End Of Surgery In Group Research Articles

Dexmedetomidine Moderate Sedation Versus General Anesthesia on the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Controlled Study.

One of the factors that affect the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the level of sedation. Therefore, we aimed to compare dexmedetomidine (DEX) as moderate sedation (MS) versus general anesthesia (GA) on the diagnostic yield of EBUS-TBNA. This randomized open-label controlled trial was carried out on 70 patients older than 18 years of age, classified as American Society of Anesthesiologists (ASA) II or III, and scheduled for EBUS-TBNA. Patients were randomly allocated into two equal groups. Group D received 1 μg/kg fentanyl 2 minutes before induction with a 1 μg/kg infusion of DEX for 10 minutes, then maintenance with 0.5 - 1 μg/kg/h aiming for a Ramsey Sedation Scale of 4 - 5 while preserving hemodynamics. Group GA received 1 μg/kg fentanyl, 2 mg/kg propofol, and 0.5 mg/kg atracurium (then 0.1 mg/kg every 20 minutes). Group D had a significantly higher rate of recalling the procedure (P = 0.005) and a lower rate of shortness of breath compared to group GA (P = 0.038). Intraoperative heart rate measurements at baseline were not significantly different between groups but were significantly lower at 5 min, 10 min, 15 min, 20 min, and at the end of surgery in group D compared to group GA (P < 0.05). Intraoperative mean arterial blood pressure measurements at baseline, 5 min, 10 min, 15 min, 20 min, and at the end of surgery were not significantly different between groups. Recovery time was significantly shorter in group D compared to group GA (P < 0.001). Compared to GA, MS with DEX showed a comparable diagnostic yield with faster recovery time and better patient satisfaction, as evidenced by a willingness to repeat procedures when needed and less shortness of breath in EBUS-TBNA.

Efficacy of Ultrasound Guided Bilateral Erector Spinae Block in Attenuating Pneumoperitoneal Stretch Response in Patients Undergoing Laparoscopic Abdominal Surg

Background: Increase in heart rate and blood pressure in response to pneumoperitoneum produced during laparoscopic abdominal surgeries is a challenging situation to anesthesiologists. Without adequate control of sympathetic response there is a chance of increase in morbidity of the patient during perioperative period. Aim of the study is to evaluate the efficacy of bilateral erector spinae plane block in attenuating pneumoperitoneal stretch response in patients undergoing laparoscopic abdominal surgeries under general anesthesia. Methodology: A randomised control trial was conducted among 70 patients, who underwent laparoscopic abdominal surgeries. Under general anesthesia, 35 patients received ESP block with 20 ml of 0.25 levobupivacaine bilaterally (Group B) and 35 patients without block (Group R). This study compared requirement of opioids and response of hemodynamic parameters (Heart Rate, Mean Arterial Pressure) during pneumoperitoneal stretch. Statistical tests were applied. Results: The intra-operative fentanyl requirement in Group B was 100.85+ and in Group R 119.375 + P value &lt;0.001, statistically significant. The intra-operative heart rate at the time of port insertion, at 5 min, 10 min of pneumoperitoneum and at the end of surgery in Group B (91.97 ±12.09, 90.82±10.7, 92.08±10.9 and 90.857±12.5) were significant when compared to Group R (R 99.9±10.5, 94.48±13.08, 96.68±14.14 and 95.35±14.14 and same is proven statistically. (p &lt; 0.05). Conclusion: Ultrasound guided bilateral Erector spinae block with Levobupivacaine results in intra-operative hemodynamic stability during port insertion and pneumoperitoneum.

The effect of restrictive vs. liberal fluid protocols on ocular parameters in patients undergoing prone spine surgery: a randomized controlled trial

BackgroundElevated intraocular pressure (IOP) and optic nerve edema occurring during prone surgeries may cause ocular and optic nerve ischaemia injury. We hypothesized that a liberal fluid protocol might further increase IOP and optic nerve sheath diameter (ONSD) than a restrictive fluid protocol for patients in the prone position.MethodsA single-centre, prospective and randomized trial was conducted. Patients were randomly allocated into 2 groups: the liberal fluid infusion group, in which repeated bolus doses of Ringer’s lactate solution were given to maintain pulse pressure variation (PPV) within 6~9%, and the restrictive fluid infusion group, where PPV was maintained within 13–16%. IOP and ONSD were measured in both eyes at 10min after the anaesthesia induction in the supine position, 10min after the prone position placement, and 1h and 2h since the prone position was placed, at the conclusion of surgery, and returned to the supine position.ResultsA total of 97 patients were recruited and completed the study. IOP increased significantly from 12±3mmHg in the supine position to 31±5 mmHg (p<0.001) at the end of surgery in the liberal fluid infusion group and from 12±2 to 28±4 mmHg (p<0.001) in the restrictive fluid infusion group. There was a statistically significant difference in the change of IOP over time between the two groups (p=0.019). ONSD increased significantly from 5.3±0.3mm in the supine position to 5.5±0.3mm (p<0.001) at the end of surgery in both groups (both p<0.001). There was no statistically significant difference in the change of ONSD over time between the two groups (p>0.05).ConclusionsCompared to the restrictive fluid protocol, the liberal fluid protocol increased IOP but not ONSD in patients undergoing prone spine surgery.Trial registrationThe study was registered in ClinicalTrials.gov (https://clinicaltrials.gov) prior to patient enrollment, ID: NCT03890510, on March 26, 2019. The principal investigator was Xiao-Yu Yang.

Leucocyte-poor-platelet-rich plasma intra-operative injection in chondral knee injuries improve patients outcomes. A prospective randomized trial.

Evaluate the effects of intra-operative leucocyte-poor-platelet-rich plasma (PRP) (type P3-Bβ with endogenous activation) injection in International Cartilage Repair Society (ICRS) grade III knee chondral injuries treated by chondroplasties, to increase and ameliorate the repair tissue. Patients were divided into twogroups. Group A (control) consisted of 31 patients and Group B (PRP) 33 patients, totaling 64 patients analyzed. Patients also could had associated injuries (meniscal and/or ACL) being equally divided between both groups to avoid bias. PRP was injected at the end of surgery in group B. The patient outcomes were assessed using subjective International Knee Documentation Committee (IKDC) form, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity forms, prior to the surgery and three, six, 12, and 24months after surgery (medium-term follow up). IKDC and KOOS scores showed increase at each evaluation time points after surgery in both groups, but the treated Group (B) showed a higher increase with statistically significant difference. The Tegner activity scores were higher for the treated group only at six and 12months. Based on the subjective IKDC, KOOS, and Tegner scores, those patients affected by ICRS grade III chondral injuries undergoing arthroscopic chondroplasty who were also treated with PRP showed better and faster outcomes than the control group. Independently from the associated injury (meniscal or ACL). This difference could be measured for up to twoyears.

COMPARATIVE STUDY ON THE USING OF THE ORIGINAL VS GENERIC BALANCED COX-1,2 INHIBITORS IN THYROID SURGERY

Background. Recently balanced analgesia (BA) has become the standard for postoperative (post-op) pain management. One of the most effective painkillers are ketoprofen and its derivatives, including dexketoprofen. Discussions on the clinical efficacy of generic drugs over the original molecules continue quite lively, especially, over cheaper generic drugs. But no direct clinical studies to compare original vs generic dexketoprofen molecules in clinical practice were found.The Goal of Study. To investigate the therapeutic efficacy and safety of the use of original vs generic dexketoprofen in the complex of BA in patients with thyroidectomy. To assess a pharmacoeconomic comparison of the use of different dexketoprofen molecules.Materials and Methods. 440 patients with thyrotoxicosis syndrome were examined and then thyroidectomy was performed. 56 patients, who met the including/excluding criteria, were included in double-blinded study. By the method of adaptive randomization, patients were split on two groups: group D (n=27), who received original dexketoprofen (Dexalgin inject) and group S (n=29), who received generic dexketoprofen (Sertofen) from EU country. Complex BA included IV bolus dexketoprofen (DEX) 50 mg, IV lidocaine 1 mg/kg, IV dexamethasone 8 mg and bilateral blockade of superficial cervical plexus (BBSCP) by 0,5% bupivacaine 75-100 mg was used as pre-emptive analgesia 30 minutes before surgery in both groups. Maintenance anaesthesia was done by sevoflurane. According to study design in post-op preventive analgesia was done by DEX 50 mg every 8 hours (h) together with paracetamol (PAR) 1 g IV in the first 6h and following by oral 500 mg every 8 h. 100 mm NRS score was used for pain control. The laboratory markers of post-op stress (LMPOS), such as cortisol (CORT), prostaglandin E2 (PG E2), glucose (GLU) with NRS also were measured.Results and Discussion. Gender distribution: women were 21 (88,9%) and 25 (86,2 %) respectively in group D and group S (not statistically differences, NS). Average age was 48,7±2,3 in group D and 49,6±2,5 in group S (NS). No differences were found between both groups according to ASA physical status score. Duration of surgery and anesthesia were 63,6±3,4 min and 84,7±3,7 min in group D, in group S these indicators were 62,9±3,9 min and 83,5±4,1 min respectively. Pain level according to NRS after 3h, 6h, 12h, 24 h was 18,9 ± 1,4 mm, 23,1 ± 1,7 mm, 24,1 ± 1,8 mm і 20,2 ± 1,2 mm respectively and was assessed as weak in group D. In group S according to NRS after 3h, 6h, 12h, 24 h pain level was 19,1 ± 1,6 mm, 23,1 ± 1,7 mm, 23,9 ± 1,9 mm і 20,3 ± 1,4 mm. Statistically difference (p<0,05, Wilcoxon test) was noted between all check-points in comparison with previous pain level by NRS, however no difference found between groups. Nobody needed more PAR doses or an addition of morphine. Dynamics of LMPOS were as follows: an increase in the GLU was noted at the end of operation in 6,2% (group D) and 7,3% (group S) (difference NS) due to surgical aggression and dexamethasone usage in the BA complex. CORT level was grown before premedication from 387,9 ± 21,2 nmol/l to 406,5 ± 36,1 nmol/l at the end of operation in group D, in group S from 390,7 ± 24,5 nmol/l to 410,3 ± 38,1 nmol/l respectively. No statistically difference was noted between groups neither before nor after the operation. However, after 24 hours CORT level was broken down till 38,4 ± 7,8 nmol/l (group D) and 41,1 ± 8,1 nmol/l (group S) (glucocorticosteroid suppression by dexamethasone). PG E2 level decreased from 281,2 ± 43,6 pg/ml till 192,1 ± 38,2 pg/ml after 24 hours in group D (p=0,018), from 288,5 ± 41,5 pg/ml till 186,8 ± 41,3 pg/ml in group S respectively without statistically differences between groups. No major bleeding complication were found in both groups, 2 cases in each group were erythematosis gastritis and erosis gastropathy. Safety level complex BA was assessed in 92,6% (group D) and 93,1% in group S (р=0,941, NS). Pharmacoeconomic analysis was shown, that using original DEX in scheme BA was more expensive by 48,2% (+additionally 58, 24 UAH per patient) vs generic DEX origin EU country.Conclusions. In double-blind randomized study has shown the therapeutic equivalence of the generic dexketoprofen solution for injection to the original drug according to the NRS and the dynamics of LMPOS. High safety of use of dexketoprofen in the complex of balanced multimodal analgesia was established. No found significant difference between groups for efficacy and safety. Pharmacoeconomic analysis has shown that the use of generic drug dexketoprofen with confirmed clinically therapeutic equivalence has significant advantages.

Effect of Timing of Intravenous Fentanyl Administration on the Incidence of Posttonsillectomy Nausea and Vomiting.

Fentanyl is commonly administered toward the end of tonsillectomy to prevent emergence delirium and reduce postoperative pain. However, it can delay emergence from anesthesia and increase the risk of postoperative nausea and vomiting (PONV). The goal of our study was to compare the risk of PONV based on the timing of fentanyl administration at the end of tonsillectomy in children. Prospective, double-blind, randomized controlled trial. One hundred forty patients aged 3 to 7 years undergoing tonsillectomy were divided into two groups. Fentanyl (1 μg/kg) was administered at the end of surgery in group 1 (n = 70) and at 10 to 15 minutes before the end of surgery in group 2 (n = 70). Time to regular breathing and time to emergence from anesthesia were measured from the end of surgery. PONV and pediatric anesthesia emergence delirium scale scores were assessed every 10 minutes after admission to the postanesthesia care unit. Incidences of PONV (2.9% vs. 2.9%, P > .99) and emergence delirium (11.4% vs. 5.7%, P = .23) were not significantly different between the two groups. Time to regular breathing (mean difference = 2.3 minutes; 95% confidence interval [CI]: 0.9 to 3.7 minutes) and time to emergence (median difference = 6.5 minutes; 95% CI, 2.5 to 10.5 minutes) were significantly longer in group 1 than in group 2. Although there was no beneficial effect on PONV, recovery of regular breathing and consciousness was quicker with earlier fentanyl administration. Emergence delirium was well-controlled, similar to that with fentanyl administration at the end of surgery. 1b Laryngoscope, 2020.

Evaluation of ultrasound-guided continuous anterior quadratus lumborum block on postoperative analgesia in total hip arthroplasty

Objective To evaluate the effect of ultrasound-guided continuous anterior quadratus lumborum block (QLB) on postoperative analgesia in total hip arthroplasty. Methods Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 65-80 yr, weighing 45-80 kg, scheduled for elective total hip arthroplasty under subarachnoid block, were divided into 2 groups (n=25 each) using a random number table method: ultrasound-guided continuous anterior quadratus lumborum block group (group Q) and routine analgesia group (group R). Anterior QLB was performed at the end of operation in group Q. Patient-controlled intravenous analgesia was performed with sufentanil after operation in two groups.Dezocine was given as rescue analgesic.Ramsay sedation score and the maximum angle for hip flexion and abduction of hip joint were recorded after operation, and the total consumption of sufentanil, requirement for dezocine and occurrence of adverse reactions were recorded within 72 h after operation.The occurrence of QLB-related complications was also recorded. Results Compared with group R, Ramsay sedation score was significantly decreased and the maximum angle for hip flexion and abduction of hip joint were increased at each time point after operation, and the total consumption of sufentanil, requirement for dezocine and incidence of nausea and vomiting were decreased in group Q (P<0.05). No QLB-related complications were found in group Q. Conclusion Ultrasound-guided continuous anterior QLB can produce better postoperative analgesia and reduce postoperative consumption of opioids with fewer adverse reactions in the patients undergoing total hip arthroplasty. Key words: Ultrasonography; Psoas muscles; Nerve block; Arthroplasty, replacement, hip; Analgesia, patient-controlled

Effects of intraoperative goal-directed fluid therapy on postoperative outcomes in patients undergoing thoracoscopic lobectomy: a comparison with restrictive fluid therapy

Objective To investigate the effects of different fluid therapies on postoperative outcomes in patients undergoing thoracoscopic lobectomy and to evaluate the advantages of intraoperative goal-directed fluid therapy when compared with restrictive fluid therapy. Methods Fifty-four patients, aged 18-64 yr, with body mass index of 18.5-24.9 kg/m2, of American Society of Anesthesiologists physical statusⅠ-Ⅲ, scheduled for elective thoracoscopic lobectomy under general anesthesia, were divided into goal-directed fluid therapy group(group G)and restrictive fluid therapy group(group R)using a random number table method, with 27 patients in each group.In group G, fluid management was guided by an oesophageal Doppler monitoring, Ringer′s solution was continuously infused at a rate of 4 ml·kg-1·h-1, with corrected flow time(FTc)≥350 ms and change in stroke volume(SV)<10% of the pre-rehydration level as the goal.In group R, restrictive fluid management was performed, and blood loss was replaced with hydroxyethyl starch 130/0.4 at a 1∶1 ratio.Compound sodium chloride injection was continuously infused at a rate of 4 ml·kg-1·h-1 until the end of surgery in both groups.Mean arterial pressure, heart rate, SpO2, FTc, SV and cardiac index were recorded at 5 min before intubation, immediately after lateral position, at the start of one-lung ventilation, at the end of one-lung ventilation and at the end of surgery.The amount of fluid intake and output during surgery was recorded.The complications on 1st, 3rd, 5th and 8th days after surgery were evaluated using POMS scale.The length of hospital stay, admission to intensive care unit and in-hospital death were also recorded. Results Compared with group R, FTc, SV and cardiac index were significantly increased at the end of one-lung ventilation and at the end of surgery in group G(P 0.05). No patients were admitted to intensive care unit after surgery, and no in-hospital death occurred in two groups. Conclusion GDFT and restrictive fluid therapy applied during surgery produce similar postoperative outcomes in patients undergoing thoracoscopic lobectomy. Key words: Fluid therapy; Lobectomy; Postoperative complications; Recovery

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

Effect of dexmedetomidine on renal function in pediatric patients undergoing living donor liver transplantation

Objective To evaluate the effect of dexmedetomidine on renal function in pediatric patients undergoing living donor liver transplantation. Methods Sixty pediatric patients of both sexes with congenital biliary atresia, aged 5-15 months, weighing 5.5-10.0 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective living donor liver transplantation, were randomly divided into either control group(group C)or dexmedetomidine group(group D)with 30 patients in each group.The infants were tracheally or nasotracheally intubated and mechanically ventilated after induction of anesthesia.Dexmedetomidine was intravenously infused in a loading dose of 1 μg/kg for 10 min, followed by a continuous infusion of 0.3 μg·kg-1·h-1 until the end of operation in group D. While the equal volume of normal saline was given instead of dexmedetomidine in group C. At skin incision (T1), at 30 min of anhepatic phase (T2), at 1 h of neohepatic phase (T3), immediately after peritoneum closure (T4) and at 24 h after operation (T5), blood samples from the central vein and urine specimens were collected for determination of creatinine and blood urea nitrogen (BUN) concentrations in serum (by colorimetric assay) and β2-microglobulin (β2-MG) concentrations in serum and urine (using immunoturbidimetric method), and concentrations of tumor necrosis factor-α, interleukin-6 (IL-6) and IL-18 in serum (by enzyme-linked immunosorbent assay). The urine volume was recorded during surgery. Results Compared with group C, the urine volume was significantly increased, and the serum creatinine, BUN and β2-MG concentrations and urine β2-MG concentrations at T3-5, serum BUN concentrations at T4, 5, and serum tumor necrosis factor-α, IL-6 and IL-18 concentrations at T2-5 were decreased in group D (P<0.05). Conclusion Dexmedetomidine can improve renal function in pediatric patients undergoing living donor liver transplantation. Key words: Dexmedetomidine; Liver transplantation; Kidney

Effects of dexmedetomidine on dreaming during general anesthesia in pediatric patients

Objective To evaluate the effects of dexmedetomidine on dreaming during general anesthesia in pediatric patients. Methods A total of 400 pediatric patients of both sexes, aged 5-12 yr, with body mass index of 15.2-18.1 kg/m2, of American Society of Anesthesiologists physical status Ⅰ, undergoing elective orthopedic surgery under general anesthesia, were randomly divided into control group (group C, n=200) and dexmedetomidine group (group D, n=200) according to the computer-generated random numeral order and numeral parity.Dexmedetomidine was infused intravenously in a loading dose of 0.5 μg/kg over 10 min before induction of anesthesia followed by infusion of 0.5 μg·kg-1·h-1 until 30 min before the end of surgery in group D, while the equal volume of normal saline was given instead of dexmedetomidine in group C. The pediatric patients who regained consciousness and recovered orientation in post-anesthesia care unit were interviewed for dreaming using a modified Brice questionnaire, and the dream(emotion, hearing and behaviours in dreams, memories for dreams) was evaluated using a 5-point Likert scale. Results Compared with group C, the incidence of dreaming was significantly decreased, the memory score was decreased (P 0.05). Conclusion Dexmedetomidine can decrease the development of dreaming during general anesthesia and produces no effect on the content of dreams (most are pleasant) in pediatric patients. Key words: Dexmedetomidine; Child; Dream; Anesthesia, general

Effects of dexmedetomidine on inflammatory responses in lung tissues during one-lung ventilation in patients undergoing esophageal cancer resection

Objective To evaluate the effects of dexmedetomidine on inflammatory responses in lung tissues during one-lung ventilation (OLV) in patients undergoing esophageal cancer resection. Methods Forty American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 25-65 yr, with body mass index of 18-25 kg/m2, scheduled for elective radical resection of esophageal cancer, were divided into 2 groups (n=20 each) using a random number table: dexmedetomidine group (group D) and control group (group C). Dexmedetomidine was infused intravenously in a loading dose of 0.6 μg/kg over 10 min before induction of anesthesia, followed by an infusion of 0.4 μg·kg-1·h-1 until 30 min before the end of operation in group D, and the equal volume of normal saline was given instead in group C. After intubation (T1), at 30, 60 and 90 min of OLV (T2-4), and at 30 min after restoration of two-lung ventilation (T5), blood samples were taken from the internal jugular vein.Broncho-alveolar lavage fluid (BALF) in ventilated lung was collected at T1-4.The concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6(IL) and IL-10 in plasma and BALF were determined by enzyme-linked immunosorbent assay. Results Compared with group C, the plasma concentrations of TNF-α at T5 and IL-6 at T4, 5 were significantly decreased, the plasma concentration of IL-10 was increased at T4, 5, and the concentration of TNF-α in BALF at T4 and concentration of IL-6 in BALF at T3, 4 were decreased, and the concentration of IL-10 in BALF was increased at T4 in group D (P<0.05). Conclusion Dexmedetomidine can significantly ameliorate the inflammatory responses in lung tissues during OLV, thus reducing systemic inflammatory responses in patients undergoing esophageal cancer resection. Key words: Dexmedetomidine; Respiration, artificial; Inflammation

Soluble Urokinase Plasminogen Activator Receptor (suPAR) in the Diagnosis of Pulmonary Embolism

Soluble Urokinase Plasminogen Activator Receptor (suPAR) in the Diagnosis of Pulmonary Embolism

Preemptive Use of Low Dose Intravenous Ketamine on Post Operative Pain after Laparoscopic Cholecystectomy

Introduction: There is a widespread belief for the efficacy of preemptive analgesia among clinicians. Different drugs and methods are used as preemptive analgesic method for postoperative pain management.&#x0D; Objective: To evaluate the efficacy of preemptive use of small dose intravenous ketamine on post operative pain on patients undergoing laparoscopic cholecystectomy.&#x0D; Materials and Methods: Sixty patients of both sexes as per American Society of Anaesthesiologists (ASA) physical status I and II underwent laparoscopic cholecystectomy were randomly allocated into two groups. In the operating room, Group A (n=30) received 0.5 mg/kg body weight of ketamine intravenously 10 minutes before the surgical incision. In Group B (n=30) 0.5 mg/kg body weight of normal saline was injected. Post operative analgesia was maintained with on demand intramuscular pethidine 1.5 mg/kg body weight. The pain intensity was assessed at time 0 (immediately after arousal) and 6, 12, and 24 hours postoperatively using the 10 points visual analogue scale (VAS). Side effects like nausea, vomiting, delirium and hallucination were also recorded.&#x0D; Results: For all of the evaluated times, the VAS score were significantly lower in Group A with ketamine compared to Group B with normal saline. The interval time for the first analgesic request was 22.9±6.8 (Mean±SD) minutes in Group A and 17.8±7.2 (Mean±SD) minutes in Group B and the difference was statistically significant (P=0.021). The total number of pethidine injections in first 24 hours postoperatively was 0.7±0.6 (Mean±SD) in Group A and 1.9±0.7 (Mean±SD) in Group B and the difference was statistically significant (P=0.037). The mean total cumulative amount of pethidine administered over 24 hrs period following the end of surgery in group A was 97.31±10.12 mg (Mean±SD) and in group B was 151.23±12.02 mg (Mean±SD) and the difference was statistically significant (P=0.008).&#x0D; Conclusion: A low dose of intravenously administered ketamine had a preemptive effect in reducing pain after laparoscopic cholecystectomy.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.12(2) 2016: 35-39

The application of conscious sedation with a small dose of dexmedetomidine and sufentanil in elderly patients undergoing multiple intestinal polyps resection

Objective: To explore the effectiveness and feasibility of conscious sedation with a low dose of dexmedetomidine and sufentanil during multiple intestinal polyps resection in elderly patients. Methods: Sixty elderly patients who underwent multiple intestinal polyps resection in Peking University Third Hospital from Janurary to May 2016 were randomly divided into dexmedetomidine group (D group, n=30) and propofol group (P group, n=30). There were 28 males and 32 females with a mean age of (70.4±4.5) years old (range: 65-80 years old). The patients in the dexmedetomidine group received a loading dose of 0.3 μg/kg followed by a continuous infusion of 0.2-0.4 μg·kg-1·min-1 of dexmedetomidine and sufentanil (0.1 μg/kg) respectively.The patients in the propofol group received sufentanil 0.1 μg/kg and propofol 1.5 mg/kg and followed by a continuous infusion of 3-6 mg·kg-1·h-1 of propofol.Blood pressure, heart rate, pulse oxygen saturation (SpO2), respiratory rate and bispectral index (BIS) were recorded at the basic status and at the beginning of operation, 10 min, 20 min, 30 min after operation, the end of operation and departure.The observer's assessment of alertness/sedation (OAA/S) scores and the clinical responses were also recorded.A statistical analysis was performed. Results: All patients in the two groups were sedated compared with baseline.The BIS values of patients in group D at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation were 89.6(87.8-91.0), 79.4(78.0-80.0), 76.9(75.0-80.0), 76.0(73.0-79.0) and 75.6(70.0-79.0) respectively, and those values were all significantly lower than baseline value[96.4(95.0-98.0)], (Z=-4.645, -4.788, -4.787, -4.789, -4.789, P<0.05). The OAA/S score at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation were 4.5(4.0-5.0), 3.4(3.0-4.0), 3.0(3.0-3.0), 3.5(3.0-4.0) and 3.3(3.0-4.0) respectively, and were significantly lower than baseline score [4.8(5.0-5.0)] (Z=-2.828, -4.862, -5.031, -4.420, -4.710, P<0.05). The BIS value of patients in group P at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation were 54.7(50.0-59.3), 54.8(50.0-59.3), 50.7(47.8-56.8), 54.4(51.5-58.0) and 53.7(50.0-57.3) respectively, and were significantly lower than baseline value[95.8(95.0-96.3)] (Z=-4.786, -4.787, -4.788, -4.786, -4.786, P<0.05). The OAA/S score at beginning of the operation , 10 min, 20 min, 30 min after operation and the end of operation were 0.4(0.0-1.0), 0.4(0.0-1.0), 0.4(0.0-1.0), 0.4(0.0-1.0) and 0.4(0.0-1.0) respectively, and were significantly lower than baseline score[4.9(5.0-5.0)] (Z=-4.927, -4.901, -4.912, -4.912, -4.901, P<0.05). The sedation state of group D were lighter than group P. The BIS value and OAA/S score at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation in group D were higher than group P (P<0.05). The breath and circulation were more stable in group D. The mean arterial pressure, breath rate and SpO2 at beginning of the operation, 10 min, 20 min, 30 min after operation and the end of operation in group D were higher than group P (P<0.05). There was no oxygen desaturation , hypotension and drowsiness in group D and the incidence in group P were 30.0%, 33.3% and 13.3% respectively.The emergency time and duration of stay in the PACU (post anesthesia care unit) were (2.0±1.2) and (22.0±7.4) min in group D, and they were (4.9±2.4) and (35.8±11.6) min in group P (t=-5.839, t=-5.472, P<0.05). There was no difference in surgery time, patient satisfaction and acceptance rate of reexamination (t=-3.031, t=-7.322, t=2.069, P>0.05). Conclusion: Conscious sedation with dexmedetomidine and sufentanil is effective and feasible in elderly patients undergoing multiple intestinal polyps resection.

The effect of dexmedetomidine on left ventricular synchronization in patients undergoing coronary artery bypass grafting

Objective This study was designed to investigate the role of dexmedetomidin(Dex) on left ventricular synchronization in patients undergoing coronary artery bypass grafting(CABG) with CPB. Methods Twenty-one patients were selected using a random number table. These patients were classified as New York Heart Association(NYHA) class Ⅱ, Ⅲ and ASA physical statusⅡ,Ⅲ with age of 45-74 y and weight of 52-85 kg. They were further divided into Dex group(group D, n=10) and control group(group C, n=11). After stopping CPB for 15 min, a loading dose of Dex at 0.5 μg/kg was injected intravenously 10 min after stopping CPB for 15 min followed by infusion at 0.5 μg·kg-1·h-1 until the end of operation in group D, while equal volume of normal saline was given in group C. At the time of before sternotomy(T0), stopping CPB for 15 min(T1), injection of Dex for 30 min(T2) and for 1 h (T3), the MAP, HR, CVP, pulmonary artery occlusion pressure(PAOP) and transesophageal echocardiography(TEE) monitoring indicators including left ventricular ejection fraction (LVEF) and cardiac output(CO), stroke volume(SV), standard deviation of time to maximum systolic velocity of the 17 left ventricular segments of longitudinal strain(Tssl-17-SD) and standard deviation of time to maximum systolic velocity of the 16 left ventricular segments of circumferential strain(Tssc-16-SD) were recorded. Results The HR were statistically lower in group D[(71.0±5.4), (69.3±2.8) bpm] than those in group C[(89.5±14.7), (89.4±14.0) bpm] at T2, T3(P<0.05). CO in group D[(4.4±1.2) L/min] was statistically lower than that in group C[(5.8±1.5) L/min] at T2(P<0.05). Compared with group C, Tssl-17-SD was statistically increased at T2 in group D(P<0.01). Conclusions In patients undergoing CABG with CPB, the injection of Dex after CPB may inhibit the synchronized movement of the left ventricular longitudinal strain. Key words: Dexmedetomidine; Coronary artery bypass grafting; Left ventricle; Systolic synchrony; Standard deviation of time to maximum systolic velocity

Intraoperative acidosis is a new predictor for postoperative pancreatic fistula after pancreaticoduodenectomy

Early diagnosis of postoperative pancreatic fistula (POPF) is important for proper interventions. The preoperative, intraoperative and early postoperative biochemical markers have predictive value of POPF. The present study was to evaluate several simple biochemical parameters in the prediction of POPF. Patients who underwent pancreaticoduodenectomy in our center between 2006 and 2015 were reviewed retrospectively. Preoperative and early postoperative biochemical parameters were evaluated. Additionally, the relationship between POPF and pH and lactate level at the end of surgery were analyzed, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width-to-platelet ratio (RPR) were calculated for postoperative days (PODs) 1 and 3. Diagnosis and grading of POPF were performed according to the standards of the International Study Group on Pancreatic Fistula. The patients were divided into two groups: Group 1 with no fistula or grade-A fistula; group 2 with grade-B or -C fistula. These simple biochemical markers were then compared between the two groups. Serum amylase level was significantly higher at POD3, and pH level was significantly lower at the end of operation in group 2 compared with those in group 1. However, the serum amylase was below the upper limit of normal serum level and therefore, the difference was not significant in clinical practice. Receiver operating charecteristic curve analysis showed that pH level was a reliable predictor of POPF (area under the curve: 0.713; 95% CI: 0.573-0.853). A low pH level at the end of pancreaticoduodenectomy was a risk factor of POPF. NLR, PLR, and RPR had no predictive value of POPF after pancreaticoduodenectomy.

A short-term increase of the postoperative naturally circulating dendritic cells subsets in flurbiprofen-treated patients with esophageal carcinoma undergoing thoracic surgery.

The present study evaluated whether flurbiprofen increased the naturally circulating dendritic cells (DCs) subsets in patients with esophageal squamous cell carcinoma (ESCC) undergoing esophageal resection. Compared to healthy donors (n=20), the significantly depressed percentages of plasmacytoid DCs (pDCs), CD1c+ myeloid DCs (mDCs), and CD141+ mDCs among ESCC patients (n=60) were confirmed. Flurbiprofen was administered before skin incision and at the end of operation in group F (n=30), as well as placebo in group C (n=30). The postoperative suppressed percentages of pDCs, CD1c+ mDCs, and CD141+ mDCs increased significantly following the perioperative treatment with flurbiprofen. Flurbiprofen also significantly stimulated the postoperative IFN-f and IL-17 production, but inhibited the immunosuppressive IL-10 and TGF-β levels. Furthermore, flurbiprofen exerted a similar analgesic effect and brought a significantly less sufentanil consumption compared to group C. Taken together, flurbiprofen provided a short-term increase of postoperative naturally circulating DCs in ESCC patients.

Effect of dexmedetomidine on quality of recovery from sevoflurane-based anesthesia in patients undergoing abdominal surgery

Objective To evaluate the effect of dexmedetomidine on the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery. Methods Eighty patients of both sexes, aged 30-64 yr, weighing 45-80 kg, with American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective abdominal surgery, were randomly assigned into 2 groups(n=40 each)using a random number table: control group(group C)and dexmedetomidine group(group D). After routine induction of anesthesia, all the patients were tracheally intubated, and mechanically ventilated.Anesthesia was maintained with sevoflurane inhalation and intermittent iv boluses of sufentanil and cisatracurium besylate, and bispectral index values were maintained at 45-60.After induction of anesthesia, dexmedetomidine was infused in a dose of 1 μg/kg over 15 min, followed by a continuous infusion of 0.6 μg·kg-1·h-1 until 30 min before the end of surgery in group D. Group C received normal saline instead.Heart rate(HR)and mean arterial pressure(MAP)were recorded at the end of surgery, and at 1 min before and after extubation.The emergence time, extubation time, and occurrence of bucking during extubation, and nausea and vomiting, respiratory depression, and agitation during recovery from anesthesia were recorded. Results Compared with group C, MAP and HR were significantly decreased at 1 min before and after extubation, the emergence time and extubation time were shortened, the incidence of bucking, nausea and vomiting, and agitation was decreased, and no significant change was found in the incidence of respiratory depression in group D. Conclusion Dexmedetomidine infused in a dose of 1 μg/kg after routine induction of anesthesia, followed by a continuous infusion of 0.6 μg·kg-1·h-1 until 30 min before the end of surgery, can significantly increase the quality of recovery from sevoflurane-based anesthesia in the patients undergoing abdominal surgery. Key words: Dexmedetomidine; Anesthetics, inhalation; Anesthesia recovery period; Laparotomy

Effect of dexmedetomidine on intestinal mucosal injury in patients undergoing cardiac valve replacement with CPB

Objective To evaluate the effect of dexmedetomidine on the intestinal mucosal injury in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB). Methods Forty patients of both sexes with rheumatic heart disease, aged 32-64 yr, weighing 40-75 kg, of ASA physical status Ⅱ or Ⅲ(NYHA class Ⅱ or Ⅲ), scheduled for elective cardiac valve replacement with CPB, were randomly divided into 2 groups (n=20 each) using a random number table: control group (group C) and dexmedetomidine group (group D). After induction of anesthesia, the patients were endotracheally intubated and mechanically ventilated. Anesthesia was maintained with 0.8%-2.0% sevoflurane inhalation and intermittent iv boluses of sufentanil 0.5-1.0 μg/kg and vecuronium 0.04-0.06 mg/kg. Before routine induction of anesthesia, a loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min, followed by continuous infusion at 0.3 μg·kg-1·h-1 until the end of surgery in group D, while the equal volume of normal saline was given in group C. Before CPB, at 30 min after aortic clamping, at the termination of CPB, at the end of surgery and at 6 and 24 h after surgery, central venous blood samples were taken for determination of concentrations of tumor necrosis factor-alpha, interleukin-6(IL-6) and IL-10 and intestinal fatty acid binding protein in plasma (by ELISA), and the plasma concentration of endotoxin (using turbidimetry). The time of postoperative mechanical ventilation and duration of ICU stay were recorded. Results Compared with group C, the concentrations of tumor necrosis factor-alpha, IL-6, IL-10 and endotoxin and intestinal fatty acid binding protein in plasma were significantly decreased, and the time of postoperative mechanical ventilation and duration of ICU stay were shortened in group D. Conclusion Dexmedetomidine infused continuously at 0.3 μg·kg-1·h-1(until the end of surgery) after a loading dose of 1 μg/kg before routine induction of anesthesia can reduce intestinal mucosal injury in the patients undergoing cardiac valve replacement with CPB. Key words: Dexmedetomidine; Cardiopulmonary bypass; Intestinal mucosa; Heart valve prosthesis implantation