Objectives To investigate the association of anesthesia recovery time and bispectral index (BIS) monitoring after gastrointestinal surgeries under general anesthesia. Methods A total of 404 cases of selective gastrointestinal surgeries under general anesthesia with BIS monitoring in West China Hospital of Sichuan University from January 2016 to June 2016 were retrieved from anesthesia medical record system as BIS monitoring exposure cohort (group BIS). In addition, 404 cases of selective gastrointestinal surgeries without BIS monitoring were matched as none BIS monitoring exposure cohort (group non-BIS). The primary outcome was the anesthesia recovery time, including the time from the end of surgery to endotracheal extubation (t1) and exiting the operation room (t2). A sub-group analysis was conducted based on patients’ age, length of operation time (t0) and type of surgery(open surgeries vs laparoscopic surgeries). Results The gender, age, body weight and ASA categories between two groups had no significant differences (P>0.05). The length of operation time also had no significant differences between two groups (P>0.05). The extubation time (10.1±4.4vs. 16.4±6.8) and OR exiting time (21.7±12.3 vs. 27.4±14.6) in group BIS were shorter than those in group non-BIS (P<0.05). This difference was markedly significant among elderly patients (age>60) or patients undergoing long operations (operation time>5hours). Among each group, the recovery time had no significant difference between open surgeries and laparoscopic surgeries. Conclusions There is an association between BIS monitoring and shorter anesthesia recovery time in gastrointestinal surgery, including the time of endotracheal extubation and exiting the operation room. BIS monitoring enhances anesthesia recovery among elderly patients and patients undergoing long-lasting operations in particular. There is no significant difference in anesthesia recovery time between open surgeries and laparoscopic surgeries.
ObjectiveTo Summarize and analyze the pheochromocytoma complications of surgery patients and its influential factors, in order to provide a basis for preoperative assessment and postoperative support treatment for the patients. MethodsWe reviewed the clinical data of 88 patients with pheochromocytoma from West China Hospital between January 2010 and December 2012. Among them, 35 had complications (complication group), and the other 53 had no complications (non-complication group). We analyzed preoperative blood catecholamine levels, preoperative preparation, tumor size, tumor location and surgical approach in all these patients. ResultsThere were 16 patients (45.7%) with bilateral adrenal tumors (χ2=19.976, P<0.001), and 9 patients (25.7%) with extra-adrenal tumors (χ2=7.380, P=0.007) in the complication group, significantly higher than 3 (5.7%) and 2 (3.8%) patients respectively in the non-complication group. The diameter of tumor in the complication group was (8.33±3.69) cm, which was significantly higher than that in the non-complication group[(4.32±3.12) cm] (t=5.484, P<0.001). The risk factors for complications in patients undergoing pheochromocytoma surgery included bilateral adrenal tumors (OR=10.316, P<0.001), extraadrenal tumors (OR=8.827, P=0.008), diameter of the tumor longer than 6 cm (OR=94.937, P<0.001), laparotomy (OR=40.727, P<0.001) and long time surgery for more than three hours (OR=312.000, P<0.001). ConclusionPatients who develop complications after pheochromocytoma surgery usually have bigger, and bilateral adrenal or extraadrenal tumors. Patients whose surgery is laparotomy or longer than three hours may also have more complications.These influential factors should be considered in future comprehensive treatment in order to achieve a good prognosis.
There are a variety of invasive or non-invasive methods for monitoring cerebral blood flow and cerebral metabolism in patients during operation with anesthesia, and different methods have their own scope of use. Transcranial Doppler can be used to monitor high-risk patients with intraoperative cerebral blood flow autoregulation dysfunction and patients with special positions during operation because of its convenience, continuity, and strong repeatability. Changes in cerebral blood flow detected by transcranial Doppler may be associated with postoperative central nervous system complications in patients. This article reviews the application of transcranial Doppler monitoring of cerebral blood flow in operation with anesthesia, aiming to provide a certain basis for the promotion of this technology in operation with anesthesia.
The mechanisms of general anesthesia, which was introduced about 170 years ago, remain poorly understood. Even less well understood are the effects of general anesthesia on the human body. Recently we identified 18 G-protein coupled receptor (GPCR) genes of Daphnia pulex, an invertebrate model organism. Phylogenetic analysis identified these genes to be the homologs of the human γ-aminobutyric acid, type B (GABAB) receptor, metabotropic glutamate receptors (mGluR), adrenergic receptor, serotonin (5-HT) receptor, dopamine receptor and muscarinic acetylcholine receptor (mAChR). Using reverse transcription and quantitative PCR techniques, we systematically measured the effects of propofol, etomidate and ethanol on these 18 GPCR mRNA expressions in Daphnia pulex.
ObjectiveTo systematically review the efficacy of opioid-sparing analgesic techniques in terms of analgesic potential, incidence of complications and quality of recovery in liver surgery. MethodsThe PubMed, Embase and Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to August 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 20 RCTs involving 1 347 patients were included. The results of meta-analysis showed that opioid-sparing techniques could significantly reduce pain scores at rest and during movement from 2h to 48h postoperatively, opioid consumption within 24h (MD=−11.17, 95%CI −14.62 to −7.71, P<0.01) and 48h (MD=−7.19, 95%CI −10.06 to −4.33, P<0.01), postoperative nausea and vomiting (PONV) (OR=0.68, 95%CI 0.50 to 0.91, P=0.01) and wound infection (OR=0.42, 95%CI 0.18 to 0.98, P=0.04), as well as reduced time to bowel recovery (MD=−12.92, 95%CI −21.24 to −4.61, P<0.01) and decreased length of hospital stay (LOS) (MD=−0.90, 95%CI −1.32 to −0.49, P<0.01). No significant difference was observed between the two groups in the incidence of excessive sedation, pruritus, hypotension, headache and respiratory depression. Time to out-of-bed activity and patient satisfaction were also similar between groups. ConclusionOpioid-sparing techniques are effective in relieving postoperative pain and reducing opioid use, with additional potential in reducing postoperative nausea or vomiting, wound infection, time to bowel recovery and length of hospital stay.