Morbidity and Mortality during Anaesthesia in Patients with versus without Diabetes: Single-Centre Cohort Study

Background and objective: Classically, diabetic subjects are at high risk of anaesthesia compared with general population. However, some recent publications have shown contrasting and sometimes contrary results. The aim of our study was to evaluate morbidity and mortality during and after anaesthesia in patients with versus without diabetes operated on at Monkole Hospital over the last ten years. Methods: Retrospective cohort study including all patients who underwent all-comers surgery excluding cardiac surgery between 2011 and 2021. Each diabetic patient was matched to 2 non-diabetic controls on age and sex. The evaluation criterion was the frequency of occurrence of at least one perioperative complication and/or death up to day 30. A multivariate analysis using a Cox model was used to determine the factors associated with the occurrence of this morbidity and mortality. The model was adjusted for comorbidities, preoperative hyperglycaemia, ASA score, type of anaesthesia and severity of surgery. Results: A total of 351 diabetic patients (mean age 53.3 ± 14.18 years) and 701 non-diabetic patients (mean age 53.52 ± 14.7 years) were included and analysed. Preoperatively, hyperglycaemia (blood glucose > 180 mg/dl) was observed in 24.3% of diabetic patients compared with 1.6% of non-diabetic patients. The incidence of overall perioperative complications was 25.6% in diabetic patients compared with 28.6% in non-diabetic patients (p = 0.27). The risk factors associated with this morbidity were general anaesthesia with oro-tracheal intubation vs loco-regional anaesthesia (OR = 3.06 [95%CI: 1.91 - 4.94];p Conclusion: This study shows that there is not significant increase in perioperative morbidity and mortality in diabetic patients compared with non-diabetic ones of similar severity. These results suggest that diabetes itself (excluding associated comorbidities) has only a minor impact on perioperative morbidity and mortality.

Effects of Combined Spinal Epidural Anaesthesia and Spinal Anaesthesia on Peri-Operative Pulmonary Status in Geriatric Patients in Lower Extremity Surgery

Background: Lower extremity surgeries performed in elderly people usually have high prevalence of peri-operative medical problems related to anaesthesia. The overall objective of peri-operative care of geriatric population is to fast recovery from anaesthesia and avoid functional decline. Objective: To compare the peri-operative pulmonary status of combined spinal epidural anaesthesia (CSEA) and spinal anaesthesia (SA) in geriatric patients underwent lower extremity surgeries. Methods: This prospective comparative study was conducted at Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2016 to June 2018. A total of 70 geriatric cases that underwent lower extremity surgeries were included in this study. Cases were randomly allocated into two groups;35 in Group A (CSEA) and 35 in Group B (SAB). The different outcome variables between the groups like-duration of anaesthesia, respiratory rates (RR), oxygen saturation (SpO2), end tidal CO2 (EtCO2), peak expiratory flow rate (PEFR), breath holding test (BHT), peri-operative side effects of anaesthesia and post-operative visual analogue score (VAS) were analyzed and compared by statistical tests. Results: The mean age, weight, BMI of Group A and Group B patients were not significantly different (p > 0.05). No significant differences were observed in duration of surgery, gender and ASA grade between the groups (p > 0.05). Mean duration of anaesthesia, mean time to achieve target level of sensory block and mean time to achieve complete motor block were significantly higher in Group A (p < 0.001). Mean RR, SpO2, EtCO2, PEFR and BHT of both groups were not significantly different (p > 0.05). Peri-operative side effects of anaesthesia and post-operative VAS were significantly less in group A patients (p < 0.05). Conclusion: Combined spinal epidural anaesthesia is effective and safe;produces stable peri-operative pulmonary status with prolonging analgesia and fewer side effects as compared to spinal anaesthesia in geriatric patients.

Instituting Pandemic Plans in a Singapore Anaesthesia Unit: The Challenges and Learning Points

The World Health Organization declared COVID-19 as a pandemic on 11 March 2020. Its rapid spread has put a strain on healthcare systems globally. Singapore ranked the highest in terms of reported cases outside of China in the first few weeks of this outbreak. The management of a patient with COVID-19 in the Operating Theatre (OT) presents a unique set of challenges to the Anaesthetist. Delivery of timely and quality care must be upheld while reducing the risk of transmission to healthcare staff and other patients. This article describes our Anaesthesia Unit’s experiences and challenges in instituting our pandemic plans. The authors hope that the sharing of our experience and practical approach would be useful to other Anaesthesia Units worldwide.

Case Report of a Patient with Swyer-James-MacLeod Syndrome Undergoing Breast Surgery under Regional Anaesthesia and Review of Literature

Swyer-James-MacLeod Syndrome is a rare acquired pulmonary disorder that develops secondary to infectious etiologies in early childhood. Patients who are affected have the potential of developing perioperative respiratory complications. While regional anaesthetic techniques are often performed as adjuncts to general anaesthesia, there is less data on breast operations being done solely under regional anaesthesia. We herein describe a patient with Swyer-James-MacLeod Syndrome who underwent breast lesion wide excision under combined paravertebral and pectoral nerves block, supplemented with propofol infusion for sedation. Choice of blocks was decided upon based on knowledge on the anatomy. Sole regional anaesthetic techniques have been the safest approach in some circumstances and should always be considered in patients who are of high risk under general anaesthesia.

Intraoperative Auditory Evoked Potential Monitoring for Anaesthesia Depth and Utilization of Inhaled Isoflurane

Background: Hypnosis monitoring has been shown to reduce the incidence of awareness. A-line ARX-IndexTM (AAI) derived from auditory evoked potentials (AEP) represents as a numerical variable depth of anaesthesia. Objectives: To study the efficacy of AEP as an indicator of anaesthetic depth and monitor intraoperative awareness in neurosurgical patients by using the AAI scale. Design: Prospective cohort study is used. Setting: The study is in Neurosurgical centre of Tertiary care hospital. Participants: Neurosurgical patients requiring general anaesthesia with duration of surgery between 90 - 150 minutes were enrolled for the study. Intervention: Patients in Group 1 (control) were monitored by conventional methods. Patients in Group 2 (study) underwent intraoperative monitoring by using the AEP monitor. Primary outcome: To study the efficacy of AEP monitoring and AAI index for monitoring the depth of anaesthesia and reducing the incidence of awareness. Results: There was no significant difference in the intraoperative haemodynamic responses measured between the two study groups (p > 0.5). There was no significant difference in the identification of intraoperative awareness by using conventional parameters between the two groups (p > 0.5). There was also a significantly faster time to recovery for patients in Group 2 (p < 0.05). Conclusion: Hypnosis monitoring using AEP monitor/AAI in neurosurgical patients under general anaesthesia did not show any significant difference in haemodynamic response and intraoperative awareness but had significant lower consumption of volatile anaesthetic with cost sparing effect and a faster recovery time as compared to conventional monitoring.

Anaesthesia for Pectoralis Major Myocutaneous Flap in a Patient with a Major Facial Defect and Restricted Mouth Opening: A Case Report

Perioperative airway management in patients with oro-facial cancers who has undergone chemo/or radiotherapy poses a great challenge to the anaesthesiologist. These challenges are mainly due to either a mass in the oral cavity or a limited mouth opening making intubation difficult or a major facial defect making mask ventilation difficult. We present our first time experience in a 27-year-old man with a malignant lymphoma of the right cheek who had undergone chemotherapy and needed plastic surgery to restore the face.

Anaesthesia for patients with arrhythmogenic right ventricular dysplasia

Arrhythmogenic right ventricular dysplasia(ARVD) is an inherited heart muscle disease.Myocyte apoptosis and fibro-fatty scar tissue predisposes patients to malignant ventricular arrhythmias.Patients may present to variety of surgical procedures with diagnosed ARVD.Surgical insult,catecholamine surge and physiological disturbance can be hazardous on the vulnerable myocardium and may result in life-threatening ventricular tachycardia or sudden cardiac death in the perioperative period.Anaesthetists have particular role in perioperative management of this patient population,meticulous perioperative planning,close haemodynamic monitoring and maintenance of physiological stability throughout helps to avoid devastating perioperative loss.

Knowledge of Anaesthesia Providers on Exposure to Inhalational Anaesthetic Agents in Ghana

Background: Chronic exposure to inhaled anaesthetic agents poses an occupational hazard related to the practice of anaesthesia. Therefore, this study sought to find out the perception of anaesthesia providers on exposure to inhalational anaesthetics, evaluate their knowledge on the effects of chronic exposure and strategies to reduce chronic exposure to operating room inhalational anaesthetic agents. Method: This cross-sectional survey was conducted by administering a self-administered questionnaire to 71 anaesthesia providers in Ghana who attended the annual refresher course of the faculty of Anaesthesia, West African College of Surgeons, in 2016. Data collected were analysed and presented as frequencies and percentages. Results: Halothane and isoflurane were the most frequently used inhalational agents by the respondents. Majority (90.1%) of the respondents perceived they are exposed to inhalational anaesthetics in their working environment. Majority of the anaesthetic providers cited poorly functioning scavenging systems (28.2%) and use of paediatric Ayre’s T-piece (28.2%) as sources of exposure to inhalational anaesthetics. All respondents admitted making attempts to reduce their exposure to inhalational anaesthetics. Majority of the respondents mentioned teratogenicity (77.5%) and hepatotoxicity (67.6%) as effects of chronic exposure to inhaled anaesthetic agents. Conclusion: Anaesthesia providers in Ghana perceived they are chronically exposed to inhalational anaesthetic agents in their work environment. They are aware of the sources of inhalational anaesthetic agent exposure, associated health risks and strategies required to reduce chronic exposure to inhaled anaesthetic agents.

Endotracheal Cuff Pressures Generated by Different Members of the Anaesthesia Services in a Ghanaian Teaching Hospital

Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse anaesthetists, student nurse anaesthetists and Anaesthesia residents.

Anaesthesia Management for Ablation Therapy in Post Heart Transplant Arrhythmia

In this case series we describe the anaesthetic management of atrial ablation for arrhythmia in three post heart transplant patients. These patients provide a unique challenge to the anaesthesiologist, as heart physiology, end organs effects, procedural related factors should all be part of the specific anaesthetic plan tailored for each patient individually. The different anaesthetic techniques applied, and procedure related complications are evaluated. Anaesthetic management, procedural related difficulties, pharmacologic aspects, and possible associated complications are reviewed.

Drugs used for pain management in gastrointestinal surgery and their implications

Pain is the predominant symptom troubling patients.Pain management is one of the most important aspects in the management of surgical patients leading to early recovery from surgical procedures or in patients with chronic diseases or malignancy.Various groups of drugs are used for dealing with this;however,they have their own implications in the form of adverse effects and dependence.In this article,we review the concerns of different pain-relieving medicines used postoperatively in gastrointestinal surgery and for malignant and chronic diseases.

超声引导菱形肌-肋间肌阻滞和TPVB在电视胸腔镜手术术后早期疼痛控制中的应用比较

目的 比较超声引导下菱形肌-肋间肌阻滞和胸椎旁神经阻滞(TPVB)对电视胸腔镜手术患者术后早期疼痛的控制效果。方法 前瞻性选取2022年1月至2023年7月秦皇岛市第一医院收治的120例行电视胸腔镜手术治疗的患者作为研究对象,按照信封法分为观察组(n=61)和对照组(n=59)。观察组采用静脉全身麻醉+超声引导菱形肌-肋间肌阻滞麻醉,对照组采用静脉全身麻醉+超声引导TPVB麻醉。比较两组患者手术指标、神经阻滞情况、视觉模拟评分法(VAS)评分、Ramsay镇静评分,统计两组患者并发症发生情况。结果 两组患者手术时间、术中出血量、引流时间、住院时间及首次进食时间比较,差异均无统计学意义(P>0.05)。两组注药时间、阻滞持续时间及补救镇痛次数比较,差异均无统计学意义(P>0.05);观察组超声定位时间、穿刺时间、操作总时间分别为(1.12±0.10)、(2.37±0.56)、(5.47±0.38)min,均短于对照组[(1.65±0.14)、(3.61±0.64)、(6.98±0.42) min],穿刺针深度为(4.43±0.52) mm,小于对照组[(5.37±0.58)mm],差异均有统计学意义(P<0.05)。两组患者术后6、12 h VAS评分、Ramsay镇静评分比较,差异均无统计学意义(P>0.05)。两组患者麻醉后恢复室(PACU)低氧血症发生率、气胸发生率、肺部感染发生率、肺不张发生率、恶心呕吐发生率及总并发症发生率比较,差异均无统计学意义(P>0.05)。结论 与TPVB比较,超声引导菱形肌-肋间肌阻滞应用于电视胸腔镜手术,患者术后恢复质量、镇痛效果及安全性相当,但超声引导菱形肌-肋间肌阻滞操作简单,操作时间更短。

静吸复合麻醉与全凭静脉麻醉对化疗后肺癌患者心肌保护及免疫水平的影响

目的探讨静吸复合麻醉与全凭静脉麻醉对化疗后肺癌患者的心肌保护及免疫水平的影响。方法选取2021年1月至2023年1月河南省胸科医院收治的化疗后行肺癌根治术的肺癌患者112例作为研究对象,按随机数字表法分为研究组、参照组,各56例。参照组接受静吸复合麻醉方案,研究组接受全凭静脉麻醉方案。比较两组临床指标[拔管/术后清醒/手术/麻醉起效/定向力恢复/听从指令时间、术中出血量、术后视觉模拟评分法(VAS)]。以术前(T_(0))、插管侧位双肺通气15 min(T_(1))、单肺通气15 min(T_(2))、单肺通气30 min(T_(3))、单肺通气60 min(T_(4))为时间点,比较两组血流动力学指标[心率(HR)、平均动脉血压(MAP)]水平。以麻醉诱导前(t_(0))、手术即刻时(t_(1))、术后6 h(t_(2))、术后12 h(t_(3))为时间点,比较两组心肌肌钙蛋白I(cTnI)水平。以术前、术后1 d、术后7 d为时间节点,比较两组免疫功能指标(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))水平及并发症发生情况。结果研究组麻醉起效、拔管、定向力恢复、听从指令、术后清醒时间均短于参照组,术后VAS评分均低于参照组(P<0.05);T_(1)~T_(4)时间段研究组MAP、HR水平均低于参照组,波动幅度均小于参照组(P<0.05);t_(2)、t_(3)时间点研究组cTnI水平均低于参照组(P<0.05);术后1、7 d研究组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于参照组(P<0.05);研究组术后并发症总发生率(8.93%)低于参照组(23.21%)(P<0.05)。结论静吸复合麻醉与全凭静脉麻醉应用于肺癌根治术中,均具有麻醉、镇痛、稳定血流动力学水平的效果,能降低术后并发症发生率和提高免疫功能,但全凭静脉麻醉的麻醉质量更高。

高职护生对精神障碍患者的疾病态度与其同理心的相关性

目的了解高职护生对精神障碍患者的疾病态度与其同理心现状,并探索两者间的相关性。方法于2020年9月至12月采用分层抽样选取泰州职业技术学院2019级在校护理学生278人进行问卷调查,完成医学生版临床医生对精神疾病态度量表(MICS-MS,中文版)和杰弗逊同理心量表护生版(JSPE-NS)问卷。结果高职护生的MICA-MS总分(43.83±7.96)分,具有一定歧视态度;JSPE-NS总分(101.80±15.93)分,总体水平偏低。女生对精神疾病态度明显好于男生,其对患者的同理心水平明显高于男生;家庭文化背景较好的护生疾病态度和同理心水平明显高于家庭文化背景偏低者,亲属有患精神疾病和与精神障碍患者有共同生活史的护生对精神疾病歧视态度较轻,且其同理心水平较高,差异均有统计学意义(P<0.05)。高职护生同理心水平可影响其对精神障碍患者的疾病态度(P<0.001),且呈负相关(P<0.01);性别、家庭背景、亲属患精神疾病、与精神障碍患者有频繁接触或生活史等4个其他因素也明显影响护生对精神障碍患者疾病态度(P<0.001)。结论高职护生对精神障碍患者同理心水平偏低,总体表现为悲观歧视态度,护理教育者需分析其诸多影响因素,有的放矢,努力改善并提升护生对精神障碍患者护理工作的岗位胜任力。

谷胱甘肽过氧化酶4在胃肠道肿瘤中的作用与治疗

胃肠道肿瘤发病率逐年上升,其病死率在我国癌症中位居前列,严重危害国民健康。只有提前预防加有效治疗双管齐下,才能更好地降低癌症负担。铁死亡是一种铁依赖的,区别于细胞凋亡、坏死、自噬的细胞程序性死亡方式。近几年,肿瘤耐药性的增加引起了学者对诱导癌细胞铁死亡的兴趣,因为铁死亡固有的生理功能之一就是肿瘤抑制。铁死亡受到氧化系统和抗氧化系统的平衡调节,谷胱甘肽过氧化酶4(glutathione peroxidase 4,GPX4)是抗氧化系统的核心因子之一,在多种恶性肿瘤中异常表达,与肿瘤的不良生物学行为相关。在胃肠道肿瘤中,GPX4表达异常,并参与肿瘤的发生发展、治疗和耐药。作为胃肠道肿瘤中许多分子的作用靶点(例如小分子化合物、miRNA和纳米反应器等),GPX4在多个水平上受到调节,并参与调控多种复杂的信号通路。以GPX4为靶点的策略有望成为治疗胃肠道肿瘤的新途径。本文就GPX4在胃肠道肿瘤中的国内外研究进展进行综述,阐明其分子调控机制和目前的药物研究进展,为胃肠道肿瘤的研究及防治提供新的思路。

电针对老年病人下肢骨科手术围术期认知功能及炎症因子的影响

目的 观察术后电针治疗对全身麻醉下行下肢骨科手术老年病人围术期神经认知功能障碍(PND)和炎症因子表达水平的影响。方法 选取全身麻醉下行下肢骨科手术的老年病人80例,随机分为对照组和电针组,每组40例。2组病人采用相同的麻醉方法,对照组在术后给予常规治疗,针刺组在常规治疗基础上给予电针治疗。2组均在术前和术后第1、3、7天采用MMSE评估认知功能,并测定血清中炎症因子(TNF-α、IL-1β、IL-6)的水平。结果 针刺组在术后第1天和第3天PND发生率低于对照组,差异具有统计学意义(P<0.05),在术后第7天,2组间PND发生率差异没有统计学意义。术后第1、3、7天,针刺组血清中TNF-α和IL-6水平均显著低于对照组(P<0.05);针刺组IL-1β水平在术后第1天和第3天显著低于对照组(P<0.05),而在术后第7天差异没有统计学意义。在术后第1、3、7天,针刺组MMSE评分均与TNF-α、IL-1β、IL-6呈负相关。结论 电针治疗可以降低老年病人下肢骨科手术PND的发生率,这种作用可能与电针抑制炎症因子的表达有关。

铁死亡调控因子花生四烯酸脂氧合酶-15与肿瘤相关性的研究进展

铁死亡(Ferroptosis)是一种铁依赖性的新型的细胞程序性死亡(PCD)方式。花生四烯酸脂氧合酶-15(Arachidonate 15-lipoxygenase,ALOX15)是铁死亡的重要调控因子,它可以催化多不饱和脂肪酸(Polyunsaturated fatty acid,PUFA)生成脂质氢过氧化物,从而促进铁死亡的发生。ALOX15参与了多种癌症的发生发展,并发挥重要作用。本文对铁死亡的重要调控因子ALOX15与乳腺癌、食管癌、胃癌、结直肠癌以及前列腺癌的相关性进行综述,为相关肿瘤的研究提供参考。

浅低温调控miRNA在肝脏缺血再灌注损伤中的研究进展

肝脏缺血再灌注损伤(HIRI)是肝脏外科手术中是无法避免的常见并发症,会导致肝脏功能衰竭甚至发展成全身多系统器官功能衰竭,因此如何减轻HIRI成为了亟待解决的问题。HIRI的发病机制复杂,涉及多因素共同作用,可导致炎症、氧化应激反应以及肝细胞的坏死、凋亡。浅低温作为临床上应用成熟的物理治疗方法,已在体内外实验中被证实可以通过调控炎症反应、氧化应激、凋亡、自噬等过程减轻HIRI。其中肝脏特异性的miRNA可直接受浅低温调控,通过上调或下调相关的miRNA减轻或加重HIRI,在HIRI中发挥重要作用,是浅低温改善HIRI的关键点之一。文章就近年来浅低温、miRNA改善HIRI的作用机制以及浅低温调控miRNA改善HIRI的研究进展进行综述。

改变诱导药物顺序对全麻诱导期呛咳、体动的影响

目的研究改变诱导顺序对全麻诱导期出现呛咳、躯体颤动的作用。方法对100例择期手术女性患者进行随机分组,分别采用诱导顺序A(咪达唑仑-舒芬太尼-依托咪酯-顺式阿曲库铵)和诱导顺序B(舒芬太尼-顺式阿曲库铵-咪达唑仑-依托咪酯-舒芬太尼)。比较2组血压、心率及血氧饱和度;比较2组不良事件发生情况;比较2组麻醉诱导期的呛咳、躯体颤动发生率以及呛咳、躯体颤动程度。结果诱导顺序B组比A组出现呛咳、体动的次数更少,呛咳发生率分别为18%和56%(P<0.05);体动发生率分别为14%和46%(P<0.05)。结论改变诱导药物顺序可以减少诱导期的呛咳和躯体颤动,建议在临床实践中开展相关策略。

视神经萎缩1型线粒体融合蛋白在心血管疾病中的研究进展

心血管疾病严重威胁着人类健康,现已成为人类死亡的主要原因。能量代谢异常对心血管疾病的发生和发展起着关键作用,人体内90%的能量来源于线粒体,因此线粒体功能的稳定对于维持细胞正常形态与功能至关重要。既往研究发现,位于线粒体内膜上的视神经萎缩1型(OPA1)对线粒体功能的维持至关重要,越来越多的研究也表明,OPA1在动脉粥样硬化、心肌缺血再灌注损伤、心力衰竭、糖尿病心肌病等心血管疾病中发挥重要作用。本综述将概述有关OPA1蛋白功能,功能障碍以及与心血管疾病相关的临床表型,重点关注治疗OPA1突变引起的相关心血管疾病的当前治疗选择和未来前景。