Anesthesia Research Articles

Deterioration of Postoperative Daily Living Activities in Elderly Patients: Incidence and Associated Factors

Background: Postoperative functional status is a concern in elderly patients. Previously, we reported that administration of non-steroidal anti-inflammatory drugs (NSAIDs) was associated with maintenance of activities of daily living (ADL) scores in elderly patients after hip fracture surgery. The aim of the present study was to investigate whether perioperative NSAIDs administration is related to ADL scores in other age groups after a wide range of surgeries. Methods: The medical records of 368,859 patients aged ≥ 15 years who underwent surgery under general anesthesia were reviewed. Results: The ADL deterioration ratios of patients aged 70 years or older were significantly higher than those of the younger cohort. NSAIDs administration was associated with postoperative ADL maintenance in elderly patients who underwent various surgeries. However, administration of NSAIDs was not related to ADL maintenance in the younger patients. Conclusions: Postoperative ADL deterioration incidences were higher in elderly patients than in younger patients. Perioperative administration of NSAIDs was associated with postoperative ADL maintenance in various surgeries in elderly patients but not in younger patients. The mechanisms of postoperative ADL deterioration are likely different in elderly and younger patients.

Kelsey and Sampsell’s Vitalized Air: Anesthetic or “Aenesthetic”?

Kelsey and Sampsell’s Vitalized Air: Anesthetic or “Aenesthetic”?

Sevoflurane impedes the progression of glioma through modulating the circular RNA has_circ_0012129/miR-761/TGIF2 axis.

Glioma is a highly aggressive and lethal brain tumor. Anesthetics have been shown to have important effects on the biological characteristics of cancer cells. Nevertheless, the molecular mechanism of anesthetic-mediated glioma cells progression remains unclear. Sevoflurane (sev) was employed to treat glioma cells. The biological characteristics (viability, colony formation, apoptosis, cell cycle, migration, and invasion) of glioma cells were determined via Cell Counting Kit-8 (CCK-8), cell colony formation, flow cytometry, PI cytometry, or transwell assays. The protein levels of Cell Cycle Dependent Kinase (CDK) 2, CDK4, E-cadherin, N-cadherin, Vimentin, and Transforming Growth Factor Beta (TGFB) induced factor homeobox 2 (TGIF2) were assessed through Western blot analysis. Glucose consumption and lactate production were measured using special commercial kits. The expression of circular RNA has_circ_0012129 (circ_0012129) and miR-761 was detected via quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). The relationship between circ_0012129 or TGIF2 and miR-761 was verified with Dual-Luciferase reporter assay. Sevoflurane-mediated molecular mechanisms have been confirmed via xenograft assay. Sevoflurane suppressed viability, colony formation, cell cycle, migration, and invasion and promoted apoptosis of glioma cells in vitro, and impeded tumor growth in vivo. Circ_0012129 and TGIF2 were downregulated and miR-761 was upregulated in sevoflurane-treated glioma cells. Circ_0012129 elevation abolished sevoflurane-mediated biological characteristics of glioma cells. MiR-761 served as target for circ_0012129 and miR-761 targeted TGIF2. Moreover, both miR-761 overexpression and TGIF2 suppression restored circ_0012129 enhancement-mediated biological characteristics of sevoflurane-treated glioma cells. Sevoflurane mediated the progression of glioma via regulating the circ_0012129/miR-761/TGIF2 axis.

Continuous epidural versus continuous adductor canal block for postoperative pain management in total knee arthroplasty

Background: The aim of the study was to compare the study of continuous epidural and continuous adductor canal block for postoperative pain management in total knee arthroplasty (TKA). Materials and Methods: A total of 150 cases were recruited with 75 cases in each group; patients participated in the study were divided into the adductor canal block (ACB) group and continued epidural group. All the patients received the standardized anesthesia and analgesia on hospitalization. Outcome evaluations included the visual analog scale (VAS) scores during activity and at rest, range of motion, quadriceps strength, complication occurrence, total opioid consumption and sleep disruptions caused by pain, postoperative hospital stay, and postoperative nausea and vomiting (PONV) before discharge in all groups. Results: The lateral VAS scores of the knee were lower in the continuous epidural group at rest and during activity as compared with the ACB group. However, the overall knee VAS score, complication occurrence, total opioid consumption and sleep disruptions caused by pain, and PONV were similar between ACB and epidural groups. The urinary retention in patients receiving continuous epidural was common compared to no retention in the adductor group, early mobilization in the adductor group, and no muscle weakness in the ACB group. Conclusion: The ACB does not relieve the lateral knee pain at an early stage but offers comparable analgesic effect and enhanced effectiveness of the early rehabilitation compared to an epidural in patients who underwent TKA.

Kedi ve Köpeklerde Sezaryen ve Piyometra Operasyonlarında Anestezi Teknikleri

Veteriner doğum ve jinekolojide sıklıkla uygulanan sezaryen ve piyometra operasyonlarında hem hastanın ağrı ve acı hissini ortadan kaldırmak hem de hekim ve yardımcılarının güvenliğini sağlamak amacıyla anestezik maddeler kullanılmaktadır. Sezaryen ve piyometra operasyonlarında yapılan premedikasyon, preoperatif dönemde yapılacak intravenöz kateterizasyon ve oksijenizasyon sırasında annede oluşabilecek stres ve kaygıyı önler. Bununla birlikte dengeli ve etkili bir premedikasyon, indüksiyon için kullanılacak anestezik madde miktarının azalmasına neden olur. İndüksiyon için sedatif-hipnotik (tiyopental, propofol, alfaksalon, etomidat), dissosiyatif (Ketamin HCL) ve inhalasyon ajanlar (izofluran, sevofluran, desfluran) sıklıkla kullanılmaktadır. Gebe hayvanlarda kullanılacak anestezik ve analjezik maddeler fiziko-kimyasal özellikleri nedeniyle etkilerini kan-beyin bariyerini geçerek gösterir. Bu durum anestezik maddelerin, plasental bariyeri de kolayca geçerek fetüs üzerinde olumsuz etkiler görülmesine yol açar. Yavruları etkilemeden sadece anneyi anesteziye alabilecek bir protokol yoktur. Bu nedenle hem anneyi hem de yavruyu en az şekilde etkileyen bir anestezi protokol seçilmelidir. Piyometralı hayvanlarda ise başlıca; böbrek yetmezliği, kardiyak aritmi ve hepatik işlev bozukluğu gözlendiğinden, bu sorunlara karşı uygun anestezi protokolü seçilmelidir. Bu derleme sezaryen ve piyometra operasyonlarına alınacak hastalarda kullanılabilecek güvenli ve etkili anestezik maddeler ve anestezi protokolleri hakkında bilgi vermek amacıyla hazırlanmıştır.

Capparis spinosa’nın yara iyileşmesi üzerindeki etkisi: Sıçanlarda klinik ve histomorfometrik bir çalışma

Amaç: Capparis spinosa (C. Spinosa) antioksidan, antienflamatuar, antialerjik, antiviral ve antikanserojenik özelliği gösteren flavanoit molekülü içerir. Bu çalışmanın amacı sıçanlarda palatinal bölgede oluşturulan yara modelinde C. spinosanın yara iyileşmesi üzerindeki etkisinin değerlendirilmesidir. Yöntem: Çalışmada 60 adet erkek Wistar sıçan kullanıldı. Başlangıçta iyileşme referansı olarak (0 gün) altı hayvan sakrifiye edildi. Sıçanlar C. spinosa, Klorheksidin (Klx) ve Kontrol (K) grubu olarak üç gruba ayrıldı. Tüm gruptaki denekler rastgele seçilerek altışar sıçandan oluşan dokuz alt grup oluşturuldu. Anestezi altına sıçanların damaklarının tam ortasında punch ile 3 mm çapında sirküler eksizyonel yara yüzeyleri oluşturuldu. Mukoperiosteal kısım keskin diseksiyonla uzaklaştırıldı ve açık kemik yüzeyindeki alan sekonder iyileşmeye bırakıldı. C. Spinosa, 1 ml/gün olacak şeklide gavaj yoluyla lokal olarak uygulandı. Sıçanlar yedinci, 14. ve 21. günlerde sakrifiye edildi ve yara bölgesinin fotoğrafları çekildi. Her bir fotoğraf özel bir programa aktarılarak defekt bölgesindeki yara alanı ölçüldü. Histolojik kesitler alınarak enflamatuar hücre varlığı, epitelizasyon ve iyileşme düzeylerine bakıldı. Bulgular: Epitelyal marjinler arasındaki ortalama yara alanı, tüm gruplarda zamanla önemli ölçüde azaldı (p <0.05). C. Spinosa grubu, Klx ve K grubu ile karşılaştırıldığında yedi, 14 ve 21. günlerde (sırasıyla 6.43±0.65; 3.87±0.50; 0.94±0.39) belirgin bir yara alanı azalması gözlemlenmiştir. 21. günde, kontrol grubunda hala enflamatuar hücreler gözlenmiştir. Sonuç: Çalışmanın bulguları ışığında C. Spinosa yara iyileşmesini hızlandırarak yumuşak dokunun iyileşmesinde olumlu etkileri gözlenmiştir.

Lower limb ischemia cured by stimulation electrode implantation assisted with microendoscopic discectomy system: A case report

A 58-year-old male patient diagnosed with thromboangiitis obliterans (Fontaine stage IV) was recently treated with microendoscope discectomy system-assisted spinal cord stimulation electrode implantation and cured by department of vascular surgery combined with department of spinal surgery at Peking University People's Hospital. The patient suffered from cold injury to the right foot 14 years ago, which was cold, painful, numb, and then the toe was ulcerated and gangrene. Only the right foot small toe was left. The right foot skin was swollen from the toe to the proximal segment 1 year ago, accompanied by resting pain. Both pain and autologous bone marrow stem cell transplantation were ineffective. The above symptoms were aggravated three months ago, and the pain was severe. The visual analogue score was 10 points. A high amputation of the left lower extremity was performed 30 years ago due to trauma. Physical examination: the bilateral femoral artery was weak, and the right radial artery, posterior tibial artery, and dorsal artery were not touched. Buerger sign (+). Auxiliary examination: angiography of both lower extremities showed complete occlusion of the bilateral external iliac artery and its distal end. The percutaneous oxygen partial pressure was measured to be 30 mmHg on the right side of the iliac crest. The operation was performed under the local anesthesia. After X-ray positioning, the body projection of the lumbar vertebrae 1-2 lamina gap was marked. The skin had a 1.8 cm incision on the caudal side 2 cm from the mark. Then the dilators were used, and the working sleeve was tilted to the lumbar vertebrae 1-2 lamina gap. The microendoscope discectomy system was installed, the electrode was directly placed into the epidural space from the interlamina space under the microendoscope, the vascular surgeon adjusted the position of the electrode in the spinal canal under fluoroscopy, then connected the stimulator, adjusted the current until the patient had the lower limb fever, fixed electrode position, removed the microendoscope discectomy system after hemostasis under the microendoscope, used the guide needle to lead the electrode through the lumbar subcutaneous and then sutured the incision. After the operation, the electrode was connected to the temporary stimulator to stimulate for several minutes, the patient felt numbness in his lower limbs. In less than one hour, the skin temperature of the affected limb increased, and the painkiller could be stopped while sleeping. After 1 week, the skin temperature of the affected limb increased, and the percutaneous oxygen partial pressure of the foot and ankle was 36 mmHg, and the pain improved, and the score was reduced to 2 points. One month after surgery, the patient underwent permanent stimulator implantation. The pain disappeared after 3 months and half year of follow-up, and the score was reduced to 1 point. Microendoscope discectomy system-assisted spinal cord stimulation electrode implantation can complete the operation quickly, safely and effectively, and greatly reduce the number of intraoperative fluoroscopy and reduce the occurrence of complications.

Gingival thickness assessment of gingival recession teeth

To evaluate the gingival thickness and gingival biotype of gingival recession teeth of Chinese population. A total of 112 non-molar teeth with gingival recession in 34 patients were included. Direct measurement, cone-beam computerized tomography (CBCT) measurement and periodontal probe method were used to evaluate gingival thickness and biotype. Gingival thickness was measured at 2 mm apical to the gingival margin. Direct measurement was performed with a caliper of 0.01 mm resolution and anesthesia needles attached to silicone disk stops. Gingival biotype was assessed by sulcus probing, if the periodontal probe was visible through the gingival tissue, the gingival biotype was thin; If not visible, the gingival biotype was thick. The differences of gingival thickness among different gingival biotype, tooth site and gingival recession type were analyzed respectively. Besides, the results of CBCT measurement was analyzed compared with the direct measurement. The average gingival thickness of non-molar recession teeth was (1.17±0.41) mm. The average gingival thickness of thick and thin biotype group were (1.38±0.4) mm and (0.97±0.30) mm, respectively, with statistically significant difference (P<0.001). The median of gingival thickness was 1.1 mm. Using 1.1 mm as the cut-off value of thick and thin gingival thickness group, the results matched well with the gingival biotype classification results by periodontal probe method (P=1.000). The average gingival thickness of maxillary teeth was significantly thicker than that of the mandibular teeth. They were (1.39±3.44) mm and (1.01±0.31) mm, respectively (P<0.001). The mean gingival thickness of MillerI, II and III degree gingival recession teeth were (1.15±0.34) mm, (0.83±0.17) mm and (1.26±0.56) mm, respectively, without statistically significant difference (P=0.205). The gingival thickness measurement results between CBCT method and direct measurement were without statistically significant difference (P=0.206). In the non-molar gingival recession teeth, the cut-off value of gingival thickness to classify thick and thin biotype of Chinese population was 1.1 mm. The average gingival thickness of the maxillary teeth was significantly thicker than that of the mandibular teeth. Besides, CBCT measurement was an accuracy method for evaluating facial gingival thickness.

Percutaneous endoscopic lumbar discectomy combined with oblique lateral interbody fusion for degenerative lumbar diseases with ruptured disc herniation

Objective To investigate the preliminary clinical and radiographic outcomes of percutaneous endoscopic lumbar discectomy (PELD) combined with oblique lateral interbody fusion (OLIF) for the degenerative lumbar spondylolisthesis, lumbar spine instability or lumbar spinal stenosis with ruptured disc herniation. Methods Data of 11 patients with degenerative lumbar spondylolisthesis, lumbar spine instability or lumbar spinal stenosis with ruptured disc herniation who had undergone PELD combined with OLIF between March 2017 to July 2018 in our spine surgery center were retrospectively analyzed. There were 5 males and 6 females with an average age of 61.2±6.8 years old. All the patients were diagnosed with degenerative lumbar diseases including lumbar spondylolisthesis (7 cases), lumbar spinal stenosis (3 cases) and segmental instability (1 case). The patients were treated with PELD combined with OLIF. The visual analogue scale (VAS) scores of low back pain and lower limb pain and the Oswestry disability index (ODI) of lumbar function, spinal canal anteroposterior diameter, intervertebral disc height, vertical diameter of intervertebral foramen, segmental angle and the whole lumbar lordotic angle were collected. Results All patients received PELD with local anesthesia before OLIF with general anesthesia. The mean operation time was 52.3±13.2 min and the mean blood loss was 10.9±4.7 ml for PELD. The mean operation time was 56.8±18.0 min and the mean blood loss was 65.5±24.6 ml for OLIF. All patients were followed up for an average of 11.2 months. At the latest follow-up, the mean VAS score for back pain was 1.3±0.8, the mean VAS score for leg pain 1.1±0.5, the mean ODI 14.6%±5.3%, thus all of those were improved significantly compared to those of pre-operation (t=10.37, 16.49, 8.73; P< 0.05). The radiographic results showed the mean pre-operative intervertebral disc height, vertical diameter of intervertebral foramen, spinal canal anteroposterior diameter, segmental angle, and lumbar lordosis angle was 7.1±1.2 mm, 15.3±2.2 mm, 6.2±1.3 mm, 10.2°±3.5°, 16.2°±6.2°, and thus all of those were increased significantly to the latest follow-up 11.5±1.8 mm, 19.2±2.6 mm, 10.4±2.5 mm, 19.3°±7.8°, 27.4°±8.3°, respectively (t=5.83, 4.21, 6.59, 10.32, 7.65; P< 0.05). One of the patients had weakness of flexor hip strength and one had a transient paresthesia immediately post-operation. All symptoms were relieved within 1 month. Another one case had cage subsidence and encountered serious back pain after 1 month, and alleviated after percutaneous pedicle screw fixation. Conclusion PELD combined with OLIF can overcome the limitations of OLIF with indirect decompression effects, resulting in successful direct neural decompression without posterior decompressive procedures and providing a satisfactory outcome for the patients with degenerative lumbar diseases with ruptured disc herniation. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Endoscopy; Spinal fusion; Surgical procedures, minimally invasive

Application of self-anchored lateral lumbar interbody fusion in lumbar degenerative diseases

Objective To evaluate the efficacy of self-anchored lateral lumbar interbody fusion (SA-LLIF) for lumbar degenerative diseases. Methods During January to December in 2019, a total of 41 patients with lumbar degenerative disease were treated with SA-LLIF, included 18 males and 23 females, aged 59.6±11.3 (range 49-77) years. There were lumbar stenosis and instability in 17 cases, disc degenerative disease in 8 cases, degenerative spondylolisthesis in 8 cases, degenerative scoliosis in 5 cases, postoperative revision in 3 cases. And osteoporosis was diagnosed in 5 of them. The index level included L2, 3 in 2 cases, L3, 4 in 11 cases, L4, 5 in 20 cases, L2-L4 in 3 cases and L3-L5 in 5 cases. After general anesthesia, the patient was placed in decubitus position. The anterior edge of psoas major muscle was exposed through 6 cm incision and extraperitoneal approach. Further, the psoas major muscle was properly retracted to expose the disc. After discectomy, the intervertebral space was prepared and moderately distracted. A suitable fusion cage filled with auto iliac graft was implanted. Two anchoring plates were inserted into the cage. Then, the caudal and cephalic vertebral body and the fusion cage were locked. Results The operation was performed successfully in all the patients. The operation duration was 79.0±19.5 (range 60-100) min. Intraoperative bleed loss was 38.0±28.2 (range 15-70) ml. The patients were followed up for averagely 10.6±4.6 (range 4-15) months. The visual analogue scale decreased from preoperative 6.2±2.1 to 1.6±1.1 and Oswestry disability index decreased from 47.8%±15.1% to 11.0%±7.3%. X-ray showed that the spine alignment recovered satisfactorily. No cage displacement was found. Sinking (2-3 mm) of cage was found in 7 patients without obvious symptom despite transient lumbar pain in an obesity woman. The lumbar lordosis recovered from 36.4°±10.2° to 48.0°±10.7°, and intervertebral height recovered from 8.3±2.5 mm to 11.3±3.3 mm. The rate of spondylolisthesis recovered from 19.7%±4.4% to 9.3%±5.3%. Conclusion SA-LLIF can provide immediate stability and good results for lumbar degenerative diseases with stand-alone anchoring cage without posterior internal fixation. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Spinal fusion; Surgical procedures, minimally invasive

Analysis of the risk factors of hypoxemia in the anesthesia recovery period after thoracoscopic surgery

Objective To investigate the incidence of hypoxemia in the anesthesia recovery period after thoracoscopic surgery and explore the risk factors of hypoxemia and its predictive efficiency. Methods A total of 841 patients, aged 18-90 years, American Society of Anesthesiologists (ASA) physical status of Ⅰ‒Ⅲ , who were scheduled for thoracoscopic surgery from October 2017 to May 2019 in the Second Affiliated Hospital of Zhejiang University School of Medicine, were retrospectively analyzed in the current study. They were divided into a hypoxemia group and a non-hypoxemia group, according to the presence of hypoxemia in the anesthesia recovery period. Both groups were compared for their clinical data before and during surgery to evaluate the condition of hypoxemia in the recovery period. Their risk factors were analyzed by multivariate Logistic regression. A receiver operating characteristic (ROC) curve was established to examine its predictive efficiency towards hypoxemia. Results Among the 841 patients, 239 patients (28.4%) presented hypoxemia during the anesthesia recovery period. The risk factors of hypoxemia included age [odds ratio (OR)=1.028, 95% confidence interval (CI) 1.006-1.050], body mass index (BMI) (OR=1.217, 95%CI 1.111-1.333), hypertension (OR=2.462, 95%CI 1.564-3.875), mediastinal surgery (OR=2.756, 95%CI 1.605-6.873) and supine position (OR=2.230, 95%CI 0.936-5.314). For hypoxemia in the anesthesia recovery period, its area under the receiver operating characteristic curve (AUC) was 0.723 (95%CI=0.685-0.761, P<0.01), with a sensitivity of 63.6% and a specificity of 69.4%. Conclusions Extensive attention towards blood pressure control and body weight management before surgery, and comprehensive understanding the mechanism of hypoxemia caused by surgery at the supine position and active prevention, may reduce the incidence of hypoxemia during the anesthesia recovery period after thoracoscopic surgery. Key words: Thoracoscopy; Anesthesia recovery period; Hypoxemia; Risk factor

Research progress on the application of muscle relaxant in infants and children

Muscle relaxants are wildly used in general anesthesia to block the electrical activity in nerve muscle joints and paralysis the skeletal muscle. However, there is still a lack of guideline and standard for the use of muscle relaxants in children. The paper introduces the usage of muscle relaxants, the classification of muscle relaxants, the interaction between intravenous anesthetics and inhalation anesthetics and muscle relaxants. It also introduces the muscle relaxant antagonist (sugammadex), as well as the endotracheal intubation under general anesthesia without muscle relaxants in those children who have a high risk of difficult airway. This review summarizes the latest progress of the muscle relaxant in children, aims to guide the rational use of muscle relaxant in clinical practice. Key words: Muscle relaxant; Pediatric anesthesia; Tracheal intubation

Isoflurane alone versus small dose propofol with isoflurane for removal of laryngeal mask airway in children-a randomized controlled trial.

To compare the safety of laryngeal mask airway removal using two different deep anaesthesia techniques in paediatric patients. The Randomized Control Trial was conducted at Aga Khan University Hospital, Karachi, from April 2012 to November 2013, and comprised patients aged 2-10 years scheduled for infraumbilical surgeries. Anaesthesia was induced with sevoflurane and later it was maintained by is oflurane, oxygen and nitrous oxide. The laryngeal mask airway was removed in the intervention group-I at 0.4 minimum alveolar concentration of isoflurane with propofol 1mg/kg. In the control group-II, it was removed at 1.2 minimum alveolar concentration of isoflurane alone. SPSS 19 was used for data analysis. Of the 50 patients, there were 25(50%) in each of the two groups. Overall, there were 46(92%) males and 4(8%) females. Incidence of airway obstruction and teeth clenching was significantly higher in group-II (p<0.05 each). Emergence duration was also significantly increased in group-II compared to group-I (p=0.001). The Post-Anaesthesia Care Unit stay timing was not significantly different between the groups (p=0.74). Laryngeal mask airway removal under deep anaesthetic technique of low-dose propofol with isoflurane was found to be associated with minimal adverse airway events than isoflurane alone in paediatric patients.

Progress in the application of perioperative cardiac risk assessment tools in elderly patients with non-cardiac surgery

With the growth of the world's older population and the improvement of anesthetic and surgical techniques, an increasing number of elderly patients would like to undergo non-cardiac surgery. Perioperative cardiovascular adverse events are still the one of most commonly reasons to increase mortality and complications. Elderly patients have an obviously higher risk of cardiovascular adverse events than young and middle-aged patients, due to degraded physiological function and increased diseases, in addition to the influence of anesthesia and operation. With respect to patient general condition, comorbidity, anesthetic method and other factors, it is a hot research topic at home and abroad to construct an accurate and feasible assessment tool or predictive model to evaluate the risk of cardiovascular adverse events in elderly patients during the perioperative period. The current paper reviews the advantages, disadvantages, clinical application and research progress of domestic and oversea assessment tools to evaluate cardiovascular risks of elderly patients with non-cardiac surgery. Key words: Non-cardiac surgery; Cardiovascular events; Aged; Perioperative period; Risk assessment

Comparison of the application of cuffed or uncuffed endotracheal tubes in full-term newborns undergoing congenital intestinal atresia surgery

Objective To compare the application of cuffed and uncuffed endotracheal tubes in full-term neonates undergoing congenital intestinal atresia surgery. Methods Sixty newborns who were scheduled to perform congenital intestinal atresia surgery under general anesthesia were selected. They were divided into two groups, according to the random number table method (n= 30): a cuffed endotracheal tube group (group C) and an uncuffed endotracheal tube group (group U). Group C used cuffed endotracheal tubes for surgical procedures, while uncuffed endotracheal tubes were adopted in group U. Both groups were compared for the changing rate of endotracheal tubes and airway condition after surgery [the incidence of hypoxemia within 5 min after extubation (SpO2<95%), laryngospasm and post-operative wheezing], and the incidence of inspiratory pneumonia during follow-up visit one week after surgery. Results Patients in group U presented increases in the changing rate of endotracheal tubes (26.7% vs 3.3%), the incidence of hypoxemia within 5 min after extubation (10.0% vs 0), laryngospasm incidence (10.0% vs 0) and inspiratory pneumonia incidence (10.0% vs 0), compared with those in group C (P 0.05). Conclusions Cuffed endotracheal tubes are superior to uncuffed ones in full-term neonates during congenital intestinal atresia surgery, with good efficacy. Key words: Neonate; Endotracheal tube; Anesthesia, general; Congenital intestinal atresia

Research progress on blood-brain barrier damage in the pathogenesis of postoperative delirium

Postoperative delirium (POD) is an acute neuropsychiatric syndrome characterized by attention deficit and cognitive dysfunction after surgery, and commonly seen in elderly patients. It is known that aging, surgical anesthesia and sleep disorders are related to the occurrence of POD, and one of the mechanisms may be blood-brain-barrier (BBB) damage. This paper summarized the role of BBB damage in the occurrence and development of POD in the recent years, and discusses the detection of BBB damage markers related to POD, so as to provide new ideas for clinical diagnosis, prevention and treatment of POD. Key words: Postoperative delirium; Blood brain barrier; Pathogenesis

A Study of Patient’s Perception about the role of Anesthesia and Anesthesiologist

A Study of Patient’s Perception about the role of Anesthesia and Anesthesiologist

Anesthesia

Anesthesia

Regain of gastrointestinal motility after general anesthesia versus spinal anesthesia in a cesarean section

Objective The objective of the study was to compare the effect of spinal and general anesthesia in return of gastrointestinal motility in an elective cesarean section (CS). Background CS is a common major hospital surgical procedure performed nowadays. One of the most common postoperative complications is postoperative gastrointestinal paralysis (ileus) that must be minimized due to its possible serious consequences. Patients and methods One hunderd and forty pregnant women who were admitted for CS and fulfilled the criteria of the study population were enlisted in this prospective, controlled study and were then assigned to either group A or B. Group A included 70 patients for general anesthesia, while group B included 70 patients for spinal anesthesia. Results This study results were shown to have a statistically significant effect of spinal anesthesia versus general anesthesia in terms of shorter mean time interval to normal intestinal sound, passage of flatus, first motion, and discharge from hospital. Also, the study showed beneficial effect of spinal anesthesia versus general anesthesia in terms of less use of opioids, less use of NSAIDs, less incidence of distension, and less incidence of ileus. Conclusion Spinal anesthesia results in a quicker return of bowel activity after a CS, decreased hospital stay, and less use of postoperative opioids than general anesthesia.

The effect of general anesthesia on geriatric patients' cognitive function

Objective The objective of this study was to review how these effects of general anesthesia affect geriatric patients' cognitive function and the precautions taken by anesthesiologists to reduce these effects. Data analysis A systematic search of MEDLINE (PubMed, Medscape, Science Direct, Journal of Clinical Anesthesia, ASA Publications, The Open Anesthesia Journal) and also of the materials available on the internet was carried out. The search was performed in the electronic databases in the English language only from 2003 to 2019. Study selection The initial search presented 150 articles of which 40 met the inclusion criteria. The articles studied the effect of general anesthesia on geriatric patients' cognitive function. Data extraction Articles not reporting on the effect of general anesthesia on geriatric patients' cognitive function in the title or abstract were not included. Four independent investigators extracted data on methods, health outcomes and traditional protocol. Data synthesis Data were synthesized qualitatively, and we did not perform a quantitative data analysis. Findings Multiple studies have found that postoperative cognitive disorders including delirium and postoperative cognitive dysfunction are common postanesthesia complications in elderly patients. Conclusion As the population ages, the number of geriatric patients undergoing surgery is increasing and, with it, the prevalence of postoperative cognitive disorders. Postoperative cognitive disorders including delirium and postoperative cognitive dysfunction are common postanesthesia complications in elderly patients. Several risk factors for postoperative disorders have been identified, and anesthesiologists usually adapt their practice habits when taking care of elderly patients to try to reduce the effects of the anesthetics on postoperative cognitive functions.