Anesthesia Recovery Period Research Articles

Effect of mild hypothermia on recovery from cisatracurium blockade during recovery from anesthesia

Objective To evaluate the effect of mild hypothermia on the recovery from cisatracurium blockade during the recovery from anesthesia in patients .Methods Thirty ASA physical status Ⅰ or Ⅱ patients , aged 18-64 yr , with body mass index 18-25 kg/m2 , scheduled for elective abdominal surgery under general anesthesia ,were enrolled in the study .The patients were divided into 2 groups according to the body temperature recorded when cisatracurium infusion was stopped at the end of surgery .The body temperature 36.0-36.9 ℃served as normothermia group （group N , n=14 ） and 34.0-35.9 ℃ served as mild hypothermia group （group H , n= 16 ） . The body temperature was measured by a thermocouple placed in the nasopharynx . Neuromuscular function was monitored by measuring the evoked mechanical response of the adductor pollicis muscle to supramaximal train-of-four （TOF） stimulation （frequency 2 Hz ,wave length 0.2 ms ,intensity 50 mA ,interval 15 s） of the ulnar nerve at the wrist using TOF-Watch SX？ .Cisatracurium was intravenously infused at 1-3μg·kg-1 ·min-1 during surgery to maintain neuromuscular block with 1% 〈first twitch （T1 ）≤10% ,and the infusion was stopped at 30 min before the end of surgery .The recovery index （time for T1 to recover from 25% to 75% ） ,time for T1 to recover from 10% to 75% ,and time for T1 to recover from 10% to T4/T1 ratio of 0.9 were recorded . Results Compared with group N ,the recovery index ,time for T1 to recover from 10% to 75% ,and time for T1 to recover from 10% to T4/T1 ratio of 0.9 were significantly prolonged in group H （ P〈0.05） .Conclusion Mild hypothermia can inhibit the recovery from cisatracurium blockade during the recovery from anesthesia in patients . Key words: Hypothermia,induced; Anesthesia recovery period; Atracurium; Neuromuscular blockade

Analysis of risk factors for postoperative nausea and vomiting following neurosurgical anesthesia

Objective To investigate the incidence and risk factors for postoperative nausea and vomiting (PONV) following neurosurgical anesthesia.Methods 7 843 patients undergoing elective neurosurgery were included in this study.Patients' perioperative informations were recorded.Univariate and multivariate logistic regression was used to analyze the risk factors for PONV.Results PONV developed in 1 176 patients within 3 h following neurosurgery and the incidence was 15％.The logistic regression analysis indicated that the risk factors for PONV included female sex,infratentorial craniotomy,longer duration of surgery and postoperative median to severe pain.5-HT3 receptor antagonists prophylaxis and total intravenous anesthesia (TIVA) were protective factors (P ＜ 0.05).Conclusions Female sex,infratentorial craniotomy,longer duration of surgery and postoperative median to severe pain were predictors of PONV.5-HT3 receptor antagonists prophylaxis or TIVA will decrease the incidence of PONV. Key words: Postoperative nausea and vomiting; Risk factors; Neurosurgical procedures; Anesthesia recovery period

Effects of different methods of administration on clinical pharmacodynamics of cisatracurium during liver transplantation

Objective To evaluate the effects of different methods of administration on clinical pharmacodynamics of cisatracurium during liver transplantation.Methods Twenty-four ASA physical status Ⅲ patients of both sexes,aged 18-63 yr,weighing 60-88 kg,with body mass index of 20-30 kg/m2,scheduled for elective liver transplantation,were randomly divided into 2 groups (n =12 each):continuous infusion group (group C) and intermittent bolus injection group (group Ⅰ).The total intravenous anesthesia was used during surgery.When T1 recovered to 10％ of control height after induction of anesthesia,continuous infusion of cisatracurium was started with an initial rate of 1.5 μg· kg-1 · min-1,and the infusion rate was manually adjusted to maintain T1 at about 10％ in group C,and intermittent iv boluses of cisatracurium 0.03 mg/kg were given to maintain T1 ≤ 10％ in group Ⅰ.The use of muscle relaxants was stopped immediately after peritoneum closure.The consumption of cisatracurium per minute,time for T1 to recover from 10％ to 25％,recovery index and time for recovery of spontaneous breathing after surgery were recorded.Results Compared with group Ⅰ,the consumption of cisatracurium per minute was significantly reduced and the time for recovery of spontaneous breathing after surgery was shortened (P ＜ 0.05),and no significant changes were found in the time for T1 to recover from 10％ to 25％ and recovery index in group C (P ＞ 0.05).Conclusion Compared with intermittent bolus injection,continuous infusion of cisatracurium during liver transplantation is helpful in improving the clinical potency of the muscle relaxant and in reducing the occurrence of complications during anesthesia recovery period. Key words: Infusions, intravenous ; Injections, intravenous ; Neuromuscular nondepolarizing agents ; Liver transplantation ; Pharmacology, clinical

Alleviate side effect of post-anesthesia recovery in patients with esophageal surgery by infusing different doses of dexmedetomidine

Objective To observe alleviation of side effect in post-anesthesia recovery patients with esophageal surgery by continuous infusion of different doses of dexmedetomidine (DEX).Methods A total of 60 patients with esophageal cancer surgery were randomly divided into three groups,20 patients in each group.Before induction of anesthesia,0.8 μg/kg of DEX were pumped into patients of group D,then 0.4 μg·kg-1·h-1 of DEX were continuously infused till the end of surgery in group D1.0.2 μg·kg-1·h-1 of DEX were continuously infused till the end of surgery in group D2.patients of group C were continuously infused saline as controls.Mean artery pressure(MAP) and heart rate(HR) were recorded once in the recovery room(T1),extubation time(T2) and five min after extubation(T3).The recovery time,agitation score and Ramsay score were recorded,the Urapidil injection 25 mg or the esmolol injection 20 mg were given while blood pressure was＞180 mm Hg/100 mm Hg(1 mm Hg=0.133 kPa) or HR was＞110 bpm.Results the recovery time of group D1(30.3±4.7) min was significantly higher than group D2 and group C(P＜0.05),group D2 and group C had no difference (P＞0.05).MAP and HR of group D1 and group D2 at extubation were significantly higher than the recovery room.MAP and HR in group C at T2 (117±12) mm Hg,(107±8) bpm and T3 (108±9) mm Hg,(118±11) bpm were significantly increased compared with the recovery room (P＜0.05).MAP and HR in group D1(88±8) mm Hg,(79±5) bpm and group D2(93±8) mm Hg,(81 ±6) bpm at T2 were significantly descreased compared with group C.the dosage of urapidil and esmolol in group C were significantly increased compared with group D.agitation score of group C (2.9±0.4) significantly higher than group D1 (1.2±0.8) and group D2(1.4±0.6) (P＜0.05).the sedation score of group C (1.1 ±0.5) significantly lower than group D1 (4.5±1.2) and group D2(4.0±0.7)(P＜0.05).Conclusions DEX was able to alleviate the side effect of patients in post-anesthesia recovery.0.2 μg·kg-1 ·h-1 of DEX will not affect the recovery time and can inhibit postoperative agitation,and reduce the adverse effects in the anesthesia recovery period. Key words: Dexmedetomidine; Esophageal surgery; General anesthesia recovery period; Side effect

Effects of dexmedetomidine or dezocine alone or combination of the two agents on emergence agitation in patients undergoing thoracic surgery

Objective To evaluate the effects of dexmedetomidine or dezocine alone or the combination of the two agents on the emergence agitation in patients undergoing thoracic surgery.Methods Eighty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 48-75 kg,scheduled for elective thoracic surgery under general anesthesia,were randomly divided into 4 groups (n =20 each):control group (group C),dexmedetomidine group (group DEX),dezocine group (group DEZ) and dexmedetomidine + dezocine group (group DEX + DEZ).In group DEX,dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia,followed by continuous infusion of dexmedetomidine at 0.4 μg· kg-1 · h-1 until beginning of chest closure.Dezocine 0.1 mg/kg was injected intravenously after beginning of chest closure in group DEZ.In group DEX + DEZ,dexmedetomidine 0.5 μg/kg was injected intravenously at 15 min before induction of anesthesia,followed by continuous infusion of dexmedetomidine at 0.4 μg·kg-1 ·h-1 until beginning of chest closure and then dezocine 0.1 mg/kg was injected intravenously.While the equal volume of normal saline was given instead in group C.Flurbiprofen axetil 50 mg was injected intravenously at beginning of skin closure in each group.Venous blood samples were collected for determination of plasma C-reactive protein (CRP),TNF-α and IL-10 levels at 10 min before induction of anesthesia (T1),before skin closure (T2),immediately after extubation (T3) and 15 min after extubation (T4).Side effects such as agitation during emergence from anesthesia were recorded.Sedation was assessed using Ramsay score.Results Compared with group C,the levels of plasma CRP and TNF-α at T2-4 and ratio of TNF-α/IL-10 were significantly decreased,the levels of IL-10 were increased at T2-4,the degree and incidence of agitation were decreased,and Ramsay score was increased in the other three groups (P ＜ 0.05).Compared with groups DEX and DEZ,the levels of plasma CRP and TNF-α at T2_4 and ratio of TNF-α/IL-10 were significantly decreased,the levels of IL-10 were increased at T2-4,and the degree and incidence of agitation were decreased in group DEX + DEZ (P ＜0.05).No side effects such as hypotension,bradycardia,respiratory depression,nausea and vomiting were observed in the four groups.Conclusion Dexmedetomidine or dezocine alone or combination of the two agents can decrease the degree and occurrence of emergence agitation and inhibit the inflammatory response simultaneously,and the combination of the two agents provides better efficacy than either alone in patients undergoing thoracic surgery. Key words: Dexmedetomidine; Analgesics, opioid; Anesthesia recovery period; Psychomotor agitation

Effects of clinical nursing pathway on patients with intranasal endoscopic cerebrospinal fluid rhinorrhea repair surgery

Objective To explore the effects of clinical nursing pathway on patients with intranasal endoscopic cerebrospinal fluid rhinorrhea repair surgery.Methods Totals of 69 patients received the implementation of the repair of cerebrospinal fluid rhinorrhea were recruited and randomly divided into intervention group (n =35) and control group (n =34).Control group received traditional preoperative visits and intraoperative coordination,traditional preoperative visits,while intervention group received clinical nursing pathway including preoperative interview pathway,operation day support pathway,and postoperative interview Pathway.Then,anxiety,surgical start time,blood loss,anesthesia recovery time and recovery period of anesthesia complications and patients' satisfaction were observed and compared.Results The SAS score of intervention group in one day before operation and before anesthesia was (46.38 ± 4.77),(49.86 ± 5.59),respectively,lower than that of control group [(50.76 ± 5.81),(53.99 ± 6.59)],and the difference was statistically significant (P ＜ 0.01).After the intervention,blood loss [(199.64 ± 46.72) vs (240.67 ±58.68) ml],anesthesia recovery time [(26.10 ± 5.09) vs (34.50 ± 6.76) min],hospital stay [(20.42 ±2.73) vs (24.61 ± 3.63) d],patients' satisfaction points [(4.56 ± 0.47) vs (3.07 ± 0.52)] in intervention group were significantly lower than that in control group (t =14.152,3.138,3.020,6.056,11.881,respectively;P ＜ 0.01).Conclusions Patients with cerebrospinal fluid rhinorrhea repair treat with surgery clinical care path,can effectively relieve the patient's preoperative anxiety,reduce anesthesia recovery time,blood loss and anesthesia recovery complications and improve the therapeutic effect of perioperative and the patient satisfaction. Key words: Clinical pathway; Endoscopy; Cerebrospinal fluid rhinorrhea; Intraoperative period ; Nursing intervention

Effect of dexmedetomidine on responses to endotracheal extubation during recovery from general anesthesia in patients with hypertension:a multicenter, randomized, blind, placebo-controlled clinical trial

Objective To evaluate the effects of dexmedetomidine on the responses to endotracheal extubation during recovery from general anesthesia in patients with hypertension in a muhicenter,randomized,blind,placebo-controlled clinical trial.Methods Five hundred and eighty ASA Ⅱ or Ⅲ patients with hypertension from 26 centers of both sexes,aged 18-64 yr,weighing 40-100 kg,scheduled for elective surgery under general anesthesia,expected surgery time 1-4 h,requiring endotracheal extubation after surgery,were randomly divided into 4groups (n =145 each):control group (group C) and different doses of dexmedetomidine group (group D1-3).Anesthesia was induced with iv injection of midazolam,fentanyl,propofol,and rocuronium or vecuronium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained with inhalation of sevoflurane and intermittent iv boluses of fentanyl and rocuronium or vecuronium.Dexmedetomidine 0.4,0.6 and 0.8 μg/kg (10 ml) were infused intravenously over 10 min starting from 30 min before the end of operation in groups D1-3,respectively.While the equal volume of normal saline was administered instead in group C.The patients were sent to postanesthesia care unit after extubaion.The time for recovery of spontaneous breathing,emergence time,time for recovery of orientation and time for Aldrete score ≥ 9 were recorded.The occurrence of adverse events and amount of vasoactive drugs used were also recorded.Results Compared with group C,the incidence of severe tachycardia and requirement for urapidil were significantly decreased in groups D1-3,and the incidence of severe hypertension was decreased in group D3 (P ＜ 0.05).There was no significant difference in the other indexes among the four groups (P ＞ 0.05).Conclusion Dexmedetomidine 0.8 μg/kg infused intravenously and slowly before the end of surgery can effectively inhibit the responses to endotracheal extubation during recovery form general anesthesia in patients with hypertension. Key words: Dexmedetomidine ; Anesthesia recovery period ; Hypertension ; Hemodynamics ; Postoperative complications

95% effective target plasma concentration of remifentanil for tracheal tube tolerance during recovery period from anesthesia following cervical spine surgery

Objective To determine the 95 ％ effective target plasma concentration (EC95) of remifentanil for tracheal tube tolerance during the recovery period from anesthesia following cervical spine surgery.Methods Thirty ASA Ⅰ or Ⅱ patients,aged 18-60 yr,weighing 50-80 kg,scheduled for elective cervical spine surgery under total intravenous anesthesia,were enrolled in this study.Anesthesia was induced with iv injection of propofol,sufentanil and rocuronium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with iv infusion of propofol and target-controlled infusion of remifentanil.The target plasma concentration (Cp) of remifentanil was set at 4-6 μg/L.BIS value was maintained at 40-60.Infusion of propofol was stopped at the end of surgery.Participants were allocated to a dose of remifentanil by 3-patient cohorts.Six Cps were selected from 1.0-3.5 μg/L before beginning and they were 1.0,1.5,2.0,2.5,3.0,3.5 μg/L.The Cp of remifentanil was 3.0 μg/L in the first cohort.After completion of the trial in each cohort,the posterior probability of each concentration was calculated according to the condition of sedation/analgesia and anterior probability of each concentration.The concentration with the posterior probability closest to 95 ％ was chosen as Cp in the next cohort.The concentration-probability curve was made according to the posterior probability of each concentration,and then EC95 and 95 ％ confidence interval of remifentanil were calculated.Results The EC95 and 95 ％ confidence interval of remifentanil were 2.77μg/L (2.65-2.83 μg/L) for tracheal tube tolerance during the recovery period from anesthesia following cervical spine surgery.Conclusion The EC95 of remifentanil for tracheal tube tolerance during the recovery period from anesthesia is 2.77 μg/L in patients undergoing cervical spine surgery. Key words: Piperidines; Anesthesia recovery period; Dose-response relationship, drug

Relationship between emergence agitation during recovery from general anesthesia and postoperative cognitive dysfunction

Objective To evaluate the relationship between emergence agitation (EA) during recovery from general anesthesia and postoperative cognitive dysfunction (POCD).Methods Two hundred and eighty ASA Ⅰ or Ⅱ patients,aged 18-70 yr,weighing 52-80 kg,undergoing elective surgery,were included.Anesthesia was induced with midazolam,fentanyl,propofol and cisatracurium.The patients were tracheal intubated and mechanically ventilated.Anesthesia was maintained with remifentanil,propofol and cisatracurium.EA was assessed at 15-40 min after extubation by using Post-operative Quality Recovery Scale and the cognitive function was assessed at day 1 before operation and days 1-7 after operation.Patients were divided into POCD or nonPOCD group according to the occurrence of POCD.The general data of patients,preoperative complications and types of surgery were recorded.If there was significant difference between the 2 groups,the factor was analyzed using multi-factor logistic regression to select the risk factor for incidence of POCD.Results The incidence of POCD was 40.7 ％.The results of logistic regression analysis showed that the dangerous degree of the risk factors for POCD in order from high to low were emergence agitation,duration of anesthesia and age.Conclusion EA during recovery from general anesthesia is an independent risk factor for POCD. Key words: Psychomotor agitation; Anesthesia recovery period; Cognition disorders ; Postoperative complications

Total laparoscopic hysterectomy – indications and complications of 158 patients

Hysterectomy is one of the most common gynecological procedures. Development of modern laparoscopic techniques made it a crucial tool in contemporary gynecology both in diagnosis and treatment. Increasing experience and improved laparoscopic instruments enabled gynecologists to extend indications for laparoscopic procedures as well as the range of the operation itself. 1) to present data (particularly perioperative) of patients who underwent laparoscopic hysterectomy 2) to analyze various information including: indication for the procedure, surgery duration, evaluation of different parameters like: volume of the excised uterus, postoperative HB and HCT drop, length of hospital stay as well as short- and long-term complications. The analysis included peri- and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Indication for hysterectomy and duration of operation were analyzed. Uterine volume, postoperative HB and HCT drop, time of hospital stay and complications were evaluated. In the study a description of the method of laparoscopic hysterectomy was presented. Mean time of procedure was 68 min. (58-135 min.). Basing on operational protocols, the time of operation was measured from the moment laparoscopy started until the patient was fully awake after anesthesia. No adjustments were made for longer anesthetic recovery period. Estimated blood loss was 166.6 ml. Mean HB drop was 1.29 g/dl (0, 1-3 g/dl). Mean volume of the excised uterus was 108.24 cm3 (25.27-440.86 cm3). In 44 patients (27.84%) bilateral salpingo-oophorectomy was performed. In 4 cases (2.53%) there was an indication for postoperative antibiotics. None of the patients required blood transfusion or conversion to open surgery or the need to re-operate. Mean hospital stay after the surgery was 2.9 days. Overall, only 2 patients suffered long-term complications (1.26%): three weeks after the surgery urethro-vaginal fistulas occurred due to thermal injury to the ureter. That complication was noted during the first year of using this technique. Between 2008 and 2011 that type of adverse effect was not reported. The analysis included perioperative and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Data suggest that patients benefit from this procedure which is safe, associated with short postoperative recovery time, minimal blood loss and low complication rate, as well as good plastic result. We recommend laparoscopic hysterectomy as an alternative to open hysterectomy in cases when it can be safely performed.

Risk factors for emergence agitation in patients after general anesthesia

Objective To determine the risk factors for emergence agitation (EA) during the recovery period after general anesthesia.Methods One thousand and thirty-four patients of both sexes aged 18-89 yr undergoing general anesthesia were divided into EA group and non-EA group.EA occurring during recovery from general anesthesia was assessed by using Riker sedation-agitation scale.Age,sex,complication,education,medical history,ASA physical status,type and duration of anesthesia and operation,volume of blood loss,fluid replacement,urine volume,duration of stay in PACU,number of drainage tubes and so forth were recorded.Multivariate logistic regression was used to analyze the risk factors for the occurrence of EA.Results Thirty-six patients developed EA during recovery from anesthesia.The incidence of EA was 3.5 ％.Logistic regression indicated that high risk operation,premedication with diazepam,induction of anesthesia without midazolom and fluid replacement during operation were the risk factors for EA (P ＜ 0.05).Conclusion High-risk operation,premedication with diazepam,induction of anesthesia without midazolom and fluid replacement during operation are the risk factors for EA during recovery from general anesthesia. Key words: Anesthesia, general; Anesthesia recovery period; DYSPHORIA; Risk factor; Postoperative complication

Causes of restlessness in the recovery period of general anesthesia

Objective To analyze the causesness of restlessness of general anesthesia.Methods After entry into PACU,306 patients under general anesthesia were observed for effects of various adverse stimulation before or after extubation,different gender,methods of anesthesia,types of surgical procedures,uses of analeptics and postoperative analgesics on postoperative restlessness.Results Restless occurred in 61 patients ( 19.93％ ) during the post-operative recovery period.Thoracic surgery ( P=0.01 ＜ 0.05 ),male ( P=0.014 ＜ 0.05 ),and no postoperative analgesic measures ( P=0.004 ＜ 0.05 ) could lead to restlessness.The factors for restlessness were endotracheal tube stimulation,pain,urethral catheter stimulation,and short-term hypoxia.Conclusions Many factors can lead to postoperative restlessness.Appropriate anesthesia,rational uses of anesthesia drugs,proper postoperative analgesia,appropriate timing of extubation,and avoidance of various adverse stimulation could significantly reduce the incidence of postoperative restlessness. Key words: Adverse stimulation; Restlessness; General anesthesia

Effects of dexmedetomidine on quality of emergence from general anesthesia in elderly patients undergoing orthopedic operation

Objective To evaluate the effects of dexmedetomidine on the quality of emergence from general anesthesia in the elderly patients undergoing orthopedic operation.Methods Sixty ASA Ⅰ -Ⅲ patients,aged ≥65 yr,undergoing elective orthopedic operation,were randomly assigned to one of 3 groups ( n =20 each):control group (group C) ; dexmedetomidine 0.25 μg/kg group (group D1 ) and dexmnedetomidine 0.50 μg/kg group (group D2).In groups D1 and D2,15 min befone anesthesia induction,dexmedetomidine 0.25 μg/kg and 0.50 μg/kg were infused over 15 min respectively,while the equal volume of normal saline 15 ml was given instead of dexmedetomidine in group C.After anesthesia induction,tracheal intubation was performed and the patients were mechanically ventilated.General anesthesia was used in the three groups.Flurbiprofen 1 mg/kg was injected intravenously immediately before skin incision.The time for recovery of spontaneous breathing,emergence time,extubation time,and adverse reactions were recorded.Pain was assessed with verbal rating scale (VRS) at 5 min after emergence from anesthesia.Results Compared with group C,the incidence of agitation,bucking,and adverse cardiovascular events and VRS score were significantly decreased,and the rate of effective analgesia was significantly increased in groups D1 and D2,and the emergence time and extubation time were significantly prolonged in group D2(P ＜0.05).Compared with group D1,the emergence time and extubation time were significantly prolonged in group D2(P＜0.05).There was no significant difference in VRS score,the rate of effective analgesia and the incidence of adverse renctions between groups D1 and D2(P＞0.05).Conclusion Ⅳ infusion of dexmedetomidine 0.25 μg/kg before induction of general anesthesia can effectively improve the quality of emergence from general anesthesia in the elderly patients undergoing orthopedic operation. Key words: Dexmedetomidine; Aged; Anesthesia,general; Anesthesia recovery period

Incidence of postoperative nausea and vomiting following neurosurgical procedures in postanesthesia care unit

Objective To study the incidence of postoperative nausea and vomiting(PONV) after different neurosurgical procedures in the postanesthesia care unit (PACU).Methods 5 078 adult patients who had undergone neurosurgical procedures enrolled into PACU were divided nine groups.The incidence of PONV were recorded and treated.Results The overall incidence of PONV following neurosurgical procedures was 15.7％.The incidence of PONV in patients undergoing craniopharyngioma、ventricular tumor、infratentorial craniotomy、intracranial aneurysm and arteriovenous malformation、supratentorial tumor、epilepsy、transsphenoidal surgery of pituitary tumor、spinal cord tumor and others was 28.4％ 、26.7％、24.2％ 、20.8％、19.3％、15.8％、8.9％、8.4％ and 7.5％,respectively.Conclusions The overall incidence of PONV in PACU following neurosurgical procedures is approximately 16％.The incidence of PONV following neurusurgical procedures is different and craniopharyngioma、ventricular tumor and posterior fossa tumor are high risk factors for PONV.Strategies for the prevention of PONV following neurusurgical procedures are required. Key words: Postoperative nausea and vomiting; Neurosurgical procedures; Anesthesia recovery period

A comparison of quality of emergence from TCI of sufentanil versus remifentanil supplementing propofol-sevoflurane anestbesia in patients undergoing radical colo-rectal cancer resection

Objective To compare the quality of emergence from TCI of sufentanil and remifentanil supplementing propofol-sevoflurane anesthesia in patients undergoing radical colo-rectal cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients of both sexes aged 40-64 yr undergoing elective radical colo-rectal cancer resection were allocated into 2 groups ( n =20 each):sufentanil group (group S) and remifentanil group (group R).Anesthesia was induced with propofol TCI at plasma concentration (Cp) of 4.0 μg/ml in both groups and sufentanil TCI (effect-site concentration Ce =0.4 ng/ml ) or remifentanil TCI ( Cp =4.0 ng/ml).Tracheal intubation was facilitated with vecuronium 0.1 mg/kg.The patients were mechanically ventilated (VT =8-10 ml/kg,RR =12-16 bpm).PErCO2 was maintained at 30-40 mm Hg.Anesthesia was maintained with propofol TCI-sevoflurane supplemented with sufentanil (Ce=0.25 ng/ml) or remifentanil (Cp=2.5 ng/ml).The depth of anesthesia was maintained at Narcotrend index of 37-56 by adjusting Cp of propofol TCI and sevoflurane concentration.The infusion of sufentanil was discontinued at 40 min before the conclusion of the operation while remifentanil was administered until the end of surgery.The incidence of postoperative adverse events,the time from the end of operation to eye openg and the time to extubation were recorded.Reesults The two groups were comparable with respect to demographic data.Neither group developed prolonged emergence and respiratory depression but the time from the end of operation to eye opening and the time to extubation were significantly longer in group S than in group R.The incidence of hypertension and tachycardia,agitation,shivering aad coughing were significantly lower in group S than in group R.Conclusion The quality of emergence from sufentanil supplementing propofol-sevoflurane anesthesia is higher than that from remifentanil. Key words: Sufentanil; Piperidines; Drug delivery systems; Anesthesia recovery period; Recovery quality

General anesthesia recovery period complicated by hysteria

The hysteria coma is a kind of pseudo-coma.It's rare during anesthesia,and coma during emergence from anesthesia is usually regarded as an accidental event.Hence,the identification of this event is very important.We reported one case who suffered from coma immediately after awakening from anesthesia.This case was diagnosed as pseudo -coma-hysteria coma.An anesthesiologist should have the ability of identification of each kind of comas.A differential diagnosis program should be initiated once coma occurs during anesthesia.Early diagnosis and treatment are very important for outcomes of patients. Key words: Anesthesia,general; Anesthesia recovery period; Coma; Hysteria

Effects of the induction with Dezocine on incidence of the postoperative agitations of the patients during recovery period after remifentanil anesthesia

Objective To investigate the effects of induction with Dezocine to prevent the agitation of the patient after remifentanil anesthesia.Methods 60 patients of upper abdominal surgery,ASA Ⅰ ～ Ⅱ class,were randomly divided into 3 groups,20 patients in each group,anesthesia was induced with the midazolam 0.05 mg/kg,propofol 1 ～2mg/kg,vecuronium 0.12mg/kg.Analgesic drugs were administer as follow:control group,remifentanil ( group Rmf )1 μg/kg; fentanyl group ( group F) 4 μg/kg; Dezocine group ( group D) 0.2mg/kg.Remifentanil、propofol are used to maintain anesthesia.The time of recovery and extubation,the VAS pain score,the Ramsay score and adverse reactions such as vomiting,respiratory depression after extubation were recorded.Results Compared with group Rmf,the hemodynamic parameters was more stable in group F and group D.Compared with group F ( 1 μg/kg),the VAS pain score,the Ramsay score and adverse reactions significantly decreased in group D ( P ＜ 0.05 ),and the time of extubation in group F was longer than group D(P ＜ 0.05).Conclusion 0.2mg/kg of Dezocine could be used for the induction of anesthesia to reduce the incidence of agitation and adverse reactions during recovery period. Key words: Anesthesia recovery period; Dezocine ; Fentanyl; Remifentanil

Incidence and nursing of postoperative nausea and vomiting following neurosurgery in the postanesthesia care unit

Objective To analyze incidence and nursing strategies of postoperative nausea and vomiting after different neurosurgery in the postanesthesia care unit (PACU).Methods 5 078 adult patients who had undergone neurosurgery enrolled into PACU were retrospectively investigated. The incidence and nursing strategies of postoperative nausea and vomiting were analyzed.Results The overall incidence of PONV following neurosurgery was 15.7％ (798 cases).The incidence of PONV in patients undergoing craniopharyngioma was 28.4％ ( 25/88),ventricular tumor 26.7％ (35/131 ),infratentorial craniotomy 24.2％ ( 157/650),intracranial aneurysm and arteriovenous malformation 20.8％ (87/4 i 8 ),supratentorial tumor 19.3％ (297/1 535 ),epilepsy 15.8％ ( 16/101 ),transsphenoidal surgery of pituitary tumor 8.8％ ( 88/991 ),spinal cord tumor 8.4％(52/619) and others 7.5％ respectively.Conclusions The overall incidence of PONV in PACU following neurosurgery was approximately 16％.These results indicate that the incidence of PONV following neurosurgery is different and craniopharyngioma,ventricular tumor and posterior fossa tumor are high risk for PONV.Nursing strategies for the prevention of PONV following neurosurgery are required. Key words: Postoperative nausea and vomiting; Neurosurgery procedures; Anesthesia recovery period; Nursing

The effects of different fractions of inspired oxygen during anesthesia recovery period on oxygen reserve and pulmonary gas exchange

Background To observe the effects of different fractions of inspired oxygen(FiO2)during anesthesia recovery period on oxygen reserve and pulmonary gas exchange before extubation.Methods One hundred and fifty-two non-smoking patients with elective surgery done under general anesthesia were included in this study.After entering post anesthesia care unit (PACU),all the patients were mechanically ventilated with SIMV mode in FiO20.35.When a stable end-tidal oxygen concentration was achieved,a lung recruitment maneuver was performed and then the mode of ventilation went back to synchronized intermittent mandatory ventilation(SIMV).The patients were randomly assigned to 4 groups(n=38):FiO2=0.35,FiO2=0.5,FiO2=0.75,FiO2=1.0.The patients were ventilated with different concentrations of oxygen corresponding to their grouping for 5 min.The ventilator was stopped and the time of apnea tolerance was recorded.Blood samples were taken from dorsal artery of foot for blood-gas analysis.The shunt(Qs/Qt)and PaO2/FiO2 were calculated as well.Results The time to apnea tolerance were in turn(129±42),(178±61),(340±152),(421±153)s(P＜0.001)in group 0.35FiO2,group 0.50FiO2,group 0.75FiO2 and group 1.0FiO2.Compared with group 0.75FiO2,apnea tolerance in group 1.0FiO2 was longer,but it was not statistically significant.Apnea tolerance in group 1.0FiO2 was significantly longer than in group 0.35FiO2 or group 0.50FiO2.Apnea tolerance in group 0.75FiO2 was significantly longer than in group 0.35FiO2 or group 0.50FiO2.Apnea tolerance in group 0.50FiO2 was longer than in group 0.35FiO2,which was not statistically significant.Shunt after apnea were in turn(4.1±1.1),(4.6±1.3),(5.1±2.5),(13.1±4.5)％ in group 0.35FiO2,group 0.50FiO2,group 0.75FiO2 and group 1.0FiO2,respectively.Shunt in group 0.35FiO2,group 0.50FiO2 and 0.75FiO2 was significantly less than that in group 1.0FiO2(P＜0.001).PaO2/FiO2 after apnea were(494±75),(523±70),(536±80),(423±94)(P＜0.001)in the turn of group 0.35FiO2,group 0.50FiO2,group 0.75FiO2 and group 1.0FiO2.Pao2/FiO2 after apnea in group 0.35FiO2,group 0.50FiO2 and group 0.75FiO2 was significant larger than in group 1.0FiO2.Conclusions The use of 75％ oxygen can improve the pulmonary gas exchange,accompanied by shortened apnea tolerance. Key words: Fraction of inspired oxygen; Oxygen reserve; Pulmonary gas exchange; Apnea tolerance; Intrapulmonary shunt

Risk factor analysis of emergence agitation during anesthesia recovery period in 90 patients with hepatobiliary diseases

Objective To analyze the risk factors of emergence agitation in patients with hepatobiliary diseases.Methods A total of 110 patients with hepatobiliary disease were enrolled in the present study.The level of emergence agitation was scored by sedation-agitation scale (SAS) 30 min after the surgery.Patients with SAS 4,were excluded.Related medical data of the rest 90 patients were subjected to univariate and multivariate Logistic regression for analysis of risk factors of emergence agitation.Results Univariate analysis revealed that the airway management method,anesthesia maintenance method,operation time and the use of anesthetic gas absorber were significantly correlated with the incidence of agitation (P values being 0.014,0.011,0.042 and 0.019,respectively).Multivariate analysis revealed that induction with midazolam,urinary catheterization after anesthesia and total inhalational anesthesia were significantly correlated with the incidence of agitation (P values being 0.026,0.049 and 0.004,and the OR values being 5.481,10.867,and 11.604,respectively).Conclusion In patients with hepatobiliary diseases,induction with midazolam,total inhalational anaesthesia and urinary catheterization after anesthesia are associated with high incidence of emergence agitation following general anaesthesia.