Objective To determine the efficiency and safety of dexmedetomidine in general anesthesia. Methods Trials were located through electronic searches of the PubMed, EBSCO, OVID, Springer, Foreign Journals Integration System, CNKI, CMBdisk (from the date of establishment of the databases to April 2008). Bibliographies of the retrieved articles were also checked. Result A total of 25 trials involving 1 241 patients were included. The Meta-analysis showed: dexmedetomidine reduced peri-operative heart rate and blood pressure, reduced the occurrence of postoperative nausea and vomitting [RR=0.57, 95%CI (0.38, 0.84)], postoperative agitation [RR=0.29, 95%CI (0.17, 0.51)], shivering [RR=0.45, 95%CI (0.29, 0.68)], increase the occurrence of bradycardia [RR=2.16, 95%CI (1.58, 2.95)], hypotension [RR=2.97, 95%CI (1.42, 6.18)]. Dexmedetomidine reduced administration of thiopental, isoflurane and fentanyl, while there was no difference in muscle relaxant. Dexmedetomidine showed no difference in emergency time compared with the control group. As a result of low incidence of adverse reaction, dexmedetomidine showed superior in discharge time [WMD15.17, 95%CI (3.87, 26.46)]. Conclusions The limited current evidence shows that dexmedetomidine is better in maintaining the hemodynamic balance; reducing occurrence of nausea, vomiting, agitation and shivering; and reducing doses of anesthetics. In emergency time, dexmedetomidine shows no difference except discharge time.
Objective To explore the effect of the feed-forward control on safety nursing of ophthalmologic day surgery patients under general anesthesia. Methods A total of 623 ophthalmologic day surgery patients under general anesthesia were retrospectively selected into the control group, who adapted the routine nursing in the Ophthalmic Day Surgery Center from January to December 2015; a total of 1 210 ophthalmologic day surgery patients under general anesthesia were retrospectively selected into the observation group, who received the feed-forward control of nursing safety management on the basis of routine nursing care from January to December 2016. The incidence rate of the adverse events and potential safety hazards and satisfaction rate were compared between the two groups. Results The incidence rate of the adverse events and potential safety hazards in the observation group (0.83%, 10/1 210) was lower than that in the control group (3.37%, 21/623), the satisfaction rate in the observation group (98.67%) was higher than that in the control group (97.11%), and the differences were statistically significant (P<0.05). Conclusion The application of feed-forward control in the safety care of patients during the ophthalmologic day surgery under general anesthesia can effectively reduce the incidence of adverse events and potential safety hazards, and ensure the safety of medical care.
ObjectiveTo systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). MethodsElectronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. ResultsA total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P＜0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P＜0.001], ICU stay time [RR=?6.86, 95%CI (?12.31, ?1.42), P=0.013], and total hospital stay time [RR=?2.02, 95%CI (?2.59, ?1.45), P＜0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. ConclusionLA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.
Objective To explore the emergence agitation resulting from postoperative indwelling urethral catheters in patients of thoracic surgery. Methods In this prospective cohort study, we recruited 140 patients who were scheduled for thoracic surgery under general anesthesia in West China Hospital from January through April 2014. These patients were divided into two groups including a control group and a trial group with 70 patients in each group. The patients in the control group had indwelled urethral catheter routinely. The catheter removed after the surgery at operation room in the trial group. Intraoperative urinary volume, emergence agitation (EA) occurrence, postoperative urinary retention, and urethral irritation were recorded. Results There was no statistical difference in postoperative urinary retention rate between the control group and the trial group (1.43% vs. 2.86%, P=0.230). However, the urethral irritation rate in the control group was significantly higher than that in the trial group (12.86% vs. 0.00%, P=0.012) . And there was a statistical difference in adverse event rate (2.86% vs. 0.00%, P=0.039) between the two groups. There was a significantly higher incidence of urethral irritation in male patients (20.51%, 8/39) than female patients (3.23%, 1/31, P=0.033).The rate of EA in the control group was significantly higher than that in the trial group (28.57% vs. 12.86%, P=0.010). There was a significantly higher EA rate in the patients who had urethral irritation by postoperative indwelling catheters compared with those without indwelling catheters (45.00% vs. 12.86%, P=0.043). Conclusion This study suggests that postoperative EA is a result from urethral irritation than local pain, and the EA rate can be decreased by removal of catheter before anaesthetic recovery.
ObjectiveTo explore the influence of general anesthesia with laryngeal mask and preoperative inhalation of budesonide aerosol on the incidence of respiratory adverse events during pediatric anesthesia recovery. MethodsA total of 100 child patients scheduled to undergoing inguinal hernia repair between December 2012 and February 2014 were randomly divided into two groups (group A and B) with 50 in each. All the patients underwent general anesthesia with laryngeal mask, while patients in group B inhaled budesonide aerosol before anesthesia. Then, we observed the incidence of adverse events in both groups, including laryngospasm, respiratory tract infection, and pulmonary complications. ResultsCompared with group A, patients in group B had a lower incidence of adverse events (P<0.05). ConclusionPreoperative application of budesonide aerosol inhalation can significantly reduce adverse events in the process of anesthesia recovery in children.
Objective To investigate the effective dose of remimazolam benzenesulfonate to suppress cardiovascular responses to laryngeal mask placement in elderly patients. Methods Elderly patients undergoing laryngeal mask anesthesia between March and June 2023 were selected. Combined with sulfentanil 0.2 μg/kg, remimazolam was used as induction hypnotic. The first patient was given remizolam benzenesulfonate 0.16 mg/kg infused by pump for 1 min. The dose of remimazolam for the next patient was determined by the biased coin up-and-down method based on the patient’s response to the laryngeal mask placement. The score of Modified Observer’s Assessment of Alert/Sedation, vital signs and anesthesia depth index (AI) were recorded during induction. Probit analysis was used to calculate the half effective dose (ED50), 95% effective dose (ED95) and half effective AI (AI50). According to the statistical requirements, at least 45 negative patients were required. Results A total of 53 elderly patients were enrolled in the study until the end of the trial. The ED50 and ED95 of remimazolam benzenesulfonate for inhibiting cardiovascular responses to laryngeal mask insertion were 0.154 mg/kg [95% confidence interval (CI) (0.034, 0.170) mg/kg] and 0.207 mg/kg [95%CI (0.190, 0.614) mg/kg], respectively. AI decreased during induction, with an AI50 of 64.119 [95%CI (60.609, 69.984)]. Conclusion When combined with 0.2 μg/kg sufentanil, infusing 0.2 mg/kg remimazolam benzenesulfonate for 1 min is effective and safe for laryngeal mask anesthesia induction in elderly patients.
ObjectiveTo explore the risk factors for death within 7 days after admission in trauma patients undergoing surgery under general anesthesia, and provide evidence for predicting the outcomes of those patients and guidance for clinical practices.MethodsThe basic information and perioperative data of trauma patients who underwent surgery under general anesthesia between January 1st 2019 and December 31st 2020 were collected from the Hospital Information System and the Anesthesia Information Management System. Patients who died within 7 days after admission were assigned into the case group and the others were assigned into the control group, and then propensity-score matching method was used based on age, sex, and injury types. Univariate analyses and multivariate binary logistic regression analysis were used to identify the risk factors for death within 7 days after admission in these patients.ResultsThere were 2 532 patients who met the inclusion criteria, of whom 96 patients with missing follow-up information were excluded, and 2 436 patients remained for the study. After propensity-score matching, there were 19 patients in the case group and 95 patients in the control group. The result of multivariate logistic regression analysis showed that the coma state at admission [odds ratio (OR)=9.961, 95% confidence interval (CI) (1.352, 73.363), P=0.024], perioperative body temperature<36℃ [OR=23.052, 95%CI (1.523, 348.897), P=0.024], intraoperative mean arterial pressure<60 mm Hg (1 mm Hg=0.133 kPa) [OR=12.158, 95%CI (1.764, 83.813), P=0.011], serum calcium concentraion<2.0 mmol/L [OR=33.853, 95%CI (2.530, 452.963), P=0.008], and prothrombin time [OR=1.048, 95%CI (1.002, 1.096), P=0.042] increased the risk of death within 7 days after admission.ConclusionThe coma state, coagulopathy, perioperative hypothermia, intraoperative hypotension, and hypocalcemia are 5 independent risk factors for death in trauma patients after surgery under general anesthesia.
Objective To explore anesthetic quality of epidural anesthesia with general anesthesia applied for surgery of rectal cancer. Methods One hundred and seventy-eight patients who were diagnosed as rectal cancer and received operation in the Central Hospital of Bazhong City from June 2010 to June 2012 were included retrospectively. These patients were divided into two groups according to the type of anesthesia， and the patients who received general anesthesia only were defined as group A， the patients who received epidural anesthesia with general anesthesia were defined as group B. The anesthetic quality and anesthetic adverse reaction were observed in two groups. Results The differences of baseline characteristics in two groups were not significant （P＞0.05）. The difference of anesthetic quality in two groups was not significant （P＞0.05）. In terms of anesthetic adverse reaction， the incidence rate of hypertension， hypotension，tachycardia， or postoperative nausea and vomiting of the group B was significantly lower than those of the group A （P＜0.05）. The incidence rate of bradycardia， premature ventricular contractions， or time of gastrointestinal function recovery had no significant differences （P＞0.05）. There was no nerve dysfunction of lower limb in two groups. Conclusion Epidural anesthesia with general anesthesia applied for surgery of rectal cancer as compared with general anesthesia only not only has the same anesthetic quality， but also has obvious advantages in decreasing anesthetic adverse reaction.