Objective To evaluate the indications, effectiveness and complications of vitreoretinal surgery using the 25G transconjunctival sutureless vitrectomy system (TSV25G) under the topical anesthesia. Methods The clinical and follow-up data of 22 eyes of 22 patients undergone vitreo-retinal surgery using TSV25G under the topical anesthesia were retrospectively analyzed. All of the patients were monocular sickened, including idiopathic macular hole in 10 eyes, idiopathic macular pucker in 6, vitreoretinal traction syndrome in 4, and vitreous hemorrhage associated with branch retinal vein occlusion in 2. Peeling of epiretinal membrane and/or internal limiting membrane, intra ocular laser coagulation, air-fluid exchange and tamponiding of C3F8 were performed according to the condition of diseases. The postoperative follow-up was 1-11 months, with the mean duration of 6.4 months. The effect of analgesia, cooperation with the patients, operative effect and complications in and after the surgery were observed. Results The operations finished successfully in all of the eyes under the topical anesthesia. The operation duration ranged from 20 to 25 minutes with average of 22 minutes. The patients cooperated with the doctor well without any discomfort. Two days after the surgery, edema of the wounded conjunctiva was found, and recovered 7 days later. A light pigment dot on the surface of the sclera could be seen at the first month. The complic ations included transient increasing of intraocular pressure in 2 eyes, feather-like opacity of lens in 5 eyes, vitreous hemorrhage in 1 eye, and air-bleb under conjunctiva in 2 eyes. No other complications related with the cut were fo und. The macular hole closed in 9 eyes with idiopathic macular hole, and the other 1 had the smaller but not closed hole. Idiopathic macular pucker, vitreoretinal traction syndrome, and vitreous hemorrhage associated with branch retinal vein occlusion were cured successfully. Conclusions Vitreoretinal surgery using the TSV25G under the topical anesthesia has many advantages such as simple procedure, short operation time, micro-invasion, less complications and rapid revovery, and mainly serves simple manipulation in some simple diseases such as idiopathic macular hole, vitreo-retinal traction syndrome, and simple hemorrhage. (Chin J Ocul Fundus Dis，2004，20：133-136)
Objective To assess the efficacy and safety of sevoflurane versus ketamine in the anesthesia of child short period surgery. Methods Such databases as EMbase, PubMed, The Cochrane Library, CNKI, VIP, CBMdisc, Ongoing Controlled Trial and Conference Articles were searched from their establishment to April 2011 to collect randomized controlled trials (RCTs) and the quasi-RCTs. The quality of those studies meeting the inclusive criteria was assessed, the data were extracted and the meta-analysis was conducted by using RevMan 5.1.1 software. Results Ten studies involving 600 participants were included. Seven studies showed that the intraoperative heart rate of the sevoflurane group was lower than that of the ketamine group (MD= –11.85, 95%CI –16.47 to –7.23, Plt;0.000 01). Nine studies showed that the revival time of the sevoflurane group was shorter than that of the ketamine group (MD= –29.05, 95%CI –37.98 to –20.12, Plt;0.000 01). Three studies showed that the anesthesia induction time of the sevoflurane group was shorter than that of the ketamine group (MD= –208.45, 95%CI –359.22 to –57.68, P=0.007). Six studies showed that the influence on mean arterial pressure (MAP) had no significante difference (MD= –4.86, 95%CI –10.02 to 0.29, P=0.06). Meanwhile, seven studies showed that the adverse events of the sevoflurane group were fewer than those of the ketamine group (Peto OR=0.29, 95%CI 0.20 to 0.40, Plt;0.000 01). Conclusion The results of this system review show that sevoflurane is more effective than ketamine with fewer adverse reactions, and it provides a new choice for clinical anesthesia for child short period surgery. However, ketamine is still the main drug in clinical anesthesia for the child short period surgery at present, so high quality studies are needed for further clinical researches.
Objective To investigate the effect of perioperative body temperature on the survival of skin flap grafting. Methods From July 2005 to November 2006, 50 cases of Ⅰ-Ⅱ grade patients undergoing elective skin flap grafting were randomly divided 2 groups. Pharyngeal temperature (PT) and skin temperature(ST) were monitored and recorded every 15 minutes. Operativetime, anesthetic time, time from the end of operation to extubation, the volume of blood transfusion, the volume of fluid transfusion and the flap survival 7 days after operation were recorded. In the experimental group, the body temperature was maintained in normal range with water market and forced air heater. In the control group， the body temperature was only monitored without any treatment. Results There were no significant differences in operating room temperature, operative time, anesthetic time, the volume of blood transfusion and fluid transfusion between 2 groups(Pgt;0.05). After induction, PT decreased gradually inboth groups during the first 45 minutes, compared with the time point of intubation(Plt;0.05),but there were no significant differences between the 2 groups(Pgt;0.05); and ST rose in both groups during the first45 minutes, compared with the time point of intubation (Plt;0.05). After 45 minutes of induction, in the experimental group, PT was in the normal range(36℃), and ST didn’t change compared with that of the timepoint of induction(Pgt;0.05). In the control group, both PT and ST decreasedgradually and timedependently compared with the time point of intubation (Plt;0.05). In the experimental group, PT and ST at each time point were higher than those in the control group (Plt;0.05). All the skin flap grafts survived in the experimental group, and skin flap grafts necrosed in 2 cases in the control group.Conclusion Keeping normal body temperature can improve the survival ofskin flap grafting. Therefore, the body temperature should be monitored and maintained in a normal range.
ObjectiveTo discuss the method and effectiveness of Wide-awake technique in flexor tendon tenolysis.MethodsThe clinical data of 16 patients (22 fingers) with flexor tendon adhesion treated by Wide-awake technique for flexor tendon tenolysis between May 2019 and December 2019 were retrospectively analyzed. The patients were all male, aged from 18 to 55 years old, with an average of 35 years old. Among them, 4 cases (7 fingers) after replantation of severed fingers, 4 cases (7 fingers) after flexor tendon rupture repair, and 8 cases (8 fingers) after open reduction and internal fixation of proximal fractures. The time from the original operation to this operation was 6-18 months, with an average of 8 months. The visual analogue scale (VAS) score was used to evaluate the patient’s pain during local anesthesia (when the first needle penetrated the skin), intraoperative, and 24 hours postoperatively; and the recovery of finger movement was evaluated by total finger joint active range of motion (TAM) evaluation system and Strickland (1980) standard after operation.ResultsIntraoperative hemostasis and anesthesia were satisfactory, and the patient could fully cooperate with the surgeon in active finger movements. There were different degrees of pain during local anesthesia (VAS score was 2-4), no pain during operation (VAS score was 0), and different degrees of pain after operation (VAS score was 1-8, 9 patients needed analgesics). All incisions healed by first intention after operation. All 16 cases were followed up 9-15 months with an average of 12 months. Finger function was significantly improved, no tendon rupture occurred. At last follow-up, the patients after proximal fracture open reduction and internal fixation were rated as excellent in 4 fingers and good in 4 fingers according to the TAM standard, and both were excellent according to the Strickland (1980) standard; and the patients after replantation of severed fingers and flexor tendon rupture repair were rated as excellent in 4 fingers and good in 10 fingers according to TAM standard, and as excellent in 6 fingers and good in 8 fingers according to Strickland (1980) standard.ConclusionWide-awake technique applied in flexor tendon tenolysis can accurately judge the tendon adhesion and release degree through the patient’s active activity, achieve the purpose of complete release, and the effectiveness is satisfactory; the effectiveness of tendon adhesion release surgery after fracture internal fixation is better than that of patients after tendon rupture suture and replantation.
Objective To evaluate the effectiveness of thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) versus GA alone on intrapulmonary shunting during one-lung ventilation (OLV). Methods We searched the Cochrane Library (Issue 4, 2009), the specialized trials registered in the Cochrane anesthesia group, PubMed (1966 to Dec. 2009), EMbase (1966 to Dec. 2008), CBM (1978 to Dec. 2009), VIP (1989 to Dec. 2009), CNKI (1915 to Dec. 2009), and handsearched Clinical Anesthesia Journal and Chinese Anesthesia Journal. Randomized controlled trials (RCTs) about the effectiveness of TEA combined with GA versus GA alone on intrapulmonary shunting during OLV were included, The methodological quality of included RCTs was evaluated by two reviewers independently, Meta-analysis was conducted using RevMan 5.0 software. Results Ten RCTs involving 506 patients were included. The results of meta-analyses showed that there were no significant differences in intrapulmonary shunting during OLV at different times-points of 5, 15, 20, 30, and 60 minutes after OLV. Conclusion Both TEA combined with GA and GA alone have the same Security during OLV. But owing to the low quality and small sample size of the included studies, further more well-designed, large sample size RCTs are needed.
ObjectiveTo observe the incidence of hypotension in general anesthesia patients in post anesthesia care unit (PACU), compare the blood pressure before and after treatment, and analyze hypotension causes. MethodBetween September 2012 and July 2013, data of 18 931 patients in PACU after general anesthesia were retrospectively analyzed for the incidence of hypotension. At the same time, the change of blood pressure was also detected before and after treatment. ResultsSixty-two patients had hypotension during the anesthesia recovery period after general anesthesia. The incidence was 0.33%. The proportion was the highest among patients who underwent abdominal surgery, reaching 41.9%. Systolic pressure and diastolic pressure improved significantly after treatment (P<0.05). ConclusionsIt is important to perform comprehensive evaluation of vital signs, closely observe disease conditions and vital sign changes, find out and manage low blood pressure for patients in PACU, which secure their safety.
Objective To investigate the preventive effect of rapid preoxygenation technique on hypoxia caused by respiratory depression during outpatient obstetrics-gynecology operations. Methods According to a computer-generated random sequence, a total of 120 ASA I-II patients undergoing outpatient obstetrics-gynecology operations were randomly allocated into the trial group or the control group, 60 in each group. Patients in the control group received preoxygenation with tidal volume breathing. Patients in the trial group received preoxygenation with eight deep breaths (DB) in 1 min before anesthesia. All patients were induced with midazolam 1 mg, fentanyl 1μg /kg and propofol 2 mg/kg, and were maintained with propofol when needed. The following parameters were observed, including the incidences of respiratory depression and apnea, the onset time of anesthesia, the total doses of propofol as well as the changes in PetCO2 and SpO2. Results No significant differences were observed in demographic characteristics, the onset time of anesthesia, the total doses of propofol, and the incidences of respiratory depression and apnea between the two groups (P gt;0.05). However, the SpO2 in the control group was decreased significantly with a higher incidence of hypoxia (Plt;0.05). Conclusions Rapid preoxygenation technique may increase the oxygen reserves and improve the tolerance to hypoxia. It is effective in avoiding hypoxia caused by respiratory depression and apnea during outpatient obstetrics-gynecology operations.
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.
ObjectiveTo discuss the intraoperative anesthesia management for complete thoracoscopic surgical atrial fibrillation (AF) ablation via the left chest. MethodsWe retrospectively analyzed the clinical data of 201 patients (106 males and 95 females aged 58.7±15.4 years) with AF underwent complete thoracoscopic surgical ablation via the left chest in Department of Cardiothoracic surgery, Xinhua Hospital From September 2010 through December 2013. ResultsAll the patients successfully underwent the minimally invasive ablation procedure. No patient required conversion to sternotomy during the surgery. The average time of operation was 104.9±37.2 min. During the ablation procedure, the patients' blood pressure and arterial oxygen saturation (SpO2) reduced at different levels. The average minimum arterial blood pressure was 44-79 (62.4±8.4) mm Hg. The average minimum SpO2 was 83%-95% (88.8%±3.1%). After the ablation, the patients' respiratory function and hemodynamic gradually recovered. The average heart rate was 40-108 (70.0±16.6) bpm when sinus rhythm was restored. The maintenance of sinus rhythm rate was 94.5% (190/201) at discharge. There was no early death, stroke, hemorrhage or permanent pacemaker implantation during perioperation. ConclusionComplete thoracoscopic surgical AF ablation via the left chest has some influence on patients' respiratory function and hemodynamic. Reasonable anesthetic management can ensure the minimally invasive ablation procedure safe and effective.
Since the proposal of enhanced recovery after surgery (ERAS), significant progress has been made in different surgical fields, but ERAS in thoracic surgery is still in its infancy. This article summarizes the research results of scholars at home and abroad, and provides a comprehensive overview of the ERAS anesthesia management pathway during the perioperative period of thoracic surgery from the aspects of preoperative evaluation, anesthesia scheme selection, ventilation strategy, fluid management, temperature protection, pain management, postoperative nausea and vomiting, and early mobilization. The aim is to provide a reference for ERAS management in thoracoscopic lung cancer surgery.