Objective:To investigate the role of Hemocoagulase Injection used in the joint operation and the effect on the blood coagulable function.Methods:A total of 60 patients who undergoing joint operation in our hospital we...Objective:To investigate the role of Hemocoagulase Injection used in the joint operation and the effect on the blood coagulable function.Methods:A total of 60 patients who undergoing joint operation in our hospital were randomly divided into two groups.Experiment group(Group A,n=30)was injected with 2 U Hemocoagulase Injection in 5 min before anesthesia induction.The contrast group(Group B,n=30)was treated with 0.9%normal saline in 5 min before anesthesia induction.Then common anesthesia was given to the two groups of patients.The venous blood was withdrawn for blood routine examination,thrombelastography and coagulable function at the time of pre-inducement, end of operation,and in 6 and 12 h after operation.The change of thrombelastograph and coagulable state were monitored during the whole surgery.And the volume of transfusion and hemorrhage between two groups was contrasted. Results:After the use of Hemocoagulase Injection,the operative time was shortened obviously(P<0.05).The volumes hemorrhage and transfusion was obviously smaller in Group A than in Group B(P<0.01).Hemocoagulase Injection did not influence fibrinogen and thrombelastograph of Group A(P>0.05).Conclusion:Hemocoagulase Injection can reduce the volumes of hemorrhage and transfusion and not influence the coagulable function.It is worth using in the joint operation.展开更多
Objective:To study the influence of general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia method on stress reaction and hemodynamics for elderly orthopedics patients during operations.Met...Objective:To study the influence of general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia method on stress reaction and hemodynamics for elderly orthopedics patients during operations.Methods: A total of 90 cases of elder patients who received orthopedic operations were randomly divided to group A, B and C, with 30 cases per group. Three groups of patients were separately given by general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia for operations;The variations of adrenocorticotrophic hormone (ACTH), Cortisol (Cor),β-endorphin (β-EP), Angiotensin-Ⅱ(Ang-Ⅱ), heart rate (HR) and blood pressure (SBP, DBP) on patients in three groups before anesthesia (T0), during skin incision (T1), after skin incision (T2) and extubation after operation (T3) were compared and analyzed.Results:During T1, T2, ACTH, Cor,β-EP and Ang-Ⅱlevels in 3 groups of patients were significantly higher than those during T0;SBP and DBP were significantly lower than that during T0;HR during T2 was significantly lower than that during T0;During T3, every index in 3 groups were recovered to levels close to that during T0;During T1, T2, ACTH, Cor,β-EP, Ang-Ⅱlevels in group B and C were significantly lower than that in group A. And levels in C was lower than that in B;SBP and DBP in group B and C were significantly higher than A. No HR statistical significance appeared between each group.Conclusions: During clinical anesthesia, we should choose suitable anesthesia method combined with actual situations of patients. Combined spinal and epidural anesthesia had a slight influence on hemodynamics of elder orthopedics patients during operation, and it could effectively alleviate stress reaction during operation.展开更多
BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system ...BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.展开更多
The effect of acupuncture anesthesia(AA) performed with unified protocol andmethod was evaluated by the National Unified Scaling Criteria. Among the 536 cases studied,there are 488 cases Grade I, the rate of Grade I (...The effect of acupuncture anesthesia(AA) performed with unified protocol andmethod was evaluated by the National Unified Scaling Criteria. Among the 536 cases studied,there are 488 cases Grade I, the rate of Grade I (success rate) being 91.05%. Of the 357 casesof temporo-parieto-occipital operations, the success rate is 91.88%, with the success rates of bodyneedling and ear needling groups being 88.16% and 98.45% respectively. Of the 179 cases of po-sterior cranial fossa operations, the success rate is 89.38%, with the success rates of body needlingand ear needling groups being 85.58% and 95.59% respectively. Randomized controlled trials wereconducted among the simple 0.1% lidocaine group, AA plus 0.1% lidocaine group and AA plusnormal saline group, the results of which prove that acupuncture analgesia plays predominant rolein AA and adjuvants can remarkably enhance the AA effect. The neuroanatomical basis of thesuperiority of ear needling to body needling is discussed here, so is the mechanism of the poten-tiating effect of the adjuvants on AA. Besides the advantages of AA in neurosurgery and problemsremaining unsolved have been summarized.展开更多
Objective:To study the effects of general anesthesia on coagulation function, stress response and other correlation factors in patients undergoing abdominal operation.Methods: To select 94 cases of patients undergoing...Objective:To study the effects of general anesthesia on coagulation function, stress response and other correlation factors in patients undergoing abdominal operation.Methods: To select 94 cases of patients undergoing abdominal operation in our hospital from February 2016 to April 2018, divided into the control group and observation group, 47 cases in each group. On the basis of the same pre-processing, the patients in the control group were given epidural anesthesia, and the patients in the observation group received general anesthesia, to detect and compare the coagulation function, stress response and other correlation factors.Results:At T1, the levels of coagulation function (D-Dimer, APTT, PT, PLT), stress response (COR, ACTH, CRP, ET-1) and other correlation factors (IL-23, IL-32, M-CSF, PRL, PCT, NO, TNF-α) between the two groups had no statistical difference (P>0.05). At T2 and T3, the levels of coagulation function(D-Dimer), stress response (COR, ACTH, CRP, ET-1) and other correlation factors (IL-23, IL-32, M-CSF, PRL, PCT, NO, TNF-α) between the two groups had statistical difference (P<0.05).Conclusion:Application of general anesthesia in abdominal endoscopic operation, there was no significant change in coagulation function compared with epidural anesthesia, it could maintain stable coagulation function, but it had a better stabilizing effect on stress response index and other correlation factor such as IL-23, IL-32, M-CSF, PRL, PCT, NO and TNF-α, it was worthy of further clinical study.展开更多
Objective To evaluate the feasibility and safety of the self developed sound outside the ventilation device-esophageal nasopharynx catheter in brain functional areas surgery applications. Methods 13 patients involved ...Objective To evaluate the feasibility and safety of the self developed sound outside the ventilation device-esophageal nasopharynx catheter in brain functional areas surgery applications. Methods 13 patients involved functional areas of brain surgery were chosed. After induction of general anesthesia,the catheters were placed in the esophagus,then connected to anesthesia machines to an external展开更多
Background: Advances in modern medicine and surgical technique have allowed patients with multiple comorbidities to undergo invasive surgery electively. This places additional stress on hospital resources to anticipat...Background: Advances in modern medicine and surgical technique have allowed patients with multiple comorbidities to undergo invasive surgery electively. This places additional stress on hospital resources to anticipate and deal with potential complications. We have introduced a preoperative safety concept called “Anesthesia Alert”. The surgeon or preoperative interviewing anesthesiologist assigns an Anesthesia Alert when booking to denote possible difficulty with anesthesia induction or intubation. As a result, two anesthesiologists and fiber optic equipment are made available on the day of surgery. Methods: A retrospective study of patients from all surgical specialties who were assigned Anesthesia Alerts between January 2012 and November 2012. Records were analyzed for reasons requiring Anesthesia Alerts. Patient demographics, comorbidities, and perioperative complications were reviewed. Results: A total of 112 patients formed this study group. Difficult airway comprised the majority of Anesthesia Alerts (n = 75, 67.0%). Hypertension was the most prevalent comorbidity among patients. There were only 7 patients (6.3%) admitted to the ICU postoperatively and no mortalities. Conclusion: Perioperative patient safety is an evolving concept that requires a team approach amongst the surgeon, anesthesiologist, and operating room staff. An Anesthesia Alert raises awareness for possible complications during anesthesia induction as well as allocates resources to increase patient safety and avoid preoperative delays. Most importantly, this concept places the onus on the surgeon to alert the anesthesiologist for possible complications during induction and extubation.展开更多
Objective: To analyze the effect of nursing intervention in operating room for gastric cancer patients in anesthesia recovery period. Methods: From June 2021 to December 2021, 78 patients who underwent gastric cancer ...Objective: To analyze the effect of nursing intervention in operating room for gastric cancer patients in anesthesia recovery period. Methods: From June 2021 to December 2021, 78 patients who underwent gastric cancer surgery in our hospital were selected for research. Combined with the random number table method, they were divided into the control group (providing routine nursing care in operating room) and the observation group (providing nursing intervention in operating room) with 39 patients in each group respectively. The body temperature of the two groups during operation, during abdominal closure and after operation, the time of leaving anesthesia room, extubation, postoperative wakefulness and hospitalization, degree of satisfaction with nursing work was compared. Results: Compared with the control group, the body temperature in the observation group tended to be more normal during operation, during abdominal closure and after operation (P 0.05). The time of leaving anesthesia room, extubation, postoperative wakefulness and hospitalization in the observation group were shorter than those in the control group (P 0.05). The satisfaction degree of the observation group with nursing work was higher than that of the control group (P 0.05). Conclusion: Nursing intervention in operating room is effective for gastric cancer patients in anesthesia recovery period, which can maintain their perioperative temperature stability, promote their postoperative recovery and enhance their satisfaction with nursing work. It is worth adopting.展开更多
AIM:To investigate the effects of preoperative other diseases on the complications of senile cerical vertebral operation in perioperative period.METHODS:800 senile cervical vertebral cases were divided into two group...AIM:To investigate the effects of preoperative other diseases on the complications of senile cerical vertebral operation in perioperative period.METHODS:800 senile cervical vertebral cases were divided into two group:group A included the cases without other comorbidities,and group B included the cases with hypertension,diabetes mellitus,coronary heart disease (GHD) or chronic obstructive pulmonary disease(COPD).We retrospectively analyzed the changes of BP,oxygen saturation (SaO2) and the incidence of cardiac arrhythmia during operation of group A and B.RESULTS:In perioperative period,the incidence of B reduction or rising and cardiac arrhythmia in group B was more than that of group A.Incidence of SaO2 decreasing increases apparently in each stage and incidence of cerebrovascular,pulmonary complications and asphyxia led by incision bleeding increases apparently.CONCLUSION:The hypertension,CHD,diabetes mellitus and COPD were the main reasons of complications of the heart,the cerebral vessels and the lung,kidney and the incision bleeding in perioperative period of senile patients.展开更多
As non-operating room anesthesia (NORA) vastly increases, so does the complexity of both the patients and the procedures. Unfamiliar environment, remote locations, and limited access to resources are some of the many ...As non-operating room anesthesia (NORA) vastly increases, so does the complexity of both the patients and the procedures. Unfamiliar environment, remote locations, and limited access to resources are some of the many challenges faced by the anesthesiologist in this environment. Understanding the environmental factors such as the room layout, machine placement and patient positioning needs advanced planning in the COVID-19 patient to determine airway management, intravenous access and overall patient safety. Communication with the proceduralist and healthcare workers (HCW) is of essence as both the procedure and anesthetic requirements may need to be altered as the case progresses. Standard monitoring guidelines should apply to all patients regardless of depth of anesthesia. The COVID-19 patient adds to these challenges. Aerosol generating medical procedures (AGMP’s) need to be identified ahead of time in order to ensure the safety of both the staff and patients. This allows for planning and preparation required for transportation of the patient to the room. HCWs may need to be identified and be available to assist with the procedure. Time should be allocated for transportation, briefing, room preparation, personal protective equipment needs of the staff and donning and doffing procedures as per institutional protocol. Communication means with staff outside of the room should be discussed in advance should an emergent situation arise during the procedure. Debriefing should be performed at the end of every procedure to improve patient safety and outcomes.展开更多
Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit...Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit triangle and provides analgesia of the entire homolateral hemi abdomen. The aim of our study was to compare post-operative analgesia and post-operative morphine requirements between transverse abdominal plane block (TAP) and peri-orificial infiltration during laparoscopic abdominal surgery. Material and method: Prospective, randomized study conducted over a 2-year period. The study was conducted in the operating theatre of the Saint Louis Regional Hospital in Senegal. All adult patients undergoing laparoscopic abdominal surgery were included. Clinical aspects, pain scales and morphine consumption were analyzed. Results: A total of 60 patients were enrolled: 30 patients in the TAP group and 30 patients in the infiltration group. The average age was 32.9 years. The indications for laparoscopy were acute appendicitis in 50% of cases, gallbladder stones in 16% and inguinal hernia in 8%. For the TAP group, the mean numerical pain scale was 3.9 at 6 hours post-operatively and 2.1 at 24 hours post-operatively. For the infiltration group, the mean numerical pain scale was 4.3 at 6 hours post-op and 3 at 24 hours post-op. Morphine consumption at 6 hours post-op was on average 0.4 mg/patient for the TAP group and 0.9 mg/patient for the infiltration group. Discussion/conclusion: Analgesia provided by ultrasound-guided TAP block for laparoscopic abdominal surgery appears to be identical to periorificial infiltration. However, the simplicity and reproducibility of ultrasound-guided TAP block gives it a definite advantage.展开更多
文摘Objective:To investigate the role of Hemocoagulase Injection used in the joint operation and the effect on the blood coagulable function.Methods:A total of 60 patients who undergoing joint operation in our hospital were randomly divided into two groups.Experiment group(Group A,n=30)was injected with 2 U Hemocoagulase Injection in 5 min before anesthesia induction.The contrast group(Group B,n=30)was treated with 0.9%normal saline in 5 min before anesthesia induction.Then common anesthesia was given to the two groups of patients.The venous blood was withdrawn for blood routine examination,thrombelastography and coagulable function at the time of pre-inducement, end of operation,and in 6 and 12 h after operation.The change of thrombelastograph and coagulable state were monitored during the whole surgery.And the volume of transfusion and hemorrhage between two groups was contrasted. Results:After the use of Hemocoagulase Injection,the operative time was shortened obviously(P<0.05).The volumes hemorrhage and transfusion was obviously smaller in Group A than in Group B(P<0.01).Hemocoagulase Injection did not influence fibrinogen and thrombelastograph of Group A(P>0.05).Conclusion:Hemocoagulase Injection can reduce the volumes of hemorrhage and transfusion and not influence the coagulable function.It is worth using in the joint operation.
文摘Objective:To study the influence of general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia method on stress reaction and hemodynamics for elderly orthopedics patients during operations.Methods: A total of 90 cases of elder patients who received orthopedic operations were randomly divided to group A, B and C, with 30 cases per group. Three groups of patients were separately given by general anesthesia, epidural anesthesia and combined spinal and epidural anesthesia for operations;The variations of adrenocorticotrophic hormone (ACTH), Cortisol (Cor),β-endorphin (β-EP), Angiotensin-Ⅱ(Ang-Ⅱ), heart rate (HR) and blood pressure (SBP, DBP) on patients in three groups before anesthesia (T0), during skin incision (T1), after skin incision (T2) and extubation after operation (T3) were compared and analyzed.Results:During T1, T2, ACTH, Cor,β-EP and Ang-Ⅱlevels in 3 groups of patients were significantly higher than those during T0;SBP and DBP were significantly lower than that during T0;HR during T2 was significantly lower than that during T0;During T3, every index in 3 groups were recovered to levels close to that during T0;During T1, T2, ACTH, Cor,β-EP, Ang-Ⅱlevels in group B and C were significantly lower than that in group A. And levels in C was lower than that in B;SBP and DBP in group B and C were significantly higher than A. No HR statistical significance appeared between each group.Conclusions: During clinical anesthesia, we should choose suitable anesthesia method combined with actual situations of patients. Combined spinal and epidural anesthesia had a slight influence on hemodynamics of elder orthopedics patients during operation, and it could effectively alleviate stress reaction during operation.
文摘BACKGROUND Primary ciliary dyskinesia(PCD)is an inherited autosomal-recessive disorder of impaired mucociliary clearance characterized by chronic respiratory diseases,otolaryngological diseases,central nervous system abnormalities,reproductive system abnormalities,and cardiac function abnormalities.General anesthesia in these patients is associated with a higher incidence of respiratory complications than in patients without the disease.CASE SUMMARY A 16-year-old male patient was referred to the emergency room complaining of right ankle pain due to distal tibiofibular fracture.Three years prior,he had been diagnosed with PCD.At that time,he had experienced several episodes of pneumonia,sinusitis,and chronic middle ear infections,for which he underwent surgical interventions.At the current admission,he presented with cough and sputum but no other respiratory symptoms.A chest computed tomography scan revealed centrilobular ground-glass opacities in both lower lobes and a calcified nodule in the left lower lobe.For the surgical procedure and postoperative pain management,combined spinal-epidural anesthesia was employed.The patient’s postoperative pain score was measured by the numerical rating scale(NRS).On the day of surgery,his NRS was 5 points.By the second postoperative day,the NRS score had decreased to 2–3 points.The epidural catheter was removed on the fourth day following the operation.The patient was subsequently discharged no respiratory complications.CONCLUSION We performed combined spinal-epidural anesthesia in a patient with PCD.The patient experienced no additional respiratory complications and was discharged with a low NRS score for pain.
文摘The effect of acupuncture anesthesia(AA) performed with unified protocol andmethod was evaluated by the National Unified Scaling Criteria. Among the 536 cases studied,there are 488 cases Grade I, the rate of Grade I (success rate) being 91.05%. Of the 357 casesof temporo-parieto-occipital operations, the success rate is 91.88%, with the success rates of bodyneedling and ear needling groups being 88.16% and 98.45% respectively. Of the 179 cases of po-sterior cranial fossa operations, the success rate is 89.38%, with the success rates of body needlingand ear needling groups being 85.58% and 95.59% respectively. Randomized controlled trials wereconducted among the simple 0.1% lidocaine group, AA plus 0.1% lidocaine group and AA plusnormal saline group, the results of which prove that acupuncture analgesia plays predominant rolein AA and adjuvants can remarkably enhance the AA effect. The neuroanatomical basis of thesuperiority of ear needling to body needling is discussed here, so is the mechanism of the poten-tiating effect of the adjuvants on AA. Besides the advantages of AA in neurosurgery and problemsremaining unsolved have been summarized.
文摘Objective:To study the effects of general anesthesia on coagulation function, stress response and other correlation factors in patients undergoing abdominal operation.Methods: To select 94 cases of patients undergoing abdominal operation in our hospital from February 2016 to April 2018, divided into the control group and observation group, 47 cases in each group. On the basis of the same pre-processing, the patients in the control group were given epidural anesthesia, and the patients in the observation group received general anesthesia, to detect and compare the coagulation function, stress response and other correlation factors.Results:At T1, the levels of coagulation function (D-Dimer, APTT, PT, PLT), stress response (COR, ACTH, CRP, ET-1) and other correlation factors (IL-23, IL-32, M-CSF, PRL, PCT, NO, TNF-α) between the two groups had no statistical difference (P>0.05). At T2 and T3, the levels of coagulation function(D-Dimer), stress response (COR, ACTH, CRP, ET-1) and other correlation factors (IL-23, IL-32, M-CSF, PRL, PCT, NO, TNF-α) between the two groups had statistical difference (P<0.05).Conclusion:Application of general anesthesia in abdominal endoscopic operation, there was no significant change in coagulation function compared with epidural anesthesia, it could maintain stable coagulation function, but it had a better stabilizing effect on stress response index and other correlation factor such as IL-23, IL-32, M-CSF, PRL, PCT, NO and TNF-α, it was worthy of further clinical study.
文摘Objective To evaluate the feasibility and safety of the self developed sound outside the ventilation device-esophageal nasopharynx catheter in brain functional areas surgery applications. Methods 13 patients involved functional areas of brain surgery were chosed. After induction of general anesthesia,the catheters were placed in the esophagus,then connected to anesthesia machines to an external
文摘Background: Advances in modern medicine and surgical technique have allowed patients with multiple comorbidities to undergo invasive surgery electively. This places additional stress on hospital resources to anticipate and deal with potential complications. We have introduced a preoperative safety concept called “Anesthesia Alert”. The surgeon or preoperative interviewing anesthesiologist assigns an Anesthesia Alert when booking to denote possible difficulty with anesthesia induction or intubation. As a result, two anesthesiologists and fiber optic equipment are made available on the day of surgery. Methods: A retrospective study of patients from all surgical specialties who were assigned Anesthesia Alerts between January 2012 and November 2012. Records were analyzed for reasons requiring Anesthesia Alerts. Patient demographics, comorbidities, and perioperative complications were reviewed. Results: A total of 112 patients formed this study group. Difficult airway comprised the majority of Anesthesia Alerts (n = 75, 67.0%). Hypertension was the most prevalent comorbidity among patients. There were only 7 patients (6.3%) admitted to the ICU postoperatively and no mortalities. Conclusion: Perioperative patient safety is an evolving concept that requires a team approach amongst the surgeon, anesthesiologist, and operating room staff. An Anesthesia Alert raises awareness for possible complications during anesthesia induction as well as allocates resources to increase patient safety and avoid preoperative delays. Most importantly, this concept places the onus on the surgeon to alert the anesthesiologist for possible complications during induction and extubation.
文摘Objective: To analyze the effect of nursing intervention in operating room for gastric cancer patients in anesthesia recovery period. Methods: From June 2021 to December 2021, 78 patients who underwent gastric cancer surgery in our hospital were selected for research. Combined with the random number table method, they were divided into the control group (providing routine nursing care in operating room) and the observation group (providing nursing intervention in operating room) with 39 patients in each group respectively. The body temperature of the two groups during operation, during abdominal closure and after operation, the time of leaving anesthesia room, extubation, postoperative wakefulness and hospitalization, degree of satisfaction with nursing work was compared. Results: Compared with the control group, the body temperature in the observation group tended to be more normal during operation, during abdominal closure and after operation (P 0.05). The time of leaving anesthesia room, extubation, postoperative wakefulness and hospitalization in the observation group were shorter than those in the control group (P 0.05). The satisfaction degree of the observation group with nursing work was higher than that of the control group (P 0.05). Conclusion: Nursing intervention in operating room is effective for gastric cancer patients in anesthesia recovery period, which can maintain their perioperative temperature stability, promote their postoperative recovery and enhance their satisfaction with nursing work. It is worth adopting.
文摘AIM:To investigate the effects of preoperative other diseases on the complications of senile cerical vertebral operation in perioperative period.METHODS:800 senile cervical vertebral cases were divided into two group:group A included the cases without other comorbidities,and group B included the cases with hypertension,diabetes mellitus,coronary heart disease (GHD) or chronic obstructive pulmonary disease(COPD).We retrospectively analyzed the changes of BP,oxygen saturation (SaO2) and the incidence of cardiac arrhythmia during operation of group A and B.RESULTS:In perioperative period,the incidence of B reduction or rising and cardiac arrhythmia in group B was more than that of group A.Incidence of SaO2 decreasing increases apparently in each stage and incidence of cerebrovascular,pulmonary complications and asphyxia led by incision bleeding increases apparently.CONCLUSION:The hypertension,CHD,diabetes mellitus and COPD were the main reasons of complications of the heart,the cerebral vessels and the lung,kidney and the incision bleeding in perioperative period of senile patients.
文摘As non-operating room anesthesia (NORA) vastly increases, so does the complexity of both the patients and the procedures. Unfamiliar environment, remote locations, and limited access to resources are some of the many challenges faced by the anesthesiologist in this environment. Understanding the environmental factors such as the room layout, machine placement and patient positioning needs advanced planning in the COVID-19 patient to determine airway management, intravenous access and overall patient safety. Communication with the proceduralist and healthcare workers (HCW) is of essence as both the procedure and anesthetic requirements may need to be altered as the case progresses. Standard monitoring guidelines should apply to all patients regardless of depth of anesthesia. The COVID-19 patient adds to these challenges. Aerosol generating medical procedures (AGMP’s) need to be identified ahead of time in order to ensure the safety of both the staff and patients. This allows for planning and preparation required for transportation of the patient to the room. HCWs may need to be identified and be available to assist with the procedure. Time should be allocated for transportation, briefing, room preparation, personal protective equipment needs of the staff and donning and doffing procedures as per institutional protocol. Communication means with staff outside of the room should be discussed in advance should an emergent situation arise during the procedure. Debriefing should be performed at the end of every procedure to improve patient safety and outcomes.
文摘Introduction/Purpose: The “transverse abdominal plane block” or TAP block was described by Rafi in 2001. It describes an approach to the neurofascial plane of the transverse abdominal muscle via the Jean-Louis Petit triangle and provides analgesia of the entire homolateral hemi abdomen. The aim of our study was to compare post-operative analgesia and post-operative morphine requirements between transverse abdominal plane block (TAP) and peri-orificial infiltration during laparoscopic abdominal surgery. Material and method: Prospective, randomized study conducted over a 2-year period. The study was conducted in the operating theatre of the Saint Louis Regional Hospital in Senegal. All adult patients undergoing laparoscopic abdominal surgery were included. Clinical aspects, pain scales and morphine consumption were analyzed. Results: A total of 60 patients were enrolled: 30 patients in the TAP group and 30 patients in the infiltration group. The average age was 32.9 years. The indications for laparoscopy were acute appendicitis in 50% of cases, gallbladder stones in 16% and inguinal hernia in 8%. For the TAP group, the mean numerical pain scale was 3.9 at 6 hours post-operatively and 2.1 at 24 hours post-operatively. For the infiltration group, the mean numerical pain scale was 4.3 at 6 hours post-op and 3 at 24 hours post-op. Morphine consumption at 6 hours post-op was on average 0.4 mg/patient for the TAP group and 0.9 mg/patient for the infiltration group. Discussion/conclusion: Analgesia provided by ultrasound-guided TAP block for laparoscopic abdominal surgery appears to be identical to periorificial infiltration. However, the simplicity and reproducibility of ultrasound-guided TAP block gives it a definite advantage.