Combined Intravenous-inhalational Anesthesia Research Articles

Effect of Dexmedetomidine on Intraoperative Hemodynamics and Blood Loss in Patients Undergoing Spine Surgery: A Systematic Review and Meta-Analysis

Objective Dexmedetomidine (Dex) is a highly selective α2 adrenoceptor agonist that reduces blood pressure and heart rate. However, its ability to provide stable hemodynamics and a clinically significant reduction in blood loss in spine surgery is still a matter of debate. This study aimed to investigate the effects of Dex on intraoperative hemodynamics and blood loss in patients undergoing spine surgery.Methods The Web of Science, MEDLINE, EMBASE, and the Cochrane Library were searched up to February 2023 for randomized controlled trials (RCTs) including patients undergoing spine surgeries under general anaesthesia and comparing Dex and saline. A fixed- or random-effect model was used depending on heterogeneity.Results Twenty-one RCTs, including 1388 patients, were identified. Dex added the overall risk of intraoperative hypotension (odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.24 - 3.58; P=0.006) and bradycardia (OR: 2.48; 95%CI: 1.57 - 3.93; P=0.0001). The use of a loading dose of Dex led to significantly increased risks of intraoperative hypotension (OR: 2.00; 95%CI: 1.06 - 3.79; P=0.03) and bradycardia (OR: 2.28; 95%CI: 1.42 - 3.66; P=0.0007). For patients receiving total intravenous anesthesia, there was an increased risk of hypotension (OR: 2.90; 95%CI: 1.24 - 6.82; P=0.01) and bradycardia (OR: 2.66; 95%CI: 1.53 - 4.61; P=0. 0005). For patients in the inhalation anesthesia group, only an increased risk of bradycardia (OR: 4.95; 95%CI: 1.41 - 17.37; P=0.01) was observed. No significant increase in the risk of hypotension and bradycardia was found in the combined intravenous-inhalation anesthesia group. The incidence of severe hypotension (OR: 2.57; 95%CI: 1.05 - 6.32; P=0.04), but not mild hypotension, was increased. Both mild (OR: 2.55; 95%CI: 1.06 - 6.15; P=0.04) and severe (OR: 2.45; 95%CI: 1.43 - 4.20; P=0.001) bradycardia were associated with a higher risk. The overall analyses did not reveal significant reduction in intraoperative blood loss. However, a significant decrease in blood loss was observed in total inhalation anesthesia subgroup (mean difference [MD]: -82.97; 95%CI: -109.04 - -56.90; P<0.001).Conclusions Dex increases the risks of intraoperative hypotension and bradycardia in major spine surgery. The administration of a loading dose of Dex and the utilization of various anesthesia maintenance methods may potentially impact hemodynamic stability and intraoperative blood loss.

Pediatric anesthetic for tracheobronchial foreign body extraction: A survey of practice in France.

Tracheobronchial foreign body aspiration is a classic pediatric emergency, and its associated morbidity particularly depends on the anesthetic management, which differs according to the center and the practitioner. The aim of this study was to evaluate the different anesthetic practices for tracheobronchial foreign body extraction. A survey was sent via email to the member physicians of the Association des Anesthésistes Réanimateurs Pédiatriques d'Expression Française (ADARPEF). The survey included 28 questions about the organizational and anesthetic management of an evolving clinical case. A total of 151 physicians responded to the survey. Only 13.2% of the respondents reported that their institution had a management protocol, and 21.7% required a computerized tomography scan before the procedure was performed for children who were asymptomatic or mildly symptomatic during the night. There were 56.3% of the respondents who reported that extraction with a rigid bronchoscope is the only procedure usually performed in their institution. Regarding rigid bronchoscopy, 47.0% used combined intravenous-inhalation anesthesia. The objective was to maintain the child on spontaneous ventilation for 63.6% of the respondents, but anesthesia management differed according to the physician's experience. Our study confirms the diversity of practices concerning anesthetic for tracheobronchial foreign body extraction and found reveal differences in practice according to physician experience.

Effects of dexmedetomidine on evoked potentials in spinal surgery under combined intravenous inhalation anesthesia: a randomized controlled trial

ObjectiveWe aimed to investigate the effects of different doses of dexmedetomidine (Dex) on evoked potentials in adult patients undergoing spinal surgery under intravenous anesthesia with low-concentration desflurane.MethodsNinety patients were divided into three groups at random. To maintain anesthesia in the control group (group C), desflurane 0.3 MAC (minimal alveolar concentration), propofol, and remifentanil were administered. Dex (0.5 μg·kg−1) was injected for 10 min as a loading dose in the low-dose Dex group (group DL), then adjusted to 0.2 μg·kg−1·h−1 until the operation was completed. Dex (1 μg·kg−1) was injected for 10 min as a loading dose in the high-dose Dex group (group DH), then adjusted to 0.7 μg·kg−1·h−1 until the operation was completed. The additional medications were similar to those given to group C. The perioperative hemodynamics, body temperature, intraoperative drug dosages, fluid volume, urine volume, blood loss, the latency and amplitude of somatosensory evoked potentials (SEPs) at four different time points, the incidence of positive cases of SEPs and transcranial motor evoked potentials (tcMEPs), and perioperative adverse reactions were all recorded.ResultsData from 79 patients were analyzed. The MAP measured at points T2-T4 in group DH was higher than at corresponding points in group C (P < 0.05). The MAP at point T4 in group DL was higher than at corresponding points in group C (P < 0.05). The remifentanil dosage in group DH was significantly lower than in group C (P = 0.015). The fluid volume in group DL was significantly lower than in group C (P = 0.009). There were no significant differences among the three groups in the amplitude and latency of SEP at different time points, nor in the incidence of warning SEP signals. The incidence of positive tcMEP signals did not differ significantly between groups C and DL (P > 0.05), but was significantly higher in group DH than in groups DL (P < 0.05) or C (P < 0.05). The incidence of intraoperative hypertension was significantly higher in group DH than in group C (P = 0.017).ConclusionsLow-dose Dex has no effect on the SEPs and tcMEPs monitoring during spinal surgery. High-dose Dex has no effect on SEPs monitoring, but it may increase the rate of false positive tcMEPs signals and the incidence of intraoperative hypertension.Trial registrationThis study has completed the registration of the Chinese Clinical Trial Center at 11/09/2020 with the registration number ChiCTR2000038154.

Effect analysis of sequential laser application in treating the hypertrophic scars of burn children at early stage

Objective: To explore the effects of sequential application of intensive pulsed light and carbon dioxide laser in treating the hypertrophic scars of burn children at early stage. Methods: A retrospective cohort before-after control study in the same patients was conducted. From January 2016 to December 2018, 145 burn children with hypertrophic scar at the early stage who met the inclusion criteria were admitted to the First Hospital of Jilin University, including 82 males and 63 females, aged 1 to 12 (3 (2, 6)) years. All the children were firstly treated with intense pulsed light therapy (no anesthesia or intravenous-inhalation combined anesthesia) at an interval of once per month, and then changed to carbon dioxide laser therapy (topical anesthesia or intravenous-inhalation combined anesthesia) when the degree of scar hyperemia was reduced, at an interval of once every 3 months, for a total of 3 times. Before the first intense pulsed light treatment (hereinafter referred to as before the first treatment) and 3 months after the last carbon dioxide laser treatment (hereinafter referred to as after the last treatment), scar scoring was evaluated by Vancouver Scar Scale (VSS), and scar hyperemia (denoted as hemoglobin level) was measured with Antera 3D® camera. The times of intense pulsed light, the time of single treatment, the anesthesia method, and the time of intravenous-inhalation combined anesthesia of intense pulsed light and carbon dioxide laser treatment were analyzed. After the last treatment, Likert Scale was used to evaluate the efficacy satisfaction of both doctors and patients. Adverse reactions were recorded during the treatment. Data were statistically analyzed with Wilcoxon signed rank sum test, and paired sample t test. Results: The color, vascular distribution, thickness, and softness scores, and total score in VSS scoring of scars of children after the last treatment were significantly lower than those before the first treatment (Z=-6.05, -10.34, -9.84, -9.28, -10.43, P<0.01). The hemoglobin level of scar of children after the last treatment was 1.86±0.24, significantly lower than 2.27±0.32 before the first treatment (t=17.65, P<0.01). A total of 411 times of intense pulsed light therapy were performed, (2.8±0.6) times per person, and the single treatment time was 35 (20, 45) s. There were 392 times (95.38%) without anesthesia, and 19 times (4.62%) with intravenous-inhalation combined anesthesia with time of 6 (5, 8) min. The single treatment time of carbon dioxide laser therapy was 5 (3, 10) min. There were 364 times (83.68%) of topical anesthesia and 71 times (16.32%) of intravenous-inhalation combined anesthesia with time of 10 (8, 15) min. After the last treatment, the efficacy satisfaction scores of doctors and patients were (4.3±0.7) and (3.8±1.0) points, respectively. Blisters occurred in 5 cases after intense pulsed light treatment, which were healed naturally after drainage. One child developed local skin infection, skin redness and swelling accompanied by purulent exudate after carbon dioxide laser treatment, which was improved after skin disinfection and external use of mupirocin ointment. No inflammatory pigmentation, worsening of hyperplasia of scar, erythema, or other skin adverse reactions or anesthetics-related adverse reactions occurred in any child. Conclusions: Sequential application of intense pulsed light and carbon dioxide laser to treat the hypertrophic scars of burn children at early stage can obviously improve the appearance and texture of scar, with higher satisfaction of doctors and patients and fewer adverse reactions.

Analysis on the Anesthesia Effects of Sevoflurane and Propofol on Laparoscopic Cholecystectomy

To compare the anesthesia effects of propofol and sevoflurane in laparoscopic cholecystectomy. 60 patients with laparoscopic cholecystectomy in our hospital from January 2019 to June 2020 were randomly divided into control group and observation group, 30 cases in each group. The control group was given total intravenous anesthesia (continuous infusion of propofol 6-8 mg/kg/h during operation), while the observation group was given intravenous inhalation combined anesthesia (continuous inhalation of 1-2.5 % sevoflurane during operation). The vital signs, anesthesia time, recovery time and extubation time of the two groups after induction and at the end of operation were compared and the occurrence of agitation during anesthesia recovery period was recorded The changes of heart rate and blood pressure before and after agitation were analyzed. The results showed that there was no significant difference in anesthesia time, recovery time and extubation time between the two groups (p>0.05); there was no significant difference in body temperature, oxygen saturation, mean arterial pressure and heart rate between the two groups after induction and at the end of operation (p>0.05); compared with the control group, the average agitation score of the observation group was significantly higher and the difference was statistically significant (p<0.05). There were 6 cases of restlessness in the control group (6/30) and 14 cases of restlessness in the observation group (14/30), the difference between the two groups was statistically significant (p<0.05); before and after the emergence of restlessness, the blood pressure fluctuation rate and heart rate fluctuation rate changed significantly and the blood oxygen saturation decreased, with significant difference (p<0.05). Sevoflurane inhalation anesthesia is more prone to emergence agitation than propofol intravenous infusion anesthesia. Intravenous anesthesia and inhalation anesthesia have their own advantages. If we fully grasp and make use of their characteristics in our work, we will make the patients wake up more smoothly and the anesthesia work more efficiently.

Effect of combined intravenous-inhalation anesthesia on postoperative cognitive dysfunction after laparoscopic radical resection of cervical cancer: A protocol for systematic review and meta-analysis.

ObjectiveTo evaluate the effect of combined intravenous–inhalation anesthesia (CIVIA) on postoperative cognitive dysfunction (POCD) after laparoscopic radical resection of cervical cancer.MethodsBy using a predefined standardized study protocol, we conducted a systematic review of randomized controlled trials (RCTs) with meta-analysis, searching the following data bases: PubMed, Embase, Web of Science, and Cochrane Library.ResultsThis systematic review evaluated the effect of CIVIA on POCD after laparoscopic radical resection of cervical cancer.ConclusionThis systematic review provided up-to-date evidence to evaluate the effect of CIVIA on POCD after laparoscopic radical resection of cervical cancer.OSF Registration number:DOI 10.17605/OSF.IO/82FNA.

Effects of intravenous and inhalation anesthesia on blood glucose and complications in patients with type 2 diabetes mellitus: study protocol for a randomized controlled trial

BackgroundDiabetes mellitus (DM) is a metabolic disorder syndrome caused by relative or absolute lack of insulin and varying degrees of insulin resistance. The type and regimen of anesthesia may affect perioperative hyperglycemia following major surgical stress. The effect of perioperative anesthetics on the blood glucose level of diabetic patients will play an essential role in the postoperative recovery of patients. However, there is no rigorously-designed randomized controlled trial to compare the effects of total intravenous anesthesia (TIVA) and total inhalation anesthesia (TIHA) on blood glucose and complications in type 2 diabetes. Hence, we design this clinical trial to compare the effects of TIVA and TIHA of hyperglycemia and clinical outcomes in type 2 diabetes undergoing surgery.MethodsThis is a randomized, double-blind, parallel controlled trial. One hundred twelve patients with type 2 DM who meet the qualification criteria will be randomly divided into two groups: TIVA group and TIHA group. The levels of serum insulin and cortisol will be measured before and after the operation, and the levels of blood glucose at different setting time will be monitored. All patients will be followed up by blinded evaluators at baseline and 1, 3, 7, and 30 days after the intervention. The follow-up included postoperative complications [such as myocardial infarction (MI), stroke, renal failure, anastomotic fistula, stress ulcer, incision infection, lung infection] and adverse events.DiscussionThe routinely used clinical anesthesia schemes are TIVA, TIHA and intravenous-inhalation combined anesthesia. We expect that the results of this trial will provide high-quality clinical evidence for the choice of anesthesia options for patients with type 2 DM.Trial registrationChinese Clinical Trial Registry: ChiCTR2000029247, registration date: 20 January 2020.

Comparison of effect of total intravenous anesthesia with propofol and combined intravenous-inhalational anesthesia with sevoflurane on postoperative sleep quality in elderly female patients

Objective To compare the effect of total intravenous anesthesia with propofol and combined intravenous-inhalational anesthesia with sevoflurane on postoperative sleep quality in elderly female patients. Methods One hundred and twenty patients, aged 65-80 yr, with body mass index of 18.5-25.0 kg/m2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for elective gynecological laparoscopic operation, were divided into 2 groups (n=60 each) by a random number table method: total intravenous anesthesia with propofol group (group P) and combined intravenous-inhalational anesthesia with sevoflurane group (group S). Anesthesia was induced with intravenous etomidate 0.2-0.3mg/kg, sufentanil 0.2-0.4 μg/kg and cisatracurium 0.10-0.15 mg/kg.Anesthesia was maintained as follows: propofol was given by target-controlled infusion with the target plasma concentration set at 2-4 μg/ml in group P, 1.2-2.3% sevoflurane was inhaled in group S, and sufentanil 0.2-0.3 μg/kg and cisatracurium 0.04-0.06 mg/kg were intermittently injected in two groups.The patients were followed up at 7-8 a. m.on the day of hospitalization, the day of operation and 1, 3, 7 and 30 days after operation.The Pittsburgh Sleep Quality Index (PSQI) was recorded, PSQI > 7 points was considered as sleep disorders, and the occurrence of sleep disorders was recorded.The morning urine was collected at the time points mentioned above, and the concentrations of melatonin sulfate and free cortisol were determined by enzyme-linked immunosorbent assay. Results Compared with group S, the PSQI was significantly decreased on 3 and 7 days after operation, the incidence of sleep disorder was decreased on 7 days after operation, the concentrations of melatonin sulfate in urine were increased (P 0.05). Conclusion The effect of total intravenous anesthesia with propofol on postoperative sleep quality is less than that of combined intravenous-inhalational anesthesia with sevoflurane in elderly female patients. Key words: Propofol; Anesthetics, inhalation; Anesthesia, general; Aged; Femininity; Sleep quality

Analysis on the correlation between rs4680 polymorphic site of catechol-O-methyl transferase and postoperative pain of mastectomy

Objective To explore the correlation between rs4680 polymorphic site of catechol-O-methyl transferase (COMT) gene and postoperative pain so as to provide theoretical evidence for individualized medicine. Methods A total of eighty -three patients [aging 29-58, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ] scheduled for mastectomy under general anesthesia was selected. Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) was adopted to identify their genotype of rs4680 polymorphic site of COMT. The patients were divided as a wild-type group(Val/Val, VV, n=51), a hybrid subtype group (Val/Met, VM, n=23) and a mutation-type group(Met/Met, MM, n=9). Then the tertiary structures of COMT protein before and after mutation were predicted through homology modeling and the physicochemical property of the protein was analyzed. Preoperative anesthesia was conducted by intravenous-inhalation combined anesthesia and postoperative anesthesia by patient controlled intravenous analgesia (PCIA). The number of effective and ineffective compressions of the analgesic pump within 24 h was recorded. Patients′ pain was assessed 2, 4, 8 h and 24 h after operation by the Numerical Rating Scale (NRS) and then its correlation with different genotypes was analyzed. Results The mutation of rs4680 polymorphic site of COMT has no significant effects on tertiary structures of COMT protein but it affected the physicochemical property of COMT protein. MM patients showed remarkably more PCIA press time than VV and VM patients 24 h after surgery (P<0.05). MM patients presented markedly more PCIA effective press time than VV patients (P<0.05). There was no significant difference in NRS score between the three genotypes at each postoperative point. Conclusions Single polymorphic site rs4680 may have little influence on individual difference of postoperative pain for patient with breast cancer. Key words: Catechol-O-methyl transferase; Gene polymorphism; Homology modeling; Postoperative pain; Breast cancer

Application of different anesthetic methods in coronary artery bypass grafting and the effect on postoperative outcome.

Application of different anesthetic methods in coronary artery bypass grafting and its effect on postoperative outcome were explored. Ninety-four patients undergoing coronary artery bypass grafting in Jining No. 1 People's Hospital from March 2017 to February 2018 were randomly divided into the control and observation groups. The control group was anesthetized by fentanyl and propofol. The observation group was anesthetized by sevoflurane combined anesthesia. The mean heart rates (HR), mean arterial pressure (MAP), systemic vascular resistance index (SVRI) and cardiac index (CI) in the two groups were compared. The levels of β endorphin (β-EP) and malondialdehyde (MDA) in patients were examined. Adverse reactions in the two groups were compared. The enzyme-linked immunosorbent assay (ELISA) was used to detect the changes of serum inflammatory factors. The prognosis of the two groups was analyzed and compared. MoCA and MMSE scale were used to evaluate postoperative cognitive function in the two groups. The levels of β-EP and MDA in the two groups during operation were higher than those before operation (P<0.05). On the third, fifth and seventh day after operation, the CRP, TNF-α and IL-6 levels of the two groups increased significantly compared to those before operation (P<0.05). The eating time and out of bed time in the observation group were significantly earlier than those in the control group, and the length of stay in the observation group was significantly shorter than that in the control group (P<0.05). On the first day after operation, the scores of MoCA and MMSE in the observation group were better than those in the control group (P<0.05). The two different anesthetic methods can maintain the perioperative hemodynamic stability of coronary artery bypass patients, but sevoflurane intravenous-inhalation combined anesthesia can effectively adjust the β-EP in the body, and reduce the oxidative stress response, which is favorable for postoperative outcome.

Effects of dexmedetomidine during combined intravenous-inhalational anesthesia on motor evoked potentials monitoring and postoperative agitation in elderly patients undergoing cervical spine surgery

Objective To investigate the effects of different doses of dexmedetomidine during combined intravenous-inhalational anesthesia on motor evoked potentials (MEPs) monitoring and postoperative agitation in elderly patients undergoing cervical spine surgery. Methods Sixty patients of both sexes, aged 65-81 yr, weighing 51-78 kg, of American Society of Anesthesiologists physical statusⅠor Ⅱ, undergoing elective cervical spine surgery under general anesthesia, were divided into 3 groups (n=20 each) using a random number table method: control group (group C), low-dose dexmedetomidine group (group D1) and high-dose dexmedetomidine group (group D2). Anesthesia was induced by intravenous injection of midazolam 0.04 mg/kg, cisatracurium 0.15 mg/kg, propofol 2 mg/kg and sufentanil 0.3-0.4 μg/kg.MEPs was assessed with nerve electrophysiology monitor after induction of anesthesia.Anesthesia was maintained by inhalation of sevoflurane (end-tidal concentration 1%)and target-controlled infusion of propofol(target plasma concentration 2-3 μg/ml). Narcotrend index was maintained at D2-E1.When T4/T1>75% (at T0), dexmedetomidine was intravenously infused over 10 min in a loading dose of 0.6 μg/kg, followed by an infusion of 0.3 μg·kg-1·h-1 until the end of surgery in group D1.Dexmedetomidine was intravenously infused over 10 min in a loading dose of 1 μg/kg, followed by an infusion of 0.3 μg·kg-1·h-1 until the end of surgery in group D2.The equal volume of normal saline was given intravenously in group C. At T0, immediately after the end of administration of dexmedetomidine loading dose (T1) and at 60 min of dexmedetomidine infusion (T2), the effective elicitation of MEPs and amplitude and latency of MEPs were recorded.The intraoperative cardiovascular events and occurrence of postoperative agitation in postanesthesia care unit were recorded. Results Compared with group C, no significant change was found in the latency, amplitude and effective elicitation rate of MEPs at each time point in group D1(P>0.05), the amplitude of MEPs was significanty decreased, the latency of MEPs was prolonged, and the elicitation rate of MEPs was decreased at T2 in group D2, and the incidence of bradycardia during operation was significanty increased, and the incidence of postoperative agitation was decreased in D1 and D2 groups (P 0.05). Conclusion Dexmedetomidine infused over 10 min in a loading dose of 0.6 μg/kg, followed by an intravenous infusion of 0.3 μg·kg-1·h-1 until the end of surgery during combined intravenous-inhalational anesthesia exerts no effect on MEPs monitoring, and can decrease the incidence of postoperative agitation at the same time in elderly patients undergoing cervical spine surgery. Key words: Anesthesia, inhalation; Anesthesia, intravenous; Dexmedetomidine; Evoked potentials, motor; Agitation

Clinical research of muscular relaxant effect of cisatracurium in infants and young children with different dose under intravenous inhalational anesthesia

Objective To study the muscular relaxant effect of doses of cisatracurium in infants and young children under combined intravenous-inhalational anesthesia, in order to optimize the dosage of cisatracurium. Methods This study enrolled one hundred infants and young children elected for operation under combined intravenous-inhalational anesthesia in our hospital. These cases were divided into group A(3-6 months old) and group B(7-36 months old). Subjects in group A and group B were further divided into two subgroups receiving either 0.10 mg/kg or 0.15 mg/kg cisatracurium. Each subgroup had 25 cases. The muscular relaxant effect was evaluated by analyzing its onset time, clinical reaction time, recovery index(RI), twich(Th) time and train-of-four(TOF) recovery time. Results The onset time of muscle relax in group A was significantly shorter than in group B(P 0.05). Conclusions The age of infants and young children and the loading doses of cisatracurium was the key factors to determine the muscular relaxant effect. Key words: Infants and young children; Combined intravenous and inhalational anesthesia; Muscular relaxant effect; Cisatracurium

Predictive Value of Intraoperative Facial Motor Evoked Potentials in Vestibular Schwannoma Surgery Under 2 Anesthesia Protocols.

We sought to validate the feasibility of facial motor evoked potential (FMEP) in facial nerve (FN) monitoring during vestibular schwannoma (VS) surgery under 2 anesthesia protocols and to examine its value for postoperative prognosis. This prospective study included 106 patients with VS who underwent microsurgical excision between May 2014 and November 2016 at the Beijing Tiantan Hospital, Capital Medical University, China. All patients were investigated for FMEP elicited by transcranial electrical stimulation in the contralateral facial motor cortex. The patients randomly received total intravenous anesthesia or combined intravenous-inhalation anesthesia. Postoperative FN function was evaluated 7-10 days after surgery (short-term) and at the last follow-up (long-term) using the House-Brackmann (HB) grading system. HB grades 1 and 2 were deemed satisfactory, whereas HB grades 3-6 were deemed unsatisfactory. The value of the final-to-start FMEP ratio for predicting short-term and long-term postoperative FN functions was examined. Valid FMEPs were obtained in 97 patients, which were recorded from the mentalis muscle. The FMEP amplitude ratio was significantly correlated with short-term and long-term postoperative FN functions. Receiver operating characteristic curve analysis showed that the FMEP ratio cut-off values of 77.4% (area under the curve= 0.797) and 56.9% (area under the curve= 0.900) predicted satisfactory FN function 7-10 days after surgery and at the last follow-up, respectively. No statistically significant difference was found in FMEP quantitative parameters between the 2 anesthesia protocols. The FMEP amplitude ratio is a valuable predictor for postoperative FN function. FMEP ratio ≥57% is predictive of satisfactory long-term FN function.

Effect of different anesthetic techniques on the prognosis of hepatocellular carcinoma after hepatectomy

Objective: To investigate the influence of different anesthetic techniques on the prognosis of hepatocellular carcinoma (HCC)after hepatectomy. Methods: A total of 185 consecutive patients with HCC confirmed underwent surgery in Cancer Hospital, Chinese Academy of Medical Sciences were recruited from January 2006 to January 2008. The patients were assessed as American Society of Anesthesiologists (ASA)Ⅰ-Ⅲ, with body mass index (BMI) (22.8±4.6)kg/m(2). There were 169 males, with an average age of 56 years old and 16 females, with an average age of 53 years old. According to the different anesthesia methods, 185 patients were divided into two groups: total intravenous anesthesia group (TIVA) (n=53) and intravenous-inhalation combined anesthesia group (n=132). Postoperative pain and adverse reactions were compared in recent follow-up, prognosis were compared in long-term follow-up. Results: Recent follow-up showed that the NRS scores 2 hours after operation in TIVA group was 2.0 (0-2.0), whereas those in intravenous-inhalation combined anesthesia group was 3.0 (1.0-3.0). The pain in TIVA groups was significantly lower than that in intravenous-inhalation combined anesthesia group (Z=-3.261, P=0.001). But for 24 hours after operation, the NRS scores in these two groups were 3.0 (2.0-5.0) and 3.0 (3.0-4.0), respectively. There was no significant difference in the two groups (Z=-0.035, P=0.972). In addition, there was no significant difference between the two groups in the incidence of sedation, nausea/vomiting, restlessness and other adverse reactions (all P>0.05). Long-term follow-up indicated that anesthetic techniques have no correlation with HCC prognosis in Kaplan-Meier analysis and Cox's regression analysis. Conclusion: There is no significant effect of two anesthesia methods on the long-term prognosis of HCC.

The effect of sevoflurane on propofol with closed-loop target controlled infusion anesthesia system

Objective The primary goal was to determine the influence of sevoflurane on propofol with closed-loop target controlled infusion(TCI) delivery system in combined intravenous-inhalation anesthesia. Methods Sixty patients with ASA Ⅰ or Ⅱ were enrolled in this double-blinded study and randomly devided into three groups using the random number table method: group A, in which patients were only administrated propofol, group B and C, in which patients were given propofol for 20 min, followed with 0.6 MAC or 0.8 MAC sevoflurane for 40 min, respectively and the inhalation concentration was adjusted according to MAC. Serum propofol concentration was monitored continuouslyin. Results There was no difference in BIS among three groups (P>0.05). Serum concentration of propofol in group B and group C decreased constantly after the inhalation of sevoflurane but increased slowly when the inhalation was terminated(P<0.05), while it remained unchanged in group A. Compared with group A[(2.53±0.55), (2.54±0.61) mg/L], the decline of serum concentration was more evident in group C[(1.81±0.63), (1.24±0.4) mg/L] than group B[(1.92±0.58), (1.67±0.64) mg/L] at 30 min and 40 min during the surgery. The changing rate in group C was higher than that of group B and became stable 40 min after the stop point of propofol. Conclusions The administration of propofol with closed-loop anesthesia delivery system could adjust the anesthesia depth automatically and effectively, when the sevoflurane was inhaled with the MAC under 0.8. Key words: Sevoflurane; Propofol; Blood drug level; Closed-loop anesthesia delivery system

Total intravenous anesthesia produces outcomes superior to those with combined intravenous-inhalation anesthesia for laparoscopic gynecological surgery at high altitude.

ObjectiveWe compared efficacy and adverse outcomes following totally intravenous anesthesia (TIVA) versus combined intravenous–inhalation anesthesia (CIVIA) on hemodynamics and postoperative recovery following laparoscopic gynecological (LG) surgery at high altitudes.MethodsWe enrolled 80 ASA I or II patients scheduled for LG surgery and randomly assigned them to TIVA with propofol (group P, n = 40) or CIVIA with isoflurane (group I, n = 40). Mean arterial pressure, heart rate, pulse oxygen saturation, and partial pressure of end-tidal carbon dioxide were measured at various time points. Outcome measures were interval to spontaneous ventilation, eye opening, return to consciousness, extubation, operating room duration. Intraoperative awareness and postoperative nausea/vomiting were assessed at follow-up.ResultsNo differences in hemodynamic parameters were detected in either group. Group P had a significantly shorter postoperative anesthetic recovery time and lower incidence of postoperative nausea/vomiting.ConclusionTIVA is superior to CIVIA for GL surgery at high altitudes.

Observation of the analgesic effects of decozine combined with sufentanil on patients after laparoscopic radical gastrectomy

Objective To investigate the analgesic efficacy and safety of decozine combined with sufentanil on patients after laparoscopic radical gastrectomy. Methods Sixty patients undergoing laparoscopic radical gastrectomy, American Society of Anesthesiologists (ASA)Ⅰ~Ⅱ, were selected, and were randomly divided into two groups. All of the patients were treated with intravenous-inhalation combined anesthesia, and was given patient controlled intraveous analgesia (PCIA) when the patient was awoken. PCIA was administered with subsequent bolus of 0.5 ml with lockout time 15 minutes and background infusion of 2 ml/h. A ratio (3 μg/kg) of sufentanil and 0.5 mg palonosetron were mixed in PCIA pump in sufentanil group (S group); and 1.5 μg/kg sufentanil, 0.3 mg/kg dezocine, and 0.5 mg palonosetron in PCIA were mixed in dezocine combined with sufentainl group (DS group), they were diluted to 100 ml with saline. The visual analogue scale (VAS), Bruggrmann comfort scale (BCS), Ramsay and incidence of adverse reactions of two groups were observed in 2 h (T1), 6 h (T2), 12 h (T3), 24 h (T4), 48 h(T5) after operation. Results There was no significant difference of VAS and BCS between two groups at each time point after operation (P>0.05); The Ramsay score of S group was significantly higher than that of DS group at T1, T2, and T3 (P<0.05). The Ramsay scores of two groups at T4, T5 were lower than those of T1, T2, and T3. The incidence of nausea, vomiting of DS group was significantly lower than that of S group (P<0.05). Conclusions Dezocine combined with sufentainl used in PCIA on postoperative gastric cancer patients can obtain satisfactory analgesic effects, but has fewer side effects than single sufentainl. Key words: Cycloparaffins/AD; Sufentanil/AD; Laparoscopy; Gastrectomy; Analgesia

Significance of changes in serum troponin and myocardial enzymes in children with living donor liver transplantation

Objective To explore the characteristics and its clinical significance of troponin I (cTnI), myocardial enzymes and intraoperative hemodynamic changes in the pediatric patients undergoing living donor liver transplantation. Methods Liver transplantation was performed in 50 congenital biliary atresia children who were ranged from grade Ⅲ or Ⅳ in Tianjin First Central Hospital from January 2013 to December 2014 according to the American Society of Anesthesiologists (ASA), meanwhile, the method of the combined intravenous-inhalation anesthesia was applied during operation.Blood samples were drawn from central vein before skin incision (T0 baseline), at 30 min of anhepatic phase (T1), 30 min of neohepatic phase (T2), and 12 h, 36 h after operation (T3, T4). Levels of cTnI, creatine kinase (CK), lactate dehydrogenase (LDH)and α-hydroxy butyric acid dehydrogenase (α-HBDH) were mearsured, respectively.Furthermore, heart rate(HR), mean arterial blood pressure(MAP), central venous pressure(CVP) and arterial blood gas analysis[pH value, pa(O2), pa(CO2), and base excess(BE)] were monitored at the moment of T0, T1, T2 as well as the end of surgery. Results The levels of cTnI, CK, LDH and α-HBDH in T1-T3 were increased, and there was a peak at the T2 compared with the baseline at T0 (all P<0.05). At T3 and T4, cTnI, CK, LDH and α-HBDH levels significantly decreased compared with those at T2 (all P<0.05), the levels of cTnI were (0.06±0.02) μg/L, (0.37±0.52) μg/L, (0.05±0.02) μg/L, CK levels were (344.6±209.5)U/L, (466.1±116.4)U/L, (219.3±111.5)U/L, LDH levels were (552.3±414.9)U/L, (966.4±454.1)U/L, (322.8±108.8)U/L, and α-HBDH levels were (301.6±124.0)U/L, (456.4±168.4)U/L, (146.2±80.2)U/L, respectively.The levels of hemodynamics significantly changed in anhepatic phase and neohepatic phase.Compared with T0: T1, HR accelerated, MAP, CVP decreased, BE value increased, and the differences were statistically significant (all P<0.05); T2, open vena cava and back to the blood volume surge, CVP, MAP increased, HR decreased but still higher than T0, BE value further increased, and the differences were statistically significant (all P<0.05). After the surgery, various hemodynamic indexes fell to preoperative levels, the levels of HR were (103.1±5.9) times/min, (128.8±8.5) times/min, (115.1±0.3) times/min, (103.5±5.9) times/min, MAP levels were (59.7±9.1) kPa, (48.7±5.4) kPa, (58.6±7.1) kPa, (59.1±8.6) kPa, CVP levels were (7.5±4.3) kPa, (3.9±4.6) kPa, (5.8±3.5) kPa, (7.2±4.1) kPa, BE levels were (-1.5±5.0) mmol/L, (-0.4±5.7) mmol/L, (1.0±3.8) mmol/L, (2.4±2.2) mmol/L, respectively. Conclusions The myocardial injury may appear during the perioperation of pediatric living donor liver transplantation and gradually aggravated during the anhepatic phase.The worst injury peaks at 12h and it gradually returns to the preoperative level 36 h postoperativelly. Key words: Liver transplantation; Troponin; Myocardial enzyme; Hemodynamic; Infant

Effect of different depths of anesthesia on postoperative cognitive function in laparoscopic patients: a randomized clinical trial

Objective:Postoperative cognitive dysfunction (POCD) is caused by many factors. This work was conducted to investigate the effect of different depths of anesthesia during combined intravenous–inhalational anesthesia on postoperative cognitive function in young and middle-aged laparoscopic patients.Methods:A total of 192 patients scheduled for gynecologic laparoscopic operations were randomly divided into three groups. Anesthesia was maintained with inhalation of sevoflurane and infusion of remifentanil, which was adjusted to maintain bispectral index (BIS) at 30 < BIS ≤ 40 in Group I, 40 < BIS ≤ 50 in Group II and 50 < BIS ≤ 60 in Group III. The Mini-Mental State Examination (MMSE) and Trail-Making Test (TMT) were used to assess cognitive function on the day before anesthesia and the day after surgery.Results:There were no significant differences in age, body mass index, educational level and surgery time. On the day before anesthesia, the average MMSE scores and TMT completion times in the three groups were not significantly different. On the day after surgery, Group II had a significantly higher average MMSE score (29.00 ± 0.89) than Group I (28.36 ± 1.42, p = 0.010) and Group III (28.45 ± 1.27, p = 0.035) and lower TMT completion time (33.68 ± 10.34) than Group I (39.45 ± 13.99, p = 0.027) and Group III (39.50 ± 12.50, p = 0.026).Conclusion:These results indicated that the depth of anesthesia, 40 < BIS ≤ 50, under combined intravenous–inhalational anesthesia yielded milder influence on postoperative cognitive function in young and middle-aged laparoscopic patients.

Total intravenous anesthesia of propofol-remifentanil for patients of cosmetic surgery

Objective To explore the effect of propofol-remifentanil total intravenous anesthesia in cosmetic surgery and the controllability of anesthesia. Methods According to the American Society of Anesthesiologists (ASA), levelsⅠ-Ⅱ hospitalized patients for elective cosmetic surgery (100 cases) were randomly divided into two groups, namely propofol-remifentanil total intravenous anesthesia group (Group T) and combined intravenous inhalational anesthesia group (Group C), 50 cases each. Observatory items of patients included intraoperative cardiovascular drug use, body movement, waking-up time, extubation time, leaving time from operation theatre, postoperative adverse reaction, hypoxemia (SpO2<95%) and anesthesia satisfaction. Results In Group C, waking-up time, extubation time and leaving time from operation theatre were (12.2±3.6), (13.8±4.6) and (4.6±5.8) min, respectively, which were longer than those (6.7±2.6), (7.8±3.3) and (3.3±3.8) min in Group T (P 0.05). Satisfactory rate with anesthesia was 84.0% (42/50) in Group T that was higher than 52.0% (26/50) in Group C (P<0.05). Conclusions Propofol-remifentanil intravenous anesthesia has definite effects with faster postoperative recovery, less adverse reaction and complications, safety and operablity. Key words: Propofol; Remifentanil; Total intravenous anesthesia; Combined intravenous inhalational anesthesia; Cosmetic surgery