Factors influencing agitation during anesthesia recovery after laparoscopic hernia repair under total inhalation combined with caudal block anesthesia

BACKGROUND Laparoscopic hernia repair is a minimally invasive surgery,but patients may experience emergence agitation(EA)during the post-anesthesia recovery period,which can increase pain and lead to complications such as wound reopening and bleeding.There is limited research on the risk factors for this agitation,and few effective tools exist to predict it.Therefore,by integrating clinical data,we have developed nomograms and random forest predictive models to help clinicians predict and potentially prevent EA.AIM To establish a risk nomogram prediction model for EA in patients undergoing laparoscopic hernia surgery under total inhalation combined with sacral block anesthesia.METHODS Based on the clinical information of 300 patients who underwent laparoscopic hernia surgery in the Nanning Tenth People’s Hospital,Guangxi,from January 2020 to June 2023,the patients were divided into two groups according to their sedation-agitation scale score,i.e.,the EA group(≥5 points)and the non-EA group(≤4 points),during anesthesia recovery.Least absolute shrinkage and selection operator regression was used to select the key features that predict EA,and incorporating them into logistic regression analysis to obtain potential pre-dictive factors and establish EA nomogram and random forest risk prediction models through R software.RESULTS Out of the 300 patients,72 had agitation during anesthesia recovery,with an incidence of 24.0%.American Society of Anesthesiologists classification,preoperative anxiety,solid food fasting time,clear liquid fasting time,indwelling catheter,and pain level upon awakening are key predictors of EA in patients undergoing laparoscopic hernia surgery with total intravenous anesthesia and caudal block anesthesia.The nomogram predicts EA with an area under the receiver operating characteristic curve(AUC)of 0.947,a sensi-tivity of 0.917,and a specificity of 0.877,whereas the random forest model has an AUC of 0.923,a sensitivity of 0.912,and a specificity of 0.877.Delong’s test shows no significant difference in AUC between the two models.Clinical decision curve analysis indicates that both models have good net benefits in predicting EA,with the nomogram effective within the threshold of 0.02 to 0.96 and the random forest model within 0.03 to 0.90.In the external model validation of 50 cases of laparoscopic hernia surgery,both models predicted EA.The nomogram model had a sensitivity of 83.33%,specificity of 86.84%,and accuracy of 86.00%,while the random forest model had a sensitivity of 75.00%,specificity of 78.95%,and accuracy of 78.00%,suggesting that the nomogram model performs better in predicting EA.CONCLUSION Independent predictors of EA in patients undergoing laparoscopic hernia repair with total intravenous anesthesia combined with caudal block include American Society of Anesthesiologists classification,preoperative anxiety,duration of solid food fasting,duration of clear liquid fasting,presence of an indwelling catheter,and pain level upon waking.The nomogram and random forest models based on these factors can help tailor clinical decisions in the future.

Observation of the Effects of Anesthesia Recovery Nursing Combined with Heat Preservation Measures in Patients Undergoing General Anesthesia Surgery

Objective:To observe the application effects of anesthesia recovery nursing with heat preservation measures in patients undergoing general anesthesia surgery.Methods:300 cases of general anesthesia surgery patients in our hospital from March 2023 to February 2024 were selected and divided into the control group and the observation group according to the random number table method,each with 150 cases.The control group adopted conventional care,while the observation group was given anesthesia recovery care and heat preservation measures on the basis of conventional care.The wake-up time,extubation time,hospitalization time,and the incidence of adverse reactions were compared between the two groups and statistically analyzed.Results:The wake-up time of patients in the control group was 9.71±1.20 hours,and that of the observation group was 6.51±1.02 hours,with statistically significant differences(P<0.05);the extubation times of patients in the observation group and the control group after awakening were 8.52±0.41 min and 10.42±1.12 min,respectively,with statistically significant differences(P<0.05)The hospital stay after the operation in the observation group and the control group was 32.91±4.71 days and 37.24±3.34 days respectively,and the difference was statistically significant(P<0.05),and the incidence rate of adverse reactions after extubation in the observation group(3.33%)was significantly lower than that in the control group(10.00%)(P<0.05).Conclusion:In general anesthesia surgery patients,the implementation of anesthesia recovery nursing with heat preservation measures can significantly improve the physical condition of patients,effectively shorten the duration of surgery and patients’wake-up time,and improve their quality of life,which is worthy of clinical promotion and application.

Evaluation of the Application Effect of Short Video Combined with BOPPPS Teaching Mode in Clinical Anesthesia Teaching

Objective:To study the application effect of short video combined with BOPPPS teaching mode in clinical anesthesia practice.Method:48 students assigned to clinical anesthesia in digestive endoscopy of Shanxi Bethune Hospital from July 1,2022 to April 1,2023 were selected as research objects.They were randomly divided into the control group(PowerPoint presentation teaching group)and the observation group(short video combined with BOPPPS teaching group),with 24 students in each group.After the internship,the students’theoretical and technical scores were tested,the effects of the two teaching modes were compared,and the students’satisfaction was investigated.Results:The test scores of students in the observation group were significantly better than those in the control group(P<0.05).The short video combined with BOPPPS teaching mode can significantly improve students’learning interest,operation skills,and memory(P<0.05).The students’satisfaction in the observation group was higher than that in the control group(P<0.05).Conclusion:In clinical practice,the application of short video combined with BOPPPS teaching mode has achieved great effect,which is worth further promotion and research.

Neuroprotective effect of bispectral index-guided fast-track anesthesia using sevoflurane combined with dexmedetomidine for intracranial aneurysm embolization

Dexmedetomidine has sedative, anxiolytic, analgesic, anti-sympathetic, and anti-shivering effects. Dexmedetomidine might be effective in combination with sevoflurane for anesthesia, but prospective randomized controlled clinical trials with which to verify this hypothesis are lacking. In total, 120 patients who underwent embolization of an intracranial aneurysm were recruited from Anhui Provincial Hospital and Renmin Hospital of Wuhan University of China and randomly allocated to two groups. After intraoperative administration of 2% to 3% sevoflurane inhalation, one group of patients received pump-controlled intravenous injection of 1.0 ~tg/kg dexmedetomidine for 15 minutes followed by maintenance with 0.3 ~tg/kg/h until the end of surgery; the other group of patients only underwent pump-controlled infusion of saline. Bispectral index monitoring revealed that dexmedetomidine-assisted anesthesia can shorten the recovery time of spon- taneous breathing, time to eye opening, and time to laryngeal mask removal. Before anesthetic induction and immediately after laryngeal mask airway removal, the glucose and lactate levels were low, the S100~ and neuron-specific enolase levels were low, the perioperative blood pressure and heart rate were stable, and postoperative delirium was minimal. These findings indicate that dexmedetomidine can effectively assist sevoflurane for anesthesia during surgical embolization of intracranial aneurysms, shorten the time to consciousness and extubation, reduce the stress response and energy metabolism, stabilize hemodynamic parameters, and reduce adverse reactions, thereby reducing the damage to the central nervous system. This trial was registered at the Chinese Clinical Trial Registry （http：//www.chictr.org. cn/） （registration number： ChiCTR-IPR- 16008113）.

Effects of Dexmedetomidine combined with Sufentanil on the hemodynamics and stress state in the wake of general anesthesia in elderly patients with lower limb fracture surgery

Objective:To study the effects of Dexmedetomidine combined with Sufentanil on hemodynamics, stress state, helper T cytokines and pain degree during the waking period of general anesthesia in elderly patients with lower limb fracture surgery were studied.Methods:From June 2017 to July 2018, 95 elderly patients with lower limb fracture who visited First Affiliated Hospital of Xi 'an Jiaotong University and received fracture surgery and general anesthesia were collected. According to their different anesthesia methods, 46 patients were divided into the sufentanil maintenance anesthesia group (Sufentanil group), and 49 patients were divided into the metopidine combined with sufentanil maintenance anesthesia group (Joint group). Changes in hemodynamics (HR, SpO2, MAP) of the two groups were monitored at different times throughout the operation. Using enzyme-linked immunoassay detection of two groups of patients in maintain anesthesia and anesthesia to stress index (Cor, E, FIns and HOMA-IR). The the changes of pain mediators (NO,β-EP, SP) and helper T cytokines (IFN-γ, TNF-α) were compared between the two groups before and 24 hours after surgery. Results:In the combined group, HR, SpO2, MAP and sufentanil groups showed little change in SpO2 during anesthesia, with no significant difference. The HR and MAP of T2 and T3 in the sufentanil group were significantly higher than those in the combined group at T2 and T3. The stress indicators Cor, E, FIns and HOMA-IR in the anesthesia of the two groups were significantly higher than those in the anesthesia maintenance. The serum stress indexes of Cor, E, FIns and HOMA-IR were significantly lower in the combined group than in the sufentanil group. The IFN-γ level of the combined group was significantly higher than that of the sufentanil group, and the TNF-α level was significantly lower than that of the control group. Serum levels of NO,β-EP and SP were significantly higher in the two groups 24 h after surgery. Serum pain mediators NO,β-EP and SP in the combined group were significantly lower than those in the sufentanil group before and 24 h after surgery.Conclusion: Combined anesthesia with Remifentanil and Propofol can stabilize the hemodynamic state of patients undergoing craniotomy, reduce cardiovascular stress response and inflammatory response, reduce nerve damage, and play a role in brain protection.

A CLINICAL STUDY ON THE SUBTOTAL GASTRECTOMY UNDER ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA OF SMALL DOSAGE

We have performed operations on the patients with perforation of gastric ulcer forsubtotal gastrectomy under acupuncture combined with epidural anesthesia of smaIl dosage （studygroup） or epidural anesthesia only（control gr0up） at rand0m, 2O cases in each group. There is no ob-vious difference of successful rates between tw0 groups （P】O. O5）. But the fluctuation of the bloodpressure of the study group is smaller than that of the control group（PwtO- O1 ）; the comparison of thefluctuations of capacity of vessel and the changes 0f TMwave of ECG before and during operationshows that the study group is better than control gr0up （PrO. O1, P【O. O5, respectively）; in thestudy group, WBC is decreased significantly after operation, while in the control guoup, CRP（C-re-active pr0tein） is markedIy increased, there are significant differences of these indices between twogroups（P【0. 05, respectively）; complement C3, IgA, IgG and IgM are decreased to a different ex- tent after operation in both groups, but the

Study on the Clinical Effect of Dezocine and Remifentanil Combined with Propofol in Anesthesia for Painless Abortion

Objective:To investigate the anesthetic effect of dezocine and remifentanil combined with propofol in painless artificial abortion.Methods:90 cases in total of painlessinduced abortion 1n our hospital from May 2017to May 2020 were retrospectively analyzed,29cases of propofol anesthesia(group A),29cases of dezocine combined with propofol anesthesia(group B),and 32 cases of remifentanil combined with propofol anesthesia(group C)were compared the anesthesia situation.Resuits:Compared with the cases in group A,the incidence of pain,body movement and sPo,90oat the injection site were lower in group B and group C,the use of propofol was reduced,and the VAS scores were lower when the patients begin to awake,and the efficiency was higher than that in group A(P<0.05);there was no statistic difference in the changes of SBP,DBP and HR index data in the operation time,postoperative awake time,and preoperative,intraoperative and postoperative time points of the three groups(P<0.05).Conclusion:Dezocine and remifentamil combined with propofol for painless artificial abortion anesthesia has more significant effect than propofol anesthesia alone,which can relieve patients'pain and reduce the chance of respiratory depression.

Investigating the application value of propofol combined with sufentanil and dexmedetomidine in cosmetic anesthesia

Objective:To investigate the effects of propofol combined wit h s u f e n t a n i l a n d dexmedetomidine in cosmetic anesthesia.Methods:The clinical data of 40 plastic surgery patients admitted to the hospital from June to November 2019 were retrospectively analyzed.According to the different anesthesia methods during surgery,they were divided into control group(propofol combined with sufentanil and normal saline,20 cases)and was compared with the observation group(propofol combined with sufentanil and dexmedetomidine,20 cases).The anesthetic effect,total dosage of propofol,spontaneous breathing recovery time,and adverse reactions were compared between the two groups.Results:The total dosage of propofol in the observation group was less than that in the control group,and the spontaneous breathing recovery time was shorter than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in the anesthetic effect and adverse reaction rate between the two groups(P>0.05).Conclusion:The application of propofol in combination with sufentanil and dexmedetomidine in cosmetic anesthesia can reduce the dosage of propofol,speed up the anesthesia recovery,and have better anesthetic effect and safety.

Protective effect of methylprednisolone combined with ulinastatin pretreatment on inflammatory lung injury induced by anesthesia for esophageal cancer

Objective:To investigate the protective effect of methylprednisolone combined with ulinastatin pretreatment on inflammatory lung injury induced by single-lung ventilation.Methods: A total of 120 patients with radical resection of cancer surgery admitted to our hospital from January 2016 to December 2017 were randomly divided into control group, methylprednisolone group, ulinastatin group, and methylprednisolone combined with ulinastatin pretreatment group. Before single lung ventilation (T0), 30 min after ventilation (T1), and 60 min (T2) after the end of ventilation, enzyme-linked immunosorbent kit method was used to detect the levels of inflammatory factors TNF-α, IL-8 and IL-10. The mean airway pressure (Pmean) at each monitoring point and the oxygenation indexes (PaO2/FiO2) before and after surgery were detected. And also, the extraction time, drainage volume and sputum volume of the drainage tube after surgery were measured.Results:Compared with the control group, the other three groups can reduce the levels of TNF-α and IL-8 in the blood of patients with esophageal cancer, improve IL-10 and increase the oxygenation index (P<0.05). However, methylprednisolone combined with ulinastatin pretreatment group was significantly better than methylprednisolone group and ulinastatin group in reducing serum inflammatory factor levels and increasing oxygenation index. In addition, the drainage tube extraction time, drainage volume and sputum volume of the patients treated with methylprednisolone combined with ulinastatin were also significantly lower than those of the control group, the methylprednisolone group and the ulinastatin group.Conclusions: Methylprednisolone combined with ulinastatin has a synergistic protective effect on inflammatory lung injury caused by radical resection of esophageal cancer patients, which is worthy of first-line clinical recommendation.

The Safety and Feasibility of Low-Molecular-Weight He-parin Prophylaxis in Major Abdominal Surgery Combined with Neuraxial Anesthesia

Background: Global guidelines for venous thromboembolism (VTE) prophylaxis of patients undergoing major surgery are well established. However, their applicability and safety in patients receiving neuraxial anesthesia is unproven. We sought to evaluate the safety and feasibility of chemical VTE prophylaxis in a prospective group of patients undergoing major foregut procedures under a combination of epidural and general anesthesia. Methods: A prospective database of all patients undergoing major foregut surgery from 2004-2009 was maintained and analyzed. Epidural catheters were placed pre-operatively and used for post-operative analgesia for three days in all patients. Factors evaluated included age, ethnicity, sex, length of stay, duration of epidural placement, complications of epidural placement and post-operative management, and VTE events. A uniform protocol was followed regarding the timing of low-molecular-weight heparin (LMWH) administration with epidural catheter insertion/removal. Results: A total of 237 patients formed the study group. The mean age was 57 years (range, 19 - 88) among 121 (51.1%) women and 65 years (range, 20 - 95) among 116 (48.9%) men. One hundred and sixty-six patients were Caucasian (70%), 37 Black (15.6%), 15 Hispanic (6.3%), 12 Asian/Pacific (5.1%), and 7 other (3%). All epidural catheters were removed on the third post-operative day. There were a total of five VTE (2.1%) events postoperatively. No peri-operative or post-operative epidural catheter associated complications occurred. Conclusions: Concomitant epidural catheterization and LMWH anticoagulation is safe and feasible in major abdominal surgery patients, including those undergoing major hepatic resection. Guidelines for VTE prophylaxis and LMWH administration in the setting of neuraxial anesthesia are well established and applicable to this unique patient population.

Effects of acupuncture combined with drug anesthesia on stress reaction and cognitive function in senior patients with total hip arthroplasty

Objective: To investigate the effects of acupuncture combined with anesthesia on stress and cognitive function in senior patients with total hip arthroplasty. Methods: A total of 89 patients who underwent total hip replacement between January 2016 and May 2018 were collected. According to whether acupuncture anesthesia was applied during total hip replacement, the patients were divided into acupuncture combined anesthesia group and drug anesthesia group. Fasting venous blood (3mL) was collected before the operation without electrical stimulation and after the operation. Cortisol (Cor) and β-endorphin (β-EP) were detected by radioimmunoassay, and neuron-specific enolase (NSE) was detected by electrochemical luminescence immunoassay. The levels of s-100β protein (s-100β), c-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) were determined by ELISA. Flow cytometry was used to determine the ratio of T cell subsets (CD3+) and natural killer cells (NK cells) in the blood. Results: The levels of Cor, β-EP, NSE, S-100β, CRP, TNF-α and the ratio of NK cell, CD3+ between the two groups have no significant differences before operation (P>0.05). Serum levels of Cor, β-EP, NSE, S-100β, CRP and TNF-α in patients in the acupuncture combined with drug anesthesia group and the single drug anesthesia group were significantly higher than those before surgery (P<0.05). In addition, serum levels of Cor, β-EP, NSE, S-100β, CRP, TNF-α in the acupuncture combined with anesthesia group were significantly lower than those in the drug group alone (P<0.05). There was no significant difference in NK cell and CD3+ ratio between postoperative and preoperative in the acupuncture combined with drug anesthesia group (P>0.05). The ratio of NK cells and CD3+ in the pure drug anesthesia group was significantly lower than that before surgery (P<0.05). Conclusion: Acupuncture combined with drug anesthesia can effectively reduce the inflammatory stress response of patients undergoing total hip arthroplasty, relieve the immune suppression caused by surgery and anesthesia, reduce the damage to the nervous system, and have a good influence in the cognitive function of the senior patients.

Comparative Study between General Anesthesia versus General Anesthesia Combined with Thoracic Epidural Analgesia on Cytokine Response in Laparoscopic Cholecystectomy Patients

Background and Objectives: The main benefits of laparoscopic surgery in comparison to open surgery involve the rapid discharge from recovery room, decreased postoperative hospital stays, reduced postoperative discomfort, easier getting back to work and faster return to ordinary daily life as well as cosmetic surgical wounds. The anesthesia type has an essential role in attenuation of the surgical stress and achievement of these advantages. We aimed to determine the outcome of giving general anesthesia in conjunction with thoracic epidural analgesia (TEA) compared to general anesthesia alone on stress response to surgery and anesthesia by investigating cytokine reaction (interleukin 6 and 8 levels), hemodynamic changes (BP, HR, RR, SPO2), and Visual Analogue Scale (VAS) scores postoperatively in patients subjected for laparoscopic cholecystectomy. Methods: This study included 40 patients aged 20 - 60 years old with American Society of Anesthesiologists physical status (ASA) I and II. They were planned for laparoscopic cholecystectomy at Aswan University Hospital from April 2017 to March 2018. They were randomly allocated into two groups. Group A (n. 20) received general anesthesia only and Group B (n. 20) received general anesthesia in conjunction with thoracic epidural analgesia using fentanyl and bupivacaine in the epidural catheter. Chi-square was applied to differentiate categorical variables, whereas comparison between continuous variables was done by using t-test. Two-tailed p < 0.05 was estimated as statistically significant. Results: As regards IL-6 and IL-8 post-operative there is significant difference (p < 0.05) between two groups during 2nd and 4th hr and 24th hr postoperative, with significantly increased postoperative levels of IL-6 and IL-8 in comparison to their preoperative baseline values. The largest increase in IL6 & IL8 levels was in group A (GA group). VAS score showed significant lower values in TEA group in comparison to GA group. No significant difference between groups as regard intraoperative and postoperative hemodynamic changes. Conclusion: Regional techniques including TEA attenuate and decrease cytokine reaction secondary to surgery which decreases inflammatory process and improves patient outcome and reduces pain score postoperatively.

Effect of CBL Combined with Case Analysis in the Teaching of Clinical Anesthesia

Objective:To evaluate the effect of CBL(case-based learning)combined with case analysis in the teaching of clinical anesthesia.Methods:From June 2018 to June 2020,a total of 100 clinical anesthesia interns in Shaanxi Provincial People’s Hospital were selected as the research subjects.They were divided into two groups,the reference group(50 interns)and the study group(50 interns),by random sampling method.The reference group was under the traditional teaching method,whereas for the study group,CBL combined with case analysis was implemented.The teaching satisfaction and achievement of the interns in both the groups were evaluated.Results:The teaching satisfaction of the study group was 98%,which was significantly higher than that of the reference group(86%)(P<0.05);before teaching,there was no significant difference in the theoretical and clinical practice scores between the two groups(P>0.05);however,after teaching,the theoretical and clinical practice scores of the two groups increased significantly,in which the change of the research group was significantly greater than that of the reference group(P<0.05).Conclusion:The application of CBL combined with case analysis in the teaching of clinical anesthesia has an ideal effect,improving the teaching satisfaction and achievement.It is a high-quality teaching method and is worthy of application.

Peripheral Nerve Block Combined with Epidural Anesthesia for Incarcerated Inguinal Hernia Repair in a Patient with Severe Chronic Obstructive Pulmonary Disease: A Case Report

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.

SUMMARY OF CLINICAL STUDY ON ACUPUNCTURE COMBINED WITH EPIDURAL ANESTHESIA FOR CHOLECYSTECTOMY

Objective: TO study clinical effect and anesthetic method of acupuncture anesthesia combined with epidural administration of small dose of anesthetic for cholecystectomy. Methods: A total of 194 cases of cholecystectomy patients were randomly divided into acupuncture combined with epidural anesthesia group (group A, n = 66), acupoint-skin electrical stimulation combined with epidural anesthesia group (group B, n = 63) and simple epidural anesthesia group (group C, n=65). Observations were conducted using single-bland method. Bilateral Neiguan (PC 6) and Zusanli (ST 36) were punctured and stimulated electrically in group A and only stimulated electrically via cutaneous electrodes in group B. Epidural anesthetic used was 1.5% Lidocaine and the anesthetic level was controlled to reach T4-11 . Results: The class-I (excellent) rates of group A, B and C were 75.76%, 60.32% and 13.85% respectively, showing significant differences between group A and C and group B and C (P <0.001). The initial dose, doses of every hour and every case of group A and B were lower than those of group C. The dose of every hour of group C was 36.23% and 3. 75% higher then group A and B respectively (P < 0. 001), suggesting that acupuncture or acupoint-skin electrical stimulation could strengthen anesthetic effect and reduce the dose of epidural anesthetic. During operation, indexes of the life signs as HR, MAP, RR, TV, MV, SpO2 and ECG kept basically stable and all patients in group A passed surgical operation safely. Conclusion: Acupuncture or acupoint-skin electrical stimulation combined with epidural anesthesia can be used as one of the anesthetic methods for cholecystectomy.

Meta analysis of application of acupuncture combined with drug anesthesia in anorectal surgery

Objective:To evaluate the effectiveness and safety of acupuncture combined drug anesthesia and simple drug anesthesia in anorectal surgery.Methods:The randomized controlled trials of acupuncture combined with drug anesthesia was evaluated using Cochrane systematic review method.The search scope was China National Knowledge Internet,wanfang database,China Biomedical Literature,Pubmed and Embase.The deadline was December 31,2018.The randomized controlled trials of acupuncture combined with anesthesia that met the inclusion criteria were selected.In terms of trial quality evaluation,Cochrane risk bias was used for evaluation.Finally,RevMan 5.2 software was used for statistical analysis.Results:This study finally included 15 articles,a total of 1321 patients.The heterogeneity of significant rate was good,and the combined effect amount OR was 3.55(95%CI[2.06,6.12]).The combined effect quantitative test(Z=4.57,P<0.00001)showed that there was a statistical significance,indicating that acupuncture combined drug anesthesia was better than simple anesthesia in anorectal surgery.The heterogeneity of adverse reactions was good,and the combined effect test(Z=8.88,P<0.00001)showed that there was a statistical significance,indicating that the adverse reaction rate of acupuncture combined with drug anesthesia was lower than that of simple drug anesthesia in the anorectal surgery.Conclusion:Compared with simple drug anesthesia,acupuncture combined with drug anesthesia can improve the anesthesia effect and reduce the occurrence of adverse reactions in anorectal surgery.

Clinical study of acupuncture combined with surface anesthesia using proparacaine in geriatric cataract phacoemulsification

BACKGROUND During anesthesia administration for cataract surgery,low pH of proparacaine may induce pain or complications such as corneal damage and poor wound healing,with the use of additional drops intraoperatively increasing the risk of complications.Accordingly,there is a clinical need for adjuncts to local anesthesia needs to improve the efficiency of anesthesia and reduce the required amount of intraoperative proparacaine.AIM To identify a method of anesthesia for geriatric cataract phacoemulsification that provides more efficient analgesia and improves clinical efficacy.METHODS A total of 130 geriatric patients with cataracts who attended Hebei Eye Hospital from December 2020 to December 2022 were included in the present study.Patients were divided into the proparacaine surface anesthesia(SA)group(65 cases)and the compound acupuncture-medicine anesthesia group(CAMA group,65 cases).Patients in the CAMA group were provided acupuncture analgesia in addition to SA.Preoperative anxiety[Self-Rating Anxiety Scale(SAS)score and state anxiety inventory(SAI)score],intraoperative stress,vital signs,analgesia,and cooperation,as well as postoperative adverse events,were compared between groups.RESULTS More marked reductions in anxiety were observed among patients in the CAMA group,with corresponding reductions in SAS and SAI scores.During the operation,no change in the secretion of E,NE,or Cor group compared to the preoperative period was observed in the CAMA,which was markedly lower than that in the SA group.Heart rate,blood pressure,and respiratory rate were more stable intraoperatively in the CAMA group.In addition,the incidence of intraoperative pain and the number of additional doses of anesthesia required in the CAMA group were markedly lower than in the SA group.Accordingly,patients in the CAMA group were able to avoid eye movements and eyelid closing leading to greater cooperation with surgeons during surgery.Furthermore,marked reductions in intraoperative adverse effects were observed in the CAMA group,indicating greater overall safety.CONCLUSION Proparacaine SA combined with acupuncture as an analgesic provides improved analgesia with greater safety compared to surface anesthesia with proparacaine during geriatric cataract phacoemulsification.

Influence of general anesthesia combined with epidural anesthesia on adrenal cortex, stress factors and immunologic function in patients with lung cancer

Objective: To observe the influence of general anesthesia combined with epidural anesthesia on adrenal cortex, stress factors and immunologic function in patients with lung cancer. Methods:A total of 60 patients with lung cancer were randomly divided into two groups: observation group (30 cases) and control group (30 cases). Observation group: general anesthesia combined with epidural anesthesia;control group: patients were treated only by general anesthesia. Recording and comparing the levels of Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS and immunologic function before and after treatment. Results: (1) Before treatment, there was no statistically significant difference in the serum Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS levels between the two groups. After treatment, the serum Ang-Ⅱ, Cor, AD, MDA, GC, ALDO, 17-OH, 17-KS levels of the two groups were significantly lower than those of the same group before treatment, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. (2) Before treatment, there was no statistically significant difference in CD4+, CD8+, CD4+/CD8+between the two groups. After treatment, the CD4+, CD4+/CD8+ of the two groups were significantly lower than those of the same group before treatment, the CD8+ of the two groups were significantly higher, and those levels of observation group were significantly better than the control group, there was significant difference between the two groups. Conclusion:General anesthesia combined with epidural anesthesia for patients with lung cancer can perfect the levels of serum adrenal cortical hormone, stress factors and be beneficial to protect their immunologic function.

CLINICAL SUMMARY ON ACUPUNCTURE COMBINED WITH ENFLURANE-INHALATION ANESTHESIA FOR RESECTION OF ESOPHAGEAL CARCINOMA

Objective: To observe the clinical effect of acupuncture combined with general anesthesia by inhaling enflurane for esophageal carcinoma resection. Methods: 120 cases of esophageal carcinoma patients were randomly divided into acupuncture+inhalation of enflurane (A+IE, n=40), electrical stimulation (ES)+IE (n=41) and IE (control, n=39) groups. In all the 3 groups, vecuronium, fentanyl, propofol (same dose) were given intravenously to induce anesthesia before operation, and during operation, fentanyl (2 ug/kg/hr) and vecuronium (0.03 mg/kg/0.5hr) and appropriate concentration of enflurane were given to the patients for maintaining anesthesia and muscular relaxation. In group A, Xiayifeng (below TE 17), Sanyangluo (TE 8) to Ximen (PC 4) were punctured and stimulated electrically, and in group B, these acupoints were stimulated electrically via cutaneous plate electrodes. Results: The anesthetic effect grade I rates of A+IE, ES+IE and IE groups were 67.50%, 68.29% and 28.21% respectively. There was a significant difference between A+IE or ES+IE and IE groups (P<0.001). In the process of anesthesia, the mean concentrations of the inhaled enflurane in A +IE, ES+IE and IE groups were 0.55% and 0.50% and 0.83% separately. The average concentrations of A+IE and ES+IE groups were lower 33.73% and 39.76% than that of group IE (P<0.005). Conclusion: Acupuncture combined with enflurane inhalation can enhance anesthetic effect, reduce the dose of the inhaled enflurane.

Effects of Remifentanil combined with Propofol anesthesia on neurological function, inflammatory response and stress state in patients undergoing craniotomy

Objective:In this study, the effects of combined anesthesia with Remifentanil and Propofol on the hemodynamics and stress state indexes at different times in patients undergoing craniotomy were studied, and the effects of combined anesthesia with Remifentanil and Propofol on neurological function and inflammatory response in patients undergoing craniotomy were explored.Methods:A total of 92 patients who underwent craniotomy in our hospital from January 2017 to February 2019 were collected and divided into observation group and control group according to their anesthesia methods. 45 patients in the control group received propofol to maintain anesthesia. In the observation group, 47 cases were treated with remifentanil combined with propofol to maintain anesthesia. Changes in hemodynamics (HR, SpO2, MAP) of the two groups were monitored at different times throughout the operation. At the same time by ria method detection in patients with two groups of T0, T1, T2, T3, T4 in serum stress state index (AngⅡ, NE, ALD) changes. The changes of nerve function indexes (NSE, S100) and inflammatory factors (CRP, TNF-α) before and after surgery were compared between the two groups.Results:There were no significant differences in hemodynamics and stress state indicators of T0 between the two groups, and there were no significant differences in preoperative inflammatory reaction and neurological function indicators between the two groups. In the observation group, the changes of HR, SpO2 and MAP at each time point during the operation were less than those in the control group, and the hemodynamic state of the observation group was more stable than that of the control group. The level of AngⅡ, NE, ALD in Control patients in T1, T2, T3, T4 were higher than T0. The level of AngⅡ, NE, ALD of the two groups in T1, T2, T3, T4 are higher than T0. Observation group of patients with T1, T2, T3, T4 AngⅡ level obviously is higher than the control group with time. In the observation group, the levels of NE and ALD were higher at T2, T3 and T4 than at T0. The levels of NE and ALD in T3 and T4 were lower in the observation group than in the control group. Postoperative neurological function (NSE, S100) and inflammatory factors (CRP, TNF-α) were significantly higher in the two groups than in the control group.Conclusion: Combined anesthesia with Remifentanil and Propofol can stabilize the hemodynamic state of patients undergoing craniotomy, reduce cardiovascular stress response and inflammatory response, reduce nerve damage, and play a role in brain protection.