The anesthetic work of day surgery should be guided by the standardized perioperative evaluation system. The evaluation methods and standards with strong operability and repeatability are the prerequisites to ensure the safety and efficiency of day surgery. For the assessment of patients’ preoperative physiological status, preoperative preparation and postoperative rehabilitation, standardized work procedures should be established to ensure patients’ medical safety to the greatest extent. Through summarizing the advanced management experience of day surgery anesthesia at home and abroad, and combining with the principled suggestions in The Consensus of Chinese Experts on Anaesthesia for Day Surgery, the First Affiliated Hospital of Dalian Medical University has repeatedly revised the perioperative anesthesia evaluation methods in practice, and gradually explored a comprehensive, rigorous and standardized perioperative anesthesia evaluation system. This paper will focus on the evaluation of perioperative anesthesia and postoperative follow-up procedures in day surgery.
ObjectiveTo analyze the value of indocyanine green (ICG) fluorescence imaging in the evaluation of blood flown of ipple-areola complex (NAC) and implant selection during single-port endoscopic breast reconstruction. Methods From November 2018 to March 2020, 19 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital were retrospectively collected. ICG fluorescence imaging technology was used to evaluate the blood supply pattern and the risk of ischemic necrosis of NAC, so as to guide the selection of implant. At the same time, 14 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital from February 2017 to October 2018 were selected as the historical control group (control group). NAC ischemic necrosis, breast satisfaction and implant removal were compared between the two groups. Results In the ICG group, there were3 cases of V1 pattern and 2 cases of NAC ischemic necrosis (1 case of grade 1, 1 case of grade 2). There was no NAC ischemic necrosis in 16 patients with V2 mode and V3 mode. No implant loss occurred in any of the patients. In the control group, 5 cases had NAC ischemic necrosis (all were severe ischemic necrosis), and 2 cases had implant loss. The rate of severe NAC ischemic necrosis in the ICG group was lower than that in the control group (P<0.01), but there was no significant difference in implant loss rate between the two groups (P=0.17). The breast satisfaction score of the ICG group was higher than that of the control group (P<0.01), but there were no significant difference in satisfaction scores of chestwell-being, psychological well-being and sexual well-being between the two groups (P>0.05). Conclusions ICG imaging can be used to evaluate the blood supply pattern during the operation of prosthetic body mass reconstruction, guide the choice of implant in immediate breast reconstruction, so as to further improve postoperative breast satisfaction.
ObjectiveTo three-dimensionally calculate the craniofacial parameters of midface of patients with Treacher Collins syndrome (TCS) in China, in order to understand the changes in the spatial position relationship between the various anatomical structures of the midface.MethodsCT imaging data of TCS patients and age- and gender-matched normal populations between January 2013 and July 2020 was retrospectively analyzed. A total of 33 cases met the selection criteria for inclusion in the study, including 14 cases in the TCS group and 19 cases in the control group. ProPlan CMF 3.0 software was used to perform three-dimensional digital reconstruction of the craniofacial bone, measure the anatomical parameters of the midface, and analyze its morphological structure; at the same time perform three-dimensional digital reconstruction of the upper airway for morphological analysis (measure upper airway volume).ResultsCT images analysis revealed that all 14 patients with TCS presented the typical features with downward slanting of the palpebral fissures and different degrees of zygomatico-orbital complex dysplasia. Cephalometric and morphological analysis of the midface revealed that, multiple transverse diameters of the midface of TCS patients were significantly decreased when compared with the control group (P<0.05), such as the width of the maxillary base, the length of the maxillary complex, and some distances related to the nasal morphology; but the distance between bilateral orbitales increased in TCS group (P<0.05). Several anteroposterior distances in TCS group were decreased significantly when compared to control group and the distance between the skull base point and the posterior nasal spine was the most shortened (P<0.05). But there was no significant difference of the distance between nasion and anterior nasal spine, which represented anterior midface height, between groups (P>0.05). The skull base angle and SNB angle (the angle between the sella point-nose root point-inferior alveolar seat point) of the TCS group both decreased when compared with the control group (P<0.05), but there was no significant difference in SNA angle (the angle between the sella point-nose root point-upper alveolar seat point) between the two groups (P>0.05). The total volume of the upper airway was (24 621.07±8 476.63) mm3 in the TCS group, which was significantly lower than that of the control group [(32 864.21±13 148.74) mm3] (t=2.185, P=0.037).ConclusionThe transverse distances, anteroposterior distances, and multiple craniofacial angles measurement of TCS patients were significantly decreased when compared to the control group, presented with different degrees of zygomatico-orbital complex dysplasia, nasal and maxillary dysplasia, but there was no obvious restriction in face height development. Reduced internal diameters of the upper airway maybe responsible for the decreased upper airway volume of patients with TCS.