Intraoperative Infusion Research Articles

The effect of perioperative esmolol infusion on the postoperative pain and nausea vomiting after middle ear surgeries

Background: Pain and postoperative nausea and vomiting are the most common postoperative complications in middle ear surgeries. Amongst the beta-blockers, esmolol is ultrashort acting cardio selective β1 receptor antagonist used for management of postoperative pain. It also contributes to the significant decrease in PONV and reduces patient distress and facilitates earlier discharge. Objective: To evaluate the effectiveness of perioperative esmolol infusion on postoperative pain relief and postoperative nausea vomiting after middle ear surgeries. Methods: After obtaining approval from Institution Ethics Committee, 70 patients of age 15 and 65 years of ASA I,II and III were allocated with randomization into two groups of 35 each. Group C: 30 ml normal saline loading dose and thereafter continuous infusion of 1ml/min and Group E:0.5mg/kg esmolol in 30ml NS loading dose and 30ug/kg/min as infusion. Results: Average duration of analgesia was about 535 min in group E as compared to 187 min in group C. For PONV requirement of inj. ondansetron in group E was after 145 min and in group C it was 20 min. Group E patients had significantly less variations in blood pressure and heart rate intraoperatively and the response to intubation was masked as compared to group C. Conclusion: Intraoperative esmolol infusion is a newer justified method to reduce postoperative pain and PONV with advantage of hemodynamic stability.

Comparative study of desflurane requirement and recovery characteristics in entropy guided general anaesthesia with or without dexmedetomidine infusion

Background: Newer anaesthetics such as desflurane have smaller blood-gas partition coefficient than older ones like halothane. Desflurane is preferred because it leads to faster onset of anaesthesia and faster emergence from anaesthesia. However, desflurane is considered to be more expensive than other volatile anaesthetics. Highly selective alpha two adrenoceptor agonists like Dexmedetomidine reduce anaesthetic requirements. Hence this study was designed to compare the effect of Dexmedetomidine infusion on desflurane consumption and recovery characteristics under entropy guided general anaesthesia. Materials and Methods: Fifty patients aged between 18-55 years belonging to ASA I and II scheduled for elective surgeries under general anaesthesia were randomly divided into two groups. Group D patients received a loading dose of inj Dexmedetomidine 1 µg/ kg, over 10 minutes before the induction of anaesthesia, and 0.5 µg/ kg/ hour infusion following induction of anaesthesia till the end of surgery. Group P patients received similar volumes of normal saline as bolus before the induction and maintenance infusion till the end of the surgery. Desflurane concentration was adjusted to maintain response entropy values between 40 to 60 and based on clinical variables like heart rate (HR), and mean arterial pressure (MAP). Muscle relaxation was guided by TOF count. HR, NIBP, MAP, SPO2, ENTROPY values were recorded. The total desflurane consumption was recorded from Anaesthesia gas module of GE Datex-Ohmeda S 5 Advance system. At end of surgery, desflurane was discontinued and patient extubated after adequate recovery and when TOF ratio was more than 0.9. Time to eye opening, extubation, response to verbal commands were recorded. Results: The mean consumption of desflurane at the end of one hour was significantly less in group D with p<0.001 (Group P 21.04±6.33 ml/hr and Group D 14.44±1.83 ml/hr). Eye opening time was significantly less in group D with p<0.001(Group P 297.60± 89.97sec and Group D 169.80±22.48 sec). Time for response to verbal commands was significantly less in group D with p<0.001 (Group P 423.60±113.02 sec and Group D 269.80±45.29 sec) Conclusion: Intraoperative Dexmedetomidine infusion reduces desflurane consumption, hastens recovery from desflurane during entropy guided general anaesthesia.

Some features of intraoperative infusion-transfusion therapy when performing cytoreductive operations with the use of hyperthermic intraperitoneal chemotherapy in patients with ovarian cancer: retrospective cohort study

Introduction. Сytoreductive operations with using hyperthermic intraoperative intraperitoneal chemotherapy(CR + HIPEC) is an effective technology in the treatment of locally advanced and metastatic ovarian cancer, the relevance of the treatment of this one’s is beyond doubt. The neсessity of protection organs and systems of the body from a stress response, correction of water and electrolyte balance, blood loss, volemia, and prevention of the toxic effects of chemotherapy make infusion-transfusion therapy (ITT) one of the main components of anesthesia during such operations. Objectives. An analyze the qualitative and quantitative composition of perioperative infusion-transfusion therapy in patients with advanced stages of ovarian cancer during cytoreductive operation with the addition of HIPEC of the abdominal cavity. Materials and methods. In retrospective study 84 patients, 2 types of surgical interventions and anesthetic accompaniment were analyzed, depending on the availability of HIPEC. The duration of the anesthetic treatment, the doses of the anesthetics, the volume of blood loss, the volume and quality of intraoperative infusion therapy were assessed. Results. With ITT carried out with cytoreduction using GIIH, the volume of administration of crystalloid solutions increases by 2.3 times; the average value of the infusion volume increases by 16 (10,5–20) ml/kg/hour. When analyzing the proportional ratio of crystalloid and colloidal solutions, their qualitative composition with CR + GIIH consists of: erythrocyte suspension 3.1 %, FFP 13.6 %, colloidal solutions 8.52 %, crystalloid solutions 74.6 % of total infusion’s volume. Conclusions. Perioperative ITT performed with cytoreduction using GIIH differs significantly from ITT without that. The necessity for high-volume infusion-transfusion therapy by increasing the introduction of crystalloids during cytoreductive operations with hyperthermic intraoperative intraperitoneal chemotherapy was revealed. This technique had no complications and allowed maintaining the stability of hemodynamics, volumetric volume and the required volume of diuresis. The use of a “balanced electrolyte solution” is preferable for intraoperative high-volume ITT.

Effect of low dose ketamine on perioperative analgesia in patients undergoing open abdominal hysterectomy - A double-blind, randomized, placebo-controlled trial

Background: Low-dose ketamine can provide effective perioperative analgesia while reducing its side effects. This study aims to estimate the effect of a low dose of ketamine administered preemptively and during the surgery on postoperative opioid requirement and the incidence of side effects of ketamine. Methods: This prospective, double-blind, randomized control trial enrolled 60 adult women (>18 years) scheduled for open abdominal hysterectomy. All patients received general anesthesia using a standard protocol. Patients were randomized to receive 0.2 mg/kg of ketamine as bolus before induction of anesthesia, followed by an infusion of 0.002 mg/kg/min for the duration of surgery (Group K) or an equivalent volume of 0.9% saline (Group C). The primary outcome was to compare the morphine requirement over the 24 h postoperatively between the two groups. The secondary outcomes were to compare the intraoperative morphine requirement, and the incidence of side effects of ketamine. Results: The intraoperative morphine requirement was significantly less (P = 0.006) in those who received ketamine (6.5 ± 1.5 mg) compared to the placebo (7.67 ± 1.7 mg). The 24-hour morphine requirement was less in the Group K (7.87 ± 4.7 mg) compared to Group C (9.2 ± 4.5 mg), but was not statistically significant. The incidence of hallucination and nystagmus was significantly higher in the ketamine group, but it lasted Conclusion: The preemptive and the intraoperative infusion of low-dose ketamine decreases the morphine requirement intraoperatively but not during the postoperative period.

The Effect of Intraoperative Magnesium Sulphate Infusion on Emergence Agitation after Ambulatory Ophthalmic Surgery in Children

This study investigated whether intraoperative infusion of magnesium sulphate reduces the incidence of emergence agitation (EA) in paediatric patients who undergo ambulatory ophthalmic surgery using the Paediatric Anaesthesia Emergence Delirium (PAED) scale. Ninety-two paediatric patients who were scheduled for elective ophthalmic surgery were randomly allocated to two groups: control or magnesium. In the magnesium group, patients received an initial intravenous loading dose of 30 mg/kg of 10% solution of magnesium sulphate over 10 min and then a continuous infusion of 10 mg/kg×h during the surgery. In the control group, an equal volume of 0.9% isotonic saline was administered in the same way as in the magnesium group. The PAED scale was assessed at 15-min intervals until the PAED score reached below 10 at the postanaesthetic care unit. EA was defined as a PAED score of 10 or higher. Of the 86 patients recruited, 44 and 42 were allocated to the control and magnesium groups, respectively. The incidence of EA was 77.3% in the control group and 57.1% in the magnesium group (odds ratio, 0.392; 95% confidence interval, 0.154 to 0.997; p = 0.046). The intraoperative infusion of magnesium sulphate significantly reduced the incidence of EA.

Effect of Intraoperative Esmolol Infusion on Haemodynamics and Surgical Field in FESS Under General Anaesthesia

Introduction: Functional endoscopic sinus surgery (FESS) is a commonly performed operation. Endoscopic sinus surgery allows enhanced illumination and visualization and it has dramatically improved surgical dissection. However major complications such as excess bleeding and poor visibility can arise do to work in a confined space.Due to poor visibility longer time to perform the surgery may arise. Material and Methods: This study was performed on randomly selected 60 patients, in a randomized placebo controlled double blind prospective study. We evaluated the hypotensive efficacy of intravenous Esmolol in FESS, reduction in blood pressure and Quality of surgical field and complications under general anaesthesia. Conclusions: Esmolol produces a lower surgical bleeding scores and better quality of operative field for the surgeon as well as less adverse effects.

Intraoperative Ketamine for the Opioid-Naïve Patients: Move Along Folks, Nothing to See Here?

Intraoperative Ketamine for the Opioid-Naïve Patients: Move Along Folks, Nothing to See Here?

Ketamine infusion reduces narcotic requirements following gastric bypass surgery: a randomized controlled trial.

As the obesity epidemic worsens, anesthesiologists should expect to see more obese patients presenting for surgical procedures. Opioids cause respiratory depression, which has caused complications in patients with obstructive sleep apnea. Opioids can also cause nausea, prolonging the time that patients spend in the postanesthesia care unit. Ketamine is a potential analgesic alternative that may have advantages to narcotics in the bariatric population. To determine whether an intraoperative ketamine infusion would reduce postoperative narcotic use in patients during the first 48 hours after laparoscopic gastric bypass. Major academic medical center. There were 54 participating patients. The intervention group (n = 27) was randomized to receive 100 μg of fentanyl with anesthesia induction, then a 20-mg bolus of ketamine, followed by a 5 μg/kg/min intraoperative ketamine infusion starting after anesthesia induction and ending after wound closure commenced. The control group (narcotic only, n = 27) also received 100 μg of fentanyl at anesthesia induction and intraoperative boluses of fentanyl at the discretion of the anesthesia team, with .3 mg of hydromorphone administered approximately 45 minutes before the completion of surgery. At 24 hours, the mean morphine-equivalent units (MEUs) were 12.7 (standard deviation [SD], 9.9; 95% confidence interval [CI], 8.8-16.6) for the ketamine group (n = 28) and 16.5 (SD, 9.8; 95% CI, 12.6-20.4) for the control group (n = 28). At 48 hours, the MEUs were 16.7 (SD, 12.0; 95% CI, 11.9-21.4) for the ketamine group and 22.7 (SD, 14.9; 95% CI, 16.8-28.6) for the control group. Cumulative MEUs for 24 hours (P = .039) and 48 hours (P = .058) postoperatively were lower in the ketamine group compared with the narcotic-only (control) group, although the difference at 48 hours did not reach statistical significance. Compared with the narcotic-only group, the ketamine group used 26% fewer MEUs after 24 hours and 31% fewer MEUs after 48 hours. This difference can mostly be attributed to group differences during the first 6 hours after surgery. Ketamine successfully reduced the amount of opioids required to control bariatric patients' pain at 24 hours postoperatively, but not over the 48-hour postoperative period.

Abstract IA21: Metabolic phenotypes and liabilities in human cancer

Abstract Metabolic reprogramming in cancer arises from a complex, incompletely-defined combination of factors intrinsic and extrinsic to malignant cells. In some cases, reprogrammed pathways contribute to the process of transformation, and in many others they enable cancer progression by supporting cell survival and excessive growth. The clinical relevance of cancer metabolism is emphasized by the fact that numerous imaging modalities and therapeutic strategies in cancer capitalize on the altered metabolic states present in tumors. Recent work has emphasized that metabolic phenotypes and liabilities evolve as cancer progresses, such that pathways required for cancer initiation may be dispensable in more advanced stages, and vice versa. A key challenge is to define metabolic properties that support key aspects of cancer progression, particularly metastasis and acquired therapy resistance, which account for the majority of cancer-related deaths. Because these processes are difficult to model in culture, we have developed clinical approaches to study cancer metabolism in vivo, in patients, and to uses these approaches to identify features that drive cancer progression. I will discuss approaches using metabolomics and intra-operative infusions with 13C-labeled nutrients to assess metabolic pathway utilization in human tumors. We use this approach to characterize metabolic heterogeneity among tumors arising in different organs, to identify areas of regional metabolic heterogeneity within solid tumors and to predict which activities support cancer progression. Our work to this point demonstrates marked diversity of fuel preferences in primary tumors and unexpected roles of particular pathways in cancer cell biology. Citation Format: Ralph J. DeBerardinis. Metabolic phenotypes and liabilities in human cancer [abstract]. In: Abstracts: AACR Special Virtual Conference on Epigenetics and Metabolism; October 15-16, 2020; 2020 Oct 15-16. Philadelphia (PA): AACR; Cancer Res 2020;80(23 Suppl):Abstract nr IA21.

Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study

BackgroundWe explored the analgesic outcomes on postoperative day (POD) 1 in patients undergoing robot-assisted laparoscopic prostatectomy (RALP) who received intravenous patient-controlled analgesia (IV-PCA), rectus sheath bupivacaine block (RSB), or intrathecal morphine with bupivacaine block (ITMB).MethodsThis was a prospective, observational clinical trial. Patients were divided into three groups: IV-PCA (n = 30), RSB (n = 30), and ITMB (n = 30). Peak pain scores at rest and with coughing, cumulative IV-PCA drug consumption, the need for IV rescue opioids, and Quality of Recovery-15 (QoR-15) questionnaire scores collected on POD 1 were compared among the groups.ResultsThe preoperative and intraoperative findings were comparable among the groups; the ITMB group required the least remifentanil of all groups. During POD 1, the ITMB group reported lower levels of pain at rest and with coughing, compared with the other two groups. During POD 1, incidences of severe pain at rest (10.0% vs. 23.3% vs. 40.0%) and with coughing (16.7% vs. 36.7% vs. 66.7%) were the lowest in the ITMB group compared with the RSB and IV-PCA groups, respectively. After adjustment for age, body mass index, diabetes mellitus, hypertension, and intraoperative remifentanil infusion, severe pain at rest was 0.167-fold less common in the ITMB group than in the IV-PCA group, while pain with coughing was 0.1-fold lower in the ITMB group and 0.306-fold lower in the RSB group, compared with the IV-PCA group. The ITMB group required lower cumulative IV-PCA drug infusions and less IV rescue opioids, while exhibiting a better QoR-15 global score, compared with the other two groups. Complications (nausea and pruritus) were significantly more common in the ITMB group than in the other two groups; however, we noted no ITMB- or RSB-related anesthetic complications (respiratory depression, post-dural headache, nerve injury, or puncture site hematoma or infection), and all patients were assessed as Clavien-Dindo grade I or II during the hospital stay.ConclusionAlthough ITMB induced complications of nausea and pruritus, this analgesic technique provided appropriate pain relief that enhanced patient perception related to early postoperative recovery.Trial registrationClinical Research Information Service, Republic of Korea, (approval number: KCT0005040) on May 20, 2020

Comparing effects of intraoperative fluid and vasopressor infusion on intestinal microcirculation

Several studies have revealed that vasopressor may be more appropriate for treating intraoperative hypotension and preventing hypervolemia. This study compared the effects of vasopressor infusion and fluid supplementation on intestinal microcirculation during treating intraoperative hypotension. Thirty-two rats were randomly divided into the following four groups: Light Anesthesia group (LA, 0.8–1% isoflurane); Deep Anesthesia group (DA, 1.5–1.8% isoflurane); Fluid DA group (1.5–1.8% isoflurane and fluid supplementation); and Norepinephrine DA group (1.5–1.8% isoflurane and norepinephrine infusion). At 240 min, perfused small vessel density (PSVD) of the mucosa did not differ significantly between the Fluid DA and Norepinephrine DA groups [26.2 (3.2) vs 28.9 (2.5) mm/mm2, P = 0.077], and tissue oxygen saturation of the mucosa was lower in the Fluid DA groups than in the Norepinephrine DA groups [ 48 (7) vs 57 (6) %, P = 0.02]. At 240 min, TSVD and PSVD of the seromuscular layer were higher in the Norepinephrine DA group than in the Fluid DA group. Fluid administration was higher in the Fluid DA group than in the Norepinephrine DA group [66 (25) vs. 9 (5) μL/g, P = 0.001]. Our results showed that norepinephrine can resuscitate intraoperative hypotension related microcirculatory alteration and avoid fluid overload.

Intraoperative infusion of lidocaine 2% reduces postoperative fentanyl requirements for pain control in renal transplantation surgery

BackgroundIntravenous lidocaine has been shown to be an analgesic and anti-inflammatory medication with modulation of excessive inflammatory response.We investigated the efficacy of intraoperative lidocaine 2% infusion in reducing the postoperative Fentanyl requirements for analgesia in renal transplant recipients. Patients were assigned equally into two groups by computer-generated list compiled before the start of the study. Control group: fentanyl (F) group and study group: lidocaine 2% (L) group. Medication used is either lidocaine in the dose of 2 mg/kg/h and the other syringe contained saline both have been infused by rate of 10 ml/h. Fentanyl induction dose given for the two groups was 1.5 mcg/kg. Both groups have received extra fentanyl according to their intraoperative analgesic requirements, patients in the lidocaine group received the fentanyl induction dose accompanied by lidocaine 2% 1.5 mg/kg as loading dose, followed by maintenance dose of lidocaine 2% infusion 2 mg/kg/h. After transfer to the PACU nursing staff administered fentanyl 0.5 mcg/kg boluses for postoperative pain relief every 10 min up to 2 mcg/kg, the recovery nurse used the pain numerical score to assess pain. The recovery nurse referred the patient to the responsible anesthesiologist covering the recovery unit if he required more than 2 mcg/kg of fentanyl to control postoperative pain. Patient was then transferred to the RTU (renal transplant unit), postoperative pain and fentanyl PCA consumption were followed up during the first 24 h.ResultsOur study detected increased fentanyl consumption in the recovery for the fentanyl group more than the lidocaine group. The request of the first dose of analgesic was significantly longer in lidocaine group than in fentanyl group.ConclusionThe usage of intraoperative lidocaine infusion decreased postoperative fentanyl requirements as analgesic in patients undergoing renal transplantation.Trial registrationRegistration on ANZCTR number ACTRN12618001335280, REGISTERED 08 August 2018.

The effect of erector spinae plane block on perioperative analgesic consumption and complications in dogs undergoing hemilaminectomy surgery: a retrospective cohort study

ObjectiveTo compare the perioperative use of analgesics and complication rates in dogs administered an erector spinae plane (ESP) block or a traditional opioid-based (OP) treatment as part of analgesic management during hemilaminectomy. Study designRetrospective cohort study. AnimalsMedical records of 114 client-owned dogs. MethodsGeneral data included demographics, duration of procedure, number of laminae fenestrated, perioperative use of steroid and non-steroidal anti-inflammatory drugs. Intra- and postoperative analgesics used in 48 hours and complications rates were compared between groups. Opioid use was expressed in morphine equivalents [ME (mg kg−1)]. Continuous data were compared using the Mann–Whitney U test and incidence of events with a Fisher's exact tests. Multiple linear regression was used to evaluate association between perioperative ME consumption (dependent variable) with other independent variables. Data are presented as median (range). Differences were considered significant when p < 0.05. ResultsGroup ESP comprised 42 dogs and group OP 72 dogs. No differences were observed in the general data. Intraoperative ME was 0.65 (0.20–3.74) and 0.79 (0.19–5.60) mg kg−1 in groups ESP and OP, respectively (p = 0.03). Intraoperative infusion of lidocaine was administered intravenously (IV) to 23.8% and 68% of groups ESP and OP, respectively (p < 0.0001). Intraoperative infusion of ketamine was administered IV to 21% and 40% of groups ESP and OP, respectively (p = 0.04). Regression analysis revealed the ESP block as the only independent variable affecting the perioperative ME consumption. Pharmacological intervention to treat cardiovascular complications was administered to 21.4% and 47.2% of dogs in groups ESP and OP, respectively (p = 0.008). There were no differences in postoperative complication rates. Conclusions and clinical relevanceESP block was associated with reduced perioperative opioid consumption, intraoperative adjuvant analgesic use and incidence of pharmacological interventions to treat cardiovascular complications in dogs undergoing hemilaminectomy.

Thromboelastography-guided blood transfusion during cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: study protocol for a prospective randomised controlled trial

IntroductionCytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a well-established treatment for peritoneal cancer (PC). However, this kind of combination therapy is associated with a high incidence of complications....

Plasma histamine concentrations in horses administered sodium penicillin, guaifenesin–xylazine–ketamine and isoflurane with morphine or butorphanol

ObjectiveVarious drugs administered to horses undergoing surgical procedures can release histamine. Histamine concentrations were evaluated in horses prepared for surgery and administered butorphanol or morphine intraoperative infusions. Study designProspective studies with one randomized. AnimalsA total of 44 client-owned horses. MethodsIn one study, anesthesia was induced with xylazine followed by ketamine–diazepam. Anesthesia was maintained with guaifenesin–xylazine–ketamine (GXK) during surgical preparation. For surgery, isoflurane was administered with intravenous (IV) morphine (group M: 0.15 mg kg–1 and 0.1 mg kg–1 hour–1; 15 horses) or butorphanol (group B: 0.05 mg kg–1 and 0.01 mg kg–1 hour–1; 15 horses). Histamine and morphine concentrations were measured using enzyme-linked immunoassay before opioid injection (time 0), and after 1, 2, 5, 30, 60 and 90 minutes. In a subsequent study, plasma histamine concentrations were measured in 14 horses before drug administration (baseline), 15 minutes after IV sodium penicillin and 15 minutes after starting GXK IV infusion. Statistical comparison was performed using anova for repeated measures. Pearson correlation compared morphine and histamine concentrations. Data are presented as mean ± standard deviation. Significance was assumed when p ≤ 0.05. ResultsWith histamine, differences occurred between baseline (3.2 ± 2.4 ng mL–1) and GXK (5.2 ± 7.1 ng mL–1) and between baseline and time 0 in group B (11.9 ± 13.4 ng mL–1) and group M (11.1 ± 12.4 ng mL–1). No differences occurred between baseline and after penicillin or between groups M and B. Morphine concentrations were higher at 1 minute following injection (8.1 ± 5.1 ng mL–1) than at 30 minutes (4.9 ± 3.1 ng mL–1) and 60 minutes (4.0 ± 2.5 ng mL–1). Histamine correlated with morphine at 2, 30 and 60 minutes. Conclusions and clinical relevanceGXK increased histamine concentration, but concentrations were similar with morphine and butorphanol.

Effect of intraoperative dexmedetomidine infusion during functional endoscopic sinus surgery: a prospective cohort study

BackgroundDexmedetomidine, an α2 agonist, has well-known anesthetic and analgesic-sparing effects. We designed this study to evaluate the effect of intraoperative dexmedetomidine infusion on intra operative blood loss and postoperative pain in functional endoscopic sinus surgery.MethodsThis prospective cohort study included 90 patients planning to undergo endoscopic sinus surgery, who were randomly divided into three groups. 2 to 2.5 mg/kg of propofol was used in all groups to induce anesthesia. One group received dexmedetomidine 0.2 μg/kg per hour infusion whereas the other group received dexmedetomidine 0.5 μg/kg per hour infusion. The control group received normal saline infusion.ResultsThe mean age of patients was 41.02 ± 11.93. 33 patients in the dexmedetomidine 0.2 μg/kg/h group, 30 patients in the dexmedetomidine 0.5 μg/kg/h group and 27 patients in the placebo group. The lowest amount of bleeding was related to the dexmedetomidine 0.5 μg/kg/h group. The volume of bleeding between the three groups was significantly different (p = 0.012). The satisfaction of the surgeon in the dexmedetomidine 0.5 μg/kg/h group was more than other groups. There was a significant relationship between the satisfaction of the surgeon and the treatment groups (p < 0.001). The lowest duration of surgery was related to the dexmedetomidine 0.2 μg/kg/h group. The most Trinitroglycerin (TNG) consumption was in the placebo group and the highest dose of labetalol was in the dexmedetomidine 0.5 μg/kg/h group. There was no significant difference in the TNG and labetalol consumption between three groups. The lowest consumption of morphine and pethidine in the dexmedetomidine 0.5 μg/kg/h group.ConclusionsInfusion of dexmedetomidine 0.5 μg/kg/h decreased blood loss and consumption of morphine and pethidine in patients who underwent endoscopic sinus surgery.

Medicated plaster at Dazhui (GV 14) for preventing perioperative hypothermia in patients undergoing PKRP and ureteroscopic laser lithotripsy

To observe the preventive effect of medicated plaster at Dazhui (GV 14) on preventing perioperative hypothermia in patients undergoing plasmakinetic resection of prostate (PKRP) and ureteroscopic laser lithotripsy. A total of 300 patients with ASA gradeⅠorⅡreceiving ureteroscopic laser lithotripsy or PKRP under total intravenous anesthesia (TIVA) were randomly divided into an observation group and a control group, 150 cases in each group. The patients in the control group received routine heat preservation measures, while on the basis of the control group, the patients in the observation group were treated with medicated plaster at Dazhui (GV 14) 30 min before operation. The temperature (ear temperature), mean arterial pressure (MAP), heart rate and blood oxygen saturation (SpO2) at each time point (resting state before operation, 5, 10 min into operation, at the end of operation, 5 and 10 min after operation) were recorded; the number of hypothermia, the classification of postoperative shivering degree, operation time, propofol dosage, intraoperative infusion volume and intraoperative flushing fluid volume were recorded. The temperature at 5 and 10 min into operation as well as at the end of operation in the two groups was all lower than that before operation and at previous time point (P<0.01). The temperature at 5 and 10 min after operation in the two groups was all higher than that at previous time point (P<0.01), but still lower than that before operation (P<0.01). The temperature at 10 min into operation, at the end of operation, 5 and 10 min after operation in the observation group was higher than that in the control group (P<0.01, P<0.05). The total incidence rate of hypothermia in the observation group was 2.0% (3/150), which was significantly lower than 13.3% (20/150) in the control group (P<0.01). The total incidence rate of shivering was 18.0% (27/150) in the observation group and 28.7% (43/150) in the control group (P>0.05). The medicated plaster at Dazhui (GV 14) can effectively prevent perioperative hypothermia and improve comfort in patients undergoing PKRP and ureteroscopic laser lithotripsy.

Evidence of potent humoral immune activity in COVID-19-infected kidney transplant recipients.

Whether kidney transplant recipients are capable of mounting an effective anti‐severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) adaptive immune response despite chronic immunosuppression is unknown and has important implications for therapy. Herein, we analyzed peripheral blood cell surface and intracellular cytokine phenotyping by flow cytometry along with serum antibody testing in 18 kidney transplant recipients with active coronavirus disease 2019 (COVID‐19) infection and 36 matched, transplanted controls without COVID‐19. We observed significantly fewer total lymphocytes and fewer circulating memory CD4+ and CD8+ T cells in the COVID‐19 subjects. We also showed fewer anergic and senescent CD8+ T cells in COVID‐19 individuals, but no differences in exhausted CD8+ T cells, nor in any of these CD4+ T cell subsets between groups. We also observed greater frequencies of activated B cells in the COVID‐19 patients. Sixteen of 18 COVID‐19 subjects tested for anti‐SARS‐CoV‐2 serum antibodies showed positive immunoglobulin M or immunoglobulin G titers. Additional analyses showed no significant correlation among immune phenotypes and degrees of COVID‐19 disease severity. Our findings indicate that immunosuppressed kidney transplant recipients admitted to the hospital with acute COVID‐19 infection can mount SARS‐CoV‐2‐reactive adaptive immune responses. The findings raise the possibility that empiric reductions in immunosuppressive therapy for all kidney transplant recipients with active COVID‐19 may not be required.

Intraoperative thermal insulation in off-pump coronary artery bypass grafting surgery: a prospective, double blind, randomized controlled, single-center study.

BackgroundAbout 50% patients who underwent off-pump coronary artery bypass grafting (OPCAB) experienced perioperative hypothermia. Pre-warming and intraoperative infusion of amino acid injection are the most popular perioperative insulation measures in recent years, but neither of them can completely prevent intraoperative hypothermia. The objective is to investigate the effect of preoperative warming and/or intraoperative infusion of amino acid injection on body temperature in patients undergoing OPCAB.MethodsA prospective, double blind, randomized controlled, single-center study. Seventy-two patients were randomly divided into 4 groups: control group, pre-warming group, amino-acid group and multi-mode group. Pre-warming and multi-mode group were pre-heated with warming blankets and forced-air warming system before induction. After that, amino-acid and multi-mode group were infused with 18-amino acid solution. The perioperative temperature and complications were monitored.ResultsThe temperature of control and amino-acid group decreased significantly, but amino-acid group recovered to preoperative level faster. The temperature of pre-warming group was stable, and that in multi-mode group increased at 60 min after the start of surgery. There was a significant difference in temperature at each time, and no difference in the incidence of complications between the groups.ConclusionsPreoperative warming and/or intraoperative infusion of amino acid injection can effectively reduce hypothermia in OPCAB surgery. Pre-warming before anesthesia is more effective, and the combination of the two methods has the best effect.

Intraoperative thermal insulation in off-pump coronary artery bypass grafting surgery: a prospective, double blind, randomized controlled, single-center study

Background: About 50% patients who underwent off-pump coronary artery bypass grafting (OPCAB) experienced perioperative hypothermia. Pre-warming and intraoperative infusion of amino acid injection are the most popular perioperative insulation measures in recent years, but neither of them can completely prevent intraoperative hypothermia. The objective is to investigate the effect of preoperative warming and/or intraoperative infusion of amino acid injection on body temperature in patients undergoing OPCAB.