Surgery is an important method for the treatment of malignant tumors. Sevoflurane is one of the most common general anesthetics, which can directly or indirectly affect the biological behavior of cells and the immune function of tumor patients, thereby affecting the recurrence and metastasis of tumor patients after surgery. From the aspects of microRNA, matrix metalloproteinase, phosphatidylinositol-3-kinase/Akt signaling pathway and hypoxia-inducible factor-1α, this article summarizes the molecular mechanisms of sevoflurane affecting the biological behavior of tumor cells, and clarifies the regulation mechanism of sevoflurane on the immune function of tumor patients. It is expected to provide a theoretical basis for precise anesthesia for tumor patients, and to provide medication basis for reducing postoperative recurrence and metastasis of tumor patients.
Objective To research anesthetic management, pathophysiologic variation of adult-to-adult living donor liver transplantation (A-ALDLT) and to probe how to improve anesthetic quality of A-ALDLT. Methods The clinical data of 47 donors from Sep. 2005 to Jan. 2007 in West China Hospital were reviewed. Intraoperative vital signs, anesthetic management, perioperative serum levels of HGB， Alb， ALT， AST, TBIL， APTT， PT were measured， and complications were assessed. Results The physical condition of all donors were good before operations and were all in grade Ⅰaccording to ASA. Under general anesthesia of intravenous and inhalation, electrocardiogram, O2 saturation, blood pressure and body temperature were continuously monitored. A radial arterial catheter and a central venous catheter were placed. Blood lavement was utilized intraoperatively in all patients. All donors maintained stable life signs intraoperatively. The average intraoperative blood losses was （603.13±317.00） ml, and donors were transfused with autologous blood 〔(381.25±171.15) ml〕, with only 4 donors required homologous blood transfusion. HR and mean arterial blood pressure (MAP) showed no significantly variations intraoperatively (Pgt;0.05). Compared with controlled central venous pressure (CVP) before and right after hepatectomy, CVP increased significantly (P＜0.05) when intubation and abdomen-closing were carried. After hepatectomy and on the first day after operation, HGB and Alb decreased significantly (P＜0.05); ALT, AST and TBIL increased significantly (P＜0.05). Right after hepatectomy, PT increased instantly and significantly (P＜0.05); On the first day after operation, APTT began to increase significantly (P＜0.05). All donors came around completely and were extubated in the liver transplantation intensive care unit on the first day after operation. There were 3 cases (6.38%) of postoperative complication, which were biliary leakage, portal vein thrombosis and serious pleural effusion. Those 3 donors were cured after treatment. Conclusion Inhalation and intravenous general anesthesia of propofol, remifen-tanil and isoflurane can maintain stable life signs and reduce liver injury. Steady anesthesia, sufficient oxygenation and effective blood protection measures, for example, by decreasing CVP to prevent bleeding and by reclaiming autologous blood to avoid transfusing homologous blood, are keys for the safety of the donor and the prevention of complications.
Objective To evaluate the indications, effectiveness and complications of vitreoretinal surgery using the 25G transconjunctival sutureless vitrectomy system (TSV25G) under the topical anesthesia. Methods The clinical and follow-up data of 22 eyes of 22 patients undergone vitreo-retinal surgery using TSV25G under the topical anesthesia were retrospectively analyzed. All of the patients were monocular sickened, including idiopathic macular hole in 10 eyes, idiopathic macular pucker in 6, vitreoretinal traction syndrome in 4, and vitreous hemorrhage associated with branch retinal vein occlusion in 2. Peeling of epiretinal membrane and/or internal limiting membrane, intra ocular laser coagulation, air-fluid exchange and tamponiding of C3F8 were performed according to the condition of diseases. The postoperative follow-up was 1-11 months, with the mean duration of 6.4 months. The effect of analgesia, cooperation with the patients, operative effect and complications in and after the surgery were observed. Results The operations finished successfully in all of the eyes under the topical anesthesia. The operation duration ranged from 20 to 25 minutes with average of 22 minutes. The patients cooperated with the doctor well without any discomfort. Two days after the surgery, edema of the wounded conjunctiva was found, and recovered 7 days later. A light pigment dot on the surface of the sclera could be seen at the first month. The complic ations included transient increasing of intraocular pressure in 2 eyes, feather-like opacity of lens in 5 eyes, vitreous hemorrhage in 1 eye, and air-bleb under conjunctiva in 2 eyes. No other complications related with the cut were fo und. The macular hole closed in 9 eyes with idiopathic macular hole, and the other 1 had the smaller but not closed hole. Idiopathic macular pucker, vitreoretinal traction syndrome, and vitreous hemorrhage associated with branch retinal vein occlusion were cured successfully. Conclusions Vitreoretinal surgery using the TSV25G under the topical anesthesia has many advantages such as simple procedure, short operation time, micro-invasion, less complications and rapid revovery, and mainly serves simple manipulation in some simple diseases such as idiopathic macular hole, vitreo-retinal traction syndrome, and simple hemorrhage. (Chin J Ocul Fundus Dis，2004，20：133-136)
ObjectiveTo discuss the intraoperative anesthesia management for complete thoracoscopic surgical atrial fibrillation (AF) ablation via the left chest. MethodsWe retrospectively analyzed the clinical data of 201 patients (106 males and 95 females aged 58.7±15.4 years) with AF underwent complete thoracoscopic surgical ablation via the left chest in Department of Cardiothoracic surgery, Xinhua Hospital From September 2010 through December 2013. ResultsAll the patients successfully underwent the minimally invasive ablation procedure. No patient required conversion to sternotomy during the surgery. The average time of operation was 104.9±37.2 min. During the ablation procedure, the patients' blood pressure and arterial oxygen saturation (SpO2) reduced at different levels. The average minimum arterial blood pressure was 44-79 (62.4±8.4) mm Hg. The average minimum SpO2 was 83%-95% (88.8%±3.1%). After the ablation, the patients' respiratory function and hemodynamic gradually recovered. The average heart rate was 40-108 (70.0±16.6) bpm when sinus rhythm was restored. The maintenance of sinus rhythm rate was 94.5% (190/201) at discharge. There was no early death, stroke, hemorrhage or permanent pacemaker implantation during perioperation. ConclusionComplete thoracoscopic surgical AF ablation via the left chest has some influence on patients' respiratory function and hemodynamic. Reasonable anesthetic management can ensure the minimally invasive ablation procedure safe and effective.
Objective To explore the clinical application of the postanesthetic autologus donation and the post-operative transfusion during the knee and hipreplacement surgeries. Methods Thirty-three patients (17 males,16 females) admitted for the elective joint replacement surgeries from September 2004 to January 2005 were included in this study. Of the 33 patients, 5 were diagnosed with rheumatoid arthritis, 23 with femoral head necrosis, and 5 with knee osteoarthritis. Immediately after anesthesia, 400 ml of the blood was drawn and transfused after the surgery. The blood pressure was monitored during the blood drawing, postoperative blood parameters were recorded, surgical site drainage and signs of infections were observed, and the other clinical data were collected.Results Of the 33 patients, 27 only received autologoustransfusion, including 21 patients who underwent the unilateral hip replacement and 6 patients who underwent the unilateral knee replacement. All these 6 patients with the unilateral knee replacement received the blood drained from the surgical sites in addition to the blood obtained from the postanesthetic autologous donation. Another 6 cases with the bilateral hip and knee replacement received the blood drained from the surgical sites, the blood obtained from the post-anesthetic autologous donation and 400 ml of the allogeneic blood transfusion. The blood received postoperatively averaged 650 ml (range, 200-1 150 ml), haemoglobin(Hb) was averaged 88 g/L (68-102 g/L), and Hct was averaged 24.6% (20.5% 31.5%). Hb and Hct were lower after operation than before operation(Plt;0.01). Conclusion Postoperative blood transfusion following the postanesthetic and preoperative autologous donation can be successfully applied to most of the patients undergoing theknee or hip replacement so as to reduce complications of the allogeneic blood transfusion.
Objective To evaluate the effectiveness of thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) versus GA alone on intrapulmonary shunting during one-lung ventilation (OLV). Methods We searched the Cochrane Library (Issue 4, 2009), the specialized trials registered in the Cochrane anesthesia group, PubMed (1966 to Dec. 2009), EMbase (1966 to Dec. 2008), CBM (1978 to Dec. 2009), VIP (1989 to Dec. 2009), CNKI (1915 to Dec. 2009), and handsearched Clinical Anesthesia Journal and Chinese Anesthesia Journal. Randomized controlled trials (RCTs) about the effectiveness of TEA combined with GA versus GA alone on intrapulmonary shunting during OLV were included, The methodological quality of included RCTs was evaluated by two reviewers independently, Meta-analysis was conducted using RevMan 5.0 software. Results Ten RCTs involving 506 patients were included. The results of meta-analyses showed that there were no significant differences in intrapulmonary shunting during OLV at different times-points of 5, 15, 20, 30, and 60 minutes after OLV. Conclusion Both TEA combined with GA and GA alone have the same Security during OLV. But owing to the low quality and small sample size of the included studies, further more well-designed, large sample size RCTs are needed.
ObjectiveTo discuss the method and effectiveness of Wide-awake technique in flexor tendon tenolysis.MethodsThe clinical data of 16 patients (22 fingers) with flexor tendon adhesion treated by Wide-awake technique for flexor tendon tenolysis between May 2019 and December 2019 were retrospectively analyzed. The patients were all male, aged from 18 to 55 years old, with an average of 35 years old. Among them, 4 cases (7 fingers) after replantation of severed fingers, 4 cases (7 fingers) after flexor tendon rupture repair, and 8 cases (8 fingers) after open reduction and internal fixation of proximal fractures. The time from the original operation to this operation was 6-18 months, with an average of 8 months. The visual analogue scale (VAS) score was used to evaluate the patient’s pain during local anesthesia (when the first needle penetrated the skin), intraoperative, and 24 hours postoperatively; and the recovery of finger movement was evaluated by total finger joint active range of motion (TAM) evaluation system and Strickland (1980) standard after operation.ResultsIntraoperative hemostasis and anesthesia were satisfactory, and the patient could fully cooperate with the surgeon in active finger movements. There were different degrees of pain during local anesthesia (VAS score was 2-4), no pain during operation (VAS score was 0), and different degrees of pain after operation (VAS score was 1-8, 9 patients needed analgesics). All incisions healed by first intention after operation. All 16 cases were followed up 9-15 months with an average of 12 months. Finger function was significantly improved, no tendon rupture occurred. At last follow-up, the patients after proximal fracture open reduction and internal fixation were rated as excellent in 4 fingers and good in 4 fingers according to the TAM standard, and both were excellent according to the Strickland (1980) standard; and the patients after replantation of severed fingers and flexor tendon rupture repair were rated as excellent in 4 fingers and good in 10 fingers according to TAM standard, and as excellent in 6 fingers and good in 8 fingers according to Strickland (1980) standard.ConclusionWide-awake technique applied in flexor tendon tenolysis can accurately judge the tendon adhesion and release degree through the patient’s active activity, achieve the purpose of complete release, and the effectiveness is satisfactory; the effectiveness of tendon adhesion release surgery after fracture internal fixation is better than that of patients after tendon rupture suture and replantation.
Objective To investigate the effect of perioperative body temperature on the survival of skin flap grafting. Methods From July 2005 to November 2006, 50 cases of Ⅰ-Ⅱ grade patients undergoing elective skin flap grafting were randomly divided 2 groups. Pharyngeal temperature (PT) and skin temperature(ST) were monitored and recorded every 15 minutes. Operativetime, anesthetic time, time from the end of operation to extubation, the volume of blood transfusion, the volume of fluid transfusion and the flap survival 7 days after operation were recorded. In the experimental group, the body temperature was maintained in normal range with water market and forced air heater. In the control group， the body temperature was only monitored without any treatment. Results There were no significant differences in operating room temperature, operative time, anesthetic time, the volume of blood transfusion and fluid transfusion between 2 groups(Pgt;0.05). After induction, PT decreased gradually inboth groups during the first 45 minutes, compared with the time point of intubation(Plt;0.05),but there were no significant differences between the 2 groups(Pgt;0.05); and ST rose in both groups during the first45 minutes, compared with the time point of intubation (Plt;0.05). After 45 minutes of induction, in the experimental group, PT was in the normal range(36℃), and ST didn’t change compared with that of the timepoint of induction(Pgt;0.05). In the control group, both PT and ST decreasedgradually and timedependently compared with the time point of intubation (Plt;0.05). In the experimental group, PT and ST at each time point were higher than those in the control group (Plt;0.05). All the skin flap grafts survived in the experimental group, and skin flap grafts necrosed in 2 cases in the control group.Conclusion Keeping normal body temperature can improve the survival ofskin flap grafting. Therefore, the body temperature should be monitored and maintained in a normal range.
ObjectiveTo analyze the occurrence of arrhythmia in patients during the recovery period of anesthesia, in order to take appropriate measures in nursing care to ensure the safety of patients. Method We carried out a retrospective analysis of 18 931 general anesthesia post-operative patients (aged 16-84 years old) transferred to anesthesia recovery from September 2012 to July 2013, and we observed the incidence rate of arrhythmia, and documented the clinical manifestations of the patients. ResultsDuring the anesthesia recovery, out of 18 931 general anesthesia postoperative patients, 269 cases of arrhythmia occurred, and the incidence rate was 1.42%. Twenty minutes after nursing intervention and use of medication, the difference of systolic blood pressure, bradycardic heart rate, and tachycardic heart rate of the patients were statistically better than those beofre the treatment (P＜ 0.05) . ConclusionEarly discovery and analysis of arrhythmia in patients during anesthesia recovery, along with timely provision of analgesic and antiarrhythmic treatment can effectively improve the circulation status of the patients, thus ensure the safety of the patients during anesthesia recovery.
ObjectiveTo evaluate the clinical effects of nebulized lidocaine anesthesia and anesthesia with lidocaine and midazolam in patients with preoperative bronchoscopy. MethodsTotally, 136 inpatients between May 2002 and June 2013 with preoperative bronchoscopy were included in the study. The patients were randomly assigned to experimental group and control group with 68 patients in each. For patients in the experimental group, 8 mL of 2% lidocaine was administered through inhalation anesthesia, followed by 2-3 mg bolus of midazolam, and subsequently 0.5 mg of midazolam was administered every 2 minutes depending on patients' awareness. Patients in the control group accepted lidocaine alone for anesthesia. The clinical efficacy and adverse effects of both the two ways of anesthesia were observed. ResultsThe time of sustained and effective anesthesia was (24.5±2.8) minutes in the experimental group, as compared with (16.8±2.1) minutes in the control group (P<0.01). The average amount of consumption of lidocaine was (12.4±1.3) mL in the experimental group, as compared with (16.8±1.5) mL in the control group (P<0.01). The heart rate at 5 min after operation was (81.5±19.5) beats/min in the experimental group, as compared with (94.6±34.6) beats/min in the control group (P<0.01). The mean pulse oxygen saturation at 5 min after operation was (93.5±3.6)% in the experimental group, as compared with (88.2±13.3)% in the control group (P<0.01). ConclusionCombined application of lidocaine and midazolam before bronchoscopy is simple and feasible for anesthesia, which has higher success rate, lesser side effects and other reactions such as body movement and coughing.