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 Perioperative anesthesia management of obese patients presents significant challenges as traditional total body weight-based dosing fails to achieve optimal anesthetic effects due to altered pharmacokinetic...BACKGROUND Perioperative anesthesia management of obese patients presents significant challenges as traditional total body weight-based dosing fails to achieve optimal anesthetic effects due to altered pharmacokinetic characteristics including abnormal drug distribution and clearance.Rocuronium exhibits markedly different distribution patterns in obese patients,with conventional weight correction methods inadequately addressing individual muscle mass variations that critically influence drug distribution.AIM To investigate the quantitative relationship between skeletal muscle index(SMI)and rocuronium distribution volume in obese colorectal cancer patients,establish a population pharmacokinetic model,and develop individualized dosing strategies based on muscle mass.METHODS A retrospective cohort study was conducted,including 100 obese patients(body mass index≥30 kg/m^(2))who underwent elective radical colorectal cancer surgery at our hospital from June 2023 to January 2025.Skeletal muscle mass was measured using InBody 260 body composition analyzer and SMI was calculated to assess muscle mass,with male SMI<7.0 kg/m^(2) and female SMI<5.7 kg/m^(2)as diagnostic criteria for sarcopenia.Plasma rocuronium concentrations were detected by liquid chromatography-tandem mass spectrometry/mass spectrometry,and nonlinear mixed-effect modeling was used to establish population pharmacokinetic modeling.Stepwise regression was used to screen covariates,and dosing regimens were optimized through Monte Carlo simulation.The primary endpoint was targeted plasma concentration achievement rate,and the secondary endpoint was postoperative residual muscle relaxation incidence.RESULTS Among 100 patients,35(35.0%)had sarcopenia and 65(65.0%)did not.Patients in the sarcopenia group were older(64.1±9.8 years vs 54.2±10.9 years,P<0.001)and had significantly lower SMI(6.2±0.8 kg/m^(2)vs 8.4±1.2 kg/m^(2),P<0.001).SMI showed strong positive correlation with rocuronium steady-state distribution volume(r=0.718,P<0.001)and moderate negative correlation with clearance(r=-0.502,P<0.001).A two-compartment population pharmacokinetic model was successfully established,with SMI being the most important covariate affecting central compartment distribution volume(△OFV=-41.2,P<0.001).Model validation showed bootstrap successful convergence rate of 92.3%,and 92.1%of observed values fell within prediction intervals in predicted concentration versus predicted concentration.The SMI-based individualized dosing regimen improved target exposure achievement rate from 82.0%in traditional regimen to 93.5%(P=0.009),and reduced postoperative residual muscle relaxation incidence from 13.0%to 3.5%(P=0.018).The sarcopenia group showed the most significant improvement in achievement rate,from 71.4%to 93.8%(P=0.017).CONCLUSION SMI shows strong correlation with rocuronium distribution volume in obese colorectal cancer patients and is a key factor affecting drug distribution.SMI-based individualized dosing strategies can significantly improve target exposure achievement rate and reduce postoperative residual muscle relaxation incidence,providing scientific evidence for precision anesthesia management in obese patients.展开更多
BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and...BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates,which threaten patient safety and functional outcomes.Enhanced recovery after surgery(ERAS)principles have been shown to improve perioperative outcomes through evidence-based,multidisciplinary care pathways.Despite its widespread adoption,there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit(PACU)and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery.This study aimed to investigate whether an ERASbased PACU nursing protocol could enhance recovery,reduce complications,and improve patient safety in this surgical population.AIM To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.METHODS A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit(PACU)were selected.They were randomly divided into the observation group(the PACU nursing process was optimized based on ERAS)and the control group(the conventional PACU nursing process was adopted)by the random number grouping method,with 130 cases in each group.The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,time of leaving the room after tube removal,retention time in the recovery room,occurrence of complications,satisfaction and readmission rate were compared between the two groups after entering the room.Compare the occurrence of adverse events in the PACU nursing process between the two groups.RESULTS The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,retention time in the recovery room,total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group,and the satisfaction rate was higher than that in the control group(P<0.05).The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group(P<0.05).CONCLUSION Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery,reduce adverse events,improve nursing satisfaction,and at the same time,lower the incidence of adverse events in the PACU nursing process,providing a more refined management basis for clinical practice.展开更多
AIM: To determine whether anaesthesiologistadministered sedation with propofol(AAP) or endoscopist-administered conscious sedation(EAC) with fentanyl/midazolam shortens colonoscopy duration/total room time. METHODS: T...AIM: To determine whether anaesthesiologistadministered sedation with propofol(AAP) or endoscopist-administered conscious sedation(EAC) with fentanyl/midazolam shortens colonoscopy duration/total room time. METHODS: This is a prospective, non-randomized, comparative study that enrolled patients greater than 18 years of age undergoing colonoscopy in a single Canadian academic outpatient endoscopy unit over a three-month consecutive period. Colonoscopies in this unit are performed both with AAP and EAC. Patient demographics, procedure-related data and adverse events were documented. Additionally, the level of procedure difficulty, and whether a staff endoscopist, trainee with assistance, or independent trainee, performed the procedure were documented. A validated modified 4-question, 5-point Likert scale telephone survey was used to assess patient satisfaction with colonoscopy. The telephone patient satisfaction survey was conducted 24-72 h following the procedure.RESULTS: Two hundred and thirty patients were enrolled during the study period with 126 patients in the AAP group and 104 patients in the EAC group. Mean procedure time was 18.3 ± 10.1 min in the AAP group and 14.7 ± 7.1 min in the EAC group(P = 0.002). Mean total room time was 36.8 ± 13.7 with AAP and 30.1 ± 11 min with EAC(P < 0.001). Multivariate analysis revealed the use of AAP(P = 0.002), resident participation(P < 0.001), diagnostic interventions(P = 0.033), therapeutic interventions(P < 0.001), lower body mass index(P = 0.008) and American Society of Anaesthesiologist class(P = 0.016), to be predictors of longer total room time. Patient age and gender were not significant predictors. After excluding cases in which trainees were involved, there was no significant difference in procedure time between the two groups(P = 0.941), however total room time was still prolonged in the AAP group(P = 0.019). The amount of pain experienced was lower with AAP(P = 0.02), with a trend toward overall higher patient satisfaction(P = 0.074). There were 2 sedation-related adverse events, both in the AAP group involving a patient with aspiration requiring hospitalization and a patient with hypoxia managed with bronchodilators.CONCLUSION: EAC results in reduced total room time compared to AAP. Resident participation doubles procedure time regardless of sedation type.展开更多
Acute liver failure(ALF)may result in severe neurological complications caused by cerebral edema and elevated intracranial pressure(ICP).Multiple pathogenic mechanisms explain the elevated ICP,and newer hypotheses hav...Acute liver failure(ALF)may result in severe neurological complications caused by cerebral edema and elevated intracranial pressure(ICP).Multiple pathogenic mechanisms explain the elevated ICP,and newer hypotheses have been described.While invasive ICP monitoring(ICPM)may have a role in ALF management,these patients are typically coagulopathic and at risk for intracranial hemorrhage.ICPM is the subject of much debate,and significant heterogeneity exists in clinical practice regarding its use.Contemporary ICPM techniques and coagulopathy reversal strategies may be associated with a lower risk of hemor-rhage;however,most of the evidence is limited by its retrospective nature and relatively small sample size.展开更多
Perioperative hypothermia, core temperature below 36.0 ℃, transpires due to disruption of thermoregulationby anesthesia coupled with cold exposure to procedural surroundings and cleansing agents. Although most public...Perioperative hypothermia, core temperature below 36.0 ℃, transpires due to disruption of thermoregulationby anesthesia coupled with cold exposure to procedural surroundings and cleansing agents. Although most publications have focused on thermoregulation disruption with general anesthesia, neuraxial anesthesia may also cause significant hypothermia. The clinical consequences of perioperative hypothermia are multiple and include patient discomfort, shivering, platelet dysfunction, coagulopathy, and increased vasoconstriction associated with a higher risk of wound infection. Furthermore, postoperative cardiac events occur at a higher rate; although it is unclear whether this is due to increased oxygen consumption or norepinephrine levels. Hypothermia may also affect pharmacokinetics and prolong postoperative recovery times and hospital length of stay. In order to combat perioperative hypothermia, many prevention strategies have been examined. Active and passive cutaneous warming are likely the most common and aim to both warm and prevent heat loss; many consider active warming a standard of care for surgeries over one hour. Intravenous nutrients have also been examined to boost metabolic heat production. Additionally, pharmacologic agents that induce vasoconstriction have been studied with the goal of minimizing heat loss. Despite these multiple strategies for prevention and treatment, hypothermia continues to be a problem and a common consequence of the perioperative period. This literature review presents the most recent evidence on the disruption of temperature regulation by anesthesia and perioperative environment, the consequences of hypothermia, and the methods for hypothermia prevention and treatment.展开更多
Objective:To compare the therapeutic effects of endovascular and open surgery on abdominal aortic aneurysms.Methods:From June 2019 to May 2020,60 cases of abdominal aortic aneurysms(AAA)were divided into observation g...Objective:To compare the therapeutic effects of endovascular and open surgery on abdominal aortic aneurysms.Methods:From June 2019 to May 2020,60 cases of abdominal aortic aneurysms(AAA)were divided into observation group(30 cases in endovascular technique group)and control group(30 cases in open technique group).Results:The blood loss,operative time and blood transfusion of the observation group were significantly lower than those of the control group(P<0.05).The incidence of postoperative complications is low,and the incidence of longterm complications is relatively high.Conclusion:In the treatment of abdominal aortic aneurysm,endovascular technology has the advantages of low risk,less trauma,and quick recovery after surgery.Open surgery is suitable for patients who cannot receive endovascular treatment.In order to achieve good treatment effects,it is necessary to choose an appropriate treatment method according to the actual situation of the patient.展开更多
Thoracic epidural anesthesia(TEA)has been the gold standard of perioperative analgesia in various abdominal and thoracic surgeries.However,misplaced or displaced catheters,along with other factors such as technical ch...Thoracic epidural anesthesia(TEA)has been the gold standard of perioperative analgesia in various abdominal and thoracic surgeries.However,misplaced or displaced catheters,along with other factors such as technical challenges,equipment failure,and anatomic variation,lead to a high incidence of unsatisfactory analgesia.This article aims to assess the different sources of TEA failure and strategies to validate the location of thoracic epidural catheters.A literature search of PubMed,Medline,Science Direct,and Google Scholar was done.The search results were limited to randomized controlled trials.Literature suggests techniques such as electrophysiological stimulation,epidural waveform monitoring,and x-ray epidurography for identifying thoracic epidural placement,but there is no one particular superior confirmation method;clinicians are advised to select techniques that are practical and suitable for their patients and practice environment to maximize success.展开更多
Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received c...Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received conventional treatment,and the experimental group received modified treatment.The changes in self-management ability,comfort level and recovery time before and after treatment were compared between the two groups.Results:The comfort level and self-management ability of the experimental group were significantly higher than that of the control group,and the recovery time was significantly shorter than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Puncture suture can safely and effectively repair the intracavity of abdominal aortic aneurysm.展开更多
BACKGROUND The intraoperative management of patients undergoing orthotopic liver transplantation(OLT)frequently encounters hemodynamic instability after reperfusion of the new liver graft.The resulting post-reperfusio...BACKGROUND The intraoperative management of patients undergoing orthotopic liver transplantation(OLT)frequently encounters hemodynamic instability after reperfusion of the new liver graft.The resulting post-reperfusion syndrome is characterized by an increase in pulmonary vascular resistance and decrease in systemic vascular resistance.In the presence of a left to right intracardiac shunt,this hemodynamic perturbance can lead to shunt reversal followed by hypoxemia and embolization of air and debris into the systemic circulatory system.CASE SUMMARY A 43 years-old male with end-stage liver disease due to primary sclerosing cholangitis complicated by portal hypertension and hepatocellular carcinoma presented for an OLT.A bedside transthoracic echocardiography(TTE)was performed immediately before the procedure and unexpectedly identified a ventricular septal defect(VSD).The patient and the surgical team agreed to proceed with the surgery as it was a time critical donation after circulatory organ death.We developed an intraoperative plan to optimize pulmonary and systemic pressures using vasoactive support,optimized mechanical ventilation,and used transesophageal echocardiography(TEE)for intraoperative monitoring.During reperfusion,considerable turbulent flows with air were noted in the right ventricle,but no air was visualized in the left ventricle.Color flow Doppler showed no reversal flow in the VSD.At the end of the procedure,the patient was extubated in the operating room without complication and was transferred to the transplant unit for recovery.CONCLUSION Our case highlights the importance of echocardiography in the perioperative assessment of patients undergoing liver transplantation.The TTE findings obtained immediately before the procedure and the real-time use of intraoperative TEE to modify our management during the critical phases of the transplant resulted in continuity of care and a good surgical outcome for this patient.展开更多
Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fl...Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF;total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.展开更多
BACKGROUND In 2017,our institution implemented a high efficiency(HE)pathway for lower limb orthopedic surgery.The employed strategy included patient selection,surgical instrument standardization,preoperative surgical ...BACKGROUND In 2017,our institution implemented a high efficiency(HE)pathway for lower limb orthopedic surgery.The employed strategy included patient selection,surgical instrument standardization,preoperative surgical nerve blocks,avoidance of general anesthesia and bypassing phase one recovery.We conducted a historic cohort study whose primary outcome was the postoperative recovery time between the HE and traditional(T)pathway.AIM To determine whether the implementation of a HE pathway was correlated with a reduction in postoperative recovery time.METHODS Patients who had unilateral elective lower limb orthopedic procedures through the T and HE pathway were screened between 2017 to 2019.Patients were at least 18 years old,and American Society of Anesthesiologists(ASA)Physical Status I to III without major systemic comorbidities were included.Propensity score was generated using multivariable regression taking age,body mass index,sex,ASA class and surgical type as covariates using nearest neighbour methods between the two pathways.Mann Whitney U test were used to analyzed total postoperative time.RESULTS There was an associated reduction in total postoperative recovery time of 63 minutes(95%CI:-69 to-57)in the HE group.The operating room time and total length of stay also had an associated decrease of 20 minutes(95%CI:-23 to-17)and 84 minutes(95%CI:-92 to-75)respectively.CONCLUSION Utilizing multifaceted strategies to improve perioperative efficiency was associated with a reduction in the postoperative recovery time in our retrospective study.This model can be a potential strategy to deal with surgical backlog in the face of ongoing human resource challenges.展开更多
BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling techn...BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.展开更多
Adolescent alcohol abuse is a substantive public health problem that has been the subject of intensive study in recent years.Despite reports of a wide range of effects of adolescent intermittent ethanol(AIE)exposure o...Adolescent alcohol abuse is a substantive public health problem that has been the subject of intensive study in recent years.Despite reports of a wide range of effects of adolescent intermittent ethanol(AIE)exposure on brain and behavior,little is known about the mechanisms that may underlie those effects,and even less about treatments that might reverse them.Recent studies from our laboratory have indicated that AIE produced enduring changes in astrocyte function and synaptic activity in the hippocampal formation,suggesting the possibility of an alteration in astrocyte-neuronal connectivity and function.We utilized astrocyte-specific,membrane restricted viral labeling paired with immunohistochemistry to perform confocal single cell astrocyte imaging,three-dimensional reconstruction,and quantification of astrocyte morphology in hippocampal area CA1 from adult rats after AIE.Additionally,we assessed the colocalization of astrocyte plasma membrane labeling with immunoreactivity for AMPA-(α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid)glutamate receptor 1,an AMPA receptor subunit and established neuronal marker of excitatory synapses,as a metric of astrocyte-synapse proximity.AIE significantly reduced the colocalization of the astrocyte plasma membrane with synaptic marker puncta in adulthood.This is striking in that it suggests not only an alteration of the physical association of astrocytes with synapses by AIE,but one that lasts into adulthood-well after the termination of alcohol exposure.Perhaps even more notable,the AIE-induced reduction of astrocyte-synapse interaction was reversed by sub-chronic treatment with the clinically used agent,gabapentin(Neurontin),in adulthood.This suggests that a medication in common clinical use may have the potential to reverse some of the enduring effects of adolescent alcohol exposure on brain function.All animal experiments conducted were approved by the Duke University Institutional Animal Care and Use Committee(Protocol Registry Number A159-18-07)on July 27,2018.展开更多
BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IP...BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative period.METHODS A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD.These factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas parameters.IPH was defined as sustained mean arterial pressure<65 mmHg,requiring prolonged deoxyepinephrine infusion for>30 min despite additional deoxyepinephrine and fluid treatments.RESULTS Among 1596 PD patients,661(41.42%)experienced IPH.Multivariate logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).展开更多
The normal presentation of a patient with a drug induced methemoglobinemia is a low pulse oximetry (SpO2) reading, usually in the mid 80% range, while having a very high PaO2 on an arterial blood gas (ABG)1. We presen...The normal presentation of a patient with a drug induced methemoglobinemia is a low pulse oximetry (SpO2) reading, usually in the mid 80% range, while having a very high PaO2 on an arterial blood gas (ABG)1. We present a case where the initial ABG showed a very high PaO2 and a metabolic alkalosis while the SpO2 fluctuated (85%- 99%). Those findings combined with hemodynamic instability complicated the diagnosis and delayed optimal care.展开更多
<b><span style="font-family:Verdana;">Background and Aims:</span></b><span style="font-family:Verdana;"> Open liver resection requiring an upper abdominal incisio...<b><span style="font-family:Verdana;">Background and Aims:</span></b><span style="font-family:Verdana;"> Open liver resection requiring an upper abdominal incision is associated with significant opioid use due to postoperative pain. We tested the hypothesis that the intraoperative combination of low dose lidocaine and ketamine would reduce opioid consumption when given in conjunction with intrathecal morphine for liver resection surgery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> In this triple blind, parallel group four-arm placebo-controlled trial, we randomized 124 adult</span><span style="font-family:Verdana;color:#FF0000;"> </span><span style="font-family:Verdana;">ASA 2</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">4 liver resection patients to receive intraoperative lidocaine 0.33 mg/kg/h (group L), ketamine 70 μg/kg/h (group K), combination of lidocaine 0.33 mg/kg/h and ketamine 70 μg/kg/h (group KL) and saline (group P). All patients received 300 μg intrathecal morphine prior to induction of anesthesia. All infusions were started immediately after intubation and continued until the end of surgery. Primary outcome measurements included opioid consumption at 24-hours. Secondary outcomes included pain scores, opioid consumption at 48 and 72-hours and side effects including nausea, vomiting, dizziness, hallucinations, headaches and signs of local anaesthetic toxicity. Patients were followed up for 12 weeks. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There was no difference in the primary outcome of opioid consumption within all 4 groups at rest or movement at 24-hours. Secondary outcome of 48-hour rest pain score was significantly higher in the L group (p = 0.03) but without any difference in opioid use.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">There was no difference in any other outcomes between the groups at any time points. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Low dose lidocaine and its combination with ketamine did not add any analgesic/morphine sparing benefit in the presence</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">of single dose intrathecal morphine in patients with major liver resection.</span>展开更多
Objective:Sinonasal squamous cell carcinoma(SNSCC)is rare in the general population.No clear and consistent etiologic correlation between human papillomavirus(HPV)and SNSCC has yet been delineated in the literature.p1...Objective:Sinonasal squamous cell carcinoma(SNSCC)is rare in the general population.No clear and consistent etiologic correlation between human papillomavirus(HPV)and SNSCC has yet been delineated in the literature.p16 is a tumor suppressor protein used as a surrogate marker for HPV.This study aims to evaluate the relationship between p16 overexpression in SNSCC and its role in prognosis and survival.Methods:A population-based retrospective analysis was performed using prospectively collected data from the Northern Alberta Head and Neck Tumour Board,the Alberta Cancer Registry,and the Alberta Cancer Research Biobank.p16 overexpression was analyzed from pathologic samples of patients meeting study criteria,and participants were dichotomized by status.Subsequently,nonparametric analysis of demographics,initial staging,and initial treatment were performed,and a Kapan–Meier curve was developed to assess differences in survival.Results:Sixteen patients were included in the analysis.p16 overexpression was seen in 68.8%of patients.p16 positive and negative groups were comparable for age,gender,smoking status,stage,and treatment.A statistically significant 5-year survival advantage was observed in patients with p16 positive SNSCC(P=0.013).Conclusions:This is the first Canadian study to demonstrate a high prevalence of p16 positivity in SNSCC and its presence denoting a statistically significant survival advantage.Results demonstrate a previously unconfirmed role of oncogenic HPV in SNSCC.展开更多
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 Perioperative anesthesia management of obese patients presents significant challenges as traditional total body weight-based dosing fails to achieve optimal anesthetic effects due to altered pharmacokinetic characteristics including abnormal drug distribution and clearance.Rocuronium exhibits markedly different distribution patterns in obese patients,with conventional weight correction methods inadequately addressing individual muscle mass variations that critically influence drug distribution.AIM To investigate the quantitative relationship between skeletal muscle index(SMI)and rocuronium distribution volume in obese colorectal cancer patients,establish a population pharmacokinetic model,and develop individualized dosing strategies based on muscle mass.METHODS A retrospective cohort study was conducted,including 100 obese patients(body mass index≥30 kg/m^(2))who underwent elective radical colorectal cancer surgery at our hospital from June 2023 to January 2025.Skeletal muscle mass was measured using InBody 260 body composition analyzer and SMI was calculated to assess muscle mass,with male SMI<7.0 kg/m^(2) and female SMI<5.7 kg/m^(2)as diagnostic criteria for sarcopenia.Plasma rocuronium concentrations were detected by liquid chromatography-tandem mass spectrometry/mass spectrometry,and nonlinear mixed-effect modeling was used to establish population pharmacokinetic modeling.Stepwise regression was used to screen covariates,and dosing regimens were optimized through Monte Carlo simulation.The primary endpoint was targeted plasma concentration achievement rate,and the secondary endpoint was postoperative residual muscle relaxation incidence.RESULTS Among 100 patients,35(35.0%)had sarcopenia and 65(65.0%)did not.Patients in the sarcopenia group were older(64.1±9.8 years vs 54.2±10.9 years,P<0.001)and had significantly lower SMI(6.2±0.8 kg/m^(2)vs 8.4±1.2 kg/m^(2),P<0.001).SMI showed strong positive correlation with rocuronium steady-state distribution volume(r=0.718,P<0.001)and moderate negative correlation with clearance(r=-0.502,P<0.001).A two-compartment population pharmacokinetic model was successfully established,with SMI being the most important covariate affecting central compartment distribution volume(△OFV=-41.2,P<0.001).Model validation showed bootstrap successful convergence rate of 92.3%,and 92.1%of observed values fell within prediction intervals in predicted concentration versus predicted concentration.The SMI-based individualized dosing regimen improved target exposure achievement rate from 82.0%in traditional regimen to 93.5%(P=0.009),and reduced postoperative residual muscle relaxation incidence from 13.0%to 3.5%(P=0.018).The sarcopenia group showed the most significant improvement in achievement rate,from 71.4%to 93.8%(P=0.017).CONCLUSION SMI shows strong correlation with rocuronium distribution volume in obese colorectal cancer patients and is a key factor affecting drug distribution.SMI-based individualized dosing strategies can significantly improve target exposure achievement rate and reduce postoperative residual muscle relaxation incidence,providing scientific evidence for precision anesthesia management in obese patients.
基金Supported by 2025 Henan Medical Education Research Project,No.WJLX2025038.
文摘BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates,which threaten patient safety and functional outcomes.Enhanced recovery after surgery(ERAS)principles have been shown to improve perioperative outcomes through evidence-based,multidisciplinary care pathways.Despite its widespread adoption,there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit(PACU)and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery.This study aimed to investigate whether an ERASbased PACU nursing protocol could enhance recovery,reduce complications,and improve patient safety in this surgical population.AIM To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.METHODS A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit(PACU)were selected.They were randomly divided into the observation group(the PACU nursing process was optimized based on ERAS)and the control group(the conventional PACU nursing process was adopted)by the random number grouping method,with 130 cases in each group.The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,time of leaving the room after tube removal,retention time in the recovery room,occurrence of complications,satisfaction and readmission rate were compared between the two groups after entering the room.Compare the occurrence of adverse events in the PACU nursing process between the two groups.RESULTS The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,retention time in the recovery room,total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group,and the satisfaction rate was higher than that in the control group(P<0.05).The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group(P<0.05).CONCLUSION Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery,reduce adverse events,improve nursing satisfaction,and at the same time,lower the incidence of adverse events in the PACU nursing process,providing a more refined management basis for clinical practice.
基金Supported by Division of Gastroenterology at Western University(in part),Canada
文摘AIM: To determine whether anaesthesiologistadministered sedation with propofol(AAP) or endoscopist-administered conscious sedation(EAC) with fentanyl/midazolam shortens colonoscopy duration/total room time. METHODS: This is a prospective, non-randomized, comparative study that enrolled patients greater than 18 years of age undergoing colonoscopy in a single Canadian academic outpatient endoscopy unit over a three-month consecutive period. Colonoscopies in this unit are performed both with AAP and EAC. Patient demographics, procedure-related data and adverse events were documented. Additionally, the level of procedure difficulty, and whether a staff endoscopist, trainee with assistance, or independent trainee, performed the procedure were documented. A validated modified 4-question, 5-point Likert scale telephone survey was used to assess patient satisfaction with colonoscopy. The telephone patient satisfaction survey was conducted 24-72 h following the procedure.RESULTS: Two hundred and thirty patients were enrolled during the study period with 126 patients in the AAP group and 104 patients in the EAC group. Mean procedure time was 18.3 ± 10.1 min in the AAP group and 14.7 ± 7.1 min in the EAC group(P = 0.002). Mean total room time was 36.8 ± 13.7 with AAP and 30.1 ± 11 min with EAC(P < 0.001). Multivariate analysis revealed the use of AAP(P = 0.002), resident participation(P < 0.001), diagnostic interventions(P = 0.033), therapeutic interventions(P < 0.001), lower body mass index(P = 0.008) and American Society of Anaesthesiologist class(P = 0.016), to be predictors of longer total room time. Patient age and gender were not significant predictors. After excluding cases in which trainees were involved, there was no significant difference in procedure time between the two groups(P = 0.941), however total room time was still prolonged in the AAP group(P = 0.019). The amount of pain experienced was lower with AAP(P = 0.02), with a trend toward overall higher patient satisfaction(P = 0.074). There were 2 sedation-related adverse events, both in the AAP group involving a patient with aspiration requiring hospitalization and a patient with hypoxia managed with bronchodilators.CONCLUSION: EAC results in reduced total room time compared to AAP. Resident participation doubles procedure time regardless of sedation type.
文摘Acute liver failure(ALF)may result in severe neurological complications caused by cerebral edema and elevated intracranial pressure(ICP).Multiple pathogenic mechanisms explain the elevated ICP,and newer hypotheses have been described.While invasive ICP monitoring(ICPM)may have a role in ALF management,these patients are typically coagulopathic and at risk for intracranial hemorrhage.ICPM is the subject of much debate,and significant heterogeneity exists in clinical practice regarding its use.Contemporary ICPM techniques and coagulopathy reversal strategies may be associated with a lower risk of hemor-rhage;however,most of the evidence is limited by its retrospective nature and relatively small sample size.
文摘Perioperative hypothermia, core temperature below 36.0 ℃, transpires due to disruption of thermoregulationby anesthesia coupled with cold exposure to procedural surroundings and cleansing agents. Although most publications have focused on thermoregulation disruption with general anesthesia, neuraxial anesthesia may also cause significant hypothermia. The clinical consequences of perioperative hypothermia are multiple and include patient discomfort, shivering, platelet dysfunction, coagulopathy, and increased vasoconstriction associated with a higher risk of wound infection. Furthermore, postoperative cardiac events occur at a higher rate; although it is unclear whether this is due to increased oxygen consumption or norepinephrine levels. Hypothermia may also affect pharmacokinetics and prolong postoperative recovery times and hospital length of stay. In order to combat perioperative hypothermia, many prevention strategies have been examined. Active and passive cutaneous warming are likely the most common and aim to both warm and prevent heat loss; many consider active warming a standard of care for surgeries over one hour. Intravenous nutrients have also been examined to boost metabolic heat production. Additionally, pharmacologic agents that induce vasoconstriction have been studied with the goal of minimizing heat loss. Despite these multiple strategies for prevention and treatment, hypothermia continues to be a problem and a common consequence of the perioperative period. This literature review presents the most recent evidence on the disruption of temperature regulation by anesthesia and perioperative environment, the consequences of hypothermia, and the methods for hypothermia prevention and treatment.
基金Shanghai Fourth People's Hospital Medicine Discipline Boosting Plan(SY-XKZT-2020-2005)Shanghai Fourth People's Hospital Medicine Discipline Boosting Plan(SY-XKZT-2020-1005).
文摘Objective:To compare the therapeutic effects of endovascular and open surgery on abdominal aortic aneurysms.Methods:From June 2019 to May 2020,60 cases of abdominal aortic aneurysms(AAA)were divided into observation group(30 cases in endovascular technique group)and control group(30 cases in open technique group).Results:The blood loss,operative time and blood transfusion of the observation group were significantly lower than those of the control group(P<0.05).The incidence of postoperative complications is low,and the incidence of longterm complications is relatively high.Conclusion:In the treatment of abdominal aortic aneurysm,endovascular technology has the advantages of low risk,less trauma,and quick recovery after surgery.Open surgery is suitable for patients who cannot receive endovascular treatment.In order to achieve good treatment effects,it is necessary to choose an appropriate treatment method according to the actual situation of the patient.
文摘Thoracic epidural anesthesia(TEA)has been the gold standard of perioperative analgesia in various abdominal and thoracic surgeries.However,misplaced or displaced catheters,along with other factors such as technical challenges,equipment failure,and anatomic variation,lead to a high incidence of unsatisfactory analgesia.This article aims to assess the different sources of TEA failure and strategies to validate the location of thoracic epidural catheters.A literature search of PubMed,Medline,Science Direct,and Google Scholar was done.The search results were limited to randomized controlled trials.Literature suggests techniques such as electrophysiological stimulation,epidural waveform monitoring,and x-ray epidurography for identifying thoracic epidural placement,but there is no one particular superior confirmation method;clinicians are advised to select techniques that are practical and suitable for their patients and practice environment to maximize success.
基金Shanghai Fourth People's Hospital Medicine Discipline Boosting Plan(SY-XKZT-2020-2005)Shanghai Fourth People's Hospital Medicine Discipline Boosting Plan(SY-XKZT-2020-1005)。
文摘Objective:To investigate the effectiveness of total percutaneous technique in endovascular repair of abdominal aortic aneurysm.Methods:Divide patients into two groups based on random tests.The control group received conventional treatment,and the experimental group received modified treatment.The changes in self-management ability,comfort level and recovery time before and after treatment were compared between the two groups.Results:The comfort level and self-management ability of the experimental group were significantly higher than that of the control group,and the recovery time was significantly shorter than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Puncture suture can safely and effectively repair the intracavity of abdominal aortic aneurysm.
文摘BACKGROUND The intraoperative management of patients undergoing orthotopic liver transplantation(OLT)frequently encounters hemodynamic instability after reperfusion of the new liver graft.The resulting post-reperfusion syndrome is characterized by an increase in pulmonary vascular resistance and decrease in systemic vascular resistance.In the presence of a left to right intracardiac shunt,this hemodynamic perturbance can lead to shunt reversal followed by hypoxemia and embolization of air and debris into the systemic circulatory system.CASE SUMMARY A 43 years-old male with end-stage liver disease due to primary sclerosing cholangitis complicated by portal hypertension and hepatocellular carcinoma presented for an OLT.A bedside transthoracic echocardiography(TTE)was performed immediately before the procedure and unexpectedly identified a ventricular septal defect(VSD).The patient and the surgical team agreed to proceed with the surgery as it was a time critical donation after circulatory organ death.We developed an intraoperative plan to optimize pulmonary and systemic pressures using vasoactive support,optimized mechanical ventilation,and used transesophageal echocardiography(TEE)for intraoperative monitoring.During reperfusion,considerable turbulent flows with air were noted in the right ventricle,but no air was visualized in the left ventricle.Color flow Doppler showed no reversal flow in the VSD.At the end of the procedure,the patient was extubated in the operating room without complication and was transferred to the transplant unit for recovery.CONCLUSION Our case highlights the importance of echocardiography in the perioperative assessment of patients undergoing liver transplantation.The TTE findings obtained immediately before the procedure and the real-time use of intraoperative TEE to modify our management during the critical phases of the transplant resulted in continuity of care and a good surgical outcome for this patient.
文摘Background: Non-invasive goal directed fluid therapy during deceased donor renal transplant (CRT) may reduce the incidence of delayed graft function. Plethysmograph Variability Index (PVI) has been shown to predict fluid responsiveness during surgery. This pilot study evaluated the feasibility of goal directed fluid administration protocol based upon PVI studying the incidence of delayed graft function (DGF) in renal transplant recipients. Methods: Twenty patients underwent primary CRT. The Control group received intravenous fluid (IVF) at a calculated constant rate. The Treatment group received a baseline IVF infusion throughout the surgery. PVI values greater than 13% were treated with 250 ml boluses of IVF. Primary end point was DGF;total IVF administration and urinary biomarker NGAL levels were secondary endpoints. Results: Treatment group at every time point received significantly less IVF. There was no significant difference in incidence of DGF between the groups. 2 patients in the Control group and 6 in the Treatment group developed DGF. NGAL was not associated with the group assignment or total IVF given (p < 0.2). Conclusions: The effectiveness of goal directed fluid therapy with non-invasive dynamic parameters has not been validated in renal transplant surgery and larger prospective studies are needed to determine its utility in renal transplantation.
文摘BACKGROUND In 2017,our institution implemented a high efficiency(HE)pathway for lower limb orthopedic surgery.The employed strategy included patient selection,surgical instrument standardization,preoperative surgical nerve blocks,avoidance of general anesthesia and bypassing phase one recovery.We conducted a historic cohort study whose primary outcome was the postoperative recovery time between the HE and traditional(T)pathway.AIM To determine whether the implementation of a HE pathway was correlated with a reduction in postoperative recovery time.METHODS Patients who had unilateral elective lower limb orthopedic procedures through the T and HE pathway were screened between 2017 to 2019.Patients were at least 18 years old,and American Society of Anesthesiologists(ASA)Physical Status I to III without major systemic comorbidities were included.Propensity score was generated using multivariable regression taking age,body mass index,sex,ASA class and surgical type as covariates using nearest neighbour methods between the two pathways.Mann Whitney U test were used to analyzed total postoperative time.RESULTS There was an associated reduction in total postoperative recovery time of 63 minutes(95%CI:-69 to-57)in the HE group.The operating room time and total length of stay also had an associated decrease of 20 minutes(95%CI:-23 to-17)and 84 minutes(95%CI:-92 to-75)respectively.CONCLUSION Utilizing multifaceted strategies to improve perioperative efficiency was associated with a reduction in the postoperative recovery time in our retrospective study.This model can be a potential strategy to deal with surgical backlog in the face of ongoing human resource challenges.
基金Supported by Discipline Advancement Program of Shanghai Fourth People’s Hospital,No.SY-XKZT-2020-2013.
文摘BACKGROUND Postoperative delirium,particularly prevalent in elderly patients after abdominal cancer surgery,presents significant challenges in clinical management.AIM To develop a synthetic minority oversampling technique(SMOTE)-based model for predicting postoperative delirium in elderly abdominal cancer patients.METHODS In this retrospective cohort study,we analyzed data from 611 elderly patients who underwent abdominal malignant tumor surgery at our hospital between September 2020 and October 2022.The incidence of postoperative delirium was recorded for 7 d post-surgery.Patients were divided into delirium and non-delirium groups based on the occurrence of postoperative delirium or not.A multivariate logistic regression model was used to identify risk factors and develop a predictive model for postoperative delirium.The SMOTE technique was applied to enhance the model by oversampling the delirium cases.The model’s predictive accuracy was then validated.RESULTS In our study involving 611 elderly patients with abdominal malignant tumors,multivariate logistic regression analysis identified significant risk factors for postoperative delirium.These included the Charlson comorbidity index,American Society of Anesthesiologists classification,history of cerebrovascular disease,surgical duration,perioperative blood transfusion,and postoperative pain score.The incidence rate of postoperative delirium in our study was 22.91%.The original predictive model(P1)exhibited an area under the receiver operating characteristic curve of 0.862.In comparison,the SMOTE-based logistic early warning model(P2),which utilized the SMOTE oversampling algorithm,showed a slightly lower but comparable area under the curve of 0.856,suggesting no significant difference in performance between the two predictive approaches.CONCLUSION This study confirms that the SMOTE-enhanced predictive model for postoperative delirium in elderly abdominal tumor patients shows performance equivalent to that of traditional methods,effectively addressing data imbalance.
基金supported by the National Institute on Alcohol Abuse and Alcoholism(NIAAA)Neurobiology of Adolescent Drinking In Adulthood(NADIA)Grant#2U01AA019925(to HSS)the National Institute on Alcohol Abuse and Alcoholism(NIAAA)R00AA022651(to TAW)the National Institute on Drug Abuse(NIDA)R01DA041455(to KJR)
文摘Adolescent alcohol abuse is a substantive public health problem that has been the subject of intensive study in recent years.Despite reports of a wide range of effects of adolescent intermittent ethanol(AIE)exposure on brain and behavior,little is known about the mechanisms that may underlie those effects,and even less about treatments that might reverse them.Recent studies from our laboratory have indicated that AIE produced enduring changes in astrocyte function and synaptic activity in the hippocampal formation,suggesting the possibility of an alteration in astrocyte-neuronal connectivity and function.We utilized astrocyte-specific,membrane restricted viral labeling paired with immunohistochemistry to perform confocal single cell astrocyte imaging,three-dimensional reconstruction,and quantification of astrocyte morphology in hippocampal area CA1 from adult rats after AIE.Additionally,we assessed the colocalization of astrocyte plasma membrane labeling with immunoreactivity for AMPA-(α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid)glutamate receptor 1,an AMPA receptor subunit and established neuronal marker of excitatory synapses,as a metric of astrocyte-synapse proximity.AIE significantly reduced the colocalization of the astrocyte plasma membrane with synaptic marker puncta in adulthood.This is striking in that it suggests not only an alteration of the physical association of astrocytes with synapses by AIE,but one that lasts into adulthood-well after the termination of alcohol exposure.Perhaps even more notable,the AIE-induced reduction of astrocyte-synapse interaction was reversed by sub-chronic treatment with the clinically used agent,gabapentin(Neurontin),in adulthood.This suggests that a medication in common clinical use may have the potential to reverse some of the enduring effects of adolescent alcohol exposure on brain function.All animal experiments conducted were approved by the Duke University Institutional Animal Care and Use Committee(Protocol Registry Number A159-18-07)on July 27,2018.
文摘BACKGROUND Intraoperative persistent hypotension(IPH)during pancreaticoduodenectomy(PD)is linked to adverse postoperative outcomes,yet its risk factors remain unclear.AIM To clarify the risk factors associated with IPH during PD,ensuring patient safety in the perioperative period.METHODS A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD.These factors included age,gender,body mass index,American Society of Anesthesiologists classification,comorbidities,medication history,operation duration,fluid balance,blood loss,urine output,and blood gas parameters.IPH was defined as sustained mean arterial pressure<65 mmHg,requiring prolonged deoxyepinephrine infusion for>30 min despite additional deoxyepinephrine and fluid treatments.RESULTS Among 1596 PD patients,661(41.42%)experienced IPH.Multivariate logistic regression identified key risk factors:increased age[odds ratio(OR):1.20 per decade,95%confidence interval(CI):1.08-1.33](P<0.001),longer surgery duration(OR:1.15 per additional hour,95%CI:1.05-1.26)(P<0.01),and greater blood loss(OR:1.18 per 250-mL increment,95%CI:1.06-1.32)(P<0.01).A novel finding was the association of arterial blood Ca^(2+)<1.05 mmol/L with IPH(OR:2.03,95%CI:1.65-2.50)(P<0.001).CONCLUSION IPH during PD is independently associated with older age,prolonged surgery,increased blood loss,and lower plasma Ca^(2+).
文摘The normal presentation of a patient with a drug induced methemoglobinemia is a low pulse oximetry (SpO2) reading, usually in the mid 80% range, while having a very high PaO2 on an arterial blood gas (ABG)1. We present a case where the initial ABG showed a very high PaO2 and a metabolic alkalosis while the SpO2 fluctuated (85%- 99%). Those findings combined with hemodynamic instability complicated the diagnosis and delayed optimal care.
文摘<b><span style="font-family:Verdana;">Background and Aims:</span></b><span style="font-family:Verdana;"> Open liver resection requiring an upper abdominal incision is associated with significant opioid use due to postoperative pain. We tested the hypothesis that the intraoperative combination of low dose lidocaine and ketamine would reduce opioid consumption when given in conjunction with intrathecal morphine for liver resection surgery. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> In this triple blind, parallel group four-arm placebo-controlled trial, we randomized 124 adult</span><span style="font-family:Verdana;color:#FF0000;"> </span><span style="font-family:Verdana;">ASA 2</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">4 liver resection patients to receive intraoperative lidocaine 0.33 mg/kg/h (group L), ketamine 70 μg/kg/h (group K), combination of lidocaine 0.33 mg/kg/h and ketamine 70 μg/kg/h (group KL) and saline (group P). All patients received 300 μg intrathecal morphine prior to induction of anesthesia. All infusions were started immediately after intubation and continued until the end of surgery. Primary outcome measurements included opioid consumption at 24-hours. Secondary outcomes included pain scores, opioid consumption at 48 and 72-hours and side effects including nausea, vomiting, dizziness, hallucinations, headaches and signs of local anaesthetic toxicity. Patients were followed up for 12 weeks. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There was no difference in the primary outcome of opioid consumption within all 4 groups at rest or movement at 24-hours. Secondary outcome of 48-hour rest pain score was significantly higher in the L group (p = 0.03) but without any difference in opioid use.</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">There was no difference in any other outcomes between the groups at any time points. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> Low dose lidocaine and its combination with ketamine did not add any analgesic/morphine sparing benefit in the presence</span><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">of single dose intrathecal morphine in patients with major liver resection.</span>
文摘Objective:Sinonasal squamous cell carcinoma(SNSCC)is rare in the general population.No clear and consistent etiologic correlation between human papillomavirus(HPV)and SNSCC has yet been delineated in the literature.p16 is a tumor suppressor protein used as a surrogate marker for HPV.This study aims to evaluate the relationship between p16 overexpression in SNSCC and its role in prognosis and survival.Methods:A population-based retrospective analysis was performed using prospectively collected data from the Northern Alberta Head and Neck Tumour Board,the Alberta Cancer Registry,and the Alberta Cancer Research Biobank.p16 overexpression was analyzed from pathologic samples of patients meeting study criteria,and participants were dichotomized by status.Subsequently,nonparametric analysis of demographics,initial staging,and initial treatment were performed,and a Kapan–Meier curve was developed to assess differences in survival.Results:Sixteen patients were included in the analysis.p16 overexpression was seen in 68.8%of patients.p16 positive and negative groups were comparable for age,gender,smoking status,stage,and treatment.A statistically significant 5-year survival advantage was observed in patients with p16 positive SNSCC(P=0.013).Conclusions:This is the first Canadian study to demonstrate a high prevalence of p16 positivity in SNSCC and its presence denoting a statistically significant survival advantage.Results demonstrate a previously unconfirmed role of oncogenic HPV in SNSCC.
