Objectives To investigate the association of anesthesia recovery time and bispectral index (BIS) monitoring after gastrointestinal surgeries under general anesthesia. Methods A total of 404 cases of selective gastrointestinal surgeries under general anesthesia with BIS monitoring in West China Hospital of Sichuan University from January 2016 to June 2016 were retrieved from anesthesia medical record system as BIS monitoring exposure cohort (group BIS). In addition, 404 cases of selective gastrointestinal surgeries without BIS monitoring were matched as none BIS monitoring exposure cohort (group non-BIS). The primary outcome was the anesthesia recovery time, including the time from the end of surgery to endotracheal extubation (t1) and exiting the operation room (t2). A sub-group analysis was conducted based on patients’ age, length of operation time (t0) and type of surgery(open surgeries vs laparoscopic surgeries). Results The gender, age, body weight and ASA categories between two groups had no significant differences (P>0.05). The length of operation time also had no significant differences between two groups (P>0.05). The extubation time (10.1±4.4vs. 16.4±6.8) and OR exiting time (21.7±12.3 vs. 27.4±14.6) in group BIS were shorter than those in group non-BIS (P<0.05). This difference was markedly significant among elderly patients (age>60) or patients undergoing long operations (operation time>5hours). Among each group, the recovery time had no significant difference between open surgeries and laparoscopic surgeries. Conclusions There is an association between BIS monitoring and shorter anesthesia recovery time in gastrointestinal surgery, including the time of endotracheal extubation and exiting the operation room. BIS monitoring enhances anesthesia recovery among elderly patients and patients undergoing long-lasting operations in particular. There is no significant difference in anesthesia recovery time between open surgeries and laparoscopic surgeries.
目的:讨论胃镜检查中更加舒适的一种镇静镇痛方法。方法:芬太尼-异丙酚为Ⅰ组,咪唑安定-异丙酚组为Ⅱ组。观察记录各组术中的反应、胃镜操作时间、麻醉药物起效时间、苏醒时间和清醒时间,检查前中后BP、HR和SpO2的变化,及术后问卷调查。结果:Ⅰ组药物的起效快,受检者苏醒及清醒时间短,术中不适反应少,与Ⅱ组比较有统计学意义(Plt;0.01)。结论:镇静无痛苦胃镜检查中芬太尼-异丙酚联合用药更舒适。
The strategies of individualized enhanced recovery after surgery (ERAS) are particularly important in the anesthesia management of same-day surgery. This review focuses on the perioperative management of day surgeries following the experiences of Day Surgery Center, West China Hospital, Sichuan University and different surgeries’ guidelines of ERAS, including anesthesia evaluation, preoperative education and optimization, comorbidity management, airway management, choice of technologies and drugs during anesthesia, intraoperative monitor and anesthesia management, postoperative analgesia, postoperative nausea and vomiting prevention, and postoperative management, which is significant to ensure the discharge of the patient in time for same-day surgeries.
目的 研究脑电双频指数（BIS）在小儿麻醉中的应用，为BIS在小儿临床麻醉上的广泛应用及提高小儿麻醉的安全性提供依据。 方法 2011年1月－3月拟行腹部外科手术的患儿60例，男39例，女21例；年龄1～4岁，美国麻醉医师协会分级Ⅰ～Ⅱ级，随机分为两组，每组各30例。S组：七氟醚、瑞芬太尼和维库溴铵维持麻醉；P组：丙泊酚、瑞芬太尼和维库溴铵维持麻醉。采用BIS监测麻醉深度，将BIS控制在50 ± 5，记录麻醉诱导前到手术探查期间不同时点的血流动力学参数及苏醒、拔管时间。 结果 手术过程中P组血压及心率明显低于麻醉前水平（P＜0.05）。S组苏醒迅速、完全，苏醒时间与P组比较差异有统计学意义（P＜0.05）。S组的血流动力学稳定性优于P组，苏醒时间、拔管时间相对较短。麻醉诱导前两组的BIS值均为97 ± 1，意识消失时的BIS值为71 ± 2。BIS值为50 ± 5时，结果显示手术过程中（T4、T5、T6、T7）两组的心率、血压都很平稳。 结论 BIS作为小儿麻醉镇静深度的监测指标有临床意义。
Abstract: Objective To investigate the feasibility of the diagnosis and treatment of pleurallung diseases by minithoracotomy and videoassisted thoracic surgery(VATS) under local anesthesia. Methods From February 2002 to March 2005,30 cases were performed by thoracotomy under local anesthesia,which were divided into two groups including minithoracotomy group and VATS group according to the different approaches; inithoracotomy group was used just for the biopsy of thicken pleura and diffuse pulmonary diseases on the state of open pneumothorax, and VATS group was for the diagnosis and treatment of malignant effusion and recurrent pneumothorax on the state of closed pneumothorax,all of them were ompleted under local anesthesia. Results Minithoracotomy group: biopsy of pleura were performed on 13 cases, 10 cases of which has been diagnosed with metastasis, one case was amyloidosis of pleura, two cases were proliferation of pleura.Three cases on diffuse pulmonary diseases were done for biopsy, 2 of which were pulmonary interstitial fibrosis, 1 of which was pulmonary tuberculosis (type Ⅱ). VATS group: Except one was converted to general anesthesia and minithoracotomy to resect the lesion due to heavy pleural adhesion, other patients who had thicken pleura and diffuse pulmonary diseases were performed operation for biopsy, bullarectomy was done on recurrent pneumothorax,and pleurodesis was done on ntractable pleuaral effusion under local anesthesia. 4 cases on pleural effusion were done by diagnostic thoracoscope under local anesthesia, 1 of which was liverrelated pleural effusion. 14 cases has been done by remedial thoracoscope, 8 cases of which malignant pleural effusion were done for pleurodesis, the other cases which have recurrent pneumothorax were given bullaectomy and pleurodesis. Spontaneous breathing and hemodynamics was maintained well during the operation. There was neither severe complication nor mortality in two groups. Conclusion Videoassisted thoracoscopic resection of peripheral pulmonary nodule and biopsy of pleura through minithoracotomy can be performed safely under local anesthesia. The novel approach will be the cost-effective procedure for management of pulmonary nodules in the present time.
【摘要】 目的 评价抚触对硬膜外麻醉穿刺疼痛的影响及效果。 方法 2009年1-12月，将485例行硬膜外麻醉穿刺患者随机分为抚触组（术中行抚触干预）和对照组（常规护理），观察两组患者的穿刺程度、穿刺时间。 结果 抚触组患者疼痛程度、穿刺时间较对照组有明显改善，且差异有统计学意义（Plt;0.01）。 结论 抚触可降低应激引起的硬膜外麻醉穿刺患者的疼痛程度，保持穿刺体位从而缩短穿刺时间，有利于麻醉操作顺利进行。【Abstract】 Objective To evaluate the effect of touching on alleviating the pain in patients undergoing epidural anesthesia puncture. Methods A total of 485 patients who underwent epidural puncture from January to December 2009 were randomly divided into two groups: 259 in touching group and 226 in control group. In the touching group, the patients were touched and consoled while undergoing epidural puncture. The pain extent and time of puncture were observed and recorded. Results The level of pain and time of puncture were obviously alleviated and shortened in the touching group and the difference between the two groups was statistically significant. Conclusion Touching could reduce the stress and pain caused by epidural puncture, which may lead to maintain the puncture position and thereby shorten the puncture time. It helps to finish the narcotic operation favorably.
In the present study carried out in our laboratory, we recorded local field potential (LFP) signals in primary visual cortex (V1 area) of rats during the anesthesia process in the electrophysiological experiments of invasive microelectrode array implant, and obtained time evolutions of complexity measure Lempel-ziv complexity (LZC) by nonlinear dynamic analysis method. Combined with judgment criterion of tail flick latency to thermal stimulus and heart rate, the visual stimulation experiments are carried out to verify the reliability of anesthetized states by complexity analysis. The experimental results demonstrated that the time varying complexity measures LZC of LFP signals of different channels were similar to each other in the anesthesia process. In the same anesthesia state, the difference of complexity measure LZC between neuronal responses before and after visual stimulation was not significant. However, the complexity LZC in different anesthesia depths had statistical significances. Furthermore, complexity threshold value represented the depth of anesthesia was determined using optimization method. The reliability and accuracy of monitoring the depth of anesthesia using complexity measure LZC of LFP were all high. It provided an effective method of realtime monitoring depth of anesthesia for craniotomy patients in clinical operation.