喉罩全醉复合神经阻滞麻醉对高龄股骨颈骨折患者髋关节置换术中血流动力学的影响

目的:探讨喉罩全醉复合神经阻滞麻醉在高龄股骨颈骨折患者髋关节置换术中的效果及其对血流动力学的影响。方法:选取我院91例择期行髋关节置换术的高龄股骨颈骨折患者,按照随机数字表法分为观察组(46例)与对照组(45例),对照组采用常规气管插管全麻复合神经阻滞,观察组采用喉罩全醉复合神经阻滞麻醉。观察对比两组血流动力学变化及术后疼痛程度。结果:观察组插管或入喉罩时、拔管/喉罩时心率(HR)、平均动脉压(MAP)波动小于对照组,差异有统计学意义(P<0.05);与对照组对比,观察组术后1h、6h、12h、24h VAS评分显著降低,差异有统计学意义(P<0.05)。结论:喉罩全醉复合神经阻滞麻醉在高龄股骨颈骨折患者髋关节置换术中麻醉效果显著,可降低术后疼痛程度,稳定血流动力学。

静吸复合全醉联合脊椎硬膜外麻醉对老年宫颈癌患者术后认知功能及苏醒质量的影响

目的:探讨静吸复合全醉联合脊椎硬膜外麻醉对老年宫颈癌患者术后认知功能及苏醒质量的影响。方法:选取2019年6月~2021年3月我院老年宫颈癌患者74例,简单随机化法分为观察组(n=37)、对照组(n=37)。均拟行腹腔镜宫颈癌根治术,对照组予以静吸复合全醉,观察组予以静吸复合全醉联合脊椎硬膜外麻醉。比较两组苏醒质量、血流动力学指标[平均动脉压(MAP)、心率(HR)]、认知功能(MMSE)评分、不良反应发生率。结果:观察组麻醉诱导后MAP、HR高于对照组,气腹后、术毕MAP、HR低于对照组(P<0.05);观察组苏醒时间、自主呼吸恢复时间、苏醒时躁动评分小于对照组(P<0.05);两组术后1d、术后3 d,MMSE评分低于术前,但观察组高于对照组(P<0.05);两组不良反应发生率对比,差异无统计学意义(P>0.05)。结论:静吸复合全醉联合脊椎硬膜外麻醉应用于老年宫颈癌患者,可有效稳定血流动力学,减轻认知功能损害,提高苏醒质量,且安全性高。

Percutaneous Microwave Coagulation Therapy for Patients with Primary and Metastatic Hepatic Tumors

Objective: To evaluate the efficacy and safety of percutaneous microwave coagulation therapy (PMCT) for patients with primary and metastatic hepatic tumors.Methods: The enrolled 100 patients with 186 tumor nodules who underwent PMCT included 79 cases of primary or recurrent liver cancers and 21 cases of metastatic liver cancer. The tumors were divided into two groups according to the tumor size in diameter: group A, 0.5 cm?<3 cm; group B, ≥3 cm?<5 cm. Under local and/or epidural anesthesia, a single percutaneous microwave antenna (or two antennas array applicator) was inserted directly into the tumor in the liver for thermo-coagulation with the aid of ultrasound guidance.Results: Among the 186 lesions in 100 patients with primary and metastatic liver cancers, in group A, 123 (66%) were coagulated once. A Follow-up of 6–12 months demonstrated that 112 lesions (91%) showed no local recurrence by CT or MRI; In group B, of the 63 lesions (33.87%) coagulated twice, 31 (49%) showed no local recurrence by CT or MRI during a follow-up of 6 months. There were no serious clinical side effects or complications in all the PMCT patients.Conclusion: PMCT gives satisfactory curative effect on tumors with <3 cm in size. It is partly effective on lesions ≥3 cm?<5 cm in size. It is a minimally invasive and effective therapy, can be used safely in the field of percutaneous hepatis surgery, and carried out even in patients with poor liver function. Key words hepatocellular carcinoma - microwave - coagulation - therapy

不同全身麻醉方法对小儿全麻喉痉挛发生率的影响

目的:观察不同全身麻醉方法在预防小儿全麻并发症喉痉挛中的作用,降低其喉痉挛的发生率。方法:选择1～3岁小儿择期下腹部及四肢短小手术全身麻醉180例,随机分为观察组即气管插管全麻组(A组)和对照组即非气管插管全麻组(B组),每组各90例。A、B2组均静注0.2mg/kg咪达唑仑入室,A组行全麻气管插管机控通气、B组以氯胺酮复合全麻不行气管插管保留自主呼吸,观察并记录2组手术麻醉过程中喉痉挛的发生情况。结果:A组麻醉过程中出现4例喉痉挛,其中2例轻度、2例中度与B组发生喉痉挛6例,其中2例轻度、2例中度、2例重度比,其喉痉挛发生率和重度喉痉挛发生率明显低,差异有显著性(P<0.05)。结论:气管插管全麻组(A组)能有效地降低小儿手术麻醉过程中的喉痉挛的发生率,提高小儿全麻醉的安全性。

试述喉罩全麻复合神经阻滞麻醉对高龄股骨颈骨折患者髋关节置换术中的影响

观察高龄股骨颈骨折患者在髋关节置换术中采取喉罩全醉复合神经阻滞麻醉的临床效果。方法:在2019年3月到2020年1月以成都市第二人民医院股骨颈骨折患者64例进行研究分析。以随机数表法将入选患者纳入实验组和常规组。常规组应用常规麻醉方式。实验组采用喉罩全麻复合神经阻滞麻醉方式。基于术后疼痛、血流动力学指标进行组间对比。结果:实验组的术后疼痛评分均显著低于常规组,P<0.05。实验组患者的血流动力学指标显著优于常规组,数据差异对比有意义,P<0.05。结论:高龄股骨颈骨折患者在髋关节手术治疗期间采用喉罩全麻复合神经阻滞麻醉具备较高的临床价值,尤其是对于患者的术后疼痛以及血流动力学指标的稳定性具备明显改善作用,值得普及。

Dynamics of vascular volume and hemodilution of lactated Ringer’s solution in patients during induction of general and epidural anesthesia

Objective： To investigate the dynamics of vascular volume and the plasma dilution of lactated Ringer＇s solution in patients during the induction of general and epidural anesthesia. Methods： The hemodilution of i.v. infusion of 1000 ml of lactated Ringer＇s solution over 60 min was studied in patients undergoing general （n=31） and epidural （n= 22） anesthesia. Heart rate, arterial blood pressure and hemoglobin （Hb） concentration were measured every 5 rain during the study. Surgery was not started until the study period had been completed. Results： General anesthesia caused the greater decrease of mean arterial blood pressure （MAP） （mean 15% versus 9%; P〈0.01） and thereby followed by a more pronounced plasma dilution, blood volume expansion （VE） and blood volume expansion efficiency （VEE）. A strong linear correlation between hemodilution and the reduction in MAP （r=-0.50;P〈0.01） was found. At the end of infusion, patients undergoing general anesthesia retained 47% （SD 19%） of the infused fluid in the circulation, while epidural anesthesia retained 29% （SD 13%） （P〈0.001）. Correspondingly, a fewer urine output （mean 89 ml versus 156 ml; P〈0.05） and extravascular expansion （454 ml versus 551 ml; P〈0.05） were found during general anesthesia. Conclusion： We concluded that the induction of general anesthesia caused more hemodilution, volume expansion and volume expansion efficiency than epidural anesthesia, which was triggered only by the lower MAP.

Comparison of 1.5% lidocaine and 0.5% ropivacaine epidural anesthesia combined with propofol general anesthesia guided by bispectral index

Objective： To compare the effects of epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine on propofol requirements, the time to loss of consciousness （LOC）, effect-site propofol concentrations, and the hemodynamic variables during induction of general anesthesia guided by bispectral index （BIS） were studied. Methods： Forty-five patients were divided into three groups to receive epidurally administered saline （Group S）, 1.5% （w/w） lidocaine （Group L）, or 0,5% （w/w） ropivacaine （Group R） Propofol infusion was started to produce blood concentration of 4 lag/ml. Once the BIS value reached 40-50, endotracheal intubation was facilitated by 0.1 mg/kg vecuronium. Measurements included the time to LOC, effect-site propofol concentrations, total propofol dose, mean arterial blood pressure （MABP）, and heart rate （HR） at different study time points. Results： During induction of anesthesia, both Groups L and R were similar for the time to LOC, effect-site propofol concentrations, total propofol dose, MABP, HR, and BIS. The total doses of propofol administered until 1 min post-intubation were significantly less in patients of Groups R and L compared with Group S. MABP and HR were significantly lower following propofol induction compared with baseline values in the three groups, or MABP was significantly increased following intubation as compared with that prior to intubation in Group S but not in Groups R and L while HR was significantly increased following intubation in the three groups. Conclusion： Epidural anesthesia with 1.5% lidocaine and 0.5% ropivacaine has similar effects on the time to LOC, effect-site propofol concentrations, total propofol dose, and the hemodynamic variables during induction of general anesthesia.

Impaired gluconeogenesis in a porcine model of paracetamol induced acute liver failure

AIM:To investigate glucose homeostasis and in particular gluconeogenesis in a large animal model of acute liver failure(ALF).METHODS:Six pigs with paracetamol induced ALF under general anaesthesia were studied over 25 h.Plasma samples were withdrawn every five hours from a central vein.Three animals were used as controls and were maintained under anaesthesia only.Using 1 H NMR spectroscopy we identified most gluconeogenic amino acids along with lactate and pyruvate in the animal plasma samples.RESULTS:No significant changes were observed in the concentrations of the amino acids studied in the animals maintained under anaesthesia only.If we look at the ALF animals,we observed a statistically significant rise of lactate(P<0.003)and pyruvate(P<0.018) at the end of the experiments.We also observed statistically significant rises in the concentrations of alanine(P<0.002),glycine(P<0.005),threonine(P< 0.048),tyrosine(P<0.000),phenylalanine(P<0.000) and isoleucine(P<0.01).Valine levels decreased significantly(P<0.05).CONCLUSION:Our pig model of ALF is characterized by an altered gluconeogenetic capacity,an impaired tricarboxylic acid(TCA)cycle and a glycolytic state.

Anesthetic Management during Cesarean Section in English Bulldogs

The authors describe their experience with the management of the perioperative period, general anesthesia and the postoperative period in English bulldogs undergoing elective cesarean section and its effect on the neonates. The anesthetist for animals undergoing cesarean operation must be aware of any special needs, not only of the patient undergoing surgery, but also of the neonates. Anesthetic drugs administered to the pregnant patient will readily cross the placenta and affect them, with the exception of local anesthetics. Pregnant female patients are at increased anesthetic risk due to pregnancy-associated physiological alterations, such as altered pulmonary function. The anesthetist is often called to perform anesthesia on brachycephalic dogs for an elective cesarean section. Due to their conformation, these animals may have one or more anatomical abnormalities of the upper airways, which compromise the ability to ventilate adequately. The induction and recovery phases of anesthesia can be extremely dangerous in these patients, but the maintenance phase is generally fairly straightforward because the airways are controlled during maintenance In addition, vagal tone is frequently high and this can contribute towards significant bradycardia and further airway narrowing. All these reasons make general anesthesia in brachycepbalic dogs undergoing cesarean section rather complicated.

Plants as Objects： Challenges for anAesthetics of Flora

This paper presents the conceptual challenges to an aesthetic model of living plants based in embodied interaction with flora through smell, taste, touch, sound and sight. I argue that the science of aesthetics is deterministically visual. Drawing from theories of landscape aesthetics put forth by Carlson and Berleant, I outline four primary obstacles to an embodied aesthetics： plants as objects of sight, plants as objects of art, plants as objects of disinterestedness and plants as objects of scientific discourse. A multi-sensorial aesthetics of flora requires auto-centric proximity and degrees of intersubjectivity between the appreciator and the appreciated plant that raise important philosophical questions about aesthetic experience of the natural world.

Improving endotracheal tube tolerance with intracufflidocaine: a meta-analysis of randomized controlled trials

Objective： The aim of this study was to compare the efficacy in alleviating the endotracheal tube related discomfort and the safetyof intracufflidocaine （in different forms） with air and/or normal saline （NS） during general anesthesia with tracheal intubation. Methods： Cochrane Central Register of Controlled Trials, PubMed and Embase were searched for relevant studies. Thirteen randomized, controlled trials involving 1 010 patients were ultimately identified. A meta-analysis of all randomized controlled trials fulfilling the predefined criteria was performed. Random-effect model and subgroup studies were used when significant heterogeneity existed among those trials. Results： Compared with air and NS, intracufflidocaine could significantly alleviate the severity of sore throat at different time points （15min, 30min, lh, 2h, 3h, 6h, 12h and 24h aiter extubation） and the occurrence of cough, restlessness, postoperative nausea and vomiting, dysphonia and hoarseness. Besides intracufflidocaine brought about a significant prolongation of spontaneous ventilation time. It was worth mentioning that, compared withlidocaine or its hydrochloride form, alkalinized lidocainewas much more efficient in reducing the severity of sore throat and prolonging spontaneous ventilation time. Conclusion： The present meta-analysis indicates that intracuttlidocaine can significantly improve endotracheal tube tolerance and this improvement can be strengthened by alkalinization of lidocaine.

Effectiveness and Safety of Computer-controlled Periodontal Ligament Injection System in Endodontic Access to the Mandibular Posterior Teeth

Objective To evaluate the effectiveness and safety of a computer-controlled periodontal ligament （PDL） injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis. Methods A total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth： the premolar group （PM, z2=38）, first molar group （FM, n=66）, and second molar group （SM, n=58）. All the patients received computer-controlled PDL injection with 4% articaine and 1 ＇ 100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure. Results The overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups （92.1%, 53.0%, 93.1%, respectively; 2 X =34.3, P〈0.01）. Both the PM and SM groups showed higher success rates than that of the FM group （v=l, f=16.73, P〈0.01, v=l, Z = 4.5, X2 2 P〈0.01）. No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups. Conclusion The computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis.

Comparison of Two Types of Nursing Application in PACU Affect Postoperative Satisfaction

The very key element in quality of nursing care is individualized nursing care. Individual differences among patients in terms of their health, illness, social classes and cultural background which lead to different needs emphasize on providing individualized care. And it is strongly related to postoperative care satisfaction. In fact, it tailored nm,ning activities with unique peculiarity of each patient. Actually, it changes all standardized nursing procedures and activities. We aimed to look into the differences between those two types of nursing application in postanesthesia care unit （PACU）, affect postoperative care satisfaction in the research. Methods： We conducted a prospective control study that included 325 patients ,randomly divided into two groups： Individualized nursing care group and ordinary nursing care group, undergoing general anesthesia. The 2 groups of patients were similar in respect to gender distribution, age, and type of surgery and had been admitted into the PACU after elective surgery. Data was collected by interviewing with patients using Satisfaction Questionnaire （North Health Service Hospital Consumer Assessment Works by and service systems （H C A H P S） in patients over Meaning of the questionnaire Chinese Translation Version ） , after assessing its content validity and reliability with Chronbach＇s alpha method. Using SPSS ver. 17 to analysis data .Results： General information on the two groups were no statistically significant differences （P〉 0. 05）. Individualized nursing care group （98.2%） compared with the ordinary nursing care group satisfaction （92%） significantly increased （P 〈0. 01）. Conclusions： Deployment of individualized nursing care in PACU can significantly improve postoperative satisfaction compared to ordinary nursing care.

中国婴幼儿全身麻醉下眼病检查专家共识(2022年)

全身麻醉下眼病检查(EUA)是诊治婴幼儿致盲眼病的关键方法。目前国内对EUA的重视和认知程度不足,开展EUA的方法和流程等缺乏统一标准。为了规范推广EUA,发挥其重要作用,中华医学会儿科学分会眼科学组组织国内相关专家,经过反复讨论,提出我国规范化开展婴幼儿EUA的共识性意见,供临床医师在工作中参考应用。

Selection of neuromuscular blocking agents in patients undergoing renal transplantation under general anesthesia

OBJECTIVE: To study the pharmacodynamics of vecuronium,atracurium, mivacurium and rocuronium in patients with end-stage renal failure. METHODS: Forty-six patients with end-stage renal failure scheduled for renal transplantation and 53 patients with normal renal function were given either vecuronium, atracurium, mivacurium or rocuronium. The neuromuscular effects were monitored by the evoked response of the adductor pollicis to train-of-four stimulation of the ulnar nerve. RESULTS: Onset of vecuronium, atracurium and mivacurium occurred faster or tended to be faster in patients with end-stage renal failure, but there was no significant difference in onset by rocuronium between the control patients and renal failure patients. Furthermore, the no-response period, duration of action and recovery of atracurium did not differ between the two groups. There was no significant difference in duration of action or recovery of mivacurium between the two groups, whereas its no-response period was significantly prolonged in the patients with end-stage renal failure. There was no difference in no-response period or duration of action after the initial dose of vecuronium or rocuronium between the two groups. However, no-response period and duration of effect by vecuronium and rocuronium were prolonged with increasing incremental doses in patients with end-stage renal failure. CONCLUSIONS: All four muscle relaxants could be safely used in patients with end-stage renal failure. Onset of the relaxants were, in some cases, accelerated and no-response period of mivacurium was prolonged in patients with end-stage renal failure undergoing dialysis therapy. End-stage renal failure prolonged the no-response period and duration of action of vecuronium and rocuronium after repeated incremental doses, but did not alter those attributed to atracurium.

Traumatic bilateral hip dislocation with bilateral sciatic nerve palsy

Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently reduced under general anaesthesia. Acetabular reconstruction was done bilaterally due to the unstable hips. The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty. The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was augmented by tendon transfer. Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time. To the best of our knowledge, this kind of injury has not been reported in the English .language literature.

Effect of acupoint massage plus acupoint sticking therapy for the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery

Objective:To observe the effect of acupoint massage plus acupoint sticking therapy for the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery.Methods:A total of 120 patients undergoing nasal endoscopic surgery were included,and all patients were under trachea intubation and general anesthesia.The patients were randomized into an observation group and a control group,with 60 patients in each group.Patients in the control group received conventional anesthesia resuscitation,while patients in the observation group received acupoint massage plus acupoint sticking therapy on the basis of conventional anesthesia resuscitation.Changes in the heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed at three time points including the end of the surgery (TO),the removal of the tracheal tube (T1) and 10 min after the removal of the tracheal tube (T2).The awakening and tube removal time,choking cough and restlessness,and adverse reactions (dizziness,nausea and vomiting) in 24 h post-surgery period were compared.Results:At T1 and T2,the comparisons of HR,SBP and DBP between the two groups showed statistical significance (all P＜0.05).Intra-group comparisons showed that the HR,SBP and DBP of the control group at T1 and T2 were significant different from those at TO (all P＜0.05).There were significant differences in the awakening time and tube removal time between the two groups (both P＜0.05).The incidences of choking cough and restlessness were 8.3％ and 3.3％ respectively in the observation group,versus 53.3％ and 30.0％ in the control group,and the between-group comparisons showed statistical significance (both P＜0.05).The incidences of dizziness,nausea and vomiting in 24 h post-surgery period were 3.3％,5.0％ and 0.0％ respectively in the observation group,versus 43.3％,33.3％ and 25.0％ in the control group,and the between-group comparisons showed statistical significance (all P＜0.05).Conclusion:Acupoint massage plus acupoint sticking therapy can effectively regulate the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery,and maintain a stable internal environment.

Inferior dislocation of the hip： a case series and litera- ture review

Inferior hip dislocation is the rarest type among all hip dislocations. Very few cases have been re ported in the English literature. Most of the earlier reported cases involves the pediatric age group. No single case series could be found in the English literature. We came across 4 cases of inferior hip dislocation with a varied age profile （range 10 to 56 years, mean 33.8 years）. Patients with this disease usually complained of pain and kept the thigh flexed and abducted. The diagnosis can be confirmed by radiographs which reveal that the long axis of the femur varies in alignment with respect to the spine from parallel toan angle almost 90° away from the axis. In our series, closed reduction was successful in all patients, either under seda tion or general anaesthesia. Skin traction for a period of 6 weeks was applied in all of them and followup revealed painfree, stable and mobile hips. In this study we present the details of these cases along with a review of literature discussing the various modes and mechanisms that pro duce inferior hip dislocation.

Irreducible traumatic posterior hip dislocation with entrapment and a buttonhole effect

The authors reported the case of a 27- year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment. Initial X-rays showed only a small acetabular fragment. After two attempts to reduce the hip with muscle paralysis under general anaesthesia failed, the patient was treated by immediate open reduction through a posterolateral approach. Surgical exploration of the hip revealed a small osteochondral fragment attached to a large piece of labrum and capsule, clogging the acetabulum. The femoralhead crossed over the torn capsule with a buttonhole effect. These elements were relieved, the bone fragment was fixed with a 2 mm screw and the capsule was repaired. At the 10- year follow-up, the functional outcome was excellent with a Harris score of 100 points and no signs of necrosis or osteoarthritis. The authors propose a literature review of this uncommon lesion.