Objective To explore the effect of the feed-forward control on safety nursing of ophthalmologic day surgery patients under general anesthesia. Methods A total of 623 ophthalmologic day surgery patients under general anesthesia were retrospectively selected into the control group, who adapted the routine nursing in the Ophthalmic Day Surgery Center from January to December 2015; a total of 1 210 ophthalmologic day surgery patients under general anesthesia were retrospectively selected into the observation group, who received the feed-forward control of nursing safety management on the basis of routine nursing care from January to December 2016. The incidence rate of the adverse events and potential safety hazards and satisfaction rate were compared between the two groups. Results The incidence rate of the adverse events and potential safety hazards in the observation group (0.83%, 10/1 210) was lower than that in the control group (3.37%, 21/623), the satisfaction rate in the observation group (98.67%) was higher than that in the control group (97.11%), and the differences were statistically significant (P<0.05). Conclusion The application of feed-forward control in the safety care of patients during the ophthalmologic day surgery under general anesthesia can effectively reduce the incidence of adverse events and potential safety hazards, and ensure the safety of medical care.
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.
Objective To systematically review the effectiveness and safety of thoracic epidural analesis (TEA) for postoperative complications after cardiac surgery. Methods Such databases as PubMed, Science Citation Index, EMbase, The Cochrane Library, CNKI and CBM were electronically searched from inception to October 2012 for collecting the randomized controlled trials on the effectiveness and safety of thoracic epidural analgesisa for postoperative complications after cardiac surgery. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Totally 14 studies were eligible, involving 1 942 patients. The results of meta-analysis showed that, TEA combined with general anesthesia (GA) was superior to GA alone in reducing the incidences of myocardial ischemia/infarction (RR=0.63, 95%CI 0.41 to 0.96, P=0.03), respiratory complications (RR=0.55, 95%CI 0.40 to 0.75, P=0.000 1), supraventricular arrhythmias (RR=0.64, 95%CI 0.47 to 0.88, P=0.005), and duration of mechanical ventilation (MD= –2.15, 95%CI –3.72 to –0.58, P=0.007), with significant differences. Conclusions Current evidence shows that, TEA after surgery is effective in reducing the incidences of myocardial ischemia/infarction, respiratory complications, supraventricular arrhythmias, and duration of mechanical ventilation. There is the lack of data on the adverse events of TEA (mainly referring to epidural hematoma). Due to limited quality and quantity of the included studies, patients’ conditions should be fully considered before applying TEA in clinical practice.
Objective To assess the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia. Methods Such databases as PubMed (1966 to March 2012), The Cochrane Library (Issue 1, 2012), EBSCO (ASP) (1984 to March 2012), Journals@Ovid Full Text (1993 to March 2012), CBM (1978 to March 2012), CNKI (1979 to March 2012), VIP (1989 to March 2012), and WanFang Data (1998 to March 2012) were searched to collect randomized controlled trials (RCTs) about the influence of dexmedetomidine on the recovery of pediatric patients after sevoflurane anesthesia, and the references of the included studies were also retrieved. Two researchers extracted the data and evaluated the methodological quality of the included studies independently. Then the RevMan 5.2 software was used for meta-analysis. Results A total of 16 RCTs involving 1 217 patients were included. The results of meta-analysis showed that, compared with the placebo, dexmedetomidine could reduce the occurrence of emergence agitation (OR=0.18, 95%CI 0.13 to 0.25, Plt;0.000 01) and increase the occurrence of postoperative lethargy (OR=0.14, 95%CI 0.03 to 0.68, P=0.01), but there were no differences in the occurrence of side effects including bronchospasm, bucking, breathholding, and oxygen desaturation. Dexmedetomidine could also reduce mean arterial blood pressure (MAP) and heart rate (HR) of pediatric patients during the recovery period after sevoflurane anesthesia, but it increased emergence time (MD=2.14, 95%CI 0.95 to 3.33, P=0.000 4), extubation time (MD=1.26, 95%CI 0.51 to 2.00, P=0.000 9) and the time of staying in PACU (MD=4.72, 95%CI 2.07 to 7.38, P=0.000 5). Conclusions For pediatric patients recovering from sevoflurane-based general anesthesia, dexmedetomidine can reduce the occurrence of emergence agitation, and is helpful to maintain the hemodynamic balance. But it prolongs emergence time, extubation time (or the time of using the laryngeal mask) and the time of staying in PACU, and increases the occurrence of postoperative lethargy.
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.
Objective To systematically evaluate the effects of magnesium sulfate on postoperative pain and complications after general anesthesia. Methods A literature search was conducted in following databases as The Cochrane Library, EMbase, PubMed, EBSCO, Springer, Ovid, CNKI and CBM from the date of establishment to September 2011 to identify randomized controlled trials (RCTs) about intravenous infusion of magnesium sulfate during general anesthesia. All included RCTs were assessed and the data were extracted according to the standard of Cochrane systematic review. The homogenous studies were pooled using RevMan 5.1 software. Results A total of 11 RCTs involving 905 patients were included. The results of meta-analyses showed that compared with the control group, intravenous infusion of magnesium sulfate during general anesthesia significantly reduced the visual analog scale (VAS) scores at the time-points of 2, 4, 6, 8, 16, and 24 hours, respectively, after surgery, the postoperative 24 hours morphine requirements, and the incidents of postoperative nausea and vomiting (RR=0.61, 95%CI 0.40 to 0.91, P=0.02) and chilling (RR=0.29, 95%CI 0.14 to 0.59, P=0.000 7). Although the incidents of bradycardia (RR=1.93, 95%CI 1.05 to 3.53, P=0.03) increased, there were no adverse events or significant differences in the incidents of hypotension and serum concentration changes of magnesium. Conclusion Intravenous infusion of magnesium sulfate during general anesthesia may obviously decrease the pain intensity, and the incidents of nausea and vomiting and chilling after surgery, without increasing cardiovascular adverse events and risk of hypermagnesemia. The results still need to be confirmed by more high-quality and large-sample RCTs.
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.
ObjectiveTo investigate the effect of etomidate and propofol on inflammatory cytokines and cortisol for patients with lung adenocarcinoma. MethodSixty patients scheduled for lung cancer surgery under general anesthesia were studied. All patients were randomly divided into an etomidate total intravenous anesthesia group (group E, 30 patients, 16 males and 14 females at age of 58.0±5.0 years) and a propofol total intravenous anesthesia group (group P, 30 patients, 17 males and 13 females at age of 55.0±5.0 years), with 30 patients in each group. ResultsThe concentration of IL-6 in serum of patients in the two groups at time points T1, T2 and T3 was significantly higher than those at time point T0 (P < 0.01). The concentration of IL-10 and TNF-α in serum of patients at time points T1 and T2 was significantly higher than those at time point T0 (P < 0.01). And the difference of the concentration of TNF-α in serum of patients at time points T0 and T3 was not statistically significant (P > 0.05). The level of Cor of patients in the group E at time point T0 was slightly higher than those at time point T1, but lower than that at time points T2 and T3. There was no statistical difference in the concentration of IL-6 and TNF-α in serum of patients between the two groups. The level of IL-10 of patients in the group E at time points T2 and T3 was lower than those in the group P (P < 0.05), but no significant difference was observed at the other time points. The concentration of Cor in the patients in the group E at time point T1 was lower than that in the group P (P < 0.01), but no significant difference was observed either at the other time points. ConclusionThe effect of etomidate used for maintenance of general anesthesia on the inflammatory factors is essentially similar to that of propofol.
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'.
ObjectiveTo explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.MethodsThe basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.ResultsThere were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.ConclusionThe coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.