Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation ...Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.展开更多
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
The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output （CO） and incidence of hypotension in elderly patients under spinal anesthesia （SA）. A randomized, double...The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output （CO） and incidence of hypotension in elderly patients under spinal anesthesia （SA）. A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement （THR）, who were randomized to three groups： the control group （C group, n = 15）, crystalloid （RS group, n =16） and colloid group （HES group, n = 16）. An intravenous preload of 8 mL/kg of either lactated Ringer’s solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline （P 0.01）. Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respec-tively （P = 0.362）. Intravascular volume preload with colloid is more effective than crystalloid solution in main-taining CO, which may be improved the hemodynamic stability in elderly patients during SA.展开更多
BACKGROUND Sedation with propofol injections is associated with a risk of addiction,but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme...BACKGROUND Sedation with propofol injections is associated with a risk of addiction,but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism.Compared to remimazolam,remimazolam benzenesulfonate has a faster effect,is more quickly metabolized,produces inactive metabolites and has weak drug interactions.Thus,remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation.AIM To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.METHODS A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study.Using a random number table,patients were divided into two anesthesia induction groups of 40 patients each:remimazolam(0.3 mg/kg remimazolam benzenesulfonate)and propofol(1.5 mg/kg propofol).Hemodynamic parameters,inflammatory stress response indices,respiratory function indices,perioperative indices and adverse reactions in the two groups were monitored over time for comparison.RESULTS At pre-anesthesia induction,the remimazolam and propofol groups did not differ regarding heart rate,mean arterial pressure,cardiac index or volume per wave index.After endotracheal intubation and when the sternum was cut off,mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group(P<0.05).After endotracheal intubation,the oxygenation index and the respiratory index did not differ between the groups.After endotracheal intubation and when the sternum was cut off,the oxygenation index values were significantly higher in the remimazolam group than in the propofol group(P<0.05).Serum interleukin-6 and tumor necrosis factor-αlevels 12 h after surgery were significantly higher than before surgery in both groups(P<0.05).The observation indices were re-examined 2 h after surgery,and the epinephrine,cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group(P<0.05).The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group(P<0.05);there were significantly fewer adverse reactions in the remimazolam group(10.00%)than in the propofol group(30.00%;P<0.05).CONCLUSION Compared with propofol,remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations.Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function,thereby reducing anesthesia-related adverse reactions.展开更多
BACKGROUND Hypotension after the induction of anesthesia is known to be associated with various adverse events.The involvement of a series of factors makes the prediction of hypotension during anesthesia quite challen...BACKGROUND Hypotension after the induction of anesthesia is known to be associated with various adverse events.The involvement of a series of factors makes the prediction of hypotension during anesthesia quite challenging.AIM To explore the ability and effectiveness of a random forest(RF)model in the prediction of post-induction hypotension(PIH)in patients undergoing cardiac surgery.METHODS Patient information was obtained from the electronic health records of the Second Affiliated Hospital of Hainan Medical University.The study included patients,≥18 years of age,who underwent cardiac surgery from December 2007 to January 2018.An RF algorithm,which is a supervised machine learning technique,was employed to predict PIH.Model performance was assessed by the area under the curve(AUC)of the receiver operating characteristic.Mean decrease in the Gini index was used to rank various features based on their importance.RESULTS Of the 3030 patients included in the study,1578(52.1%)experienced hypotension after the induction of anesthesia.The RF model performed effectively,with an AUC of 0.843(0.808-0.877)and identified mean blood pressure as the most important predictor of PIH after anesthesia.Age and body mass index also had a significant impact.CONCLUSION The generated RF model had high discrimination ability for the identification of individuals at high risk for a hypotensive event during cardiac surgery.The study results highlighted that machine learning tools confer unique advantages for the prediction of adverse post-anesthesia events.展开更多
Objective of this investigation is to further analyze the cardiac function status change by phonocar-diogram during mixed anesthesia which is conducted by midazolam,skelaxin,fentanyi and propofol.The results show that...Objective of this investigation is to further analyze the cardiac function status change by phonocar-diogram during mixed anesthesia which is conducted by midazolam,skelaxin,fentanyi and propofol.The results show that blood pressure,heart rate,amplitude of R wave and T wave,amplitude of first heart sound（S1）and second heart sound（S2）about 37 subjects after anesthesia decrease compared with baseline,while the ratio of first heart sound and second heart sound（S1/S2）and the ratio of diastole duration and systole duration（D/S）increase.Our study demonstrates that phonocardiogram as a noninvasive,high benefit/cost ratio,objective,repeatable and portable method can be used for the monitoring and evaluation of cardiac function status during anesthesia and operations.展开更多
Objective To explore the mechanism of effects o f cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF)and left cardiac cavity size of patie nts with dilated cardiomyopathy.Method121consecutive pa...Objective To explore the mechanism of effects o f cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF)and left cardiac cavity size of patie nts with dilated cardiomyopathy.Method121consecutive patients with dilat ed cardiomyopathy were divided into cardiac sympathetic nerve blockade group(TEAgroup)and control group(c group).In TEAgroup,5%lidocaine was injected into thoracic epidural cavity for about 4to 8weeks in addition with routine therapy.In c group,only routine therapy was use d.We observe the changes of LVEF and left cardiac cavity size before a nd after treatment in both groups.Result I n TEAgroup,after anesthesia,LVEF w as increased from(31.3±12.8)to(47.3±21.3),P <0.001;left ventricular end -dia stolic diameter was reduced from(69.1±7.1)to(65.1±8.0),P <0.001;left atrial diameter was decreased from(44.0±6.2)to(39.4±7.2),P <0.001.Conclusion Cardiac sympathetic anesthesia can effectively improve the ejectio n performance of dilated cardiomyopathy and make the dilated cardiac cavity turn to normal level.展开更多
文摘Background:There is no gold standard sedation method for pediatric cardiac catheterization.In congenital heart diseases with intracardiac shunts,hemodynamic parameters are prone to change depending on the ventilation conditions and anesthetics,although few studies have examined these effects.The purpose of this study was to investigate the effects of two different sedation methods on the hemodynamic parameters.Methods:This study retrospectively evaluated consecutive patients with ventricular septal defect(VSD)below 1 year of age who underwent cardiac catheterization at Aichi Children’s Health and Medical Center,who were divided into age-and VSD diameter-matched general anesthesia(GA)and monitored anesthesia care(MAC)under the natural airway groups(n=40 each),for comparison of hemodynamic parameters.Results:In the GA group,arterial blood pH and arterial partial pressure of oxygen were significantly higher(p<0.01),whereas arterial partial pressure of carbon dioxide was significantly lower than in the MAC group(p<0.01).Mean pulmonary artery pressure(p<0.05)and systemic blood pressure(p<0.01)were lower in the GA group.Pulmonary vascular resistance index(p<0.01)and systemic vascular resistance index(p<0.01)were also significantly lower in the GA group than the MAC group.There were no significant differences in pulmonary blood flow index,systemic blood flow index,and pulmonary/systemic blood flow ratio between the two groups.Conclusions:Cardiac catheterization under GA in VSD patients results in different hemodynamic parameters compared to that under MAC.In particular,when using pulmonary artery pressure and pulmonary vascular resistance measured under GA for judgment regarding the surgical indications or perioperative management,consideration should be given to the fact that these parameters might be lower compared to those measured under MAC.
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The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output （CO） and incidence of hypotension in elderly patients under spinal anesthesia （SA）. A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement （THR）, who were randomized to three groups： the control group （C group, n = 15）, crystalloid （RS group, n =16） and colloid group （HES group, n = 16）. An intravenous preload of 8 mL/kg of either lactated Ringer’s solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline （P 0.01）. Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respec-tively （P = 0.362）. Intravascular volume preload with colloid is more effective than crystalloid solution in main-taining CO, which may be improved the hemodynamic stability in elderly patients during SA.
基金The First Affiliated Hospital of Nanchang University Ethics Committee.
文摘BACKGROUND Sedation with propofol injections is associated with a risk of addiction,but remimazolam benzenesulfonate is a comparable anesthetic with a short elimination half-life and independence from cell P450 enzyme metabolism.Compared to remimazolam,remimazolam benzenesulfonate has a faster effect,is more quickly metabolized,produces inactive metabolites and has weak drug interactions.Thus,remimazolam benzenesulfonate has good effectiveness and safety for diagnostic and operational sedation.AIM To investigate the clinical value of remimazolam benzenesulfonate in cardiac surgery patients under general anesthesia.METHODS A total of 80 patients who underwent surgery in the Department of Cardiothoracic Surgery from August 2020 to April 2021 were included in the study.Using a random number table,patients were divided into two anesthesia induction groups of 40 patients each:remimazolam(0.3 mg/kg remimazolam benzenesulfonate)and propofol(1.5 mg/kg propofol).Hemodynamic parameters,inflammatory stress response indices,respiratory function indices,perioperative indices and adverse reactions in the two groups were monitored over time for comparison.RESULTS At pre-anesthesia induction,the remimazolam and propofol groups did not differ regarding heart rate,mean arterial pressure,cardiac index or volume per wave index.After endotracheal intubation and when the sternum was cut off,mean arterial pressure and volume per wave index were significantly higher in the remimazolam group than in the propofol group(P<0.05).After endotracheal intubation,the oxygenation index and the respiratory index did not differ between the groups.After endotracheal intubation and when the sternum was cut off,the oxygenation index values were significantly higher in the remimazolam group than in the propofol group(P<0.05).Serum interleukin-6 and tumor necrosis factor-αlevels 12 h after surgery were significantly higher than before surgery in both groups(P<0.05).The observation indices were re-examined 2 h after surgery,and the epinephrine,cortisol and blood glucose levels were significantly higher in the remimazolam group than in the propofol group(P<0.05).The recovery and extubation times were significantly lower in the remimazolam group than in the propofol group(P<0.05);there were significantly fewer adverse reactions in the remimazolam group(10.00%)than in the propofol group(30.00%;P<0.05).CONCLUSION Compared with propofol,remimazolam benzenesulfonate benefited cardiac surgery patients under general anesthesia by reducing hemodynamic fluctuations.Remimazolam benzenesulfonate influenced the surgical stress response and respiratory function,thereby reducing anesthesia-related adverse reactions.
文摘BACKGROUND Hypotension after the induction of anesthesia is known to be associated with various adverse events.The involvement of a series of factors makes the prediction of hypotension during anesthesia quite challenging.AIM To explore the ability and effectiveness of a random forest(RF)model in the prediction of post-induction hypotension(PIH)in patients undergoing cardiac surgery.METHODS Patient information was obtained from the electronic health records of the Second Affiliated Hospital of Hainan Medical University.The study included patients,≥18 years of age,who underwent cardiac surgery from December 2007 to January 2018.An RF algorithm,which is a supervised machine learning technique,was employed to predict PIH.Model performance was assessed by the area under the curve(AUC)of the receiver operating characteristic.Mean decrease in the Gini index was used to rank various features based on their importance.RESULTS Of the 3030 patients included in the study,1578(52.1%)experienced hypotension after the induction of anesthesia.The RF model performed effectively,with an AUC of 0.843(0.808-0.877)and identified mean blood pressure as the most important predictor of PIH after anesthesia.Age and body mass index also had a significant impact.CONCLUSION The generated RF model had high discrimination ability for the identification of individuals at high risk for a hypotensive event during cardiac surgery.The study results highlighted that machine learning tools confer unique advantages for the prediction of adverse post-anesthesia events.
基金supported by the National Nature Science Foundation of China under Grant No. 30400105973 Project under Grant No. 2003CB716106Outstanding Youth Fund of China under Grant No. 30525030
文摘Objective of this investigation is to further analyze the cardiac function status change by phonocar-diogram during mixed anesthesia which is conducted by midazolam,skelaxin,fentanyi and propofol.The results show that blood pressure,heart rate,amplitude of R wave and T wave,amplitude of first heart sound（S1）and second heart sound（S2）about 37 subjects after anesthesia decrease compared with baseline,while the ratio of first heart sound and second heart sound（S1/S2）and the ratio of diastole duration and systole duration（D/S）increase.Our study demonstrates that phonocardiogram as a noninvasive,high benefit/cost ratio,objective,repeatable and portable method can be used for the monitoring and evaluation of cardiac function status during anesthesia and operations.
文摘Objective To explore the mechanism of effects o f cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF)and left cardiac cavity size of patie nts with dilated cardiomyopathy.Method121consecutive patients with dilat ed cardiomyopathy were divided into cardiac sympathetic nerve blockade group(TEAgroup)and control group(c group).In TEAgroup,5%lidocaine was injected into thoracic epidural cavity for about 4to 8weeks in addition with routine therapy.In c group,only routine therapy was use d.We observe the changes of LVEF and left cardiac cavity size before a nd after treatment in both groups.Result I n TEAgroup,after anesthesia,LVEF w as increased from(31.3±12.8)to(47.3±21.3),P <0.001;left ventricular end -dia stolic diameter was reduced from(69.1±7.1)to(65.1±8.0),P <0.001;left atrial diameter was decreased from(44.0±6.2)to(39.4±7.2),P <0.001.Conclusion Cardiac sympathetic anesthesia can effectively improve the ejectio n performance of dilated cardiomyopathy and make the dilated cardiac cavity turn to normal level.
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。
