Hemodynamic monitoring and management of patients undergoing high-risk surgery:a survey among Chinese anesthesiologists

Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery.However,hemodynamic management practices among Chinese anesthesiologists are largely unknown.This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China.From September 2010 to November 2011,we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces.All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists.Once completed,the 29-item questionnaires were collected and analyzed.Two hundred and 10 questionnaires from 265 hospitals in China were collected.We found that 91.4%of anesthesiologists monitored invasive arterial pressure,82.9%monitored central venous pressure（CVP）,13.3%monitored cardiac output（CO）,10.5%monitored mixed venous saturation,and less than 2%monitored pulse pressure variation（PPV） or systolic pressure variation（SPV） during high-risk surgery.The majority（88%） of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80%relied on blood pressure,CVP and urine output.Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV,SPV and CO during fluid management in high-risk surgical patients.The lack of CO monitoring may be attributed largely to the limited access to technologies,the cost of the devices and the lack of education on how to use them.There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China.

Preventing Lower Extremity Deep Vein Thrombosis After Hip Fracture Surgery in Elderly Patients by Acupoint Application Combined with Pneumatic Compression Therapy

Objective:To investigate and analyze the long-term clinical effects of acupoint application combined with pneumatic compression therapy in the prevention of deep venous thrombosis after hip fracture surgery among the elderly.Methods:Sixty elderly patients who had undergone hip fracture surgery from February 2021 to February 2022 were selected as the research subjects.The patients were divided into two groups via drawing lots.Both the groups received nursing care,but the patients in the observation group were treated with TCM acupoint application combined with pneumatic compression therapy,whereas the control group received pneumatic compression therapy.The evaluation indicators included the patients’quality of life and complications.Results:The incidence of lower extremity deep vein thrombosis in the observation group was more than twice(0.3%),whereas the incidence of lower extremity complications in the control group was more than 6 times(20%).There was a significant difference between the two groups(p<0.05).Conclusion:Traditional Chinese medicine acupoint application combined with pneumatic compression therapy is beneficial for the prevention of postoperative lower extremity deep vein thrombosis among elderly patients.In addition,the patients’overall quality-of-life scores in both physiological and psychological aspects improved significantly,which carries significant clinical reference value.

Outcomes of cardiac surgery in senior aged patients with ventricular dysfunction:analysis of a large national database

OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western surgical populations involving specific surgery types,our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in senior-aged heart failure patients with reduced EF across a broad range cardiac surgeries.METHODS Data were obtained from the China Heart Failure Surgery Registry(China-HFSR)database,a nationwide multicenter registry study in China's Mainland.Multiple variable regression analysis was performed in patients over 75 years old to identify risk factors associated with mortality.RESULTS From 2012 to 2017,578 senior-aged(>75 years)patients were enrolled in China HFSR,21.1%of whom were female.Isolated coronary bypass grafting(CABG)were performed in 71.6%of patients,10.1%of patients underwent isolated valve surgery and 8.7%received CABG combined with valve surgery.In-hospital mortality was 10.6%,and the major complication rate was 17.3%.Multivariate analysis identified diabetes mellitus(odds ratio(OR)=1.985),increased creatinine(OR=1.007),New York Heart Association(NYHA)Class III(OR=1.408),NYHA class IV(OR=1.955),cardiogenic shock(OR,6.271),and preoperative intra-aortic balloon pump insertion(OR=3.426)as independent predictors of in-hospital mortality.CONCLUSIONS In senior-aged patients,preoperative evaluation should be carefully performed,and strict management of reversible factors needs more attention.Senior-aged patients commonly have a more severe disease status combined with more frequent comorbidities,which may lead to a high risk in mortality.

Awake off-pump coronary artery bypass surgery in 25 patients

Objectives To test the feasibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Resuits The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotomy. There was no mortality. Mean length of stay in the intensive care unit was 16 .2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypasses in conscious patients without endotracheal general anesthesia

Predictive risk factors for prolonged stay in intensive care unit in patients undergoing coronary artery bypass grafting surgery

Objective To describe the preoperative factors of prolonged intensive care unit length of stay after coronary artery bypass grafting. Methods From 1997 to 2009, 1318 patients underwent isolated CABG in our hospital. Retrospective analysis was performed on these cases. Univariate and multivariate analyses

Predictive risk factors associated with prolonged stay in the intensive care unit for patients undergoing coronary artery bypass grafting surgery

Objective The rate of post-operative complications has been increased with the changes in patients’age,prolonged duration,more severe and diffused lesions,and more patients with complications in recent years. We try to identify the risk factors associated with prolonged stay in the intensive care unit (ICU) after coronary artery bypass graft surgery (CABG) . Methods 1623 patients who received CABG surgery in Beijing Anzhen Hospital

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

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

Femtosecond laser corneal refractive surgery for the correction of high myopic anisometropic amblyopia in juveniles

AIM： To evaluate the effects of femtosecond laser-assisted in situ keratomileusis（FS-LASIK） and small-incision lenticule extraction（SMILE） to correct high myopic anisometropic amblyopia in juvenile patients. METHODS： From November 2013 to January 2015, 33 amblyopic patients with high myopic anisometropic amblyopia were studied. FS-LASIK（30 eyes） or SMILE（3 eyes） was performed in the amblyopic eyes. Visual acuity, refraction, contrast sensitivity, stereoacuity and complications were evaluated. Patients completed followup examinations at 3 d, 1 mo, 3 mo and the last follow-up time（mean 8.17±3.23 mo） after surgery. RESULTS： The mean age at surgery was 9.04±3.04 y（range 6-16 y）. The mean spherical equivalent in the amblyopic eyes was significantly decreased from-10.00±2.39 D preoperatively to-0.06±1.06 D at 1 mo,-0.19±1.33 D at 3 mo and-0.60±1.43 D at approximately 8 mo postoperatively（P〈0.05 for all）. The mean myopic anisometropia was significantly decreased from-9.45±2.33 D preoperatively to ＋0.37±1.48 D at 1 mo,-0.46±1.47 D at 3 mo and-0.09±1.83 D at approximately 8 mo（P〈0.05 for all）. The logarithm of the minimum angle of resolution（log MAR） for uncorrected and corrected distance visual acuity（UDVA and CDVA, respectively） of the amblyopic eye improved from 1.74±0.35 and 0.98±0.63 preoperatively to 0.45±0.31 and 0.41±0.33 at approximately 8 mo after surgery, respectively. The logM AR CDVA at 3 d, 1, 3 and 8 mo postoperatively improved by means of 1.42, 2.22, 2.96, and 4.39 lines, and a gain of more than two lines accounted for 45%, 50%, 74% and 86% of all patients, respectively. The contrast sensitivity of both amblyopic eyes and dominant eyes at 0.5, 2, 8 cycles perdegree was significantly improved postoperatively（P〈0.05 for all）. Of the 33 pediatric patients, no patients had near stereopsis preoperatively and seven patients（21.2%） recovered near stereopsis（400″ to 60″） at approximately 8 mo after surgery. No intraoperative or postoperative complications occurred in any patient.CONCLUSION： FS-LASIK or SMILE can be promising alternative methods to correct high myopic anisometropic amblyopia in juvenile patients who have failed with traditional approaches.

Clinical observation of traditional Chinese medicine nursing on recovery of gastrointestinal function in patients after abdominal operation

Objective: To observe the clinical effect of traditional Chinese medicine nursing on the recovery of gastrointestinal function after abdominal operation. Methods: A total of 148 patients undergoing abdominal surgery from June 2013 to June 2014 in our hospital were randomly divided into observation group and control group, 74 cases in each group. The control group received routine nursing and the observation group was treated with the pointer, acupuncture and external application of abdominal treatment on the basis of routine nursing, which is 2 times a day,7 days for a course of treatment. Results: The recovery time of bowel sound, the first anal exhaust defecation time the in the observation group and the hospital day was less than the control group. With the comparison of two groups, the difference between the two groups was statistically significant (P < 0.05). The incidence of abdominal pain, abdominal distension, nausea, vomiting and constipation in the observation group was significantly lower than that in the control group (P < 0.05). Conclusion: On the basis of routine nursing, the implementation of traditional Chinese medicine characteristic nursing can effectively promote the recovery of gastrointestinal function, reduce the occurrence of complications, shorten the length of stay and improve the clinical effect.

Prevalence and Risk Factors of Postoperative Pressure Ulcers:A Systematic Review and Meta-analysis of Diagnostic Test

[Objectives]The paper was to analyze the total prevalence of postoperative pressure ulcers in patients and to reveal the epidemic law.[Methods]By searching English databases such as PubMed,Google Academics,Scopus,Science Direct and Web of Science(WOS),a total of 2018 English articles on pressure ulcers published from January 2015 to December 2020 were selected.According to the inclusion criteria,19 high-quality literatures were selected for the study,and the extended function of meta-analysis software of Review Manager 5.1 diagnostic test was used for data statistics and meta analysis of the results.[Results]There were 19 literatures with a total of 9400 patients included in the meta-analysis.The results showed that the total prevalence estimate of postoperative pressure ulcers was 20.00%(CI 95%:15.3-24.1).The total prevalence estimate of postoperative pressure ulcers in males was 10.1%(CI 95%:7.2-13.02),and that in females was 12.8%(CI 95%:8.1-17.3).The total prevalence estimates of stage I to IV postoperative pressure ulcers were 17.02%(CI 95%:11.06-22.09),6.7%(CI 95%:3.76-9.69),0.9%(CI 95%:0.21-1.26)and 0.4%(CI 95%:-0.05-0.8),respectively.[Conclusions]The prevalence of postoperative pressure ulcers is generally high.The prevalence of postoperative pressure ulcers in females is higher than that in males,and the prevalence of stage I pressure ulcers is higher than that of other stages,which is related to age,gender and other related risk factors.

EVALUATION OF A TUBULAR MESH AND A SPIRAL STENT WOVEN FROM TITANIUM NICKEL ALLOY FOR PROSTATIC OBSTRUCTION IN PATIENTS AT HIGH RISK FOR SURGERY REPORT OF 62 CASES

The use of two urethral stents woven from titanium nickel alloy (TiNi) in the form of a tubular mesh or a spiral stent (both made in China) is described. They were implanted in 62 patients,vith prostatic outflow obstruction. till patients were considered contraindicated for surgery. They were divided into a spiral stent group (group I) treated between March 1992 and May 1993, comprising 35 cases, and a tubular mesh group (group 2) treated between October 1993 and December 1994, comprising 31 cases, including four failures in group 1. Thirty-three out of the 35 patients in group 1 were treated successfully. Good results were achieved in eight cases (22.8%) and significant improvements occurred in 24 (68.5%), giving a total effective rate of 91.3%, with a follow-up of 11 to 27 months. Fourteen stents were removed within 6 months after the insertion and six more were removed within 12 months. The mean effective time of the stent in situ was 10.8 months. All 31 cases in the mesh group were treated successfully. Dramatically good effects were obtained in 28 cases (over 90%) and distinct improvements were achieved in two, giving a total effective rate of over 96.5%, with a follow-up of 6 to 14 months (mean 10.5 months). Cystoscopy was carried out in 12 patients after 6 months following the insertion. The major part of the meshes became covered by urothelium. Compared with the spiral, the mesh makes it possible to insert a prosthesis with a larger diameter and anti-pressure. The spiral, however, can be used as a temporary alternative for the relief of prostatic obstruction. A tubular mesh can work well for the relief of prostatic obstruction and remain in situ without causing major problems for at least I year.

Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone havebeen unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stake-holders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.

Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes:A meta-analysis of randomised controlled trials

Background The choice between coronary artery bypass surgery （CABG） and percutaneous coronary intervention （PCI） for revascularisation in patients with diabetes and multivessel coronary artery disease, who account for 25% of revascularisation procedures, is much debated. We aimed to assess whether all-cause mortality differed be- tween patients with diabetes who had CABG or PCI by doing a systematic review and meta-analysis of ran- domised controlled trials （RCTs） comparing CABG with PCI in the modem stent era.