Cancer,potentially the second leading cause of mortality globally,poses a significant health challenge.The conventional treatment for solid tumors typically involves surgical intervention,followed by chemotherapy,radi...Cancer,potentially the second leading cause of mortality globally,poses a significant health challenge.The conventional treatment for solid tumors typically involves surgical intervention,followed by chemotherapy,radiotherapy,and targeted therapies.However,cancer recurrence and metastasis remain major issues.Anesthesia is essential for ensuring patient comfort and safety during surgery.Despite its crucial role in surgery,the precise effect of anesthesia on cancer patients'outcomes has not been clearly understood.This comprehensive review aims to elucidate perioperative anesthesia strategies for cancer patients and their potential effects on prognosis.Given the complexity of cancer treatments,understanding the relationship between anesthesia and cancer outcomes is crucial.By examining potential implications of anesthesia strategies for cancer prognosis,this review may help better understand treatment efficacy and risk factors for cancer recurrence and metastasis.Ultimately,a detailed analysis of anesthesia practices in cancer surgery may provide insights to refine existing anesthesia protocols and reduce risk factors for poor patient outcomes.展开更多
Background： Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined...Background： Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 （50% effective dose） and ED95 （95% effective dose） of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods： Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1-L2 vertebral interspace then lumbar puncture was performed at the L3-L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels （pinprick） were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results： ED50 （95% confidence interval） of spinal hyperbaric ropivacaine was determined to be 10.37 （5.23-11.59） mg and ED95 （95% confidence interval） to be 15.39 （13.81-23.59） mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion： The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.展开更多
Objective：To describe the use of the GlideScope in comparison with direct laryngoscopy for elective surgical patients requiring tracheal intubation. Methods：Two hundred patients, ASA Ⅰ - Ⅱ scheduled for elective s...Objective：To describe the use of the GlideScope in comparison with direct laryngoscopy for elective surgical patients requiring tracheal intubation. Methods：Two hundred patients, ASA Ⅰ - Ⅱ scheduled for elective surgery under general anesthesia requiring orotracheal intubation were selected. Information was collected identifying the patient demographics and airway assessment features （Mallampati oropharyngeal scale, thyromenta distance and mouth opening）. In a random crossover design, after induction of anesthesia and neuromuscular block, the laryngoscopes were inserted in turn, and the views of the glottis at laryngoscopy （Cormack and Lehane scores） were compared. The tracchea was intubated using either the standard Macintosh laryngoscope or GlideScope after the second grading at laryngoscopy was done. Complications associated with intubating were recorded. Results： There were 200 patients including 107 males and 93 females, with mean age being 52±13 years, height 164.8±11.3 cm, weight 64.0±11. 5 kg, thyromental distance 6. 9± 1.1 cm, and mouth opening 5.7±0.5 cm. There was a significant association between the preoperative view of the oropharynx （Mallampati score） and the view of the glottis at laryngoscopy for both the direct Macintosh laryngoscope （P〈0. 001） and the GlideScope （P〈0. 001）. Among 200 patients, 106 patients had the same C＆L grade, 91 of remaining patients showed improvement in the C＆L grade （P〈0. 001 ） obtained with GlideScope compared with the direct Macintosh laryngoscope. 3 of remaining patients showed better view of the glottis（C＆L grade） with the direct Macintosh laryngoscope （grade 1） than with GlideScope （grade 2）. There were no cases of failure to be intubated. There were no cases of dental or mucosal injury in all patients. Conclusion： GlideScope videolaryngoscope yielded comparable or superior laryngeal view compared with Macintosh laryngoscope. The new type of laryngoscope may have potential advantages for managing the difficult airway.展开更多
<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performan...<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. <b>Methods:</b> 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. <b>Results:</b> 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). <b>Conclusions:</b> In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.展开更多
Background Intrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose （MLAD） of intrathecal ropivac...Background Intrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose （MLAD） of intrathecal ropivacaine for nonobstetric patients has been reported. However, few data are available on the MLAD of hyperbaric ropivacine for obstetric patients and the relative potency to bupivacaine has not been fully determined. In this study, we sought to determine the MLAD of intrathecal ropivacaine and bupivacaine for elective cesarean section and to define their relative potency ratio.Methods We enrolled forty parturients undergoing elective cesarean section under combined spinal-epidural anesthesia and randomized them to one of two groups to receive intrathecal 0.5% hyperbaric ropivacaine or bupivacaine.The initial dose was 10 mg, and was increased in increments of 1 mg, using the technique of up-down sequential allocation. Efficacy was accepted if adequate sensory dermatomal anesthesia to pin prick to T7 or higher was attained within 20 minutes after intrathecal injection, and required no supplementary epidural injection for procedure until at least 50 minutes after the intrathecal injection.Results The intrathecal MLAD was 9.45 mg （95%confidence interval （CI）, 8.45-10.56 mg） for ropivacaine and 7.53 mg （95%CI, 7.00-8.10 mg） for bupivacaine. The relative potency ratio was 0.80 （95% Cl, 0.74-0.85） for ropivacaine/bupivacaine when given intrathecally in cesarean section.Conclusion Ropivacaine is 20% less potent than bupivacaine during intrathecal anesthesia for cesarean delivery.展开更多
基金Innovative and Entrepreneurial Team of Jiangsu Province(Grant No.JSSCTD202144)Nanjing Postdoctoral Program(Grant No.BSHNJ2023006)National Natural Science Foundation of China(Grant No.82201380)。
文摘Cancer,potentially the second leading cause of mortality globally,poses a significant health challenge.The conventional treatment for solid tumors typically involves surgical intervention,followed by chemotherapy,radiotherapy,and targeted therapies.However,cancer recurrence and metastasis remain major issues.Anesthesia is essential for ensuring patient comfort and safety during surgery.Despite its crucial role in surgery,the precise effect of anesthesia on cancer patients'outcomes has not been clearly understood.This comprehensive review aims to elucidate perioperative anesthesia strategies for cancer patients and their potential effects on prognosis.Given the complexity of cancer treatments,understanding the relationship between anesthesia and cancer outcomes is crucial.By examining potential implications of anesthesia strategies for cancer prognosis,this review may help better understand treatment efficacy and risk factors for cancer recurrence and metastasis.Ultimately,a detailed analysis of anesthesia practices in cancer surgery may provide insights to refine existing anesthesia protocols and reduce risk factors for poor patient outcomes.
文摘Background： Spinal hyperbaric ropivacaine may produce more predictable and reliable anesthesia than plain ropivacaine for cesarean section. The dose-response relation for spinal hyperbaric ropivacaine is undetermined. This double-blind, randomized, dose-response study determined the ED50 （50% effective dose） and ED95 （95% effective dose） of spinal hyperbaric ropivacaine for cesarean section anesthesia. Methods： Sixty parturients undergoing elective cesarean section delivery with use of combined spinal-epidural anesthesia were enrolled in this study. An epidural catheter was placed at the L1-L2 vertebral interspace then lumbar puncture was performed at the L3-L4 vertebral interspace, and parturients were randomized to receive spinal hyperbaric ropivacaine in doses of 10.5 mg, 12 mg, 13.5 mg, or 15 mg in equal volumes of 3 ml. Sensory levels （pinprick） were assessed every 2.5 min until a T7 level was achieved and motor changes were assessed by modified Bromage Score. A dose was considered effective if an upper sensory level to pin prick of T7 or above was achieved and no intraoperative epidural supplement was required. ED50 and ED95 were determined with use of a logistic regression model. Results： ED50 （95% confidence interval） of spinal hyperbaric ropivacaine was determined to be 10.37 （5.23-11.59） mg and ED95 （95% confidence interval） to be 15.39 （13.81-23.59） mg. The maximum sensory block levels and the duration of motor block and the rate of hypotension, but not onset of anesthesia, were significantly related to the ropivacaine dose. Conclusion： The ED50 and ED95 of spinal hyperbaric ropivacaine for cesarean delivery under the conditions of this study were 10.37 mg and 15.39 mg, respectively. Ropivacaine is suitable for spinal anesthesia in cesarean delivery.
文摘Objective：To describe the use of the GlideScope in comparison with direct laryngoscopy for elective surgical patients requiring tracheal intubation. Methods：Two hundred patients, ASA Ⅰ - Ⅱ scheduled for elective surgery under general anesthesia requiring orotracheal intubation were selected. Information was collected identifying the patient demographics and airway assessment features （Mallampati oropharyngeal scale, thyromenta distance and mouth opening）. In a random crossover design, after induction of anesthesia and neuromuscular block, the laryngoscopes were inserted in turn, and the views of the glottis at laryngoscopy （Cormack and Lehane scores） were compared. The tracchea was intubated using either the standard Macintosh laryngoscope or GlideScope after the second grading at laryngoscopy was done. Complications associated with intubating were recorded. Results： There were 200 patients including 107 males and 93 females, with mean age being 52±13 years, height 164.8±11.3 cm, weight 64.0±11. 5 kg, thyromental distance 6. 9± 1.1 cm, and mouth opening 5.7±0.5 cm. There was a significant association between the preoperative view of the oropharynx （Mallampati score） and the view of the glottis at laryngoscopy for both the direct Macintosh laryngoscope （P〈0. 001） and the GlideScope （P〈0. 001）. Among 200 patients, 106 patients had the same C＆L grade, 91 of remaining patients showed improvement in the C＆L grade （P〈0. 001 ） obtained with GlideScope compared with the direct Macintosh laryngoscope. 3 of remaining patients showed better view of the glottis（C＆L grade） with the direct Macintosh laryngoscope （grade 1） than with GlideScope （grade 2）. There were no cases of failure to be intubated. There were no cases of dental or mucosal injury in all patients. Conclusion： GlideScope videolaryngoscope yielded comparable or superior laryngeal view compared with Macintosh laryngoscope. The new type of laryngoscope may have potential advantages for managing the difficult airway.
文摘<b>Background:</b> Peripheral block techniques for total hip arthroplasty have been used as an analgesic strategy, only a few studies described it as an anesthetic technique, so the perioperative performance and safety are poorly studied. <b>Methods:</b> 78 total hip arthroplasties were prospectively observed in our hospital. Divided into 2 groups: 1) General anesthesia;and 2) Lumbar sacral plexus block anesthesia. Variables measured in both groups were: demographics, conversion to general anesthesia, total opioid doses, surgical time, blood loss, postoperative pain, use and total dose of vasopressors drugs, transfusion and ICU transfer needs, postoperative ambulation time, and length of hospital stay. T student and chi-square tests were used upon the case. A significant difference was considered when a value of p < 0.05 was obtained. Descriptive statistics were performed in frequency, percentages, variance and standard deviation. <b>Results:</b> 3 patients (7.3%) anesthetized with combined lumbar sacral plexus block were converted to general anesthesia. When comparing peripheral nerve block and general anesthesia, less intraoperative (p = 0.000) and postoperative (p = 0.002) opioid consumption were noted, less postoperative pain in PACU (p = 0.002) and in the first 24 hours (p = 0.005), as well as earlier onset of ambulation (p = 0.008) and shorter hospital stay (p = 0.031). <b>Conclusions:</b> In our study, the lumbar and sacral plexus block anesthesia technique provided anesthetic conditions to perform hip joint arthroplasty and it was proved to be advantageous in comparison to general anesthesia.
文摘Background Intrathecal anesthesia is commonly used for cesarean section. Bupivacaine and ropivacaine have all been used as intrathecal drugs. The minimum effective local anesthetic dose （MLAD） of intrathecal ropivacaine for nonobstetric patients has been reported. However, few data are available on the MLAD of hyperbaric ropivacine for obstetric patients and the relative potency to bupivacaine has not been fully determined. In this study, we sought to determine the MLAD of intrathecal ropivacaine and bupivacaine for elective cesarean section and to define their relative potency ratio.Methods We enrolled forty parturients undergoing elective cesarean section under combined spinal-epidural anesthesia and randomized them to one of two groups to receive intrathecal 0.5% hyperbaric ropivacaine or bupivacaine.The initial dose was 10 mg, and was increased in increments of 1 mg, using the technique of up-down sequential allocation. Efficacy was accepted if adequate sensory dermatomal anesthesia to pin prick to T7 or higher was attained within 20 minutes after intrathecal injection, and required no supplementary epidural injection for procedure until at least 50 minutes after the intrathecal injection.Results The intrathecal MLAD was 9.45 mg （95%confidence interval （CI）, 8.45-10.56 mg） for ropivacaine and 7.53 mg （95%CI, 7.00-8.10 mg） for bupivacaine. The relative potency ratio was 0.80 （95% Cl, 0.74-0.85） for ropivacaine/bupivacaine when given intrathecally in cesarean section.Conclusion Ropivacaine is 20% less potent than bupivacaine during intrathecal anesthesia for cesarean delivery.
