The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output （CO） and incidence of hypotension in elderly patients under spinal anesthesia （SA）. A randomized, double...The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output （CO） and incidence of hypotension in elderly patients under spinal anesthesia （SA）. A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement （THR）, who were randomized to three groups： the control group （C group, n = 15）, crystalloid （RS group, n =16） and colloid group （HES group, n = 16）. An intravenous preload of 8 mL/kg of either lactated Ringer’s solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline （P 0.01）. Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respec-tively （P = 0.362）. Intravascular volume preload with colloid is more effective than crystalloid solution in main-taining CO, which may be improved the hemodynamic stability in elderly patients during SA.展开更多
Objective of this investigation is to further analyze the cardiac function status change by phonocar-diogram during mixed anesthesia which is conducted by midazolam,skelaxin,fentanyi and propofol.The results show that...Objective of this investigation is to further analyze the cardiac function status change by phonocar-diogram during mixed anesthesia which is conducted by midazolam,skelaxin,fentanyi and propofol.The results show that blood pressure,heart rate,amplitude of R wave and T wave,amplitude of first heart sound（S1）and second heart sound（S2）about 37 subjects after anesthesia decrease compared with baseline,while the ratio of first heart sound and second heart sound（S1/S2）and the ratio of diastole duration and systole duration（D/S）increase.Our study demonstrates that phonocardiogram as a noninvasive,high benefit/cost ratio,objective,repeatable and portable method can be used for the monitoring and evaluation of cardiac function status during anesthesia and operations.展开更多
Objective To explore the mechanism of effects o f cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF)and left cardiac cavity size of patie nts with dilated cardiomyopathy.Method121consecutive pa...Objective To explore the mechanism of effects o f cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF)and left cardiac cavity size of patie nts with dilated cardiomyopathy.Method121consecutive patients with dilat ed cardiomyopathy were divided into cardiac sympathetic nerve blockade group(TEAgroup)and control group(c group).In TEAgroup,5%lidocaine was injected into thoracic epidural cavity for about 4to 8weeks in addition with routine therapy.In c group,only routine therapy was use d.We observe the changes of LVEF and left cardiac cavity size before a nd after treatment in both groups.Result I n TEAgroup,after anesthesia,LVEF w as increased from(31.3±12.8)to(47.3±21.3),P <0.001;left ventricular end -dia stolic diameter was reduced from(69.1±7.1)to(65.1±8.0),P <0.001;left atrial diameter was decreased from(44.0±6.2)to(39.4±7.2),P <0.001.Conclusion Cardiac sympathetic anesthesia can effectively improve the ejectio n performance of dilated cardiomyopathy and make the dilated cardiac cavity turn to normal level.展开更多
BACKGROUND: Cardiac output monitoring is important for critical patients. This study aimed to determine the delayed response of continuous cardiac output (CCO) thermodilution measurement, whether CCO and bolus cardiac...BACKGROUND: Cardiac output monitoring is important for critical patients. This study aimed to determine the delayed response of continuous cardiac output (CCO) thermodilution measurement, whether CCO and bolus cardiac output (BCO) thermodilution agree sufficiently to be used interchangeably, and whether CCO monitoring is reliable for patients undergoing liver transplantation. METHODS: Thirteen patients undergoing liver transplantation without veno-venous bypass were studied (37-66 years old, weight 46-75 kg). Continuous and bolus thermodilution measurements were performed at predefined time points using an 'Opti-Q' SvO(2)/CCO monitor (Abbott Laboratories, North Chicago, IL, USA). Bias and 95% limits of agreement were calculated according to Bland and Altman analysis. The limits of agreement by which two methods are judged to be interchangeable were defined in advance as +/-(13%X BCO(mean)) L/min. The repeatability and relative error of CCO, and the differences between CCO and the mean of the two measurements were calculated. RESULTS: Cardiac output measurements yielded 196 data pairs with ranges of 1.9 to 17.9 L/min for CCO and 2.1 to 18.3 L/min for BCO. The response time of CCO was delayed in the early phases after caval clamping and after reperfusion. At most of the measurement points, bias and 95% limits of agreement were -0.18 +/- 1.91 L/min. 95% limits of agreement did not fall within the predetermined limits of agreement of +/- 1.14 L/min. The repeatability coefficient of CCO was 0.36 L/min and the relative error was 4.6 +/- 4.7%. The mean difference between CCO and the average of the two methods was -0.09 L/min (0.49 L/min). CONCLUSIONS: In patients undergoing liver transplantation, the delayed response of CCO limits its application during the early phases after caval clamping and after reperfusion of the graft. The two methods are not interchangeable even in hemodynamic stability. Continuous thermodilution monitoring, however, is reliable or acceptable for clinical purposes.展开更多
Brugada’s Syndrome (BrS) is a rare but highly risky medical condition. It is a genetic disorder that may result in Ventricular Fibrillations (VF) that can lead to sudden cardiac arrest. The highest possible standards...Brugada’s Syndrome (BrS) is a rare but highly risky medical condition. It is a genetic disorder that may result in Ventricular Fibrillations (VF) that can lead to sudden cardiac arrest. The highest possible standards of safety in anesthetic medications must be followed and adequate measures must be taken with sufficient monitorization in patients with BrS. We wanted to mention the importance of monitorization in the early detection of possible complications and a careful follow-up even though no administration of anesthetic medication is present.展开更多
The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different p...The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety.展开更多
文摘The aim of the present study was to compare the effects of colloid and crystalloid preload on cardiac output （CO） and incidence of hypotension in elderly patients under spinal anesthesia （SA）. A randomized, double-blinded study was conducted including 47 elderly patients undergoing scheduled total hip replacement （THR）, who were randomized to three groups： the control group （C group, n = 15）, crystalloid （RS group, n =16） and colloid group （HES group, n = 16）. An intravenous preload of 8 mL/kg of either lactated Ringer’s solution in the RS group or 6% hydroxyethyl starch in the HES group was infused within 20 min before SA induction, while no intravenous preload was given in the C group. There was a trend of decrease in CO and systolic blood pressure after SA with time in the C group. In the RS and HES groups, CO increased significantly after fluid preloading as compared with baseline （P 0.01）. Thereafter, CO remained higher than baseline until 30 min after SA in the HES group. The change of systolic blood pressure was similar to CO, but no significant difference from baseline was observed in each group. Hypotension occurred in 3 patients in the C group and one each in the RS and HES group, respec-tively （P = 0.362）. Intravascular volume preload with colloid is more effective than crystalloid solution in main-taining CO, which may be improved the hemodynamic stability in elderly patients during SA.
基金supported by the National Nature Science Foundation of China under Grant No. 30400105973 Project under Grant No. 2003CB716106Outstanding Youth Fund of China under Grant No. 30525030
文摘Objective of this investigation is to further analyze the cardiac function status change by phonocar-diogram during mixed anesthesia which is conducted by midazolam,skelaxin,fentanyi and propofol.The results show that blood pressure,heart rate,amplitude of R wave and T wave,amplitude of first heart sound（S1）and second heart sound（S2）about 37 subjects after anesthesia decrease compared with baseline,while the ratio of first heart sound and second heart sound（S1/S2）and the ratio of diastole duration and systole duration（D/S）increase.Our study demonstrates that phonocardiogram as a noninvasive,high benefit/cost ratio,objective,repeatable and portable method can be used for the monitoring and evaluation of cardiac function status during anesthesia and operations.
文摘Objective To explore the mechanism of effects o f cardiac sympathetic anesthesia on left ventricular ejection fraction(LVEF)and left cardiac cavity size of patie nts with dilated cardiomyopathy.Method121consecutive patients with dilat ed cardiomyopathy were divided into cardiac sympathetic nerve blockade group(TEAgroup)and control group(c group).In TEAgroup,5%lidocaine was injected into thoracic epidural cavity for about 4to 8weeks in addition with routine therapy.In c group,only routine therapy was use d.We observe the changes of LVEF and left cardiac cavity size before a nd after treatment in both groups.Result I n TEAgroup,after anesthesia,LVEF w as increased from(31.3±12.8)to(47.3±21.3),P <0.001;left ventricular end -dia stolic diameter was reduced from(69.1±7.1)to(65.1±8.0),P <0.001;left atrial diameter was decreased from(44.0±6.2)to(39.4±7.2),P <0.001.Conclusion Cardiac sympathetic anesthesia can effectively improve the ejectio n performance of dilated cardiomyopathy and make the dilated cardiac cavity turn to normal level.
文摘超快通道麻醉(ultra-fast-track anesthesia,UFTA)指在手术后立即恢复患者的自主呼吸并拔除气管导管,已成为心脏外科手术的一个重要议题。这种方法旨在通过缩短机械通气时间,降低术后并发症的风险,加快康复进程,从而优化医疗资源的使用并改善患者的预后。本综述围绕加强康复外科(enhanced recovery after surgery,ERAS)的理念,探讨UFTA在心脏手术中的应用,分析其优点、潜在风险与局限性,并探索现有研究进展和未来的发展方向,以便为临床实践和未来研究提供指导和启示。
文摘BACKGROUND: Cardiac output monitoring is important for critical patients. This study aimed to determine the delayed response of continuous cardiac output (CCO) thermodilution measurement, whether CCO and bolus cardiac output (BCO) thermodilution agree sufficiently to be used interchangeably, and whether CCO monitoring is reliable for patients undergoing liver transplantation. METHODS: Thirteen patients undergoing liver transplantation without veno-venous bypass were studied (37-66 years old, weight 46-75 kg). Continuous and bolus thermodilution measurements were performed at predefined time points using an 'Opti-Q' SvO(2)/CCO monitor (Abbott Laboratories, North Chicago, IL, USA). Bias and 95% limits of agreement were calculated according to Bland and Altman analysis. The limits of agreement by which two methods are judged to be interchangeable were defined in advance as +/-(13%X BCO(mean)) L/min. The repeatability and relative error of CCO, and the differences between CCO and the mean of the two measurements were calculated. RESULTS: Cardiac output measurements yielded 196 data pairs with ranges of 1.9 to 17.9 L/min for CCO and 2.1 to 18.3 L/min for BCO. The response time of CCO was delayed in the early phases after caval clamping and after reperfusion. At most of the measurement points, bias and 95% limits of agreement were -0.18 +/- 1.91 L/min. 95% limits of agreement did not fall within the predetermined limits of agreement of +/- 1.14 L/min. The repeatability coefficient of CCO was 0.36 L/min and the relative error was 4.6 +/- 4.7%. The mean difference between CCO and the average of the two methods was -0.09 L/min (0.49 L/min). CONCLUSIONS: In patients undergoing liver transplantation, the delayed response of CCO limits its application during the early phases after caval clamping and after reperfusion of the graft. The two methods are not interchangeable even in hemodynamic stability. Continuous thermodilution monitoring, however, is reliable or acceptable for clinical purposes.
文摘Brugada’s Syndrome (BrS) is a rare but highly risky medical condition. It is a genetic disorder that may result in Ventricular Fibrillations (VF) that can lead to sudden cardiac arrest. The highest possible standards of safety in anesthetic medications must be followed and adequate measures must be taken with sufficient monitorization in patients with BrS. We wanted to mention the importance of monitorization in the early detection of possible complications and a careful follow-up even though no administration of anesthetic medication is present.
文摘The increasing scope of interventions in the cardiac catheterization laboratory (CCL) and electrophysiological laboratory (EPL) has resulted in new challenges for the anaesthesia teams where they deal with different patient categories, complications and safety issues. Collaboration and planning between cardiologist and anaesthesiologist are required for both patient safety and procedural success. This review aims to discuss procedures performed in interventional cardiology and the importance of anaesthesiologists in managing such patients. Percutaneous interventions are being increasingly performed in adult as well as in pediatric patients. Procedures are usually done under mild to moderate sedation. General anaesthesia is required in certain conditions and also in pediatric patients. Knowledge of echocardiography, individual disease condition and fluoroscopy is important. Anaesthesiologists are assuming an increasingly important role in the multidisciplinary management of complex patients and interventions. A comprehensive understanding of procedures is essential to provide a high level of anaesthetic care and maintain patient safety.
