Effect of pneumatic leg compression on post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy: a double-blind randomised controlled trial

Post-induction hypotension is common and associated with postoperative complications. We hypothesised that pneumatic leg compression reduces post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy. In this double-blind randomised study, patients were allocated randomly to the pneumatic leg compression group (n = 50) or control (n = 50). In the intervention group, pneumatic leg compression was initiated before induction of anaesthesia. In the control group, pneumatic leg compression was initiated 20 min after anaesthesia induction. The primary outcome was the incidence of post-induction hypotension in these groups. Post-induction hypotension was defined as systolic blood pressure < 90 mmHg during the first 20 min after induction. Haemodynamic variables and area under the curve of post-induction systolic blood pressure over time were assessed. Complications associated with pneumatic leg compression were recorded, including: peripheral neuropathy; compartment syndrome; extensive bullae beneath the leg sleeves; and pulmonary thromboembolism. The incidence of post-induction hypotension decreased in the pneumatic leg compression group compared with that in the control group; 5 (10%) vs. 29 (58%), respectively, p < 0.001. In the pneumatic leg compression group, the lowest systolic, diastolic and mean blood pressures 20 min after induction of anaesthesia were significantly greater than the control group. Pneumatic leg compression resulted in an increased area under the curve of systolic blood pressure in the first 20 min after induction, p = 0.001. There were no pneumatic leg compression-related complications. Pneumatic leg compression reduced post-induction hypotension in elderly patients undergoing robot-assisted laparoscopic prostatectomy, suggesting that it is an effective and safe intervention to prevent post-induction hypotension among elderly patients undergoing general anaesthesia.     

Successful treatment of linezolid-induced severe lactic acidosis with continuous venovenous hemodiafiltration: A case report

Linezolid is an oxazolidinone antibiotic. Linezolid-associated lactic acidosis has been reported in 6.8% of linezolid-treated patients. Lactic acidosis is associated with poor clinical outcomes, with high blood lactate levels resulting in organ dysfunction and mortality. This case report describes the development of lactic acidosis in a 64-year-old Chinese woman who had received 33 days of treatment with antituberculosis drugs and 28 days of treatment with oral linezolid for tuberculous meningitis. Severe lactic acidosis was reversed by withdrawing antituberculosis drugs and using continuous venovenous hemodiafiltration (CVVH). When the patient's condition was stable, she was transferred to the infectious disease department, and antituberculosis drugs, with the exception of linezolid, were reintroduced. This did not result in recurrence of lactic acidosis. The causal relationship between lactic acidosis and linezolid was categorized as ‘probable’ on the Adverse Drug Reaction Probability Scale. This case demonstrates that CVVH has potential as an alternative to discontinuation of linezolid alone for rapid reversal of linezolid-associated severe lactic acidosis.     

术中静脉注射吲哚菁绿在慢性萎缩性胆囊炎腔镜手术中的应用

目的探讨术中静脉注射吲哚菁绿在慢性萎缩性胆囊炎腔镜手术中辨清肝外胆管结构的临床价值。方法回顾性分析2020年1月—2021年7月南京医科大学附属常州第二人民医院肝胆胰外科收治的110例诊断为慢性萎缩性胆囊炎行腹腔镜胆囊切除术(LC)的患者资料,术前所有患者均行腹部B超检查明确诊断,按照术中是否静脉注射吲哚菁绿将其分为实验组(n=55)和对照组(n=55),实验组术中经外周静脉注射吲哚菁绿5 mg,术中吲哚菁绿荧光显影技术导航下行LC。对照组行常规LC。统计实验组胆囊管、胆总管、肝总管的显影率及显影时间,比较两组患者的一般临床资料、辨清三管时间、手术时间、术中出血量、放置腹腔引流管及拔管时间、中转开腹及胆管损伤、术后住院时间、术后第一次复查丙氨酸氨基转移酶(ALT)、谷氨酰转移酶(GGT)水平、随访等结果。服从正态分布的计量资料采用均数±标准差(±s)表示,两组比较采用独立样本t检验。偏态分布的计量资料以M(Q₁,Q₃)描述,采用非参数检验中的Mann-Whitney U检验。计数资料组间比较采用χ²检验或Fisher确切概率法。结果两组均成功实施手术,实验组所有患者均成功显影肝总管,54例显影胆总管,52例可显影胆囊管,且显影三管时间为(15.8±1.2)min。实验组中辨清三管时间、手术时间、术中出血量及放置腹腔引流管病例分别为(18.5±1.3)min、(64.0±6.8)min、(16.3±6.7)mL、43例,对照组分别为(46.3±8.1)min、(98.7±10.5)min、(53.6±14.9)mL、55例,实验组均明显低于对照组,两组相比差异有统计学意义(P<0.05)。实验组无中转开腹及胆管损伤病例,对照组有1例中转开腹及1例胆管损伤病例,两组差异无统计学意义(P>0.05)。两组术后拔管时间及术后住院时间差异有统计学意义(P<0.05)。实验组患者术后第一次复查ALT、GGT水平分别为47(31,75)U/L、38(19,114)U/L,对照组分别为62(53,92)U/L、76(63,96)U/L,两组相比差异有统计学意义(P<0.05)。两组患者出院后均随访3个月,实验组无明显并发症,对照组出院后7 d有1例患者出现少量腹腔积液。结论面对慢性萎缩性胆囊炎行LC时,术中静脉注射吲哚菁绿显影肝外胆管有助于辨清其解剖结构避免胆管损伤,提高手术安全性及进度的同时最大限度锻炼并提升术者水平。     

数字化技术在可摘局部义齿和全口义齿制作中的应用现状与未来

数字化技术的发展为可摘局部义齿/全口义齿的设计和制作提供了全新的选择,具有高精度、高质量和高效率的特点。其中,本文就数字化印模、数字化设计与数字化制作这三个关键因素进行了重点讨论。     

Retroperitoneal-first laparoscopic approach (Retlap)-assisted distal pancreatectomy with celiac axis resection (DP-CAR): A novel minimally invasive approach for achieving adequate dorsal surgical margin

BackgroundDistal pancreatectomy with celiac axis resection (DP-CAR) is a procedure to secure a surgical margin for a locally advanced pancreatic body cancer that invades the celiac axis. However, in patients with cancer close to the root of the celiac axis, obtaining adequate surgical margins can be difficult because the tumor obstructs the field of vision to the root of the celiac axis. Previously, we described the retroperitoneal-first laparoscopic approach (Retlap) to achieve both accurate evaluation of resectability for locally advanced pancreatic cancer requiring DP-CAR [1] and adequate surgical margin for laparoscopic distal pancreatectomy [2]. In this video, we introduce Retlap-assisted DP-CAR as a minimally invasive approach for performing an artery-first pancreatectomy [3, 4] and achieving sufficient dorsal surgical margin (Fig. 1).MethodsOur patient is a 67-year-old man with a 55 × 29-mm pancreatic body tumor after chemotherapy. Preoperative computed tomography revealed a tumor close to the root of the celiac axis. Because the area of tumor invasion on preoperative images was near the root of the celiac artery, Retlap-assisted DP-CAR was performed to determine whether the celiac axis can be secured and obtain an adequate dorsal surgical margin (Fig. 2).ResultsThe operative time and estimated blood loss was 715 min and 449 mL, respectively. In spite of the advanced tumor's location and size, R0 resection was achieved in a minimally invasive way.ConclusionRetlap-assisted DP-CAR is not only technically feasible and useful for achieving accurate evaluation of resectability but also facilitates obtaining an adequate surgical margin.