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
Dear Editor,We read with interest the article by Chen etaitlj on the visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery. The authors reported that 93.3% of patients in the...Dear Editor,We read with interest the article by Chen etaitlj on the visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery. The authors reported that 93.3% of patients in the study experienced loss of perception of light at least during one of the surgical steps after the contralateral eye was covered intraoperatively. Most of the patients （81%） reported losing light perception between 6min and 30min from the commencement of the surgery.展开更多
The purpose of this study is to investigate the perioperative changes of erythrocyte kinase (PK) activity. Thirty patients undergoing upper abdominal surgery were dirided into epidural blockade(EB) group or intra veno...The purpose of this study is to investigate the perioperative changes of erythrocyte kinase (PK) activity. Thirty patients undergoing upper abdominal surgery were dirided into epidural blockade(EB) group or intra venous procaine balanced anesthesia(IPBA) group. The blood level of glucose increased significantly at 60 min after the beginning of operations in both groups. Blood glucose levels on the first postoperative day were significantly higher than the baselines in both groups [(8. 29±1. 5)vs (4. 8±0.18) mmol/L (P< 0.01) in EB, (6.36±0.33) vs (4. 55±0.18 ) mmol/L (P<0. 01 ) in IPBA]. The concentrations of 2, 3-DPG in RBC were not significantly changed in both groups. The PK activity in RBC decreased signficantly at 60 min after the end of operation in both groups. The PK activity levels on the first postoperative day were significantly lower than the baselines in both groups [(7. 59±1. 01) vs (11. 62±1. 06) IU/gHb (P<0. 05) in EB; (7. 75±0. 94) vs (11. 84 ±1.12) IU/gHb (P<0. 05 ) in IPBA]. The results suggest that the PK activity is decreased and the concentration of 2, 3-DPG remians unchanged under the hyperglycemic response to surgical stress, which may be related to an inhibition of glycolysis in RBC.展开更多
This paper reviews a local anesthesia for resection of back mass, and the rescue of patients with sudden apnea during the operation. It also summarizes the nursing experience and shortcomings of the visiting nurses du...This paper reviews a local anesthesia for resection of back mass, and the rescue of patients with sudden apnea during the operation. It also summarizes the nursing experience and shortcomings of the visiting nurses during the operation, which provides relevant experience for the future local anesthesia operation for patients with cardiovascular complications. The patient underwent left back mass resection under local anesthesia. Blood pressure, heart rate and blood oxygen saturation were monitored. The right lateral position was adopted during the operation. During the 5-minute operation to separate the tumor, the visiting nurse noticed that the patient was pale and weak in answering the questions, and immediately she cried out. The ECG monitor showed that the heart rate was 45 beats/min and the SpO2 was 85%, with continuous decrease. Immediately call the surgeon to stop the operation. Change the patient from lateral position to supine position. Due to the timely rescue and proper measures, the patients heart rate rose to 70 beats/min, BP120/70mmHg, R22 beats/min, SpO2 was 98% after about 10 minutes. The patient regained consciousness and was able to correctly answer the questions. After 15 minutes of observation, the patients condition was stable and there was no discomfort. The right lateral decubitus position was placed again and the operation was completed after the drape was disinfected again. Conclusion: local anesthesia operation has certain risks. Attention should be paid to local anesthesia operation for patients with cardiovascular and other complications. Preoperative preparation should be adequate, peripheral veins should be opened regularly, and ECG and blood pressure should be monitored. During the operation, the patients complexion, consciousness and breathing were closely observed. If there is any abnormal situation, the surgeon should be reported in time and the emergency plan should be started to ensure the safety of the patients during the operation and to improve the quality of nursing cooperation during the operation.展开更多
Objective: to study and analyze the intervention value of psychological nursing in patients undergoing non-general anesthesia after entering the operating room. Methods: A total of 98 patients who underwent non-genera...Objective: to study and analyze the intervention value of psychological nursing in patients undergoing non-general anesthesia after entering the operating room. Methods: A total of 98 patients who underwent non-general anesthesia from April 2019 to April 2020 were selected as the research sample, and were evenly assigned to the reference group and the experimental group. After entering the operating room, the patients received routine nursing and psychological nursing respectively, and the psychological state and intraoperative physiological indexes of the patients were observed. Results: after the test evaluation and index data collection, the psychological and physiological indexes of the test group were lower after the nursing was carried out (P < 0.05). Conclusion: after entering the operating room, psychological nursing can make the individual mentality and physiological state of the patients undergoing non-general anesthesia remain stable, and the intervention effect is significant.展开更多
BACKGROUND Owing to the particularities of their physical characteristics,older patients undergoing surgery under general anesthesia experience great surgical traumas.Thus,exploring more refined and individualized nur...BACKGROUND Owing to the particularities of their physical characteristics,older patients undergoing surgery under general anesthesia experience great surgical traumas.Thus,exploring more refined and individualized nursing approaches is an urgent need to mitigate the negative effects of surgery on such patients.AIM To analyze the influence of preoperative comprehensive education on anxiety,depression,pain,and sleep in older patients who underwent surgery under general anesthesia.METHODS In total,163 older adults who underwent surgery under general anesthesia between June 2022 and November 2023 were selected,77 of them received routine nursing care(control group),and 86 received preoperative comprehensive education(research group).Subsequently,comparative analyses were performed from the following perspectives:Surgical indicators(operation time,time to complete regain of consciousness,and temperature immediately after the procedure and upon recovery from anesthesia)before and after nursing care;negative emotions[self-rating anxiety scale(SAS)/self-rating depression scale(SDS)];pain severity[visual analog scale(VAS)];sleep quality[Pittsburgh sleep quality index(PSQI)];incidence of sleep disturbances(difficulties in falling asleep for the first time,falling asleep again after waking up frequently at night,falling asleep again after waking up early,and falling asleep all night);and incidence of adverse events(airway obstruction,catheter detachment,aspiration,and asphyxia).RESULTS The research group had significantly lower operation time and time to complete regain of consciousness than the control group after nursing care and markedly better recovery of postoperative body temperature and body temperature at awakening.In addition,more notable decreases in SAS,SDS,VAS,and PSQI scores were observed in the research group than in the control group.Furthermore,the incidence rate of sleep disturbance(8.14%vs 29.87%)and adverse events(4.65%vs 19.48%)were lower in the research group than in the control group.CONCLUSION Preoperative comprehensive education in older patients who underwent surgery under general anesthesia can improve postoperative indicators,effectively reduce the occurrence of anxiety and depression,alleviate postoperative pain,and improve sleep quality.展开更多
Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between Octo...Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Resuits The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotomy. There was no mortality. Mean length of stay in the intensive care unit was 16 .2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia展开更多
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）.
基金Supported by the National Healthcare Group Clinician Scientist Career Scheme Grant CSCS/12005
文摘Dear Editor,We read with interest the article by Chen etaitlj on the visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery. The authors reported that 93.3% of patients in the study experienced loss of perception of light at least during one of the surgical steps after the contralateral eye was covered intraoperatively. Most of the patients （81%） reported losing light perception between 6min and 30min from the commencement of the surgery.
文摘The purpose of this study is to investigate the perioperative changes of erythrocyte kinase (PK) activity. Thirty patients undergoing upper abdominal surgery were dirided into epidural blockade(EB) group or intra venous procaine balanced anesthesia(IPBA) group. The blood level of glucose increased significantly at 60 min after the beginning of operations in both groups. Blood glucose levels on the first postoperative day were significantly higher than the baselines in both groups [(8. 29±1. 5)vs (4. 8±0.18) mmol/L (P< 0.01) in EB, (6.36±0.33) vs (4. 55±0.18 ) mmol/L (P<0. 01 ) in IPBA]. The concentrations of 2, 3-DPG in RBC were not significantly changed in both groups. The PK activity in RBC decreased signficantly at 60 min after the end of operation in both groups. The PK activity levels on the first postoperative day were significantly lower than the baselines in both groups [(7. 59±1. 01) vs (11. 62±1. 06) IU/gHb (P<0. 05) in EB; (7. 75±0. 94) vs (11. 84 ±1.12) IU/gHb (P<0. 05 ) in IPBA]. The results suggest that the PK activity is decreased and the concentration of 2, 3-DPG remians unchanged under the hyperglycemic response to surgical stress, which may be related to an inhibition of glycolysis in RBC.
文摘This paper reviews a local anesthesia for resection of back mass, and the rescue of patients with sudden apnea during the operation. It also summarizes the nursing experience and shortcomings of the visiting nurses during the operation, which provides relevant experience for the future local anesthesia operation for patients with cardiovascular complications. The patient underwent left back mass resection under local anesthesia. Blood pressure, heart rate and blood oxygen saturation were monitored. The right lateral position was adopted during the operation. During the 5-minute operation to separate the tumor, the visiting nurse noticed that the patient was pale and weak in answering the questions, and immediately she cried out. The ECG monitor showed that the heart rate was 45 beats/min and the SpO2 was 85%, with continuous decrease. Immediately call the surgeon to stop the operation. Change the patient from lateral position to supine position. Due to the timely rescue and proper measures, the patients heart rate rose to 70 beats/min, BP120/70mmHg, R22 beats/min, SpO2 was 98% after about 10 minutes. The patient regained consciousness and was able to correctly answer the questions. After 15 minutes of observation, the patients condition was stable and there was no discomfort. The right lateral decubitus position was placed again and the operation was completed after the drape was disinfected again. Conclusion: local anesthesia operation has certain risks. Attention should be paid to local anesthesia operation for patients with cardiovascular and other complications. Preoperative preparation should be adequate, peripheral veins should be opened regularly, and ECG and blood pressure should be monitored. During the operation, the patients complexion, consciousness and breathing were closely observed. If there is any abnormal situation, the surgeon should be reported in time and the emergency plan should be started to ensure the safety of the patients during the operation and to improve the quality of nursing cooperation during the operation.
文摘Objective: to study and analyze the intervention value of psychological nursing in patients undergoing non-general anesthesia after entering the operating room. Methods: A total of 98 patients who underwent non-general anesthesia from April 2019 to April 2020 were selected as the research sample, and were evenly assigned to the reference group and the experimental group. After entering the operating room, the patients received routine nursing and psychological nursing respectively, and the psychological state and intraoperative physiological indexes of the patients were observed. Results: after the test evaluation and index data collection, the psychological and physiological indexes of the test group were lower after the nursing was carried out (P < 0.05). Conclusion: after entering the operating room, psychological nursing can make the individual mentality and physiological state of the patients undergoing non-general anesthesia remain stable, and the intervention effect is significant.
基金Supported by the Autonomous Region Key R&D Program Project“Research on the Prevention and Treatment System and Key Technologies of Elderly Related Diseases",No.2022B03009-4.
文摘BACKGROUND Owing to the particularities of their physical characteristics,older patients undergoing surgery under general anesthesia experience great surgical traumas.Thus,exploring more refined and individualized nursing approaches is an urgent need to mitigate the negative effects of surgery on such patients.AIM To analyze the influence of preoperative comprehensive education on anxiety,depression,pain,and sleep in older patients who underwent surgery under general anesthesia.METHODS In total,163 older adults who underwent surgery under general anesthesia between June 2022 and November 2023 were selected,77 of them received routine nursing care(control group),and 86 received preoperative comprehensive education(research group).Subsequently,comparative analyses were performed from the following perspectives:Surgical indicators(operation time,time to complete regain of consciousness,and temperature immediately after the procedure and upon recovery from anesthesia)before and after nursing care;negative emotions[self-rating anxiety scale(SAS)/self-rating depression scale(SDS)];pain severity[visual analog scale(VAS)];sleep quality[Pittsburgh sleep quality index(PSQI)];incidence of sleep disturbances(difficulties in falling asleep for the first time,falling asleep again after waking up frequently at night,falling asleep again after waking up early,and falling asleep all night);and incidence of adverse events(airway obstruction,catheter detachment,aspiration,and asphyxia).RESULTS The research group had significantly lower operation time and time to complete regain of consciousness than the control group after nursing care and markedly better recovery of postoperative body temperature and body temperature at awakening.In addition,more notable decreases in SAS,SDS,VAS,and PSQI scores were observed in the research group than in the control group.Furthermore,the incidence rate of sleep disturbance(8.14%vs 29.87%)and adverse events(4.65%vs 19.48%)were lower in the research group than in the control group.CONCLUSION Preoperative comprehensive education in older patients who underwent surgery under general anesthesia can improve postoperative indicators,effectively reduce the occurrence of anxiety and depression,alleviate postoperative pain,and improve sleep quality.
文摘Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Resuits The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotomy. There was no mortality. Mean length of stay in the intensive care unit was 16 .2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia
