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Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment
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作者 Jie Xu Linyan Li Ning Wang 《Journal of Clinical and Nursing Research》 2024年第3期7-11,共5页
Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our... Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion. 展开更多
关键词 Hip fracture in the elderly SURGERY Combined spinal and epidural anesthesia Analgesic effect TNF-Α CRP level
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Dural puncture epidural technique provides better anesthesia quality in repeat cesarean delivery than epidural technique:Randomized controlled study 被引量:4
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作者 Sheng-You Wang Yan He +1 位作者 Hai-Juan Zhu Bo Han 《World Journal of Clinical Cases》 SCIE 2022年第20期6890-6899,共10页
BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia fo... BACKGROUND Repeat cesarean deliverys involve a longer surgery and more severe visceral traction than primary cesarean deliverys.The dural puncture epidural(DPE)technique provides faster and more effective analgesia for labor,but there is no sufficient evidence to indicate whether it is suitable for parturients undergoing repeat cesarean delivery.AIM To determine the efficacy and safety of the DPE anesthesia technique in patients undergoing repeat cesarean delivery.METHODS Patients undergoing repeat cesarean delivery were randomly divided into the DPE and epidural anesthesia(EA)groups.A 25-G spinal needle was used for dural puncture via a 19-G epidural needle.The patients in the two groups were injected with 5 mL of 2%lidocaine followed by 15 mL of a mixture of 1%lidocaine+0.5%ropivacaine as the epidural dosage.The primary outcome was the onset time of sensory block to the T6 dermatome level and the sensory and motor block degree.RESULTS A total of 115 women were included(EA:57,DPE:58).The mean time to sensory block to the T6 Level was significantly shorter in the DPE group than in the EA group(14.7 min vs 16.6 min;95%confidence interval,13.9 to 15.4 vs 15.8 to 17.4;P=0.001).The cranial sensory block level was significantly higher at 5,10,and 15 min after the initial dose in the DPE group than in the EA group(P<0.05).The sacral sensory block level was significantly higher and the modified bromage score was significantly lower in the DPE group at each time point(P<0.05).Adverse effects and neonatal outcomes were comparable between the two groups(P>0.05).CONCLUSION The DPE technique provided higher-quality anesthesia than the EA technique,with a rapid onset of surgical anesthesia,better cranial and sacral sensory block spread and a higher motor block degree,without increasing the incidence of maternal or fetal side effects in patients undergoing repeat cesarean delivery. 展开更多
关键词 Parturients Repeat cesarean delivery epidural Dural puncture epidural anesthesia Onset time
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SUMMARY OF CLINICAL STUDY ON ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA FOR CHOLECYSTECTOMY
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作者 秦必光 刘颖涛 +5 位作者 李长根 任亚川 张兰英 艾中立 彭小云 白占勇 《World Journal of Acupuncture-Moxibustion》 2001年第3期41-49,共9页
Objective: TO study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of small dose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystecto... Objective: TO study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of small dose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia group (group A, n = 66), acupoint-skin electrical stimulation combined with epidural anesthesia group (group B, n = 63) and simple epidural anesthesia group (group C, n=65). Observations were conducted using single-bland method. Bilateral Neiguan (PC 6) and Zusanli (ST 36) were punctured and stimulated electrically in group A and only stimulated electrically via cutaneous electrodes in group B. Epidural anesthetic used was 1.5% Lidocaine and the anesthetic level was controlled to reach T4-11 . Results: The class-I (excellent) rates of group A, B and C were 75.76%, 60.32% and 13.85% respectively, showing significant differences between group A and C and group B and C (P <0.001). The initial dose, doses of every hour and every case of group A and B were lower than those of group C. The dose of every hour of group C was 36.23% and 3. 75% higher then group A and B respectively (P < 0. 001), suggesting that acupuncture or acupoint-skin electrical stimulation could strengthen anesthetic effect and reduce the dose of epidural anesthetic. During operation, indexes of the life signs as HR, MAP, RR, TV, MV, SpO2 and ECG kept basically stable and all patients in group A passed surgical operation safely. Conclusion: Acupuncture or acupoint-skin electrical stimulation combined with epidural anesthesia can be used as one of the anesthetic methods for cholecystectomy. 展开更多
关键词 Acupuncture anesthesia epidural compound anesthesia Cholecystectomy Clinical study of anesthesia
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EFFECT OF ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA ON PLASMA CATECHOLAMINE CONTENT IN CHOLECYSTECTOMY PATIENTS
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作者 李长根 彭小云 +1 位作者 徐明玉 王忠成 《World Journal of Acupuncture-Moxibustion》 2001年第4期38-42,共5页
Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods: 33 ch... Objective: To observe changes of plasma catecholamine (CA) level in patients experiencing cholecystectomy under acupuncture anesthesia combined with epidural administration of small dose of anesthetics. Methods: 33 cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia (A) group (n=11), acupoint skin electrical stimulation combined with epidural anesthesia (B) group (n=11) and simple epidural anesthesia (C) group (n=11). Acupoints used were bilateral Zusanli (ST 36) and Neiguan (PC 6) and stimulated with parameters of frequency 2/15 Hz, intermittent waves, electric current 2~3 mA for group A and 13mA for group B. Extradural anesthetic administered was 1.5% Lidocaine 5 mL. Venous blood samples were collected one day before, during and 3 days after operation for detecting plasma NE, E and DA contents. Results: ① During operation, plasma NE of group A and B lowered in comparison with pre operation, particularly group A (P<0.01), while in group C, plasma NE level increased slightly; plasma E of group A and B increased significantly compared with pre operation (P< 0.01). Plasma DA in the 3 groups all raised during operation. ② Three days after operation, plasma NE, E and DA levels recovered basically in comparison with those of one day before operation. It indicates that acupuncture or acupoint skin electrical stimulation is capable of regulating sympathetic activity during epidural anesthesia. The anesthetic effect has a closer relation with changes of plasma NE level rather than changes of plasma E or DA levels. Conclusion: Acupuncture or acupoint surface electrical stimulation combined with epidural anesthesia may be of reducing or releasing surgical operation generated stress response during cholecystectomy. 展开更多
关键词 Cholecystectomy Acupuncture anethesia Acupoint skin electrical stimulation epidural anesthesia Plasma catecholamine
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Role of epidural anesthesia in a fast track liver resection protocol for cirrhotic patients-results after three years of practice 被引量:13
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作者 Antonio Siniscalchi Lorenzo Gamberini +4 位作者 Tommaso Bardi Cristiana Laici Elisa Gamberini Letizia Francorsi Stefano Faenza 《World Journal of Hepatology》 CAS 2016年第26期1097-1104,共8页
AIM To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific subpopulation.METHODS A retrospective review was conducted, including all cirrh... AIM To evaluate the potential benefits and risks of the use of epidural anaesthesia within an enhanced recovery protocol in this specific subpopulation.METHODS A retrospective review was conducted, including all cirrhotic patients who underwent open liver resection between January 2013 and December 2015 at Bologna University Hospital. Patients with an abnormal coagulation profile contraindicating the placement of an epidural catheter were excluded from the analysis. The control group was composed by patients refusing epidural anaesthesia. RESULTS Of the 183 cirrhotic patients undergoing open liver resections, 57 had contraindications to the placement of an epidural catheter; of the remaining 126, 86 patients received general anaesthesia and 40 combined anaesthesia. The two groups presented homogeneous characteristics. Intraoperatively the metabolic data did not differ between the two groups, whilst the epidural group had a lower mean arterial pressure(P = 0.041) and received more colloid infusions(P = 0.007). Postoperative liver and kidney function did not differ significantly.Length of mechanical ventilation(P = 0.003) and hospital stay(P = 0.032) were significantly lower in the epidural group. No complications related to the epidural catheter placement or removal was recorded.CONCLUSION The use of Epidural Anaesthesia within a fast track protocol for cirrhotic patients undergoing liver resections had a positive impact on the patient's outcomes and comfort as demonstrated by a significantly lower length of mechanical ventilation and hospital stay in the epidural group. The technique appears to be safely manageable in this fragile population even though these results need confirmation in larger studies. 展开更多
关键词 anesthesia POSTOPERATIVE care ANALGESIA epidural POSTOPERATIVE LIVER cirrhosis LIVER function tests Complication
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Epidural anesthesia is effective for extracorporeal shock wave lithotripsy of pancreatic and biliary calculi 被引量:13
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作者 Santosh Darisetty Manu Tandan +6 位作者 Duvvuru Nageshwar Reddy Rama Kotla Rajesh Gupta Mohan Ramchandani Sandeep Lakhtakia Guduru Venkat Rao Rupa Banerjee 《World Journal of Gastrointestinal Surgery》 SCIE CAS 2010年第5期165-168,共4页
AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large ... AIM: To evaluate the efficacy of thoracic epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). METHODS: ESWL is an effective, non-invasive technique for the treatment of difficult pancreatic and large bile duct calculi. The procedure is often painful and requires large doses of analgesics. Many different anesthetic techniques have been used. Patients with either large bile duct calculi or pancreatic duct calculi which could not be extracted by routine endoscopic methods were selected. Thoracic epidural anesthesia (TEA) was routinely used in all the subjects unless contraindicated. Bupivacaine 0.25% with or without clonidine was used to block the segments D6 to D12. The dose was calculated depending on the age, height and weight of the patient. It was usually 1-2 mL per segment blocked.RESULTS: Ninety eight percent of the 1509 patients underwent ESWL under TEA. The subjects selected were within American Society of Anesthesiologists grade Ⅰ to Ⅲ. ESWL using EA permitted successful elimination of bile duct or pancreatic calculi with minimal morbidity. The procedure time was shorter in patients with TEA than in those who underwent ESWL under total intravenous anesthesia. CONCLUSION: Almost all patients undergoing ESWL with EA had effective blocks with a single catheter insertion and local anesthetic injection. 展开更多
关键词 Thoracic epidural anesthesia EXTRACORPOREAL shock wave LITHOTRIPSY Bile DUCT CALCULI PANCREATIC DUCT CALCULI
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Epidural anesthesia improves pancreatic perfusion and decreases the severity of acute pancreatitis 被引量:24
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作者 Samira M Sadowski Axel Andres +5 位作者 Philippe Morel Eduardo Schiffer Jean-Louis Frossard Alexandra Platon Pierre-Alexandre Poletti Leo Bühler 《World Journal of Gastroenterology》 SCIE CAS 2015年第43期12448-12456,共9页
AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranso... AIM: To study the safety of epidural anesthesia(EA),its effect on pancreatic perfusion and the outcome of patients with acute pancreatitis(AP).METHODS: From 2005 to August 2010,patients with predicted severe AP [Ranson score ≥ 2,C-reactive protein > 100 or necrosis on computed tomography(CT)] were prospectively randomized to either a group receiving EA or a control group treated by patientcontrolled intravenous analgesia. Pain management was evaluated in the two groups every eight hours using the visual analog pain scale(VAS). Parameters for clinical severity such as length of hospital stay,use of antibiotics,admission to the intensive care unit,radiological/clinical complications and the need for surgical necrosectomy including biochemical data were recorded. A CT scan using a perfusion protocol was performed on admission and at 72 h to evaluate pancreatic blood flow. A significant variation in blood flow was defined as a 20% difference in pancreatic perfusion between admission and 72 h and was measured in the head,body and tail of the pancreas.RESULTS: We enrolled 35 patients. Thirteen were randomized to the EA group and 22 to the control group. There were no differences in demographic characteristics between the two groups. The Balthazar radiological severity score on admission was higher in the EA group than in the control group(mean score 4.15 ± 2.54 vs 3.38 ± 1.75,respectively,P = 0.347) and the median Ranson scores were 3.4 and 2.7 respectively(P = NS). The median duration of EA was 5.7 d,and no complications of the epidural procedure were reported. An improvement in perfusion of the pancreas was observed in 13/30(43%) of measurements in the EA group vs 2/27(7%) in the control group(P = 0.0025). Necrosectomy was performed in 1/13 patients in the EA group vs 4/22 patients in the control group(P = 0.63). The VAS improved during the first ten days in the EA group compared to the control group(0.2 vs 2.33,P = 0.034 at 10 d). Length of stay and mortality were not statistically different between the 2 groups(26 d vs 30 d,P = 0.65,and 0% for both respectively).CONCLUSION: Our study demonstrates that EA increases arterial perfusion of the pancreas and improves the clinical outcome of patients with AP. 展开更多
关键词 Severe acute PANCREATITIS epidural anes thesia Pan
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Thoracic epidural anesthesia:Effects on splanchnic circulation and implications in Anesthesia and Intensive care 被引量:8
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作者 Antonio Siniscalchi Lorenzo Gamberini +2 位作者 Cristiana Laici Tommaso Bardi Stefano Faenza 《World Journal of Critical Care Medicine》 2015年第1期89-104,共16页
AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic conditions.METHODS:A Pub Med search was conducted using... AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic conditions.METHODS:A Pub Med search was conducted using the Me SH database.Anesthesia,Epidural was always the first MeS H heading and was combined by boolean operator AND with the following headings:Circulation,Splanchnic;Intestines;Pancreas and Pancreatitis;LiverFunction Tests.EMBASE,Cochrane library,ClinicalT rials.gov and clinicaltrialsregister.eu were also searched using the same terms.RESULTS:Twenty-seven relevant studies and four ongoing trials were found.The data regarding the effects of epidural anesthesia on splanchnic perfusion are conflicting.The studies focusing on regional macro-hemodynamics in healthy animals and humans undergoing elective surgery,demonstrated no influence or worsening of regional perfusion in patients receiving thoracic epidural anesthesia(TEA).On the other hand most of the studies focusing on micro-hemodynamics,especially in pathologic low flow conditions,suggested that TEA could foster microcirculation.CONCLUSION:The available studies in this field are heterogeneous and the results conflicting,thus it is difficult to draw decisive conclusions.However there is increasing evidence deriving from animal studies,that thoracic epidural blockade could have an important role in modifying tissue microperfusion and protecting microcirculatory weak units from ischemic damage,regardless of the effects on macro-hemodynamics. 展开更多
关键词 anesthesia epidural Circulation SPLANCHNIC INTESTINE MICROCIRCULATION PANCREATITIS Liver function tests
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CLINICAL EFFECTS OF ROPIVACAINE MESYLATE IN EPIDURAL ANESTHESIA AND ANALGESIA 被引量:1
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作者 Jian-qingXu BoZhu Tie-huYe 《Chinese Medical Sciences Journal》 CAS CSCD 2005年第1期70-73, ,共4页
关键词 epidural anesthesia postoperative analgesia ropivacaine mesylate ropivacaine hydrochloride
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Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index 被引量:2
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作者 XIANG Yan LI Yu-hong 《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》 SCIE CAS CSCD 2007年第6期428-434,共7页
Objective: To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness (LOC), effect-site propofol concentrations, and the hemo... Objective: To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness (LOC), effect-site propofol concentrations, and the hemodynamic variables during induction of general anesthesia guided by bispectral index (BIS) were studied. Methods: Forty-five patients were divided into three groups to receive epidurally administered saline (Group S), 1.5% (w/w) lidocaine (Group L), or 0,5% (w/w) ropivacaine (Group R) Propofol infusion was started to produce blood concentration of 4 lag/ml. Once the BIS value reached 40-50, endotracheal intubation was facilitated by 0.1 mg/kg vecuronium. Measurements included the time to LOC, effect-site propofol concentrations, total propofol dose, mean arterial blood pressure (MABP), and heart rate (HR) at different study time points. Results: During induction of anesthesia, both Groups L and R were similar for the time to LOC, effect-site propofol concentrations, total propofol dose, MABP, HR, and BIS. The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S. MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups, or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups. Conclusion: Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC, effect-site propofol concentrations, total propofol dose, and the hemodynamic variables during induction of general anesthesia. 展开更多
关键词 PROPOFOL LIDOCAINE ROPIVACAINE epidural anethesia Bispectral index
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Effect of epidural block combined intravenous general anesthesia stress on the stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy 被引量:3
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作者 Yuan Yao Yong-Sheng Wu +1 位作者 Hong-Xia Zhu Xin-Jing Su 《Journal of Hainan Medical University》 2017年第18期120-123,共4页
Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hos... Objective: To investigate the effect of epidural block combined with intravenous anesthesia on stress response and T lymphocyte subsets in patients with breast cancer undergoing radical mastectomy. Methods: In our hospital from July 2016 to June 2017 undergoing radical mastectomy for breast cancer of 88 patients were randomly divided into observation group and control group of 44 cases, 2 patients underwent routine preoperative preparation, and routine blood pressure, heart rate, pulse, oxygen saturation, ECG monitoring, control group with intravenous anesthesia. The observation group was treated with epidural block combined with intravenous anesthesia. 2 groups of patients before anesthesia, 30 MIM (T0), 1 h after skin incision (T1), 4 h after operation (T2), 24 h after operation (T3), 48 h after operation (T4) from peripheral venous blood were measured by interleukin-8 (IL-8) and interferon gamma (IFN-γ), cortisol (Cor), prolactin (PRL), growth hormone (GH) and T lymphocyte subsets (CD3+, CD4+, CD8+), the calculation of CD4+/CD8+ value. Results: the serum IL-8 level of T1, T2, T3and T4 decreased gradually, were lower than at T0, and the control group at each time point had no significant difference, T1, T2, T3group, T4IL-8 levels lower than the control group;the 2 groups of serum IFN-γ levels T1 and T2had no significant change, T3and T4increased gradually, was higher than that of T0, but no significant difference between the 2 groups of IFN-γ levels. 2 serum Cor levels peaked at T1, decreased at T2, was higher than that of T0, T3, T4returned to T0, the observation group T1, T2Cor level lower than the control group;the serum PRL levels of 2 groups reached a peak at T1, T2, T3at the time of T4decreased gradually, was higher than that of T0, T1, T2, T3of the observation group at the PRL level is lower than the control group;the serum level of GH 2 in group T1increased gradually, reached a peak at T2, T3and T4 decreased gradually, was higher than that of T0, the observation group T1, T2, T3, T4, GH levels lower than the control group. 2 groups of CD3+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD3+ was higher than the control group;group CD4+ decreased gradually in T1, T2, T3and T4were lower than control, T0when, and the observation group CD4+ in T1, T2, T3, T4, no significant changes were observed in group T1, T2, T3, T4and CD4+ higher than that of the control group;the 2 group CD8+ had no obvious changes in T1, T2, T3, T4;observation group CD4+/CD8+ decreased gradually in T1, T2, were lower than T0, T3, T4returned to T0, the observation group T1, T2CD4+/CD8+ was higher than the control group. Conclusion: epidural block combined with intravenous anesthesia for breast cancer radical mastectomy can effectively relieve the stress and inflammatory reaction, alleviate the immunosuppression, and help to restore the postoperative immune function. 展开更多
关键词 Total INTRAVENOUS anesthesia epidural block COMBINED INTRAVENOUS general anesthesia Radical MASTECTOMY STRESS response T lymphocyte subsets
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Effects of combined spinal-epidural anesthesia on anxiety,labor analgesia and motor blocks in women during natural delivery 被引量:2
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作者 Ling Cai Jiao-Jiao Jiang +1 位作者 Ting-Ting Wang Shuang Cao 《World Journal of Psychiatry》 SCIE 2023年第11期838-847,共10页
BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesi... BACKGROUND The background of this study was analgesia in natural delivery.The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor,and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.AIM To study the effects of combined spinal-epidural anesthesia on anxiety,labor analgesia,and motor blocks in parturients during natural delivery.METHODS A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included;a random number table approach was employed to divide the women into a control group and a joint group,with each group consisting of 60 women.The control group was given epidural anesthesia,while the joint group was given combined spinal-epidural anesthesia.The visual analog scale(VAS)was used to evaluate the degree of maternal pain.Comparisons were made between the two groups’conditions of childbirth and the duration of labor.Apgar scores were used to evaluate the status of the newborns at birth;Self-rating Anxiety Scale(SAS)and General Self-Efficacy Scale(GSES)scores,umbilical artery blood gas analysis indices and stress indices were compared between the two groups;and the frequencies of motor block and postpartum complications were analyzed.RESULTS In comparison to the control group,in the joint group,the VAS scores for the first,second,and third stages of labor were lower(P<0.05).The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group(P<0.05).No significant differences were observed in the Apgar score,the duration of the first stage of labor,or the total duration of labor between the two groups(P>0.05).The second and third stages of labor in the joint group were shorter than those in the control group(P<0.05).When compared to the control group,the postpartum SAS score of the joint group was lower,while the GSES score was greater(P<0.05).Between the control group and the joint group,the differences observed in pH,arterial carbon dioxide partial pressure,arterial oxygen partial pressure,or arterial hydrogen ion concentration were not significant(P>0.05).Nitric oxide,cortisol,and adrenaline levels were lower in the joint group than in the control group(P<0.05).There were no substantial differences in Bromage grade or rate of complications between the two groups(P>0.05).CONCLUSION For parturients during natural delivery,combined spinal-epidural anesthesia can reduce anxiety,provide labor analgesia,shorten labor time,and reduce postoperative stress levels but did not result in a motor block. 展开更多
关键词 Combined spinal-epidural anesthesia Natural delivery Anxiety level Labor analgesia Motor block
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Pregnant women’s awareness and acceptance of epidural anesthesia and its influence on cesarean section rate control in China: A qualitative study
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作者 Ruirui Chen Yuli Cheng Jianmei Li 《Health》 2013年第9期1455-1460,共6页
Background: Epidural anesthesia, as an effective pain relief method, could be viewed as an attempt to encourage vaginal delivery and control cesarean section. Increased demand caused by psychosocial factors such as fe... Background: Epidural anesthesia, as an effective pain relief method, could be viewed as an attempt to encourage vaginal delivery and control cesarean section. Increased demand caused by psychosocial factors such as fear of childbirth and labor pain is supposed to be one predictable drive of high cesarean section rate in present China. Little qualitative information on women’s awareness and perceptions of epidural anesthesia was found, but conscious efforts should be focused on this part to help generate policy-making priority. Methods: This study was carried out under an exploratory descriptive design in Bao’an Maternity and Child Health Hospital. Those interested in participating would be invited to focus group discussion or individual interview according to a semi-structured open-ended guide after collecting the participants’ demographic characteristics. The thematic content analysis approach was used for data analysis. Results: Five major themes were identified: 1. the sources to gain information on epidural anesthesia;2. clinical impact;3. social impact on awareness;4. association between epidural anesthesia and cesarean section;5. attitudes and questions about the current service implementation. Discussions: The interplay between pregnancy knowledge, socio-economic conditions, social support, insurance policy environment, women’s judgment of health care quality influences the ways women acknowledge and utilize epidural anesthesia service. Conclusions: As maternal requested CS due to low pain tolerance emerges gradually, natural labor with epidural anesthesia is a more suitable childbirth option, which is also expected to function in reducing CS rate by service-providers and administrators in the health departments of China besides building up a pain-free labor environment. 展开更多
关键词 epidural anesthesia AWARENESS Qualitative CESAREAN Section
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Pneumocephalus Following Combined Spinal-Epidural Anesthesia: A Case Report Analysis
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作者 Tao Li Xiaoqin Zeng Yin Wu 《Case Reports in Clinical Medicine》 2024年第9期418-424,共7页
Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have redu... Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have reduced the frequency and severity of common complications, reports of rare and serious complications such as pneumocephalus, remain scarce. Case Report: This article presents a case of pneumocephalus following CSEA in a middle-aged female patient undergoing surgery for an intrauterine space-occupying lesion. The patient experienced severe headache postoperatively, and imaging confirmed the presence of intracranial air. After receiving active symptomatic treatment, the patient recovered and was discharged. Conclusion: This case underscores the importance of adhering to standard anesthesia protocols and increasing awareness of rare CSEA complications, particularly the risk of pneumocephalus. Early recognition and timely management are crucial. There is a need to further enhance training and research in anesthetic procedures to improve clinical anesthesia quality and ensure patient safety. 展开更多
关键词 Combined Spinal-epidural anesthesia PNEUMOCEPHALUS Intrauterine Space-Occupying Lesion anesthesia Complications Clinical anesthesia Quality
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Comparative Study between General Anesthesia versus General Anesthesia Combined with Thoracic Epidural Analgesia on Cytokine Response in Laparoscopic Cholecystectomy Patients
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作者 Amir Abouzkry Elsayed Nagwa Mohammed Gamal EI-deen +2 位作者 Gamal Hendawy Rezk Shams Ahmed Elsaied Abd-elrahman Aly Wafaa Salah Mohammed 《Open Journal of Anesthesiology》 2020年第6期247-262,共16页
<b><span>Background and Objectives: </span></b><span>The main benefits of laparoscopic surgery in comparison to open surgery involve the rapid discharge from recovery room, decreased post... <b><span>Background and Objectives: </span></b><span>The main benefits of laparoscopic surgery in comparison to open surgery involve the rapid discharge from recovery room, decreased postoperative hospital stays, reduced postoperative discomfort, easier getting back to work and faster return to ordinary daily life as well as cosmetic surgical wounds. The anesthesia type has an essential role in attenuation of the surgical stress and achievement of these advantages. We aimed to determine the outcome of giving general anesthesia in conjunction with thoracic epidural analgesia (TEA) compared to general anesthesia alone on stress response to surgery and anesthesia by investigating cytokine reaction (interleukin 6 and 8 levels), hemodynamic changes (BP, HR, RR, SPO2), and Visual Analogue Scale (VAS) scores postoperatively in patients subjected for laparoscopic cholecystectomy. </span><b><span>Methods: </span></b><span>This study included 40 patients aged 20</span><span> </span><span>- 60 years old with American Society of Anesthesiologists physical status (ASA) I and II. They were planned for laparoscopic cholecystectomy at Aswan University Hospital from April 2017 to March 2018. They were randomly allocated into two groups.</span><b><span> </span></b><span>Group A (n. 20) received general anesthesia only and Group B (n. 20) received general anesthesia in conjunction with thoracic epidural analgesia using fentanyl and bupivacaine in the epidural catheter. Chi-square was applied to differentiate categorical variables, whereas comparison between continuous variables was done by using t-test. Two-tailed p < 0.05 was estimated as statistically signi</span><span>fi</span><span>cant. </span><b><span>Results:</span></b><span> As regards IL-6 and IL-8 post-operative there is significant difference (p < 0.05) between two groups during 2</span><sup><span style="vertical-align:super;">nd</span></sup><span> and 4</span><sup><span style="vertical-align:super;">th</span></sup><span> hr and 24</span><sup><span style="vertical-align:super;">th</span></sup><span> hr postoperative, with significantly increased postoperative levels of IL-6 and IL-8 in comparison to their preoperative baseline values. The largest increase in IL6 & IL8 levels was in group A (GA group). VAS score showed significant lower values in TEA group in comparison to GA group. No significant difference between groups as regard intraoperative and postoperative hemodynamic changes. </span><b><span>Conclusion: </span></b><span>Regional technique</span><span>s</span><span> including TEA attenuate and decrease cytokine reaction secondary to surgery which decrease</span><span>s</span><span> inflammatory process and improve</span><span>s</span><span> patient outcome and reduce</span><span>s</span><span> pain score postoperatively. 展开更多
关键词 General anesthesia Thoracic epidural Analgesia CYTOKINE Laparoscopic Cholecystectomy
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Peripheral Nerve Block Combined with Epidural Anesthesia for Incarcerated Inguinal Hernia Repair in a Patient with Severe Chronic Obstructive Pulmonary Disease: A Case Report
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作者 Yui Ikuta Hideya Kato +3 位作者 Yuko YNishiwaki Junko Tamura Ryuhei Araki Shinji Nozuchi 《Open Journal of Anesthesiology》 2022年第3期105-112,共8页
Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. ... Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation. 展开更多
关键词 COPD Hernia Repair Peripheral Nerve Block epidural anesthesia
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Influence of general anesthesia combined with epidural anesthesia on adrenal cortex, stress factors and immunologic function in patients with lung cancer
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作者 Xiang-Yu Yin Fan Huang Zi-Ge Xu 《Journal of Hainan Medical University》 2018年第1期89-92,共4页
Objective: To observe the influence of general anesthesia combined with epidural anesthesia on adrenal cortex, stress factors and immunologic function in patients with lung cancer. Methods:A total of 60 patients with ... Objective: To observe the influence of general anesthesia combined with epidural anesthesia on adrenal cortex, stress factors and immunologic function in patients with lung cancer. Methods:A total of 60 patients with lung cancer were randomly divided into two groups: observation group (30 cases) and control group (30 cases). Observation group: general anesthesia combined with epidural anesthesia;control group: patients were treated only by general anesthesia. Recording and comparing the levels of Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS and immunologic function before and after treatment. Results: (1) Before treatment, there was no statistically significant difference in the serum Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS levels between the two groups. After treatment, the serum Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS levels of the two groups were significantly lower than those of the same group before treatment, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. (2) Before treatment, there was no statistically significant difference in CD4+, CD8+, CD4+/CD8+between the two groups. After treatment, the CD4+, CD4+/CD8+ of the two groups were significantly lower than those of the same group before treatment, the CD8+ of the two groups were significantly higher, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. Conclusion:General anesthesia combined with epidural anesthesia for patients with lung cancer can perfect the levels of serum adrenal cortical hormone, stress factors and be beneficial to protect their immunologic function. 展开更多
关键词 General anesthesia epidural anesthesia ADRENAL cortical HORMONE T cell SUBGROUP
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Effect of general anesthesia combined with epidural anesthesia on stress response, inflammatory reaction and coagulation in patients with colon cancer
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作者 Si-Yang Yi Xian-Jie Zhang +2 位作者 Yu-Kai Zhou Wang Ya-Li Xing You 《Journal of Hainan Medical University》 2018年第18期59-63,共5页
Objective: To investigate the effects of general anesthesia combined with epidural anesthesia on stress response, inflammation level and coagulation function in patients undergoing laparoscopic colon cancer resection ... Objective: To investigate the effects of general anesthesia combined with epidural anesthesia on stress response, inflammation level and coagulation function in patients undergoing laparoscopic colon cancer resection during intraoperative and postoperative. Methods: A total of 98 patients undergoing colon cancer radical surgery in our hospital from August 2015 to August 2017 were randomly divided into control group and observation group with 49 cases in each group. In the control group, systemic intravenous anesthesia was used;and in the observation group, a systemic intravenous anesthesia combined epidural anesthesia was used. Serum of venous blood was collected from patients before anaesthesia, 30 min after anesthesia, and two hours after operation to detect stress response indexes, such as adreno-cortico-tropic-hormone (ACTH), adrenaline (AD), norepinephrine (NE) and cortisol (Cor), and inflammatory response indexes, such as tumor necrosis factor-α (TNF-α), procalcitonin (PCT) and C-reaction protein (CRP). Venous blood was collected at the same time points for coagulation testing. Functional indicators such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (FBG) were detected. Results: There was no significant difference in the level of each index between the two groups before anesthesia. At 30 minutes after anesthesia and at 2 hours after operation, the stress response indicators and inflammatory response indicators in the observation group were lower than those in the control group at the same time points;apart of the blood coagulation function indexes (PT, APTT and TT) in the observation group were higher than the corresponding indicators of the control group at the same time points, but the FBG content in the observation group was lower than that of the control group at the same time points, and these differences were significant. Conclusion: The method of general anesthesia combined with epidural anesthesia can effectively reduce the stress and inflammatory reaction during and after operation of laparoscopic colon cancer resection, and reduce the abnormal coagulation function as well as the blood hypercoagulability. 展开更多
关键词 epidural anesthesia COLON cancer Stress response INFLAMMATION COAGULATION
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Changes in Gaze Behavior during the Learning of the Epidural Technique with a Simulator in Anesthesia Novices
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作者 Emanuele Capogna Francesco Salvi +2 位作者 Angelica Del Vecchio Matteo Velardo Giorgio Capogna 《Open Journal of Anesthesiology》 2020年第11期361-370,共10页
<b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Current literature demonstrates the ability of eye tracking to provide ... <b><span style="font-family:Verdana;">Background: </span></b><span style="font-family:Verdana;">Current literature demonstrates the ability of eye tracking to provide reliable quantitative data as an objective assessment tool, with potential applications to medical and surgical training to improve performance.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">The aim of this study was to evaluate the changes in gaze behavior in anesthesia novice trainees when performing a simulated epidural technique before and after a hands-on training on the epidural simulator.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">We enrolled 48 novice trainees who had never previously performed an epidural block. After a standardized learning module, each trainee practiced the epidural procedure on the epidural simulator while wearing a pair of eye tracking glasses (Tobii Pro Glasses 50 Hz wearable wireless eye tracker). After this baseline recording, each trainee spent two hours practicing with the epidural simulator and afterwards once again performed the eye tracking epidural procedure.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Eye tracking metrics and epidural learning (duration of the procedure and number of attempts) before and after the simulated practice were recorded.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">The duration of the epidural procedure and of the epidural needle advancement phase (P < </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.05) and the number of epidural attempts (P < </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.001) were reduced after the tutorial.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">When considering the eye tracking metrics, after the tutorial</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> the number of visit counts decreased and their duration increased (P < </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.05). The number of epidural needle insertions (additional attempts) showed a significant positive correlation with the visits number (aOR = 2.02 (95% CI = 1.26</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">3.55;P = </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.008)) and a significant negative correlation with the visit duration (aOR = 0.65 (95% CI = 0.39</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.99;P = </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.05)). </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">We observed significant changes in gaze behavior associated with increased performance during the epidural technique learning with a simulator in anesthesia trainees who had never previously performed an epidural block.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">These results may create a prototype for future studies on eye tracking technique as a teaching and evaluating tool in simulation.</span> 展开更多
关键词 Simulation epidural Technique Eye Tracking
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Effect of combined spinal and epidural anesthesia on the level of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section
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作者 Tian Shun Huang Cui-yuan +1 位作者 Pu Le-hua Tian Yu 《Journal of Hainan Medical University》 2019年第17期71-75,共5页
Objective: To discuss the effect of combined spinal and epidural anesthesia on the levels of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section. Methods: Eight... Objective: To discuss the effect of combined spinal and epidural anesthesia on the levels of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section. Methods: Eighty patients who underwent cesarean section in our hospital from January 2017 to April 2019 were enrolled in the hospital. They were divided into two groups according to the patient's anesthesia. Fourty patients receiving epidural anesthesia were included in the control group, and another 40 patients received lumbar stiffness. The combined anesthesia patient was included in the observation group. Changes in pain mediators [Serum neuropeptide Y (NPY), endorphin (β-EP), substance P (SP)], stress indicators [Serum cortisol (Cor), C-peptide (C-P), advanced oxidative protein product (AOPP)], inflammatory factor levels [Hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α)], and immunoglobulin levels [Serum IgA, IgG, IgM] were compared between the two groups. Results: Before anesthesia, there were no significant difference in pain media, stress index, inflammatory factor level and immunoglobulin level between the two groups (P>0.05). At 12 h after operation, the two groups of patients were NPY, β-EP, SP, Cor. The levels of C-P, AOPP, hs-CRP and TNF-α were higher than those before operation (P<0.05). The levels of IgA, IgG and IgM were lower than those before operation (P<0.05). Among them, observation group NPY, β-EP, SP, Cor, C-P, AOPP, hs-CRP and TNF-α were significantly lower than those of the control group (P<0.05). The serum levels of IgA, IgG and IgM were significantly higher than those of the control group (P<0.05). Conclusion: Combined spinal and epidural anesthesia can more effectively alleviate maternal pain in high altitude cesarean section, more effectively reduce the inflammatory stress response of patients, promote the humoral immune function of patients, and is beneficial to the early recovery of maternal postoperative, and has high clinical value. 展开更多
关键词 COMBINED SPINAL and epidural anesthesia High ALTITUDE area CESAREAN section surgery PAIN Stress Inflammation
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