ObjectiveTo Summarize and analyze the pheochromocytoma complications of surgery patients and its influential factors, in order to provide a basis for preoperative assessment and postoperative support treatment for the patients. MethodsWe reviewed the clinical data of 88 patients with pheochromocytoma from West China Hospital between January 2010 and December 2012. Among them, 35 had complications (complication group), and the other 53 had no complications (non-complication group). We analyzed preoperative blood catecholamine levels, preoperative preparation, tumor size, tumor location and surgical approach in all these patients. ResultsThere were 16 patients (45.7%) with bilateral adrenal tumors (χ2=19.976, P<0.001), and 9 patients (25.7%) with extra-adrenal tumors (χ2=7.380, P=0.007) in the complication group, significantly higher than 3 (5.7%) and 2 (3.8%) patients respectively in the non-complication group. The diameter of tumor in the complication group was (8.33±3.69) cm, which was significantly higher than that in the non-complication group[(4.32±3.12) cm] (t=5.484, P<0.001). The risk factors for complications in patients undergoing pheochromocytoma surgery included bilateral adrenal tumors (OR=10.316, P<0.001), extraadrenal tumors (OR=8.827, P=0.008), diameter of the tumor longer than 6 cm (OR=94.937, P<0.001), laparotomy (OR=40.727, P<0.001) and long time surgery for more than three hours (OR=312.000, P<0.001). ConclusionPatients who develop complications after pheochromocytoma surgery usually have bigger, and bilateral adrenal or extraadrenal tumors. Patients whose surgery is laparotomy or longer than three hours may also have more complications.These influential factors should be considered in future comprehensive treatment in order to achieve a good prognosis.
Objectives To investigate the association of anesthesia recovery time and bispectral index (BIS) monitoring after gastrointestinal surgeries under general anesthesia. Methods A total of 404 cases of selective gastrointestinal surgeries under general anesthesia with BIS monitoring in West China Hospital of Sichuan University from January 2016 to June 2016 were retrieved from anesthesia medical record system as BIS monitoring exposure cohort (group BIS). In addition, 404 cases of selective gastrointestinal surgeries without BIS monitoring were matched as none BIS monitoring exposure cohort (group non-BIS). The primary outcome was the anesthesia recovery time, including the time from the end of surgery to endotracheal extubation (t1) and exiting the operation room (t2). A sub-group analysis was conducted based on patients’ age, length of operation time (t0) and type of surgery(open surgeries vs laparoscopic surgeries). Results The gender, age, body weight and ASA categories between two groups had no significant differences (P>0.05). The length of operation time also had no significant differences between two groups (P>0.05). The extubation time (10.1±4.4vs. 16.4±6.8) and OR exiting time (21.7±12.3 vs. 27.4±14.6) in group BIS were shorter than those in group non-BIS (P<0.05). This difference was markedly significant among elderly patients (age>60) or patients undergoing long operations (operation time>5hours). Among each group, the recovery time had no significant difference between open surgeries and laparoscopic surgeries. Conclusions There is an association between BIS monitoring and shorter anesthesia recovery time in gastrointestinal surgery, including the time of endotracheal extubation and exiting the operation room. BIS monitoring enhances anesthesia recovery among elderly patients and patients undergoing long-lasting operations in particular. There is no significant difference in anesthesia recovery time between open surgeries and laparoscopic surgeries.
There are a variety of invasive or non-invasive methods for monitoring cerebral blood flow and cerebral metabolism in patients during operation with anesthesia, and different methods have their own scope of use. Transcranial Doppler can be used to monitor high-risk patients with intraoperative cerebral blood flow autoregulation dysfunction and patients with special positions during operation because of its convenience, continuity, and strong repeatability. Changes in cerebral blood flow detected by transcranial Doppler may be associated with postoperative central nervous system complications in patients. This article reviews the application of transcranial Doppler monitoring of cerebral blood flow in operation with anesthesia, aiming to provide a certain basis for the promotion of this technology in operation with anesthesia.
Objective To assess the analgesic effect of caudal bupivacaine with neostigmine for hypospadias surgery in children. Methods We searched The Cochrane Library (Issue 2, 2008), MEDLINE (1966-2008), EMbase (1980-2008), CBMdisc (1978-2008), CNKI (1989-2008) and Wanfang Database using the keywords “bupivacaine”, “neostigmine” and “hypospadias” to identify randomized control trials (RCTs) of caudal bupivacaine with neostigmine versus bupivacaine alone for hypospadias surgery in children. The methodological quality of included RCTs was evaluated by two reviewers independently, and Meta-analysis was conducted using RevMan 5.0.13 software. Results We identified 3 RCTs including 160 patients which had an uncertain risk of bias. The results of meta-analysis showed no significant difference found between bupivacine alone and bupivacine plus 1 µg/kg neostigmine (WMD= 0.05, 95%CI – 6.76 to 6.86, P= 0.99), but a difference was found between bupivacine alone and bupivacine plus 1 µg/ kg, 2 µg/kg, or 3 µg/ kg neostigmine (WMD= 12.79, 95%CI 10.96 to 14.62, Plt; 0.000 01; WMD= 12.10, 95%CI – 6.76 to 6.86, Plt; 0.000 01; WMD= 11.90, 95%CI 9.17 to 14.63, Plt;0.000 01). The duration of postoperative analgesia of the bupivacaine with neostigmine group was longer than that of bupivacine alone. Conclusions Because of the small sample size and the unclear risk of bias in the included RCTs, the effectiveness of caudal bupivacaine with neostigmine for postoperative pain management after hypospadias surgery in children is not completely confirmed. So more large sample size, double-blind RCTs are needed.
The mechanisms of general anesthesia, which was introduced about 170 years ago, remain poorly understood. Even less well understood are the effects of general anesthesia on the human body. Recently we identified 18 G-protein coupled receptor (GPCR) genes of Daphnia pulex, an invertebrate model organism. Phylogenetic analysis identified these genes to be the homologs of the human γ-aminobutyric acid, type B (GABAB) receptor, metabotropic glutamate receptors (mGluR), adrenergic receptor, serotonin (5-HT) receptor, dopamine receptor and muscarinic acetylcholine receptor (mAChR). Using reverse transcription and quantitative PCR techniques, we systematically measured the effects of propofol, etomidate and ethanol on these 18 GPCR mRNA expressions in Daphnia pulex.
Lung transplantation is the only treatment for patients with end-stage lung diseases. And this field is also a research hotspot in the international field at presen. Relevant researches not only promote the progress and development of lung transplantation, but also improve the life quality of patients after transplantation. With the development of lung transplantation technology, the guidelines for identifying candidates are constantly being revised, and the source of donor lungs has always been an urgent problem for all transplantation centers. The standardized management during transplantation period involves anesthesia induction, intraoperative fluid management, airway management, management of important operative steps and postoperative pain management. Extracorporeal life support (ECLS) includes cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO). With the progress and development of ECLS technology, the advantages of ECMO as a bridge for lung transplantation, intraoperative and postoperative circulatory support are becoming more and more prominent, enabling recipient patients to successfully pass the period of lung transplantation. Although lung transplantation in basic science and clinical researches has got a lot of progress, to improve the survival rate after transplantation, we must overcome many challenges including how to successfully perform lung transplantation, expand lung donor library, induce tolerance, and prevent complications after transplantation, primary graft dysfunction (PGD), cell and antibody mediated rejection and infection.