Objective To investigate the applied significance of adjustable low-concentration of mixed oxygenand nitrous oxide inhalation sedation combined with lidocaine local anesthesia in anorectal surgery. Methods Three hundreds patients underwent anorectal surgery in our hospital were divided into control group （n=154） and observation group （n=146）. Patients of control group underwent pure lidocaine local anesthesia， and patients of observation group underwent mixed oxygen and nitrous oxide sedation analgesia combined with lidocaine local anesthesia. Vital signs before and after operation as well as results of sedation and analgesia were compared between the 2 groups. Results Anorectal surgeries of all patients were performed successfully. There were no significant differences on change of heart rate， blood pressure， and oxygen saturation between the 2 groups before and after operation （P＞0.05）. The operation time between the control group 〔（36.3±6.8） min〕 and observation group 〔（35.4±6.5） min〕 had no statistically significant difference（t=-0.607， P=0.544）. The analgesic effects （Z=-6.859， P=0.000） and sedative effects （Z=-5.275， P=0.000） of obser-vation group were both better than those of control group. Conclusions Low-concentration of mixed oxygen and nitrous oxide inhalation sedation combined with lidocaine local anesthesia can relieve the discomfort of fear and pain， no side-impacts on vital sign before and after operation were observed，and it has better effects of sedation and analgesia， therefore it can be recommended to clinical application.
目的:觀察丙泊酚靜脈泵注復合腰硬聯合麻醉于剖宮產術中的可行性及安全性。方法:50例ASA I~II級行擇期剖宮產術產婦,于L2-3行腰硬聯合麻醉,確定麻醉平面為T4-6,取出胎兒后靜脈緩推丙泊酚1mg/kg,然后2~4mg·kg-1·h-1靜脈泵入,連續監測平均動脈壓,心率,血氧飽和度,呼吸頻率。結果:腰硬聯合麻醉及靜脈推注負荷劑量丙泊酚后平均動脈壓降低,但無臨床意義。余心率,氧飽和度,呼吸頻率各時點無統計學差異。結論:丙泊酚復合腰硬聯合麻醉用于剖宮產術患者生命體征平穩,鎮靜效果良好。
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.
ObjectiveTo investigate the feasibility, safety and effectiveness of video-assisted thoracic surgery (VATS) sympathectomy under monitored anesthesia care (MAC) and local anesthesia (LA) without endotracheal intubation as a new fast track recovery surgical strategy for the treatment of palmar hyperhidrosis. MethodsA total of 124 patients with intermediate or severe hyperhidrosis who were admitted to Guangdong General Hospital were enrolled in this study. With SPSS18 random number generator, all the patients were divided into MAC+LA group and general anesthesia (GA) group with 62 patients in each group. There were 43 males and 19 females in MAC+LA group with their age of 22.25±6.22 years, and 42 males and 20 females in GA group with their age of 23.98±6.67 years. During the surgery, MAC+LA group patients received MAC and oxygen via nasal tube or face mask instead of endotracheal intubation, and GA group patients received GA, endotracheal intubation and controlled ventilation. Clinical outcomes were compared between the 2 groups. ResultsAll the patients received their operations safely. None of MAC+LA group patients received conversion to GA and controlled ventilation. There was statistical difference in operation time (47.18±12.06 minutes vs. 39.33±13.21 minutes, P=0.002) and length of theatre stay 84.52±22.56 minutes vs. 134.68±26.12 minutes, P=0.000) between MAC+LA and GA group patients. There was no statistical difference in blood loss, incidence of intraoperative SpO2 lower than 95% (2 patients vs. 0 patient), postoperative hospital stay, incidence of postoperative compensatory sweating (86.5% vs. 89.0%) and patient satisfaction rate (94.59% vs.95.12%) between the 2 groups. No intraoperative pain, postoperative complication or symptom recurrence was observed in either group. There was statistical difference in anesthetic preparation time (20.52±10.55 minutes vs. 36.47±12.16 minutes), duration between operation finish and returning to ward (11.26±7.09 minutes vs. 59.39±19.89) minutes and hospitalization cost (RMB 6 376.86±746.00 yuan vs. RMB 8 812.04±867.93 yuan) between the 2 groups. The incidence of postoperative sore throat (0% vs. 100%), monitor time (4 hours vs. 12 hours) and time to resume oral intake (2 hours vs. 6 hours) of MAC+LA group were significantly lower or shorter than those of GA group. ConclusionVATS sympathectomy under MAC and LA can avoid complications of GA and endotracheal intubation, and provide a safe, feasible, effective and more minimally invasive fast track alternative for the treatment of palmar hyperhidrosis.
This study was designed to determine the effects of different anaesthesia on the postoperative gastrointestinal motility after cholecystectomy. Postoperative gastrointestinal motility were recorded continuously by means of gastrointestinal manometry in 20 patients subject to cholecystectomy (general anaesthesia 10, epidural anaesthesia 10). Normal migrating motor complex (MMC) was abolished during the early postoperative period in all patients. The time of reappearance of intestinal MMC varied from 0.5 to 2 hours . Gastric MMC recurred 5.5 to 14 hours postoperatively and the normal MMC completely recovered 22 to 43 hours after the operations. Ingestion of food changed the MMC into a fed pattern during the early postoperative period. There was no difference between the general anaesthesia group and epidural anaesthesia group in terms of gastrointestinal motility. The results indicate that postoperative gastrointestinal motility recovers faster than that was thought conventionally. Cholecystectomy under general anaesthesia or under epidural anaesthesia makes no difference in postoperative gastrointestinal motility.
Objective To assess the efficacy and safety of dexmedetomidine used for intravertebral anesthesia. Methods A search in PubMed Central, EBSCO, Springer, Ovid, CNKI and WanFang Data was conducted from the date of their establishment to February 2011, so as to collect the randomized controlled trails (RCTs) on dexmedetomidine used for intravertebral anesthesia. The reference lists of identified papers were examined for further trials. After the data were extracted and the quality was assessed in accordance with the inclusion and exclusion criteria, the Meta-analysis was conducted with RevMan5.0 software. Results A total of 13 RCTs involving 672 patients were included. The results of meta-analyses showed that compared with saline solution, dexmedetomidine tended to speed up the mean time of sensory block to reach T10 dermatome (MD= –2.39, 95%CI –4.40 to –0.39) and motor block to reach Bromage 3 (MD= –5.30, 95%CI –7.18 to –3.43). It also prolonged the time for two dermatomes regression of sensory blockade (MD=51.14, 95%CI 44.96 to 57.32) and complete resolution of motor blockade (MD=68.46, 95%CI 38.56 to 98.35). Peri-operative bradycardia significantly increased (RR=3.03, 95%CI 1.64 to 5.59) but shivering decreased (RR=0.47, 95%CI 0.28 to 0.80). In comparison with the control group, dexmedetomidine showed no difference in low blood pressure and occurrence of postoperative nausea and vomiting. Conclusion The current evidence shows that dexmedetomidine shortens the time for taking effect, prolongs the duration of intravertebral anesthesia, decreases the occurrence of shivering, and increases the occurrence of bradycardia.