Factors of nonspecific resistance in patients with cancer under various types of general anesthesia

The study of changes in the factors of natural resistance (blood serum bactericidal activity, lysozyme, B-lysines) and immunogenesis (T- and B-lymphocytes, immunoglobulins A, M, G) observed in cancer patients subject to 4 distinct types of anesthesia (ketamine anesthesia, hallothane anesthesia, ester anesthesia, neuroleptanalgesia + N2O) has demonstrated differences in the effect of various anesthesia techniques on the above homeostasis parameters. The changes in natural resistance factors proved to be more informative for predicting the course of the postoperative period. Heterogeneity of changes caused by various types of anesthesia and corresponding clinical and experimental results confirm the effect of anesthesia on the course of the postoperative period. It has been established that ketamine anesthesia affects the T-system (causing its significant inhibition), with ester anesthesia attenuating humoral immunity. Neuroleptanalgesia combined with N2O proved to be the most avequate technique of anesthesia in cancer patients, sparing their body resistance factors. Our results correlate with the data on postoperative complications.     

State of central hemodynamics in various kinds of anesthesia during short-term ENT surgery in children

The study was carried out in 124 children aged 4-10 years with ASA risk I or II. Group 1 consisted of 40 patients operated on under combined anesthesia with midazolam, fentanyl, and N2O, group 2 were 30 children operated on under mask anesthesia with fluothane, and nitric oxide + oxygen, group 3 patients were operated on under combined anesthesia with ketamine, midazolam, and N2O + CO2, and group 4 patients were operated on under thiopental and N2O + CO2. Cardiovascular function was evaluated by the NCCOM3-R-7 device (BoMed) by the bioimpedance method. Satisfactory cardiovascular function was observed in all groups, but the best stability was noted in the midazolam-fentanyl group. Hence, midazolam-fentanyl combination can be the method of choice in short-term ENT operations.     

气管插管静脉复合全麻下行上腹部手术术中使用布地奈德雾化治疗对COPD患者呼吸功能的影响

【目的】观察慢性阻塞性肺病（COPD）患者于气管插管静脉复合全麻下行上腹部手术术中使用布地奈德雾化治疗对术中气道压变化及术后呼吸功能恢复情况的影响。【方法】ASAⅡ～Ⅲ级、年龄65～75岁,拟行上腹部手术且患有重度COPD怠者40例,手术时间3～4h,随机分为两组。雾化组（W组）：气管插管后30min进行布地奈德雾化治疗一次;对照组（D组）：术中不做任何雾化治疗。记录两组患者雾化治疗前后气道压的变化、麻醉前后脉搏血氧饱和度（SpO。）的变化以及术后患者呼吸功能恢复情况。【结果】W组在气管插管后30min时气道压有明显降低（P〈0．05）;与D组比较,W组在麻醉苏醒后的Sp02明显高于麻醉前（P〈0．05）,W组术后1h内成功拔除气管导管的病例人数明显增多（P〈0．05）。【结论】COPD患者于气管插管静脉复合全麻下行上腹部手术术中给予布地奈德雾化治疗能降低术中气道峰压,显著改善患者术后的呼吸功能恢复,减少低氧血症的发生。     

A comparative evaluation of "cerebral oximetry" during anesthesia with xenon and other anesthetics

The oxygen status dynamics during the general anesthesia is one of the most important issues of anesthetic monitoring. The set target was to study the cerebral oximetry (rSO2) in anesthesia with xenon as compared with other anesthetics. A total of 80 patients (class ASA I-II) were examined in the venectomy surgery. According to an anaesthetic used in induction and anesthesia management, the patients were divided into 3 groups. Group 1--40 patients with xenon mono-anesthesia; group 2--20 patients with propofol + N2O + neurolpangesia; and group 3--20 patients with N2O + ftorotan. At xenon induction, rSO2 went up by 6.4%. At propofol induction, there were no changes in rSO2. A biggest increase in the cerebral blood circulation was noted, at the anesthesia management stage, in the patients' group, who received ftorotan; a lesser increase was registered in xenon anesthesia. An increased rSO2 level was higher, during the wakening stage, in case of ftorotan administration than in the group, which received xenon; the process of recovering the initial parameters was slower in the former group. Xenon and ftorotan were shown to contribute to a higher oxygen status and an increased volume of the cerebral blood circulation. In case of xenon mono-anesthesia, there was a smaller increase in the cerebral blood circulation as compared to N2O + ftoratan anesthesia. Further special investigations are needed to give a final answer to the question on whether it is possible to use xenon in neuroanesthesiology and in intensive care of patients with a neuroresuscitation-type pathology of the brain.     

两种不同硬膜外麻醉方式对胆囊切除术患者麻醉效果的对比研究

目的 探讨两种不同硬膜外麻醉方式对胆囊切除术患者麻醉效果.方法 将胆囊疾病患者86例,按数字法随机分为硬膜外麻醉组（对照组,n=43）和硬膜外复合静脉麻醉组（观察组,n=43）,进行麻醉方式的效果研究.结果①两组间手术前指标包括皮质醇、肾上腺素及血糖浓度检测值比较差异无统计学意义（P＆gt;0.05）;手术后10 min,研究组患者的肾上腺素、皮质醇及血糖监测值浓度均显著低于对照组（P＜0.05）.②患者86例手术过程顺利均获成功,患者术后住院时间为5～10 d,平均住院时间（7.2＆#177;0.8）d.研究组术中失血量较对照组明显减少（t=3.814,P＜0.05）,手术时间较对照组明显缩短（t=2.128,P＜0.05）.③研究组患者37例（86.05%）术后第2日下床活动,无术中胆道损伤发生,且无术后腹腔出血、漏胆、伤口感染等情况发生;对照组患者34例（79.07%）术后第2日下床活动,无术中胆道损伤,术后无腹腔出血、漏胆发生,术后伤口感染发生1例,经积极抗感染后痊愈.结论 硬膜外复合静脉复合麻醉具有麻醉效果较好、患者生命体征稳定、应激反应较为平和的优点,增加了手术及麻醉过程的安全系数,明显优于单纯硬膜外麻醉,因此较适合基层医院开展腹腔镜手术中应用.     

Controlled combination anesthesia

The improvement of combined anesthesia is associated with the improvement of its control. The latter is possible only with continuous administration of anesthetics. 130 procedures of combined anesthesia were performed in patients subject to abdominal and other types of operations. With this in view fentanyl and calipsol were continuously injected, using modified dosators, to patients pretreated with N2O and total curarization. It has been found that with continuous administration adequate analgesia with stable blood pressure can be achieved provided that 1/3-2/3 of the total fentanyl dose is used as a loading dose at the beginning of anesthesia. The maintenance dose does not change considerably blood anesthetic concentration. If required, changes in the concentrations were achieved by additional fentanyl administration, using a dosator for 25-50 mukg. The technique described has advantages over bolus drug injection and continuous drug infusion. The technique may be considered a controlled one.     

悬雍垂腭咽成形术围术期的麻醉处理

[目的]探讨悬雍垂腭咽成形术(UPPP)围术期适宜的插管和麻醉方法。[方法]对40例行UPPP病人围术期采用不同的插管方法,其中16例采用静脉快诱导经鼻明视气管内插管,12例术前行预防性气管切开,12例采用清醒镇静表麻下经鼻盲探气管内插管．比较插管时情况。其中非静脉诱导插管24例病人根据插管前是否泵入异舒吉分为异舒吉组和对照组,观察插管前后血压变化。[结果]经鼻明视气管内插管4例插管不顺利,2例插管期间SPO2下降明显;清醒镇静表麻下经鼻盲探气管内插管成功率100％,插管期间SPO2无明显变化,4例插管后无呛咳反应。插管前后异舒吉组血压无明显变化,对照组插管后血压明显升高。[结论]清醒镇静表麻下经鼻盲探气管内插管为UPPP首选;合适的麻醉深度加血管活性药物可维持稳定的血流动力学状态。     

Combined intravenous and epidural anesthesia in laparoscopic surgery]

Two methods of anesthesia (total intravenous and combined intravenous + epidural) are compared in patients after laparoscopic cholecystectomy with grave concomitant diseases of the circulatory and respiratory systems. Combined anesthesia should be preferred in this category of patients.     

Approaches to anesthesia management of a patient during oncological pulmonary surgery

The results of lungs' excision in 82 patients made under a combined anesthesia of 2 types are comparatively analyzed. A surface low-level endobronchial narcosis by isoflurane was administered in 42 patients concurrently with a "high" epidural anesthesia by bupivakain and fentanyl. The other 40 patients received isoflurane and intravenous bolus injections of fentanyl concurrently with epidural anesthesia by morphine administered at the lumbar level. The epidural analgesia by bupivakain and fentanyl made at the thoracal level or by morphine made at the lumbar level was carried on in the early postoperative period. The results show both variations to ensure a reliable intraoperative anesthesia, a smooth recovery and a good postoperative analgesia. Better results were on the whole obtained by the variant of high epidural anesthesia/analgesia; however, the method of lumbar morphine administration has a number of advantages primarily related with its simplicity.     

Porcine systemic and regional organ blood flow during 1.0 and 1.5 minimum alveolar concentrations of sevoflurane anesthesia without and with 50% nitrous oxide

Effects of sevoflurane anesthesia on organ blood flow were examined in nine healthy isocapnic pigs using 15-mumol diameter radionuclide-labeled microspheres that were injected into the left atrium. Minimum alveolar concentration (MAC) of sevoflurane required to prevent 50% of the pigs from responding by gross purposeful movement to a noxious stimulus was found to be 2.66 +/- 0.20%. Hemodynamic measurements were made on each pig during the following five conditions: awake (control); 1.0 MAC of sevoflurane anesthesia; 2.66% (1.0 MAC) sevoflurane + 50% N2O anesthesia; 1.5 MAC of sevoflurane anesthesia; and 3.99% (1.5 MAC) sevoflurane + 50% N2O anesthesia. Dose-related decrease in cardiac output, mean aortic pressure and left ventricular work occurred with sevoflurane anesthesia but heart rate was unchanged. Addition of 50% N2O to either of the pre-established sevoflurane concentrations did not change heart rate or the cardiac output, but with 3.99% sevoflurane mean aortic pressure decreased further. Unlike isoflurane and halothane which increase porcine brain blood flow, cerebral blood flow decreased to a similar level with both levels of sevoflurane anesthesia. Whereas cerebellar perfusion was unaltered with both levels of sevoflurane anesthesia, brain-stem blood flow decreased to a similar level from the control value. However, during 3.99% sevoflurane anesthesia, brain-stem blood flow exceeded that at 2.66% sevoflurane anesthesia. Addition of N2O to pre-established concentrations of sevoflurane increased regional brain blood flow but cerebral and brain-stem blood flow exceeded awake value only during 2.66% sevoflurane + 50% N2O anesthesia. Transmural myocardial blood flow decreased in a dose-dependent manner during sevoflurane anesthesia but the subendocardial/subepicardial perfusion ratio remained at control value.(ABSTRACT TRUNCATED AT 250 WORDS)     

The presurgical management with erythrocytapheresis of a patient with a high-oxygen-affinity, unstable Hb variant (Hb Bryn Mawr)

BACKGROUND: Hemoglobin (Hb) Bryn Mawr is an unstable Hb variant resulting in congenital hemolytic anemia. This variant Hb also has an increased affinity for oxygen. The perioperative transfusion management of this disorder is described, and the first genomic analysis of this Hb variant is given. CASE REPORT: An 11-year-old boy, heterozygous for Hb Bryn Mawr, was referred for cholecystectomy. Sequence analysis of genomic DNA confirmed that the patients was heterozygous for a T–>C transition in the codon for amino acid 85, causing a substitution of serine for phenylalanine in the beta-globin chain. On the basis of whole-blood O2 dissociation studies, projected tissue O2 delivery would have been suboptimal during general anesthesia; therefore, a partial red cell exchange transfusion was performed to lower variant Hb and prevent tissue hypoxia during surgery. The red cell mass to be exchanged (50%) was determined from the calculated increase in O2 delivery capacity required to maintain an O2 extraction of 4 to 5 mL of O2 per dL of whole blood. The p50 of whole blood from the patients immediately after the exchange transfusion was 16.0 torr. At the time of surgery, the p50 was normal (25.9 torr). The patient's whole blood 2,3 DPG levels were 4.70 mmol per mL of red cells (before transfusion) (normal range=4.8 +/? 0.3 mmol/mL red cells), 4.07 mmol per mL of red cells (immediately after transfusion), and 4.55 mmol per mL of red cells (48 hours after transfusion). CONCLUSION: This patient with Hb Bryn Mawr was prepared for surgery with a partial exchange transfusion to prevent tissue hypoxia during anesthesia. Decreased 2,3 DPG levels immediately after transfusion resulted in increased O2 affinity of whole blood; however, 48 hours after exchange transfusion, a normal p50 (due to both removal of variant Hb and regeneration of 2,3, DPG) was observed. Partial exchange transfusion is useful in the preoperative management of patients with Hb variants characterized by increased O2 affinity.     

Use of average-acting nondepolarizing myorelaxants in abdominal surgery

The efficiency and safety of use of average-acting nondepolarizing myorelaxants, such as atracurium, vecuronuim, rocuronium, and cisatracurum, during abdominal surgical interventions under general anesthesia (combined or total intravenous anesthesia) were investigated in 162 patients. There is evidence that the use of the above agents ensures a qualitative myorelaxation during different types of operations (laparoscopic and laparotomic) and no impact on hemodynamics (according to the data of continuous non-invasive monitoring) allows these myorelaxants to be used in patients with concomitant cardiovascular diseases. Rocuronium is the myorelaxant of choice for rapid tracheal intubation. The high degree of predictability of the duration of an effect produced by atracurium and cisatracurium enables these myorelaxants to be used without monitoring neuromuscular conduction. With the equally good quality of myoplegia and with virtually comparable consumed diseases, the infusion procedure of relaxation maintenance is preferable for early activation of patients. Insignificant effects on histamine release make it possible to use vecuronium, rocuronium, and cisatracurium in patients with the compromised immune system.     

Use of laryngeal masks: variants of hemodynamic response to various methods of anesthesia

Choice of induction agent is the decisive factor in utilization of a laryngeal mask (LM) under spontaneous respiration, as insufficient relaxation and unwanted laryngopharyngeal reflexes deteriorate the efficiency of LM functioning during operation and anesthesia. 132 anesthesias with LM were performed, 86 of these for laparoscopic cholecystectomies (LCE) (group 1) and 42 for saphenectomies (group 2). Control group consisted of 60 patients anesthetized for LCE by means of an endotracheal tube (ETT). Combined induction intravenous anesthesia with ketamine, barbiturates, and diprivan was used in group 1 and controls. In group 2 induction anesthesia was based on ketamine and diprivan. Group 1 and control group were matched for demographic characteristics and concomitant diseases. All groups were divided into subgroups, depending on anesthesia. In all groups pipecuronium bromide (0.06 mg/kg) was administered before insertion of EET or LM after injection of induction agents. In total myoplegia, installation of LM was simple, involving no untoward laryngo-pharyngeal reflexes. LM was correctly installed from the first attempt in 98.7% cases. In combined intravenous ketamine-based anesthesia, pressor reaction to LM installation consisted in an increase of heart rate by 5.6% (1K group--control), by 10.2% in 2K group (fractionated ketamine (1.5-2 mg/kg) + diazepam (0.1 mg/kg) and fentanyl (2.6 micrograms/kg); after barbiturates heart rate increased by 6.7% in 1B group (control), after diprivan it did not increase in 1D group (control), while the mean arterial pressure in 2D group (fractionated diprivan (1 mg/kg) + ketamine (25-50 mg), diazepam (0.08 mg/kg) and fentanyl (2.6 micrograms/kg) increased by 10% and heart rate by 6.6%. Reaction to tracheal intubation was pronounced in all types of induction anesthesia. No regurgitation or aspiration was observed in any case. Hence, use of total myoplegia in installation of LM allows the use of various modern anesthetics in optimal doses and notably simplifies the utilization of LM.     

光棒引导气管插管的临床应用

目的对光棒引导气管插管的操作方法及其有效性、安全性等进行探讨和评价。方法随机选择需气管插管全身麻醉的患者60例,其中男21例,女39例;年龄15～79岁,体重35～110kg,术前预测存在困难气道者3例。采用Tubestat光棒引导气管插管,观察并记录插管时间、插管次数、血流动力学变化及不良反应。结果60例患者中有57例使用光棒插管成功（95％）其中1次插管成功者38例（63％）,试插2次成功者12例,试插3次成功者7例,插管失败3例（5％l插管时间（29．9l±24．21）s。插管后1min与麻醉前比较血流动力学变化无差异;术后诉有轻度咽喉痛者3例,未见其他与插管有关的并发症。结论光棒插管技术简单实用,容易掌握,成功率高,并发症少,可作为麻醉科常规气管插管方法。     

Increased hyaluronic acid production in lung--a possible important factor in interstitial and alveolar edema during general anesthesia and in adult respiratory distress syndrome

The tremendous swelling potential of hyaluronic acid (HA) is well established, however, the possible role of HA for interstitial and alveolar edema of the lung during general anesthesia and in adult respiratory distress syndrome (ARDS) has not received attention. Bronchoalveolar lavage (BAL) was therefore performed on 28 apparently lung-healthy patients; first 24 h prior to induction of general anesthesia and then--in the same lung segment--approximately 30 min after anesthesia induction with endotracheal intubation and mechanical ventilation with N2O in O2. The second BAL was undertaken prior to surgery. Another group of 11 patients with ARDS was also subjected to BAL. A third control group of 10 patients was investigated with BAL 24 h apart to see if a prior BAL influenced the second BAL. Prominent findings were that induction of general anesthesia was associated with significantly (P less than 0.001) increased amount of HA in BAL, on average 77 micrograms/l (range 24-181 micrograms/l) as compared with HA-level 24 h before anesthesia, where all values were below 20 micrograms/l. ARDS patients ranged from 72 to 1636 micrograms/l with a mean of 515 micrograms/l, which was significantly (P less than 0.001) higher than HA-level after induction of anesthesia. The control group that had BAL of the same lung segment 24 h apart did not show any increase in HA-level during the second BAL; with HA-level below 20 micrograms/l.(ABSTRACT TRUNCATED AT 250 WORDS)     

羟考酮复合右美托咪定对清醒气管插管患者术中呼吸及循环功能的影响

[目的]探讨羟考酮复合右美托咪定对清醒气管插管患者术中呼吸及循环功能的影响.[方法]预计困难气道的择期手术患者82例均分为两组,各41例,患者均在清醒状态下气道插管,对照组患者给予舒芬太尼复合右美托咪定麻醉诱导,观察组给予羟考酮复合右美托咪定麻醉诱导.比较不同时间点两组患者收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR)等循环系统参数以及气道压力(PAW)、呼气末二氧化碳分压(PETCO2)等呼吸功能指标水平变化,比较两组插管前镇静(Ramsay)、插管后舒适度评分及不良反应发生率.[结果]观察组患者诱导后1 min、5 min时SBP、DBP、MAP、HR水平与对照组比较显著增高(P<0.05).插管后1 min时MAP水平较对照组高(P<0.05).插入后3 min、拔除即刻对照组PAW、PETCO2水平显著高于观察组(P<0.05).观察组患者不良反应总发生率为9.76%(4/41)明显低于对照组29.27%(12/41)(P<0.05).[结论]羟考酮复合右美托咪定能安全的应用于清醒气管插管患者中,对患者的呼吸和循环功能影响较小,镇痛镇静效果良好,不良反应发生率低,值得临床应用推广.     

胸腔镜下脊柱前路手术的麻醉探讨

目的:探讨胸腔镜下脊柱前路手术麻醉方法的选择及术中处理。方法:胸腔镜下脊柱前路手术42例。T10以上脊柱病变选择双腔支气管插管10例,常规气管插管32例。本组病例术前进行等容量血液稀释,术中采用控制性降压,预计术中出血量较大。应用血液回收机进行自体血回收。结果:T10以上平面脊柱病变选择双腔支气管插管,进行单肺通气,术中充分暴露手术野,缩短手术时间。而T10以下脊柱病变手术,采用常规气管插管,通过增加呼吸频率,减少肺潮气量,也能顺利完成手术。本组病例42例,输异体血只有15例,占35％。结论:胸腔镜下脊柱前路手术,T10以下平面的脊柱病变,可选择常规气管插管。术中采用控制性降压和血液回收机的应用,可以较大程度降低输血量,缓解血源的紧张,和减少输血引起的不良反应。     

手汗症患者电视纵隔镜下胸交感神经切断术的麻醉处理

目的 探讨电视纵隔镜行T2～T4交感神经切断术治疗手汗症的麻醉管理.方法 150例手汗症患者随机分为3组,每组50例.分别选择双腔管(A组)、单腔管低潮气量机械通气组(B组)和单腔管暂停机械通气组(C组)插管静脉吸入复合全身麻醉,连续监测呼气末二氧化碳分压、脉搏氧饱和度、有创动脉压、心电图,于插管前、插管后5min、切断交感神经即刻、膨肺维持气道正压时、术毕即刻等时点记录上述参数的变化,同时抽取动脉血行血气分析.结果 与术前比较,各组患者切断双侧胸交感神经后心率减慢(P ＜0.05);膨肺维持正压时血压明显下降(P＜0.05);B、C两组患者于切断胸交感神经即刻PaCO2明显升高,但术毕恢复正常.结论 应用电视纵隔镜行胸交感神经切断术治疗手汗症,使用单腔或双腔气管插管静脉吸入复合全身麻醉均安全可行,且使用单腔管插管技术简单、费用低及术后并发症无明显增加.     

Effect of anesthesia with xenon and nitrous oxide with fentanyl on dynamics of cellular immunity and cytokines

Immunological parameters were studied at randomization in 60 surgical patients during the similar operation--cholecystectomy made under combined endotracheal low-flow general anesthesia using N2O:O2+fentanyl in 32 patients and Xe:O2 in 28 patients. The time course of changes in cellular immunity and cytokines was closely related to the type of an anesthetic. Unlike N2O:O2+fentanyl, Xe did not show such a marked proinflammatory activity, exerted a mild normalizing effect on leuko- and lymphopoiesis, had an immunostimulating activity, and reduced the frequency of postoperative inflammatory complications and the length of stay at hospital. The differences in the action of the anesthetics were due to the fact that Xe had a greater narcotic potential, a protective action on neuroendocrine function, and no toxicity. Xe is indicated to patients with baseline immunodeficiency.     

Autonomic reactivity and intraoperative arterial hypertension in patients with ischemic heart disease

As patients with ischemic heart disease (IHD) may develop intraoperative hypertensive and hyperdynamic reactions provoking myocardial ischemia, the authors estimated reactivity of the autonomic nervous system before giving anesthesia. This was made for prediction of intraoperative hypertensive reactions and choice of an optimal anesthesia variant. Combination of spectral analysis of variability of the heart rhythm and active orthostatic test was employed for this purpose in 50 IHD patients undergoing myocardial revascularization.