Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are t...Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are the clinical manifestations of the disease. An ideal anesthetic technique has not been described for this patient population because of the rarity of the disease. This case report describes the successful use of total intravenous anesthesia in a patient with Stiff- Person Syndrome.展开更多
Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Me...Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.展开更多
Objective:To study the effect of epidural anesthesia combined with total intravenous anesthesia on stress response and coagulation function in and after laparoscopic surgery. Methods: A total of 219 cases of patients ...Objective:To study the effect of epidural anesthesia combined with total intravenous anesthesia on stress response and coagulation function in and after laparoscopic surgery. Methods: A total of 219 cases of patients who underwent laparoscopic cholecystectomy in our hospital between August 2014 and February 2017 were collected and divided into control group (n=125) who accepted total intravenous anesthesia alone and observation group (n=94) who accepted epidural anesthesia combined with total intravenous anesthesia after the anesthesia scheme was reviewed. Perioperative stress response and coagulation function were compared between two groups of patients.Results: Before operation, differences in the serum stress index contents and peripheral blood coagulation index levels were not statistically significant between two groups of patients. In operation and 2 h after operation, serum stress indexes Cor, Ang-Ⅰ, Ang-Ⅱ and NE contents of observation group were significantly lower than those of control group;peripheral blood coagulation indexes PT, TT and APTT levels were significantly higher than those of control group while TXA2, TXB2 and FBG levels were significantly lower than those of control group.Conclusions: Epidural anesthesia combined with total intravenous anesthesia can effectively alleviate the systemic stress response and reduce the hypercoagulable state in and early after laparoscopic surgery.展开更多
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
The purpose of this study was to evaluate effects of controlled ventilation and positioning on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using a drug combination of medetomidine...The purpose of this study was to evaluate effects of controlled ventilation and positioning on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using a drug combination of medetomidine,lidocaine,butorphanol and propofol (MLBP-TIVA).Five healthy adult horses were anesthetized with MLBP-TIVA for 2-hours on 3-occasions at 4-week interval. In each occasion,horses were anesthetized in lateral recumbency with (CV-LR-group) or without controlled ventilation (SB-LRgroup) or in dorsal recumbency with controlled ventilation (CV-DR-group). Anesthesia was induced with lidocaine (1mg/kg: IV) and propofol (3 mg/kg: IV) following premedications with medetomidine (0. 005 mg/kg: IV) and butorphanol (0. 02 mg/kg: IV),and then maintained by constant rate infusions of propofol (6 mg/kg/hr),medetomidine (0. 0035 mg/kg/h),lidocaine (3 mg/kg/h) and butorphanol (0. 024 mg/kg/h). All horses breathed 100% oxygen during anesthesia. In the CV-groups,horses were mechanically ventilated to maintain arterial CO2pressure (PaCO2)within 40 ~ 50 mmHg. Cardiopulmonary parameters were compared between groups using repeated-measures ANOVA.The level of significance was set at P 【 0. 05.In the SB-LR group,cardiovascular parameters were maintained within acceptable ranges (heart rate: 37 ~ 39beats/min,mean arterial blood pressure: 109 ~ 115 mmHg,mean pulmonary arterial pressure [MPAP]: 28 ~ 29 mmHg,mean right atrial pressure [MRAP]: 19 ~ 21 mmHg,cardiac output: 27 ~ 30 L/min) but severe hypercapnia with insufficient oxygenation (PaCO283 ~ 103 mmHg,arterial O2pressure [PaO2]155 ~171 mmHg) was observed. Cardiopulmonary parameters were maintained with acceptable ranges in the both CV groups. In the CV-LR group,significant decreases in heart rate (29 ~ 31 beats/min,P = 0. 020),cardiac output (17 ~ 21 L/min,P = 0. 005) and PaCO2 (42 ~50 mmHg,P =0. 001) and a significant increase in PaO2 (395 ~419 mmHg,P =0. 005) were observed compared to the SB-group. In the CV-DR group,MPAP (18 ~ 20 mmHg,P = 0. 001),MRAP (15 ~ 17 mmHg,P =0. 003) and PaO2 (171 ~301 mmHg,P =0. 043) were significantly decreased compared to the CV-LR-group.Cardiovascular functions were well maintained in horses during MLBP-TIVA. Controlled ventilation was useful for improving hypercapnia and oxygenation. It is thought that MLBP-TIVA preserves cardiovascular function and provides compensation for decreased preload in horses positioned in dorsal recumbency.展开更多
BACKGROUND Patients with Becker muscular dystrophy(BMD)have a high risk of developing hyperkalemia,rhabdomyolysis,and malignant hyperthermia when exposed to volatile anesthetics and depolarizing muscle relaxants.Patie...BACKGROUND Patients with Becker muscular dystrophy(BMD)have a high risk of developing hyperkalemia,rhabdomyolysis,and malignant hyperthermia when exposed to volatile anesthetics and depolarizing muscle relaxants.Patients with BMD are also prone to respiratory depression after general anesthesia.Thus,it is extremely challenging for anesthesiologists to manage anesthesia in BMD patients,particularly in pediatric BMD patients.Here,we present successful anesthesia management using transversus abdominis plane block(TAPB)combined with total intravenous anesthesia(TIVA)in a pediatric BMD patient undergoing laparoscopic inguinal hernia repair.CASE SUMMARY A 2-year-old boy,weighing 15 kg,with BMD,was scheduled for laparoscopic inguinal hernia repair.TIVA was used for induction,and continuous infusions of short-acting intravenous anesthetics combined with TAPB were performed for anesthesia maintenance.Moreover,TAPB provided good postoperative analgesia.The patient underwent uneventful surgery and anesthesia,and over the 17 mo follow-up period showed no anesthesia-induced complications.CONCLUSION TAPB combined with TIVA,using short-acting intravenous anesthetic agents,can provide safe and effective anesthesia management in pediatric BMD patients undergoing short-term abdominal surgery.展开更多
Objective:To observe the effects of different anesthesia depths on the level of plasma cortisol during operation and the score of postoperative MMSE in elderly patients underwent radical gastrectomy.Methods: A total o...Objective:To observe the effects of different anesthesia depths on the level of plasma cortisol during operation and the score of postoperative MMSE in elderly patients underwent radical gastrectomy.Methods: A total of eighty seven elderly patients undergoing radical gastrectomy were enrolled in this study. Continuous infusion of propofol and remifentanil for anesthesia and maintenance of propofol were divided into two groups: BIS-I (BIS: 45-55) and BIS-II (BIS: 55-65) by adusting the doses of propofol. The data were recorded as following, thewhole dosage of propofol, the time of extubation and the score of VAS. The level of plasma cortisol was finished at the time of incision and tracheal intubation. MMSE scores were recorded on the day before operation and follow-up at 3 and 7 d postoperatively. Record the patient's operation to discharge time, postoperative complications.Results: The concentration of cortisol in BIS-I group was higher than that in BIS-II group. There was no significant difference in extubation time, extubation VAS score and MMSE score after operation.Conclusion:There were no significant differences in the BIS values between 45 and 65 for the elderly patients undergoing upper abdominal surgery, and there were no significant differences in the patients' postoperative stress, wake, extubation, early postoperative pain scores and postoperative cognitive function. BIS values in 45-55 compared to 55-65 patients with low plasma cortisol levels may be associated with better control of stress levels, to maintain the BIS value between 45-55 anesthesia depths is more reasonable.展开更多
BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyel...BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.展开更多
Intraoperative awareness is the explicit recall of sensory perceptions during general anesthesia.I presume the epidemiology and characteristics of intraoperative awareness from these surveys in Japan.A questionnaire s...Intraoperative awareness is the explicit recall of sensory perceptions during general anesthesia.I presume the epidemiology and characteristics of intraoperative awareness from these surveys in Japan.A questionnaire survey was conducted via the Internet.The first survey was conducted in 2008.Our survey showed 17% of anesthesiologists experienced definite or possible awareness.The second survey was conducted to evaluate the first survey in detail in 2008.A total of 172 anesthesiologists answered.The total number of reported anesthetic cases was 85156.Twenty-four cases of definite or possible awareness were reported by 21 anesthesiologists.The most surprising finding was total intravenous anesthesia(TIVA) was used in 21 of the 24 cases.The third survey was conducted in 2011 as a continuous survey.Six cases of definite or possible awareness were reported by six anesthesiologists(7%).Two cases were maintained by TIVA,and 2 cases were sevoflurane.The survey showed 76% anesthesiologists routinely use bispectral index(BIS) for TIVA,but for sevoflurane only 27% anesthesiologists routinely use BIS.The incidence of intraoperative awareness decreased in the third survey.The continuous survey revealed the current status of daily anesthesia and the results might be used to prevent the awareness during general anesthesia.展开更多
文摘Stiff-Person syndrome is a rare autoimmune neurologic disorder that affects the central nervous system by inhibiting production of the neurotransmitter gamma-aminobutyric acid. Painful muscle spasms and rigidity are the clinical manifestations of the disease. An ideal anesthetic technique has not been described for this patient population because of the rarity of the disease. This case report describes the successful use of total intravenous anesthesia in a patient with Stiff- Person Syndrome.
文摘Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.
文摘Objective:To study the effect of epidural anesthesia combined with total intravenous anesthesia on stress response and coagulation function in and after laparoscopic surgery. Methods: A total of 219 cases of patients who underwent laparoscopic cholecystectomy in our hospital between August 2014 and February 2017 were collected and divided into control group (n=125) who accepted total intravenous anesthesia alone and observation group (n=94) who accepted epidural anesthesia combined with total intravenous anesthesia after the anesthesia scheme was reviewed. Perioperative stress response and coagulation function were compared between two groups of patients.Results: Before operation, differences in the serum stress index contents and peripheral blood coagulation index levels were not statistically significant between two groups of patients. In operation and 2 h after operation, serum stress indexes Cor, Ang-Ⅰ, Ang-Ⅱ and NE contents of observation group were significantly lower than those of control group;peripheral blood coagulation indexes PT, TT and APTT levels were significantly higher than those of control group while TXA2, TXB2 and FBG levels were significantly lower than those of control group.Conclusions: Epidural anesthesia combined with total intravenous anesthesia can effectively alleviate the systemic stress response and reduce the hypercoagulable state in and early after laparoscopic surgery.
文摘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.
文摘The purpose of this study was to evaluate effects of controlled ventilation and positioning on cardiopulmonary function in horses anesthetized with total intravenous anesthesia using a drug combination of medetomidine,lidocaine,butorphanol and propofol (MLBP-TIVA).Five healthy adult horses were anesthetized with MLBP-TIVA for 2-hours on 3-occasions at 4-week interval. In each occasion,horses were anesthetized in lateral recumbency with (CV-LR-group) or without controlled ventilation (SB-LRgroup) or in dorsal recumbency with controlled ventilation (CV-DR-group). Anesthesia was induced with lidocaine (1mg/kg: IV) and propofol (3 mg/kg: IV) following premedications with medetomidine (0. 005 mg/kg: IV) and butorphanol (0. 02 mg/kg: IV),and then maintained by constant rate infusions of propofol (6 mg/kg/hr),medetomidine (0. 0035 mg/kg/h),lidocaine (3 mg/kg/h) and butorphanol (0. 024 mg/kg/h). All horses breathed 100% oxygen during anesthesia. In the CV-groups,horses were mechanically ventilated to maintain arterial CO2pressure (PaCO2)within 40 ~ 50 mmHg. Cardiopulmonary parameters were compared between groups using repeated-measures ANOVA.The level of significance was set at P 【 0. 05.In the SB-LR group,cardiovascular parameters were maintained within acceptable ranges (heart rate: 37 ~ 39beats/min,mean arterial blood pressure: 109 ~ 115 mmHg,mean pulmonary arterial pressure [MPAP]: 28 ~ 29 mmHg,mean right atrial pressure [MRAP]: 19 ~ 21 mmHg,cardiac output: 27 ~ 30 L/min) but severe hypercapnia with insufficient oxygenation (PaCO283 ~ 103 mmHg,arterial O2pressure [PaO2]155 ~171 mmHg) was observed. Cardiopulmonary parameters were maintained with acceptable ranges in the both CV groups. In the CV-LR group,significant decreases in heart rate (29 ~ 31 beats/min,P = 0. 020),cardiac output (17 ~ 21 L/min,P = 0. 005) and PaCO2 (42 ~50 mmHg,P =0. 001) and a significant increase in PaO2 (395 ~419 mmHg,P =0. 005) were observed compared to the SB-group. In the CV-DR group,MPAP (18 ~ 20 mmHg,P = 0. 001),MRAP (15 ~ 17 mmHg,P =0. 003) and PaO2 (171 ~301 mmHg,P =0. 043) were significantly decreased compared to the CV-LR-group.Cardiovascular functions were well maintained in horses during MLBP-TIVA. Controlled ventilation was useful for improving hypercapnia and oxygenation. It is thought that MLBP-TIVA preserves cardiovascular function and provides compensation for decreased preload in horses positioned in dorsal recumbency.
文摘BACKGROUND Patients with Becker muscular dystrophy(BMD)have a high risk of developing hyperkalemia,rhabdomyolysis,and malignant hyperthermia when exposed to volatile anesthetics and depolarizing muscle relaxants.Patients with BMD are also prone to respiratory depression after general anesthesia.Thus,it is extremely challenging for anesthesiologists to manage anesthesia in BMD patients,particularly in pediatric BMD patients.Here,we present successful anesthesia management using transversus abdominis plane block(TAPB)combined with total intravenous anesthesia(TIVA)in a pediatric BMD patient undergoing laparoscopic inguinal hernia repair.CASE SUMMARY A 2-year-old boy,weighing 15 kg,with BMD,was scheduled for laparoscopic inguinal hernia repair.TIVA was used for induction,and continuous infusions of short-acting intravenous anesthetics combined with TAPB were performed for anesthesia maintenance.Moreover,TAPB provided good postoperative analgesia.The patient underwent uneventful surgery and anesthesia,and over the 17 mo follow-up period showed no anesthesia-induced complications.CONCLUSION TAPB combined with TIVA,using short-acting intravenous anesthetic agents,can provide safe and effective anesthesia management in pediatric BMD patients undergoing short-term abdominal surgery.
文摘Objective:To observe the effects of different anesthesia depths on the level of plasma cortisol during operation and the score of postoperative MMSE in elderly patients underwent radical gastrectomy.Methods: A total of eighty seven elderly patients undergoing radical gastrectomy were enrolled in this study. Continuous infusion of propofol and remifentanil for anesthesia and maintenance of propofol were divided into two groups: BIS-I (BIS: 45-55) and BIS-II (BIS: 55-65) by adusting the doses of propofol. The data were recorded as following, thewhole dosage of propofol, the time of extubation and the score of VAS. The level of plasma cortisol was finished at the time of incision and tracheal intubation. MMSE scores were recorded on the day before operation and follow-up at 3 and 7 d postoperatively. Record the patient's operation to discharge time, postoperative complications.Results: The concentration of cortisol in BIS-I group was higher than that in BIS-II group. There was no significant difference in extubation time, extubation VAS score and MMSE score after operation.Conclusion:There were no significant differences in the BIS values between 45 and 65 for the elderly patients undergoing upper abdominal surgery, and there were no significant differences in the patients' postoperative stress, wake, extubation, early postoperative pain scores and postoperative cognitive function. BIS values in 45-55 compared to 55-65 patients with low plasma cortisol levels may be associated with better control of stress levels, to maintain the BIS value between 45-55 anesthesia depths is more reasonable.
文摘BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.
文摘Intraoperative awareness is the explicit recall of sensory perceptions during general anesthesia.I presume the epidemiology and characteristics of intraoperative awareness from these surveys in Japan.A questionnaire survey was conducted via the Internet.The first survey was conducted in 2008.Our survey showed 17% of anesthesiologists experienced definite or possible awareness.The second survey was conducted to evaluate the first survey in detail in 2008.A total of 172 anesthesiologists answered.The total number of reported anesthetic cases was 85156.Twenty-four cases of definite or possible awareness were reported by 21 anesthesiologists.The most surprising finding was total intravenous anesthesia(TIVA) was used in 21 of the 24 cases.The third survey was conducted in 2011 as a continuous survey.Six cases of definite or possible awareness were reported by six anesthesiologists(7%).Two cases were maintained by TIVA,and 2 cases were sevoflurane.The survey showed 76% anesthesiologists routinely use bispectral index(BIS) for TIVA,but for sevoflurane only 27% anesthesiologists routinely use BIS.The incidence of intraoperative awareness decreased in the third survey.The continuous survey revealed the current status of daily anesthesia and the results might be used to prevent the awareness during general anesthesia.
