Efficacy and Safety of Dexmedetomidine during Anesthesia Induction of Patients with Intracranial Tumor: A Preliminary Observational Trial

Background: The efficacy and safety of dexmedetomidine during the anesthesia induction of intracranial tumor patients remain unknown. We wondered whether loading infusion of dexmedetomidine 1 μg/kg over 10 min to intracranial tumor patients was as efficient and safe as to those abdominal disease patients. Methods: Patients aged 18-60 years, male or female, ASA I or II, scheduled for intracranial tumor resection (Group N, n = 30) or abdominal operation (Group A, n = 30) were enrolled in this observational trial. Dexmedetomidine was administrated with a loading dosage of 1 μg/kg over 10 min following with continuous infusing of 0.5 μg/kg/h. Fentanyl, propofol and rocuronium were sequentially administered for anesthesia induction. Heart rate (HR), blood pressure (BP), pulse oxygen saturation (SpO2), bispectral index (BIS) and other adverse effects were recorded from the beginning of loading infusion of dexmedetomidine to the end of endotracheal intubation. Results: Among with loading infusion, HR and BIS value decreased and were significantly lower at the end of infusion than before infusion (P P > 0.05). One patient of Group N dropped out from this trial because of a serious headache. 14 of 29 patients during dexmedetomidine loading infusion suffered hypoxemia (SpO2 P Conclusion: A loading dosage of 1 μg/kg of dexmedetomidine was not suitable for the anesthesia induction of intracranial tumor patients as compared to patients undergoing abdominal operation.

Extrahepatic bile duct reconstruction in pigs with heterogenous animal-derived artificial bile ducts:A preliminary experience

BACKGROUND Extrahepatic biliary duct injury(BDI)remains a complicated issue for surgeons.Although several approaches have been explored to address this problem,the high incidence of complications affects postoperative recovery.As a nonimmunogenic scaffold,an animal-derived artificial bile duct(ada-BD)could replace the defect,providing good physiological conditions for the regeneration of autologous bile duct structures without changing the original anatomical and physiologic conditions.AIM To evaluate the long-term feasibility of a novel heterogenous ada-BD for treating extrahepatic BDI in pigs.METHODS Eight pigs were randomly divided into two groups in the study.The animal injury model was developed with an approximately 2 cm segmental defect of various parts of the common bile duct(CBD)for all pigs.A 2 cm long novel heterogenous animal-derived bile duct was used to repair this segmental defect(group A,ada-BD-to-duodenum anastomosis to repair the distal CBD defect;group B,ada-BD-to-CBD anastomosis to repair the intermedial CBD defect).The endpoint for observation was 6 mo(group A)and 12 mo(group B)after the operation.Liver function was regularly tested.Animals were euthanized at the above endpoints.Histological analysis was carried out to assess the efficacy of the repair.RESULTS The median operative time was 2.45 h(2-3 h),with a median anastomosis time of 60.5 min(55-73 min).All experimental animals survived until the endpoints for observation.The liver function was almost regular.Histologic analysis indicated a marked biliary epithelial layer covering the neo-bile duct and regeneration of the submucosal connective tissue and smooth muscle without significant signs of immune rejection.In comparison,the submucosal connective tissue was more regular and thicker in group B than in group A,and there was superior integrity of the regeneration of the biliary epithelial layer.Despite the advantages of the regeneration of the bile duct smooth muscle observed in group A,the effect on the patency of the ada-BD grafts in group B was not confirmed by macroscopic assessment and cholangiography.CONCLUSION This approach appears to be feasible for repairing a CBD defect with an ada-BD.A large sample study is needed to confirm the durability and safety of these preliminary results.

Robot-assisted surgery in total knee arthroplasty:trauma maker or trauma savior?A prospective,randomized cohort study

Background:Robotic assistance has been increasingly employed to improve the operative precision in modern knee surgery.The purpose of the study was to evaluate the trauma effect of one of the first domestically developed orthopedic surgical robots in China in a clinical trial of robot-assisted total knee arthroplasty(RA-TKA).Methods:A total of 33 patients who underwent unilateral TKA for end-stage osteoarthritis were randomized to receive RA-TKA(17 cases)or conventional manual TKA(CM-TKA)in our institution in 2020.The trauma effects of the 4 main indicators with 48 sub-indicators in terms of subsectional operative time,inflammation and coagulation markers,physical and radiographical analyses of osteotomy deviation,and postoperative comfort were analyzed.Results:Subsectional operative time analysis showed that the times for bone cutting and gap balancing with RA-TKA were 5.3 and 2.2 min shorter than those with CM-TKA(p=0.010,p=0.02),respectively.Arterial blood gas indicators(partial pressure of carbon dioxide,partial pressure of oxygen and SO2)24 h after RA-TKA,as well as the white blood cell count and neutrophil ratio,were significantly lower than those after CM-TKA(p<0.05).Inflammatory markers at 72 h after surgery showed the increments of C-reactive protein,erythrocyte sedimentation rate and D-dimer of RA-TKA declined by 180.7,22.0 and 1050.0%(p<0.05),respectively,referenced to the preoperative baseline values,as compared to CM-TKA.Mechanical deviation distribution exhibited percentages of region I errors for RA-TKA and CM-TKA of 76.5%and 27.1%(p=0.000),respectively,and the success rates of one-time osteotomy were 94.1%and 62.5%(p=0.039),respectively.Radiographi-cal verification showed RA-TKA was more conducive to achieving mechanical alignment and ideal tibial component azimuths.Postoperative efficacy showed that patients were more comfortable after RA-TKA in terms of reduced administration of tranexamic acid,hydrocortisone and the utilization rate of temporary intensive opioid analgesics.No statistical difference in patient-reported outcome measures and complications were recorded between the two groups during continuous observation.Conclusions:Compared with CM-TKA,RA-TKA decreases rather than increases trauma.It might shorten the time required for bone cutting and gap balancing,reduce mechanical errors related to the osteotomy and prosthesis position,and improve the accuracy of the mechanical alignment reconstruction.RA-TKA is also favorable in promoting postoperative comfort and minimizing inflammatory response and drug consumption.