Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neur...Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neurosur-gery and an appropriate degree of PaCO2 during neuroanesthesia. Methods: One hundred and fourteen patients with supratentorial tumors for elective craniotomy, ASA grade I - II , were randomly allocated to six groups. Patients were anesthetized with continuous intravenous infusion of 2% procaine 1. 0 mg · kg-1 · min-1 in Group I , inhalation of 1. 0% - 1. 5% isoflurane in Group II , and infusion of 2% procaine 0. 5 mg·kg · min-1 combined with inhalation of 0.5% -0.7% isoflurane in Group III during the period of study. The end-tidal pressure of CO2(PET CO2 ) was maintained at 4.0 kPa in these 3 groups. In Group IV, V and VI, the anesthetic technique was the same as that in Group I but the PETCO2 was adjusted to 3. 5, 4. 0 and 4. 5 kPa respectively for 60 min during which the study was performed. The radial arterial and retrograde jugular venous blood samples were obtained at the onset and the end of this study for determining jugular venous bulb oxygen saturation ( SjvO2 ) , arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2). Results: In Group I and I SjvO2, AVDO2 and CEO2 remained stable. Although SjvO2 kept constant, AVDO2 and CEO2 decreased significantly (P <0. 05) in Group II. Moreover, AVDO2 and CEO2 in Group II were significantly lower than those of Group III (P<0. 05). In Group IV, 60 min after hyperventilation, SjvO2 and jugular venous oxygen content ( CjvO2 ) decreased markedly (P < 0. 01 ) while CEO2 increased significantly ( P <0.01) . In addition, SjvO2, CjvO2 and CEO2 in Group IV were significantly different from the corresponding parameters in Group V and Group VI (P <0. 05) . In view of sustained excessive hyperventilation, SjvO2 was less than 50% in 37.5% patients of Group IV. Conclusion: Anesthesia with intravenous infusion of procaine combined with isoflurane inhalation proved to be more suitable for neurosurgery than procaine intravenous anesthesia or isoflurane inhalation anesthesia alone. PaCO2 at 4.0 -4. 5 kPa in patients undergoing craniocerebral surgery during neuroanesthesia would be beneficial in both decreasing ICP and maintaining cerebral oxygen supply/consumption balance.展开更多
Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been succe...Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been successfully applied in clinical guidance. Regional oxygen saturation is usually referred to as regional cerebral oxygen saturation (rScO2) and regional tissue oxygen saturation (rStO2) depending on the site of monitoring. Initially, cerebral oxygen saturation monitoring has been used in cardiothoracic surgery and in non-cardiac surgery for elderly and critically ill patients. With the increase of clinical application, regional oxygen saturation is gradually extended to the determination of oxygen saturation in peripheral tissues, which is used to evaluate the relationship between peripheral tissue microcirculation function and the prognosis of patients. Timely detection of tissue ischemia and hypoxia and intervention can optimize the whole clinical treatment management, especially for major surgery and critically ill patients can reduce the incidence of complications during hospitalization, shorten hospitalization time, improve the prognosis of patients. This article will focus on the clinical application of cerebral oxygen saturation and tissue oxygen saturation in perioperative period.展开更多
BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer pa...BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer patients.However,due to age-related physiological changes,especially a decline in cognitive function,older patients are more susceptible to the effects of surgery and anesthesia,increasing the relative risk of postoperative cognitive dysfunction(POCD).There-fore,in the surgical treatment of elderly patients with colon cancer,it is of pa-ramount importance to select an appropriate anesthetic approach to reduce the occurrence of POCD,protect brain function,and improve surgical success rates.METHODS One hundred and seventeen patients with colon cancer who underwent elective surgery under general anesthesia were selected and divided into two groups:A and B.Group A received Dex before anesthesia induction,and B group received an equivalent amount of normal saline.Changes in the mini-mental state exami-nation,regional cerebral oxygen saturation(rSO2),bispectral index,glucose uptake rate(GluER),lactate production rate(LacPR),serum S100βand neuron-specific enolase(NSE),POCD,and adverse anesthesia reactions were compared between the two groups.RESULTS Surgical duration,duration of anesthesia,and intraoperative blood loss were comparable between the two groups(P>0.05).The overall dosage of anesthetic drugs used in group A,including propofol and remifentanil,was significantly lower than that used in group B(P<0.05).Group A exhibited higher rSO2 values at the time of endotracheal intubation,30 min after the start of surgery,and immediately after extubation,higher GluER values and lower LacPR values at the time of endotra-cheal intubation,30 min after the start of surgery,immediately after extubation,and 5 min after extubation(P<0.05).Group A exhibited lower levels of serum S100βand NSE 24 h postoperatively and a lower incidence of cognitive dysfunction on the 1st and 5th postoperative days(P<0.05).CONCLUSION The use of Dex in elderly patients undergoing radical colon cancer surgery helps maintain rSO2 Levels and reduce cerebral metabolic levels and the incidence of anesthesia-and surgery-induced cognitive dysfunction.展开更多
基金Supported by the"Tenth five-year-plan"Medical Science Foundation of PLA(NO.01M118 to Dr.CHEN).
文摘Objective: To assess the effects of various anesthetic techniques and PaCO2 levels on cerebral oxygen supply/consumption balance during craniotomy for removal of tumors, and to explore an anesthetic technique for neurosur-gery and an appropriate degree of PaCO2 during neuroanesthesia. Methods: One hundred and fourteen patients with supratentorial tumors for elective craniotomy, ASA grade I - II , were randomly allocated to six groups. Patients were anesthetized with continuous intravenous infusion of 2% procaine 1. 0 mg · kg-1 · min-1 in Group I , inhalation of 1. 0% - 1. 5% isoflurane in Group II , and infusion of 2% procaine 0. 5 mg·kg · min-1 combined with inhalation of 0.5% -0.7% isoflurane in Group III during the period of study. The end-tidal pressure of CO2(PET CO2 ) was maintained at 4.0 kPa in these 3 groups. In Group IV, V and VI, the anesthetic technique was the same as that in Group I but the PETCO2 was adjusted to 3. 5, 4. 0 and 4. 5 kPa respectively for 60 min during which the study was performed. The radial arterial and retrograde jugular venous blood samples were obtained at the onset and the end of this study for determining jugular venous bulb oxygen saturation ( SjvO2 ) , arteriovenous oxygen content difference (AVDO2) and cerebral extraction of oxygen (CEO2). Results: In Group I and I SjvO2, AVDO2 and CEO2 remained stable. Although SjvO2 kept constant, AVDO2 and CEO2 decreased significantly (P <0. 05) in Group II. Moreover, AVDO2 and CEO2 in Group II were significantly lower than those of Group III (P<0. 05). In Group IV, 60 min after hyperventilation, SjvO2 and jugular venous oxygen content ( CjvO2 ) decreased markedly (P < 0. 01 ) while CEO2 increased significantly ( P <0.01) . In addition, SjvO2, CjvO2 and CEO2 in Group IV were significantly different from the corresponding parameters in Group V and Group VI (P <0. 05) . In view of sustained excessive hyperventilation, SjvO2 was less than 50% in 37.5% patients of Group IV. Conclusion: Anesthesia with intravenous infusion of procaine combined with isoflurane inhalation proved to be more suitable for neurosurgery than procaine intravenous anesthesia or isoflurane inhalation anesthesia alone. PaCO2 at 4.0 -4. 5 kPa in patients undergoing craniocerebral surgery during neuroanesthesia would be beneficial in both decreasing ICP and maintaining cerebral oxygen supply/consumption balance.
文摘Regional oxygen saturation (rSO2) is a new method to evaluate regional oxygen supply and demand balance by near-infrared spectroscopy. It has the advantages of noninvasive, continuous and sensitive, and has been successfully applied in clinical guidance. Regional oxygen saturation is usually referred to as regional cerebral oxygen saturation (rScO2) and regional tissue oxygen saturation (rStO2) depending on the site of monitoring. Initially, cerebral oxygen saturation monitoring has been used in cardiothoracic surgery and in non-cardiac surgery for elderly and critically ill patients. With the increase of clinical application, regional oxygen saturation is gradually extended to the determination of oxygen saturation in peripheral tissues, which is used to evaluate the relationship between peripheral tissue microcirculation function and the prognosis of patients. Timely detection of tissue ischemia and hypoxia and intervention can optimize the whole clinical treatment management, especially for major surgery and critically ill patients can reduce the incidence of complications during hospitalization, shorten hospitalization time, improve the prognosis of patients. This article will focus on the clinical application of cerebral oxygen saturation and tissue oxygen saturation in perioperative period.
文摘BACKGROUND Colon cancer presents a substantial risk to the well-being of elderly people worldwide.With advancements in medical technology,surgical treatment has become the primary approach for managing colon cancer patients.However,due to age-related physiological changes,especially a decline in cognitive function,older patients are more susceptible to the effects of surgery and anesthesia,increasing the relative risk of postoperative cognitive dysfunction(POCD).There-fore,in the surgical treatment of elderly patients with colon cancer,it is of pa-ramount importance to select an appropriate anesthetic approach to reduce the occurrence of POCD,protect brain function,and improve surgical success rates.METHODS One hundred and seventeen patients with colon cancer who underwent elective surgery under general anesthesia were selected and divided into two groups:A and B.Group A received Dex before anesthesia induction,and B group received an equivalent amount of normal saline.Changes in the mini-mental state exami-nation,regional cerebral oxygen saturation(rSO2),bispectral index,glucose uptake rate(GluER),lactate production rate(LacPR),serum S100βand neuron-specific enolase(NSE),POCD,and adverse anesthesia reactions were compared between the two groups.RESULTS Surgical duration,duration of anesthesia,and intraoperative blood loss were comparable between the two groups(P>0.05).The overall dosage of anesthetic drugs used in group A,including propofol and remifentanil,was significantly lower than that used in group B(P<0.05).Group A exhibited higher rSO2 values at the time of endotracheal intubation,30 min after the start of surgery,and immediately after extubation,higher GluER values and lower LacPR values at the time of endotra-cheal intubation,30 min after the start of surgery,immediately after extubation,and 5 min after extubation(P<0.05).Group A exhibited lower levels of serum S100βand NSE 24 h postoperatively and a lower incidence of cognitive dysfunction on the 1st and 5th postoperative days(P<0.05).CONCLUSION The use of Dex in elderly patients undergoing radical colon cancer surgery helps maintain rSO2 Levels and reduce cerebral metabolic levels and the incidence of anesthesia-and surgery-induced cognitive dysfunction.
