of 78.00%,suggesting that the nomogram model performs better in predicting EA.CONCLUSION Independent predictors of EA in patients undergoing laparoscopic hernia repair with total intravenous anesthesia combined with caudal block include American Society of Anesthesiologists classification,preoperative anxiety,duration of solid food fasting,duration of clear liquid fasting,presence of an indwelling catheter,and pain level upon waking.The nomogram and random forest models based on these factors can help tailor clinical decisions in the future.展开更多
Objective: to analyze the application effect of ultrasound-guided nerve block anesthesia in the treatment of clavicle fracture. Methods: 30 patients with clavicle fracture treated in our hospital from June 2018 to Aug...Objective: to analyze the application effect of ultrasound-guided nerve block anesthesia in the treatment of clavicle fracture. Methods: 30 patients with clavicle fracture treated in our hospital from June 2018 to August 2020 were selected and divided into groups according to the drawing method. There were 15 cases in the control group and the observation group. The control group received traditional anesthesia, and the observation group received ultrasound - guided nerve block anesthesia. Results: the overall anesthesia effect of the observation group was significantly better than that of the control group, the operation time and the onset time of anesthesia were significantly shortened, and there was a significant difference between the groups (P < 0.05). Conclusion: ultrasound-guided nerve block anesthesia has a more ideal anesthesia effect in the treatment of clavicle fracture. It is a simple and convenient operation mode, and can also enhance the anesthesia effect of patients, which is worthy of clinical promotion.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
文摘BACKGROUND Surgery is a common treatment for gastrointestinal tumors.General anesthesia(GA),while effective,can cause oxidative stress reactions and neuroinflammation,potentially leading to postoperative cognitive dysfunction and gastrointestinal dysfunction.The stellate ganglion block(SGB)can reduce sympathetic excitability and stress responses.This study aims to investigate whether combining SGB with GA can mitigate these adverse effects in patients undergoing gastrointestinal surgery.AIM To analyze the effects of SGB plus GA on hemodynamic stability,oxidative stress,neuroinflammation,cognitive function,and gastrointestinal function in patients undergoing gastrointestinal surgery.METHODS Patients undergoing gastrointestinal surgery between October 2022 and December 2024 were divided into two groups:A single GA group and an SGB combined with GA group(40 patients each).Hemodynamics,oxidative stress response,laboratory indices,cognitive function,and gastrointestinal function were compared preoperatively and 24 hours postoperatively between the two groups.Pain levels and complications were also recorded.RESULTS Before anesthesia induction,no significant differences were found in various indexes(including hemodynamics,oxidative stress indicators,laboratory indices,cognitive function scores,and gastrointestinal function indicators)between the two groups(P>0.05).At tracheal intubation,3 minutes after,and extubation,the GA-only group had significantly higher mean arterial pressure and heart rate postoperatively than preoperatively and compared to the SGB-GA combined group(P<0.05).Twentyfour hours postoperatively,oxidative stress indicators(malondialdehyde and nitric oxide)were significantly higher and superoxide dismutase was significantly lower in the GA group than in the SGB-GA combined group(P<0.05).Cognitive function scores[Mini-Mental State Examination and Montreal Cognitive Assessment(MoCA)]and gastrointestinal function indicators(motilin)were also significantly better in the SGB-GA combined group(P<0.05).The 24-hour postoperative MoCA score was 0.98 points higher in the SGB-GA combined group.No significant differences were found in the time of first postoperative ambulation,catheter removal time,and 24-hour postoperative pain between groups(P>0.05).CONCLUSION Combining SGB with GA can maintain perioperative hemodynamic stability,reduce oxidative stress and neuroinflammatory injury,and attenuate postoperative cognitive decline and gastrointestinal dysfunction in patients undergoing gastrointestinal surgery.
文摘BACKGROUND Thoracic surgery for radical resection of lung tumor requires deep anesthesia which can lead to an adverse inflammatory response,loss of hemodynamic stability,and decreased immune function.Herein,we evaluated the feasibility and benefits of ultrasound-guided paravertebral nerve block anesthesia,in combination with general anesthesia,for thoracic surgery for lung cancer.The block was performed by diffusion of anesthetic drugs along the paravertebral space to achieve unilateral multi-segment intercostal nerve and dorsal branch nerve block.AIM To evaluate the application of ultrasound-guided paravertebral nerve block anesthesia for lung cancer surgery to inform practice.METHODS The analysis was based on 140 patients who underwent thoracic surgery for lung cancer at our hospital between January 2018 and May 2020.Patients were randomly allocated to the peripheral+general anesthesia(observation)group(n=74)or to the general anesthesia(control)group(n=66).Patients in the observation group received ultrasound-guided paravertebral nerve block anesthesia combined with general anesthesia,with those in the control group receiving an epidural block combined with general anesthesia.Measured outcomes included the operative and anesthesia times,as well as the mean arterial pressure(MAP),heart rate(HR),and blood oxygen saturation(SpO;)measured before surgery,15 min after anesthesia(T1),after intubation,5 min after skin incision,and before extubation(T4).RESULTS The dose of intra-operative use of remifentanil and propofol and the postoperative use of sufentanil was lower in the observation group(1.48±0.43 mg,760.50±92.28 mg,and 72.50±16.62 mg,respectively)than control group(P<0.05).At the four time points of measurement(T1 through T4),MAP and HR values were higher in the observation than control group(MAP,90.20±9.15 mmHg,85.50±7.22 mmHg,88.59±8.15 mmHg,and 90.02±10.02 mmHg,respectively;and HR,72.39±8.22 beats/min,69.03±9.03 beats/min,70.12±8.11 beats/min,and 71.24±9.01 beats/min,respectively;P<0.05).There was no difference in SpO;between the two groups(P>0.05).Postoperative levels of epinephrine,norepinephrine,and dopamine used were significantly lower in the observation than control group(210.20±40.41 pg/mL,230.30±65.58 pg/mL,and 54.49±13.32 pg/mL,respectively;P<0.05).Similarly,the postoperative tumor necrosis factor-αand interleukin-6 levels were lower in the observation(2.43±0.44 pg/mL and 170.03±35.54 pg/mL,respectively)than control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Ultrasound-guided paravertebral nerve block anesthesia improved the stress and hemodynamic response in patients undergoing thoracic surgery for lung cancer,with no increase in the rate of adverse events.
文摘BACKGROUND Laparoscopic hernia repair is a minimally invasive surgery,but patients may experience emergence agitation(EA)during the post-anesthesia recovery period,which can increase pain and lead to complications such as wound reopening and bleeding.There is limited research on the risk factors for this agitation,and few effective tools exist to predict it.Therefore,by integrating clinical data,we have developed nomograms and random forest predictive models to help clinicians predict and potentially prevent EA.AIM To establish a risk nomogram prediction model for EA in patients undergoing laparoscopic hernia surgery under total inhalation combined with sacral block anesthesia.METHODS Based on the clinical information of 300 patients who underwent laparoscopic hernia surgery in the Nanning Tenth People’s Hospital,Guangxi,from January 2020 to June 2023,the patients were divided into two groups according to their sedation-agitation scale score,i.e.,the EA group(≥5 points)and the non-EA group(≤4 points),during anesthesia recovery.Least absolute shrinkage and selection operator regression was used to select the key features that predict EA,and incorporating them into logistic regression analysis to obtain potential pre-dictive factors and establish EA nomogram and random forest risk prediction models through R software.RESULTS Out of the 300 patients,72 had agitation during anesthesia recovery,with an incidence of 24.0%.American Society of Anesthesiologists classification,preoperative anxiety,solid food fasting time,clear liquid fasting time,indwelling catheter,and pain level upon awakening are key predictors of EA in patients undergoing laparoscopic hernia surgery with total intravenous anesthesia and caudal block anesthesia.The nomogram predicts EA with an area under the receiver operating characteristic curve(AUC)of 0.947,a sensi-tivity of 0.917,and a specificity of 0.877,whereas the random forest model has an AUC of 0.923,a sensitivity of 0.912,and a specificity of 0.877.Delong’s test shows no significant difference in AUC between the two models.Clinical decision curve analysis indicates that both models have good net benefits in predicting EA,with the nomogram effective within the threshold of 0.02 to 0.96 and the random forest model within 0.03 to 0.90.In the external model validation of 50 cases of laparoscopic hernia surgery,both models predicted EA.The nomogram model had a sensitivity of 83.33%,specificity of 86.84%,and accuracy of 86.00%,while the random forest model had a sensitivity of 75.00%,specificity of 78.95%,and accuracy of 78.00%,suggesting that the nomogram model performs better in predicting EA.CONCLUSION Independent predictors of EA in patients undergoing laparoscopic hernia repair with total intravenous anesthesia combined with caudal block include American Society of Anesthesiologists classification,preoperative anxiety,duration of solid food fasting,duration of clear liquid fasting,presence of an indwelling catheter,and pain level upon waking.The nomogram and random forest models based on these factors can help tailor clinical decisions in the future.
文摘Objective: to analyze the application effect of ultrasound-guided nerve block anesthesia in the treatment of clavicle fracture. Methods: 30 patients with clavicle fracture treated in our hospital from June 2018 to August 2020 were selected and divided into groups according to the drawing method. There were 15 cases in the control group and the observation group. The control group received traditional anesthesia, and the observation group received ultrasound - guided nerve block anesthesia. Results: the overall anesthesia effect of the observation group was significantly better than that of the control group, the operation time and the onset time of anesthesia were significantly shortened, and there was a significant difference between the groups (P < 0.05). Conclusion: ultrasound-guided nerve block anesthesia has a more ideal anesthesia effect in the treatment of clavicle fracture. It is a simple and convenient operation mode, and can also enhance the anesthesia effect of patients, which is worthy of clinical promotion.
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.
