Ma zui xue za zhi = Anaesthesiologica Sinica最新文献

The purpose of this study is to evaluate the effectiveness of lidocaine administered via the endotracheal tube in suppressing cough reflex during anesthetic recovery in children. Fifty ASA class I-II children, aged from 1-5 years old undergoing elective abdominal or urogenital surgery were randomly assigned into two groups. 2% lidocaine 1.5 mg/kg (1ml = 20mg) was administered in group B while normal saline (N/S) 0.1 ml/kg was used in group A (control group). Either one of the agents was instilled into the endotracheal tube right before the end of operation. Airway responses and other associated phenomena were recorded during the recovery period. Recovery condition was categorized into a two-grade categories, namely "good", and "poor" to denote the quality of recovery. Recovery conditions differ significantly between the control group and the experimental group. In group A, 3 patients were classified as the "good" grade but 22 patients were categorized in the "poor" grade. Group B (lidocaine 1.5 mg/kg) has a much better recovery condition than the control group, there were 19 in the "good" grade and only 6 in the "poor" grade. The experimental group treated with 2% lidocaine presented a significantly better recovery than the control group. This effective suppression of the cough reflex might be due to the local anesthetic effect exerted by lidocaine. For the sake of safety all patients were closely followed up at the post anesthesia room until the return of consciousness and laryngeal reflexes. In conclusion, we found that 2% lidocaine 1.5 mg/kg given intratracheally via the endotracheal tube could attenuate cough response during recovery in pediatric anesthesia.

Every anesthesia providers is aware of the serious consequences of anoxia subsequent to acute airway obstruction, and is trained to manage such situations when they occur. Nonetheless, a patent airway is not always attainable. Percutaneous needle laryngostomy with translaryngeal ventilation has been widely advocated for emergency ventilation in desperate situations in which other efforts, including intubation have failed. A review of literature suggested that using a large bore (> 18 Ga) needle/catheter with a jet ventilator, or alternatively connecting it to an oxygen source of high pressure (40-50 psi; i.e. anesthesia machine, wall outlet etc.) via a low compliance tubing will effectively resuscitate an animal or patient. However, this method may expose the patients to the risk of barotrauma which has inhibited its widespread adoption. In order to assess this risk, we have conducted an in vitro study employing a simple lung simulator and an anesthesia machine. Variables of the experiment included the make of the anesthesia machine, size of the needle/catheter, degree and duration of depression of the flush valve, as well as the size of the pop-off valve opening. Based on the data obtained from our study as well as others by an extensive literature review, we have proposed some guidelines for this technique when a jet ventilator is not available.

Unlabelled: Perioperative abnormalities and complications were reviewed in 556 geriatric patients retrospectively to assess the safety of geriatric anesthesia. Preoperatively, the percentages of cases with cardiovascular and pulmonary abnormalities were 49.6% (276 cases) and 21.8% (121 cases) respectively. 77 percent of out patients (428 cases) were in the ASA class II physical status. The most common intraoperative complication was blood pressure instability and the incidence was noted to be of 34.8% (130 cases) with general anesthesia and of 15.8% (26 cases) with regional anesthesia. With general anesthesia, incidence for postoperative events such as non-fatal complications (i.e., sore throat and eye dryness), cardiovascular abnormalities and pulmonary disorders were found to be 39.0% (146 cases), 22.2% (83 cases) and 6.2% (23 cases) respectively. With regional anesthesia, the most common postoperative event was blood pressure instability (incidence: 21.2%, 35 cases). Total mortality rate of the first 15 postoperative days was 2.0% (11 cases). Mortality rate in elective and emergency surgery was 1.1% (5 cases) and 6.8% (6 cases) respectively. Causes of death were mainly related to illness deterioration (cancer and infection) or location of surgery. Death due to anesthetic mishap was nil in this study.

In conclusion: Most geriatric patients had more than one system or one organ dysfunction before operation. Cardiovascular instability was the most common intraoperative complication. Postoperative mortality correlates closely with the preoperative ASA physical status. Mortality rate was significantly higher in emergency cases than in elective cases. A thorough pre-operative assessment and proper perioperative management are mandatory in geriatric anesthesia.

The safety and efficacy of patient-controlled analgesia used for postoperative pain relief were evaluated. Cumulative 24-hour requirements were analyzed for possible correlation with patient characteristics. All patients who used a patient-controlled analgesia device for postoperative pain relief were reviewed from June to October 1991. The device Baxter's basal/bolus infusor with patient control module, was used to deliver fentanyl in 379 patients. The fentanyl requirement, verbal analog pain score, first passage of flatus, side effects, sedative score, and degree of satisfaction were examined. The fentanyl requirement during the first 24 hours after operation was analyzed with regard to age, body weight, and sex. The daily fentanyl consumption in the first three postoperative days was 928 +/- 352 micrograms (n = 338), 553 +/- 259 micrograms (n = 220), and 490 +/- 222 micrograms (n = 71), respectively. The requirement for fentanyl during the first 24 hours after surgery was significantly higher than for the next two days (p-value < 0.001). Fentanyl consumption correlated well with body weight, and inversely with age. No difference was found between fentanyl consumption and sex (p-value = 0.4687). The mean time to the first passage of flatus in patients with abdominal surgery was 54.6 +/- 26.4 hours. The incidence of nausea, vomiting, and dizziness was similar, about 20% of patients. Itching was noted in 7% of patients. Oversedation (class 4) was found in three patients during the first operative day, the sedative score for other patients were around class 1-3. No patient exhibited signs of respiratory depression or withdrawal syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Simple O2 mask has been used in patient under regional anesthesia for increasing the FiO2, especially in the aged and the pregnant. The relationships between maternal FiO2 and umbilical arterial (UA) and venous (UV) PO2, PCO2, pH, and neonatal Apgar score were studied in 45 patients receiving Cesarean section under epidural anesthesia. 2% xylocaine 18-20 ml with adrenaline 1:200,000 was used to attain the sensory level of T-4. Patients were allocated randomly into three groups. Group I, acting as a control group, breath only room air during the course of anesthesia. Group II was breathing through a simple face mask with an oxygen inflow of 6L/min. Group III was breathing oxygen with a flow rate of 10L/min through a simple face mask. UA and UV blood samples were collected separately at the time of delivery for blood gas analysis. The 1-min, and 5-min Apgar scores were recorded also. Mean values of the UA blood samples for the 3 groups (Gp. I, Gp. II and Gp. III respectively) were: PO2--16.50 mmHg, 20.20 mmHg and 19.50 mmHg; PCO2--49.20 mmHg, 48.10 mmHg and 50.3 mmHg; pH--7.31, 7.30 and 7.30. Mean values of the UV blood samples for the 3 groups (Gp. I, Gp. II and Gp. III respectively) were: PO2--28.6 mmHg, 36.9 mmHg and 36.5 mmHg; PCO2--38.20 mmHg, 38.80 mmHg and 40.40 mmHg; pH--7.36, 7.36 and 7.34. There was a significant increase in UA and UV PO2 when using a simple O2 mask (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)