ObjectivesTo systematically review the efficacy of lidocaine injected prior to tracheal extubation in preventing hemodynamic responses to tracheal extubation in general anesthesia.MethodsPubMed, Ovid, Web of Science, EMbase, The Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of lidocaine administrated prior to extubation in preventing hemodynamic responses to tracheal extubation in patients undergoing general anesthesia from inception to October, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 and Stata 13.0 software.ResultsA total of 10 RCTs involving 525 patients were included. The results of meta-analysis showed that: compared with control group, lidocaine could reduce mean arterial pressure in 5 min after extubation (MD=–5.10, 95%CI –9.41 to –0.79, P=0.02), weaken the increase in systolic blood pressure caused by extubation from the moment before extubation to 5 minutes after extubation (before extubation: MD=–7.22, 95%CI –10.34 to –4.11, P<0.000 01; at extubation: MD=–14.02, 95%CI –19.42 to –8.62, P<0.000 01; 1 minutes after extubation: MD=–15.82, 95%CI –22.20 to –9.45, P<0.000 01; 3 minutes after extubation: MD=–12.55, 95%CI –20.36 to –4.74, P=0.002; and 5 minutes after extubation: MD=–12.05, 95%CI –20.35 to –3.74, P=0.004), and weakened extubation-induced increase in diastolic blood pressure at extubation (MD=–9.71, 95%CI –16.57 to –2.86, P=0.005). In addition, lidocaine inhibited heart rate in all time points except the moment of before and at 10 minutes after extubation.ConclusionsCurrent evidence shows that lidocaine can inhibit the increase in blood pressure and heart rate caused by extubation at certain times. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusions.
Objective To evaluate the influence of combined general and epidural anesthesia on the prognosis of patients undergoing cancer surgery. Methods Such database as PubMed, OVID, EBSCO, The Cochrane Library and CNKI were searched, and other relevant journals and references of the included literature were also hand searched from 1986 to 2011. Two evaluators independently screened the studies in accordance with the inclusion and exclusion criteria, extracted the data and assessed the methodology quality. RevMan 5.0 software was used for meta-analyses. Results Seven studies involving 2 513 patients were included. The results of meta-analyses showed that compared with the single general anesthesia, the combined general and epidural anesthesia had no significant differences in postoperative recurrence and metastasis rate (OR=0.71, 95%CI 0.44 to 1.17, P=0.18). Based on the following four factors i.e. category of cancer, time of follow-up, having preoperative metastais or not, and patients’ age, the sensitivity analysis showed significant differences in the postoperative recurrence and metastasis rate between the two anesthesia methods were found in the group of patients at or above 64 years old and the group with follow-up equal to or less than two years (OR=1.46, 95%CI 1.00 to 2.14, P=0.05; OR=1.55, 95%CI 1.06 to 2.26, P=0.02; respectively). Nevertheless, there was no significant difference in the groups of patients with colorectal cancer or without preoperative metastasis (OR=1.00, 95%CI 0.62-1.61, P=0.99; OR=1.26, 95%CI 0.86 to 1.86, P=0.23; respectively). Conclusion Compared with single general anesthesia, the combined general and epidural anesthesia cannot reduce the recurrence and metastasis rate for cancer patients, and has no marked improvement in prognosis of patients with colorectal cancer or without preoperative metastasis, but it obviously decreases the probability of forward recurrence and metastasis for the patients at or above 64 years old and the patients with follow-up equal to or less than two years.
Objective To explore the feasibility and safety of early feeding after arthroscopic surgery with general anesthesia. Methods One hundred patients undergoing arthroscopic surgery with general anesthesia between January and December 2017 were randomly divided into the routine feeding group and the early feeding group, with 50 cases in each group. In the routine feeding group, patients were feeding after anus gas passage or 6 hours after surgery. Under full assessment, patients in the early feeding group could drink or eat when recovered from anesthesia. The nausea, vomiting, abdominal distension, and thirst incidences and the comfort degree 6 hours after surgery, the time of first stand up on foot, and the length of hospital stay between the two groups were compared. Results There was no statistical difference (P>0.05) in the incidence of disgusting (10.0%vs. 22.0%), vomiting (6.0% vs. 16.0%), abdominal distention (4.0% vs. 12.0%) or length of hospital stay [(6.44±2.28) vs. (6.34±0.94) days]. The difference in the incidence of postoperative thirst (14.0% vs. 40.0%), the comfort degree 6 hours after surgery (2.36±1.21 vs. 4.14±1.53), the time of the first stand up on foot [(17.30±10.32) vs. (20.84±3.92) hours] were statistically significant (P<0.05). Conclusions Early feeding is safe and feasible for the postoperiative arthroscopic surgery after general anesthesia, and can improve the patients’ comfort degree.
Objective To determine the efficiency and safety of dexmedetomidine in general anesthesia. Methods Trials were located through electronic searches of the PubMed, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, CMBdisk (from the date of establishment of the databases to April 2008). Bibliographies of the retrieved articles were also checked. Result A total of 25 trials involving 1 241 patients were included. The Meta-analysis showed: dexmedetomidine reduced peri-operative heart rate and blood pressure, reduced the occurrence of postoperative nausea and vomitting [RR=0.57, 95%CI (0.38, 0.84)], postoperative agitation [RR=0.29, 95%CI (0.17, 0.51)], shivering [RR=0.45, 95%CI (0.29, 0.68)], increase the occurrence of bradycardia [RR=2.16, 95%CI (1.58, 2.95)], hypotension [RR=2.97, 95%CI (1.42, 6.18)]. Dexmedetomidine reduced administration of thiopental, isoflurane and fentanyl, while there was no difference in muscle relaxant. Dexmedetomidine showed no difference in emergency time compared with the control group. As a result of low incidence of adverse reaction, dexmedetomidine showed superior in discharge time [WMD15.17, 95%CI (3.87, 26.46)]. Conclusions The limited current evidence shows that dexmedetomidine is better in maintaining the hemodynamic balance; reducing occurrence of nausea, vomiting, agitation and shivering; and reducing doses of anesthetics. In emergency time, dexmedetomidine shows no difference except discharge time.
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 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 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.
目的探討單腔氣管內插管保留自主呼吸的靜脈全身麻醉下小兒胸腔鏡手術的可行性及安全性。 方法選取鄭州大學第一附屬醫院胸外科2012年2～12月采用單腔氣管內插管保留自主呼吸行靜脈全身麻醉下胸腔鏡手術治療的14例患兒作為試驗組，男9例、女5例，年齡4～9歲；選取2010年5月至2011年10月采用常規雙腔氣管內插管全身麻醉下胸腔鏡手術治療的20例小兒患者作為對照組，男13例、女7例，年齡3～10歲。比較兩組手術時間、術中失血量、術畢至拔管時間、住院費用、住院時間及術后并發癥發生率等指標。 結果兩組患兒手術均順利，無術中術后死亡。試驗組和對照組患兒平均手術時間[（85.7±16.9）min vs.（83.5±16.5）]及術中失血量[（90.0±55.0）ml vs.（85.0±50.0）ml]差異無統計學意義（P>0.05）。試驗組的術畢至拔管時間[（0.5±0.1）min vs.（8.3±1.4）min]、住院費用[（24.3±4.7）千元vs.（27.8±5.3）千元]、住院時間[（6.6±0.9）d vs.（12.7±3.2）d]、術后并發癥發生率（7.1%vs.25.0%）都顯著短或少于對照組（P < 0.05）。 結論單腔氣管內插管保留自主呼吸靜脈全身麻醉下小兒胸腔鏡手術治療小兒胸部疾病具有一定的安全性及可行性。