Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controll...Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.展开更多
Historically,patients undergoing liver transplantation were left intubated and extubated in the intensive care unit(ICU)after a period of recovery.Proponents of this practice argued that these patients were critically...Historically,patients undergoing liver transplantation were left intubated and extubated in the intensive care unit(ICU)after a period of recovery.Proponents of this practice argued that these patients were critically ill andneed time to be properly optimized from a physiological and pain standpoint prior to extubation.Recently,there has been a growing movement toward early extubation in transplant centers worldwide.Initially fueled by research into early extubation following cardiac surgery,extubation in the operating room or soon after arrival to the ICU,has been shown to be safe with proper patient selection.Additionally,as experience at determining appropriate candidates has improved,some institutions have developed systems to allow select patients to bypass the ICU entirely and be admitted to the surgical ward after transplant.We discuss the history of early extubation and the arguments in favor and against fast track anesthesia.We also described our practice of fast track anesthesia at Mayo Clinic Florida,in which,we extubate approximately 60%of our patients in the operating room and send them to the surgical ward after a period of time in the post anesthesia recovery unit.展开更多
Background:The purpose of this study is to summarize the application of day surgery combined with fast track program in strabismus operation under general anesthesia.Methods:The clinical data of 2,000 cases of strabis...Background:The purpose of this study is to summarize the application of day surgery combined with fast track program in strabismus operation under general anesthesia.Methods:The clinical data of 2,000 cases of strabismus patients who had underwent surgery in day surgery or traditional hospitalization in the duration from 2015 to 2016 was retrospectively analyzed.The safety and efficacy were assessed by comparing the average length of stay in hospitals,anesthesia recovery time,patient satisfaction and number of adverse events.Results:Compared with the traditional group,the average length of stay in hospital and recovery time in day surgery group were significantly lower(P<0.001)and the satisfaction of patient was improved(P<0.05),which were statistically significant difference.Moreover,no adverse events occurred among these patients.Conclusions:The application of day surgery in strabismus operation under general anesthesia is feasible,which can reduce the recovery time and shorten the hospital stay of patients safely and effectively,and their satisfaction was improved at the same time.展开更多
Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate ...Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate if there were improvements in the performance of anesthesia novice trainees when executing the epidural technique after an EMME of epidural block procedure. Methods: We developed an eye movement modeling example (EMME) from eye tracking recordings made by experienced anesthesiologists with more than 20 years of experience. Forty-two PGY3 anesthesia trainees who had never previously performed an epidural block were randomized to receive (study group) or not receive (control group) the EMME video before their institutional training. All the trainees were evaluated every 10 epidural blocks until the end of the rotation period, by an independent, blinded observer using the Global Rating Scale for Epidural Anesthesia (GRS). Results: Trainees who received the EMME training exhibited more respect for the patient’s tissues (P Discussion: This is the first study that has used the EMME for a practical, clinical teaching purpose on real patients and that has used it as an aid in teaching epidural anesthesia. We demonstrated that inexperienced trainees who received the EMME training improved their proficiency at epidural blocks as compared to those who had no EMME training beforehand. Given this result, we welcome further studies to investigate the impact and the role of EMME on clinical teaching in the field of anesthesia.展开更多
目的探讨术前给予帕瑞昔布钠对瑞芬太尼快通道麻醉行腹腔镜胆囊切除术后苏醒期的影响。方法择期行腹腔镜胆囊切除术患者64例,随机均分为两组,术前20min分别静注帕瑞昔布钠40mg(P组)或等量生理盐水2ml(C组)。术中持续泵注丙泊酚和瑞芬太...目的探讨术前给予帕瑞昔布钠对瑞芬太尼快通道麻醉行腹腔镜胆囊切除术后苏醒期的影响。方法择期行腹腔镜胆囊切除术患者64例,随机均分为两组,术前20min分别静注帕瑞昔布钠40mg(P组)或等量生理盐水2ml(C组)。术中持续泵注丙泊酚和瑞芬太尼维持麻醉。记录自主呼吸恢复时间、睫毛反射时间、睁眼时间、拔管时间;记录拔管后患者疼痛VAS评分、Ramsay镇静评分和躁动情况。结果两组患者的自主呼吸恢复时间、睫毛反射时间、睁眼时间、拔管时间差异无统计学意义。与C组比较,拔管后10、30、60 min P组疼痛VAS评分、躁动评分明显降低,Ramsay镇静评分明显升高(P<0.05)。结论帕瑞昔布钠能较好地减轻快通道麻醉清醒期的躁动和疼痛,明显改善患者的血流动力学和应激反应,不良反应少,提高患者苏醒期的安全性。展开更多
目的比较两种快通道麻醉方法在肾移植手术的应用效果。方法 36例符合美国麻醉师协会（American Society of Anesthesiologists,ASA）分级Ⅲ~Ⅳ级的终末期肾病拟行肾移植术患者,采用随机数字法将患者随机分为Ⅰ组和Ⅱ组各18例。两组麻醉...目的比较两种快通道麻醉方法在肾移植手术的应用效果。方法 36例符合美国麻醉师协会（American Society of Anesthesiologists,ASA）分级Ⅲ~Ⅳ级的终末期肾病拟行肾移植术患者,采用随机数字法将患者随机分为Ⅰ组和Ⅱ组各18例。两组麻醉诱导用药相同。Ⅰ组吸入0.8%-1.8%七氟醚,使用小剂量顺式阿曲库胺[0.05-0.10 mg/（kg.h）]持续输注和常规剂量瑞芬太尼[0.1-1.0μg/（kg.min）]维持麻醉,预计手术结束前30 min停用顺式阿曲库胺,结束前15 min停止使用七氟醚,并将瑞芬太尼减低至维持量的1/10-1/5用至拔除气管导管。Ⅱ组使用丙泊酚[5-12 mg/（kg.h）]全凭静脉麻醉,以常规剂量顺式阿曲库胺[0.1-0.2 mg/（kg.h）]及瑞芬太尼[0.1-1.0μg/（kg.min）]维持麻醉,预计手术结束前30 min停用顺式阿曲库胺,手术结束后观察两组患者的睫毛反射时间、睁眼时间、拔管时间、术中知晓例数以及苏醒期躁动评分。结果Ⅰ组与Ⅱ组的睫毛反射时间、睁眼时间、拔管时间比较差异无统计学意义（均为P〉0.05）。两组患者均未出现术中知晓。Ⅰ组的躁动发生率明显低于Ⅱ组（P〈0.05）。Ⅰ组的顺式阿曲库胺、瑞芬太尼用量均明显少于Ⅱ组（均为P〈0.05）。结论七氟醚＋瑞芬太尼＋顺式阿曲库铵或丙泊酚＋瑞芬太尼＋顺式阿曲库铵这两种快通道麻醉方法用于肾移植手术均具有可控性良好、安全性高、患者苏醒迅速等特点,而七氟烷＋瑞芬太尼＋顺式阿曲库铵的组合更节省药物用量,且苏醒质量更高。展开更多
基金supported by the National Natural Science Foundation of China,No.81671891
文摘Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.
文摘Historically,patients undergoing liver transplantation were left intubated and extubated in the intensive care unit(ICU)after a period of recovery.Proponents of this practice argued that these patients were critically ill andneed time to be properly optimized from a physiological and pain standpoint prior to extubation.Recently,there has been a growing movement toward early extubation in transplant centers worldwide.Initially fueled by research into early extubation following cardiac surgery,extubation in the operating room or soon after arrival to the ICU,has been shown to be safe with proper patient selection.Additionally,as experience at determining appropriate candidates has improved,some institutions have developed systems to allow select patients to bypass the ICU entirely and be admitted to the surgical ward after transplant.We discuss the history of early extubation and the arguments in favor and against fast track anesthesia.We also described our practice of fast track anesthesia at Mayo Clinic Florida,in which,we extubate approximately 60%of our patients in the operating room and send them to the surgical ward after a period of time in the post anesthesia recovery unit.
文摘超快通道麻醉(ultra-fast-track anesthesia,UFTA)指在手术后立即恢复患者的自主呼吸并拔除气管导管,已成为心脏外科手术的一个重要议题。这种方法旨在通过缩短机械通气时间,降低术后并发症的风险,加快康复进程,从而优化医疗资源的使用并改善患者的预后。本综述围绕加强康复外科(enhanced recovery after surgery,ERAS)的理念,探讨UFTA在心脏手术中的应用,分析其优点、潜在风险与局限性,并探索现有研究进展和未来的发展方向,以便为临床实践和未来研究提供指导和启示。
基金This study was approved by The Medical Committee of Zhongshan Ophthalmic Center,Sun Yat-sen University(approval number 2018KYPJ127)written informed consent was obtained from all patients.
文摘Background:The purpose of this study is to summarize the application of day surgery combined with fast track program in strabismus operation under general anesthesia.Methods:The clinical data of 2,000 cases of strabismus patients who had underwent surgery in day surgery or traditional hospitalization in the duration from 2015 to 2016 was retrospectively analyzed.The safety and efficacy were assessed by comparing the average length of stay in hospitals,anesthesia recovery time,patient satisfaction and number of adverse events.Results:Compared with the traditional group,the average length of stay in hospital and recovery time in day surgery group were significantly lower(P<0.001)and the satisfaction of patient was improved(P<0.05),which were statistically significant difference.Moreover,no adverse events occurred among these patients.Conclusions:The application of day surgery in strabismus operation under general anesthesia is feasible,which can reduce the recovery time and shorten the hospital stay of patients safely and effectively,and their satisfaction was improved at the same time.
文摘Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate if there were improvements in the performance of anesthesia novice trainees when executing the epidural technique after an EMME of epidural block procedure. Methods: We developed an eye movement modeling example (EMME) from eye tracking recordings made by experienced anesthesiologists with more than 20 years of experience. Forty-two PGY3 anesthesia trainees who had never previously performed an epidural block were randomized to receive (study group) or not receive (control group) the EMME video before their institutional training. All the trainees were evaluated every 10 epidural blocks until the end of the rotation period, by an independent, blinded observer using the Global Rating Scale for Epidural Anesthesia (GRS). Results: Trainees who received the EMME training exhibited more respect for the patient’s tissues (P Discussion: This is the first study that has used the EMME for a practical, clinical teaching purpose on real patients and that has used it as an aid in teaching epidural anesthesia. We demonstrated that inexperienced trainees who received the EMME training improved their proficiency at epidural blocks as compared to those who had no EMME training beforehand. Given this result, we welcome further studies to investigate the impact and the role of EMME on clinical teaching in the field of anesthesia.
文摘目的探讨术前给予帕瑞昔布钠对瑞芬太尼快通道麻醉行腹腔镜胆囊切除术后苏醒期的影响。方法择期行腹腔镜胆囊切除术患者64例,随机均分为两组,术前20min分别静注帕瑞昔布钠40mg(P组)或等量生理盐水2ml(C组)。术中持续泵注丙泊酚和瑞芬太尼维持麻醉。记录自主呼吸恢复时间、睫毛反射时间、睁眼时间、拔管时间;记录拔管后患者疼痛VAS评分、Ramsay镇静评分和躁动情况。结果两组患者的自主呼吸恢复时间、睫毛反射时间、睁眼时间、拔管时间差异无统计学意义。与C组比较,拔管后10、30、60 min P组疼痛VAS评分、躁动评分明显降低,Ramsay镇静评分明显升高(P<0.05)。结论帕瑞昔布钠能较好地减轻快通道麻醉清醒期的躁动和疼痛,明显改善患者的血流动力学和应激反应,不良反应少,提高患者苏醒期的安全性。
