老年病人全麻术后颅内兴奋性氨基酸水平与术后认知功能障碍的关系

Objective To investigate the relationship between the changes in intracranial excitatory amino acid(EAA) levels and the incidence of postoperative cognitive dysfunction (POCD) in eldedy patients after general anesthesia. Methods Forty ASA Ⅰ-Ⅲ patients of both sexes aged 65-79 yr weighing 48-76 kg undergoing elective non-cardiac surgery under general anesthesia were studied.Anesthesia was induced with midazolam,fentanyl,etomidate and succinylcholine and maintained with continuous iv infusion of propofol,remifentanil,isoflurane inhalation and intermittent iv boluses of vecuronium.The right internal jugular vein was cannulated with a catheter which was advanced cephalad until jugular bulb.The jugular bulb venous blood samples were taken before (T0,baseline),at the end of (T1) and at 24,48 and 72h(T2-4) after operation for measurement of plasma concentrations of glutamate (Glu),aspartate (Asp) and glycine (Gly) by RP-HPLC.The cognitive function was evaluated by mini-mental state examination (MMSE) at T0 and T4.Results Eleven of the 40 patients developed POCD (28%).The plasma Gh,Asp and Gly concentrations were significantly increased after operation as compared with the baseline values in POCD patients and were significantly higher than in non-POCD patients.The plasma concentrations of Glu and Asp were negatively correlated with MMSE score(Glu:r=-0.86.P<0.01;Asp:r=-0.99,P<0.01).Conclusion Elderly patients may develop POCD after operation performed under general anesthesia through increase in intracranial EAA levels.     

全麻下血管化游离皮瓣修复术后患者谵妄的危险因素

Objective To investigate the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.Methods Two hundred and sixteen ASA Ⅰ-Ⅲ patients aged 18-80 yr undergoing vascular free flap reconstruction surgery were enrolled in this study.Patient characteristics before and during operation were recorded.The patients were followed up for 5 days after operation.Their level of consciousness,severity of pain and sleep quality were evaluated daily.The patients were divided into 2 groups according to the occurrence of delirium during the 5 days after operation:delirium group and non-delirium group.The method of CAM-ICU was reed in the diagnosis of postoperative delirium.Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results logistic regression analysis showed that old age,history of alcohol abuse and sleep diacrder after operation were risk factors for delirium developed after free flap surgery.Conclusion Old age,history of alcohol abuse and sleep disorder after operation were the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.     

全麻下血管化游离皮瓣修复术后患者谵妄的危险因素

Objective To investigate the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.Methods Two hundred and sixteen ASA Ⅰ-Ⅲ patients aged 18-80 yr undergoing vascular free flap reconstruction surgery were enrolled in this study.Patient characteristics before and during operation were recorded.The patients were followed up for 5 days after operation.Their level of consciousness,severity of pain and sleep quality were evaluated daily.The patients were divided into 2 groups according to the occurrence of delirium during the 5 days after operation:delirium group and non-delirium group.The method of CAM-ICU was reed in the diagnosis of postoperative delirium.Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results logistic regression analysis showed that old age,history of alcohol abuse and sleep diacrder after operation were risk factors for delirium developed after free flap surgery.Conclusion Old age,history of alcohol abuse and sleep disorder after operation were the risk factors for postoperative delirium in patients after vascular free flap reconstruction performed under general anesthesia.     

右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果

Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage ( BAL). Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups ( n = 12 each) : topical anesthesia group (group A) , topical anesthesia + dexmedetomidine group (group B) . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required (the total amount was within 20 ml) . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected (time of injection≥ 10 min) followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage (T1-3 ) for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A ( P < 0.05). The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2,3 in group A, while lower at T2,3 in group B than at T1 ( P < 0.05) . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A ( P < 0.05). Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.     

超声引导下肢神经阻滞联合喉罩下全麻用于全膝关节置换术的效果

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.     

超声引导下肢神经阻滞联合喉罩下全麻用于全膝关节置换术的效果

Objective To evaluate the efficacy of uhrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway in patients undergoing total knee arthroplasty.Methods Forty ASA Ⅰ-Ⅲ patients of both sexes,aged 52-80 yr,weighing 67-94 kg,undergoing total knee arthroplasty under general anesthesia,were randomly divided into 2 groups(n=20 each).Group Ⅰ received combined intravenous-inhalational anesthesia with endotracheal tube.Group Ⅱ received lower extremity nerve block guided by ultrasound and then combined intravenous-inhalational anesthesia with laryngeal mask airway.HR was maintained at 50-100bpm,MAP was maintained at the preoperative baseline level(increase or decrease amplitude<20%of the baseline level)during operation and in pestanesthesia care unit(PACU)and vasoaetive drugs(atropine,esmolol,efedrina,urapidil or labetalol)were given when necessary.The patients received patient-controlled intravenous analgesia with tramedol and lornoxicam(background infusion 2 ml/h,bolus dose 1 ml,lockout interval 15 min)after operation and VAS score was maintained at≤2.The requirement for vasoactive drugs during operation and in PACU,PACU stay length,and consumption of analgesics and occurrence of nausea and vomiting within 24 h after operation were recorded.Results Compared with group Ⅰ,the requirement for all vasoaetive drugs during operation and for esmolol,urapidil and labetalol in PACU was significantly reduced,PACU stay length Was significantly shortened,and the consumption of analgesics and incidence of nausea and vomiting were significantly reduced in group Ⅱ(P<0.01).Conclusion Ultrasound-guided lower extremity nerve block combined with general anesthesia with laryngeal mask airway provides better emcacy with fewer complications and less consumption of postoperative analgesics than general anesthesia with endotracheal tube in patients undergoing total knee arthroplasty.     

小儿和成年患者全麻时瑞芬太尼药代动力学的比较

Objective To compare the pharmacokinetics of remifentanil during general anesthesia in children and adults.Methods Eight children(4 male,4 female)and 8 adults(4 male,4 female),undergoing elective operation under general anesthesia,were randomly divided into 2 groups(n=8 each):group adults(aged 19-60 yr,weighing 45-81 kg)and group children(aged 10 months-7 yr,weighins 7.2-21.0 kg).Remifentanil 5μg/kg was injected intravenously during induction of anesthesia.Arterial blood samples 1.0 ml were taken at 1,2,3,5,7,10,15,20,25,30,45 and 60 min after injection for determination of the plasma concentrations of remifentanil.The pharmacokinetic parameters were calculated using software 3P97.Results Elimination half-life was significantly shorter and apparent volume of distribution and clearance were significantly greater in children than in adults(P<0.05),while no significant change was found in the other pharmacokinetic parameters between the two groups(P>0.05).Conclusion There is difference in the pharmacokineties of remifentanil during general anesthesia between children and adults.The plasma concentration of remifentanil is lower in children than in adults after using the same dose,and the dose should be increased appropriately.     

小儿和成年患者全麻时瑞芬太尼药代动力学的比较

Objective To compare the pharmacokinetics of remifentanil during general anesthesia in children and adults.Methods Eight children(4 male,4 female)and 8 adults(4 male,4 female),undergoing elective operation under general anesthesia,were randomly divided into 2 groups(n=8 each):group adults(aged 19-60 yr,weighing 45-81 kg)and group children(aged 10 months-7 yr,weighins 7.2-21.0 kg).Remifentanil 5μg/kg was injected intravenously during induction of anesthesia.Arterial blood samples 1.0 ml were taken at 1,2,3,5,7,10,15,20,25,30,45 and 60 min after injection for determination of the plasma concentrations of remifentanil.The pharmacokinetic parameters were calculated using software 3P97.Results Elimination half-life was significantly shorter and apparent volume of distribution and clearance were significantly greater in children than in adults(P<0.05),while no significant change was found in the other pharmacokinetic parameters between the two groups(P>0.05).Conclusion There is difference in the pharmacokineties of remifentanil during general anesthesia between children and adults.The plasma concentration of remifentanil is lower in children than in adults after using the same dose,and the dose should be increased appropriately.     

子宫切除术后舒芬太尼病人自控-靶控镇痛的安全性和有效性

Objective To investigate the efficacy and safety of patient-controlled analgesia (PCA) with target controlled infusion (TCI) of sufentanil after abdominal total hysterectomy. Methods Sixty ASA I or II patients aged 20-59 yr weighing 45-75 kg undergoing elective abdominal total hysterectomy were randomly allocated into 3 groups of 20 patients each. The initial target plasma concentration (CP ) of sufentanil was set at 0.08 μg/L in group I and II and at 0.1 μg/L in group Ⅲ . The operation was performed under combined spinal-epidural anesthesia with 0.75% bupivacaine (for spinal) and 2% lidocaine (for epidural). The epidural catheter was removed after operation. TCI of sufentanil was started after operation when the patients felt no pain (VAS = 0) in group I and when VAS ≥ 2 in group Ⅱ and Ⅲ . The lockout interval was set at 6 min. If the patients pressed the button once, the target CP increased by 0.005 μg/L. If the button was pressed 3 times successively within 20 s, the target CP increased by 0.008 μg/L. If the button was not pressed for 80 min, the target CP decreased by 0 .005 μg/L automatically. VAS scores, BIS values, MAP, HR, SpO2 and RR were recorded immediately before (T0) and at 1, 2, 4, 8, 16, 24 h (T1-6) after TCI was started. The number of attempts (D1) and successfully delivered doses (D2) was recorded. The total amount of sufentanil administered and side effects were recorded during the 24 h after operation. Results The analgesia was satisfactory in all 3 groups. The VAS scores were < 3 and significantly higher in group Ⅱ and Ⅲ than in group I . The total amount of sufentanil administered during the 24 h after operation was significantly larger in group II and HI than in group I . The D1 and D2 were significantly larger during the 0-2 h after operation in group Ⅱ and Ⅲ than in group I .Tachycardia, bradycardia, respiratory depression, hypotension and over-sedation were not observed. Conclusion PCA with TCI of sufentanil is effective and safe for postoperative analgesia. It is better to start PCA-TCI before the patient feels pain after operation with the initial target CP set at 0.08 μg/L.