Evaluation of Light Specific Gravity Ropivacaine Combined with Sufentanil in Hip Arthroplasty at An Advanced Age

combined with sufentanil in elderly patients undergoing hip replacement.Methods:89 elderly patients with hip arthroplasty from July 2019 to September 2020 were randomly divided into experimental group and control group.The experimental group was anesthetized with light specific gravity ropivacaine combined with sufentanil.The control group was anesthetized with equal specific gravity ropivacaine to compare the effect of anesthesia and the incidence of adverse reactions.Results:there was no significant difference in sensory recovery time and motor recovery time between the experimental group and the control group(P>0.05),and the incidence of adverse reactions between the two groups was low.The sensory block time in the experimental group was shorter than that in the control group(PP>0.05).Conclusion:ropivacaine combined with sufentanil subarachnoid anesthesia is more effective in elderly patients undergoing hip arthroplasty,and the safety of the anesthesia scheme is higher,which will not lead to serious adverse reactions during operation.Moreover,the application of the anesthesia scheme can effectively improve the analgesic effect during and after operation,and the clinical application value is high.

Stress Hyperglycemia:A Problem that Cannot be Ignored

Stress hyperglycemia is a strong neuroendocrine reaction in the hypothalamic pituitary adrenal cortex under severe infection,trauma,burns,hemorrhage,surgery and other harmful stimulated,resulting in increased secretion of counter-regulatory hormones.These hormones promoted the production of sugar and cause glucose metabolism disorders with cytokines and insulin resistance.In this condition,the production of sugar exceeds the utilization of sugar by the tissues,which eventually leads to an increase in blood glucose levels in plasma.In the intensive care unit,stress hyperglycemia is very common and can occur in patients with or without diabetes.The incidence is as high as 96%,and it is an independent factor in the death of critically ill patients.Hyperglycemia not only prolongs the hospitalization time,mechanical ventilation time and increased the incidence of serious infections in critically ill patients,but can also lead to the occurrence of type 2 diabetes.Therefore,it is very important to learn the pathological mechanism of stress hyperglycemia,the harm of hyperglycemia and blood sugar management.

Postoperative Delirium in Elderly Patients May be Associated with Perioperative Blood Pressure Fluctuations

Postoperative delirium(PD)is a common complication of surgery in elderly patients,but its pathophysiological mechanism remains unclear.In order to clarify the role of intraoperative hypotension and fluctuation of blood pressure in the development of PD,we conducted a follow-up study in elderly patients with intraoperative hypotension and fluctuation of blood pressure.A total of 237 patients underwent hip surgery between July 2018 and September 2019,and 158 patients who were eligible for inclusion were enrolled in the study.One day before the operation,the mentality of patients was evaluated by Mini-mental State Examina­tion(MMSE),and the sex,age,height,and weight of the patients were recorded.Radial artery puncture was performed in all patients before anesthesia,intraoperative SBP,MAP and DBP were recorded,and the surgical events of the patients was recorded.The markers associated with PD(TNF-α,IL-6 and S-100β)were determined before and after surgery.Perioperative delirium(PD)was assessed by the prevailing standard of assessment,Confusion of Consciousness Assessment(CAM).Cognitive assessment was evaluated using the Mini-mental State Examination(MMSE).In addition,the timing and type of delirium were recorded.There were 158 patients which were accorded with the inclusion criteria came into the study.The results of our data showed that delirium occurred in 41 patients(25.9%)during the first week after surgery.In the compar­ison between the PD group and the non-PD group,it was found that the patients with postoperative delirium were older,lower body mass index and higher MMSE score before operation.Intraoperative blood pressure is low,usually more than 30%lower than preoperative blood pressure.The levels of TNF-α,IL-6 and Smur100βwere higher after operation.The increased incidence of postoperative delirium may be related to in­traoperative hypotension and intraoperative blood pressure fluctuation.The pathophysiological mechanism may be that hypotension causes low cerebral perfusion,which in turn causes local inflammation in the brain.In addition,postoperative delirium is also more likely to occur in older patients with lower body mass index.