Objective To study the application, safety and efficiency of tetracaine sprayed through thyrocricoid puncture before intubation in intensive care unit ( ICU) . Methods Forty-one patients ready to undergo intubation, admitted in ICU from November 2009 to February 2010, were recruited in the study. They were randomly divided into a tetracaine group and a control group. 2% tetracaine was sprayed through thyrocricoid puncture before intubation in the tetracaine group but not in the control group. The hemodynamic variables and SpO2 at baseline ( T0 ) , beginning of intubation ( T1 ) , 1 min after intubation ( T2 ) , and 5 min after intubation ( T3 ) were recorded. The dosage of propofol and vasoactive agents, the incidence of hypotension, the times of intubation, and complications were also recorded. Results The variance rate about heart rate ( HR) , mean arterial pressure ( MAP) and rate pressure production on time of T1 and T2 were significantly lower in the tetracaine group than those in the control group ( P lt; 0. 05) . There was no difference about the incidence of successful intubation and hypoxia ( P gt; 0. 05) . The dosage of propofol during induction and vasoactive agents after intubation in the tetracaine group were less than those in the control group ( P lt;0. 05) . The incidence of hypotension after intubation in the tetracaine group was 35% , which was lower than 61. 9% in the control group ( P lt;0. 05) . There was no any complications and adverse accidents in the tetracaine group. Conclusions It is safe and simple to spray tetracaine through thyrocricoid puncture before intubation in ICU, which can effectively stabilize the hemodynamics, and decrease the dosages of propofol and vasoactive agents.
目的:比较舒芬太尼与芬太尼复合七氟烷麻醉在神经外科手术中对血流动力学、拔管时间、苏醒时间及术后疼痛情况的影响。方法:择期开颅手术患者60例,随机分为舒芬太尼(S)组和芬太尼(F)组,每组30例。将S和F的效能比定为10:l,复合咪唑安定、维库溴胺、异丙酚来进行麻醉诱导;麻醉维持均复合七氟烷。分别记录麻醉前、诱导后、插管时和拔管时血压和心率变化;呼吸恢复、睁眼和拔管时间以及拔管后半小时疼痛评分(VAS评分)。结果:两组麻醉诱导后收缩压(SBP)、舒张压(DBP)、心率(HR)均较诱导前有显著性下降(Plt;0．05)。F组插管及拔管时,血流动力学变化均较S组有显著性升高(Plt;0.05)。S组苏醒期呼吸恢复、睁眼、拔管时间较F组明显缩短;拔管后半小时疼痛评分(VAS评分)S组低于F组。结论:与芬太尼相比,等效剂量的舒芬太尼用于脑外科手术患者麻醉诱导可更有效地减轻全麻诱导气管插管时的心血管反应;在麻醉苏醒期,更有利于呼吸管理及术后镇痛。舒芬太尼在神经外科麻醉中具有很好的临床应用价值。
ObjectiveTo investigate various methods and strategies of lowering central venous pressure (CVP) during hepatectomy.MethodThrough literature review, the definition, implementation, related complications, and prognosis of low CVP were reviewed and summarized and the most appropriate CVP in the liver surgery was also summarized.ResultsThe low CVP had been widely applied in the different clinical settings. Its effect of reducing hemorrhage and transfusion had been recognized. There were many techniques to intraoperatively reduce the CVP such as the volatile anesthetics, vasoactive agents, fluid restrictive strategy, inferior vena cava clamping, low tidal volume, etc. However, there was no consensus on the best strategy to reduce the CVP and there were no studies focusing on the prognosis of patients underwent the low CVP hepatectomy. Maintaining the CVP between 2.1–3 mm Hg (1 mm Hg=0.133 kPa) intraoperatively might be appropriate, once the section had been made normal hemodynamic state of the patient should be restored immediately.ConclusionsApplication of low CVP could reduce blood loss and transfusion in hepatectomy. Prognosis of patients receiving low CVP is not clear. Application of low CVP in specific population should be cautious.
Perioperative neurocognitive disorder (PND) is one of the common perioperative complications in surgical patients, which has been concerned by most researchers. With the gradual increase of the elderly population in China, the complexity of individual diseases and the risk of PND is more and more severe. In recent years, a large number of studies have confirmed the close relationship between intestinal flora and neurological diseases and various studies have also proved that gut microbiota may contribute to the occurrence and development of PND. Based on the current studies, this article summarizes the effects of gut microbiota on PND, including possible mechanisms and intervention measures, providing some ideas for researchers and treatment of PND.
The strategies of individualized enhanced recovery after surgery (ERAS) are particularly important in the anesthesia management of same-day surgery. This review focuses on the perioperative management of day surgeries following the experiences of Day Surgery Center, West China Hospital, Sichuan University and different surgeries’ guidelines of ERAS, including anesthesia evaluation, preoperative education and optimization, comorbidity management, airway management, choice of technologies and drugs during anesthesia, intraoperative monitor and anesthesia management, postoperative analgesia, postoperative nausea and vomiting prevention, and postoperative management, which is significant to ensure the discharge of the patient in time for same-day surgeries.
The concept of enhanced recovery after surgery (ERAS) is composed of multidisciplinary, multimodal, and evidence-based approaches, providing a safe and cost-effective method for perioperative management to improve patient prognosis without increasing the incidence of complications. At present, ERAS for cardiac surgery has developed slowly. This article provides a review of the application and prospects of ERAS concept in the perioperative period of cardiac surgery. The measures for applying ERAS concept to the perioperative period of cardiac surgery are divided into three parts: preoperative, intraoperative, and postoperative. The aim is to provide information for the perioperative management of cardiac surgery patients and assist in their rapid recovery during the perioperative period.
As the concept of enhanced recovery after surgery (ERAS) has promoted the revolution of day surgery, more complicated surgery such as radical resection of early cancer and other fourth-level surgery can be performed in day surgery mode. Since 2010, West China Hospital of Sichuan University has introduced ERAS program and gradually performed fourth-level surgery in day surgery center. With the measures of reasonable inclusion criteria, team construction, and optimization of treatment and nursing procedures, the quality and safety of day surgery are guaranteed. Between January 2019 and August 2023, a total of 2531 patients underwent 24-hour fourth-level day surgery for early cancer, with a delayed discharge rate of 2.09%, a readmission rate of 2.57%, and a readmission rate of 1.11%, without death case, and the patient satisfaction was above 98%. The perioperative management scheme of fourth-level day surgery provides a reference for the management of day surgery for more diseases.
Day surgery is flourishing in public hospitals in China with the advantages of strong planning, short stay and high efficiency. Under the background of “diversification of surgeons, diversification of disease structure and precision of scheduling needs”, higher requirements are put forward for refined scheduling strategies of day surgery. The research of scientific and precise surgical scheduling strategy is of great significance to realize efficient coordination and optimal allocation of day surgical resources. This article reviews the necessity of precise scheduling of day surgery, the current situation of scheduling of day surgery, the key dimensions affecting the scheduling of day surgery, and the evaluation system for precise scheduling of day surgery.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.
With the rapid development of day surgery in China, ensuring continuous recovery services for patients after discharge has become an urgent issue. In response, this paper outlines the concept and development status of day surgery, emphasizes the importance of establishing an extended recovery system, summarizes relevant model innovation cases, discusses key elements for building an extended recovery system, including social resource engagement, multidisciplinary collaboration, institutional safeguards and technical support, and docking system platform to smooth the transmission of information, and proposes suggestions for future development. This paper provides theoretical and practical references for developing an extended recovery system for day surgery in China.