Objective To study the influence of low-tidal volume and positive end expiratory pressure (PEEP) protective ventilation on cardiac output volume in elderly patients under general anesthesia. Methods From August 2012 to July 2014, 60 elderly patients undergoing selective surgery were divided into three groups with 20 patients in each. Group A was treated with conventional ventilation: tidal volume at 8 mL/kg, PEEP at 0 cm H2O (1 cm H2O=0.098 kPa); group B was treated with a tidal volume of 6 mL/kg and a PEEP of 5 cm H2O; group C was treated with a tidal volume of 6 mL/kg and a PEEP of 8 cm H2O. We then observed and analyzed the blood pressure, heart rate, cardiac output, arterial blood gas and airway mean pressure before induction of anesthesia (T0), 15 minutes of mechanical ventilation after the induction of anesthesia (T1), 60 minutes after anesthesia induction (T2), and 15 minutes after tracheal extubation (T3). Results In all the three groups, the mean arterial pressure and cardiac output were stable. In group B and C, central venous pressure increased significantly, the mean airway pressure and lung compliance increased, and the arterial oxygen branch pressure also increased significantly (P < 0.05). Conclusion Low-tidal volume combined with 5-cm H2O or 8-cm H2O positive end expiratory pressure lung-protective ventilation had a small influence on the cardiac output of elderly patients under anesthesia, which can be safely used.
ObjectiveTo summarize the management of anesthesia during robotic off-pump coronary artery bypass grafting (CABG) with the da Vinci surgical system in minimal thoractomy. MethodsFrom May 2011 to December 2014, 24 patients (20 males and 4 females) at the average age of 62.1±12.8 years underwent robotic off-pump CABG with the da Vinci surgical system in our hospital. All the patients underwent the continuous invasive blood pressure monitoring, endotracheal intubation with the double-lumen tube after induction of general anesthesia, fiber bronchoscope positioning, intraoperative application of one-lung ventilation, placing the Swan-Ganz floating catheter, and monitoring the echocar-diography (TEE) and blood gas analysis and indexes of hemodynamics. ResultsAll the patients were stable during the anesthesia induction period. There was no severe hypoxemia and hypercapnia. The surgery was successful and there was no thoracotomy. All the patients left off breathing machine postoperatively.The duration of mechanical ventilation was 5.3±2.8 hours. All patients were moved out from ICU in 18 hours.There was no thoracotomy for hemostasis after surgery. All the patients were discharged on the fourth or fifth day postoperatively. There was no death relevant to surgery or perioperative complications. There was no recurrence of cardiovascular events on the 30th day,3 months and 6 months postoperative follow-up. ConclusionThis anesthesia method is safe and effective. It is a rapid recovery way with the fewer complications, less suffering of the patients, reliable anesthesia management and high satisfaction of the patients'.
Same-day surgery mode is an efficient medical mode, and the key point of its management is multidisciplinary collaboration optimization of the process and integration of enhanced recovery after surgery concept. This paper introduces the establishment of multidisciplinary collaboration system, clinical pathway maintenance, patient visit procedure optimization, preoperative and postoperative care and follow-up management of same-day surgery mode for children with strabismus correction under general anesthesia at West China Tianfu Hospital of Sichuan University, aiming to promote the further improvement of the pediatric same-day surgery process and provide a reference for the promotion of the pediatric same-day surgery mode.
ObjectiveTo compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement (TAVR).MethodsA total of 399 severe aortic stenosis patients were included, who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019. The baseline characteristics, procedural details, postprocedural outcomes, and ultrasound data of those patients were collected. All patients were followed up and the end date of follow-up was June 20th 2020. According to anesthetic mode, the patients were divided into local anesthesia group and general anesthesia group. The differences between the two groups in incidence of postprocedural complications, hemodynamics, postprocedural 30-day mortality, and postprocedural 1-year mortality were retrospectively analyzed.ResultsOf the 399 patients, 206 (51.6%) received local anesthesia and 193 (48.4%) received general anesthesia. There was no statistical difference between the two groups in baseline characteristics. The symptoms of both groups were relieved. But the incidences of mild bleeding events (12.4% vs. 1.5%, P<0.001), severe bleeding events (10.4% vs. 0.5%, P<0.001), major vascular complications (0.5% vs. 3.6%, P=0.032), and postprocedural 30-day all causes mortality (1.9% vs. 6.7%, P=0.018) were significantly lower in the local anesthesia group than those in the general anesthesia group.ConclusionIn TAVR, compared with general anesthesia, local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.
ObjectiveTo explore the influence of general anesthesia with laryngeal mask and preoperative inhalation of budesonide aerosol on the incidence of respiratory adverse events during pediatric anesthesia recovery. MethodsA total of 100 child patients scheduled to undergoing inguinal hernia repair between December 2012 and February 2014 were randomly divided into two groups (group A and B) with 50 in each. All the patients underwent general anesthesia with laryngeal mask, while patients in group B inhaled budesonide aerosol before anesthesia. Then, we observed the incidence of adverse events in both groups, including laryngospasm, respiratory tract infection, and pulmonary complications. ResultsCompared with group A, patients in group B had a lower incidence of adverse events (P<0.05). ConclusionPreoperative application of budesonide aerosol inhalation can significantly reduce adverse events in the process of anesthesia recovery in children.
Objective To explore the timing of indwelling urinary catheter removal in male patients undergoing orthopedic surgery under general anesthesia by a prospective randomized controlled study. Methods Male patients who underwent orthopedic surgery under general anesthesia in the First People’s Hospital of Shuangliu District between September 2019 and January 2021 were selected prospectively. The patients were randomly assigned to group A (pull out the catheter before anesthesia) and group B (pull out the catheter within 24 hours after anesthesia) at a ratio of 1∶1 by sortition. The age, operation duration, operation site, heart rate when pulling out the catheter, first urination, urinary tract infection, patient comfort score, nursing satisfaction score and patient satisfaction related indicators of the two groups were recorded and analyzed. Results A total of 120 patients were included in the study. All patients successfully completed the trial without dropping out or quitting. There was no significant difference between the two groups in terms of age, operation duration and operation site (P>0.05). No urinary tract infection occurred in both groups. There was no significant difference in the first urination between the two groups (P>0.05). The heart rate of patients in group A when pulling out the catheter was slower than that of group B [(74.62 ± 11.38) vs. (84.52 ± 8.98) times/min], and the satisfaction of patients in group A (group A: 46 cases were satisfied, 11 cases were relatively satisfied, 3 cases were dissatisfied; group B: 17 cases were satisfied, 25 cases were relatively satisfied, 18 cases were dissatisfied), comfort score (17.82±2.73 vs. 16.68±2.13), and nursing satisfaction score (19.62±1.59 vs. 16.32±2.05) were better than those in group B (P<0.05). Conclusions For male patients who need catheterization before orthopedic surgery under general anesthesia, pulling out the catheter before waking up after anesthesia can effectively reduce the physiological stress reaction of patients, reduce discomfort, improve patient satisfaction, and reduce the workload of nurses after surgery, which is conducive to early rehabilitation exercise of patients.
Objective To investigate the impact of optimized preoperative fasting scheme for gynecological day surgery with general anesthesia. Methods We retrospectively selected 639 patients undergoing gynecological day surgery with general anesthesia between June 2021 and August 2021 in the day surgery department of West China Second University Hospital of Sichuan University as the control group, and 920 patients undergoing gynecological day surgery with general anesthesia in the same hospital between November 2021 and February 2022 as the observational group. The patients in the control group were treated with routine preoperative fasting scheme, and the ones in the observational group were treated with optimized preoperative fasting scheme. The differences in preoperative duration of water deprivation, intraoperative and postoperative incidences of aspiration, and postoperative first anal exhaust time between the two groups were compared. Results The preoperative duration of water deprivation in the control group was longer than that in the observational group [(12.49±2.63) vs. (6.69±2.76) h, P<0.05]. The incidences of intraoperative and postoperative aspiration were both 0. The postoperative first anal exhaust time in the control group was later than that in the observational group [(11.51±6.58) vs. (8.19±4.13) h, P<0.05]. Conclusions For patients undergoing gynecological day surgery with general anesthesia, the implementation of the optimized preoperative fasting scheme can effectively shorten the preoperative duration of water deprivation, without increasing the risk of anesthesia. It can accelerate the recovery of intestinal function for gynecological laparoscopic day surgery with general anesthesia, promote the implementation of enhanced recovery after surgery, and improve the efficiency of day surgery.
Objective To explore anesthetic quality of epidural anesthesia with general anesthesia applied for surgery of rectal cancer. Methods One hundred and seventy-eight patients who were diagnosed as rectal cancer and received operation in the Central Hospital of Bazhong City from June 2010 to June 2012 were included retrospectively. These patients were divided into two groups according to the type of anesthesia， and the patients who received general anesthesia only were defined as group A， the patients who received epidural anesthesia with general anesthesia were defined as group B. The anesthetic quality and anesthetic adverse reaction were observed in two groups. Results The differences of baseline characteristics in two groups were not significant （P＞0.05）. The difference of anesthetic quality in two groups was not significant （P＞0.05）. In terms of anesthetic adverse reaction， the incidence rate of hypertension， hypotension，tachycardia， or postoperative nausea and vomiting of the group B was significantly lower than those of the group A （P＜0.05）. The incidence rate of bradycardia， premature ventricular contractions， or time of gastrointestinal function recovery had no significant differences （P＞0.05）. There was no nerve dysfunction of lower limb in two groups. Conclusion Epidural anesthesia with general anesthesia applied for surgery of rectal cancer as compared with general anesthesia only not only has the same anesthetic quality， but also has obvious advantages in decreasing anesthetic adverse reaction.
【摘要】 目的 比较靶控诱导后Shikani喉镜、Macintosh直接喉镜和GlideScope®视频喉镜插管时的应激反应。 方法 选取2008年12月-2009年2月期间ASA Ⅰ~Ⅱ级、拟于全身麻醉下行择期颅内占位病变切除术的患者30例，随机分为Shikani喉镜组（S组）、Macintosh直接喉镜组（M组）与GlideScope®视频喉镜组（G组）。靶控异丙酚和瑞芬太尼诱导，分别采用上述3种喉镜行经口气管插管。记录患者的心率、血压，计算心率收缩压乘积（RPP）。 结果 3组插管时间、心率、血压和RPP比较差异无统计学意义（Pgt;0.05）。S组和M组插管后心率、血压及RPP均较插管前显著升高（Plt;0.05），而G组插管后的心率、60~300 s时的收缩压、平均动脉压和RPP与插管前比较，差异无统计学意义（Pgt;0.05）。 结论 3种喉镜进行经口气管插管时具有相似的血流动力学反应，GlideScope®视频喉镜更有利于循环稳定。【Abstract】 Objective To compare the hemodynamic responses of orotracheal intubations with GlideScope® videolaryngoscope, Macintosh direct laryngoscope, and Shikani optical stylet after target-controlled-infusion (TCI). Methods Thirty patients with American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, scheduled for elective intracranial mass lesion surgery under general anesthesia were randomly allocated equally to Shikani optical stylet group (group S) Macintosh laryngoscope group (group M), and GlideScope® videolaryngoscope group (group G). After the patients became unconscious by TCI induction of propofpol and remifentanil, the endotracheal intubation were carried out through above three laryngoscope. The heart rate (HR), blood pressure and rate pressure product (RPP) were recorded. Results The differences of intubation time, HR, blood pressure and RPP in three groups were not statistically significant (Pgt;0.05). After intubation, the HR, blood pressure and RPP of group S and M were obviously higher than those before intubation (Plt;0.05); while there was no obvious change on the HR, systolic pressure at 60-300 s, mean arterial pressure and RPP of group G compared before intubation (Pgt;0.05). Conclusions There are similar hemodynamic responses in the three laryngoscope. GlideScope® is more advantageous to cycle stability.