BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
General anesthesia(GA)is a pharmacologically induced,reversible state characterized by unconsciousness,amnesia,analgesia,and immobility in response to noxious stimuli.Accumulating evidence from animal models has eluci...General anesthesia(GA)is a pharmacologically induced,reversible state characterized by unconsciousness,amnesia,analgesia,and immobility in response to noxious stimuli.Accumulating evidence from animal models has elucidated diverse mechanisms of the action underlying GA,including disruption of large-scale brain network connectivity,regulation of multiple neural pathways,and modulation of specific receptors and ion channels.Despite advances in dissecting the neurobiological basis of anesthetic action,the precise cellular and circuit-level processes remain incompletely understood,limiting the development of safer and more effective strategies.Recent studies in Drosophila melanogaster,a genetically tractable model organism offering robust genetic analysis,advanced imaging capabilities,and compact neural architecture,have yielded critical insights into the conserved neurobiological mechanisms of GA,offering translational value for mammalian systems.This review outlines:1)experimental paradigms used to evaluate anesthetic sensitivity and behavioral responses in Drosophila;2)molecular targets and their mechanistic roles in mediating GA;and 3)neural circuit architectures and activity patterns shared by GA and sleep.Cross-species comparisons are integrated to highlight conserved mechanisms that may guide the development of more refined anesthetic strategies.展开更多
BACKGROUND Older patients often experience thirst after general anesthesia for gastrointestinal surgery,particularly during the post-anesthesia care unit(PACU)phase.Thirst not only compromises patient comfort but also...BACKGROUND Older patients often experience thirst after general anesthesia for gastrointestinal surgery,particularly during the post-anesthesia care unit(PACU)phase.Thirst not only compromises patient comfort but also induces anxiety,which may hinder recovery.Although previous studies have addressed postoperative thirst,research specifically examining thirst experiences and nursing needs in older patients remains limited.AIM To explore thirst experiences and nursing needs of older PACU patients following gastrointestinal surgery,aiming to inform targeted interventions.METHODS This study employed a phenomenological approach within a qualitative research framework.A purposeful sampling method was used to select 12 older patients who underwent gastrointestinal surgery under general anesthesia at a tertiary hospital in Shanghai between November and December 2024.Data were collected through semi-structured interviews and analyzed using Colaizzi’s seven-step method.Themes were extracted from the interview data.RESULTS Analysis of the interview data identified four main themes and eight subthemes:(1)Intense sensations of thirst post-surgery(subjective experience of thirst and duration of thirst);(2)Emotional experiences of thirst-related discomfort(anxiety,irritability,and helplessness);(3)Practical challenges in relieving thirst(limitations of current interventions and nursing response time);and(4)Patient expectations of nursing care(desire for more timely interventions and expectation for more proactive attention from nursing staff).CONCLUSION Older patients frequently experience substantial thirst discomfort after gastrointestinal surgery under general anesthesia.A multidisciplinary perioperative intervention plan is essential to alleviate these symptoms and enhance postoperative comfort.展开更多
Objective:This study primarily analyzes the effectiveness of thermal insulation nursing(empowered by temperature intervention)in urological stone patients during the general anesthesia recovery period.Methods:A total ...Objective:This study primarily analyzes the effectiveness of thermal insulation nursing(empowered by temperature intervention)in urological stone patients during the general anesthesia recovery period.Methods:A total of 76 urological stone patients who underwent surgical treatment as the preferred option were selected as the research subjects.The earliest consultation time was May 2024,and the latest was May 2025.The patients were randomly divided into two groups using the random number table method,namely the observation group and the control group,with 38 patients in each group.The intervention indicators of the patients were compared.Results:The overall satisfaction rate in the observation group was higher than that in the control group,and the incidence of adverse reactions was lower,with p<0.05.At 0.5 hours,1 hour after surgery,and at the end of surgery,the body temperature in the observation group was significantly different from that in the control group,with p<0.05.Postoperatively,various hemodynamic indicators in the observation group were significantly different from those in the control group,with p<0.05.The time to clench the first upon verbal command,the time to open the eyes upon verbal command,the extubating time,and the recovery retention time in the observation group were all shorter than those in the control group,with p<0.05.Postoperative stress indicators and agitation scores at different time points in the observation group were significantly different from those in the control group,with p<0.05.Conclusion:For urological stone patients during the general anesthesia recovery period,actively implementing thermal insulation nursing combined with temperature intervention not only enhances hemodynamic stability but also effectively reduces the risk of adverse reactions such as hypothermia and shivering.It optimizes the recovery condition,significantly improves the stress state,and increases nursing satisfaction.展开更多
Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60...Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60 pediatric patients undergoing elective surgery admitted to our hospital from January to August 2025 were selected and randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.The control group received an intravenous infusion of 0.9% sodium chloride injection 30 minutes before the end of surgery,while the observation group received an intravenous pump infusion of dexmedetomidine(1μg/kg,diluted to 4μg/ml with normal saline).The severity of cough(graded from 0 to 3)and vital signs,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO₂),were recorded 5 minutes before extubation,at the time of extubation,and 5 minutes after extubation in both groups.Results:The severity of cough in the observation group was significantly milder than that in the control group(P<0.05),with a significantly higher proportion of grade 0 cough in the observation group(23.33%vs 3.33%).At extubation and five minutes post-extubation,the observation group exhibited significantly lower HR,SBP,and DBP than the control group(P<0.05).In contrast,SpO_(2)levels remained comparable between the groups(P>0.05).Conclusion:Dexmedetomidine can effectively suppress the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia,reduce the severity of cough,stabilize hemodynamic parameters,and has no significant impact on respiratory function,demonstrating good clinical safety.展开更多
BACKGROUND Thirst management in convalescent patients recovering from a digestive surgery performed under general anesthesia requires attention.A simple,practical,and safe method can effectively relieve thirst symptom...BACKGROUND Thirst management in convalescent patients recovering from a digestive surgery performed under general anesthesia requires attention.A simple,practical,and safe method can effectively relieve thirst symptoms in such patients.AIM To evaluate the enhanced recovery after surgery(ERAS)-based evidence-based care(EBC)plus ice stimulation therapy for thirst management of convalescent patients following digestive surgery performed under general anesthesia.METHODS A total of 191 patients convalescing after digestive surgery performed under general anesthesia between March 2020 and February 2023 and experiencing thirst were selected.In total,89 patients and 102 patients in the control and research groups received routine care and ERAS-based EBC plus ice stimulation therapy,respectively.The following data were comparatively analyzed:(1)Thirst degree(thirst intensity numerical rating scale)and thirst distress(TD)degree(TD scale);(2)Oral mucosal wetness;(3)Unstimulated whole salivary flow rate(UWSFR);(4)Adverse reactions(palpitation,fatigue,chapped lips,and nausea and vomiting);and(5)Nursing satisfaction.RESULTS After nursing,thirst degree and distress were statistically lower in the research group than in the control group.Additionally,compared with the control group,the research group exhibited a lower degree of oral mucosal wetness,higher UWSFR,fewer adverse reactions,and more total nursing satisfaction.CONCLUSION ERAS-based EBC plus ice stimulation therapy can effectively alleviate thirst in convalescent patients recovering from a digestive surgery performed under general anesthesia.It can alleviate xerostomia symptoms,reduce adverse reactions,and improve patient comfort.展开更多
BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress respon...BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.展开更多
BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerv...BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.展开更多
Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find o...Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1,2014 to December 31,2016.Clinical data(baseline maternal status,preoperative status,perioperative information,maternal and fetal outcomes)of parturients and neonates were collected and analyzed.We summarized the common reasons for applying general anesthesia,and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists(ASA)grade,gestational weeks and intraoperative blood loss,as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study.Among the maternal and fetal factors,pregnancy with internal or surgical diseases is the most common reason(59 cases,60.2%)for choosing GA,followed by the placenta and fetal membrane abnormalities(38 cases,38.8%)and the pregnancy-specific disorders(36 cases,36.7%).ASA gradeⅢ-Ⅳof parturients(χ2=44.3,P<0.05),gestation period<37 weeks(χ2=23.4,P<0.05),and blood loss>800 ml(χ2=5.5,P<0.05)were related to the higher postoperative intensive care unit(ICU)rate in parturients.ASA gradeⅢ-Ⅳof parturients(t=-2.99,P<0.05),gestation period<37 weeks(t=2.47,P<0.05)were related to the longer hospital stay.ASA gradeⅢ-Ⅳof parturients(t=2.21,P=0.01)and gestation period<37 weeks(t=-3.21,P=0.002)were related to the lower one-minute Apgar score of neonates.Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS.High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.展开更多
AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thora- coscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment...AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thora- coscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC). METHODS: Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied en- ergy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L). RESULTS: The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G. CONCLUSION: These results suggest that EI-RFA, un- der general anesthesia, may be effective for the treat- ment of HCC because a larger quantity of ethanol and energy could be applied during treatment under pain- free condition for the patients.展开更多
Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- at...Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- ative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether ad- ministering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. Methods： A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists （ASh,） grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 pg/kg via direct injection （control group） or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Re- sults： Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction （9.1%, 95% confidence interval （CI）： 6.7%-11.4% vs. 55.9%, 95% CI： 51.8%-60.0%, P=0.000）, as were the severity grades （P=0.000）. There were no statistical differences between the two groups with regard to other adverse reactions （P〉0.05）. Conclusions： The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.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
AIM: To evaluate corneal injury during general anesthesia and analyze the protective effect of medical hydro-gel eye patch in clinics.METHODS:Seventy-sixpatientswith152 eyesundergoing general anesthesia were included....AIM: To evaluate corneal injury during general anesthesia and analyze the protective effect of medical hydro-gel eye patch in clinics.METHODS:Seventy-sixpatientswith152 eyesundergoing general anesthesia were included. None had positive corneal fluorescein staining before surgery. Both eyes of each patient were analyzed, with one randomly allocated to receive medical hydro-gel eye patch, and the other to receive common adhesive tape as a control. Corneal injuries were evaluated by scoring fluorescein staining under a hand-held slit lamp immediately after surgery in postanesthesia care unit and 24 h thereafter. Patients’ discomforts were also evaluated.RESULTS: Twelve eyes(15.8%) in the hydro-gel patch group and 30 eyes(39.5%) in the adhesive tape group showed corneal injury immediately after surgery. The eyes protected with hydro-gel patch showed statistically less corneal fluorescein staining than the control group.Four eyes in hydro-gel patch group and 6 eyes in adhesive tape group suffered discomfort immediately after surgery without intergroup difference and all discomforts disappeared after 24h(P =0.257). No side effect was observed in hydro-gel patch group, while 5eyes had brow avulsion and 2 got skin itching in adhesive tape group.CONCLUSION: Corneal injury complication was morefrequent than we thought following general anesthesia.The medical hydro-gel eye patch can protect the occurrence of corneal injury following general anesthesia.展开更多
BACKGROUND Radical gastrectomy(RG)is commonly used in the treatment of patients with gastric cancer(GC),but this procedure may lead to stress responses,postoperative cognitive dysfunction,and blood coagulation abnorma...BACKGROUND Radical gastrectomy(RG)is commonly used in the treatment of patients with gastric cancer(GC),but this procedure may lead to stress responses,postoperative cognitive dysfunction,and blood coagulation abnormalities in patients.AIM To investigate the influences of dexmedetomidine(DEX)on stress responses and postoperative cognitive and coagulation functions in patients undergoing RG under general anesthesia(GA).METHODS One hundred and two patients undergoing RG for GC under GA from February 2020 to February 2022 were retrospectively reviewed.Of these,50 patients had received conventional anesthesia intervention[control group(CG)]and 52 patients had received DEX in addition to routine anesthesia intervention[observation group(OG)].Inflammatory factor(IFs;tumor necrosis factor-α,TNF-α;interleukin-6,IL-6),stress responses(cortisol,Cor;adrenocorticotropic hormone,ACTH),cognitive function(CF;Mini-Mental State Examination,MMSE),neurological function(neuron-specific enolase,NSE;S100 calciumbinding protein B,S100B),and coagulation function(prothrombin time,PT;thromboxane B2,TXB2;fibrinogen,FIB)were compared between the two groups before surgery(T0),as well as at 6 h(T1)and 24 h(T2)after surgery.RESULTS Compared with T0,TNF-α,IL-6,Cor,ACTH,NSE,S100B,PT,TXB2,and FIB showed a significant increase in both groups at T1 and T2,but with even lower levels in OG vs CG.Both groups showed a significant reduction in the MMSE score at T1 and T2 compared with T0,but the MMSE score was notably higher in OG compared with CG.CONCLUSION In addition to a potent inhibitory effect on postoperative IFs and stress responses in GC patients undergoing RG under GA,DEX may also alleviate the coagulation dysfunction and improve the postoperative CF of these patients.展开更多
BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system.At present,surgery is the most important treatment strategy.After esophagectomy and gastric esophagoplasty,the patients are prone to reg...BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system.At present,surgery is the most important treatment strategy.After esophagectomy and gastric esophagoplasty,the patients are prone to regurgitation.However,these patients currently do not receive much attention,especially from anesthesiologists.CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy.The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior.Although the patient had fasted for>17 h,unexpected aspiration still occurred during induction of general anesthesia.Throughout the operation,oxygen saturation was 98%-100%,but the airway pressure was high(35 cmH2O at double lung ventilation).The patient was sent to the intensive care unit after surgery.Bedside chest radiography was performed,which showed exudative lesions in both lungs compared with the preoperative image.After surgery,antibiotics were given to prevent lung infection.On day 2 in the intensive care unit,the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia.CONCLUSION After esophagectomy,patients are prone to regurgitation.We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.展开更多
BACKGROUND： Acupuncture anesthesia was created in the 1950＇s in China and continues to be used there today during most major surgeries. It is widely used in China for such complex operations as brain heart, and abdo...BACKGROUND： Acupuncture anesthesia was created in the 1950＇s in China and continues to be used there today during most major surgeries. It is widely used in China for such complex operations as brain heart, and abdominal surgery. It is popular in China because it is economical, practical, and beneficial to the patients. With acupuncture anesthesia there is less bleeding during surgery and there is also quicker post-operative recovery. OBJECTIVE： This randomized prospective study aims at comparing the effect of two acupoints （Yongquan, KI1 and Renzhong, DU26） with sham acupuncture and no acupuncture on the time to recovery of consciousness after general anesthesia by means of the Bispectral Index monitor （BIS） DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a prospective randomized controlled study. We randomly assigned 50 patients to 5 groups during recovery from surgical anesthesia. Four groups had acupuncture on KI1 （group A）, DU26 （groups B）, both KI1 and DU26 （group C）, and sham points （group D）, and one had no acupuncture （group E）. MAIN OUTCOME MEASURES： Bispectral Index （BIS）, time to spontaneous eye opening, time to tracheal extubation, and time to following commands were measured as the main outcome measures RESULTS： Time to spontaneous eye opening differed among groups （P=0.002）, as well as time to tracheal extubation （P〈0.000 1） and time to following commands （P=0.000 6）. BIS values differed significantly among groups both 5 and 10 min after the end of anesthesia （P〈0.000 1 and P=0.000 4, respectively）. BIS values of groups D and E were lower than those of the other groups and those of group C were higher. The same pattern was observed also 15 and 30 rain after the end of anesthesia although the difference among groups was not significant at these time points （P=0.164 and P=0.104 respectively）. CONCLUSION： Acupuncture on DU26 and KI 1 accelerates recovery of consciousness after general anesthesia. Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This issue may play a role in the optimization of operating room management and raise interest about the usefulness of acupuncture on unconsciousness states of different nature.展开更多
AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpat...AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the different groupsand their relation with the quantity of medication usedand the duration of anesthesia.RESULTS:We compiled data for 108 cases of general anesthesia with intubation.We did not observeany permanent anesthesia-related complications;themost frequent side effects of anesthesia were hypo-tension(30.55%),desaturation(21.29%),and apnea(17.59%).These complications were significantly more frequent among patients with multiple additional diseases [hypotension(23.1% vs 76.9%,P = 0.005),desaturation(12.3% vs 69.2%,P < 0.001) and apnea(7.7% vs 53.8%,P = 0.001)],however,their incidence was not proportional to the quantity of medication used or the duration of anesthesia.CONCLUSION:General anesthesia with intubation is definitely a viable option among DBE methods.It is highly recommended in patients with multiple additional diseases.展开更多
BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecyst...BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecystectomy,combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA)in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included.The study populations in the RA and GA groups were of comparable age(P=0.41),gender(P=0.98)and body mass index(P=0.24).The conversion rate from RA to GA was 2.3%.RA was associated with significantly less postoperative pain at 4 h[mean difference(MD):-2.22,P<0.00001],8 h(MD:-1.53,P=0.0006),12 h(MD:-2.08,P<0.00001),and 24 h(MD:-0.90,P<0.00001)compared to GA.Moreover,it was associated with significantly lower rate of nausea and vomiting[risk ratio(RR):0.40,P<0.0001].However,RA significantly increased postoperative headaches(RR:4.69,P=0.03),and urinary retention(RR:2.73,P=0.03).The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes,with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA.However,its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.展开更多
BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often ...BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.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
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
基金supported by the National Natural Science Foundation of China(32371063,82341288,32071009)to C.L.Guangdong Basic and Applied Basic Research Foundation(2024A1515011500)to C.L.
文摘General anesthesia(GA)is a pharmacologically induced,reversible state characterized by unconsciousness,amnesia,analgesia,and immobility in response to noxious stimuli.Accumulating evidence from animal models has elucidated diverse mechanisms of the action underlying GA,including disruption of large-scale brain network connectivity,regulation of multiple neural pathways,and modulation of specific receptors and ion channels.Despite advances in dissecting the neurobiological basis of anesthetic action,the precise cellular and circuit-level processes remain incompletely understood,limiting the development of safer and more effective strategies.Recent studies in Drosophila melanogaster,a genetically tractable model organism offering robust genetic analysis,advanced imaging capabilities,and compact neural architecture,have yielded critical insights into the conserved neurobiological mechanisms of GA,offering translational value for mammalian systems.This review outlines:1)experimental paradigms used to evaluate anesthetic sensitivity and behavioral responses in Drosophila;2)molecular targets and their mechanistic roles in mediating GA;and 3)neural circuit architectures and activity patterns shared by GA and sleep.Cross-species comparisons are integrated to highlight conserved mechanisms that may guide the development of more refined anesthetic strategies.
文摘BACKGROUND Older patients often experience thirst after general anesthesia for gastrointestinal surgery,particularly during the post-anesthesia care unit(PACU)phase.Thirst not only compromises patient comfort but also induces anxiety,which may hinder recovery.Although previous studies have addressed postoperative thirst,research specifically examining thirst experiences and nursing needs in older patients remains limited.AIM To explore thirst experiences and nursing needs of older PACU patients following gastrointestinal surgery,aiming to inform targeted interventions.METHODS This study employed a phenomenological approach within a qualitative research framework.A purposeful sampling method was used to select 12 older patients who underwent gastrointestinal surgery under general anesthesia at a tertiary hospital in Shanghai between November and December 2024.Data were collected through semi-structured interviews and analyzed using Colaizzi’s seven-step method.Themes were extracted from the interview data.RESULTS Analysis of the interview data identified four main themes and eight subthemes:(1)Intense sensations of thirst post-surgery(subjective experience of thirst and duration of thirst);(2)Emotional experiences of thirst-related discomfort(anxiety,irritability,and helplessness);(3)Practical challenges in relieving thirst(limitations of current interventions and nursing response time);and(4)Patient expectations of nursing care(desire for more timely interventions and expectation for more proactive attention from nursing staff).CONCLUSION Older patients frequently experience substantial thirst discomfort after gastrointestinal surgery under general anesthesia.A multidisciplinary perioperative intervention plan is essential to alleviate these symptoms and enhance postoperative comfort.
文摘Objective:This study primarily analyzes the effectiveness of thermal insulation nursing(empowered by temperature intervention)in urological stone patients during the general anesthesia recovery period.Methods:A total of 76 urological stone patients who underwent surgical treatment as the preferred option were selected as the research subjects.The earliest consultation time was May 2024,and the latest was May 2025.The patients were randomly divided into two groups using the random number table method,namely the observation group and the control group,with 38 patients in each group.The intervention indicators of the patients were compared.Results:The overall satisfaction rate in the observation group was higher than that in the control group,and the incidence of adverse reactions was lower,with p<0.05.At 0.5 hours,1 hour after surgery,and at the end of surgery,the body temperature in the observation group was significantly different from that in the control group,with p<0.05.Postoperatively,various hemodynamic indicators in the observation group were significantly different from those in the control group,with p<0.05.The time to clench the first upon verbal command,the time to open the eyes upon verbal command,the extubating time,and the recovery retention time in the observation group were all shorter than those in the control group,with p<0.05.Postoperative stress indicators and agitation scores at different time points in the observation group were significantly different from those in the control group,with p<0.05.Conclusion:For urological stone patients during the general anesthesia recovery period,actively implementing thermal insulation nursing combined with temperature intervention not only enhances hemodynamic stability but also effectively reduces the risk of adverse reactions such as hypothermia and shivering.It optimizes the recovery condition,significantly improves the stress state,and increases nursing satisfaction.
文摘Objective:To investigate the suppressive effect of dexmedetomidine on the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia and its impact on vital signs.Methods:A total of 60 pediatric patients undergoing elective surgery admitted to our hospital from January to August 2025 were selected and randomly divided into an observation group and a control group,with 30 cases in each group,using a random number table method.The control group received an intravenous infusion of 0.9% sodium chloride injection 30 minutes before the end of surgery,while the observation group received an intravenous pump infusion of dexmedetomidine(1μg/kg,diluted to 4μg/ml with normal saline).The severity of cough(graded from 0 to 3)and vital signs,including heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO₂),were recorded 5 minutes before extubation,at the time of extubation,and 5 minutes after extubation in both groups.Results:The severity of cough in the observation group was significantly milder than that in the control group(P<0.05),with a significantly higher proportion of grade 0 cough in the observation group(23.33%vs 3.33%).At extubation and five minutes post-extubation,the observation group exhibited significantly lower HR,SBP,and DBP than the control group(P<0.05).In contrast,SpO_(2)levels remained comparable between the groups(P>0.05).Conclusion:Dexmedetomidine can effectively suppress the cough reflex during tracheal extubation in pediatric patients undergoing general anesthesia,reduce the severity of cough,stabilize hemodynamic parameters,and has no significant impact on respiratory function,demonstrating good clinical safety.
文摘BACKGROUND Thirst management in convalescent patients recovering from a digestive surgery performed under general anesthesia requires attention.A simple,practical,and safe method can effectively relieve thirst symptoms in such patients.AIM To evaluate the enhanced recovery after surgery(ERAS)-based evidence-based care(EBC)plus ice stimulation therapy for thirst management of convalescent patients following digestive surgery performed under general anesthesia.METHODS A total of 191 patients convalescing after digestive surgery performed under general anesthesia between March 2020 and February 2023 and experiencing thirst were selected.In total,89 patients and 102 patients in the control and research groups received routine care and ERAS-based EBC plus ice stimulation therapy,respectively.The following data were comparatively analyzed:(1)Thirst degree(thirst intensity numerical rating scale)and thirst distress(TD)degree(TD scale);(2)Oral mucosal wetness;(3)Unstimulated whole salivary flow rate(UWSFR);(4)Adverse reactions(palpitation,fatigue,chapped lips,and nausea and vomiting);and(5)Nursing satisfaction.RESULTS After nursing,thirst degree and distress were statistically lower in the research group than in the control group.Additionally,compared with the control group,the research group exhibited a lower degree of oral mucosal wetness,higher UWSFR,fewer adverse reactions,and more total nursing satisfaction.CONCLUSION ERAS-based EBC plus ice stimulation therapy can effectively alleviate thirst in convalescent patients recovering from a digestive surgery performed under general anesthesia.It can alleviate xerostomia symptoms,reduce adverse reactions,and improve patient comfort.
文摘BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.
文摘BACKGROUND Subcutaneous implantable cardioverter-defibrillator(S-ICD)implantation requires effective anesthesia.General anesthesia(GA)carries risks like hemodynamic instability,while ultrasound-guided intercostal nerve block(US-ICNB)may offer better pain control.This study hypothesized US-ICNB is superior in perioperative safety and pain management.AIM To compare perioperative outcomes of GA and US-ICNB in S-ICD implantation.METHODS This retrospective single-center study included 64 patients who received S-ICD implantation between February 2021 and December 2024.They were divided into GA and US-ICNB groups based on anesthesia type.Demographic data,perioperative parameters(operation time,pain scores,analgesic usage),and postoperative outcomes(complications,defibrillation events)were collected and analyzed.Statistical tests were used to compare the two groups.RESULTS This study included 64 patients(20 in the GA group and 44 in the US-ICNB group).Baseline left ventricular ejection fraction was significantly lower in the US-ICNB group(39.20%±12.00%vs 56.20%±11.50%in GA,P<0.001),while American Society of Anesthesiologists scores and comorbidities were comparable.US-ICNB showed superior pain control,with significantly lower numeric rating scale scores at 6-48 hours(P<0.001)and fewer patients requiring analgesics(P=0.02).The US-ICNB group had shorter operation times(P<0.001),total hospital stays(P<0.001),and later first analgesia times(P<0.001).No anesthesia-related complications occurred in either group.CONCLUSION Both anesthetic methods were safe in the short term.However,US-ICNB was superior in reducing operation and hospital stay times and alleviating peri-operative pain.It has high safety in S-ICD implantation and deserves further clinical promotion,though large-scale,multi-center,randomized controlled trials are needed to confirm these findings.
基金Fund supported by the CAMS Innovation Fund for Medical Sciences(CIFMS:2016-12M-3-024)~~
文摘Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1,2014 to December 31,2016.Clinical data(baseline maternal status,preoperative status,perioperative information,maternal and fetal outcomes)of parturients and neonates were collected and analyzed.We summarized the common reasons for applying general anesthesia,and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists(ASA)grade,gestational weeks and intraoperative blood loss,as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study.Among the maternal and fetal factors,pregnancy with internal or surgical diseases is the most common reason(59 cases,60.2%)for choosing GA,followed by the placenta and fetal membrane abnormalities(38 cases,38.8%)and the pregnancy-specific disorders(36 cases,36.7%).ASA gradeⅢ-Ⅳof parturients(χ2=44.3,P<0.05),gestation period<37 weeks(χ2=23.4,P<0.05),and blood loss>800 ml(χ2=5.5,P<0.05)were related to the higher postoperative intensive care unit(ICU)rate in parturients.ASA gradeⅢ-Ⅳof parturients(t=-2.99,P<0.05),gestation period<37 weeks(t=2.47,P<0.05)were related to the longer hospital stay.ASA gradeⅢ-Ⅳof parturients(t=2.21,P=0.01)and gestation period<37 weeks(t=-3.21,P=0.002)were related to the lower one-minute Apgar score of neonates.Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS.High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.
文摘AIM: To summarize the effects of laparoscopic ethanol injection and radiofrequency ablation (L-EI-RFA), thora- coscopic (T-EI-RFA) and open-surgery assisted EI-RFA (O-EI-RFA) under general anesthesia for the treatment of hepatocellular carcinoma (HCC). METHODS: Time-lag performance of RFA after ethanol injection (Time-lag PEI-RFA) was performed in all cases. The volume of coagulated necrosis and the applied en- ergy for total and per unit volume coagulated necrosis were examined in the groups treated under general (group G) or local anesthesia (group L). RESULTS: The results showed that the total applied energy and the applied energy per unit volume of whole and marginal, coagulated necrosis were significantly larger in group G than those in the group L, resulting in a larger volume of coagulated necrosis in the group G. The rate of local tumor recurrence within one year was extremely low in group G. CONCLUSION: These results suggest that EI-RFA, un- der general anesthesia, may be effective for the treat- ment of HCC because a larger quantity of ethanol and energy could be applied during treatment under pain- free condition for the patients.
文摘Objective： Fentanyl-induced cough （FIC） is a common complication with a reported incidence from 18.0% to 74.4% during general anesthesia induction. FIC increases the intrathoracic pressure and risks of postoper- ative nausea and vomiting, yet available treatments are limited. This study was designed to investigate whether ad- ministering fentanyl via a slow intravenous fluid line can effectively alleviate FIC during induction of total intravenous general anesthesia. Methods： A total number of 1200 patients, aged 18-64 years, were enrolled, all of whom were American Society of Anesthesiologists （ASh,） grade I or II undergoing scheduled surgeries. All patients received total intravenous general anesthesia, which was induced sequentially by midazolam, fentanyl, propofol, and cisatracurium injection. Patients were randomly assigned to receive fentanyl 3.5 pg/kg via direct injection （control group） or via a slow intravenous fluid line. FIC incidence and the severity grades were analyzed with the Mann-Whitney test. Other adverse reactions, such as hypotension, hypertension, bradycardia, tachycardia, hypoxemia, vomiting, and aspiration, during induction were also observed. The online clinical registration number of this study was ChiCTR-IOR-16009025. Re- sults： Compared with the control group, the incidence of FIC was significantly lower in the slow intravenous fluid line group during induction （9.1%, 95% confidence interval （CI）： 6.7%-11.4% vs. 55.9%, 95% CI： 51.8%-60.0%, P=0.000）, as were the severity grades （P=0.000）. There were no statistical differences between the two groups with regard to other adverse reactions （P〉0.05）. Conclusions： The administration of fentanyl via a slow intravenous fluid line can alleviate FIC and its severity during induction for total intravenous general anesthesia. This method is simple, safe, and reliable, and deserves clinical expansion.
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.
基金Supported by National Natural Science Foundation of China (No.81070705 81270974)+1 种基金Zhejiang Provincial Natural Science Foundation of China (LQ13H120003)Zhejiang Key Laboratory Fund of China (No.2011233)
文摘AIM: To evaluate corneal injury during general anesthesia and analyze the protective effect of medical hydro-gel eye patch in clinics.METHODS:Seventy-sixpatientswith152 eyesundergoing general anesthesia were included. None had positive corneal fluorescein staining before surgery. Both eyes of each patient were analyzed, with one randomly allocated to receive medical hydro-gel eye patch, and the other to receive common adhesive tape as a control. Corneal injuries were evaluated by scoring fluorescein staining under a hand-held slit lamp immediately after surgery in postanesthesia care unit and 24 h thereafter. Patients’ discomforts were also evaluated.RESULTS: Twelve eyes(15.8%) in the hydro-gel patch group and 30 eyes(39.5%) in the adhesive tape group showed corneal injury immediately after surgery. The eyes protected with hydro-gel patch showed statistically less corneal fluorescein staining than the control group.Four eyes in hydro-gel patch group and 6 eyes in adhesive tape group suffered discomfort immediately after surgery without intergroup difference and all discomforts disappeared after 24h(P =0.257). No side effect was observed in hydro-gel patch group, while 5eyes had brow avulsion and 2 got skin itching in adhesive tape group.CONCLUSION: Corneal injury complication was morefrequent than we thought following general anesthesia.The medical hydro-gel eye patch can protect the occurrence of corneal injury following general anesthesia.
基金Supported by Project of Guangxi Health and Health Commission,No.Z20201268。
文摘BACKGROUND Radical gastrectomy(RG)is commonly used in the treatment of patients with gastric cancer(GC),but this procedure may lead to stress responses,postoperative cognitive dysfunction,and blood coagulation abnormalities in patients.AIM To investigate the influences of dexmedetomidine(DEX)on stress responses and postoperative cognitive and coagulation functions in patients undergoing RG under general anesthesia(GA).METHODS One hundred and two patients undergoing RG for GC under GA from February 2020 to February 2022 were retrospectively reviewed.Of these,50 patients had received conventional anesthesia intervention[control group(CG)]and 52 patients had received DEX in addition to routine anesthesia intervention[observation group(OG)].Inflammatory factor(IFs;tumor necrosis factor-α,TNF-α;interleukin-6,IL-6),stress responses(cortisol,Cor;adrenocorticotropic hormone,ACTH),cognitive function(CF;Mini-Mental State Examination,MMSE),neurological function(neuron-specific enolase,NSE;S100 calciumbinding protein B,S100B),and coagulation function(prothrombin time,PT;thromboxane B2,TXB2;fibrinogen,FIB)were compared between the two groups before surgery(T0),as well as at 6 h(T1)and 24 h(T2)after surgery.RESULTS Compared with T0,TNF-α,IL-6,Cor,ACTH,NSE,S100B,PT,TXB2,and FIB showed a significant increase in both groups at T1 and T2,but with even lower levels in OG vs CG.Both groups showed a significant reduction in the MMSE score at T1 and T2 compared with T0,but the MMSE score was notably higher in OG compared with CG.CONCLUSION In addition to a potent inhibitory effect on postoperative IFs and stress responses in GC patients undergoing RG under GA,DEX may also alleviate the coagulation dysfunction and improve the postoperative CF of these patients.
基金Supported by Natural Science Foundation of Chongqing,China,No.CSTC2019JCYJ-MSXMX0623。
文摘BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system.At present,surgery is the most important treatment strategy.After esophagectomy and gastric esophagoplasty,the patients are prone to regurgitation.However,these patients currently do not receive much attention,especially from anesthesiologists.CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy.The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior.Although the patient had fasted for>17 h,unexpected aspiration still occurred during induction of general anesthesia.Throughout the operation,oxygen saturation was 98%-100%,but the airway pressure was high(35 cmH2O at double lung ventilation).The patient was sent to the intensive care unit after surgery.Bedside chest radiography was performed,which showed exudative lesions in both lungs compared with the preoperative image.After surgery,antibiotics were given to prevent lung infection.On day 2 in the intensive care unit,the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia.CONCLUSION After esophagectomy,patients are prone to regurgitation.We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.
文摘BACKGROUND： Acupuncture anesthesia was created in the 1950＇s in China and continues to be used there today during most major surgeries. It is widely used in China for such complex operations as brain heart, and abdominal surgery. It is popular in China because it is economical, practical, and beneficial to the patients. With acupuncture anesthesia there is less bleeding during surgery and there is also quicker post-operative recovery. OBJECTIVE： This randomized prospective study aims at comparing the effect of two acupoints （Yongquan, KI1 and Renzhong, DU26） with sham acupuncture and no acupuncture on the time to recovery of consciousness after general anesthesia by means of the Bispectral Index monitor （BIS） DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a prospective randomized controlled study. We randomly assigned 50 patients to 5 groups during recovery from surgical anesthesia. Four groups had acupuncture on KI1 （group A）, DU26 （groups B）, both KI1 and DU26 （group C）, and sham points （group D）, and one had no acupuncture （group E）. MAIN OUTCOME MEASURES： Bispectral Index （BIS）, time to spontaneous eye opening, time to tracheal extubation, and time to following commands were measured as the main outcome measures RESULTS： Time to spontaneous eye opening differed among groups （P=0.002）, as well as time to tracheal extubation （P〈0.000 1） and time to following commands （P=0.000 6）. BIS values differed significantly among groups both 5 and 10 min after the end of anesthesia （P〈0.000 1 and P=0.000 4, respectively）. BIS values of groups D and E were lower than those of the other groups and those of group C were higher. The same pattern was observed also 15 and 30 rain after the end of anesthesia although the difference among groups was not significant at these time points （P=0.164 and P=0.104 respectively）. CONCLUSION： Acupuncture on DU26 and KI 1 accelerates recovery of consciousness after general anesthesia. Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This issue may play a role in the optimization of operating room management and raise interest about the usefulness of acupuncture on unconsciousness states of different nature.
文摘AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the different groupsand their relation with the quantity of medication usedand the duration of anesthesia.RESULTS:We compiled data for 108 cases of general anesthesia with intubation.We did not observeany permanent anesthesia-related complications;themost frequent side effects of anesthesia were hypo-tension(30.55%),desaturation(21.29%),and apnea(17.59%).These complications were significantly more frequent among patients with multiple additional diseases [hypotension(23.1% vs 76.9%,P = 0.005),desaturation(12.3% vs 69.2%,P < 0.001) and apnea(7.7% vs 53.8%,P = 0.001)],however,their incidence was not proportional to the quantity of medication used or the duration of anesthesia.CONCLUSION:General anesthesia with intubation is definitely a viable option among DBE methods.It is highly recommended in patients with multiple additional diseases.
文摘BACKGROUND In an effort to further reduce the morbidity and mortality profile of laparoscopic cholecystectomy,the outcomes of such procedure under regional anesthesia(RA)have been evaluated.In the context of cholecystectomy,combining a minimally invasive surgical procedure with a minimally invasive anesthetic technique can potentially be associated with less postoperative pain and earlier ambulation.AIM To evaluate comparative outcomes of RA and general anesthesia(GA)in patients undergoing laparoscopic cholecystectomy.METHODS A comprehensive systematic review of randomized controlled trials with subsequent meta-analysis and trial sequential analysis of outcomes were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards.RESULTS Thirteen randomized controlled trials enrolling 1111 patients were included.The study populations in the RA and GA groups were of comparable age(P=0.41),gender(P=0.98)and body mass index(P=0.24).The conversion rate from RA to GA was 2.3%.RA was associated with significantly less postoperative pain at 4 h[mean difference(MD):-2.22,P<0.00001],8 h(MD:-1.53,P=0.0006),12 h(MD:-2.08,P<0.00001),and 24 h(MD:-0.90,P<0.00001)compared to GA.Moreover,it was associated with significantly lower rate of nausea and vomiting[risk ratio(RR):0.40,P<0.0001].However,RA significantly increased postoperative headaches(RR:4.69,P=0.03),and urinary retention(RR:2.73,P=0.03).The trial sequential analysis demonstrated that the meta-analysis was conclusive for most outcomes,with the exception of a risk of type 1 error for headache and urinary retention and a risk of type 2 error for total procedure time.CONCLUSION Our findings indicate that RA may be an attractive anesthetic modality for daycase laparoscopic cholecystectomy considering its associated lower postoperative pain and nausea and vomiting compared to GA.However,its associated risk of urinary retention and headache and lack of knowledge on its impact on procedure-related outcomes do not justify using RA as the first line anesthetic choice for laparoscopic cholecystectomy.
文摘BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.
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.
