Ma zui xue za zhi = Anaesthesiologica Sinica最新文献

We studied the sedative, analgesic and amnesic effects of intravenous midazolam and meperidine for colonoscopy, and also compared patient's satisfaction, changes of vital signs, safety and complications with intramuscular meperidine during the colonoscopy. Two hundred and ninety-nine patients undergoing physical check-up were randomized to receive intramuscular meperidine 50 mg and Hyoscine-N-Butylbromide (buscopan) 20 mg (Group IM-MB, n = 57) or intravenous midazolam 0.05 mg/kg, meperidine 1 mg/kg and buscopan 20 mg (Group IV-MMB, n = 242) before colonoscopy. All patients were closely observed and arterial oxygen saturations (SaO2) were monitored with pulse oximeter in Group IV-MMB. The demographic data of both groups were similar. There were significantly more severe pain responses (grimacing, moaning, shouting for pain, abdominal rigidity and body moving during colonoscopy) in Group IM-MB (51%) than in Group IV-MMB (13%) (p < 0.01). In immediate procedure recall after recovery from medications, 39% of Group IM-MB remembered severe pain during colonoscopy and only 3% of Group IV-MMB did (p < 0.01). 92% of Group IV-MMB who felt satisfactory with the medications were significantly higher than 21% in Group IM-MB (p < 0.01). Both groups significantly increased in heart rate after the injection of medications (p < 0.01). Group IM-MB increased 15 +/- 18% and Group IV-MMB 61 +/- 28% with significant difference between groups (p < 0.01). This might be caused by meperidine, buscopan, and relative hypovolemia of patients. There were significant decreases in SaO2 in Group IV-MMB, mean 4.5 +/- 1.7% (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Pheochromocytoma is a catecholamine secreting tumor originating from the adrenal medulla (up to 90%), or from the chromaffin tissue along the paravertebral sympathetic chain. The hallmark of pheochromocytoma is paroxysmal hypertension associated with diaphoresis, headache, tremulousness, and palpitations. The triad of diaphoresis, tachycardia, and headache in hypertensive patients is highly suggestive of pheochromocytoma. Other symptoms like flushing, nausea, vomiting, personality changes, and visual disturbances may however cast doubt on the diagnosis of pheochromocytoma. Death resulting from pheochromocytoma is usually due to congestive heart failure, myocardial infarction, or intracerebral hemorrhage. Although less than 0.1 percent of patients with hypertension have a pheochromocytoma, nearly 50 percent of the mortality with unsuspected pheochromocytoma occurred during anesthesia and surgery or parturition. Patients of unsuspected pheochromocytoma have higher risk for surgery, because some mandatory pre-op medical treatments might have been ignored. It is also a challenge to anesthesiologists to handle unsuspected hypertensive crisis during anesthesia and surgery. We presented such a case of unexpected Pheochromocytoma which was mis-diagnosed by the surgeon and was treated as an ordinary adrenal gland tumor and was scheduled for surgical operation. When the patient was undergoing excision of the tumor, manipulations of the tumor initiated an tremendous elevation of the blood pressure. Upon reviewing her history of normotension with visual disturbance, nausea and restlessness, she was immediate treated as with a pheochromocytoma. Appropriate managements were applied to control her abnormally high fluctuating blood pressure with success and with no complications or adverse effect.(ABSTRACT TRUNCATED AT 250 WORDS)

The study was designed to observe continuous succinylcholine infusion and phase II block in short surgical procedures (duration < 90 min). The characteristics of neuromuscular blockade produced by continuous succinylcholine infusion were observed in 15 adult patients anesthetized with nitrous-oxide-isoflurane (0.7% end tidal concentration) and fentanyl, and were compared with the single-dose technique (n = 13) in recovery time. Ulnar nerve was stimulated supramaximally with repeated train-of-four (interval = 10 sec, frequency = 2 Hz) via surface electrodes at the wrist using an electromyographic monitor (Datex, Relaxograph, Finland). The infusion rate was adjusted to maintain the height of the first twitch (T1) in each train of four at 5-10% of control twitch height. The mean duration of infusion was 50.74 +/- 18.06 minutes. The steady state infusion rate required to maintain 90% to 95% twitch depression was 83.5 +/- 21.4 micrograms/kg/min. Five patients developed phase II block (T4/T1 < 0.5) designated as IB. The other ten did not develop phase II block as IA. Recovery times (T1 = 10.50%, 10-100%) between IA and IB were not statistically significantly different. The recovery time of train-of-four fade (T1 = 10% to T1 = 100% and train of four > 75%) was 5.73 +/- 0.43 minutes. However, recovery times between continuous infusion group and single dose group were significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Seven patients scheduled for resection of pheochromocytoma with loose preoperative control of their blood pressure were selected in our study. All the cases are impressed of pheochromocytoma that predominantly excrete norepinephrine. Anesthesia was induced with fentanyl, 2.5% sodium thiopental, valium and atracurium. Labetalol was used as antihypertensive agent and was given in repeated bolus (up to total dose of 2 mg/kg) intravenously before skin incision and no supplemental dosage was given later on. The anesthesia was maintained with nitrous oxide, oxygen, isoflurane and atracurium. Blood pressure, heart rate and arterial blood gas analysis were recorded. After giving intravenous labetalol, mean systolic blood pressure and heart rate declined by 26.2% and 29.76% respectively when compared to preanesthetic values. Although bradycardia was noted after administration of labetalol, it seemed acceptable except for one patient who needed atropine right after receiving labetalol and another patient who needed levophed infusion after tumor removal. During tumor removal, the blood pressure of all patients was stable except one patient who needed sodium nitroprusside infusion together with labetalol to help control the elevated blood pressure. All the patients in our study had no sequela postoperatively. We concluded that total dose of labetalol (2 mg/kg) administered intravenously at the beginning of anesthesia was possible to control blood pressure during the resection of pheochromocytoma under general anesthesia even in the case of poor preoperative blood pressure control.

Thirty ASA class I female patients underwent gynecologic pelvioscopy and laparoscopic cholecystectomy were included in this study. All of them received general anesthesia and certain volume of CO2 pneumoperitoneum. We evaluated the effect of positioning (Trendelenburg as group I and reverse Trendelenburg as group II) on hemodynamic parameters and ventilation. The hemodynamic parameters, ventilation, and arterial blood gas were determined at the following stages: (1) after 10 minutes of normoventilation and before CO2 pneumoperitoneum (as control), (2) 5 minutes after CO2 pneumoperitoneum and positioning, (3) 25 minutes after positioning, (4) 50 minutes after positioning, (5) 10 minutes after resumption of supine position and decompression of abdomen. Arterial blood pressure, heart rate, minute volume, end-tidal CO2, oxygen saturation and blood gas analysis were taken during normoventilation. We found that there was no statistical difference between either group in respect to hemodynamic parameters. For the ventilation, both groups had appropriate SpO2 during the period of CO2 pneumoperitoneum, but PaCO2 was significantly increased in group I 25 min after CO2 pneumoperitoneum and Trendelenburg positioning. Nonetheless, end-tidal CO2 was not significantly increased. pH value and PaCO2 did respectively decrease and increase significantly in group I 50 min after Trendelenburg position. However, no change was found in end-tidal CO2. All data were not significantly different after resumption of supine position and decompression of abdomen. Conclusively, except that pH and PaCO2 had changed after a period of Trendelenburg positioning with CO2 pneumoperitoneum, the patients who underwent laparoscopic surgery with normoventilation have no hemodynamic and respiratory change.(ABSTRACT TRUNCATED AT 250 WORDS)

Pheochromocytoma is a rare tumor which develops in chromaffin cells and secrets excessive catecholamine. Unless patients harboring this uncommon tumor are exactly diagnosed preoperatively, well prepared, and protected from the effects of excessive catecholamine release, they are greatly at risk when undergoing any surgical procedures. This brief review contains the clinical symptoms, signs and syndromes associated with pheochromocytoma, the diagnostic methods which may identify and localize the lesion, the regimens of preoperative preparation and pharmacological control, the anesthetic management which has proved safe and effective in many patients, the anesthetic agents which may be contraindicated in some patients, and the postoperative management.

Two hundred and thirty healthy children scheduled for receiving elective minor surgery were assigned into 4 different groups. Group I (small infant group) included 27 infants of age from 1 to 3 months (2.0 +/- 0.6 months), Group II (infant group) included 42 infants age from 3 to 12 months (7.4 +/- 2.8 months), Group III (pre-school children group) included 122 patients of age from 1 to 6 years (3.1 +/- 1.4 years). The remained 39 cases of age older than 6-years-old (8.0 +/- 1.5 years) were collected in group IV (old children group). All studied children were starved for at least 4, 6, or 8 hours in infants, pre-school children, and old children group, respectively, pre-operatively. The fasting time and fasting blood glucose levels of the 4 groups were 6.7 +/- 1.4 hours and 109.0 +/- 22.9 mg% in group I, 7.7 +/- 2.3 hours and 98.6 +/- 18.0 mg% in group II, 10.4 +/- 2.9 hours and 96.9 +/- 24.7 mg% in group III, and 12.6 +/- 2.6 hours and 95.7 +/- 20.5 mg% in group IV, respectively. No one in the 230 children had blood glucose less than 40 mg% even in 5 infants who were starved for 12 hours or more. Therefore, we concluded that preoperative starvation is well tolerated than the originally expected in the infants and children. The fasting time before anesthesia can be executed safely even though the operation schedule may not be right on time.

A case of severe hypoglycemia (30 mg/dL) after resection of unilateral pheochromocytoma is reported. Consciousness regained after 20 gm dextrose water was given intravenously. Rebound insulin storm is highly suspected as the main mechanism for the development of post-operative hypoglycemia. Administration of alpha and beta adrenergic blockers may also contribute to the severity of the hypoglycemia. Closely monitoring blood sugar level during the perioperative period is the only way to prevent the occurrence of such a catastrophe.

As high dose intravenous labetalol was always used in performing deliberate hypotensive anesthesia and it was reported that small dose of intravenous labetalol would decrease the hyperglycemic response under surgical stress, high dose intravenous labetalol may theoretically causes more pronounced reduction in plasma glucose. 14 female cervical cancer patients (ASA physical status I-II) undergoing radical total hysterectomy were selected and randomly assigned into two groups (group A and group B). The anesthesia was induced with 2.5% sodium thiopental 4 mg/kg, atropine 0.3 mg, succinylcholine 1.5 mg/kg and fentanyl 3 micrograms/kg intravenously. The anesthesia was maintained with isoflurane, nitrous oxide, oxygen and vecuronium under artificial controlled ventilation. Radial artery was cannulated for continuous blood pressure monitoring and blood sampling. The first sample was taken after intubation and before skin incision and the second sample was taken 5 minutes after skin incision in group A and after giving total dose of labetalol in group B, other blood samples were taken every 30 minutes thereafter. No labetalol was given in group A patients. In group B, labetalol (1.0-1.5 mg/Kg) was administrated intravenously in repeated bolus (10 mg/bolus) to achieve a mean blood pressure around 60 torr after skin incision. All the fluid administered intraoperatively was free of glucose. Any patients with blood loss greater than 1000 ml or having blood transfusion before the 5th samples (S5) were excluded because stored blood was rich of glucose. The result revealed that plasma glucose rose significantly in both groups but the rise occurred later in group B.(ABSTRACT TRUNCATED AT 250 WORDS)

The influence of the addition of epinephrine to epidural morphine on postoperative analgesia were investigated in 60 ASA physical status I or II patients aged average 45 yr. The treatments were given following lower extremity operation under epidural anesthesia with 2% Xylocaine solution in 20 mL. The subjects were randomly divided into 2 groups. Group A (n = 30) received 2 mg epidural morphine in 10 mL normal saline without epinephrine. Group B (n = 30) received 2 mg epidural morphine in 10 mL normal saline with epinephrine 0.1 mg (1:100,000, 10 micrograms/mL). Patients were assessed for quality and duration of postoperative analgesia, as well as the incidence and severity of side effects after epidural morphine administration. The addition of epinephrine to epidural morphine had significantly increased the quality and duration of analgesia. The side effects of pruritus, nausea, vomiting, and urinary retention were more intense after epinephrine-morphine administration. However, respiratory depression was not observed in both groups.