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 strategies of individualized enhanced recovery after surgery (ERAS) are particularly important in the anesthesia management of same-day surgery. This review focuses on the perioperative management of day surgeries following the experiences of Day Surgery Center, West China Hospital, Sichuan University and different surgeries’ guidelines of ERAS, including anesthesia evaluation, preoperative education and optimization, comorbidity management, airway management, choice of technologies and drugs during anesthesia, intraoperative monitor and anesthesia management, postoperative analgesia, postoperative nausea and vomiting prevention, and postoperative management, which is significant to ensure the discharge of the patient in time for same-day surgeries.
Objective To investigate the risk factors for delayed discharge following same-day choledochoscopic lithotomy for residual stones after biliary tract surgery. Methods The clinical data of 607 patients with residual stone after biliary tract surgery admitted to the Day Surgery Center of West China Hospital of Sichuan University between July 2019 and July 2022 were retrospectively collected. According to whether the patients were discharged on the same day, they were divided into same-day discharge group and delayed discharge group. The differences in gender, age, first surgical procedure (surgical method, hepatectomy or not, intraoperative choledochoscopy or not), choledochoscopic lithotomy (first choledochoscopy or not, lithotomy method, number of stones and site of stones), operation duration, hospital stay, hospital cost, and postoperative complications (fever, poor drainage, and T tube dislodgement) between the two groups were compared and analyzed. Multiple logistic regression model was used to analyze the risk factors for delayed discharge following same-day choledochoscopic lithotomy. Results All patients were admitted and discharged within 24 h, among them, 557 cases (91.8%) were discharged on the same day and 50 cases (8.2%) were discharged the next day. The results of multiple logistic regression analysis showed that choledochoscopy for the first time [odds ratio (OR)=2.359, 95% confidence interval (CI) (1.303, 4.273), P=0.005], lithotomy after electrohydraulic lithotripsy [OR=1.857, 95%CI (1.013, 3.402), P=0.045], and multiple stones (number of stones ≥2) [OR=2.741, 95%CI (1.194, 6.288), P=0.017] were independent risk factors for delayed discharge. Conclusion The operation of same-day choledochoscopic lithotomy is mature, and choledochoscopy for the first time, lithotomy after electrohydraulic lithotripsy, and multiple stones (number of stones ≥2) are independent risk factors for delayed discharge.
Day surgery is flourishing in public hospitals in China with the advantages of strong planning, short stay and high efficiency. Under the background of “diversification of surgeons, diversification of disease structure and precision of scheduling needs”, higher requirements are put forward for refined scheduling strategies of day surgery. The research of scientific and precise surgical scheduling strategy is of great significance to realize efficient coordination and optimal allocation of day surgical resources. This article reviews the necessity of precise scheduling of day surgery, the current situation of scheduling of day surgery, the key dimensions affecting the scheduling of day surgery, and the evaluation system for precise scheduling of day surgery.
As the concept of enhanced recovery after surgery (ERAS) has promoted the revolution of day surgery, more complicated surgery such as radical resection of early cancer and other fourth-level surgery can be performed in day surgery mode. Since 2010, West China Hospital of Sichuan University has introduced ERAS program and gradually performed fourth-level surgery in day surgery center. With the measures of reasonable inclusion criteria, team construction, and optimization of treatment and nursing procedures, the quality and safety of day surgery are guaranteed. Between January 2019 and August 2023, a total of 2531 patients underwent 24-hour fourth-level day surgery for early cancer, with a delayed discharge rate of 2.09%, a readmission rate of 2.57%, and a readmission rate of 1.11%, without death case, and the patient satisfaction was above 98%. The perioperative management scheme of fourth-level day surgery provides a reference for the management of day surgery for more diseases.
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。
Perioperative neurocognitive disorder (PND) is one of the common perioperative complications in surgical patients, which has been concerned by most researchers. With the gradual increase of the elderly population in China, the complexity of individual diseases and the risk of PND is more and more severe. In recent years, a large number of studies have confirmed the close relationship between intestinal flora and neurological diseases and various studies have also proved that gut microbiota may contribute to the occurrence and development of PND. Based on the current studies, this article summarizes the effects of gut microbiota on PND, including possible mechanisms and intervention measures, providing some ideas for researchers and treatment of PND.