Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.014
Ruyue Mu, Yi-sa Shi
With the increasing number of pediatric surgeries, pediatric tracheal intubation under general anesthesia increases, and the complications associated with extubation increase. Therefore, the choice of timing of tracheal extubation is increasingly con-cerned by anesthesiologists. How to wake up children in a more comfortable environment under the premise of safety is the goal pur-sued by pediatric anesthesiologists. A large number of clinical studies have confirmed that tracheal extubation under deep anesthesia can reduce respiratory complications, relieve hemodynamic fluctuations and decline child agitation after extubation in the anesthesia re-covery period, and enable children to survive the recovery period of anesthesia in a more comfortable state. This article reviews the ef-fects of deep anesthesia extubation on the body, methods of extubation, medication, and limitations. Key words: Pediatric anesthesia; Deep anesthesia; Extubation
{"title":"Research progresses in tracheal extubation under deep anesthesia in children","authors":"Ruyue Mu, Yi-sa Shi","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.014","url":null,"abstract":"With the increasing number of pediatric surgeries, pediatric tracheal intubation under general anesthesia increases, and the complications associated with extubation increase. Therefore, the choice of timing of tracheal extubation is increasingly con-cerned by anesthesiologists. How to wake up children in a more comfortable environment under the premise of safety is the goal pur-sued by pediatric anesthesiologists. A large number of clinical studies have confirmed that tracheal extubation under deep anesthesia can reduce respiratory complications, relieve hemodynamic fluctuations and decline child agitation after extubation in the anesthesia re-covery period, and enable children to survive the recovery period of anesthesia in a more comfortable state. This article reviews the ef-fects of deep anesthesia extubation on the body, methods of extubation, medication, and limitations. \u0000 \u0000 \u0000Key words: \u0000Pediatric anesthesia; Deep anesthesia; Extubation","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"297-300"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47197945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.004
Guoliang Liu, Jianmin Zhang, Jia Gao, Wei Hao, Xiaoxue Wang
Objective To compare the effects of extraluminal use of the Arndt endobronchial blocker and CO2 artificial pneu-mothorax for one lung ventilation in infants and children. Methods A total of 28 infants and children, aged from 6 to 36 months, American Society of Anesthesiologists (ASA) grades Ⅰ or Ⅱ , who were scheduled for thoracoscopy were selected. After induction of general anesthesia, they were placed with the Arndt endobronchial blocker or a single lumen tracheal tube, with one lung ventilation if needed during surgery. According to the differences in diseased lung collapse method, they were divided into two groups based on the random number table method (n=14): an Arndt endobronchial blocker group (group A) and a CO2 artificial pneumothorax group (group C). Then, we observed and recorded the changes of mean arterial pressure (MAP), heart rate, and airway pressure (Paw) before intuba-tion (T1), after intubation (T2), when one lung ventilation began (T3), when one lung ventilation ends (T4), and at the time of extubation(T5), and blood analysis was performed at important time points during surgery to measure arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2). We also recorded lung collapse degree, one lung ventilation time, extubation time, as well as the condition of perioperative hypoxia (with less than 90% of SpO2). Results Operation was successfully finished in all pa-tients. Compared with group C, group A presented remarkable increases in MAP at T2, T4 and T5 and Paw at T4 and T5 (P 0.05). There was one case of hypoxia due to tube displacement in group A. Two children in group C present-ed hypoxia due to excessive chest pressure for a long time. No serious adverse outcomes were found. Conclusions Compared with CO2 artificial pneumothorax, extraluminal use of the Arndt endobronchial blocker has better effects on lung collapse at the diseased side and more stable hemodynamics in infants and children with one lung ventilation. Key words: Infant; One lung ventilation; Artificial pneumothorax; Fiber bronchoscope; Arndt endobronchial blocker
{"title":"Comparison of extraluminal use of the Arndt endobronchial blocker and CO2 artificial pneumothorax for one lung ventila-tion in infants and children","authors":"Guoliang Liu, Jianmin Zhang, Jia Gao, Wei Hao, Xiaoxue Wang","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.004","url":null,"abstract":"Objective \u0000To compare the effects of extraluminal use of the Arndt endobronchial blocker and CO2 artificial pneu-mothorax for one lung ventilation in infants and children. \u0000 \u0000 \u0000Methods \u0000A total of 28 infants and children, aged from 6 to 36 months, American Society of Anesthesiologists (ASA) grades Ⅰ or Ⅱ , who were scheduled for thoracoscopy were selected. After induction of general anesthesia, they were placed with the Arndt endobronchial blocker or a single lumen tracheal tube, with one lung ventilation if needed during surgery. According to the differences in diseased lung collapse method, they were divided into two groups based on the random number table method (n=14): an Arndt endobronchial blocker group (group A) and a CO2 artificial pneumothorax group (group C). Then, we observed and recorded the changes of mean arterial pressure (MAP), heart rate, and airway pressure (Paw) before intuba-tion (T1), after intubation (T2), when one lung ventilation began (T3), when one lung ventilation ends (T4), and at the time of extubation(T5), and blood analysis was performed at important time points during surgery to measure arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2). We also recorded lung collapse degree, one lung ventilation time, extubation time, as well as the condition of perioperative hypoxia (with less than 90% of SpO2). \u0000 \u0000 \u0000Results \u0000Operation was successfully finished in all pa-tients. Compared with group C, group A presented remarkable increases in MAP at T2, T4 and T5 and Paw at T4 and T5 (P 0.05). There was one case of hypoxia due to tube displacement in group A. Two children in group C present-ed hypoxia due to excessive chest pressure for a long time. No serious adverse outcomes were found. \u0000 \u0000 \u0000Conclusions \u0000Compared with CO2 artificial pneumothorax, extraluminal use of the Arndt endobronchial blocker has better effects on lung collapse at the diseased side and more stable hemodynamics in infants and children with one lung ventilation. \u0000 \u0000 \u0000Key words: \u0000Infant; One lung ventilation; Artificial pneumothorax; Fiber bronchoscope; Arndt endobronchial blocker","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"244-248"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46262073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.003
Dengwen Zhang, Ruichun Long, Yingzhu Liu, Yi He, Yi Sun, Z. Xia, Sheng Wang
Objective To investigate the effects of hypoxia/reoxygenation (HR) on apoptosis, autophagy and pyroptosis in H9C2 cardiomyocytes. Methods The cultured H9C2 cardiomyocytes were divided into two groups according to the random number table method: a normal control (Ctrl) group and an HR group. The H9C2 cardiomyocytes in the HR group were deprived of oxygen and glucose for 8 h in a hypoxic incubator, followed by reoxygenation for 12 h. Cell damage was assessed through detection of lactate dehy-drogenase (LDH) content in culture medium and determination of cell viability by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) method (n=6). Apoptosis related proteins [cysteinyl aspartate-specific proteinase (caspase)-3, B-cell lymphoma/leuke-mia 2 (Bcl-2) and Bcl-associate x protein (Bax)], autophagy related proteins [(light chain 3 (LC3) Ⅱ/Ⅰ , p62, Beclin-1, and phosphory-lated mammalian target of rapamycin (p-mTOR)]and pyroptosis related proteins [(nod-like receptor pyrin domain 3 (NLRP3), apoptosis associated speck-like protein (ASC), caspase-1p20, interleukin (IL)-1β, and IL-18]were detected by Western blot (n=9). Cell apopto-sis, autophagy and pyroptosis were further assessed by immunofluorescence staining (n=6) Results Compared with the Ctrl group, the HR group presented reduced viability of H9C2 cardiomyocytes (P<0.05), increased LDH release (P<0.05), and up-regulated expres-sion of activated caspase-3 and Bax (P<0.05), as well as decreased expression of Bcl-2 (P<0.05). TUNEL staining showed that apoptosis significantly was enhanced in the cells after HR (P<0.05). These results indicated that apoptosis and cell damage were enhanced after HR. In contrast, the expression of p-mTOR and p62 increased (P<0.05), but the expression of LC3 Ⅱ/Ⅰ and Beclin-1 protein decreased(P<0.05). The immunofluorescence staining of LC3 Ⅱ/Ⅰ showed that the number of autophagosome within the cells increased after HR(P<0.05), indicating that autophagy in H9C2 myocardial cells was significantly inhibited. Meanwhile, the expression of NLRP3 inflamma-some, ASC and caspase-1p20 protein was remarkably up-regulated (P<0.05), and the expression of activated inflammatory cellular factors IL-1β and IL-18 increased (P<0.05), suggesting that NLRP3 inflammasomes were activated and pyroptosis enhanced after HR. Conclusions Autophagy is inhibited in H9C2 cardiomyocytes during HR injury, but pyroptosis and apoptosis are enhanced. Key words: Autophagy; Apoptosis; Pyroptosis; Cardiomyocytes; Hypoxia-reoxygenation injury
{"title":"Effects of hypoxia/reoxygenation on apoptosis, autophagy and pyroptosis in H9C2 cardiomyocytes","authors":"Dengwen Zhang, Ruichun Long, Yingzhu Liu, Yi He, Yi Sun, Z. Xia, Sheng Wang","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.003","url":null,"abstract":"Objective \u0000To investigate the effects of hypoxia/reoxygenation (HR) on apoptosis, autophagy and pyroptosis in H9C2 cardiomyocytes. \u0000 \u0000 \u0000Methods \u0000The cultured H9C2 cardiomyocytes were divided into two groups according to the random number table method: a normal control (Ctrl) group and an HR group. The H9C2 cardiomyocytes in the HR group were deprived of oxygen and glucose for 8 h in a hypoxic incubator, followed by reoxygenation for 12 h. Cell damage was assessed through detection of lactate dehy-drogenase (LDH) content in culture medium and determination of cell viability by 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) method (n=6). Apoptosis related proteins [cysteinyl aspartate-specific proteinase (caspase)-3, B-cell lymphoma/leuke-mia 2 (Bcl-2) and Bcl-associate x protein (Bax)], autophagy related proteins [(light chain 3 (LC3) Ⅱ/Ⅰ , p62, Beclin-1, and phosphory-lated mammalian target of rapamycin (p-mTOR)]and pyroptosis related proteins [(nod-like receptor pyrin domain 3 (NLRP3), apoptosis associated speck-like protein (ASC), caspase-1p20, interleukin (IL)-1β, and IL-18]were detected by Western blot (n=9). Cell apopto-sis, autophagy and pyroptosis were further assessed by immunofluorescence staining (n=6) \u0000 \u0000 \u0000Results \u0000Compared with the Ctrl group, the HR group presented reduced viability of H9C2 cardiomyocytes (P<0.05), increased LDH release (P<0.05), and up-regulated expres-sion of activated caspase-3 and Bax (P<0.05), as well as decreased expression of Bcl-2 (P<0.05). TUNEL staining showed that apoptosis significantly was enhanced in the cells after HR (P<0.05). These results indicated that apoptosis and cell damage were enhanced after HR. In contrast, the expression of p-mTOR and p62 increased (P<0.05), but the expression of LC3 Ⅱ/Ⅰ and Beclin-1 protein decreased(P<0.05). The immunofluorescence staining of LC3 Ⅱ/Ⅰ showed that the number of autophagosome within the cells increased after HR(P<0.05), indicating that autophagy in H9C2 myocardial cells was significantly inhibited. Meanwhile, the expression of NLRP3 inflamma-some, ASC and caspase-1p20 protein was remarkably up-regulated (P<0.05), and the expression of activated inflammatory cellular factors IL-1β and IL-18 increased (P<0.05), suggesting that NLRP3 inflammasomes were activated and pyroptosis enhanced after HR. \u0000 \u0000 \u0000Conclusions \u0000Autophagy is inhibited in H9C2 cardiomyocytes during HR injury, but pyroptosis and apoptosis are enhanced. \u0000 \u0000 \u0000Key words: \u0000Autophagy; Apoptosis; Pyroptosis; Cardiomyocytes; Hypoxia-reoxygenation injury","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"238-243"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42486514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.015
Rui Wang
Hypoxic pulmonary hypertension (HPH) is often caused by lung diseases such as chronic obstructive pulmonary dis-ease, which ultimately leads to pulmonary heart disease. It is currently believed that hypoxic pulmonary vasoconstriction (HPV) and pulmonary vascular remodeling (PVR) are two main stages of HPH whereas PVR is the main cause of ineffective vasodilators. PVR was thought to be caused by an inflammatory response, but nowadays it was considered as the common results of multiple factors. This re-view focuses on the role of cytokines, oxidative stress, intracellular and extracellular ions, autophagy and apoptosis in the HPH process. We introduces the current research achievements on HPH treatment, and proposes conjectures for future research directions. As an irre-versible lethal disease, pulmonary arterial hypertension (PAH) has been a hot topic in current lung transplantation research, but there are many types of PAH while different types of PAH formation mechanisms are different. This review summarized the progress in mech-anism of PVR and corresponding treatments. Key words: Hypoxic pulmonary hypertension; Pulmonary vascular remodeling; Pulmonary arterial hypertension
{"title":"Research advances in pulmonary vascular remodeling mechanism of hypoxic pulmonary hypertension","authors":"Rui Wang","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.015","url":null,"abstract":"Hypoxic pulmonary hypertension (HPH) is often caused by lung diseases such as chronic obstructive pulmonary dis-ease, which ultimately leads to pulmonary heart disease. It is currently believed that hypoxic pulmonary vasoconstriction (HPV) and pulmonary vascular remodeling (PVR) are two main stages of HPH whereas PVR is the main cause of ineffective vasodilators. PVR was thought to be caused by an inflammatory response, but nowadays it was considered as the common results of multiple factors. This re-view focuses on the role of cytokines, oxidative stress, intracellular and extracellular ions, autophagy and apoptosis in the HPH process. We introduces the current research achievements on HPH treatment, and proposes conjectures for future research directions. As an irre-versible lethal disease, pulmonary arterial hypertension (PAH) has been a hot topic in current lung transplantation research, but there are many types of PAH while different types of PAH formation mechanisms are different. This review summarized the progress in mech-anism of PVR and corresponding treatments. \u0000 \u0000 \u0000Key words: \u0000Hypoxic pulmonary hypertension; Pulmonary vascular remodeling; Pulmonary arterial hypertension","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"301-304"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41576791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.007
Shiwei Huang, Chen Liang, B. Zou
Objective To evaluate the analgesic application of thoracic paravertebral blockade (TPVB) and transverse abdom-inal plane block (TAPB) for multiple costal margins after open liver surgery. Methods A total of sixty patients [American Society Anesthesiologists (ASA) Ⅰ-Ⅲ ]who were scheduled for open liver surgery (with a classical reverse L-shaped incision) were enrolled. The patients were divided into two groups according to the random number table method (n=30): a TPAB group (group TP) and a group of TAPB for multiple costal margins (group TA). Both groups received ultrasound guided nerve block before surgery. Group TP under-went bilateral TPVB at T7-T8 and T8-T9, while group TA underwent TAPB under bilateral costal margins and the classical site between the costal margin and the anterior inferior iliac spine, with a total of four block points. Then, both groups were compared and recorded for the duration of block procedures; the mean arterial pressure (MAP) and heart rate before incision (T0), after incision (T1), and at the times of block of the superior vena cava (T2), liver removal (T3) and stitching (T4); surgical duration, the inflow of liquid during surgery, the consumption of remifentanil, and the length of post-anesthesia care unit (PACU) stay after surgery; the Visual Analogue Scale (VAS) scores at resting and during movement immediately after surgery (when patients were awaken after extubation and able to communicate normally), and 2 h and 6 h after surgery; and the number of patients requiring opioids within 6 h after surgery and the time when opioids were first given after surgery. Results Group TA presented shorter duration of block procedures than group TP (P 0.05). Conclusions During open liver surgery, compared with TAPB for multiple costal margins, TPVB can maintain more stable hemody-namics, require less doses of opioids and improve perioperative analgesia. Key words: Open liver surgery; Thoracic paravertebral nerve block; Transverse abdominal plane block; Postoperative analgesia
{"title":"Comparison of thoracic paravertebral nerve block and transverse abdominal plane block for multiple costal margins in anal-gesia after open liver surgery","authors":"Shiwei Huang, Chen Liang, B. Zou","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.007","url":null,"abstract":"Objective \u0000To evaluate the analgesic application of thoracic paravertebral blockade (TPVB) and transverse abdom-inal plane block (TAPB) for multiple costal margins after open liver surgery. \u0000 \u0000 \u0000Methods \u0000A total of sixty patients [American Society Anesthesiologists (ASA) Ⅰ-Ⅲ ]who were scheduled for open liver surgery (with a classical reverse L-shaped incision) were enrolled. The patients were divided into two groups according to the random number table method (n=30): a TPAB group (group TP) and a group of TAPB for multiple costal margins (group TA). Both groups received ultrasound guided nerve block before surgery. Group TP under-went bilateral TPVB at T7-T8 and T8-T9, while group TA underwent TAPB under bilateral costal margins and the classical site between the costal margin and the anterior inferior iliac spine, with a total of four block points. Then, both groups were compared and recorded for the duration of block procedures; the mean arterial pressure (MAP) and heart rate before incision (T0), after incision (T1), and at the times of block of the superior vena cava (T2), liver removal (T3) and stitching (T4); surgical duration, the inflow of liquid during surgery, the consumption of remifentanil, and the length of post-anesthesia care unit (PACU) stay after surgery; the Visual Analogue Scale (VAS) scores at resting and during movement immediately after surgery (when patients were awaken after extubation and able to communicate normally), and 2 h and 6 h after surgery; and the number of patients requiring opioids within 6 h after surgery and the time when opioids were first given after surgery. \u0000 \u0000 \u0000Results \u0000Group TA presented shorter duration of block procedures than group TP (P 0.05). \u0000 \u0000 \u0000Conclusions \u0000During open liver surgery, compared with TAPB for multiple costal margins, TPVB can maintain more stable hemody-namics, require less doses of opioids and improve perioperative analgesia. \u0000 \u0000 \u0000Key words: \u0000Open liver surgery; Thoracic paravertebral nerve block; Transverse abdominal plane block; Postoperative analgesia","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"260-264"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49023469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.013
Yi Peng
Hitherto, dynamic hemodynamic indicators based on "heart-lung interactions" are the gold standard for guiding fluid resuscitation, but such indicators often were obtained by invasive monitoring and complexity process. In recent years, with the emergence of non-invasive methods such as continuous non-invasive arterial pressure (CNAP), hemodynamic monitoring system and ultrasound mon-itoring system were used in clinic, new prospects for the application of heart-lung interactions indicators for volume therapy were opened up. This review describes the dynamic hemodynamics indicators based on "heart-lung interactions" measured by CNAP system and ultra-sound monitoring for estimating the volume responsiveness. Application of both methods has certain debate. Non-invasive monitoring for assessing volume responsiveness is the trend of clinical fluid therapy. However, it is not currently recommended to use a non-invasive method to guide fluid therapy because its application conditions are limited. But it can be used as a supplement of invasive monitoring to help doctors perform proper fluid management and reduce adverse events. Key words: Heart-lung interactions; Ultrasound; Continuous non-invasive arterial pressure; Fluid responsiveness
{"title":"Research advances of fluid responsiveness evaluation by non-invasive circulatory monitoring indicators based on \"heart-lung interactions\"","authors":"Yi Peng","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.013","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.013","url":null,"abstract":"Hitherto, dynamic hemodynamic indicators based on \"heart-lung interactions\" are the gold standard for guiding fluid resuscitation, but such indicators often were obtained by invasive monitoring and complexity process. In recent years, with the emergence of non-invasive methods such as continuous non-invasive arterial pressure (CNAP), hemodynamic monitoring system and ultrasound mon-itoring system were used in clinic, new prospects for the application of heart-lung interactions indicators for volume therapy were opened up. This review describes the dynamic hemodynamics indicators based on \"heart-lung interactions\" measured by CNAP system and ultra-sound monitoring for estimating the volume responsiveness. Application of both methods has certain debate. Non-invasive monitoring for assessing volume responsiveness is the trend of clinical fluid therapy. However, it is not currently recommended to use a non-invasive method to guide fluid therapy because its application conditions are limited. But it can be used as a supplement of invasive monitoring to help doctors perform proper fluid management and reduce adverse events. \u0000 \u0000 \u0000Key words: \u0000Heart-lung interactions; Ultrasound; Continuous non-invasive arterial pressure; Fluid responsiveness","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"293-296"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41928642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.011
Lixia Li, Lei Zhao, Tianlong Wang, Wei Xiao, Yi An, Pi-Shan Wang
Carotid endarterectomy (CEA) is effective treatment approach to prevent stroke in both symptomatic and asymptom-atic patients with carotid artery stenosis. However, cerebral hypoperfusion during carotid artery cross-clamping may lead to periopera-tive stroke, and nerve monitoring can be helpful in detection of cerebral ischemia, so as to take relevant treatment therapy. Near-infra-red spectroscopy (NIRS) measures the changes of regional cerebral oxygen saturation (rSO2) which can reflect intracranial perfusion, so as to determine the occurrence of cerebral ischemia. Its technique is simple and non-invasive, and can perform continuous and re-al-time monitoring during CEA. In this paper, the practicality and accuracy of various intraoperative neuro-monitoring techniques for CEA were analyzed in combination with the latest domestic and foreign studies in recent years. This paper focuses on various intraoper-ative neuro-monitoring techniques in CEA, the correlation between NIRS and other monitoring techniques, and the role of NIRS in pre-dicting intraoperative ischemia and postoperative hyperperfusion, which can further understand the clinical role of NIRS, so as to facili-tate its application in clinical setting. Key words: Carotid endarterectomy; Near-infrared spectroscopy; Cerebral ischemia; Cerebral oximetry; Cerebral hy-perperfusion syndrome
{"title":"Application of near-infrared spectroscopy in carotid endarterectomy","authors":"Lixia Li, Lei Zhao, Tianlong Wang, Wei Xiao, Yi An, Pi-Shan Wang","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.011","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.011","url":null,"abstract":"Carotid endarterectomy (CEA) is effective treatment approach to prevent stroke in both symptomatic and asymptom-atic patients with carotid artery stenosis. However, cerebral hypoperfusion during carotid artery cross-clamping may lead to periopera-tive stroke, and nerve monitoring can be helpful in detection of cerebral ischemia, so as to take relevant treatment therapy. Near-infra-red spectroscopy (NIRS) measures the changes of regional cerebral oxygen saturation (rSO2) which can reflect intracranial perfusion, so as to determine the occurrence of cerebral ischemia. Its technique is simple and non-invasive, and can perform continuous and re-al-time monitoring during CEA. In this paper, the practicality and accuracy of various intraoperative neuro-monitoring techniques for CEA were analyzed in combination with the latest domestic and foreign studies in recent years. This paper focuses on various intraoper-ative neuro-monitoring techniques in CEA, the correlation between NIRS and other monitoring techniques, and the role of NIRS in pre-dicting intraoperative ischemia and postoperative hyperperfusion, which can further understand the clinical role of NIRS, so as to facili-tate its application in clinical setting. \u0000 \u0000 \u0000Key words: \u0000Carotid endarterectomy; Near-infrared spectroscopy; Cerebral ischemia; Cerebral oximetry; Cerebral hy-perperfusion syndrome","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"285-288"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45004359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.008
Man Li, Yanan Cao, Sisi Dai, G. Qin, Junjie Zhang, E. Wang
Objective To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) protocol in elderly patients receiving cardiac valve surgery under cardiopulmonary bypass (CPB). Methods Elderly inpatients who were scheduled for valve plasty or replacement under CPB due to cardiac valve diseases were prospectively enrolled. According to the random number table method, they were divided into an ERAS group (n=22) and a control group (n=28). Patients in the ERAS group received ERAS protocol for perioperative management, while those in the control group received routine perioperative treatment. Both groups were com-pared for the length of hospitalization stay, the length of intensive care unit (ICU) stay, the indwelling time of tracheal catheters after surgery, the dosage of sufentanil, the recovery time, the consumption of red blood cell suspension after surgery, post-operative hemato-globin (Hb), the first defecation time after surgery, the time of postoperative use of vasoactive agents, the extubation time of drainage tubes after surgery, the Visual Analogue Scale (VAS) scores after surgery, hospitalization expense and postoperative adverse reactions. Results Compared with the control group, the ERAS group showed decreases in the length of hospitalization stay, the length of ICU stay, the indwelling time of tracheal catheters after surgery, the recovery time, the first defecation time after surgery, the time of postoperative use of vasoactive agents, and the extubation time of drainage tubes after surgery, where statistical differences were found as to the length of ICU stay, the indwelling time of tracheal catheters after surgery, the recovery time, the first defecation time after surgery, and the extubation time of drainage tubes after surgery between the two groups (P 0.05). Conclusions ERAS protocol is safe and effective for elderly patients receiving cardiac valve surgery under CPB. Key words: Valvular heart disease; Enhanced recovery after surgery; Postoperative recovery; Aged
目的探讨ERAS (enhanced recovery after surgery)方案在老年体外循环(CPB)下心脏瓣膜手术中的安全性和有效性。方法前瞻性纳入因心脏瓣膜疾病行CPB下瓣膜成形术或置换术的老年住院患者。根据随机数字表法将患者分为ERAS组(n=22)和对照组(n=28)。ERAS组患者接受ERAS方案围手术期管理，对照组患者接受常规围手术期治疗。比较两组患者的住院时间、重症监护病房(ICU)住院时间、术后气管导管留置时间、舒芬太尼用量、恢复时间、术后红细胞悬浮液消耗、术后血红蛋白(Hb)、术后首次排便时间、术后血管活性药物使用时间、术后拔管时间。术后视觉模拟评分(VAS)、住院费用及术后不良反应。结果ERAS组患者住院时间、ICU住院时间、术后气管导管留置时间、术后恢复时间、术后首次排便时间、术后血管活性药物使用时间、术后引流管拔管时间均较对照组减少，其中ICU住院时间、术后气管导管留置时间、术后气管导管留置时间、两组患者术后恢复时间、术后首次排便时间、术后拔管时间比较，差异有统计学意义(P < 0.05)。结论ERAS治疗老年CPB下心脏瓣膜手术安全有效。关键词:瓣膜性心脏病;增强术后恢复;术后恢复;岁的
{"title":"Application of enhanced recovery after surgery protocol in elderly patients receiving cardiac valve surgery","authors":"Man Li, Yanan Cao, Sisi Dai, G. Qin, Junjie Zhang, E. Wang","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.008","url":null,"abstract":"Objective \u0000To investigate the safety and efficacy of enhanced recovery after surgery (ERAS) protocol in elderly patients receiving cardiac valve surgery under cardiopulmonary bypass (CPB). \u0000 \u0000 \u0000Methods \u0000Elderly inpatients who were scheduled for valve plasty or replacement under CPB due to cardiac valve diseases were prospectively enrolled. According to the random number table method, they were divided into an ERAS group (n=22) and a control group (n=28). Patients in the ERAS group received ERAS protocol for perioperative management, while those in the control group received routine perioperative treatment. Both groups were com-pared for the length of hospitalization stay, the length of intensive care unit (ICU) stay, the indwelling time of tracheal catheters after surgery, the dosage of sufentanil, the recovery time, the consumption of red blood cell suspension after surgery, post-operative hemato-globin (Hb), the first defecation time after surgery, the time of postoperative use of vasoactive agents, the extubation time of drainage tubes after surgery, the Visual Analogue Scale (VAS) scores after surgery, hospitalization expense and postoperative adverse reactions. \u0000 \u0000 \u0000Results \u0000Compared with the control group, the ERAS group showed decreases in the length of hospitalization stay, the length of ICU stay, the indwelling time of tracheal catheters after surgery, the recovery time, the first defecation time after surgery, the time of postoperative use of vasoactive agents, and the extubation time of drainage tubes after surgery, where statistical differences were found as to the length of ICU stay, the indwelling time of tracheal catheters after surgery, the recovery time, the first defecation time after surgery, and the extubation time of drainage tubes after surgery between the two groups (P 0.05). \u0000 \u0000 \u0000Conclusions \u0000ERAS protocol is safe and effective for elderly patients receiving cardiac valve surgery under CPB. \u0000 \u0000 \u0000Key words: \u0000Valvular heart disease; Enhanced recovery after surgery; Postoperative recovery; Aged","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"265-270"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43748834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.010
Jiao Wang, Mingxin Xu
Ultrasound-guided erector spinae plane block (ESPB) is a novel interfacial plane block that can be used to relieve pain after thoracolumbar surgery. It is advantageous in simple and safe procedures, reliable effects and fewer complications and has been drawn increasing attention since 2016. This review introduces the anatomical basis of ultrasound-guided ESPB, expounds the mechanism by which ESPB works, summarizes the clinical application of ESPB in thoracic, abdominal and lumbar surgery, concludes the advantages and disadvantages of ESPB and its complications, and compares ESPB with other commonly thoracolumbar analgesic block methods. With respect to its advantages, few complications and contraindications, ultrasound-guided ESPB can be widely applied in the field of anesthesia and pain, and improve the effect and safety of anesthesia. This review aims to explore the clinical research and future development of ESPB, providing evidence for better clinical application. Key words: Erector spinae plane block; Ultrasound guidance; Postoperative analgesia
{"title":"Recent progresses in the clinical application of ultrasound-guided erector spinae plane block","authors":"Jiao Wang, Mingxin Xu","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.010","url":null,"abstract":"Ultrasound-guided erector spinae plane block (ESPB) is a novel interfacial plane block that can be used to relieve pain after thoracolumbar surgery. It is advantageous in simple and safe procedures, reliable effects and fewer complications and has been drawn increasing attention since 2016. This review introduces the anatomical basis of ultrasound-guided ESPB, expounds the mechanism by which ESPB works, summarizes the clinical application of ESPB in thoracic, abdominal and lumbar surgery, concludes the advantages and disadvantages of ESPB and its complications, and compares ESPB with other commonly thoracolumbar analgesic block methods. With respect to its advantages, few complications and contraindications, ultrasound-guided ESPB can be widely applied in the field of anesthesia and pain, and improve the effect and safety of anesthesia. This review aims to explore the clinical research and future development of ESPB, providing evidence for better clinical application. \u0000 \u0000 \u0000Key words: \u0000Erector spinae plane block; Ultrasound guidance; Postoperative analgesia","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"278-284"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43936390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-15DOI: 10.3760/CMA.J.ISSN.1673-4378.2020.03.018
Mingsheng Dai, Yuan Han, He Liu, Cao Jun-li
Elderly patients undergoing hip fracture surgery have high risk to develop postoperative delirium (POD). At present, the pathophysiological mechanism of POD is unclear, and research on cerebrospinal fluid (CSF) biomarkers is helpful to elucidate the pathophysiological mechanism of POD. This paper reviews the literature concerning CSF biomarkers associated with POD after hip frac-ture surgery, where the CSF biomarkers were classified based on the features of POD risk markers, POD active markers and POD end products. This paper will provide evidence for investigation of the pathophysiological mechanism of POD and for prevention, diagnosis and treatment of POD. Key words: Hip fracture surgery; Postoperative delirium; Cerebrospinal fluid; Biomarker
{"title":"Research progress in cerebrospinal fluid biomarkers associated with postoperative delirium after hip fracture surgery","authors":"Mingsheng Dai, Yuan Han, He Liu, Cao Jun-li","doi":"10.3760/CMA.J.ISSN.1673-4378.2020.03.018","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1673-4378.2020.03.018","url":null,"abstract":"Elderly patients undergoing hip fracture surgery have high risk to develop postoperative delirium (POD). At present, the pathophysiological mechanism of POD is unclear, and research on cerebrospinal fluid (CSF) biomarkers is helpful to elucidate the pathophysiological mechanism of POD. This paper reviews the literature concerning CSF biomarkers associated with POD after hip frac-ture surgery, where the CSF biomarkers were classified based on the features of POD risk markers, POD active markers and POD end products. This paper will provide evidence for investigation of the pathophysiological mechanism of POD and for prevention, diagnosis and treatment of POD. \u0000 \u0000 \u0000Key words: \u0000Hip fracture surgery; Postoperative delirium; Cerebrospinal fluid; Biomarker","PeriodicalId":13847,"journal":{"name":"国际麻醉学与复苏杂志","volume":"41 1","pages":"315-320"},"PeriodicalIF":0.0,"publicationDate":"2020-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42371036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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