Effects of lornoxicam combining with fentanyl on postoperative arrhythmia and platelet function in patients with coronary artery disease after abdominal surgery

To investigate the effects of patient-controlled intravenous analgesia (PCIA) with lornoxicam and fentanyl on arrhythmia and the expression of platelet membrane glycoproteins in patients with coronary artery disease (CAD) after abdominal surgery.Methods Eighty ASA Ⅱ or Ⅲ patients with CAD aged 51～66 yrs weighing 59～68 kg presenting for abdominal surgery participated in this study.CAD was diagnosed by clinical symptoms and ischemic changes on ECG.The patients were premedicated with intramuscular henobarbital 0.1 g and scopolamine 0.3 mg.Anesthesia was induced with fentanyl,droperidol,propofol and vecuronium and maintained with propofol,fentanyl and vecuronium.The patients received PCIA after operation.The PCIA solution contained fentanyl 0.9 mg and droperidol 5 mg in 100 ml of normal saline (N.S.) in group A (n=40) or lornoxicam 56 mg,fentanyl 0.2 mg and droperidol 5 mg in 100 ml N.S. in group B (n=40).In group A the loading dose was fentanyl 0.05 mg and group B lornoxicam 4 mg.PCIA included a background infusion at 2 ml·h -1 and a bolus of 0.5 ml with a 15 min lock-out.VAS(0=no pain,10= worst pain) was used to measure pain intensity.In addition to BP,HR and SpO2 monitoring ECG was continuously monitored with a Holter monitor after operation.Blood samples were taken from peripheral vein before and 6 h after operation and on the 1st,2nd,7th and 8th postoperative days for determination of the expression of CD 62p ,CD 63 and CD 41 /CD 61 on the platelet membrane,platelet count,prothrombin time (PT) thrombin time (TT) and partial thromboplastin time (PTT).Results The two groups were comparable with respect to sex,age,body weight,severity of CAD,duration of operation and intraoperative blood loss.The patients received no blood transfusion during operation.There was no significant difference in VAS score,platelet count,PT,TT and PTT between the two groups.The incidence of atrial and ventricular premature beat on ECG and the expression of CD 41 /CD 61 ,CD 62p and CD 63 on the platelet membrane were significantly lower in group B than in group A on the 7th and 8th postoperative days(P<0.05 or 0.01).Conclusion Postoperative PCIA with lornoxicam and fentanyl can more effectively reduce the incidence of postoperative arrhythmia in patients with CAD.Suppression of activation of platelets by lornoxicam may contribute to the mechanism.10 refs,3 tabs.

Results of 50 adult patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock

Objective Extracorporeal membrane oxygenation is a cardiopulmonary supportive therapy. Since 2004,our institution has adopted venoarterial ECMO for adult patients who otherwise could not be weaned from cardiopulmonary bypass and patients experiencing postcardiotomy cardiogenic shock and / or pulmonary dysfunction

Hidden blood loss after intertrochanteric fractures in elderly patients and its influence on the postoperative function recovery:a random controlled trial

Objective To investigate hidden blood loss after various types of intertrochanteric fractures and to determine whether oral iron supplementations is benefical for the postoperative functional recovery in elderly patients.Methods From

Intraoperative patient information handover between anesthesia providers

Currently,no reported studies have evaluated intraoperative handover among anesthesia providers.Studies on anesthetic handover in the US recovery room setting observed that handover processes are insufficient and,in many instances,significant intraoperative events are disregarded.An online survey tool was sent to anesthesia providers at US anesthesia residency programs nationwide（120 out of the 132 US programs encompassing around 4500 residents and their academic MDAs） and a smaller survey selection of CRNAs（10 institutions about 300 CRNAs in the metropolitan area of Detroit,MI,USA） to collect information on handover practices.The response rate to this survey（n=216） was comprised of approximately 5%（n = 71） of the resident population in US anesthesia programs,5%（n=87） of MDAs,and 20%（n=58） of the CRNAs.Out of all respondents（n=212）,49.1%had no hand-over protocol at their institution and 88%of respondents who did have institutional handover protocols believed them insufficient for effective patient handover.In addiiton,84.8%of all responders reported situations where there was insufficient information received during a patient handover.Only 7%of the respondents reported never experiencing complications or mismanagement due to poor or incomplete hand-overs.In contrast,60%reported rarely having complications,31%reported sometimes having complications,and 3%reported frequent complications.In conclusion,handover transition of patient care is a vulnerable and potentially life-threatening event in the operating room.Our preliminary study suggests that current intraoperatvive handover practices among anesthesia providers are suboptimal and that national patient handover guidelines are required to improve patient safety.

Nursing Practice in Recovery Room: A Case of Kibuye Hope Hospital and Mutoyi Hospital

Background: Nursing care in the recovery room is oriented to take into account the patient’s condition after surgery intervention with its main purpose of providing direct and continuous patient observation in emergence from general or regional anesthesia. In the absence of professional assistance, patients can develop complications that can lead them into shock or death. This study aims to understand the place of nurses in guiding nursing care in recovery room in two hospitals of Gitega Province by assessing the nurse’s knowledge and attitudes for the promotion of quality nursing care for post-operative patients. Methods: A cross sectional study design was used to assess the practice of nurses in managing nursing care in the recovery room in these two hospitals. A purposive sampling method was used to select the 82 nurses working in the recovery room for these two hospitals and Alain Bouchard’s formula was used to calculate the sample size. Data were collected using a self-report method involving questionnaire completion with five components addressing participants identifications, factors related to the work organization, factors related to the work environment, factors related to healthcare system, and nursing interventions in recovery room. Results: Findings revealed a significant lack of knowledge among the participants and their attitudes were slightly poor as for most of the variables of factors related to healthcare system as their score was less than 50% and their knowledge for nursing interventions was also poor as most of variable scores were less than 25%. Conclusions: The study findings were slightly poor as their scores were less than 50% in most of the variables;therefore, it was recommended that in-service training and workshops should be organized by these healthcare facilities for the purpose of empowering the nurse’s knowledge and practice. Moreover, these institutions should provide and encourage nurses to use nursing guidelines and protocols.

Impact of Acupuncture Therapy in Postoperative Aortic Dissection Patients with Cerebral Infarction:A Case Study

Aortic dissection is a life-threatening disease that can produce a variety of symptoms and complications. Patients at high risk for mortality, such as individuals with aortic regurgitation, cardiac tamponade, or myocardial infarction, should be treated by surgery as soon as possible, especially in cases with acute ascending aortic dissections （Stanford type A）. However, patients with aortic dissection may suffer adverse outcomes that lead to mortality and morbidity, such as stoke, re-dissection, myocardial infarction, and heart failure. Patients with surgically treated acute type A aortic dissection show an 18.2% likelihood of stroke in early morbidity.

Clinical Study on Shenmai Injection in Promoting Postoperative Recovery in Patients of Breast Cancer

To investigate the effect of Shenmai injection in promoting postoperative recovery of patients with breast cancer. Methods: Eighty postoperative patients of breast cancer were selected and divided into two groups, the treated group (40 cases) was given intravenous Shenmai injection for 7 days and compared with the control group (40 cases) in wound healing time, postoperative drainage volume, complication and blood picture, and the NK cell, T lymphocyte subsets (CD 3, CD 4, CD 8), were compared before and after treatment. Results: The wound healing time and postoperational complication in the treated group were less than those in the control group significantly. There was no difference between the two groups in WBC and platelet count, but the recovery of hemoglobin in the treated group was quicker than that in the control group significantly (P<0 05), as comparing with the control group, the NK cell, CD 4, CD 4/CD 8 ratio in the treated group were elevated faster than those in the control group significantly (P<0 05). Conclusion: Shenmai injection was beneficial to the recovery of postoperative patients of breast cancer, to reducing the occurrence of complication and was favorable to conduct postoperative chemotherapy smoothly.