Objective To explore anesthetic quality of epidural anesthesia with general anesthesia applied for surgery of rectal cancer. Methods One hundred and seventy-eight patients who were diagnosed as rectal cancer and received operation in the Central Hospital of Bazhong City from June 2010 to June 2012 were included retrospectively. These patients were divided into two groups according to the type of anesthesia， and the patients who received general anesthesia only were defined as group A， the patients who received epidural anesthesia with general anesthesia were defined as group B. The anesthetic quality and anesthetic adverse reaction were observed in two groups. Results The differences of baseline characteristics in two groups were not significant （P＞0.05）. The difference of anesthetic quality in two groups was not significant （P＞0.05）. In terms of anesthetic adverse reaction， the incidence rate of hypertension， hypotension，tachycardia， or postoperative nausea and vomiting of the group B was significantly lower than those of the group A （P＜0.05）. The incidence rate of bradycardia， premature ventricular contractions， or time of gastrointestinal function recovery had no significant differences （P＞0.05）. There was no nerve dysfunction of lower limb in two groups. Conclusion Epidural anesthesia with general anesthesia applied for surgery of rectal cancer as compared with general anesthesia only not only has the same anesthetic quality， but also has obvious advantages in decreasing anesthetic adverse reaction.
Objective To investigate change of bispectral index(BIS) and hemodynamic index during induction and orotracheal intubation of sevoflurane anesthesia. Methods This study was a prospective before-after study in the same patients. A total of 30 ASA physical status I and II adult patients without airway abnormalities were enrolled to receive inhalation induction of anesthesia with 8% sevoflurane. Mean arterial pressure(MAP),heart rate(HR) and BIS were recorded before anesthesia(T1),when patients loss of consciousness(T2), before intubation (T3),at 1 min(T4) and 3 min(T5) after intubation. Results BIS at T1-T5 were 96.8±1.7,70.4±8.8,39.2±8.4,43.6±12.9 and 41.6±9.3 respectively, the measurements at T2-T5 were all markedly lower than at T1(Plt;0.05). HR at T3-T5 were all markedly higher than at T1(Plt;0.05). MAP at T2 and T3 were markedly lower than at T1, but at T4 was higher than at T1(Plt;0.05), and recovered to the level at T1 at T5(Pgt;0.05).BIS,HR and MAP at T4 were all significantly higher than T3(Plt;0.05). Conclusion Anesthesia induction with sevoflurane and small dose of succinylchoiline we used can provide adequate depth of general anesthesia,but can not prevent cardiovascular adverse reactions to intubation.
ObjectivesTo systematically review the efficacy of lidocaine injected prior to tracheal extubation in preventing hemodynamic responses to tracheal extubation in general anesthesia.MethodsPubMed, Ovid, Web of Science, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of lidocaine administrated prior to extubation in preventing hemodynamic responses to tracheal extubation in patients undergoing general anesthesia from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 13.0 software.ResultsA total of 10 RCTs involving 525 patients were included. The results of meta-analysis showed that: compared with control group, lidocaine could reduce mean arterial pressure in 5 min after extubation (MD=–5.10, 95%CI –9.41 to –0.79, P=0.02), weaken the increase in systolic blood pressure caused by extubation from the moment before extubation to 5 minutes after extubation (before extubation: MD=–7.22, 95%CI –10.34 to –4.11, P<0.000 01; at extubation: MD=–14.02, 95%CI –19.42 to –8.62, P<0.000 01; 1 minutes after extubation: MD=–15.82, 95%CI –22.20 to –9.45, P<0.000 01; 3 minutes after extubation: MD=–12.55, 95%CI –20.36 to –4.74, P=0.002; and 5 minutes after extubation: MD=–12.05, 95%CI –20.35 to –3.74, P=0.004), and weakened extubation-induced increase in diastolic blood pressure at extubation (MD=–9.71, 95%CI –16.57 to –2.86, P=0.005). In addition, lidocaine inhibited heart rate in all time points except the moment of before and at 10 minutes after extubation.ConclusionsCurrent evidence shows that lidocaine can inhibit the increase in blood pressure and heart rate caused by extubation at certain times. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
ObjectiveTo compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement (TAVR).MethodsA total of 399 severe aortic stenosis patients were included, who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019. The baseline characteristics, procedural details, postprocedural outcomes, and ultrasound data of those patients were collected. All patients were followed up and the end date of follow-up was June 20th 2020. According to anesthetic mode, the patients were divided into local anesthesia group and general anesthesia group. The differences between the two groups in incidence of postprocedural complications, hemodynamics, postprocedural 30-day mortality, and postprocedural 1-year mortality were retrospectively analyzed.ResultsOf the 399 patients, 206 (51.6%) received local anesthesia and 193 (48.4%) received general anesthesia. There was no statistical difference between the two groups in baseline characteristics. The symptoms of both groups were relieved. But the incidences of mild bleeding events (12.4% vs. 1.5%, P<0.001), severe bleeding events (10.4% vs. 0.5%, P<0.001), major vascular complications (0.5% vs. 3.6%, P=0.032), and postprocedural 30-day all causes mortality (1.9% vs. 6.7%, P=0.018) were significantly lower in the local anesthesia group than those in the general anesthesia group.ConclusionIn TAVR, compared with general anesthesia, local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.
Objective To assess the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia. Methods Such databases as PubMed (1966 to March 2012), The Cochrane Library (Issue 1, 2012), EBSCO (ASP) (1984 to March 2012), Journals@Ovid Full Text (1993 to March 2012), CBM (1978 to March 2012), CNKI (1979 to March 2012), VIP (1989 to March 2012), and WanFang Data (1998 to March 2012) were searched to collect randomized controlled trials (RCTs) about the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia, and the references of the included studies were also retrieved. Two researchers extracted the data and evaluated the methodological quality of the included studies independently. Then the RevMan 5.2 software was used for meta-analysis. Results A total of 16 RCTs involving 1 217 patients were included. The results of meta-analysis showed that, compared with the placebo, dexmedetomidine could reduce the occurrence of emergence agitation (OR=0.18, 95%CI 0.13 to 0.25, Plt;0.000 01) and increase the occurrence of postoperative lethargy (OR=0.14, 95%CI 0.03 to 0.68, P=0.01), but there were no differences in the occurrence of side effects including bronchospasm, bucking, breathholding, and oxygen desaturation. Dexmedetomidine could also reduce mean arterial blood pressure (MAP) and heart rate (HR) of pediatric patients during the recovery period after sevoflurane anesthesia, but it increased emergence time (MD=2.14, 95%CI 0.95 to 3.33, P=0.000 4), extubation time (MD=1.26, 95%CI 0.51 to 2.00, P=0.000 9) and the time of staying in PACU (MD=4.72, 95%CI 2.07 to 7.38, P=0.000 5). Conclusions For pediatric patients recovering from sevoflurane-based general anesthesia, dexmedetomidine can reduce the occurrence of emergence agitation, and is helpful to maintain the hemodynamic balance. But it prolongs emergence time, extubation time (or the time of using the laryngeal mask) and the time of staying in PACU, and increases the occurrence of postoperative lethargy.
ObjectiveTo investigate the effect of etomidate and propofol on inflammatory cytokines and cortisol for patients with lung adenocarcinoma. MethodSixty patients scheduled for lung cancer surgery under general anesthesia were studied. All patients were randomly divided into an etomidate total intravenous anesthesia group (group E, 30 patients, 16 males and 14 females at age of 58.0±5.0 years) and a propofol total intravenous anesthesia group (group P, 30 patients, 17 males and 13 females at age of 55.0±5.0 years), with 30 patients in each group. ResultsThe concentration of IL-6 in serum of patients in the two groups at time points T1, T2 and T3 was significantly higher than those at time point T0 (P < 0.01). The concentration of IL-10 and TNF-α in serum of patients at time points T1 and T2 was significantly higher than those at time point T0 (P < 0.01). And the difference of the concentration of TNF-α in serum of patients at time points T0 and T3 was not statistically significant (P > 0.05). The level of Cor of patients in the group E at time point T0 was slightly higher than those at time point T1, but lower than that at time points T2 and T3. There was no statistical difference in the concentration of IL-6 and TNF-α in serum of patients between the two groups. The level of IL-10 of patients in the group E at time points T2 and T3 was lower than those in the group P (P < 0.05), but no significant difference was observed at the other time points. The concentration of Cor in the patients in the group E at time point T1 was lower than that in the group P (P < 0.01), but no significant difference was observed either at the other time points. ConclusionThe effect of etomidate used for maintenance of general anesthesia on the inflammatory factors is essentially similar to that of propofol.
Objective To systematically evaluate the effects of magnesium sulfate on postoperative pain and complications after general anesthesia. Methods A literature search was conducted in following databases as The Cochrane Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date of establishment to September 2011 to identify randomized controlled trials (RCTs) about intravenous infusion of magnesium sulfate during general anesthesia. All included RCTs were assessed and the data were extracted according to the standard of Cochrane systematic review. The homogenous studies were pooled using RevMan 5.1 software. Results A total of 11 RCTs involving 905 patients were included. The results of meta-analyses showed that compared with the control group, intravenous infusion of magnesium sulfate during general anesthesia significantly reduced the visual analog scale (VAS) scores at the time-points of 2, 4, 6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24 hours morphine requirements, and the incidents of postoperative nausea and vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29, 95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia (RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse events or significant differences in the incidents of hypotension and serum concentration changes of magnesium. Conclusion Intravenous infusion of magnesium sulfate during general anesthesia may obviously decrease the pain intensity, and the incidents of nausea and vomiting and chilling after surgery, without increasing cardiovascular adverse events and risk of hypermagnesemia. The results still need to be confirmed by more high-quality and large-sample RCTs.
Day surgery has been applied in practice since more than 30 years ago in western world, which could obviously reduce the length of hospital stay, accelerate the recovery of patients, and achieve desirable economic and social benefits. Despite of the common development of day surgery in various diseases, the application of day surgery in breast general anesthesia surgery is limited. No related management standard has been established. By summarizing the experience of breast cancer day-surgery, Xijing Hospital of Air Force Medical University has established a comprehensive management standard, including preoperation, intraoperation, and postoperation management. Meanwhile, the nursing, resource allocation, follow-up, and stuff management are all enrolled into the management standard, aiming to improve the development of day surgery in general anesthesia breast cancer operation.
Objective To systematically review the effectiveness and safety of thoracic epidural analesis (TEA) for postoperative complications after cardiac surgery. Methods Such databases as PubMed, Science Citation Index, EMbase, The Cochrane Library, CNKI and CBM were electronically searched from inception to October 2012 for collecting the randomized controlled trials on the effectiveness and safety of thoracic epidural analgesisa for postoperative complications after cardiac surgery. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Totally 14 studies were eligible, involving 1 942 patients. The results of meta-analysis showed that, TEA combined with general anesthesia (GA) was superior to GA alone in reducing the incidences of myocardial ischemia/infarction (RR=0.63, 95%CI 0.41 to 0.96, P=0.03), respiratory complications (RR=0.55, 95%CI 0.40 to 0.75, P=0.000 1), supraventricular arrhythmias (RR=0.64, 95%CI 0.47 to 0.88, P=0.005), and duration of mechanical ventilation (MD= –2.15, 95%CI –3.72 to –0.58, P=0.007), with significant differences. Conclusions Current evidence shows that, TEA after surgery is effective in reducing the incidences of myocardial ischemia/infarction, respiratory complications, supraventricular arrhythmias, and duration of mechanical ventilation. There is the lack of data on the adverse events of TEA (mainly referring to epidural hematoma). Due to limited quality and quantity of the included studies, patients’ conditions should be fully considered before applying TEA in clinical practice.
Objective To study the influence of low-tidal volume and positive end expiratory pressure (PEEP) protective ventilation on cardiac output volume in elderly patients under general anesthesia. Methods From August 2012 to July 2014, 60 elderly patients undergoing selective surgery were divided into three groups with 20 patients in each. Group A was treated with conventional ventilation: tidal volume at 8 mL/kg, PEEP at 0 cm H2O (1 cm H2O=0.098 kPa); group B was treated with a tidal volume of 6 mL/kg and a PEEP of 5 cm H2O; group C was treated with a tidal volume of 6 mL/kg and a PEEP of 8 cm H2O. We then observed and analyzed the blood pressure, heart rate, cardiac output, arterial blood gas and airway mean pressure before induction of anesthesia (T0), 15 minutes of mechanical ventilation after the induction of anesthesia (T1), 60 minutes after anesthesia induction (T2), and 15 minutes after tracheal extubation (T3). Results In all the three groups, the mean arterial pressure and cardiac output were stable. In group B and C, central venous pressure increased significantly, the mean airway pressure and lung compliance increased, and the arterial oxygen branch pressure also increased significantly (P < 0.05). Conclusion Low-tidal volume combined with 5-cm H2O or 8-cm H2O positive end expiratory pressure lung-protective ventilation had a small influence on the cardiac output of elderly patients under anesthesia, which can be safely used.