Anesthesia Research Articles

Effects of warming carbon dioxide pneumoperitoneum on the prognosis of patients undergoing pancreaticoduodenectomy by Da Vinci robot

Objective To study the effect of heated carbon dioxide pneumoperitoneum on the prognosis of patients undergoing pancreaticoduodenectomy by Da Vinci robot. Methods A total of 307 patients who underwent pancreaticoduodenectomy by Da Vinci robot from January 2016 to December 2018 were selected as subjects. 140 patients who underwent pancreaticoduodenectomy from January 2016 to April 2017 were selected as the control group, and room temperature carbon dioxide pneumoperitoneum was used. From May 2017 to December 2018, 167 patients were set as the intervention group, and heated carbon dioxide pneumoperitoneum was used. Body temperature, heart rate and blood oxygen saturation of the two groups were compared after entering the operating room, before anesthesia, before the establishment of carbon dioxide pneumoperitoneum and after the closure of carbon dioxide pneumoperitoneum, and the duration of operation, intraoperative blood loss, postoperative anesthesia recovery time, hospitalization time and postoperative complication rate were recorded. Results There was no significant difference in body temperature after entering the operating room, before the establishment of carbon dioxide pneumoperitoneum between the two groups (P>0.05). After the closure of carbon dioxide pneumoperitoneum, the decline range of the body temperature of the control group was(1.24±2.36) ℃, which was significantly higher than that of the intervention group (0.60±0.25) ℃, and the difference was statistically significant (t value was 6.892, P 0.05). The intraoperative blood loss, resuscitation time, drainage time was (291.08±265.42) ml, (27.04±10.89) min, (8.69±6.64) d in the intervention group and (364.29±309.28) ml, (32.60±12.17) min, (10.76±6.25) d in the control group, and the difference was statistically significant (t value was 2.232, 7.294, 2.789, P<0.05 or 0.01). There was statistically significant difference in The incidence of pancreatic fistula and biliary fistula, and length of hospital stay was 20 cases, 7 cases, (27.62±17.30) d in the intervention group, and 31 cases, 15 cases, (32.38±12.22) d in the control group, and the difference was statistically significant (χ2 value was 4.653, 4.870, t value was 6.284, P<0.05). Conclusions Warming carbon dioxide pneumoperitoneum can reduce the incidence of perioperative hypothermia and improve the prognosis of patients undergoing pancreaticoduodenectomy by Da Vinci robot. Key words: Warming carbon dioxide pneumoperitoneum; Da Vinci robot; Pancreaticod-uodenectomy; Prognosis; Hypothermia

The comparison of clinical outcomes of popliteal tendon recess and reconstruction technique

Objective To compare the objective and subjective clinical outcomes of recess procedure versus popliteal tendon reconstruction in patients with posterolateral corner injury. Methods From January 2012 to January 2017, patients who were eligible for inclusion in this study if they 1) had acute posterolateral rotational instability (PLRI) and were treated surgically in our institution, 2) were followed for a minimum of 2 years with examination under anesthesia results. The mean age was 34.5±7.4 years (range 20-45 years). According to Fanelli's classification, there were 31 type A, 17 type B and 6 type C cases. There were 26 patients in reconstruction group and 28 patients in recess group. Outcomes included subjective scoring systems (Lysholm score, Tegner score and International Knee Documentation Committee (IKDC) subjective score), knee stability examinations (the side-to-side difference (SSD) of tibial external rotation angle by dial test, posterior and varus stress radiograph) and second-look arthroscopic lateral gutter drive-through test during hardware removal operation. Results The mean follow-up duration was 30.2±4.9 months in reconstruction group and 32.2±9.9 months in recess group. At the final follow-up, there were no significant differences in Lysholm scores (reconstruction group: 70.1±15.5, recess group: 70.0±10.2; t=0.089, P=0.926), Tegner scores (reconstruction group: 3(2, 5), recess group: 2(1, 4); U=395.522, P=0.156), or IKDC subjective scores (reconstruction group: 74.8±19.3, recess group: 71.2±17.6; t=0.381, P=0.722) between the groups. No significant difference in SSD on posterior stress radiography (reconstruction group: 4.1±3.4 mm, recess group: 4.7±2.6 mm; t=0.918, P=0.345) or medial stress radiography (reconstruction group: 4.0±1.7 mm, recess group: 3.8±1.9 mm; t=0.208, P=0.820) was observed. There was no significant difference on SSD of dial test (reconstruction group: 1.5°±4.2°, recess group: 1.1°±4.0°, t=0.586, P=0.565). No positive lateral gutter drive-through test was observed in all groups. Conclusion Both recess procedure and popliteal tendon reconstructions significantly improve the knee stability and subjective outcomes of patients with PLRI. In a comparison with popliteal tendon reconstruction, the recess procedure has similar subjective and objective clinical outcomes. Key words: Collateral ligaments; Tendon injuries; Arthroscopy; Reconstructive surgical procedures

The new nurse manager survival guide Part 1.

Leading in a time of crisis We created this series to offer new nurse managers basic tenets of leadership to help them succeed in this pivotal organizational role Little did we imagine the chaos and disruption that were in store for all of us as the coronavirus pandemic has changed life as we know it Hospitals have been reconfigured for the sole purpose of creating maximum capacity for infected patients Elective surgeries and routine procedures have been canceled;ORs and postanesthesia care units have been turned into patient care units to provide ventilator support with anesthesia machines when there are no more ICU beds New protocols are being created and implemented in real time as physicians and nurses learn what to do and when to do it as they go Clinicians are required to make immediate choices about how to best care for huge numbers of very sick patients who appear in EDs with breathtaking rapidity, and the ethics of allocating scarce resources when the pace is fast and actions need to be decisive have their own emotional toll 1 Rigid hierarchies and siloed fiefdoms that have characterized hospitals are rapidly breaking down as new models of teamwork take hold This energy pulsating in hospitals is in sharp contrast to the eerily empty streets outside silenced by shelter-in-place orders 2 No nurse manager practicing today has experienced anything like the coronavirus pandemic;this will be a formative event for all nurses as we move into an unknown future None of us has managed this degree of chaos, complexity, and uncertainty before so, in a sense, we're all new nurse managers trying to find our way Here are some things to think about that may be helpful to you as you navigate this new reality

Erector spinae plane block for postoperative analgesia after total laparoscopic hysterectomy: case series and review of the literature.

Total laparoscopic hysterectomy (TLH) is associated with significant postoperative pain that worsens outcomes and prolongs hospital stay. Ultrasound guided erector spinae plane block (ESPB) is a new technique for thoracic analgesia. Few cases have been described for postoperative analgesia in laparoscopy. We describe the use of preoperatory bilateral ESPB at level T10 to provide postoperative analgesia following THL. We enrolled 10 ASA 1-2 patients scheduled for TLH. After written informed consent we performed bilateral ESPB at T10 level in sitting position, with a linear probe and in plane cranio-caudal approach and ropivacaine 0.5% 20 for each side. The sensitive block was tested by pinprick. Standard general anesthesia was administered. Patient controlled analgesia (PCA) with morphine 1 mg/ml was delivered. We measured postoperative pain by visual analogue scale (VAS). Five patients (50%) underwent simple TLH, 5 women (50%) had TLH plus salpingo-oophorectomy. VAS scores was <4 in all cases but one, and PCA morphine consumption was 4.1 ± 3.5 mg (mean ± SD). Pinprick was positive bilaterally in 3 patients (30%). ESPB was an effective and safe procedure for postoperative pain control after TLH. Future research should compare ESPB to other techniques to assess its role on perioperative management of THL.

Methodology analysis of flash visual evoked potential and its preliminary application in intraoperative monitoring during operation of sellar region tumors

Objective To analyze the methodology parameters of intraoperative monitoring of flash visual evoked potential (F-VEP) and to explore its application value in the operation of sellar region tumors. Methods The clinical data of 117 patients admitted to Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from May 2018 to August 2019 were retrospectively analyzed. A total of 86 patients with intraductal space-occupying lesions were enrolled as A group (112 eyes) for the study of intraoperative F-VEP parameters. The stable parameters obtained from the parameter study were applied to 31 patients with sellar region tumors (B group, 62 eyes). All patients underwent tumor resection and intraoperative F-VEP monitoring under general intravenous anesthesia. F-VEP amplitudes under various electrode channels and different stimulus frequencies (0.7-1.2 Hz) were compared. Results In the A group, at any stimulation frequencies, the amplitude between N75 and P100 wave (A1) of O2-Fz channel and Oz-Fz channel were significantly higher than those of O1-Fz channel (all P<0.05). At various stimulus frequencies within the range of 0.7-1.0 Hz, the amplitude of A2 of O2-Fz channel and Oz-Fz channel was significantly higher than those of O1-Fz channel (all P<0.05). In any electrode channel, A1 obtained at various stimulus frequencies within the range of 0.7-1.2 Hz did not vary significantly, while A2 at the frequency of 0.7 Hz was significantly higher than that at any other frequency (all P<0.05). In the B group, the stable F-VEP waveform was obtained in 61 eyes with an extraction rate of 98.4% (61/62). There was no change in F-VEP waveform in 19 patients in the B group, of which 13 had the same visual function as that before operation, and 6 of them had improved visual function. In the B group, among the 12 patients with reversible F-VEP waveform, 4 had the same visual function as that before surgery, 7 had improved visual function, and only 1 had decreased visual function. Conclusions After selecting appropriate stimulus parameters, stable and reliable F-VEP waveform can be obtained during operation. By means of preliminary application of F-VEP monitoring in sellar region tumor surgery, it has been preliminarily confirmed that intraoperative F-VEP monitoring could be used to predict the prognosis of postoperative visual function in patients. Key words: Brain Neoplasms; Monitoring, intraoperative; Evoked potentials, visual; Sellar region; Prognosis

Application of neuronavigation combined with yellow fluorescence staining in the resection of supratentorial glioma

Objective To explore the application of neuronavigation combined with yellow fluorescence staining in the operation of glioma. Methods A retrospective study was conducted on the clinical data of 172 patients with supratentorial glioma who underwent surgical treatment at Department of Neurosurgery, Zhongnan Hospital of Wuhan University from January 2016 to March 2018. Among them, 55 cases were treated with neuronavigation combined with yellow fluorescence staining (navigation + fluorescence group) and 117 cases with conventional surgical techniques (control group). There were 81 patients with tumors involving the eloquent area, and neuroelectrophysiological monitoring and/or intraoperative awake anesthesia were applied in all those patients. Total resection rate was compared between the 2 groups to analyze the factors influencing the total resection rate. Results Total resection was performed in 58 patients confirmed by postoperative imaging. The total resection rate was 45.5%(25/55) in group of neuronavigation + fluorescence and 28.2%(33/117) in the control group. There was statistically significant difference between the 2 groups(P=0.026). Multiple logistic regression analysis revealed that involvement of eloquent area (OR=0.502, 95% CI: 0.253-0.998, P=0.049) and the technique of neuronavigation plus fluorescence (OR=2.173, 95% CI: 1.080-4.371, P=0.030) were independent prognostic factors of the total resection for glioma. Among the 81 patients involving the eloquent area, total resection was achieved in 21 patients(25.9%), of whom 13(61.9%) were treated with fluorescence combined with neuronavigation. Incomplete resection was achieved in 60 patients, of whom 16(26.7%) were treated with fluorescence combined with neuronavigation. There was statistically significant difference between the 2 groups (P=0.004). Multiple logistic regression analysis revealed that the technique of neuronavigation combined with fluorescence (OR=3.896, 95% CI: 1.331-11.405, P=0.013) were independent prognostic factors of total resection. Conclusion Neuronavigation combined with yellow fluorescence staining can be helpful in the total resection of glioma . Key words: Glioma; Neuronavigation; Fluorescence staining; Neurosurgical procedures; Extent of resection

Anesthetic Care During Posterior Spinal Fusion in an Adolescent With Ebstein’s Anomaly

Ebstein’s anomaly is a rare form of cyanotic congenital heart disease (CHD) that involves malformation and dysfunction of the tricuspid valve and right ventricle (RV). The severity of the defect impacts clinical presentation, survival, and treatment options. Presentation during the neonatal period with hypoxemia and cyanosis is noted in patients with severe tricuspid valve malformation, a hypoplastic RV, or RV outflow tract obstruction. However, presentation later in infancy is more common when there is a moderate tricuspid valve malformation and no associated RV outflow tract obstruction. Although Ebstein’s anomaly is not generally associated with other congenital defects, patients may occasionally require surgery for other comorbid conditions. We describe the perioperative anesthetic management of an adolescent with Ebstein’s anomaly for posterior spinal fusion. Previous reports of anesthetic care in this clinical scenario are reviewed, anesthetic considerations discussed, and options for intraoperative monitoring and anesthetic care presented. J Med Cases. 2020;11(3):68-72 doi: https://doi.org/10.14740/jmc3449

Preoperative interview mode with Child Life in the management of preschool children′s anxiety

Objective To explore the effect of preoperative visit with Child Life mode in the management of preschool children′s anxiety. Methods A total of 80 cases of children of pre-school age who were operated from September 2018 to February 2019 were selected by cluster sampling method. The children from September to November 2018 who were given the traditional mode of preoperative visit were set as the control group. Children from December 2018 to February 2019 who were given preoperative visit with Child Life mode were set as the experimental group. The Modified Yale Perioperative Anxiety Scale (m-YPAS) scores, Induction Compliance Checklist (ICC) scores and Pediatric Anesthesia Emergence Delirium (PAED) scores were compared between the two groups at 4 different perioperative time points (6 hours after admission, waiting for surgery, induction of anesthesia, and 6 hours after surgery). Results Totally three patients were suspended from the study due to surgery. A total of 77 children were studied, 38 in the experimental group and 39 in the control group. The score of m-YPAS in the experimental group was significantly lower than that of the control group(17.57±16.64 vs. 42.04±27.46, t value was 3.85, P 0.05) and 6 hours after surgery(35.61±15.70 vs. 41.81±17.97, t value was 1.37, P>0.05). Compare with the control group the score of ICC in the experimental group was significantly decreased (1.40±1.39 vs. 3.78±2.60, t value was 4.88, P 0.05). Conclusions Compared with the traditional preoperative visit mode, the preoperative visit mode of Child Life can effectively relieve the anxiety of preschool children undergoing general anesthesia surgery while they are waiting for surgery and during anesthesia induction, and can improve the degree of cooperation during anesthesia induction. Key words: Child Life; Preoperative interview; Preschool child; Anxiety

Evaluation of the effect of paravertebral block combined with general anesthesia on patients with thoracotomy and its effect on perioperative stress

Objective To evaluate the effect of subtotal paravertebral block combined with general anesthesia on the application of open thoracic surgery and its effect on perioperative stress. Methods From January 2016 to January 2018, 70 cases of patients who underwent thoracotomy were studied. According to the simple random method, patients were divided into control group and observation group. The control group was given general anesthesia, and the observation group was given thoracic paravertebral nerve combined with general anesthesia. The changes of hemodynamics, anesthetic effect, anesthesia recovery, stress response and adverse reaction during anesthesia were compared between the two groups. Results There was no significant difference in heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SaO2) between the two groups at 1 min after induction, 1 min intubation and 1 min after extubation (P>0.05). The anesthetic effect of the patients in the observation group was better than that of the control group (P 0.05). Conclusions Ultrasound paravertebral block combined with general anesthesia can improve the anesthesia effect, and has better analgesic effect, less postoperative stress response, and high safety. Key words: Ultrasonography; Paravertebral nerve block; Anesthesia, general; Thoracic surgical procedures

The effect and possible mechanism of sevoflurane exposure on electroencephalographic seizures and long-term cognitive function in neonatal rats

Objective To investigate the effect of sevoflurane anesthesia on electroencephalographic (EEG) seizures and long-term behavior and possible mechanism in neonatal rats. Methods A total of 141 postnatal days 4-6 Sprague-Dawley rats (66 male, 75 female) were divided into 3 groups (n=47 in each group) according to random number table method: control group, sevoflurane group, and NKCC1 inhibitor group, with 22 males and 25 females in each group. Rats in the control group were fed in normal cage without anesthesia; rats in the sevoflurane group were anesthetized with 2.1% sevoflurane for 6 hours; rats in the NKCC1 blocker group received intraperitoneal injection of 1.82 mg / kg bumetanide 30 minutes before anesthesia with 2.1% sevoflurane. The rats in the control group and sevoflurane group were injected subcutaneously with the same dose of DMSO at the same time when the NKCC1 blocker group received the drug intervention, so as to eliminate the influence caused by the solvent. The rats were observed for 30 minutes after recovery from anesthesia and then continued to breastfeed normally. Some of the new born rats received EEG monitoring from 9 to 11 days after being raised; the other rats received EPM and PPI respectively at 60 and 70 days after being raised. Results The results of EEG showed that, compared with the control group, the number of epileptic waves((0.429±0.787), (1.571±0.787), t=2.753, P 0.05). Compared with male rats, the average duration of female rats in sevoflurane group decreased ((6.392±3.374), (2.515±2.992), t=3.044, P 0.05). Comparison between male and female rats: compared with male rats in sevoflurane group, the female rats in sevoflurane group had a longer open arm stay time in EPM experiment (P<0.05), the difference was statistically significant. Conclusion Sevoflurane anesthesia for 6 hours can significantly increase the generation of epileptic waves in EEG of male newborn rats, and cause behavioral abnormalities in adult male rats, which may be related to NKCC1.And male rats are more vulnerable to the negative effects of sevoflurane anesthesia on brain nerve development. Key words: Sevoflurane; Neonatal anesthesia; Bumetanide; Gender; Electroencephalo-graphic; Behaviour; Rat

Effects of magnetic hospital concept in nursing management of Operating Room

Objective To explore the effects of magnetic hospital concept in nursing management of Operating Room. Methods From January to December 2018, this study selected 60 nurses in Department of Anesthesia Operation of Maoming People's Hospital of Guangdong Province by cluster sampling. All of nurse were divided into control group and observation group with the method of random number table, 30 cases in each group. Control group carried out the routine management model of Operating Room, while observation group implemented the nursing management model of Operating Room based on magnetic hospital concept. Working satisfaction and working pressure of nurses between two groups were compared. Results The working satisfaction of nurses in observation group was higher than that in control group; the scores of working pressure of nurses in observation group were lower than those in control group with statistical differences (P<0.05) . Conclusions The magnetic hospital concept-based nursing management model of Operating Room can reduce nurses' working pressure and improve their working satisfaction which is worthy of popularization. Key words: Operating Room; Nursing administration; Magnetic hospital; Working pressure; Satisfaction

Application of ultrasound in spinal anesthesia puncture

As a visual technology, ultrasound has made great progress in the application of spinal anesthesia. Spinal anesthesia is a common anesthesia method for lower abdomen and lower limb surgery. Ultrasound can clearly show the spinal canal and its sur-rounding anatomy, which makes great significance to the precision of spinal anesthesia. Scanning before spinal anesthesia with ultra-sound can predict the difficulty of puncture, locate the puncture point and measure the depth of puncture, thereby improving the suc-cess rate of spinal anesthesia, real-time ultrasound guided spinal anesthesia can observe the angle and depth of the needle in real time , which makes the whole process of anesthesia visible, the application of ultrasound to difficult and pediatric spinal puncture can reduce the complications and risks caused by multiple puncture, which has far-reaching significance. Key words: Ultrasound; Spinal anesthesia; Position; Puncture

Research progresses in tracheal extubation under deep anesthesia in children

With the increasing number of pediatric surgeries, pediatric tracheal intubation under general anesthesia increases, and the complications associated with extubation increase. Therefore, the choice of timing of tracheal extubation is increasingly con-cerned by anesthesiologists. How to wake up children in a more comfortable environment under the premise of safety is the goal pur-sued by pediatric anesthesiologists. A large number of clinical studies have confirmed that tracheal extubation under deep anesthesia can reduce respiratory complications, relieve hemodynamic fluctuations and decline child agitation after extubation in the anesthesia re-covery period, and enable children to survive the recovery period of anesthesia in a more comfortable state. This article reviews the ef-fects of deep anesthesia extubation on the body, methods of extubation, medication, and limitations. Key words: Pediatric anesthesia; Deep anesthesia; Extubation

Recent progresses in the clinical application of ultrasound-guided erector spinae plane block

Ultrasound-guided erector spinae plane block (ESPB) is a novel interfacial plane block that can be used to relieve pain after thoracolumbar surgery. It is advantageous in simple and safe procedures, reliable effects and fewer complications and has been drawn increasing attention since 2016. This review introduces the anatomical basis of ultrasound-guided ESPB, expounds the mechanism by which ESPB works, summarizes the clinical application of ESPB in thoracic, abdominal and lumbar surgery, concludes the advantages and disadvantages of ESPB and its complications, and compares ESPB with other commonly thoracolumbar analgesic block methods. With respect to its advantages, few complications and contraindications, ultrasound-guided ESPB can be widely applied in the field of anesthesia and pain, and improve the effect and safety of anesthesia. This review aims to explore the clinical research and future development of ESPB, providing evidence for better clinical application. Key words: Erector spinae plane block; Ultrasound guidance; Postoperative analgesia

Effectiveness of preoperative prewarming for maintenance of intraoperative core body temperature: an Meta-analysis

Objective To systematically evaluate the effectiveness of preoperative prewarming for maintenance of intraopera-tive core body temperature, so as to provide clinical evidence for perioperative temperature management. Methods We retrieved PubMed, Web of Science, the Cochrane Library, EMBACE, CINAHL, CNKI, Wanfang Database, CQVIP and China Biology Medicine disc, so as to comprehensively search randomized controlled trials (RCTs) about preoperative prewarming for maintenance of intraopera-tive core body temperature. The retrieval time was limited from January 2000 to April 2019 and the references of the included trials were also reviewed. Two researchers independently screened literature according to the inclusion and exclusion criteria, evaluated the quality of the included literature, and extracted data. RevMan 5.3 software was adopted to perform Meta-analysis. Results Fourteen RCTs involving a total of 902 patients were included. The results of Meta-analysis indicated that the preoperative prewarming group presented a remarkably increased core body temperature 30 min, 60 min, and 90 min after anesthesia induction and at the end of opera-tion, as well as a markedly decreased incidence of intraoperative hypothermia and postoperative hypothermia, compared with the con-trol group (P 0.05). Conclusions Preoperative prewarming can effectively increaese intraoperative core body temperature and reduce the inci-dence of hypothermia. Key words: Prewarming; Intraoperative; Core body temperature; Hypothermia; Meta-analysis

Risk factors for delirium after intertrochanteric fracture surgery in the elderly

Objective To investigate the risk factors for delirium after intertrochanteric fracture surgery in the elderly. Methods The data of 423 elderly patients with femoral intertrochanteric fracture were retrospectively analyzed who had been treated by closed reduction and internal fixation with proximal femoral nail antirotation (PFNA) at Department of Orthopedics, The Second Central Hospital of Baoding from December 2010 to April 2018. They were 205 males and 218 females, aged from 70 to 98 years (mean, 78.6 years). By AO classification, 239 fractures were type 31-A1, 141 ones type 31-A2, and 43 ones type 31-A3. Of them, 362 were complicated with disease of internal medicine. The interval from injury to surgery ranged from 4 to 72 hours with an average of 46.6 hours. The incidence of postoperative delirium was recorded. The risk factors were screened by univariate analysis from the hidden blood loss, gender, age, body mass index, complications, anesthesia method, preoperative preparation time and electrolyte disturbance; multivariate logistic regression analysis was used to determine the independent risk factors from the factors with P< 0.05. Results Post-operative delirium occurred in 49 of the 423 patients (11.58%) (29 cases on the first postoperative day and 20 ones on the second postoperative day). It was not observed in the other 374 (88.42%) patients. Univariate analysis showed significant differences in the interval from injury to surgery, hidden blood loss and electrolyte disturbance between the patients with and without postoperative delirium (P 48 hours (OR=3.386, 95% CI: 1.362 to 6.638), hidden blood loss>600 mL (OR=10.292, 95% CI: 1.244 to 35.091) and electrolyte disturbance (OR=4.157, 95% CI: 1.595 to 7.626) were the independent risk factors for postoperative delirium in elderly patients with intertrochanteric fracture. Conclusion Long preoperative preparation, a large amount of hidden blood loss and postoperative electrolyte disturbance may be the risk factors for post-operative delirium in elderly patients with intertrochanteric fracture afterinternal fixation. Key words: Hip fractures; Latent blood loss; Delirium; Risk factors; Aged

Effect of quality nursing care on stress response and VAS score of emergency surgical debridement and suture patients

Objective To explore the effect of quality nursing care on stress response and visual analogue pain score (VAS) in patients undergoing surgical debridement and suture in emergency department. Methods A total of 116 patients receiving debridement suture from the emergency surgery department of this hospital from March 2017 to February 2018 were selected and divided into control group (March to August 2017) and observation group (September 2017 to February 2018) according to the order of admission, with 58 patients in each group.The control group was given routine nursing, and the observation group was given high-quality nursing service on the basis of routine nursing.Changes in stress response indicators such as adrenaline, TNF-α, Interleukin-6, Cortisol, VAS score, heart rate, systolic blood pressure, operation time and nursing satisfaction were compared between the two groups. Results The levels of epinephrine, TNF-α, Interleukin-6, Cortisol and other stress response indicators in the observation group were lower than those in the control group, and the VAS score 3 hours after the elimination of postoperative anesthesia was lower than that in the control group, with statistically significant differences(P<0.05). The intraoperative systolic blood pressure, heart rate and operation time of the observation group were lower than that of the control group, and the nursing satisfaction rate was higher than that of the control group, and the differences were statistically significant(P<0.05). Conclusions The application of high-quality nursing care in debridement and suture of emergency surgery can effectively alleviate the stress response of patients, maintain the operation center rate and blood pressure to be stable, shorten the operation time, reduce the VAS score, and improve the nursing satisfaction of patients. Key words: Emergency surgery; Debridement suture; High quality care; Stress response; Pain

Feasibility of early water intake in patients undergoing laparoscopic salpingectomy under general anesthesia

Objective To evaluate the feasibility of early litter water intake in patients after general anesthesia. Methods Totally 130 patients undergoing laparoscopic salpingectomy under general anesthesia in Yantai Yuhuangding Hospital were selected from December 2018 to May 2019, and divided into the control group (n=65) and the experimental group (n=65) . Patients in the control group were routinely abstained from drinking and fasting, while patients in the experimental group were conscious after surgery and took in a small amount of water after cough and swallowing reflexes recovered. The incidence of nausea, vomiting, dry mouth, and hunger within 24 hours after surgery was recorded in both groups, and the time of anal exhaust was recorded. Results The anal exhaust time of patients in the experimental group was (12.0±1.22) h, while that in the control group was (15.1±1.05) h, and the difference between the two groups was statistically significant (t= 15.527, P<0.01) . Patients with dry mouth and hunger in the experimental group accounted for 38.5% (25/65) and 13.8% (9/65) , while those in the control group were 58.5% (38/65) and 32.3% (21/65) , and the differences between the two groups were statistically significant (χ2=5.205, 6.240; P<0.05) . Conclusions Patients undergoing laparoscopic salpingectomy under general anesthesia are conscious in the recovery room and take in water immediately after recovery of cough and swallowing reflexes, which can increase the patient's comfort, reduce adverse reactions and help promote the early recovery of gastrointestinal function. Key words: Anesthesia, general; Enhanced recovery after surgery; Postoperative water intake; Gastrointestinal function; Anesthesiology recovery room

Effect of enhanced recovery after surgery nursing in patients with cervical single-door spinal canal augmentation and angioplasty

Objective To evaluate the application effect of a series of optimized nursing measures under the concept of enhanced recovery after surgery (ERAS) on the perioperative period of patients with posterior cervical single-door spinal canal augmentation and angioplasty. Methods A retrospective cohort study design was used. From April to December 2018, using cluster sampling method, 476 patients admitted to a class third hospital for posterior cervical single-door spinal canal augmentation and angioplasty were selected as research objects. According to whether or not to implement ERAS optimization, the patients were divided into ERAS group with 100 cases and control group with 376 cases. The control group underwent routine measures such as preoperative evaluation and education, blood management, anesthesia points, surgical points, incision closure, pain management, drainage tube management, and prevention of complications. On the basis of routine measures, the ERAS group implemented optimized measures for ERAS on clinical measures such as fasting water and infusion management before surgery, postoperative diet and infusion management, bowel preparation, urinary tube management, and out of bed activities. A self-designed questionnaire was used to investigate the two groups of patients. The general information, implementation of ERAS nursing (preoperative fasting time, the preoperative water cut-off time, the time for anesthesia, the time for surgery, the amount of infusion before surgery, the amount of infusion during surgery, the amount of infusion after surgery, use of indwelling urinary catheters) , recent effect evaluation indicators [length of hospitalization, cost of hospitalization, discharge daily living ability score (Barthel index) , postoperative complications, postoperative urinary retention]and long-term effect evaluation indicators [Japan Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, neck and shoulder pain VAS score, neck and shoulder stiffness and numbness VAS score, 90-day readmission rate]of the two groups were compared. Results A total of 295 cases were included in the study, including 69 cases in the ERAS group and 226 cases in the control group. The study found that there were statistically significant differences between the two groups of patients in terms of preoperative fasting time, the preoperative water cut-off time, the amount of infusion before surgery, the amount of infusion after surgery and the use of indwelling urinary catheters (P 0.05) . The comparison of long-term effects showed that there was no significant difference in the modified JOA score, NDI score, neck and shoulder discomfort and the 90-day readmission rate in the two groups (P>0.05) . Conclusions The application of ERAS nursing in the perioperative period of patients with posterior cervical single-door spinal canal augmentation and angioplasty can effectively reduce patients' fasting time and water cut-off time, use of urinary catheters, which can reduce patients' hospitalization time, but has no significant effect on the long-term effect of surgery. Key words: Perioperative nursing; Enhanced recovery after surgery; Cervical single-door spinal canal augmentation and angioplasty; Effect evaluation

Anesthetic management of a patient with COVID-19 in incubation period undergoing total hip arthroplasty

One of the characteristics of coronavirus disease 2019 (COVID-19) epidemiology is that asymptomatic infection is also a source of infection There was no fever and/or respiratory symptoms in this patient before the operation, and the results of routine blood test showed decreased lymphocyte count and lymphocyte percentage, and novel coronavirus pathogen detection was not carried out in the hospital, and the detection was not performed, chest imaging examination showed no obvious ground glass shadow, so viral pneumonia was not considered The medical staff involved in the operation all adopted standard secondary medical protection measures Five days after the operation, the patient was tested positive for novel coronavirus nucleic acid, which was a confirmed case of COVID-19 The results of epidemiological investigation and analysis showed that the patient was in the incubation period of COVID-19 before operation, however, none of the medical staff involved in surgical anesthesia and none of the patients in the next operation were infected The reason is that the author′s hospital has strict training for all staff in infection control, and surgical anesthesiology medical staff have mastered the relevant basic knowledge and operation skills, have a good sense of infection control in the operating room, and can standardize the implementation This case also suggested that attention should be paid to the patients with significant preoperative simple lymphocyte level decline, and measures should be taken to identify asymptomatic infection early © 2020 Chinese Medical Association