BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outc...BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outcomes.AIM To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.METHODS One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled.The patients were assigned to control(n=60,receiving standard nursing care)and observation groups(n=60,receiving music therapy,anesthesia recovery care,and standard nursing care).We comparatively analyzed the time to regain consciousness,extubation time,and length of stay in the postanesthesia care unit;heart rate,systolic blood pressure,and diastolic blood pressure before anesthesia and during recovery;cortisol,aldosterone,norepinephrine,and adrenaline levels before anesthesia and 24 hours postoperatively;Postoperative Quality of Recovery Scale scores;and complication rates between the groups.RESULTS The observation group exhibited a significantly shorter time to regain consciousness,extubation time,and postanesthesia care unit stay than the control group(P<0.05).During the recovery period,heart rate,systolic blood pressure,and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels,with the levels in the observation group being significantly lower than those in the control group(P<0.05).At 24 hours postoperatively,cortisol,aldosterone,norepinephrine,and adrenaline levels were elevated in both groups compared with preanesthesia levels,with levels in the observation group being significantly lower than those in the control group(P<0.05).The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group(P<0.05).Moreover,the complication rate in the observation group was significantly lower than that in the control group(10.00%vs 40.00%,P<0.05).CONCLUSION Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection,mitigated fluctuations in vital signs and stress responses,improved postoperative recovery quality,and reduced complication rates,demonstrating substantial clinical value.展开更多
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
Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environm...Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environment. Methods: This is a cross-sectional study carried out at Monkole hospital from May 2016 to May 2023. It concerns patients anesthetized for laparoscopic surgery. Perianesthetic data were collected and analyzed with SPSS 26.0 for p Results: Eighty-four patients (4.2%) were selected out of 2000 eligible patients. The median age was 31 years, the range between 15 and 30 years (40.5%), female gender and approved patients (70.3%) predominated. Comorbidities were: sickle cell disease, high blood pressure, thinness and obesity. The ASA class was: I (35.2%), II (36.3%) and III (28.6%). Anesthesia was general with intubation for all patients. Generally, the surgery lasted less than two hours and the anesthesia lasted more than two hours. Postoperative analgesia used morphine in 27.5%. The operative indications were dominated by lithiasis with or without cholecystitis (48.4%) and appendicitis (16.5%). Intraoperative complications (18.7%) were: hypotension, allergy, spasm, accidental gallbladder and bile duct perforation. Postoperative complications (9.9%) were: anemia, digestive fistula, septic shock, multi-organ failure, acute lung edema and two deaths. Alcohol consumption was associated with intraoperative complications. Anesthesia duration greater than two hours, ASA3 class, alcohol consumption and cholecystectomy were associated with postoperative complications. Conclusion: Celiosurgery is not yet established in Monkole probably due to the lack of permanent surgeons and the higher cost than open surgery.展开更多
BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic ...BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.展开更多
Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specif...Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specific descriptions of randomization,allocation concealment,and blinding processes,with subsequent systematic reviews indicating a risk of bias.Objective:Clinical trial registration is essential for the enhancement of the quality of clinical trials.This study aims to summarize the status of clinical trial registrations for acupuncture anesthesia listed on the World Health Organization International Clinical Trials Registry Platform(ICTRP).Search strategy:We searched the ICTRP for clinical trials related to acupuncture anesthesia registered between January 1,2001 and May 31,2023.Additionally,related publications were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data.Registrations and publications were analyzed for consistency in trial design characteristics.Inclusion criteria:Clinical trials that utilized one of several acupuncture-related therapies in combination with pharmacological anesthesia during the perioperative period were eligible for this review.Data extraction and analysis:Data extracted from articles included type of surgical procedure,perioperative symptoms,study methodology,type of intervention,trial recruitment information,and publication information related to clinical enrollment.Results:A total of 166 trials related to acupuncture anesthesia from 21 countries were included in the analysis.The commonly reported symptoms in the included studies were postoperative nausea and vomiting(19.9%)and postoperative pain(13.3%).The concordance between the publications and the trial protocols in the clinical registry records was poor,with only 31.7%of the studies being fully compatible.Inconsistency rates were high for sample size(39.0%,16/41),blinding(36.6%,15/41),and secondary outcome indicators(24.4%,10/41).Conclusion:The volume of acupuncture anesthesia clinical trials registered in international trial registries over the last 20 years is low,with insufficient disclosure of results.Postoperative nausea and vomiting as well as postoperative pain,are the most investigated for acupuncture intervention.展开更多
General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relyin...General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relying on physiological indicators or behavioral responses,fall short of accurately capturing the nuanced states of unconsciousness.This study introduces a machine learning-based approach to decode anesthesia depth,leveraging EEG data across different anesthesia states induced by propofol and esketamine in rats.Our findings demonstrate the model’s robust predictive accuracy,underscored by a novel intrasubject dataset partitioning and a 5-fold cross-validation method.The research diverges from conventional monitoring by utilizing anesthetic infusion rates as objective indicators of anesthesia states,highlighting distinct EEG patterns and enhancing prediction accuracy.Moreover,the model’s ability to generalize across individuals suggests its potential for broad clinical application,distinguishing between anesthetic agents and their depths.Despite relying on rat EEG data,which poses questions about real-world applicability,our approach marks a significant advance in anesthesia monitoring.展开更多
Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized reside...Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized residency training in our department from July 2018 to July 2020 were randomly divided into an ultrasound group and a control group, with 20 participants in each group. The ultrasound group was taught by ultrasound-guided central venipuncture, while the control group was taught by traditional anatomy. After ten training punctures, all trainees were assessed twice. Results: Both groups could master the technique of central venipuncture. The success rate of first puncture and the overall success rate of puncture in the ultrasound group were significantly higher than those in the control group (p p < 0.05). Conclusion: Compared with the traditional anatomical localization teaching, the use of ultrasound-guided technology can improve the success rate of puncture, save puncture time, reduce related complications, and have a better training effect.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
The anesthesia awareness with recall(AAWR) phenomenon represents a complication of general anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or...The anesthesia awareness with recall(AAWR) phenomenon represents a complication of general anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or at a variable distance from it. Approximately 20% of AAWR cases occur during emergence from anesthesia. Clinically, these unexpected experiences are often associated with distress especially due to a sense of paralysis. Indeed, although AAWR at the emergence has multiple causes, in the majority of cases the complication develops when the anesthesia plan is too early lightened at the end of anesthesia and there is a lack of use, or misuse, of neuromuscular monitoring with improper management of the neuromuscular block. Because the distress caused by the sense of paralysis represents an important predictor for the development of severe psychological complications, the knowledge of the phenomenon, and the possible strategies for its prophylaxis are aspects of considerable importance. Nevertheless, a limited percentage of episodes of AAWR cannot be prevented. This paradox holds also during the emergence phase of anesthesia which represents a very complex neurophysiological process with many aspects yet to be clarified.展开更多
BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of periop...BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of perioperative anesthesia needs special attention.As anα2-adrenergic receptor agonist,dexmedetomidine(Dex)has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure,inhibitory effect on inflammation,and sedative and analgesic effects.Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer.METHODS A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital,Qingdao,China were recruited and divided into two groups:A and B.In group A,Dex was administered 30 min before surgery,while group B received an equivalent amount of normal saline.The hemodynamic changes,pulmonary compliance,airway pressure,inflammatory factors,confusion assessment method scores,Ramsay Sedation-Agitation Scale scores,and cellular immune function indicators were compared between the two groups.RESULTS Group A showed less intraoperative hemodynamic fluctuations,better pulmonary compliance,and lower airway resistance compared with group B.Twelve hours after the surgery,the serum levels of TLR-2,TLR-4,IL-6,and TNF-αin group A were significantly lower than those of group B(P<0.05).After extubation,the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients,indicating a higher level of sedation.The incidence of delirium was significantly lower in group A than in group B(P<0.05).CONCLUSION The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.展开更多
Using acupuncture instead of anesthetics to induce analgesia was performed in China many years ago in surgical anesthetization. Although many medical units in China's cities and rural areas are applying these tech...Using acupuncture instead of anesthetics to induce analgesia was performed in China many years ago in surgical anesthetization. Although many medical units in China's cities and rural areas are applying these techniques in operations, it should be pointed out that acupuncture anesthesia is still in the process of development and is of next to no practical and even less scientific value in the western world. However, acupuncture-assisted anesthesia can be useful also in countries other than China.展开更多
Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare...Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.展开更多
Purpose: Objective of this study was to determine whether video assisted anesthesia induction reduced pediatric patients’ stress. Methods: With approval from the local ethics committee and parental informed consent, ...Purpose: Objective of this study was to determine whether video assisted anesthesia induction reduced pediatric patients’ stress. Methods: With approval from the local ethics committee and parental informed consent, 75 children undergoing minor surgery were investigated in this prospective observational study. Patients were divided into three groups: group 1 was aged two to three years old, group 2 was aged four to six years old and group 3 was aged from seven to ten years old. The following three characteristics were evaluated: 1) the pulse rate at four points (the ward, the entrance at the operating room, mask notification and the mask fit);2) the behavioral score in the operating room;3) the amount of pain killers after the operation. Results: In group 1 (N = 20), there was a significant difference between the control group and the video assisted group regarding the percentage change in pulse rate based on the children’s ward when the patients looked at the mask. In group 2 (N = 26), there was no significant difference regarding any points. In group 3 (N = 29), there was a significant difference between control and video assisted group regarding the percentage change in pulse rate based on the children’s ward for all points. Also, regarding to the behavioral score, there was a significant difference between the control group and the video assisted group of all ages. However, there was no significant difference regarding the use of NSAIDs in the postoperative period between the control and the video assisted group. Conclusion: These results show that the video assisted anesthesia induction is effective for pediatric patients.展开更多
Dopaminergic neurons in the ventral tegmental area(VTA)play an important role in cognition,emergence from anesthesia,reward,and aversion,and their projection to the cortex is a crucial part of the"bottom-up"...Dopaminergic neurons in the ventral tegmental area(VTA)play an important role in cognition,emergence from anesthesia,reward,and aversion,and their projection to the cortex is a crucial part of the"bottom-up"ascending activating system.The prelimbic cortex(PrL)is one of the important projection regions of the VTA.However,the roles of dopaminergic neurons in the VTA and the VTADA–PrL pathway under sevoflurane anesthesia in rats remain unclear.In this study,we found that intraperitoneal injection and local microinjection of a dopamine D1 receptor agonist(Chloro-APB)into the PrL had an emergence-promoting effect on sevoflurane anesthesia in rats,while injection of a dopamine D1 receptor antagonist(SCH23390)deepened anesthesia.The results of chemogenetics combined with microinjection and optogenetics showed that activating the VTADA–PrL pathway prolonged the induction time and shortened the emergence time of anesthesia.These results demonstrate that the dopaminergic system in the VTA has an emergence-promoting effect and that the bottom-up VTADA–PrL pathway facilitates emergence from sevoflurane anesthesia.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
Although it has been more than 165 years since the first introduction of modern anesthesia to the clinic, there is surprisingly little understanding about the exact mechanisms by which general anesthetics induce uncon...Although it has been more than 165 years since the first introduction of modern anesthesia to the clinic, there is surprisingly little understanding about the exact mechanisms by which general anesthetics induce unconsciousness. As a result, we do not know how general anesthetics produce anesthesia at different levels. The main handicap to understanding the mechanisms of general anesthesia is the diversity of chemically unrelated compounds including diethyl ether and halogenated hydrocarbons, gases nitrous oxide, ketamine, propofol, benzodiazepines and etomidate, as well as alcohols and barbiturates. Does this imply that general anesthesia is caused by many different mechanisms? Until now, many receptors, molecular targets and neuronal transmission pathways have been shown to contribute to mechanisms of general anesthesia. Among these molecular targets, ion channels are the most likely candidates for general anesthesia, in particular γ-aminobutyric acid type A, potassium and sodium channels, as well as ion channels mediated by various neuronal transmitters like acetylcholine, amino acids amino-3-hydroxy-5-methyl-4-isoxazolpropionic acid or N-methyl-D-aspartate. In addition, recent studies have demonstrated the involvement in general anesthesia of other ion channels with distinct gating properties suchas hyperpolarization-activated, cyclic- nucleotide-gated channels. The main aim of the present review is to summarize some aspects of current knowledge of the effects of general anesthetics on various ion channels.展开更多
The success of acupuncture anesthesia (AA) for pneumonectomy in Shanghai in 1960 was a key event for AA gaining practical clinical application. The effort was a close collaboration between the Shanghai First Tuberculo...The success of acupuncture anesthesia (AA) for pneumonectomy in Shanghai in 1960 was a key event for AA gaining practical clinical application. The effort was a close collaboration between the Shanghai First Tuberculosis Hospital and the Shanghai Institute of Acupuncture and Moxibustion. One of the most important factors of AA success was the great financial and political support provided by the Chinese central government and Shanghai local government. In December 1965 the State Science and Technology Commission of China issued a formal document acknowledging AA as an important first-leve national achievement of the integration of Chinese and Western medicine, and a collaborative effort of the whole scientific community in China. AA was an important influential factor that helped acupuncture spread across the world.展开更多
Emergence from anesthesia(AE) is the ending stage of anesthesia featuring the transition from unconsciousness to complete wakefulness and recovery of consciousness(RoC). A wide range of undesirable complications, incl...Emergence from anesthesia(AE) is the ending stage of anesthesia featuring the transition from unconsciousness to complete wakefulness and recovery of consciousness(RoC). A wide range of undesirable complications, including coughing, respiratory/cardiovascular events, and mental status changes such as emergence delirium, and delayed RoC, may occur during this critical phase. In general anesthesia processes, induction and AE represent a neurobiological example of "hysteresis". Indeed, AE mechanisms should not be simply considered as reverse events of those occurring in the induction phase. Anesthesia-induced loss of consciousness(LoC) and AE until RoC are quite distinct phenomena with, in part, a distinct neurobiology. Althoughanaesthetics produce LoC mostly by affecting cortical connectivity, arousal processes at the end of anesthesia are triggered by structures deep in the brain, rather than being induced within the neocortex. This work aimed to provide an overview on AE processes research, in terms of mechanisms, and EEG findings. Because most of the research in this field concerns preclinical investigations, translational suggestions and research perspectives are proposed. However, little is known about the relationship between AE neurobiology, and potential complications occurring during the emergence, and after the RoC. Thus, another scope of this review is to underline why a better understanding of AE mechanisms could have significant clinical implications, such as improving the patients' quality of recovery, and avoiding early and late postoperative complications.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
Objective:To investigate the role of Hemocoagulase Injection used in the joint operation and the effect on the blood coagulable function.Methods:A total of 60 patients who undergoing joint operation in our hospital we...Objective:To investigate the role of Hemocoagulase Injection used in the joint operation and the effect on the blood coagulable function.Methods:A total of 60 patients who undergoing joint operation in our hospital were randomly divided into two groups.Experiment group(Group A,n=30)was injected with 2 U Hemocoagulase Injection in 5 min before anesthesia induction.The contrast group(Group B,n=30)was treated with 0.9%normal saline in 5 min before anesthesia induction.Then common anesthesia was given to the two groups of patients.The venous blood was withdrawn for blood routine examination,thrombelastography and coagulable function at the time of pre-inducement, end of operation,and in 6 and 12 h after operation.The change of thrombelastograph and coagulable state were monitored during the whole surgery.And the volume of transfusion and hemorrhage between two groups was contrasted. Results:After the use of Hemocoagulase Injection,the operative time was shortened obviously(P<0.05).The volumes hemorrhage and transfusion was obviously smaller in Group A than in Group B(P<0.01).Hemocoagulase Injection did not influence fibrinogen and thrombelastograph of Group A(P>0.05).Conclusion:Hemocoagulase Injection can reduce the volumes of hemorrhage and transfusion and not influence the coagulable function.It is worth using in the joint operation.展开更多
文摘BACKGROUND Current standard nursing practices demonstrate limited effectiveness in perioperative colorectal cancer(CRC)management,highlighting the need to explore alternative care strategies that improve clinical outcomes.AIM To investigate the impact of music therapy and anesthesia recovery care on anesthesia recovery in patients with CRC undergoing laparoscopic radical resection.METHODS One hundred and twenty patients scheduled for elective laparoscopic CRC radical resection at Affiliated Hospital of Jiangnan University from January 2022 to May 2024 were enrolled.The patients were assigned to control(n=60,receiving standard nursing care)and observation groups(n=60,receiving music therapy,anesthesia recovery care,and standard nursing care).We comparatively analyzed the time to regain consciousness,extubation time,and length of stay in the postanesthesia care unit;heart rate,systolic blood pressure,and diastolic blood pressure before anesthesia and during recovery;cortisol,aldosterone,norepinephrine,and adrenaline levels before anesthesia and 24 hours postoperatively;Postoperative Quality of Recovery Scale scores;and complication rates between the groups.RESULTS The observation group exhibited a significantly shorter time to regain consciousness,extubation time,and postanesthesia care unit stay than the control group(P<0.05).During the recovery period,heart rate,systolic blood pressure,and diastolic blood pressure significantly increased in both groups compared with preanesthesia levels,with the levels in the observation group being significantly lower than those in the control group(P<0.05).At 24 hours postoperatively,cortisol,aldosterone,norepinephrine,and adrenaline levels were elevated in both groups compared with preanesthesia levels,with levels in the observation group being significantly lower than those in the control group(P<0.05).The observation group achieved significantly higher Postoperative Quality of Recovery Scale scores than the control group(P<0.05).Moreover,the complication rate in the observation group was significantly lower than that in the control group(10.00%vs 40.00%,P<0.05).CONCLUSION Music therapy combined with anesthesia recovery care remarkably boosted the quality of anesthesia recovery in patients undergoing laparoscopic CRC radical resection,mitigated fluctuations in vital signs and stress responses,improved postoperative recovery quality,and reduced complication rates,demonstrating substantial clinical value.
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.
文摘Objective: Anesthesia for laparoscopic surgery is particular because of the cardiopulmonary repercussions of pneumoperitoneum. This study reports the experience in secondary level hospital located in suburban environment. Methods: This is a cross-sectional study carried out at Monkole hospital from May 2016 to May 2023. It concerns patients anesthetized for laparoscopic surgery. Perianesthetic data were collected and analyzed with SPSS 26.0 for p Results: Eighty-four patients (4.2%) were selected out of 2000 eligible patients. The median age was 31 years, the range between 15 and 30 years (40.5%), female gender and approved patients (70.3%) predominated. Comorbidities were: sickle cell disease, high blood pressure, thinness and obesity. The ASA class was: I (35.2%), II (36.3%) and III (28.6%). Anesthesia was general with intubation for all patients. Generally, the surgery lasted less than two hours and the anesthesia lasted more than two hours. Postoperative analgesia used morphine in 27.5%. The operative indications were dominated by lithiasis with or without cholecystitis (48.4%) and appendicitis (16.5%). Intraoperative complications (18.7%) were: hypotension, allergy, spasm, accidental gallbladder and bile duct perforation. Postoperative complications (9.9%) were: anemia, digestive fistula, septic shock, multi-organ failure, acute lung edema and two deaths. Alcohol consumption was associated with intraoperative complications. Anesthesia duration greater than two hours, ASA3 class, alcohol consumption and cholecystectomy were associated with postoperative complications. Conclusion: Celiosurgery is not yet established in Monkole probably due to the lack of permanent surgeons and the higher cost than open surgery.
文摘BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.
基金supported by grants from Shanghai Municipal Health Commission and Shanghai Municipal Administration of TCM—Standardization of TCM in 2023“Clinical Practice Guide for Combined Acupuncture-Drug Anesthesia”(No.2023JS05)Shanghai Clinical Medical Research Center of Acupuncture and Moxibustion(No.20MC1920500)+1 种基金Shanghai master Chinese medicine practitioners academic experience research studio construction project(No.SHGZS-202212)Shanghai Key Clinical Specialties 2019 Accreditation Program(No.shslczdzk04701)。
文摘Background:Modern acupuncture anesthesia is a combination of Chinese and Western medicine that integrates the theories of acupuncture with anesthesia.However,some clinical studies of acupuncture anesthesia lack specific descriptions of randomization,allocation concealment,and blinding processes,with subsequent systematic reviews indicating a risk of bias.Objective:Clinical trial registration is essential for the enhancement of the quality of clinical trials.This study aims to summarize the status of clinical trial registrations for acupuncture anesthesia listed on the World Health Organization International Clinical Trials Registry Platform(ICTRP).Search strategy:We searched the ICTRP for clinical trials related to acupuncture anesthesia registered between January 1,2001 and May 31,2023.Additionally,related publications were retrieved from PubMed,Cochrane Library,Embase,China National Knowledge Infrastructure,China Science and Technology Journal Database,and Wanfang Data.Registrations and publications were analyzed for consistency in trial design characteristics.Inclusion criteria:Clinical trials that utilized one of several acupuncture-related therapies in combination with pharmacological anesthesia during the perioperative period were eligible for this review.Data extraction and analysis:Data extracted from articles included type of surgical procedure,perioperative symptoms,study methodology,type of intervention,trial recruitment information,and publication information related to clinical enrollment.Results:A total of 166 trials related to acupuncture anesthesia from 21 countries were included in the analysis.The commonly reported symptoms in the included studies were postoperative nausea and vomiting(19.9%)and postoperative pain(13.3%).The concordance between the publications and the trial protocols in the clinical registry records was poor,with only 31.7%of the studies being fully compatible.Inconsistency rates were high for sample size(39.0%,16/41),blinding(36.6%,15/41),and secondary outcome indicators(24.4%,10/41).Conclusion:The volume of acupuncture anesthesia clinical trials registered in international trial registries over the last 20 years is low,with insufficient disclosure of results.Postoperative nausea and vomiting as well as postoperative pain,are the most investigated for acupuncture intervention.
基金supported by grants from the Shanghai Municipal Health Commission(2023ZDFC0203)the National Natural Science Foundation of China(32171044).
文摘General anesthesia,pivotal for surgical procedures,requires precise depth monitoring to mitigate risks ranging from intraoperative awareness to postoperative cognitive impairments.Traditional assessment methods,relying on physiological indicators or behavioral responses,fall short of accurately capturing the nuanced states of unconsciousness.This study introduces a machine learning-based approach to decode anesthesia depth,leveraging EEG data across different anesthesia states induced by propofol and esketamine in rats.Our findings demonstrate the model’s robust predictive accuracy,underscored by a novel intrasubject dataset partitioning and a 5-fold cross-validation method.The research diverges from conventional monitoring by utilizing anesthetic infusion rates as objective indicators of anesthesia states,highlighting distinct EEG patterns and enhancing prediction accuracy.Moreover,the model’s ability to generalize across individuals suggests its potential for broad clinical application,distinguishing between anesthetic agents and their depths.Despite relying on rat EEG data,which poses questions about real-world applicability,our approach marks a significant advance in anesthesia monitoring.
文摘Objective: To evaluate the application effect of ultrasound-guided central venous catheterization in the teaching of anesthesia residents. Methods: Forty anesthesia resident companions who received standardized residency training in our department from July 2018 to July 2020 were randomly divided into an ultrasound group and a control group, with 20 participants in each group. The ultrasound group was taught by ultrasound-guided central venipuncture, while the control group was taught by traditional anatomy. After ten training punctures, all trainees were assessed twice. Results: Both groups could master the technique of central venipuncture. The success rate of first puncture and the overall success rate of puncture in the ultrasound group were significantly higher than those in the control group (p p < 0.05). Conclusion: Compared with the traditional anatomical localization teaching, the use of ultrasound-guided technology can improve the success rate of puncture, save puncture time, reduce related complications, and have a better training effect.
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The anesthesia awareness with recall(AAWR) phenomenon represents a complication of general anesthesia consisting of memorization of intraoperative events reported by the patient immediately after the end of surgery or at a variable distance from it. Approximately 20% of AAWR cases occur during emergence from anesthesia. Clinically, these unexpected experiences are often associated with distress especially due to a sense of paralysis. Indeed, although AAWR at the emergence has multiple causes, in the majority of cases the complication develops when the anesthesia plan is too early lightened at the end of anesthesia and there is a lack of use, or misuse, of neuromuscular monitoring with improper management of the neuromuscular block. Because the distress caused by the sense of paralysis represents an important predictor for the development of severe psychological complications, the knowledge of the phenomenon, and the possible strategies for its prophylaxis are aspects of considerable importance. Nevertheless, a limited percentage of episodes of AAWR cannot be prevented. This paradox holds also during the emergence phase of anesthesia which represents a very complex neurophysiological process with many aspects yet to be clarified.
文摘BACKGROUND Radical resection of colon cancer under general anesthesia is one of the main treatment methods for this malignancy.However,due to the physiological charac-teristics of elderly patients,the safety of perioperative anesthesia needs special attention.As anα2-adrenergic receptor agonist,dexmedetomidine(Dex)has attracted much attention from anesthesiologists due to its stabilizing effect on heart rate and blood pressure,inhibitory effect on inflammation,and sedative and analgesic effects.Its application in general anesthesia may have a positive impact on the quality of anesthesia and postoperative recovery in elderly patients undergoing radical resection of colon cancer.METHODS A total of 165 colon cancer patients who underwent radical surgery for colon cancer under general anesthesia at Qingdao University Affiliated Haici Hospital,Qingdao,China were recruited and divided into two groups:A and B.In group A,Dex was administered 30 min before surgery,while group B received an equivalent amount of normal saline.The hemodynamic changes,pulmonary compliance,airway pressure,inflammatory factors,confusion assessment method scores,Ramsay Sedation-Agitation Scale scores,and cellular immune function indicators were compared between the two groups.RESULTS Group A showed less intraoperative hemodynamic fluctuations,better pulmonary compliance,and lower airway resistance compared with group B.Twelve hours after the surgery,the serum levels of TLR-2,TLR-4,IL-6,and TNF-αin group A were significantly lower than those of group B(P<0.05).After extubation,the Ramsay Sedation-Agitation Scale score of group A patients was significantly higher than that of group B patients,indicating a higher level of sedation.The incidence of delirium was significantly lower in group A than in group B(P<0.05).CONCLUSION The use of Dex as an adjunct to general anesthesia for radical surgery in elderly patients with colon cancer results in better effectiveness of anesthesia.
基金Supported by The Austrian Federal Ministries of Science,Research and Economy and of Health and by Eurasia-Pacific Uninet(project"Evidence-based high-tech acupuncture and integrative laser medicine for prevention and early intervention of chronic diseases")
文摘Using acupuncture instead of anesthetics to induce analgesia was performed in China many years ago in surgical anesthetization. Although many medical units in China's cities and rural areas are applying these techniques in operations, it should be pointed out that acupuncture anesthesia is still in the process of development and is of next to no practical and even less scientific value in the western world. However, acupuncture-assisted anesthesia can be useful also in countries other than China.
文摘Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.
文摘Purpose: Objective of this study was to determine whether video assisted anesthesia induction reduced pediatric patients’ stress. Methods: With approval from the local ethics committee and parental informed consent, 75 children undergoing minor surgery were investigated in this prospective observational study. Patients were divided into three groups: group 1 was aged two to three years old, group 2 was aged four to six years old and group 3 was aged from seven to ten years old. The following three characteristics were evaluated: 1) the pulse rate at four points (the ward, the entrance at the operating room, mask notification and the mask fit);2) the behavioral score in the operating room;3) the amount of pain killers after the operation. Results: In group 1 (N = 20), there was a significant difference between the control group and the video assisted group regarding the percentage change in pulse rate based on the children’s ward when the patients looked at the mask. In group 2 (N = 26), there was no significant difference regarding any points. In group 3 (N = 29), there was a significant difference between control and video assisted group regarding the percentage change in pulse rate based on the children’s ward for all points. Also, regarding to the behavioral score, there was a significant difference between the control group and the video assisted group of all ages. However, there was no significant difference regarding the use of NSAIDs in the postoperative period between the control and the video assisted group. Conclusion: These results show that the video assisted anesthesia induction is effective for pediatric patients.
基金supported by the National Natural Science Foundation of China(81801366 and 82001453)and the National Key R&D Program of China(2018YFC2001901).
文摘Dopaminergic neurons in the ventral tegmental area(VTA)play an important role in cognition,emergence from anesthesia,reward,and aversion,and their projection to the cortex is a crucial part of the"bottom-up"ascending activating system.The prelimbic cortex(PrL)is one of the important projection regions of the VTA.However,the roles of dopaminergic neurons in the VTA and the VTADA–PrL pathway under sevoflurane anesthesia in rats remain unclear.In this study,we found that intraperitoneal injection and local microinjection of a dopamine D1 receptor agonist(Chloro-APB)into the PrL had an emergence-promoting effect on sevoflurane anesthesia in rats,while injection of a dopamine D1 receptor antagonist(SCH23390)deepened anesthesia.The results of chemogenetics combined with microinjection and optogenetics showed that activating the VTADA–PrL pathway prolonged the induction time and shortened the emergence time of anesthesia.These results demonstrate that the dopaminergic system in the VTA has an emergence-promoting effect and that the bottom-up VTADA–PrL pathway facilitates emergence from sevoflurane anesthesia.
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.
文摘Although it has been more than 165 years since the first introduction of modern anesthesia to the clinic, there is surprisingly little understanding about the exact mechanisms by which general anesthetics induce unconsciousness. As a result, we do not know how general anesthetics produce anesthesia at different levels. The main handicap to understanding the mechanisms of general anesthesia is the diversity of chemically unrelated compounds including diethyl ether and halogenated hydrocarbons, gases nitrous oxide, ketamine, propofol, benzodiazepines and etomidate, as well as alcohols and barbiturates. Does this imply that general anesthesia is caused by many different mechanisms? Until now, many receptors, molecular targets and neuronal transmission pathways have been shown to contribute to mechanisms of general anesthesia. Among these molecular targets, ion channels are the most likely candidates for general anesthesia, in particular γ-aminobutyric acid type A, potassium and sodium channels, as well as ion channels mediated by various neuronal transmitters like acetylcholine, amino acids amino-3-hydroxy-5-methyl-4-isoxazolpropionic acid or N-methyl-D-aspartate. In addition, recent studies have demonstrated the involvement in general anesthesia of other ion channels with distinct gating properties suchas hyperpolarization-activated, cyclic- nucleotide-gated channels. The main aim of the present review is to summarize some aspects of current knowledge of the effects of general anesthetics on various ion channels.
文摘The success of acupuncture anesthesia (AA) for pneumonectomy in Shanghai in 1960 was a key event for AA gaining practical clinical application. The effort was a close collaboration between the Shanghai First Tuberculosis Hospital and the Shanghai Institute of Acupuncture and Moxibustion. One of the most important factors of AA success was the great financial and political support provided by the Chinese central government and Shanghai local government. In December 1965 the State Science and Technology Commission of China issued a formal document acknowledging AA as an important first-leve national achievement of the integration of Chinese and Western medicine, and a collaborative effort of the whole scientific community in China. AA was an important influential factor that helped acupuncture spread across the world.
文摘Emergence from anesthesia(AE) is the ending stage of anesthesia featuring the transition from unconsciousness to complete wakefulness and recovery of consciousness(RoC). A wide range of undesirable complications, including coughing, respiratory/cardiovascular events, and mental status changes such as emergence delirium, and delayed RoC, may occur during this critical phase. In general anesthesia processes, induction and AE represent a neurobiological example of "hysteresis". Indeed, AE mechanisms should not be simply considered as reverse events of those occurring in the induction phase. Anesthesia-induced loss of consciousness(LoC) and AE until RoC are quite distinct phenomena with, in part, a distinct neurobiology. Althoughanaesthetics produce LoC mostly by affecting cortical connectivity, arousal processes at the end of anesthesia are triggered by structures deep in the brain, rather than being induced within the neocortex. This work aimed to provide an overview on AE processes research, in terms of mechanisms, and EEG findings. Because most of the research in this field concerns preclinical investigations, translational suggestions and research perspectives are proposed. However, little is known about the relationship between AE neurobiology, and potential complications occurring during the emergence, and after the RoC. Thus, another scope of this review is to underline why a better understanding of AE mechanisms could have significant clinical implications, such as improving the patients' quality of recovery, and avoiding early and late postoperative complications.
基金Supported by the Autonomous Region Key R&D Program Project“Research on the Prevention and Treatment System and Key Technologies of Elderly Related Diseases",No.2022B03009-4.
文摘BACKGROUND Owing to the particularities of their physical characteristics,older patients undergoing surgery under general anesthesia experience great surgical traumas.Thus,exploring more refined and individualized nursing approaches is an urgent need to mitigate the negative effects of surgery on such patients.AIM To analyze the influence of preoperative comprehensive education on anxiety,depression,pain,and sleep in older patients who underwent surgery under general anesthesia.METHODS In total,163 older adults who underwent surgery under general anesthesia between June 2022 and November 2023 were selected,77 of them received routine nursing care(control group),and 86 received preoperative comprehensive education(research group).Subsequently,comparative analyses were performed from the following perspectives:Surgical indicators(operation time,time to complete regain of consciousness,and temperature immediately after the procedure and upon recovery from anesthesia)before and after nursing care;negative emotions[self-rating anxiety scale(SAS)/self-rating depression scale(SDS)];pain severity[visual analog scale(VAS)];sleep quality[Pittsburgh sleep quality index(PSQI)];incidence of sleep disturbances(difficulties in falling asleep for the first time,falling asleep again after waking up frequently at night,falling asleep again after waking up early,and falling asleep all night);and incidence of adverse events(airway obstruction,catheter detachment,aspiration,and asphyxia).RESULTS The research group had significantly lower operation time and time to complete regain of consciousness than the control group after nursing care and markedly better recovery of postoperative body temperature and body temperature at awakening.In addition,more notable decreases in SAS,SDS,VAS,and PSQI scores were observed in the research group than in the control group.Furthermore,the incidence rate of sleep disturbance(8.14%vs 29.87%)and adverse events(4.65%vs 19.48%)were lower in the research group than in the control group.CONCLUSION Preoperative comprehensive education in older patients who underwent surgery under general anesthesia can improve postoperative indicators,effectively reduce the occurrence of anxiety and depression,alleviate postoperative pain,and improve sleep quality.
文摘Objective:To investigate the role of Hemocoagulase Injection used in the joint operation and the effect on the blood coagulable function.Methods:A total of 60 patients who undergoing joint operation in our hospital were randomly divided into two groups.Experiment group(Group A,n=30)was injected with 2 U Hemocoagulase Injection in 5 min before anesthesia induction.The contrast group(Group B,n=30)was treated with 0.9%normal saline in 5 min before anesthesia induction.Then common anesthesia was given to the two groups of patients.The venous blood was withdrawn for blood routine examination,thrombelastography and coagulable function at the time of pre-inducement, end of operation,and in 6 and 12 h after operation.The change of thrombelastograph and coagulable state were monitored during the whole surgery.And the volume of transfusion and hemorrhage between two groups was contrasted. Results:After the use of Hemocoagulase Injection,the operative time was shortened obviously(P<0.05).The volumes hemorrhage and transfusion was obviously smaller in Group A than in Group B(P<0.01).Hemocoagulase Injection did not influence fibrinogen and thrombelastograph of Group A(P>0.05).Conclusion:Hemocoagulase Injection can reduce the volumes of hemorrhage and transfusion and not influence the coagulable function.It is worth using in the joint operation.
