Perioperative Stress Response Research Articles

Abstract #4313 Perioperative stress and hypothermic responses jeopardize beneficial effects of immune stimulation by CpG-C: Partial mediation through glucocorticoid responses

Abstract #4313 Perioperative stress and hypothermic responses jeopardize beneficial effects of immune stimulation by CpG-C: Partial mediation through glucocorticoid responses

ERAS in colorectal surgery - neglected preadmission items.

The Enhanced Recovery After Surgery (ERAS) concept is acomplex of strategies intended to reduce the perioperative stress response and achieve faster postoperative convalescence and rapid recovery of normal physiological functions. Adherence to ERAS should reduce the length of stay and postoperative complications, and it should improve the physical condition of the patient after dimission. This article is focused on those ERAS guidelines that apply to preadmission care.

Effect of auricular-point pressure combined with personalized music therapy on perioperative stress response in primipara

To explore the effect of auricula-point pressure combined with personalized music therapy on perioperative stress response in primipara. A total of 1000 primiparas who were elective for cesarean section were randomly divided into an observation group and a control group, 500 cases in each one. 1 h before surgery and 3 h, 6 h, 12 h and 24 h after surgery, individualized music relaxation intervention was given for 1 h in the two groups. On the basis of the treatment, auricular-point pressure was added at Pizhixia (AT4), Shenmen (TF4), Xin (CO15), Zigong (uterus), Luanchao (ovary), Neishengzhiqi (TF2) in the observation group. Each point was pressed for 1 min each time, repeated once every 15 min, the force is from light to heavy, and it is better to have a feeling of distension, sourness and radiation in the auricle. The scores of anxiety self-rating scale, visual analog scale (VAS), heart rate, systolic blood pressure, thyroid stimulating hormone, cortisol and blood glucose levels were observed in the two groups. A total of 973 primiparas completed the clinical study in the end, including 488 patients in the observation group and 485 patients in the control group. Compared to enrollment, the scores of anxiety self-rating scale before entering the operating room in the two groups were significantly improved (P<0.05), and the observation group was superior to the control group (P<0.05). Entering the operating room and tracheal extubation, the heart rate and systolic blood pressure of the primiparas in the observation group were more stable than those in the control group, and the differences were statistically significant (P<0.05). Entering the operating room, 1 h into the surgery and 3 h after surgery, the thyroid stimulating hormone, cortisol and blood glucose levels of the primiparas in the observation group were significantly better than those in the control group (P<0.05). The VAS scores in the observation group at 6 h, 12 h and 24 h after surgery were lower than those in the control group (P<0.05). Auricular-point pressure combined with personalized music therapy can reduce the perioperative stress response in primipara and promote the improvement of psychological, physiological and emotional.

Effect of therapeutic touch combined with progressive muscle relaxation training on reducing stress response in perioperative gastric cancer patients

Objective To explore the effect of therapeutic touch (TT) combined with progressive muscle relaxation training (PMRT) on reducing perioperative stress response in patients with gastric cancer. Methods By convenience sampling, 120 patients with gastric cancer admitted in the department of general surgery of a Class Ⅱ Grade A hospital in Jiangsu Province from May to October of 2018 were selected as research objects. According to the random number table, they were divided into the experimental group (n=60) and control group (n=60) . Conventional nursing approach was adopted in the control group while TT combined with PMRT was adopted in the experimental group. The Self-rating Anxiety Scale (SAS) , Numerical Rating Scale (NRS) , and Nursing Satisfaction Questionnaire were used to evaluate the intervention effect. Results The NRS score of the experimental group were lower than that of the control group at 24 and 48 hours after operation with statistical differences (P<0.05) . After intervention, SAS score of the experimental group was lower than that of the control group, and the difference was statistically significant (P< 0.01) . At discharge, the nursing satisfaction of the experimental group was higher than that of the control group, and the difference was statistically significant (P<0.05) . Conclusions The application of TT combined with PMRT is helpful to reduce the stress response in perioperative patients with gastric cancer. Key words: Gastric neoplasm; Perioperative period; Therapeutic touch; Progressive muscle relaxation training; Stress response

Effects of dexmedetomidine on the modulation of perioperative blood glucose

Hyperglycemia caused by stress is commonly seen during perioperative period, which is closely related to infection, death and other postoperative complications. Therefore, it is necessary to pay attention to stress-induced hyperglycemia and the modulation of blood glucose concentrations. This paper discusses the effects of dexmedetomidine on perioperative stress response and insulin secretion and eventually the blood glucose level. Dexmedetomidine is a highly selective α2 adrenergic receptor agonist that can inhibit stress and lower blood glucose. Meanwhile, it can also directly activate α2 adrenergic receptors on the pancreatic β-cells to reduce insulin secretion and increase blood glucose level. The effects of dexmedetomidine on blood glucose are needed to be further explored. Key words: Dexmedetomidine; Stress; Insulin; Blood glucose

The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection

BackgroundEpidural use can prevent peri-operative neuro-endocrine stress responses, mitigate pain after surgery, and reduce opioid use, which all lead to immunosuppression.MethodsForty patients with gastric cancer were ultimately enrolled into the study. Patients who received general anaesthesia (GA group, n = 20) or a combination of general anaesthesia and peri-operative epidural use (EGA group, n = 20) were given intravenous analgesia or epidural analgesia, respectively. We collected visual analogue scale (VAS) scores, length of hospital stay, the time of the first passage of flatus and incidence of postoperative nausea and vomiting (PONV). We also collected data on the cluster of differentiation markers (CD)3+, CD4+, CD8+, CD4+/CD8+, interleukin (IL)-4, IL-6, and interferon (IFN)-γ the day before surgery as well as on postoperative days 1, 3, and 7.ResultsVAS scores and PONV in the GA group were higher than in the EGA group on postoperative day 3. CD3+, CD4+, and CD4+/CD8+ T cells declined on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. CD3+ T cells decreased more in the GA group than in the EGA group. IL-4, IL-6, and IFN-γ increased on postoperative day 3 and nearly recovered to baseline seven days after surgery in both groups. IL-4 and IL-6 increased more in the GA group than in the EGA group. IFN-γ increased more in the EGA group than in the GA group.ConclusionsA combination of general anaesthesia and peri-operative epidural use can relieve postoperative pain and PONV. A combination of general anaesthesia and peri-operative epidural use decreases immunosuppression in gastric cancer resection.Trial registrationThe study procedures were approved by the Ethics Committee of The Harbin Medical University Cancer Hospital. This study was registered prospectively at http://www.chictr.org.cn/index.aspx on October 10, 2017 (Registered ChiCTR-INR-17012939).

The Effect of Deep Neuromuscular Block on the Perioperative Stress Response Reduction and Postoperative Recovery Enhancement in Laparoscopic Stomach Cancer Surgery

The Effect of Deep Neuromuscular Block on the Perioperative Stress Response Reduction and Postoperative Recovery Enhancement in Laparoscopic Stomach Cancer Surgery

Mo2059 – Effect of Addition of Preoperative Oral Pregabalin to Perioperative Intravenous Lidocaine Infusion on Postoperative Pain and Perioperative Stress Response in Patients Undergoing Elective Laparotomy: A Double Blind Randomised Controlled Trial

Mo2059 – Effect of Addition of Preoperative Oral Pregabalin to Perioperative Intravenous Lidocaine Infusion on Postoperative Pain and Perioperative Stress Response in Patients Undergoing Elective Laparotomy: A Double Blind Randomised Controlled Trial

Effect of dexmedetomidine anesthesia on perioperative levels of TNF-α and IL-6 in patients with ovarian cancer.

Effect of continuous use of dexmedetomidine during general anesthesia on perioperative levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in patients undergoing radical resection of ovarian cancer was investigated. The initial treatment of ovarian cancer is mainly radical surgery. Most patients with ovarian cancer radical surgery can achieve good results, but the use of improper anesthetic drugs in radical surgery can easily lead to unstable patient vital signs. Therefore, the selection of appropriate anesthetic drugs has become the key to radical ovarian cancer surgery. There are few reports on the use of dexmedetomidine in anesthesia for ovarian cancer radical surgery. This study was performed to retrospectively analyze the case data of patients undergoing laparoscopic ovarian cancer radical surgery, and to compare the hemodynamics of dexmedetomidine anesthesia with midazolam anesthesia and the concentrations of TNF-α and IL-6, to provide reference for clinical implementation of ovarian cancer radical surgery. The hemodynamics of patients in the dexmedetomidine group were stable compared with the midazolam group. Serum TNF-α and IL-6 levels were significantly lower in the dexmedetomidine group than that in the midazolam group. If dexmedetomidine were continuously used during general anesthesia, the perioperative serum levels of TNF-α and IL-6 could be effectively reduced in patients undergoing radical resection of ovarian cancer, and the perioperative stress response was suppressed.

Effects of combined intravenous anesthesia and epidural anesthesia on the perioperative stress response and immune function in elderly patients with hepatectomy

目的 探讨静脉复合麻醉联合硬膜外麻醉对老年人肝癌切除术围术期应激反应、免疫功能的影响。 方法 选择2016年7月至2017年7月在浙江金华广福肿瘤医院择期行肝癌切除术的老年原发性肝癌患者82例，采用随机数字表法分为观察组和对照组，每组41例。对照组采取静脉复合麻醉，观察组采取静脉复合麻醉联合硬膜外麻醉，比较两组患者围术期血流动力学指标、血糖、肾上腺素水平以及T细胞免疫功能。 结果 切皮时、切皮后1 h两组患者平均动脉压(MAP)、心率(HR)均较麻醉前显著降低[对照组MAP切皮时(80.52±7.44)mmHg、切皮后1 h(78.52±6.49)mmHg，均高于麻醉前的(91.28±7.20)mmHg(t＝6.655、8.429，均P<0.05)；对照组HR切皮时(60.37±2.04)次/min、切皮后1 h(58.47±1.95)次/min，均高于麻醉前的(66.72±6.12)次/min(t＝6.303、8.224，均P<0.05)；观察组MAP切皮时(85.21±8.49)mmHg、切皮后1 h(86.21±7.63)mmHg，均高于麻醉前的(92.31±6.47)mmHg(t＝4.259、3.904，均P<0.05)；观察组HR切皮时(63.85±2.31)次/min、切皮后1 h(64.21±2.51)次/min，均高于麻醉前的(67.42±5.94)次/min(t＝3.587、3.187，均P<0.05)]，且对照组降低程度明显高于观察组(P<0.05)。术后1 h、术后6 h两组患者肾上腺素、皮质醇以及血糖水平均较麻醉前显著升高[对照组肾上腺素术后1 h(69.48±9.27)μg/L、术后6 h(60.12±8.43)μg/L，均高于麻醉前的(36.47±6.83)μg/L(t＝18.357、13.958，均P<0.05)；对照组皮质醇术后1 h(0.91±0.18)×103 mmol/L、术后6 h(0.84±0.25)×103 mmol/L，均高于麻醉前的(0.59±0.26)×103 mmol/L(t＝6.480、4.438，均P<0.05)；对照组血糖术后1 h(7.64±0.93)mmol/L、术后6 h(7.21±0.83)mmol/L，均高于麻醉前的(4.63±0.56)mmol/L(t＝17.754、16.499，均P<0.05)；观察组肾上腺素术后1 h(57.46±7.82)μg/L、术后6 h(49.32±8.39)μg/L，均高于麻醉前的(35.26±5.82)μg/L(t＝14.582、8.817，均P<0.05)；观察组皮质醇术后1 h(0.71±0.21)×103 mmol/L、术后6 h(0.68±0.19)×103 mmol/L，均高于麻醉前的(0.58±0.22)×103 mmol/L(t＝2.737、2.203，均P<0.05)；观察组血糖术后1 h(6.18±0.79)mmol/L、术后6 h(5.72±0.82)mmol/L，均高于麻醉前的(4.87±0.48)mmol/L(t＝9.074、5.728，均P<0.05)]，且对照组升高程度均明显高于观察组(均P<0.05)。术后1 h、术后1 d、术后3 d两组患者外周血CD3＋、CD4＋、CD4＋/CD8＋水平均较麻醉前显著降低(均P<0.05)，而术后3 d观察组患者外周血CD3＋、CD4＋、CD4＋/CD8＋水平均明显高于对照组(均P<0.05)。 结论 静脉复合麻醉联合硬膜外麻醉可有效降低老年肝癌切除术患者围术期应激反应，加快患者术后免疫功能的恢复，是一种较为理想的麻醉方式。

Transcutaneous Electrical Acupoint Stimulation for Improving Postoperative Recovery, Reducing Stress and Inflammatory Responses in Elderly Patient Undergoing Knee Surgery.

Transcutaneous electrical acupoint stimulation (TEAS) is a form of acupuncture treatment that applies electrical stimulation on specific acupoint through cutaneous electrodes. This technique has been used for perioperative anesthesia management as part of after surgery recovery. However, to date, limited data are available for using the TEAS for postoperative recovery in elderly surgical patients. We conducted this prospective randomized sham-control trail to evaluate the efficacy of TEAS in a group of elderly patients receiving knee surgery under epidural anesthesia. 52 subjects were assigned to either the experimental group (Group E) or control group (Group C). The patients in Group E received TEAS at zusanli (ST36), sanyinjiao (SP6), neiguan (PC6), and quchi acupoints (LI11) 30min prior to the epidural anesthesia and postoperative day 1 and 2, while patients in Group C received sham TEAS on the same acupoints for 30min same as those of Group E. The primary endpoint was the Quality of Recovery-40 questionnaire (QR-40) and the secondary endpoints were the biomarkers level of stress and inflammatory responses and visual analogue scale (VAS). A one-way ANOVA (SNK method) was used in statistic, and is considered to be statistically significant. Our data showed that the QoR-40 was significantly lower in Group C than that in Group E at postoperative day 1 (); Similarly, Cortisol (COR), Adrenocorticotropic Hormone (ACTH), and C-reactive protein (CRP) were significantly lower in Group E than those of Group C at postoperative day 1, 3, and 7 (), while the neutrophil/lymphocyte ratio (N/L) was lower in Group E than that in Group C at postoperative day 1 and 3 (). Our results showed that perioperative TEAS administration is able to facilitate the development of postoperative recovery of elderly patients, especially at the early stage after surgery. The reported results are likely to be mediated by the reduction of surgical inflammation and perioperative stress response.

Comparative Evaluation of Dexmedetomidine and Pregabalin as Premedication Agent to Attenuate Adverse Hemodynamic and Stress Response in Patients Undergoing Laparoscopic Cholecystectomy.

Background:Laparoscopic cholecystectomy is the most commonly performed laparoscopic procedure. The goal of anesthetic management is to minimize stress response and early discharge. Dexmedetomidine, and pregabalin have been used successfully to attenuate laryngoscopy and intubation response in various surgical procedures.Aim:To compare efficacy of pregablin and dexmedetomidine in attenuating hemodynamic and stress response.Setting and Design:A prospective, double blind randomized trial comprising 130 ASA physical status class I and II patients posted for laparsoscopic cholecystectomy.Materials and Methods:Patients were randomized in to Group A and Group B. Group A received intravenous dexmedetomidine in a dose of 1 ug.kg-1, through an infusion pump 20 min prior to induction of anaesthesia. Group B subjects received oral pregabalin 150 mg. Parameters observed were vitals, discharge time, cortisol level, side effects if any.Results:Post intervention heart rate got reduced significantly in Group A and it remained low in comparison to baseline during whole peri-operative period. In Group B, immediate post-pneumoperitoneum heart rate, and post exubation heart rate was higher than baseline. Blood pressure (BP) decreased significantly post intervention in Group A which persisted till pneumoperitoneum. In Group B there was statistically significant rise in systolic, diastolic and mean blood pressure postpneumoperitoneum as compared to baseline blood pressure. Post-operative cortisol level was significantly higher than baseline values and the level is more in Group B.Conclusion:Intravenous dexmedetomidine is more effective than oral pregabalin in attenuating perioperative stress response.

Effect of dexmedetomidine on perioperative stress and postoperative pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope

Objective: To investigate the effects of dexmedetomidine on perioperative stress and postoperative pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope. Methods: In this prospective study, one hundred patients undergoing radical resection of esophageal cancer in Affiliated Cancer Hospital of Zhengzhou University from January 2016 to October 2017, were randomly divided into control group (group C) and dexmedetomidine group (group D), n=50. All patients were anaesthetized (induced and maintained) with intravenous target-controlled infusion(TCl) of propofol and remifentanil, and intermittent intravenous injection of cisatracuriumbesylate. Bispectral index(BIS) was used to monitor the depth of anesthesia and maintained between 45-60 during operation.All patients received sufentanil (0.3 μg/kg) 30 min before the end of the operation and then received intravenous analgesia pump for postoperative patient controlled analgesia(PCA). Patients in group D received intravenous infusion of dexmedetomidine(1 μg/kg) 20 min before anesthesia induction, followed by intravenous pumping of dexmedetomidine(0.2 μg·kg(-1)·h(-1)) intraoperatively.Postoperative intravenous patient-controlled analgesia(PCA) was performed in all patients, with background doses of sufentanil 0.04 μg· kg(-1)·h(-1) for patients in group C, and sufentanil 0.025 μg·kg(-1)·h(-1) plus dexmedetomidine 0.1 μg· kg(-1)·h(-1) for patients in group D. The operation time, liquid input and output during operation, the number of PCA pressings after operation were recorded. At these time points: T(0)(the day before operation), T(1)(immediate before anesthesia induction), T(2)(1 h after emergence), T(3)(24 h after operation), T(4)(3 d after operation), T(5)(7 d after operation), T(6)(one month after operation), T(7)(3 months after operation) and T(8)(6 month after operation) , venous blood samples of patients were collected for detection of epinephrine, norepinephrine and corticosterone. The pain visual analogue scale(VSA) was used to assess pain levels in patients at T(2), T(3), T(4), T(5), T(6), T(7), T(8). Results: The age, sex ratio, body mass index (BMI) and ASA grading ratio in two groups were not significantly different(all P>0.05). There were no Significant differences in operation time, liquid input and blood output between group C and group D(all P>0.05). Within 24 h after operation, the sufentanil consumption in group D[(35.86±8.65)μg]was significantly less than that in group C[(59.53±15.26) μg, t=7.061, P<0.05], and the number of PCA pressing in group D(2.15±1.38) was obviously less than that in group C(5.85±2.16, t=4.971, P<0.05). Compared with group C, serum norepinephrines in group D was significantly less (t=13.276, 16.027, 14.319, 12.771, 12.296, respectively; all P<0.05) at T(1), T(2), T(3), T(4), T(5).And there were no difference between these two groups at T(0), T(6), T(7), T(8)(all P>0.05). Serum epinephrine in group D were significantly lower than them in group C at T(2), T(3), T(4), T(5) (t=6.153, 8.774, 9.127, 8.409, respectively; all P<0.05), but there were no difference between these two groups at T(0), T(1), T(6), T(7), T(8)(all P>0.05). Serum corticosterone in group D were sharply less than them in group C at T(2), T(3), T(4), T(5) (t=16.364, 15.306, 12.153, 12.592, respectively; all P<0.05), but at T(0), T(1), T(6), T(7), T(8), there were no difference between these two groups (all P>0.05). Compared with group C, the number of patients with postoperative pain(VAS score≥4) in group D was obviously less at T(6), T(7), T(8)(10 vs 20, 4 vs 12, 3 vs 10; χ(2)=4.762, 4.762, 4.332, respectively; all P<0.05). Conclusion: Perioperative application of dexmedetomidine can effectively decrease the perioperative stress response, obviously cut down the perioperative opioid consumption, and prevent the transition from postoperative acute pain to chronic pain in patients with radical resection of esophageal cancer under combined thoracoscope and laparoscope.

Ultrasound guided superior laryngeal nerve block as an adjuvant to generalanesthesia during endoscopic laryngeal surgery: A prospective, randomized, double-blind trial

IntroductionBlindly administered bilateral (B/L) superior laryngeal nerve (SLN) blocks, have been used to decrease the perioperative stress response of endoscopic laryngosurgeries. Use of ultrasound (USG) for giving these blocks is more likely to be successful, with fewer complications. We evaluated the efficacy of USG guided B/L SLN block in decreasing perioperative cough, sore-throat and hoarseness of voice. Material and methodsThis study was conducted on forty patients undergoing endoscopic laryngosurgery under GA. Patients were randomized into two groups of 20 patients each. Patients in group C received GA, whereas those in group L received USG-guided SLN block bilaterally with 2.5 ml of 2% lignocaine, along with GA. Postoperative cough, sore throat and hoarseness of voice was measured at 30 min, 2 h, 4 h and 24 h following transfer to post-anesthesia care unit. ResultsPatients receiving SLN block had significantly lower incidence of perioperative cough (20% in group L vs 90% in group C; p value - 0.0001) as well as sore throat (5% in group L vs 95% in group C; p value - 0.0001). In these patients, severity of hoarseness of voice was greater in the early postoperative period (100% in group L vs 70% in group C; p value - 0.027), while it decreased significantly at 24 h postoperatively(0.0% in group L vs 30% in group C; p value - 0.027). ConclusionUSG guided SLN block as an adjuvant to GA resulted in better recovery profile of the patients with significant reduction in postoperative cough, sore throat and hoarseness of voice.

Effects of dexmedetomidine on perioperative stress response, inflammation and immune function in patients with different degrees of liver cirrhosis.

Effects of dexmedetomidine (DEX) on perioperative stress response, inflammation and immune function in patients with different degrees of liver cirrhosis were investigated. A total of 94 patients with liver cirrhosis who were admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from December 2016 to November 2017 were included, and randomly divided into control and observation group (n=47). Patients in control group were given remifentanil for anesthesia, while patients in observation group were treated with remifentanil and for DEX anesthesia. Venous blood was collected immediately before induction of anesthesia (T1), 10 min (T2) after the beginning of surgery, immediately after surgery (T3) and 2 h after surgery (T4). Hemodynamic parameters, stress response factors, adverse reactions and levels of inflammatory cytokines and T lymphocyte subsets were compared between the two groups. The mean arterial pressure in both groups was lower at T2-T4 than that at T1 (p<0.05), and mean arterial pressure was lower in observation group than in control group (p<0.05). Visual analogue pain score (VAS) of observation group was significantly lower than that of control group at 6, 12 and 24 h after operation (p<0.05). There was no significant difference between the two groups in incidence of nausea, vomiting, hypoxemia and delayed awakening (p>0.05). Incidence of postoperative agitation in observation group was significantly lower than that in control group (p<0.05). The levels of CD3+, CD4+, and CD4+/CD8+ in both groups were significantly lower at T2-T4 than those at T1 (p<0.05). Levels of IL-10 and TNF-α in both groups were significantly higher at T2-T4 than those at T1, but levels of IL-2 and TNF-α were significantly lower in observation group than in control group (p<0.05). In conclusion, the use of DEX for anesthesia in patients with liver cirrhosis can improve hemodynamic stability, reduce stress response and reduce inflammation level without affecting immune function, which has important clinical significance.

The cortisol stress response induced by surgery: A systematic review and meta-analysis.

Surgery is a stressor that can be categorized by duration and severity and induces a systemic stress response that includes increased adrenal cortisol production. However, the precise impact of surgical stress on the cortisol response remains to be defined. We performed a systematic review and meta-analysis to assess the cortisol stress response induced by surgery and to stratify this response according to different parameters. We conducted a comprehensive search in several databases from 1990 to 2016. Pairs of reviewers independently selected studies, extracted data and evaluated the risk of bias. Cortisol concentrations were standardized, pooled in meta-analysis and plotted over time. We included 71 studies reporting peri-operative serum cortisol measurements in 2953 patients. The cortisol response differed substantially between moderately/highly invasive and minimally invasive surgical procedures. Minimally invasive procedures did not show a peri-operative cortisol peak, whereas more invasive surgeries caused a cortisol surge that was more pronounced in older subjects, women and patients undergoing open surgery and general anaesthesia. The duration of the procedure and the use of etomidate for induction of anaesthesia did not affect the cortisol response. The peri-operative cortisol stress response is dynamic and influenced by patient-specific, surgical and anaesthetic features. However, the available evidence is derived from highly heterogeneous studies, with only two of 71 studies measuring cortisol by mass spectrometry, which currently prevents a precise and reproducible definition of this response.

Effect of dexmedetomidine on blood coagulation in patients undergoing radical gastrectomy under general anesthesia: A prospective, randomized controlled clinical trial.

Background:Dexmedetomidine can inhibit the perioperative stress response, which plays an important role in postoperative hypercoagulability. This study aimed to investigate whether dexmedetomidine could attenuate the activation of postoperative coagulation.Methods:Patients undergoing open radical gastrectomy under total intravenous anesthesia were randomly allocated to the control group (group Con) and the dexmedetomidine group (group Dex). Dexmedetomidine was intravenously infused at 0.5 μg/kg over 10 minutes before anesthesia induction and then infused at a rate of 0.5 μg/kg/h until peritoneal closure in group Dex, whereas saline was administered in group Con. Blood samples were collected for thrombelastograph (TEG) analysis [reaction time (R time), clot formation time (K time), and clot formation rate (α angle)] and laboratory coagulation testing before dexmedetomidine administration and at the end of surgery.Results:Coagulation was activated after radical gastrectomy, as indicated by TEG analysis and the increased concentrations of plasma fibrin (fibrinogen) degradation product (FDP) and thrombin-antithrombin complex (TAT). The R and K times were significantly prolonged and α angle was significantly decreased in group Dex compared with that in group Con at the end of surgery (P < .05). The concentrations of plasma TAT and FDP in group Dex were significantly lower than those in group Con at the end of surgery (P < .05 or .01).Conclusion:Adjunctive dexmedetomidine with general anesthesia attenuates the activation of coagulation following radical gastrectomy.

Application of iliac fascia gap blockage in elderly patients with femoral intertrochanteric fractures and its impact on stress indicators

Objective To investigate the anesthetic effect of the iliac fascia gap block in patients with senile femoral intertrochanteric fractures and its effect on stress indicators. Methods A total of 100 elderly patients with intertrochanteric fractures were selected and randomly divided into control group(n=50) and observation group(n=50) by digital table.The control group was treated with general anesthesia.The observation group was anesthetized with iliac fascia gap block on the basis of the control group.The levels of norepinephrine(NE), epinephrine(E) and cortisol(Cor) were measured by double antibody radioimmunoassay.The effects of anesthesia and stress indicators of the patients were compared. Results The dosages of propofol and remifentanil in the observation group were (721.21±21.24)mg and (421.25±8.94)μg, respectively, which were less than those in the control group [(946.46±24.35)mg and (545.42±9.13)μg, t=18.832, 19.231, P 0.05). The NE, E, Cor levels at 24h after operation had no statistically significant differences between the two groups (all P>0.05). The postoperative 24h VAS scores in the two groups were lower than those after extubation and before anesthesia(t=14.395, 13.882, 19.662, 12.501, all P 0.05). Conclusion The use of iliac fascia gap blockage in elderly patients with intertrochanteric fractures is effective and can reduce the dose of anesthetic drugs, reduce perioperative stress response, and does not increase the incidence of adverse reactions, it is worthy of application. Key words: Iliac fascial space block; Femoral fractures; Anesthesia; Aged

Enhanced recovery after surgery and video-assisted thoracic surgery lobectomy: the Italian VATS Group surgical protocol.

Enhanced recovery after surgery (ERAS®) is a strategy that seeks to reduce patients' perioperative stress response, thereby reducing potential complications, decreasing hospital length of stay and enabling patients to return more quickly to their baseline functional status. The concept was introduced in the late 1990s and was first adopted in patients undergoing open colorectal surgery. Since then, the concept of ERAS has been adopted by multiple surgical specialties. The diffusion of video-assisted thoracic surgery lobectomy (VATS-L) sets also the surgical treatment of lung cancer as a new area for ERAS development. In this paper, we present the Italian VATS Group (www.vatsgroup.org) surgical protocol as part of the ERAS clinical pathway belonging to the VATS-L national database.

Enhanced Recovery After Surgery (ERAS®) in thoracic surgical oncology.

Enhanced recovery after surgery (ERAS®) is a strategy that seeks to reduce patients' perioperative stress response, thereby reducing potential complications, decreasing hospital length of stay and enabling patients to return more quickly to their baseline functional status. The concept was introduced in the late 1990s and was first adopted for use with patients undergoing open colorectal surgery. Since that time, the concept of ERAS has spread to multiple surgical specialties. This article explores the key elements for patient care using an ERAS protocol applied to minimally invasive thoracic surgery.