ObjectivesTo systematically review the efficacy and safety of controlled hypotension for total hip or knee replacement.MethodsPubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on controlled hypotension for total hip or knee replacement from inception to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by RevMan 5.3 software.ResultsA total of 15 RCTs involving 854 patients were included. The results of meta-analysis showed that compared with no controlled hypotension during surgery, controlled hypotension could reduce intraoperative blood loss (MD=?267.35, 95%CI ?314.54 to ?220.16, P<0.000 01), allogeneic blood transfusion (MD=?292.84, 95%CI ?384.95 to ?200.73, P<0.000 01), and 24 h postoperative mini-mental state examination (MMSE) score (MD=?1.08, 95%CI ?1.82 to ?0.34, P=0.004). However, there were no significant differences in 96 h postoperative MMSE score (MD=?0.11, 95%CI ?0.50 to 0.28, P= 0.57) and intraoperative urine volume (MD=57.93, 95%CI ?152.57 to 268.44, P=0.59).ConclusionsThe current evidence shows that controlled hypotension during total hip or knee replacement can reduce intraoperative blood loss and allogeneic blood transfusion. Furthermore, there is no obvious effect on the maintenance of blood perfusion in important organs, despite certain effects on the postoperative cognitive function, which can be recovered in short term. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To investigate the occurrence, progress and conversion of hypotony in anterior proliferative vitreoretinopathy (aPVR), and to provide knowledge about how to prevent and treat it． Methods Animal models of chronic hypotony by aPVR were made with cultured ho mologous dermal fibroblasts on pigmented rabbits．The intraocular pressure (IOP) and ultrasound biomicroscopy(UBM) examination were taken preoperatively and on days 7,14, 28 and 56 postoperatively．Rabbits were killed on days 14, 28 or 56 postoperatively, prepared for histology and ultrastructure examination． Results The average IOP of experimental group was lower than that of control group on days 7,14,28 and 56 significantly (Plt;0．01)．UBM demonstrated that trip like echo emerged in front of ciliary body four weeks postoperatively, and tractional retinal detachment was found four weeks and eight weeks postoperatively in experimental group． Microscopic examination showed atrophy orabsence of the non-pigmented ciliary epithelium on days 28 and 56 postoperatively in experimental group．Electronic microscopy showed that the amount of mitochondrions decreased and there were many vacuoles in the non-pigmented ciliary epithelium in experimental group four and eight weeks postoperatively． Conclusions Atrophic change of the non-pigmented epithelium due to dragging effect of the ciliary body from the epiciliary membrane in aPVR might be the main cause of hypotony． (Chin J Ocul Fundus Dis, 2001,17:216-220)
ObjectiveTo systematically review the efficacy of dexmedetomidine for controlled hypotension in orthognathic surgery. MethodsThe PubMed, Embase, Cochrane Library, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on dexmedetomidine for controlled hypotension in orthognathic surgery from inception to May, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by using RevMan 5.4 software. ResultsA total of 8 RCTs involving 371 patients were included. The results of meta-analysis showed that the operation time of dexmedetomidine group was not significantly different from that of hypotensive drug group, but was shorter than that of saline group (MD=?23.20, 95%CI ?44.05 to ?2.35, P=0.03). There were no statistically significant differences in the mean arterial pressure and the intraoperative blood loss between dexmedetomidine group and the control group. Compared with those in the control group, the heart rate (MD=?18.78, 95%CI ?30.80 to ?6.77, P=0.002) and the incidence of postoperative adverse events (OR=0.25, 95%CI 0.08 to 0.76, P=0.01) in dexmedetomidine group were less than those in the control group significantly. ConclusionCurrent evidence shows that dexmedetomidine can be used effectively for controlled hypotension in orthognathic surgery. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
ObjectiveTo evaluate the feasibility and clinical effect of controlled hypotension in video-assisted thoracoscopic surgery (VATS) for subcarinal lymph node dissection in patients with lung cancer.MethodsWe analyzed the clinical data of 53 non-small cell lung cancer (NSCLC) patients undergoing VATS with controlled systolic blood pressure while dissecting the subcarinal lymph node from September to October 2016 in our department (a treatment group, including 31 males and 22 females with an average age of 53.20±8.80 years ranging 43-68 years). We selected 112 NSCLC patients undergoing VATS without controlled systolic blood pressure while dissecting the subcarinal lymph node from January to August 2016 in our department (a contol group, including 67 males and 45 females with an average age of 54.32±7.81 years ranging 39-73 years). The clinical data of both groups were compared.ResultsThe operation time and blood loss of the treatment group were less than those of the control group (177.6±39.4 min vs. 194.3±47.8 min, 317.9±33.6 ml vs. 331.2±38.7 ml, P<0.05). The duration of subcarinal lymph node dissection and total duration of lymph node dissection of the treatment group were also less than those of the control group (10.5±4.3 min vs. 13.6±5.2 min, 37.7±7.5 min vs. 48.7±6.4 min, P<0.001). The thoracic drainage at postoperative days 1, 2, 3 and total drainage volume, duration of tube placement and hospital stay of the treatment group were less than those of the control group (P<0.05). Whereas the postoperative complications of the two groups did not differ significantly (P>0.05).ConclusionControlled hypotension reduces the difficulty of dissecting subcarinal lymph nodes and the risk of bleeding, and produces less drainage volume, which is safe and effective.
Objective To investigate and compare the effects of succinylated gelatin injection and saline priming on the first hour blood pressure in critically ill patients receiving continuous renal replacement therapy (CRRT). Methods Inpatients who received continuous venous-venous dialysis filtration therapy in the intensive care unit of West China Hospital of Sichuan University between January and May 2024 were selected. The patients were randomly divided into an experimental group (colloidal solution group) and a control group (crystalloid solution group) in a 1∶1 ratio. The colloidal solution group used succinylated gelatin injection as the priming solution, and used the dual connection method to draw blood to the machine. The patient’s systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at 10 minutes before and 0, 1, 3, 5, 10, 30 and 60 minute after CRRT initiation, the name and dosage of vascular compression drugs pumped intravenously at 0, 30 and 60 minutes, and the liquid inlet and outlet in the first hour were monitored and recorded. The crystalloid solution group used normal saline as the priming solution, and the rest of the methods were the same as those of the colloidal solution group. Two groups of patients were compared for changes in blood pressure and heart rate during the first hour of CRRT, as well as the incidence of hypotension. Results A total of 208 patients were included, with 104 cases in each group. There was no significant difference in baseline data between the two groups (P>0.05). At 3 minutes after CRRT, the systolic blood pressure of the crystalloid solution group was lower than that of the colloidal solution group [(122.56±23.82) vs. (129.43±25.46) mm Hg (1 mm Hg=0.133 kPa); t=?2.005, P=0.046]. There was no statistically significant difference in diastolic blood pressure, mean arterial pressure, or heart rate between the two groups at different time points (P>0.05). The intra group comparison results showed that the systolic blood pressure of the crystalloid solution group decreased compared to before at 1, 3, 5, and 10 minutes after CRRT (P<0.05), while the diastolic blood pressure and mean arterial pressure decreased compared to before at 3, 5, and 10 minutes after the start of CRRT (P<0.05); there was no statistically significant difference in blood pressure of the colloidal solution group among different time points after the start of CRRT (P>0.05). The heart rate of the crystalloid solution group was higher at 10 minutes after the start of CRRT than at 3 minutes after CRRT (P=0.045); 60 minutes after the start of CRRT, the heart rate in the colloidal solution group was lower than that 0 minutes after CRRT (P=0.032); there was no statistically significant difference between the two groups at other time points within each group (P>0.05). On the first hour of CRRT, there was a statistically significant difference in the incidence of hypotension between the two groups [33 cases (31.7%) vs. 18 cases (17.3%); χ2=5.845, P=0.016]. Conclusions The use of colloidal solution pre-flushing is more advantageous to improving the decrease in blood pressure in the first hour of CRRT in severe patients than crystalloid solution group pre-flushing. And it can reduce the incidence of hypotension in the first hour of CRRT in severe patients.
Objective To observe the incidence of ciliary detachment and its relationship with intraocular hypotension soon after vitrectomy. Methods A total of 46 eyes of 46 patients who underwent vitrectomy were examined by ultrasound biomicroscope (UBM). The patients were divided into three groups according to different tamponade: gas group (11 eyes), silicone oil group (8 eyes) and balanced saline solution (BSS) group (27 eyes). Basing on the postoperative intraocular pressure (IOP), the patients were divided into two groups: IOPlt; 10 mm Hg (25 eyes) and IOPge;10 mm Hg (21 eyes). UBM was applied to determine the tomographic features of the ciliary body 3 days after the surgery. IOP were monitored by noncontact tonometer daily after the surgery. The eyes with ciliary detachment were then examined once a week till the ciliary detachment reattached. The followup period was from 14 to 35 days. Results After vitrectomy, ciliary detachment was observed in 20 eyes of 46 eyes (43.5%), The incidence of ciliary detachment was 27.3％ in gas group, 25.0％ in silicone oil group, and 55.6％in BSS group. The average IOP in eyes with ciliary detachment ［(6.47plusmn;4.49) mm Hg （1 mm Hg=0.133 kPa）］ was significantly lower than that in the eyes without ciliary detachmen ［(15.61plusmn;7.72) mm Hg］ (t=8.031,Plt;0.001). The incidence of ciliary detachment was higher in eyes with postoperative IOP lt;10 mm Hg (68.0％) than that in the eyes with postoperative IOP ge;10 mm Hg (14.3%) (chi;2＝15.60, Plt;0.001). All eyes with postoperative ciliary detachment got spontaneous reattachment within 30 days after the surgery except that one eye had optic disc edema due to severe intraocular hypotension. Conclusions Early postoperative ciliary detachment is a common complication after vitrectomy. Eyes filled with BSS have the highest incidence of postoperative ciliary detachment. Most of the patients with ciliary detachment may get spontaneous reattahment within 30 days after the surgery.
Objective To observe the relationship between the suturing patterns to close the scleral incision and postoperative intraocular pressure (IOP) in 23G minimally invasive vitrectomy. Methods Eighty eyes of 80 patients with vitreoretinal diseases, who were treated with primary 23G minimally invasive vitrectomy, were enrolled in this prospective clinical study. Patients with poor closed scleral incision which need suturing were excluded from this study. The corrected visual acuity ranged from hand movement to 0.2. The IOP ranged from 7.9 to 19.8 mm Hg (1 mm Hg=0.133 kPa), with the mean of (13.9plusmn;1.8) mm Hg. The eyes were randomly divided into three groups: group A (20 eyes), suturing all three scleral puncture after vitrectomy; group B (20 eyes), suturing only two upper scleral puncture, but not the lower infusion puncture after vitrectomy; group C (40 eyes), no suturing for all 3 scleral puncture after vitrectomy. All patients underwent 23G vitrectomy only. The corrected visual acuity and IOP were observed after surgery. Results The corrected visual acuity were 0.1 -0.3, 0.2- 0.5, 0.3 -0.8 in one, seven and 14 days after surgery, respectively. No one in group A, B experienced hypotony in one, three, seven and 14 days after surgery. Thirteen (32.5%), five (12.5 %), two eyes (5.0%) in group C experienced hypotony in one, three and seven days after surgery. Seven eyes (17.5%) experienced severe hypotony (＜5 mm Hg) in 14 day after surgery in group C. The difference was statistically significant compared the incidence of hypotony in group C with group A, B respectively at different time points after surgery (chi;2= 16.82,P=0.007). The difference was statistically significant compared the incidence of hypotony in group C at different time points after surgery (chi;2=11.64,P=0.003). The difference was no significant compared the IOP between group A and B at different time points after surgery (F=1.618,P=0.205). Compared the IOP of group C to group A and B, the difference was statistically significant in one and three days after vitrectomy (F=9.351,P=0.000); but not statistically significant in seven and 14 days after vitrectomy(F=0.460,P=0.633). Conclusions Whether or not suturing the scleral punctures is closely related to postoperative hypotony in 23G vitrectomy. Suturing only the two upper scleral punctures can reduce the occurrence of postoperative hypotony.
ObjectiveTo summarize the clinical features in idiopathic hypotony maculopathy.MethodsA retrospective case series study. Eighteen eyes of 18 patients who were diagnosed with idiopathic hypotony maculopathy were enrolled in the Second Affiliated Hospital of Wenzhou Medical University from August 2012 to December 2017. There were 8 males (8 eyes) and 10 females (10 eyes). All patients underwent examinations including BCVA, optometry, slit lamp microscope, fundus color photography, UBM, B-mode ultrasound, OCT, FFA and axial length (AL). BCVA was recorded with logMAR acuity. The results of affected eyes and contralateral healthy eyes were compared. Paired t test was performed to compare the intraocular pressure (IOP), diopter and AL of the affected eyes and contralateral healthy eyes.ResultsAmong 18 eyes, there were 6 eyes with logMAR BCVA＜1.0, 10 eyes with logMAR BCVA 1.0?2.0, 2 eyes with light perception. The average diopter was +2.32±1.78 D. The average IOP was 5.18±1.38 mmHg (1 mmHg=0.133 kPa). The average AL was 20.92±1.61 mm. The differences of IOP (t=21.6, P＜0.000), diopter (t=5.9, P=0.002) and AL (t=9.13, P＜0.000) between the affected eyes and contralateral healthy eyes were significant. The inflammatory reaction in the anterior segment was observed in 13 eyes (72.22%). In the posterior segment, all the eyes were documented with chorioretinal folds, optic disc swelling and retinal phlebectasia were also demonstrated in 14 eyes, while with macular uplift in 7 eyes. In the UBM and gonioscope examination, the angle chamber was open in all patients with ciliary body cyst in 6 eyes, while no ciliary body detachment was detected. All eyes had been examined with B-scan ultrasound and found the increasing thickness of eye ball in all eyes, and nodular changes in the optic papilla in 5 eyes. The chorioretinal folds were further confirmed by OCT with the appearance of the gear shape, much more obviously in the choroid than that in retina. In the FFA, fluorescein leakage was found around the optic disc in 13 eyes at the late stage, while there was no obvious abnormal leakage in the macular or poster part of retina.ConclusionsIdiopathic hypotony maculopathy could present with various clinical manifestations. The choroiretinal folds is typical clinical sign.
ObjectiveTo summarize the clinical features of and prognosis factors for spontaneous intracranial hypotension (SIH). MethodsWe continuously registered hospitalized patients diagnosed with SIH from December 1st, 2010 to February 1st, 2014. Etiology information and clinical features were collected at the first day of admission. Routine blood test and lumbar puncture were done as soon as possible. Every patient got position and fluid infusion therapy. During the one-week follow-up, headache level was evaluated with Visual Analogue Scale (VAS). ResultsThere were 110 patients included, and among them, 39(35.5%) were male and 71(64.55%) were female. The age of onset was between 17 and 91 years old with a mean onset age of (42.0±12.4). Besides postural headache, common signs were nausea (68 cases, 61.8%), vomiting (63 cases, 57.3%), dizziness (40 cases, 36.4%), neck pain (27 cases, 24.5%), and tinnitus (23 cases, 20.9%). VAS at baseline was (7.46±0.86), and at the last follow-up, VAS was (3.45±2.17), with an average improvement of 53.75%. Patients with ANA marker positive had better prognosis. ConclusionSIH can accompany serious brain stem and cerebellum signs, and even meningeal irritation. Cerebrospinal fluid (CSF) changes are similar to virus infection with negative serum virus screening. If CSF leak cannot be found on imaging, patients can improve through fluid infusion therapy and postural treatment.
ObjectiveTo evaluate the effectiveness and safety of tranexamic acid (TXA) combined with intraoperative controlled hypotension (ICH) for reducing perioperative blood loss in primary total hip arthroplasty (THA).MethodsThe clinical data of 832 patients with initial THA due to osteonecrosis of femoral head between January 2017 and July 2020 were retrospectively analyzed. All patients received TXA treatment, and 439 patients (hypotension group) received ICH treatment with an intraoperative mean arterial pressure (MAP) below 80 mm Hg (1 mm Hg=0.133 kPa) while 393 patients (normotension group) received standard general anesthesia with no special invention on blood pressure. There was no significant difference in age, gender, body mass index, American Society of Anesthesiologists (ASA) classification, basic arterial pressure, hip range of motion, internal diseases, preoperative hemoglobin (HB) and hematocrit (HCT), coagulation function, surgical approach, and TXA dosage between the two groups (P>0.05). The perioperative blood loss and blood transfusion, anesthesia and operation time, hospitalization stay, postoperative range of motion, and complications were recorded and compared between the two groups. The patients were further divided into MAP<70 mm Hg group (group A), MAP 70-80 mm Hg group (group B), and normotension group (group C). The perioperative blood loss and postoperative complications were further analyzed to screen the best range of blood pressure.ResultsThe intraoperative MAP, total blood loss, dominant blood loss, recessive blood loss, blood transfusion rate and blood transfusion volume, anesthesia time, operation time, and hospitalizarion stay in the hypotension group were significantly lower than those in the normotension group (P<0.05). The postoperative hip flexion range of motion in the hypotension group was significantly better than that of the normotension group (Z=2.743, P=0.006), but there was no significant difference in the abduction range of motion between the two groups (Z=0.338, P=0.735). In terms of postoperative complications, the incidence of postoperative hypotension in the hypotension group was significantly higher than that in the normotension group (χ2=6.096, P=0.014), and there was no significant difference in the incidence of other complications (P>0.05). There was no stroke, pulmonary embolism, or deep vein thrombosis in the two groups, and no patients died during hospitalization. Subgroup analysis showed that there was no significant difference in total blood loss, dominant blood loss, and recessive blood loss in groups A and B during the perioperative period (P>0.05), which were significantly lower than those in group C (P<0.05). There was no significant difference in blood transfusion rate, blood transfusion volume, and incidence of acute myocardial injury between 3 groups (P>0.05); the incidence of acute kidney injury in group A was significantly higher than that in group B, and the incidence of postoperative hypotension in group A was significantly higher than that in groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05).ConclusionThe combination of TXA and ICH has a synergistic effect. Controlling the intraoperative MAP at 70-80 mm Hg can effectively reduce the perioperative blood loss during the initial THA, and it is not accompanied by postoperative complications.