嗜铬细胞瘤切除术不同麻醉的比较

１２例嗜铬细胞瘤手术病人随机分为两组：全麻组与硬膜外＋全麻组。比较两组病人术中不同时点的平均动脉压、心率、中心静脉压及术中扩血管药、术后去甲肾上腺素的应用情况。结果显示：硬膜外＋全麻组病人于分离肿瘤时平均动脉压升高程度显著低于全麻组；且全麻组病人术中扩血管药使用普遍而量大，术后去甲肾上腺素的应用亦多。认为硬膜外＋全麻应用于嗜铬细胞瘤切除术易于维持围术期血流动力学平稳。

麻醉和手术创伤对病儿红细胞免疫功能的影响

麻醉和手术创伤对病儿红细胞免疫功能的影响姜先敏１张秋业２徐宾１以往的研究证实，全身麻醉和手术创伤可引起受术者暂时性Ｔ，Ｂ细胞和吞噬细胞功能异常，此与病人术后易感倾向增加密切相关〔１〕，而有关麻醉和手术创伤对红细胞免疫功能的影响罕见报道。本文选择我院５...

熵指数监测下观察七氟烷在全麻过程中的应用

目的:研究熵指数指导下七氟烷在全麻过程中的应用,并与丙泊酚进行比较,初步探讨熵指数与镇静/警觉评分(OAA/S评分)的相关性。方法:将40例ASAⅠ或Ⅱ级在全麻下行择期腹腔镜下胆囊切除术的患者分为七氟烷组和丙泊酚组,每组20例,麻醉期间分别采用七氟烷、雷米芬太尼和阿曲库铵或丙泊酚,雷米芬太尼和阿曲库铵维持。采用熵指数监测麻醉深度,将熵指数控制在40～60之间,术毕采用OAA/S评分反映患者全麻后意识恢复程度,并记录到达不同评分的时间及相应熵值(反应熵和状态熵),同时记录麻醉过程中及术毕清醒时对应的心率、平均动脉压(MAP)、脉搏血氧饱和度、呼气末二氧化碳,并计算比较两组参数的变化情况。结果:手术维持在同等熵指数下,切皮前两组MAP均高于术前,手术进行至10min时丙泊酚组的MAP持续升高,当30min时,丙泊酚组的SE值低于七氟烷组。手术结束苏醒时,最终到达OAA/S评分和定向力恢复时间,两组差异无统计学意义。结论:两组在麻醉维持有效性和安全性及苏醒时间上无明显差别,七氟烷的血流动力学稳定性优于丙泊酚,熵指数与OAA/S评分有良好相关性。

小儿腭裂修补术全麻中辅以腭前神经阻滞的临床观察

目的 :观察小儿腭裂修补术全麻中辅以腭前神经阻滞的麻醉效果。方法 :先天性腭裂患儿 10 7例 ,随机分为两组 ,A组在全麻后、手术开始前以 2 %利多卡因 2～ 3ml行双侧腭前神经阻滞 ,再行手术 ;B组在单纯全麻下手术。观察两组静脉麻醉药的用量和全麻苏醒时间以及术后恶心呕吐、疼痛等情况。结果 :A组静脉麻醉药用量明显少于B组 ,苏醒时间短于B组 (P <0 .0 5 ) ,术后恶心呕吐及疼痛轻于B组 (P <0 .0 1)。结论 :小儿腭裂修补术全麻中辅以腭前神经阻滞能减少静脉麻醉药用量 ,缩短麻醉苏醒时间 ,减轻术后并发症 。

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.

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.

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.

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.

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.

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.

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.

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.

Brachiocephalic trunk and left brachiocephalic vein injuries following penetrating right sternoclavicular junction trauma： a case report

A 46-year-old male sustained severe pe- netrating injury by a sharp instrument to his right upper sternoclavicular junction. The wound tract was from su- prasternal notch to mediastinum. Exploratory operation via median sternotomy under general anesthesia found a large mediastinal septum hematoncus, as well as brachiocephalic trunk and left brachiocephalic vein injuries. The perforating vascular wounds were repaired with 5-0 prolene suture. He was recovered uneventfully and discharged 9 days after operation. There was no sequel found during 7 years fol- low-up.

Anterior dislocation of shoulder in eclampsia： a case report

This case report presents a 25-year-old female patient with anterior dislocation of right shoulder secondary to seizures as a complication of eclampsia. This is an unusual mechanism of injury, but similar to other un- controlled muscular contractions caused by electroconvul- sive therapy, etc. To the best of our knowledge only one such case has been reported in the English literature. Closed reduction under general anaesthesia was successfully achieved. High suspicion in patients complaining of pain over shoulder joint is necessary for early diagnosis of this condition.