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,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
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
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
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
Financial pressure of multifactorial etiology promises to create new obstacles for academic anesthesia departments. Integrating the priorities of the academic and clinical mission of the anesthesia department, the med...Financial pressure of multifactorial etiology promises to create new obstacles for academic anesthesia departments. Integrating the priorities of the academic and clinical mission of the anesthesia department, the medical school, and the university hospital will require that anesthesia departments operate with maximal operational efficiency. Maintenance or expansion of institutional infrastructural support of the university anesthesia department will be necessary to achieve operational efficiencies, and to ensure that the safety of our patients is in no way compromised by financial concerns. Previous studies have documented increasing need for monetary institutional supports of academic anesthesia departments [1]. The purpose of this study is to delineate non-monetary institutional support afforded to academic anesthesia departments by their University Hospitals. After IRB approval, we electronically solicited the response to a 63 question survey (43 of which were used for the present study) from all 133 chairpersons of academic anesthesia departments in the United States. The remaining 20 questions were unrelated to the topics presented in this manuscript. 62 responded electronically, for an overall response rate of 46.6%. This study establishes the current state of infrastructural support afforded to academic anesthesia departments in the United States.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 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
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
Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians ...Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.展开更多
BACKGROUND Surgery,which is a major risk factor for venous thrombosis,has rarely been considered a risk factor for arterial thrombosis.Recent studies have suggested that venous and arterial thromboses share common ris...BACKGROUND Surgery,which is a major risk factor for venous thrombosis,has rarely been considered a risk factor for arterial thrombosis.Recent studies have suggested that venous and arterial thromboses share common risk factors and have a bidirectional relationship.Accordingly,there is a growing interest in the risk of arterial thrombosis after surgery.We report a case of acute bilateral lower extremity arterial thromboses that developed after a prolonged surgery.CASE SUMMARY A 59-year-old man was hospitalized for intraocular foreign body removal surgery.He was a heavy-drinking smoker and had untreated hypertension and varicose veins in both legs.The operation was unexpectedly prolonged,lasting 4 h and 45 min.Immediately after emergence from general anesthesia,the patient complained of extreme pain in both legs.After the surgical drape was removed,cyanosis was evident in both feet of the patient.The pulse was not palpable,and continuous-wave Doppler signals were inaudible in the bilateral dorsalis pedis and posterior tibial arteries.Computed tomography angiography confirmed acute bilateral thrombotic occlusion of the popliteal arteries,proximal anterior tibial arteries,and tibioperoneal trunks.Arterial pulse returned in both lower limbs after 6 h of heparin initiation.The patient was discharged on postoperative day 26 without any sequelae.CONCLUSION Acute lower extremity arterial thrombosis can occur after surgery.Anesthesiologists should pay particular attention to patients with risk factors for thrombosis.展开更多
Objective:To study the effects of Dexmedetomidine combined with Sufentanil on hemodynamics, stress state, helper T cytokines and pain degree during the waking period of general anesthesia in elderly patients with lowe...Objective:To study the effects of Dexmedetomidine combined with Sufentanil on hemodynamics, stress state, helper T cytokines and pain degree during the waking period of general anesthesia in elderly patients with lower limb fracture surgery were studied.Methods:From June 2017 to July 2018, 95 elderly patients with lower limb fracture who visited First Affiliated Hospital of Xi 'an Jiaotong University and received fracture surgery and general anesthesia were collected. According to their different anesthesia methods, 46 patients were divided into the sufentanil maintenance anesthesia group (Sufentanil group), and 49 patients were divided into the metopidine combined with sufentanil maintenance anesthesia group (Joint group). Changes in hemodynamics (HR, SpO2, MAP) of the two groups were monitored at different times throughout the operation. Using enzyme-linked immunoassay detection of two groups of patients in maintain anesthesia and anesthesia to stress index (Cor, E, FIns and HOMA-IR). The the changes of pain mediators (NO,β-EP, SP) and helper T cytokines (IFN-γ, TNF-α) were compared between the two groups before and 24 hours after surgery. Results:In the combined group, HR, SpO2, MAP and sufentanil groups showed little change in SpO2 during anesthesia, with no significant difference. The HR and MAP of T2 and T3 in the sufentanil group were significantly higher than those in the combined group at T2 and T3. The stress indicators Cor, E, FIns and HOMA-IR in the anesthesia of the two groups were significantly higher than those in the anesthesia maintenance. The serum stress indexes of Cor, E, FIns and HOMA-IR were significantly lower in the combined group than in the sufentanil group. The IFN-γ level of the combined group was significantly higher than that of the sufentanil group, and the TNF-α level was significantly lower than that of the control group. Serum levels of NO,β-EP and SP were significantly higher in the two groups 24 h after surgery. Serum pain mediators NO,β-EP and SP in the combined group were significantly lower than those in the sufentanil group before and 24 h after surgery.Conclusion: Combined anesthesia with Remifentanil and Propofol can stabilize the hemodynamic state of patients undergoing craniotomy, reduce cardiovascular stress response and inflammatory response, reduce nerve damage, and play a role in brain protection.展开更多
Introduction: Although inhalational anesthesia and nitrousoxide (N<sub>2</sub>O) are known to affect the intraocular pressure (IOP), little is known about the effect of nitrousoxide on the IOP during sevof...Introduction: Although inhalational anesthesia and nitrousoxide (N<sub>2</sub>O) are known to affect the intraocular pressure (IOP), little is known about the effect of nitrousoxide on the IOP during sevoflurane and remifentanil anesthesia. In the present study, we examined the effect of balanced anesthesia on the IOP. Materials and Methods: After obtaining informed consent, the patients undergoing abdominal surgery under general anesthesia were divided into two groups: N<sub>2</sub>O group (n = 10) and control group (n = 12). General anesthesia was maintained with remifentanil (0.05 - 0.3 μg/kg/min), 33% O<sub>2</sub> and 1.2% sevoflurane to keep ETCO<sub>2</sub> of 35 - 40 mmHg following tracheal intubation. After baseline measurement of IOP (T0, 20 minutes after injection of anesthesia), the patients in the N<sub>2</sub>O group received 67% nitrousoxide, and the patients in the control group received air, with O<sub>2</sub> and 1.2% sevoflurane. Then, IOP was measured at 1 hour (T1), 2 hours (T2), and 3 hours (T3) after anesthesia induction in the supineposition. Blood pressure and heart rate were recorded at the same time interval. Results: There was no significant difference in the IOP at any period between the two groups. In both groups, the IOP at the T3 was significantly higher than that at T0. Conclusion: These results suggest that N2O does not affect the IOP in patients undergoing abdominal surgery under sevoflurane and remifentanil anesthesia.展开更多
<strong></strong><strong></strong>In Mali, chest injuries remain a real public health problem and are associated with heavy morbidity and mortality. Faced with a resurgence of urban civil viole...<strong></strong><strong></strong>In Mali, chest injuries remain a real public health problem and are associated with heavy morbidity and mortality. Faced with a resurgence of urban civil violence and the explosion of road accidents, we decided to conduct this study in order to describe the epidemiological, clinical and therapeutic aspects of thoracic trauma in the emergency department. <strong>Method and Material:</strong> This is a descriptive prospective study over a period of one year in the emergency department of the CHU Gabriel Touré. Including all patients admitted for thoracic trauma. <strong>Analysis and Entry: </strong>Data were entered and analyzed on SPSS software version 20.0. The test was significant for a p value < 0.05. <strong>Results:</strong> We recorded 21,090 appeals in our structure among which 1284 patients were suspected of thoracic trauma. The diagnosis of thoracic trauma was retained in 119 (0.56%) patients. All patients were transported to the emergency room without prehospital medicalization. Clinical presentation was dominated by dyspnea in 54.6% of patients, however pain was the almost constant symptom in conscious victims. Various traumatic mechanisms had caused these lesions of the thorax, of which road traffic accidents represented half of the causes, followed by urban civil violence in 28.6% of patients. Landslides and falls from a great height were responsible for 19.5% of chest injuries. Open chest trauma was the type of lesion found in a third of the cases. This type of injury was exclusively due to blows and injuries during the brawls. Standard chest radiography was performed as the first intention in 60% of patients compared to 10.9% for the pleuropulmonary ultrasound. Thirteen patients required ventilatory assistance after orotracheal intubation. The average length of stay was 65.23 hours. During the period of our study, the overall mortality was 1.85% in the emergency departments with a lethality specific to chest trauma of 15%. <strong>Conclusion:</strong> Urban violence with its share of ballistic wounds determined the severity of this condition.展开更多
Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bon...Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bone. The epulis sits classically on the vestibular gum, rarely on the palatal side. We report a case of palatal giant epulis which posed a diagnostic problem. Case report: This was a 50-year-old patient with a large tumor occupying the entire oral cavity and pushing all nearby organs. This lesion had been evolving for ten years, with a tendency to gradually increase of its volume. The orthopantomogram revealed the destruction of the underlying alveolar bone without signs of tumor invasion. Surgical excision was performed, removing all the tumor in the vicinity of the nasopalatine vascular pedicle. The pathological examination concludes with an inflammatory epulis. Conclusion: The epulis is a benign tumor of the gum, circumscribed, localized preferentially at the neck of one or two contiguous teeth. It occurs more in women, with a predilection for the vestibular side, rarely the palatal side. In the absence of appropriate treatment it can lead to a large tumor, posing a diagnostic problem and causing functional or aesthetic discomfort. Complete surgical excision with histological examination remains the solution. Healing without sequelae is the rule.展开更多
BACKGROUND： Animal experiments have demonstrated that isoflurane exposure alone induces learning and memory deficits for weeks or months. However, the molecular mechanisms of learning and memory remain poorly underst...BACKGROUND： Animal experiments have demonstrated that isoflurane exposure alone induces learning and memory deficits for weeks or months. However, the molecular mechanisms of learning and memory remain poorly understood. Hippocampal expression of calcium/phospholipid- dependent protein kinase （PKC） and cAMP-dependent protein kinase （PKA） in rats have been shown to be associated with memory processing. OBJECTIVE： To investigate changes in rat spatial memory and hippocampal CA1 neuronal kinase system following isoflurane anesthesia, and to explore the correlation between molecular changes in cerebral neurons and behavioral manifestations following anesthesia. DESIGN, TIME AND SE＇rFING： A randomized, controlled, animal study. All experiments were performed at the Department of Anesthesia, Beijing Chaoyang Hospital, Capital Medical University from November 2007 to December 2008. MATERIALS： A total of 72 male, 3 month-old （young group）, Sprague Dawley rats, and 36 male, 20 month-old （aged group）, Sprague-Dawley rats were used in the study. Isoflurane was purchased from Baxter, USA. METHODS： Young and aged rats were randomly assigned to control, training （no anesthesia, Morris water maze training）, and isoflurane （1.2% isoflurane, Morris water maze training） groups. The isoflurane group was further subdivided into four groups, which were exposed to anesthesia for 2 or 4 hours, and were subjected to Morris water maze training at 2 days or 2 weeks postanesthesia. Finally, each aged group comprised 6 rats, and the young group comprised 12 rats. MAIN OUTCOME MEASURES： Spatial learning and memory were observed during Morris water maze training. Hippocampal CA1 PKA and PKC expression and activity were detected by immunohistochemistry and enzyme-linked immunosorbent assay （ELISA）. RESULTS： A 4-hour isoflurane exposure induced spatial memory deficits in all rats for 2 days to 2 weeks. In particular, aged rats exhibited more severe spatial memory deficits. Immunohistochemistry and ELISA results showed a significant increase in PKC and PKA expression and activity in the hippocampus CA1 subfield following Morris water maze training （P 〈 0.05）. Moreover, isoflurane anesthesia inhibited PKC and PKA expression and activity, and this inhibition increased with increasing exposure duration and increasing age. CONCLUSION： Results suggested that increased isoflurane exposure and age could extensively inhibit the hippocampal CA1 kinase system. Inhibition of protein kinases could play an important role in the cognitive decline following anesthesia.展开更多
BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevof...BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.AIM To compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.METHODS We enrolled 61 American Society of Anesthesia(ASA) class Ⅰ-Ⅱ outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index(PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.RESULTS For the propofol group, the mean postoperative global PSQI score(3.3 ± 1.3) was lower than the mean preoperative global PSQI score(4.9 ± 2.3)(P < 0.001);for the sevoflurane group, the mean postoperative global PSQI score(6.5 ± 2.8) was higher than the mean preoperative global PSQI score(5.5 ± 3.2)(P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.CONCLUSION Sleep quality assessed by the PSQI is better improved in ASA class Ⅰ-Ⅱ female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.展开更多
Anesthesiologists perform a broad spectrum of tasks. However, in many countries, there is no legal basis for personnel staffing of physicians in anesthesia. Also, the German diagnosis related groups system for refundi...Anesthesiologists perform a broad spectrum of tasks. However, in many countries, there is no legal basis for personnel staffing of physicians in anesthesia. Also, the German diagnosis related groups system for refunding does not deliver such a basis. Thus, in 2006 a new calculation base for the personnel requirement that included an Excel calculation sheet was introduced by the German Board of Anesthesiologists(BDA) and the German Society of Anesthesiology and Intensive Care Medicine(DGAI), and updated in 2009 and 2015. Oriented primarily to organizational needs, in 2015, BDA/DGAI defined quantitative and qualitative cornerstones for personnel requirement of physicians in anesthesia, especially reflecting recent laws governing physician's working conditions and competence in the field of anesthesia, as well as demands of strengthened legal rights of patients, patient care and safety. We present a workload-oriented model, integrating core working hours, shift work or standby duty, quality of care, efficiency of processes, legal, educational, controlling, local, organizational and economic aspects for calculating personnel demands. Auxiliary tables enable physicians to calculate personnel demands due to differing employee workload, non-patient oriented tasks and reimbursement of full-equivalents due to parental leave, prohibition of employment, or longterm illness. After 10 years of experience with the first calculation tool, we report the generalizable key aspects and items of a necessary calculation tool which may help physicians to justify realistic workload-oriented personnel staffing demands in anesthesia. A modular, flexiblenature of a calculation tool should allow adaption to the respective legal and organizational demands of different countries.展开更多
Severe pre<span>e</span><span>clampsia is a challenging issue facing both intensivist and anesthetic team carrying both maternal and fetal morbidity and mortality. Termination of pregnancy after bloo...Severe pre<span>e</span><span>clampsia is a challenging issue facing both intensivist and anesthetic team carrying both maternal and fetal morbidity and mortality. Termination of pregnancy after blood pressure control is the golden key in management. Cerebral complications due to diffuse cerebral vasospasm are most common and serious. Intrathecal midazolam with its gamma amino butyric action may antidote glutamate mediated sympathetic surge and decreasing cerebral vasospasm. Temporal view transcranial Doppler imaging maternal middle cerebral artery is used to examine blood flow indices namely pulsat</span><span>i</span><span>lity index and resistiv</span><span>e</span><span> index. One hundred ladies with severe pre</span><span>e</span><span>clampsia scheduled for urgent caesarian section were recruited in 2 groups, both received 10</span><span> </span><span>mg bupivacaine 0.5%, Midazolam group received 1</span><span> </span><span>mg midazolam and the other group received 0.2</span><span> </span><span>ml sterile saline 0.9% NaCl. All vascular indices were significantly better in midazolam group, less ICU stay.</span>展开更多
Background: Global guidelines for venous thromboembolism (VTE) prophylaxis of patients undergoing major surgery are well established. However, their applicability and safety in patients receiving neuraxial anesthesia ...Background: Global guidelines for venous thromboembolism (VTE) prophylaxis of patients undergoing major surgery are well established. However, their applicability and safety in patients receiving neuraxial anesthesia is unproven. We sought to evaluate the safety and feasibility of chemical VTE prophylaxis in a prospective group of patients undergoing major foregut procedures under a combination of epidural and general anesthesia. Methods: A prospective database of all patients undergoing major foregut surgery from 2004-2009 was maintained and analyzed. Epidural catheters were placed pre-operatively and used for post-operative analgesia for three days in all patients. Factors evaluated included age, ethnicity, sex, length of stay, duration of epidural placement, complications of epidural placement and post-operative management, and VTE events. A uniform protocol was followed regarding the timing of low-molecular-weight heparin (LMWH) administration with epidural catheter insertion/removal. Results: A total of 237 patients formed the study group. The mean age was 57 years (range, 19 - 88) among 121 (51.1%) women and 65 years (range, 20 - 95) among 116 (48.9%) men. One hundred and sixty-six patients were Caucasian (70%), 37 Black (15.6%), 15 Hispanic (6.3%), 12 Asian/Pacific (5.1%), and 7 other (3%). All epidural catheters were removed on the third post-operative day. There were a total of five VTE (2.1%) events postoperatively. No peri-operative or post-operative epidural catheter associated complications occurred. Conclusions: Concomitant epidural catheterization and LMWH anticoagulation is safe and feasible in major abdominal surgery patients, including those undergoing major hepatic resection. Guidelines for VTE prophylaxis and LMWH administration in the setting of neuraxial anesthesia are well established and applicable to this unique patient population.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 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.
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Financial pressure of multifactorial etiology promises to create new obstacles for academic anesthesia departments. Integrating the priorities of the academic and clinical mission of the anesthesia department, the medical school, and the university hospital will require that anesthesia departments operate with maximal operational efficiency. Maintenance or expansion of institutional infrastructural support of the university anesthesia department will be necessary to achieve operational efficiencies, and to ensure that the safety of our patients is in no way compromised by financial concerns. Previous studies have documented increasing need for monetary institutional supports of academic anesthesia departments [1]. The purpose of this study is to delineate non-monetary institutional support afforded to academic anesthesia departments by their University Hospitals. After IRB approval, we electronically solicited the response to a 63 question survey (43 of which were used for the present study) from all 133 chairpersons of academic anesthesia departments in the United States. The remaining 20 questions were unrelated to the topics presented in this manuscript. 62 responded electronically, for an overall response rate of 46.6%. This study establishes the current state of infrastructural support afforded to academic anesthesia departments in the United States.
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 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 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Background: The availability of an anesthesiologist is often a limiting factor in the number of operations that can be performed by International Medical Surgical Response Teams (IMSuRT). Because emergency physicians (EPs) possess skills in airway control, management of moderate and deep sedation, and ventilator management, we propose that with proper training in general anesthesia, EPs can serve as anesthetists for IMSuRT with anesthesiologist supervision. Methods: During a 10-week period, a board-certified EP administered general anesthesia to 60 patients prior to a surgical medical mission trip. The breakdown of surgical cases was: 11 orthopedic, 2 genitourinary, 20 ear, nose, and throat, 8 obstetrics and gynecological, 13 general surgery, and 6 vascular. A simplified protocol for induction, maintenance, and emergence was adhered to for all cases. Results: Fourteen orthopedic cases using general anesthesia were performed in a one-week period in Haiti. These cases involved open reduction and internal fixation (ORIF), hemiarthoplasty, hardware removal, tendon transfer and external fixation of fractured bone. Conclusion: We demonstrate the feasibility of a model curriculum to train EPs in the basics of anesthesia. The EP can safely and effectively deliver general anesthesia for major cases on surgical medical mission trips under the auspices of an anesthesiologist in an austere environment.
文摘BACKGROUND Surgery,which is a major risk factor for venous thrombosis,has rarely been considered a risk factor for arterial thrombosis.Recent studies have suggested that venous and arterial thromboses share common risk factors and have a bidirectional relationship.Accordingly,there is a growing interest in the risk of arterial thrombosis after surgery.We report a case of acute bilateral lower extremity arterial thromboses that developed after a prolonged surgery.CASE SUMMARY A 59-year-old man was hospitalized for intraocular foreign body removal surgery.He was a heavy-drinking smoker and had untreated hypertension and varicose veins in both legs.The operation was unexpectedly prolonged,lasting 4 h and 45 min.Immediately after emergence from general anesthesia,the patient complained of extreme pain in both legs.After the surgical drape was removed,cyanosis was evident in both feet of the patient.The pulse was not palpable,and continuous-wave Doppler signals were inaudible in the bilateral dorsalis pedis and posterior tibial arteries.Computed tomography angiography confirmed acute bilateral thrombotic occlusion of the popliteal arteries,proximal anterior tibial arteries,and tibioperoneal trunks.Arterial pulse returned in both lower limbs after 6 h of heparin initiation.The patient was discharged on postoperative day 26 without any sequelae.CONCLUSION Acute lower extremity arterial thrombosis can occur after surgery.Anesthesiologists should pay particular attention to patients with risk factors for thrombosis.
文摘Objective:To study the effects of Dexmedetomidine combined with Sufentanil on hemodynamics, stress state, helper T cytokines and pain degree during the waking period of general anesthesia in elderly patients with lower limb fracture surgery were studied.Methods:From June 2017 to July 2018, 95 elderly patients with lower limb fracture who visited First Affiliated Hospital of Xi 'an Jiaotong University and received fracture surgery and general anesthesia were collected. According to their different anesthesia methods, 46 patients were divided into the sufentanil maintenance anesthesia group (Sufentanil group), and 49 patients were divided into the metopidine combined with sufentanil maintenance anesthesia group (Joint group). Changes in hemodynamics (HR, SpO2, MAP) of the two groups were monitored at different times throughout the operation. Using enzyme-linked immunoassay detection of two groups of patients in maintain anesthesia and anesthesia to stress index (Cor, E, FIns and HOMA-IR). The the changes of pain mediators (NO,β-EP, SP) and helper T cytokines (IFN-γ, TNF-α) were compared between the two groups before and 24 hours after surgery. Results:In the combined group, HR, SpO2, MAP and sufentanil groups showed little change in SpO2 during anesthesia, with no significant difference. The HR and MAP of T2 and T3 in the sufentanil group were significantly higher than those in the combined group at T2 and T3. The stress indicators Cor, E, FIns and HOMA-IR in the anesthesia of the two groups were significantly higher than those in the anesthesia maintenance. The serum stress indexes of Cor, E, FIns and HOMA-IR were significantly lower in the combined group than in the sufentanil group. The IFN-γ level of the combined group was significantly higher than that of the sufentanil group, and the TNF-α level was significantly lower than that of the control group. Serum levels of NO,β-EP and SP were significantly higher in the two groups 24 h after surgery. Serum pain mediators NO,β-EP and SP in the combined group were significantly lower than those in the sufentanil group before and 24 h after surgery.Conclusion: Combined anesthesia with Remifentanil and Propofol can stabilize the hemodynamic state of patients undergoing craniotomy, reduce cardiovascular stress response and inflammatory response, reduce nerve damage, and play a role in brain protection.
文摘Introduction: Although inhalational anesthesia and nitrousoxide (N<sub>2</sub>O) are known to affect the intraocular pressure (IOP), little is known about the effect of nitrousoxide on the IOP during sevoflurane and remifentanil anesthesia. In the present study, we examined the effect of balanced anesthesia on the IOP. Materials and Methods: After obtaining informed consent, the patients undergoing abdominal surgery under general anesthesia were divided into two groups: N<sub>2</sub>O group (n = 10) and control group (n = 12). General anesthesia was maintained with remifentanil (0.05 - 0.3 μg/kg/min), 33% O<sub>2</sub> and 1.2% sevoflurane to keep ETCO<sub>2</sub> of 35 - 40 mmHg following tracheal intubation. After baseline measurement of IOP (T0, 20 minutes after injection of anesthesia), the patients in the N<sub>2</sub>O group received 67% nitrousoxide, and the patients in the control group received air, with O<sub>2</sub> and 1.2% sevoflurane. Then, IOP was measured at 1 hour (T1), 2 hours (T2), and 3 hours (T3) after anesthesia induction in the supineposition. Blood pressure and heart rate were recorded at the same time interval. Results: There was no significant difference in the IOP at any period between the two groups. In both groups, the IOP at the T3 was significantly higher than that at T0. Conclusion: These results suggest that N2O does not affect the IOP in patients undergoing abdominal surgery under sevoflurane and remifentanil anesthesia.
文摘<strong></strong><strong></strong>In Mali, chest injuries remain a real public health problem and are associated with heavy morbidity and mortality. Faced with a resurgence of urban civil violence and the explosion of road accidents, we decided to conduct this study in order to describe the epidemiological, clinical and therapeutic aspects of thoracic trauma in the emergency department. <strong>Method and Material:</strong> This is a descriptive prospective study over a period of one year in the emergency department of the CHU Gabriel Touré. Including all patients admitted for thoracic trauma. <strong>Analysis and Entry: </strong>Data were entered and analyzed on SPSS software version 20.0. The test was significant for a p value < 0.05. <strong>Results:</strong> We recorded 21,090 appeals in our structure among which 1284 patients were suspected of thoracic trauma. The diagnosis of thoracic trauma was retained in 119 (0.56%) patients. All patients were transported to the emergency room without prehospital medicalization. Clinical presentation was dominated by dyspnea in 54.6% of patients, however pain was the almost constant symptom in conscious victims. Various traumatic mechanisms had caused these lesions of the thorax, of which road traffic accidents represented half of the causes, followed by urban civil violence in 28.6% of patients. Landslides and falls from a great height were responsible for 19.5% of chest injuries. Open chest trauma was the type of lesion found in a third of the cases. This type of injury was exclusively due to blows and injuries during the brawls. Standard chest radiography was performed as the first intention in 60% of patients compared to 10.9% for the pleuropulmonary ultrasound. Thirteen patients required ventilatory assistance after orotracheal intubation. The average length of stay was 65.23 hours. During the period of our study, the overall mortality was 1.85% in the emergency departments with a lethality specific to chest trauma of 15%. <strong>Conclusion:</strong> Urban violence with its share of ballistic wounds determined the severity of this condition.
文摘Introduction: Epulis is a pseudotumor very common in women. If neglected, it can reach a considerable volume. The marginal gingiva is very involved in the tumor either in isolation or with periodontal and alveolar bone. The epulis sits classically on the vestibular gum, rarely on the palatal side. We report a case of palatal giant epulis which posed a diagnostic problem. Case report: This was a 50-year-old patient with a large tumor occupying the entire oral cavity and pushing all nearby organs. This lesion had been evolving for ten years, with a tendency to gradually increase of its volume. The orthopantomogram revealed the destruction of the underlying alveolar bone without signs of tumor invasion. Surgical excision was performed, removing all the tumor in the vicinity of the nasopalatine vascular pedicle. The pathological examination concludes with an inflammatory epulis. Conclusion: The epulis is a benign tumor of the gum, circumscribed, localized preferentially at the neck of one or two contiguous teeth. It occurs more in women, with a predilection for the vestibular side, rarely the palatal side. In the absence of appropriate treatment it can lead to a large tumor, posing a diagnostic problem and causing functional or aesthetic discomfort. Complete surgical excision with histological examination remains the solution. Healing without sequelae is the rule.
基金the National Natural Science Foundation of China, No. 30471665
文摘BACKGROUND： Animal experiments have demonstrated that isoflurane exposure alone induces learning and memory deficits for weeks or months. However, the molecular mechanisms of learning and memory remain poorly understood. Hippocampal expression of calcium/phospholipid- dependent protein kinase （PKC） and cAMP-dependent protein kinase （PKA） in rats have been shown to be associated with memory processing. OBJECTIVE： To investigate changes in rat spatial memory and hippocampal CA1 neuronal kinase system following isoflurane anesthesia, and to explore the correlation between molecular changes in cerebral neurons and behavioral manifestations following anesthesia. DESIGN, TIME AND SE＇rFING： A randomized, controlled, animal study. All experiments were performed at the Department of Anesthesia, Beijing Chaoyang Hospital, Capital Medical University from November 2007 to December 2008. MATERIALS： A total of 72 male, 3 month-old （young group）, Sprague Dawley rats, and 36 male, 20 month-old （aged group）, Sprague-Dawley rats were used in the study. Isoflurane was purchased from Baxter, USA. METHODS： Young and aged rats were randomly assigned to control, training （no anesthesia, Morris water maze training）, and isoflurane （1.2% isoflurane, Morris water maze training） groups. The isoflurane group was further subdivided into four groups, which were exposed to anesthesia for 2 or 4 hours, and were subjected to Morris water maze training at 2 days or 2 weeks postanesthesia. Finally, each aged group comprised 6 rats, and the young group comprised 12 rats. MAIN OUTCOME MEASURES： Spatial learning and memory were observed during Morris water maze training. Hippocampal CA1 PKA and PKC expression and activity were detected by immunohistochemistry and enzyme-linked immunosorbent assay （ELISA）. RESULTS： A 4-hour isoflurane exposure induced spatial memory deficits in all rats for 2 days to 2 weeks. In particular, aged rats exhibited more severe spatial memory deficits. Immunohistochemistry and ELISA results showed a significant increase in PKC and PKA expression and activity in the hippocampus CA1 subfield following Morris water maze training （P 〈 0.05）. Moreover, isoflurane anesthesia inhibited PKC and PKA expression and activity, and this inhibition increased with increasing exposure duration and increasing age. CONCLUSION： Results suggested that increased isoflurane exposure and age could extensively inhibit the hippocampal CA1 kinase system. Inhibition of protein kinases could play an important role in the cognitive decline following anesthesia.
文摘BACKGROUND Sleep disturbance on the first postoperative night commonly develops for patients after day surgeries. The choice of either total intravenous anesthesia by propofol or total inhalation anesthesia with sevoflurane has become an issue for preventing sleep disturbance.AIM To compare sleep quality on the first postoperative night for female patients after total intravenous anesthesia by propofol and total inhalation anesthesia with sevoflurane.METHODS We enrolled 61 American Society of Anesthesia(ASA) class Ⅰ-Ⅱ outpatients who underwent minor gynecologic surgeries by either propofol or sevoflurane anesthesia. Sleep quality of the very night was assessed by the Pittsburgh Sleep Quality Index(PSQI) on the next day, and PSQI scores were compared by the Wilcoxon signed-rank test and paired t-test pre-operatively and postoperatively.RESULTS For the propofol group, the mean postoperative global PSQI score(3.3 ± 1.3) was lower than the mean preoperative global PSQI score(4.9 ± 2.3)(P < 0.001);for the sevoflurane group, the mean postoperative global PSQI score(6.5 ± 2.8) was higher than the mean preoperative global PSQI score(5.5 ± 3.2)(P = 0.02). Eighty percent of patients receiving propofol anesthesia subjectively reported improved sleep quality, but only 17% of patients receiving sevoflurane anesthesia reported improved sleep quality.CONCLUSION Sleep quality assessed by the PSQI is better improved in ASA class Ⅰ-Ⅱ female patients receiving propofol anesthesia other than sevoflurane anesthesia for undergoing minor gynecologic surgeries.
文摘Anesthesiologists perform a broad spectrum of tasks. However, in many countries, there is no legal basis for personnel staffing of physicians in anesthesia. Also, the German diagnosis related groups system for refunding does not deliver such a basis. Thus, in 2006 a new calculation base for the personnel requirement that included an Excel calculation sheet was introduced by the German Board of Anesthesiologists(BDA) and the German Society of Anesthesiology and Intensive Care Medicine(DGAI), and updated in 2009 and 2015. Oriented primarily to organizational needs, in 2015, BDA/DGAI defined quantitative and qualitative cornerstones for personnel requirement of physicians in anesthesia, especially reflecting recent laws governing physician's working conditions and competence in the field of anesthesia, as well as demands of strengthened legal rights of patients, patient care and safety. We present a workload-oriented model, integrating core working hours, shift work or standby duty, quality of care, efficiency of processes, legal, educational, controlling, local, organizational and economic aspects for calculating personnel demands. Auxiliary tables enable physicians to calculate personnel demands due to differing employee workload, non-patient oriented tasks and reimbursement of full-equivalents due to parental leave, prohibition of employment, or longterm illness. After 10 years of experience with the first calculation tool, we report the generalizable key aspects and items of a necessary calculation tool which may help physicians to justify realistic workload-oriented personnel staffing demands in anesthesia. A modular, flexiblenature of a calculation tool should allow adaption to the respective legal and organizational demands of different countries.
文摘Severe pre<span>e</span><span>clampsia is a challenging issue facing both intensivist and anesthetic team carrying both maternal and fetal morbidity and mortality. Termination of pregnancy after blood pressure control is the golden key in management. Cerebral complications due to diffuse cerebral vasospasm are most common and serious. Intrathecal midazolam with its gamma amino butyric action may antidote glutamate mediated sympathetic surge and decreasing cerebral vasospasm. Temporal view transcranial Doppler imaging maternal middle cerebral artery is used to examine blood flow indices namely pulsat</span><span>i</span><span>lity index and resistiv</span><span>e</span><span> index. One hundred ladies with severe pre</span><span>e</span><span>clampsia scheduled for urgent caesarian section were recruited in 2 groups, both received 10</span><span> </span><span>mg bupivacaine 0.5%, Midazolam group received 1</span><span> </span><span>mg midazolam and the other group received 0.2</span><span> </span><span>ml sterile saline 0.9% NaCl. All vascular indices were significantly better in midazolam group, less ICU stay.</span>
文摘Background: Global guidelines for venous thromboembolism (VTE) prophylaxis of patients undergoing major surgery are well established. However, their applicability and safety in patients receiving neuraxial anesthesia is unproven. We sought to evaluate the safety and feasibility of chemical VTE prophylaxis in a prospective group of patients undergoing major foregut procedures under a combination of epidural and general anesthesia. Methods: A prospective database of all patients undergoing major foregut surgery from 2004-2009 was maintained and analyzed. Epidural catheters were placed pre-operatively and used for post-operative analgesia for three days in all patients. Factors evaluated included age, ethnicity, sex, length of stay, duration of epidural placement, complications of epidural placement and post-operative management, and VTE events. A uniform protocol was followed regarding the timing of low-molecular-weight heparin (LMWH) administration with epidural catheter insertion/removal. Results: A total of 237 patients formed the study group. The mean age was 57 years (range, 19 - 88) among 121 (51.1%) women and 65 years (range, 20 - 95) among 116 (48.9%) men. One hundred and sixty-six patients were Caucasian (70%), 37 Black (15.6%), 15 Hispanic (6.3%), 12 Asian/Pacific (5.1%), and 7 other (3%). All epidural catheters were removed on the third post-operative day. There were a total of five VTE (2.1%) events postoperatively. No peri-operative or post-operative epidural catheter associated complications occurred. Conclusions: Concomitant epidural catheterization and LMWH anticoagulation is safe and feasible in major abdominal surgery patients, including those undergoing major hepatic resection. Guidelines for VTE prophylaxis and LMWH administration in the setting of neuraxial anesthesia are well established and applicable to this unique patient population.
