Ma zui xue za zhi = Anaesthesiologica Sinica最新文献

To evaluate the effects of ketamine, N2O, propofol on visual evoked potential (VEP) during fentanyl anesthesia, 14 patients undergoing transphenoid pituitary dissections were studied. Visual stimulation was done by using the goggles with red light diodes through closed eyelids and responses were recorded in one channel montage, Cz against Oz. The stimulus frequency was 1.9 flashes/sec. The VEPs were recorded from skin incision until the opening of the dura. For comparison, the preanesthesia to anesthesia values were determined. The ratio for N2 (N75) latency were 100.5 +/- 13.9% in ketamine group, 104 +/- 3.5% in N2O group, 100.5 +/- 4.2% in propofol group. The ratios for P2 (P100) latency were 97.45 +/- 5.7% in ketamine group, 101.9 +/- 3.5% in N2O group, 96.8 +/- 5.5% in propofol group. For N2P2 amplitude, the ratios were 36.3% +/- 31.4% in ketamine group, 138.5 +/- 58.0% in N2O group, 80.8 +/- 42.2% in propofol group. The percentage of inadequate recordings were 2.5 +/- 4.3% in ketamine group, 19.2 +/- 2.2% in N2O group and 20.6 +/- 16.0% in propofol group. The percentage of false positive results were 0 +/- 0% in ketamine group, 9.8 +/- 19.9% in N2O group, 12.7 +/- 13.2% in propofol group. Satisfactory anesthesia was achieved in all groups except for ketamine group which required additional medications for elevated blood pressure and intracranial pressure, and postoperative nausea and vomiting. It is concluded that there was great variability of VEP during anesthesia and surgery. Amplitude rather than latency changes were observed during anesthesia combined with fentanyl.(ABSTRACT TRUNCATED AT 250 WORDS)

During open heart surgery, the release of oxygen free radicals as a result of ischemia and reperfusion often induces post-operative low cardiac output, arrhythmias or cardiac re-performance failure. Changes in serum lipid peroxide (LPO) concentrations were studied in 72 patients undergoing open heart surgery, to quantitate the rhythm of changes, and to seek for proper measures in myocardial protection. Blood samples were drawn before induction of anesthesia, just before aortic cross-clamping, 5 min after the release of aortic cross-clamping, immediately after rewarming to 35 degrees C, 30 min after cardiac performance, and at the end of the procedure. Fluorescent spectrophotometric method was used to detect the variation of LPO concentrations. The results showed that intraoperative serum LPO concentrations were significantly lower than pre-induction serum LPO concentrations (P < 0.01). It seems probable that methods of myocardial protection, hypothermia and hemodilution may induce lower concentrations of LPO. Serum LPO concentrations at the end of the procedure were smaller than those of the pre-induction concentrations (P > 0.05). This phenomena was caused by numerous factors that reduce serum LPO concentration.

The purpose of this study was to compare the effects of preoperative and postoperative iliohypogastric ilioinguinal nerve block (IINB) performed on 30 pediatric patients having elective unilateral herniorrhaphy for postoperative pain control and to discuss the theory of post-injury hypersensitivity of the nerves system. The patients were assigned into two groups (A = 15, B = 15) randomly. Both groups were given GA during the surgical procedure except that group A received IINB 15 minutes prior to skin incision and group B immediately after skin closure. The local anesthetic used was 0.25% bupivacaine and the dosage was 1 mg/Kg. The heart rate, BP, and anesthetic concentration (halothane) were recorded during the procedure and postoperative pain was assessed by using the modification of the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) behavior pain score which were taken at 1 hr, 3 hr (POR), 6 hr, and 24 hr (ward) postoperatively. Group A had less pain at 1 hr and 3 hr than group B postoperatively and is statistically significant. There was no statistically significant in pain score at 6 hr and 24 hr between the two groups.

A 31 year-old T1PoAoL1 female developed the early Disseminated Intravascular Coagulation (DIC) signs after cesarean section. The patient had recovery completely after transabdomen total hysterectomy (TAH) and blood products transfusion. Case presentation, literature review, possible pathogenetic mechanism and treatment of DIC were discussed.

We evaluated the efficacy of a closed airway suctioning (CAS) system in sixteen ASA Class I-II patients undergoing surgery of the extremities. All patients were anesthetized with 50% N2O and oxygen with adequate halogenated anesthesia. Full muscle relaxation was provided and all patients were ventilated with an anesthesia volume controlled ventilator. Endotracheal suctioning without preoxygenation was performed during anesthesia in randomly selected patients by either the CAS or the standard suctioning (SS) technique with a 30 minute rest period between suctioning. Both CAS and SS, used 14Fr catheters, were applied intermittently for 15 seconds at (-)150 mmHg suctioning pressure. SaO2 was continuously monitored throughout the suction period by a pulse oximeter. Arterial blood gas sample was drawn before each suction and 30 sec., 1 min, 3 min, 5 min, 10 min, 15 min, 30 min afterwards. No alteration of SaO2 or PaO2 was noted during CAS but significant lowering of PaO2 was noted for SS at the 30 seconds and 1 minutes post-suctional points. Potential advantages of CAS include: 1) PEEP can be maintained during suctioning. 2) Operating room pollution is minimized. 3) Accidental contamination of both the patient and the anesthesiologist can be prevented. 4) Time is saved during frequent intraoperative suctioning as no preoxygenation is required. 5) There is no need to turn off the anesthetic gases. We conclude that as CAS can maintain steady PaO2 during airway suctioning, it may be a better alternative for repeated intraoperative suctioning.

The purpose of this study was to determine whether prior administration of a small, sub-paralytic dose of nondepolarizing muscle relaxant, vecuronium, would have a better intubating condition than a single bolus dose when vecuronium was used as the muscle relaxant during rapid sequence induction and tracheal intubation. Six groups of 15 patients each (ASA class I or II) were involved in this study. Anesthesia was induced with fentanyl 2-3 micrograms/kg and thiopental 4-5 mg/kg. In group 1, 2 and 3, the patients were given the same priming dose of 0.1 mg/kg. Four min later, different doses of vecuronium were given to each group: 0.09 mg/kg (Gp1), 0.14 mg/kg (Gp2), and 0.19 mg/kg (Gp3). In group 4, 5 and 6, no priming vecuronium was given and the intubating doses given to each group were as follow: 0.1 mg/kg (Gp4), 0.15 mg/kg (Gp5) and 0.2 mg/kg (Gp6). At the end of a 60 sec, the percentage of patient with excellent intubating condition were 46.6%, 66.6%, 86.6%, 20%, 40% and 80% respectively for group 1, 2, 3, 4, 5 and 6 respectively. The percentage with good intubating condition were 46.6%, 33.4%, 13.4%, 46.6%, 53.2%, and 20% for group 1, 2, 3, 4, 5 and 6 respectively. The percentage of poor intubating condition were 6.8% in group 1, 33.4% in group 4, 6.8% in group 5 and 0% in group 2, 3, 6. All patients receiving a priming dose could sustain head lift for 5 sec and did not complain any respiratory discomfort 3 min after the priming dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Under different infusion rates in normal hearts and hearts with coronary ligation, the hemodynamic effects of propofol were measured in a coronary artery ligation model in twelve mongrel dogs. Propofol was given by 10 mg/kg intravenous bolus followed by 30 min infusion in succession with 20 mg/kg/hr, 40 mg/kg/hr and 80 mg/kg/hr in both normal hearts and hearts with coronary ligation. The range of blood concentrations in our study is 2.19 +/- 0.56 microgram/ml to 15.78 +/- 3.31 micrograms/ml. After ligation at 1 cm below first diagonal branch of left anterior descending artery (LAD) obvious cardiovascular changes were seen in a few seconds. However, non-significant hemodynamic changes were demonstrated between pre-ligated and 30 min after ligation. With increasing blood propofol concentrations, there was significant negative correlation (p < 0.01) in mean arterial pressure (MAP), cardiac output (CO) and heart rate (HR) but central venous pressure (CVP) and pulmonary arterial occlusion pressure (PAOP) decreased non-significantly with increasing propofol concentrations in both non-ligated and ligated groups. Propofol infusion up to 80 mg/kg/hr did not decrease MAP, CO and systemic vascular resistance (SVR) further in hearts with coronary ligation than normal hearts in our study. SVR and pulmonary vascular resistance (PVR) changed non-significantly between each groups even in blood concentration as high as 15 micrograms/ml. We conclude that propofol depresses myocardial function associated with increasing blood propofol concentrations despite stable SVR and PVR. The hemodynamic effects of propofol were similar in the normal hearts and hearts with coronary ligation.(ABSTRACT TRUNCATED AT 250 WORDS)

Shivering is a common and complex phenomenon that occurs in many patients during spinal anesthesia. Shivering can increase oxygen consumption up to 500 per cent which may be detrimental to patients with decreased myocardial reserve. The metabolic costs and cardiorespiratory consequences of shivering are important particularly for patients with anemia, coronary arterial disease, cardiopulmonary insufficient, debilitated status or are elderly. We studied whether intrathecal meperidine could prevent shivering after spinal anesthesia. 60 patients with ASA class I-II were divided into intrathecal meperidine group (Group I) (n = 30) and control group (Group II) (n = 30). Group I received spinal tetracaine 12-16 mg with meperidine 0.2 mg/kg and Group II received spinal tetracaine 12-16 mg without meperidine. During operation the highest level of spinal anesthesia, ambient and rectal temperatures, blood pressure (BP) and heart rate (HR), presence or absence of shivering, intensity of shivering in both groups were recorded. Close observation for side effects was given post-operatively. There was a significant reduction (p < .005) in incidence of shivering in group I patients (16.7%) when compared with group II (56.7%). There was no or less side effects observed with other neuraxial opioids except nausea. We concluded that intrathecal meperidine could suppress shivering induced by spinal anesthesia.