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.
ObjectiveTo systematically review the influence of dexmedetomidine on early postoperative cognitive dysfunction in adult patients after receiving noncardiac surgery under general anesthesia. MethodsThe randomized controlled trials (RCTs) about the influence of dexmedetomidine on the early postoperative cognitive dysfunction of patients after receiving noncardiac surgery with general anesthesia was searched in PubMed, EBSCO, Springer, Ovid, The Cochrane Library (Issue 1, 2013), CNKI, VIP, WanFang Data and Google Scholar up to November 30th, 2013. The references of included literature were also retrieved manually. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. ResultsA total of 22 RCTs involving 1 356 patients were enrolled. The results of meta-analysis indicated that:a) dexmedetomidine reduced the incidence of postoperative cognitive dysfunction on the first day (RR=0.38, 95%CI 0.29 to 0.49, P < 0.001), on the seventh day (RR=0.55, 95%CI 0.23 to 1.29, P=0.17); improved postoperative MMSE scores after surgery (on the first day:MD=2.38, 95%CI 1.42 to 3.34, P < 0.001; on the seventh day:MD=0.92, 95%CI 0.16 to 1.68, P=0.02), and decreased the expression of inflammatory factor IL-6 (instant:MD=-11.96, 95%CI-18.45 to-5.46, P=0.000 3; after 24 h:MD=-7.50, 95%CI-13.73 to-1.27, P=0.02); and TNF-α (instant:MD=-4.09, 95%CI-7.02 to-1.16, P=0.006)) in patients. b) No significant difference was found between two groups (MD=-0.97, 95%CI-2.37 to 0.43, P=0.17). ConclusionDexmedetomidine can effectively reduce the early-stage postoperative cognitive dysfunction, improve MMSE scores after the operation, and reduce inflammatory reaction. In addition, due to the limited quantity and quality of studies included, larger sample, high quality RCTs are needed to verify the abovementioned conclusion.
ObjectiveTo explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.MethodsThe basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.ResultsThere were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.ConclusionThe coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.
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.
ObjectiveTo evaluate if intravenous lidocaine can reduce the stress response induced by fiberoptic bronchoscopy in patients under general anesthesia. MethodsSixty patients undergoing fiberoptic bronchoscopy under unconsciousness between November 2013 and July 2014 were randomly divided into two groups: lidocaine group (n=30) and control group (n=30). Patients in the lidocaine group received an intravenous injection of lidocaine for 1 mg/kg during induction and then continuous intravenous infusion of 2% lidocaine with a dose of 3 mg/(kg·h). The same volume of saline was given to patients of the control group in the same way. Laryngeal mask airway was placed after anesthesia induction. Variables of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse oxygen saturation were observed and recorded at five time points: before induction, immediately after induction, immediately after laryngeal mask airway placement, fiberoptic bronchoscopy across tracheal carina and before leaving examination room. Complications including cough reflex, toxicity reaction of local anesthetics, and injection pain were also observed. ResultsThe examination was successfully completed in all patients. Blood pressure and heart rate increased in all patients when fiberoptic bronchoscopy got across tracheal carina. There were no statistically significant differences in the two groups (P>0.05). Patients in the two groups had no statistic difference in tinnitus and numbness of tongue (P>0.05). Compared with the control group, patients in the lidocaine group had lower incidence of injection pain (P<0.05). ConclusionIntravenous lidocaine cannot suppress stress response induced by fiberoptic bronchoscopy effectively.
Objective To evaluate the influence of combined general and epidural anesthesia on the prognosis of patients undergoing cancer surgery. Methods Such database as PubMed, OVID, EBSCO, The Cochrane Library and CNKI were searched, and other relevant journals and references of the included literature were also hand searched from 1986 to 2011. Two evaluators independently screened the studies in accordance with the inclusion and exclusion criteria, extracted the data and assessed the methodology quality. RevMan 5.0 software was used for meta-analyses. Results Seven studies involving 2 513 patients were included. The results of meta-analyses showed that compared with the single general anesthesia, the combined general and epidural anesthesia had no significant differences in postoperative recurrence and metastasis rate (OR=0.71, 95%CI 0.44 to 1.17, P=0.18). Based on the following four factors i.e. category of cancer, time of follow-up, having preoperative metastais or not, and patients’ age, the sensitivity analysis showed significant differences in the postoperative recurrence and metastasis rate between the two anesthesia methods were found in the group of patients at or above 64 years old and the group with follow-up equal to or less than two years (OR=1.46, 95%CI 1.00 to 2.14, P=0.05; OR=1.55, 95%CI 1.06 to 2.26, P=0.02; respectively). Nevertheless, there was no significant difference in the groups of patients with colorectal cancer or without preoperative metastasis (OR=1.00, 95%CI 0.62-1.61, P=0.99; OR=1.26, 95%CI 0.86 to 1.86, P=0.23; respectively). Conclusion Compared with single general anesthesia, the combined general and epidural anesthesia cannot reduce the recurrence and metastasis rate for cancer patients, and has no marked improvement in prognosis of patients with colorectal cancer or without preoperative metastasis, but it obviously decreases the probability of forward recurrence and metastasis for the patients at or above 64 years old and the patients with follow-up equal to or less than two years.
ObjectiveTo summarize the management of anesthesia during robotic off-pump coronary artery bypass grafting (CABG) with the da Vinci surgical system in minimal thoractomy. MethodsFrom May 2011 to December 2014, 24 patients (20 males and 4 females) at the average age of 62.1±12.8 years underwent robotic off-pump CABG with the da Vinci surgical system in our hospital. All the patients underwent the continuous invasive blood pressure monitoring, endotracheal intubation with the double-lumen tube after induction of general anesthesia, fiber bronchoscope positioning, intraoperative application of one-lung ventilation, placing the Swan-Ganz floating catheter, and monitoring the echocar-diography (TEE) and blood gas analysis and indexes of hemodynamics. ResultsAll the patients were stable during the anesthesia induction period. There was no severe hypoxemia and hypercapnia. The surgery was successful and there was no thoracotomy. All the patients left off breathing machine postoperatively.The duration of mechanical ventilation was 5.3±2.8 hours. All patients were moved out from ICU in 18 hours.There was no thoracotomy for hemostasis after surgery. All the patients were discharged on the fourth or fifth day postoperatively. There was no death relevant to surgery or perioperative complications. There was no recurrence of cardiovascular events on the 30th day,3 months and 6 months postoperative follow-up. ConclusionThis anesthesia method is safe and effective. It is a rapid recovery way with the fewer complications, less suffering of the patients, reliable anesthesia management and high satisfaction of the patients'.
Same-day surgery mode is an efficient medical mode, and the key point of its management is multidisciplinary collaboration optimization of the process and integration of enhanced recovery after surgery concept. This paper introduces the establishment of multidisciplinary collaboration system, clinical pathway maintenance, patient visit procedure optimization, preoperative and postoperative care and follow-up management of same-day surgery mode for children with strabismus correction under general anesthesia at West China Tianfu Hospital of Sichuan University, aiming to promote the further improvement of the pediatric same-day surgery process and provide a reference for the promotion of the pediatric same-day surgery mode.
Objective To explore the effect of the feed-forward control on safety nursing of ophthalmologic day surgery patients under general anesthesia. Methods A total of 623 ophthalmologic day surgery patients under general anesthesia were retrospectively selected into the control group, who adapted the routine nursing in the Ophthalmic Day Surgery Center from January to December 2015; a total of 1 210 ophthalmologic day surgery patients under general anesthesia were retrospectively selected into the observation group, who received the feed-forward control of nursing safety management on the basis of routine nursing care from January to December 2016. The incidence rate of the adverse events and potential safety hazards and satisfaction rate were compared between the two groups. Results The incidence rate of the adverse events and potential safety hazards in the observation group (0.83%, 10/1 210) was lower than that in the control group (3.37%, 21/623), the satisfaction rate in the observation group (98.67%) was higher than that in the control group (97.11%), and the differences were statistically significant (P<0.05). Conclusion The application of feed-forward control in the safety care of patients during the ophthalmologic day surgery under general anesthesia can effectively reduce the incidence of adverse events and potential safety hazards, and ensure the safety of medical care.
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.