Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our...Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.展开更多
Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the...Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (p<.05). The probability of making an accidental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.展开更多
Nonintubated video-assisted thoracic surgery (VATS) that is also defined awake VATS entails thoracoscopic procedures performed by regional anesthesia in spontaneously ventilating,mildly sedated or fully awake patients.
Thoracoscopic surgeries usually require single-lung ventilation under general anesthesia because of the need to obtain a sufficient working space.In patients with impaired pulmonary function,if the patient can undergo...Thoracoscopic surgeries usually require single-lung ventilation under general anesthesia because of the need to obtain a sufficient working space.In patients with impaired pulmonary function,if the patient can undergo general anesthesia,a more selected collapse of the lung is considered to be beneficial for intraoperative oxygenation.The selective bronchial blockade of the lobe to be resected has been reported by several investigators (1-3).Mukaida and coworkers first reported thoracoscopic surgery for pnenmothorax under local and epidural anesthesia in 1998 in high-risk patients contraindicated for general anesthesia (4).展开更多
Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. ...Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.展开更多
Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate ...Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate if there were improvements in the performance of anesthesia novice trainees when executing the epidural technique after an EMME of epidural block procedure. Methods: We developed an eye movement modeling example (EMME) from eye tracking recordings made by experienced anesthesiologists with more than 20 years of experience. Forty-two PGY3 anesthesia trainees who had never previously performed an epidural block were randomized to receive (study group) or not receive (control group) the EMME video before their institutional training. All the trainees were evaluated every 10 epidural blocks until the end of the rotation period, by an independent, blinded observer using the Global Rating Scale for Epidural Anesthesia (GRS). Results: Trainees who received the EMME training exhibited more respect for the patient’s tissues (P Discussion: This is the first study that has used the EMME for a practical, clinical teaching purpose on real patients and that has used it as an aid in teaching epidural anesthesia. We demonstrated that inexperienced trainees who received the EMME training improved their proficiency at epidural blocks as compared to those who had no EMME training beforehand. Given this result, we welcome further studies to investigate the impact and the role of EMME on clinical teaching in the field of anesthesia.展开更多
BACKGROUND Eisenmenger’s syndrome(ES)is a rare complication of congenital heart disease that includes pulmonary artery hypertension and reversed or bidirectional shunts.The mortality rate of pregnant women with ES is...BACKGROUND Eisenmenger’s syndrome(ES)is a rare complication of congenital heart disease that includes pulmonary artery hypertension and reversed or bidirectional shunts.The mortality rate of pregnant women with ES is 30%-70%due to pathophysiological deterioration.Successful perioperative management of a pregnant patient with ES is a challenge for anesthesiologists.CASE SUMMARY A 38-year-old pregnant woman was admitted to the cardiology department of our hospital at 22 wk of gestation with complaints of chest tightness and shortness of breath for 3 wk.Transthoracic echocardiography revealed a bidirectional shunt between the descending aorta and pulmonary artery after interventional closure of the patent ductus arteriosus and severe pulmonary hypertension.ES in pregnancy was our primary suspicion.The patient elected to terminate the pregnancy under adequate preoperative preparation,rigorous intraoperative monitoring,and perfect epidural anesthesia.She was discharged successfully on postoperative day 16.CONCLUSION Our experience in this case suggests that successful outcomes are possible in pregnant patients with ES for termination of pregnancy under epidural anesthesia and intensive monitoring.展开更多
In most adults, the conus medullaris ends at around the inferior margin of the first lumbar (L1) vertebral body.However, location of terminus of the conus medullaris is variable and even extends more distally in pat...In most adults, the conus medullaris ends at around the inferior margin of the first lumbar (L1) vertebral body.However, location of terminus of the conus medullaris is variable and even extends more distally in patients with diseases such as tethered cord syndrome (TCS). Here, we reported a conus medullaris injury following combined spinal and epidural anesthesia (CSEA) in a pregnant woman with unknown TCS.展开更多
Objective: To investigate the effects of acupuncture on the morphine-related side effects (nausea, vomiting, itchiness and gastrointestinal disorders) in patients undergoing anesthesia and analgesia and try to find...Objective: To investigate the effects of acupuncture on the morphine-related side effects (nausea, vomiting, itchiness and gastrointestinal disorders) in patients undergoing anesthesia and analgesia and try to find the clinical mechanism of acupuncture. Methods: Patients scheduled to have transurethral prostatic resection enrolled in the study (69 patients), characterized as Grade Ⅱ or Ⅲ by the American Society of Anesthesiologists physical status classification, were randomly assigned to three groups, 23 patients in each group: the placebo group (control group), non-anesthesia area (NAA) group, and the anesthesia area (AA) group. After spinal anesthesia, all patients received Patients Controlled Epidural Analgesia. The vital signs, bowel sounds, visual analogue scales, itchiness, nausea and vomiting, and time for first exhaust post operation were observed. Results: Altogether, nine cases were eliminated, three in each group. Finally, sixty cases completed this study, twenty in each group. There was a significant decrease of bowel sounds after morphine spinal anesthesia in the three groups. Compared with the control or AA group, the bowel sound recovered after acupuncture, the incidences of nausea and vomiting, itchiness, and time for first exhaust after operation decreased in the NAA group (P〈0.05). There was a significant decrease of the incidence for itchiness in the NAA group compared with the control group (P〈0.05). Conclusions: On the basis of this study, it is obviously seen that acupuncture could decrease the incidence of morphine-related side effects (nausea and vomiting, itchiness and gastrointestinal disorders) when the spinal cord conduct is normal. However, it decreases only the incidence of itchiness but not for gastrointestinal dysfunction when the spinal cord is blocked.展开更多
This study was designed to evaluate the effect of tracheal topical anesthesia using EMLA■Cream(EC)coated on the endotracheal tube(ETT)with or without epidural anesthesia(EA)on isoflurane requirement during general an...This study was designed to evaluate the effect of tracheal topical anesthesia using EMLA■Cream(EC)coated on the endotracheal tube(ETT)with or without epidural anesthesia(EA)on isoflurane requirement during general anesthesia(GA)and investigate whether EC coated on the ETT with EA was associated with the additive effect compared with the effect when each anesthetic was administered independently.The prospective randomized,double-blinded,and controlled study included 60 ASA Ⅰ-Ⅱ patients scheduled for upper abdominal surgery requiring GA.Patients were randomly assigned to one of the following groups:group 1 received GA,group 2 received EC+GA,group 3 received GA+EA,and group 4 received EC+GA+EA.Isoflurane was administered at the required concentrations to maintain the mean arterial pressure at a level not exceeding 20% of preoperative values.The percentage mean expired concentration(%MEC)was used in calculating the isoflurane requirement.Emergence agitation,postoperative sore throat,and hoarseness were recorded.Groups 2,3,and 4 exhibited a significant reduction on isoflurane requirement compared with group 1(P<0.05).The isoflurane requirement evaluated by%MEC decreased by 12%,38%,and 50% in groups 2,3,and 4,respectively.The incidence of emergence agitation was significantly lower in groups 2 and 4 than those in groups 1 and 3(P<0.05).Tracheal topical anesthesia using EC coated on ETT with or without EA reduced the isoflurane requirement during GA,indicating that EC combined with EA exhibited an additive effect on the requirement of general anesthetic.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Cancer colon is one of the most common malignancies.</span><sp...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Cancer colon is one of the most common malignancies.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">After colon cancer surgery patients may experience severe pain.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. </span><b><span style="font-family:Verdana;">Aim:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Our goal was to assess the effect of combined epidural anaesthesia either with propofol</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">or sevoflurane on intraoperative fentanyl consumption and postoperative pain</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">in patients undergoing open surgical resection of colon cancer.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Patients and Methods:</span></b><span style="font-family:Verdana;"> 48 adult patients suffering from cancer colon scheduled for </span><span style="font-family:Verdana;">open surgical resection randomly allocated either to receive epidural-pro</span><span style="font-family:Verdana;">pofol</span><span style="font-family:Verdana;"> by total intra venous anaesthesia</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(TIVA)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(n</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">24) or epidural-sevoflu</span><span style="font-family:Verdana;">rane</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">anaesthesia (n</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">24),</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">intraoperative heart rate and fentanyl consumption and postoperative pain score</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(verbal analogue scale,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">10) were recorded.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">In our study we found that</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">the intensity of postoperative pain was low in all patients and</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">the propofol based anaesthesia had relatively lower pain scores up to 24</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hrs postoperatively in comparison to sevoflurane based anaesthesia,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">intraoperative fentanyl consumption was lower with sevoflurane and heart rate lower with propofol group. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">we recommend that use of multimodal analgesia decrease postoperative pain in all cancer colon patients undergoing open surgery who anaesthetized with either propofol or sevoflurane.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Also use of propofol</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">showed better analgesic outcomes postoperatively.</span>展开更多
Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be fa...Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.展开更多
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 Octo...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展开更多
Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly, but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration (MLAC) of lidocai...Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly, but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration (MLAC) of lidocaine is not known. We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults. Methods One hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions: lidocaine, or lidocaine plus fentanyl 1 pg/ml, 2 pg/ml, or 3 pg/ml. The first patient in each group was administered 1% lidocaine weight by volume; subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments. Efficacy was assessed using a visual analog pain scale, and accepted if this was 〈10 mm on a 100 mm scale within 30 minutes. The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery, respectively. Results The MLAC of lidocaine in those receiving lidocaine alone was 0.785% (95%C/0.738-0.864). A significant dose-dependent reduction was observed with the addition of fentanyl: the MLAC of lidocaine with fentanyl at 2 pg/ml was 0.596% (95%C/0.537-0.660) and 0.387% with fentanyl at 3 pg/ml (95%C/0.329-0.446, P 〈0.001). Conclusion Epidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects. (Chi CTR-TRC-11001559)展开更多
基金Weifang Municipal Science and Technology Bureau(Medical)Project“Effects and Mechanisms of Oxycodone and Alfentanil on IgFs in Mouse Ovarian Granulosa Cells”(2021YX035)。
文摘Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.
文摘Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (p<.05). The probability of making an accidental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.
文摘Nonintubated video-assisted thoracic surgery (VATS) that is also defined awake VATS entails thoracoscopic procedures performed by regional anesthesia in spontaneously ventilating,mildly sedated or fully awake patients.
文摘Thoracoscopic surgeries usually require single-lung ventilation under general anesthesia because of the need to obtain a sufficient working space.In patients with impaired pulmonary function,if the patient can undergo general anesthesia,a more selected collapse of the lung is considered to be beneficial for intraoperative oxygenation.The selective bronchial blockade of the lobe to be resected has been reported by several investigators (1-3).Mukaida and coworkers first reported thoracoscopic surgery for pnenmothorax under local and epidural anesthesia in 1998 in high-risk patients contraindicated for general anesthesia (4).
文摘Background: Invasive mechanical ventilation worsens prognosis in patients with severe chronic obstructive pulmonary disease (COPD). To avoid complications in these patients, anesthesia should be carefully considered. Case presentation: A 78-year-old man with COPD presented with dyspnea and pain from the epigastric to the umbilical regions. He was diagnosed with left incarcerated inguinal hernia and underwent radical inguinal hernia repair and surgical ileus treatment. To avoid general anesthesia with tracheal intubation, epidural anesthesia was combined with peripheral nerve blocks. An epidural catheter was inserted from T12/L1, and ilioinguinal-iliohypogastric and genitofemoral nerve blocks were performed under ultrasound guidance. No post-surgery complications or pain symptoms were noted. Conclusions: General anesthesia would likely have been challenging due to the patient’s COPD;however, management of peritoneal traction pain is difficult using peripheral nerve block alone. By combining epidural anesthesia with peripheral nerve blocks, we safely performed a procedure in a patient with severe COPD while avoiding invasive positive pressure ventilation.
文摘Introduction: Video examples with task demonstrations by experts, with the expert’s eye movements superimposed on the task, are known as “eye movement modeling examples” (EMME). We performed this study to evaluate if there were improvements in the performance of anesthesia novice trainees when executing the epidural technique after an EMME of epidural block procedure. Methods: We developed an eye movement modeling example (EMME) from eye tracking recordings made by experienced anesthesiologists with more than 20 years of experience. Forty-two PGY3 anesthesia trainees who had never previously performed an epidural block were randomized to receive (study group) or not receive (control group) the EMME video before their institutional training. All the trainees were evaluated every 10 epidural blocks until the end of the rotation period, by an independent, blinded observer using the Global Rating Scale for Epidural Anesthesia (GRS). Results: Trainees who received the EMME training exhibited more respect for the patient’s tissues (P Discussion: This is the first study that has used the EMME for a practical, clinical teaching purpose on real patients and that has used it as an aid in teaching epidural anesthesia. We demonstrated that inexperienced trainees who received the EMME training improved their proficiency at epidural blocks as compared to those who had no EMME training beforehand. Given this result, we welcome further studies to investigate the impact and the role of EMME on clinical teaching in the field of anesthesia.
文摘BACKGROUND Eisenmenger’s syndrome(ES)is a rare complication of congenital heart disease that includes pulmonary artery hypertension and reversed or bidirectional shunts.The mortality rate of pregnant women with ES is 30%-70%due to pathophysiological deterioration.Successful perioperative management of a pregnant patient with ES is a challenge for anesthesiologists.CASE SUMMARY A 38-year-old pregnant woman was admitted to the cardiology department of our hospital at 22 wk of gestation with complaints of chest tightness and shortness of breath for 3 wk.Transthoracic echocardiography revealed a bidirectional shunt between the descending aorta and pulmonary artery after interventional closure of the patent ductus arteriosus and severe pulmonary hypertension.ES in pregnancy was our primary suspicion.The patient elected to terminate the pregnancy under adequate preoperative preparation,rigorous intraoperative monitoring,and perfect epidural anesthesia.She was discharged successfully on postoperative day 16.CONCLUSION Our experience in this case suggests that successful outcomes are possible in pregnant patients with ES for termination of pregnancy under epidural anesthesia and intensive monitoring.
文摘In most adults, the conus medullaris ends at around the inferior margin of the first lumbar (L1) vertebral body.However, location of terminus of the conus medullaris is variable and even extends more distally in patients with diseases such as tethered cord syndrome (TCS). Here, we reported a conus medullaris injury following combined spinal and epidural anesthesia (CSEA) in a pregnant woman with unknown TCS.
基金Supported by the Research Item of Guangxi Science and Technology Committee(No.0848013)Research Item of Guangxi Medicine Committee(No.2008256)
文摘Objective: To investigate the effects of acupuncture on the morphine-related side effects (nausea, vomiting, itchiness and gastrointestinal disorders) in patients undergoing anesthesia and analgesia and try to find the clinical mechanism of acupuncture. Methods: Patients scheduled to have transurethral prostatic resection enrolled in the study (69 patients), characterized as Grade Ⅱ or Ⅲ by the American Society of Anesthesiologists physical status classification, were randomly assigned to three groups, 23 patients in each group: the placebo group (control group), non-anesthesia area (NAA) group, and the anesthesia area (AA) group. After spinal anesthesia, all patients received Patients Controlled Epidural Analgesia. The vital signs, bowel sounds, visual analogue scales, itchiness, nausea and vomiting, and time for first exhaust post operation were observed. Results: Altogether, nine cases were eliminated, three in each group. Finally, sixty cases completed this study, twenty in each group. There was a significant decrease of bowel sounds after morphine spinal anesthesia in the three groups. Compared with the control or AA group, the bowel sound recovered after acupuncture, the incidences of nausea and vomiting, itchiness, and time for first exhaust after operation decreased in the NAA group (P〈0.05). There was a significant decrease of the incidence for itchiness in the NAA group compared with the control group (P〈0.05). Conclusions: On the basis of this study, it is obviously seen that acupuncture could decrease the incidence of morphine-related side effects (nausea and vomiting, itchiness and gastrointestinal disorders) when the spinal cord conduct is normal. However, it decreases only the incidence of itchiness but not for gastrointestinal dysfunction when the spinal cord is blocked.
文摘This study was designed to evaluate the effect of tracheal topical anesthesia using EMLA■Cream(EC)coated on the endotracheal tube(ETT)with or without epidural anesthesia(EA)on isoflurane requirement during general anesthesia(GA)and investigate whether EC coated on the ETT with EA was associated with the additive effect compared with the effect when each anesthetic was administered independently.The prospective randomized,double-blinded,and controlled study included 60 ASA Ⅰ-Ⅱ patients scheduled for upper abdominal surgery requiring GA.Patients were randomly assigned to one of the following groups:group 1 received GA,group 2 received EC+GA,group 3 received GA+EA,and group 4 received EC+GA+EA.Isoflurane was administered at the required concentrations to maintain the mean arterial pressure at a level not exceeding 20% of preoperative values.The percentage mean expired concentration(%MEC)was used in calculating the isoflurane requirement.Emergence agitation,postoperative sore throat,and hoarseness were recorded.Groups 2,3,and 4 exhibited a significant reduction on isoflurane requirement compared with group 1(P<0.05).The isoflurane requirement evaluated by%MEC decreased by 12%,38%,and 50% in groups 2,3,and 4,respectively.The incidence of emergence agitation was significantly lower in groups 2 and 4 than those in groups 1 and 3(P<0.05).Tracheal topical anesthesia using EC coated on ETT with or without EA reduced the isoflurane requirement during GA,indicating that EC combined with EA exhibited an additive effect on the requirement of general anesthetic.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Cancer colon is one of the most common malignancies.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">After colon cancer surgery patients may experience severe pain.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. </span><b><span style="font-family:Verdana;">Aim:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">Our goal was to assess the effect of combined epidural anaesthesia either with propofol</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">or sevoflurane on intraoperative fentanyl consumption and postoperative pain</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">in patients undergoing open surgical resection of colon cancer.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Patients and Methods:</span></b><span style="font-family:Verdana;"> 48 adult patients suffering from cancer colon scheduled for </span><span style="font-family:Verdana;">open surgical resection randomly allocated either to receive epidural-pro</span><span style="font-family:Verdana;">pofol</span><span style="font-family:Verdana;"> by total intra venous anaesthesia</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(TIVA)</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(n</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">24) or epidural-sevoflu</span><span style="font-family:Verdana;">rane</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">anaesthesia (n</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">24),</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">intraoperative heart rate and fentanyl consumption and postoperative pain score</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(verbal analogue scale,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">10) were recorded.</span><span style="font-family:Verdana;"> </span><b><span style="font-family:Verdana;">Results:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">In our study we found that</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">the intensity of postoperative pain was low in all patients and</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">the propofol based anaesthesia had relatively lower pain scores up to 24</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">hrs postoperatively in comparison to sevoflurane based anaesthesia,</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">intraoperative fentanyl consumption was lower with sevoflurane and heart rate lower with propofol group. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><b><span style="font-family:Verdana;"> </span></b><span style="font-family:Verdana;">we recommend that use of multimodal analgesia decrease postoperative pain in all cancer colon patients undergoing open surgery who anaesthetized with either propofol or sevoflurane.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Also use of propofol</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">showed better analgesic outcomes postoperatively.</span>
文摘Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome;cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.
文摘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
文摘Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly, but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration (MLAC) of lidocaine is not known. We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults. Methods One hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions: lidocaine, or lidocaine plus fentanyl 1 pg/ml, 2 pg/ml, or 3 pg/ml. The first patient in each group was administered 1% lidocaine weight by volume; subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments. Efficacy was assessed using a visual analog pain scale, and accepted if this was 〈10 mm on a 100 mm scale within 30 minutes. The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery, respectively. Results The MLAC of lidocaine in those receiving lidocaine alone was 0.785% (95%C/0.738-0.864). A significant dose-dependent reduction was observed with the addition of fentanyl: the MLAC of lidocaine with fentanyl at 2 pg/ml was 0.596% (95%C/0.537-0.660) and 0.387% with fentanyl at 3 pg/ml (95%C/0.329-0.446, P 〈0.001). Conclusion Epidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects. (Chi CTR-TRC-11001559)