Grisel’s syndrome is a rare cervical spine disorder characterized by non-traumatic rotary subluxation of the atlantoaxial joint. This article provides a systematic review to collect evidence on its pathogenesis, clinical manifestations, diagnosis, treatment, complications, and risk management, in order to guide clinical diagnosis and treatment. The syndrome is often associated with adenotonsillectomy. Patients typically present with neck stiffness, pain, and a “cock robin posture” (chin tucked in and head tilted forward). Diagnosis relies on MRI and CT scans. After timely diagnosis, most patients can control the condition through conservative treatment. However, those with ineffective conservative treatment or severe subluxation may require surgical intervention. Therefore, early diagnosis and treatment are crucial. This article focuses on the progress in the diagnosis and treatment of Grisel’s syndrome after adenotonsillectomy, which will provide new insights into the diagnosis and treatment of this rare disease.
The concept of enhanced recovery after surgery (ERAS) is composed of multidisciplinary, multimodal, and evidence-based approaches, providing a safe and cost-effective method for perioperative management to improve patient prognosis without increasing the incidence of complications. At present, ERAS for cardiac surgery has developed slowly. This article provides a review of the application and prospects of ERAS concept in the perioperative period of cardiac surgery. The measures for applying ERAS concept to the perioperative period of cardiac surgery are divided into three parts: preoperative, intraoperative, and postoperative. The aim is to provide information for the perioperative management of cardiac surgery patients and assist in their rapid recovery during the perioperative period.
ObjectiveTo investigate various methods and strategies of lowering central venous pressure (CVP) during hepatectomy.MethodThrough literature review, the definition, implementation, related complications, and prognosis of low CVP were reviewed and summarized and the most appropriate CVP in the liver surgery was also summarized.ResultsThe low CVP had been widely applied in the different clinical settings. Its effect of reducing hemorrhage and transfusion had been recognized. There were many techniques to intraoperatively reduce the CVP such as the volatile anesthetics, vasoactive agents, fluid restrictive strategy, inferior vena cava clamping, low tidal volume, etc. However, there was no consensus on the best strategy to reduce the CVP and there were no studies focusing on the prognosis of patients underwent the low CVP hepatectomy. Maintaining the CVP between 2.1–3 mm Hg (1 mm Hg=0.133 kPa) intraoperatively might be appropriate, once the section had been made normal hemodynamic state of the patient should be restored immediately.ConclusionsApplication of low CVP could reduce blood loss and transfusion in hepatectomy. Prognosis of patients receiving low CVP is not clear. Application of low CVP in specific population should be cautious.
With the rapid development of day surgery in China, ensuring continuous recovery services for patients after discharge has become an urgent issue. In response, this paper outlines the concept and development status of day surgery, emphasizes the importance of establishing an extended recovery system, summarizes relevant model innovation cases, discusses key elements for building an extended recovery system, including social resource engagement, multidisciplinary collaboration, institutional safeguards and technical support, and docking system platform to smooth the transmission of information, and proposes suggestions for future development. This paper provides theoretical and practical references for developing an extended recovery system for day surgery in China.
目的:比较舒芬太尼与芬太尼复合七氟烷麻醉在神经外科手术中对血流动力学、拔管时间、苏醒时间及术后疼痛情况的影响。方法:择期开颅手术患者60例,随机分为舒芬太尼(S)组和芬太尼(F)组,每组30例。将S和F的效能比定为10:l,复合咪唑安定、维库溴胺、异丙酚来进行麻醉诱导;麻醉维持均复合七氟烷。分别记录麻醉前、诱导后、插管时和拔管时血压和心率变化;呼吸恢复、睁眼和拔管时间以及拔管后半小时疼痛评分(VAS评分)。结果:两组麻醉诱导后收缩压(SBP)、舒张压(DBP)、心率(HR)均较诱导前有显著性下降(Plt;0．05)。F组插管及拔管时,血流动力学变化均较S组有显著性升高(Plt;0.05)。S组苏醒期呼吸恢复、睁眼、拔管时间较F组明显缩短;拔管后半小时疼痛评分(VAS评分)S组低于F组。结论:与芬太尼相比,等效剂量的舒芬太尼用于脑外科手术患者麻醉诱导可更有效地减轻全麻诱导气管插管时的心血管反应;在麻醉苏醒期,更有利于呼吸管理及术后镇痛。舒芬太尼在神经外科麻醉中具有很好的临床应用价值。
In order to optimize the postoperative rehabilitation path of patients undergoing fourth-level day surgery, West China Hospital of Sichuan University has learned from the abroad “recovery hotel” mode and innovatively regarded the primary rehabilitation institution as an extended service carrier for thoracoscopic lung nodule day surgery. This extended rehabilitation mode based on primary rehabilitation institutions is not only beneficial for shortening the hospitalization period and reducing medical costs, but also ensures medical safety through a standardized postoperative monitoring system, providing innovative solutions for the full process management of day surgeries. This article will introduce the specific implementation methods and preliminary practical results of the extended rehabilitation mode mentioned above.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.