细针引导腰麻针径路的解剖特点与临床应用

目的：评价细针引导腰麻针穿刺径路的解剖特点与其临床应用效果。方法：经尿道微创腔镜手术30例,用9号穿刺针置于皮下引导,25GWhitacre腰穿针通过9号穿刺针孔进行蛛网膜下腔穿刺,成功后拔出内芯,可见脑脊液外流,注入0.5%布比卡因2～3ml退针,立即平卧位。观察病人麻醉平面、血压变化及麻醉效果。结果：穿刺操作简单,全部病例完成腰麻,麻醉效果好,一次腰麻能够完成手术。术后随访无任何异常。结论：掌握正确的解剖要领作细针引导下腰麻穿刺可降低病人的损伤,是一种可行、安全及有效的麻醉方法。     

Arterial hypertension associated with the use of a tourniquet with either general or regional anaesthesia

A hypertensive patient with left cardiac enlargement developed marked hypertension under general anaesthesia, during which time a tourniquet was applied around his thigh. When the tourniquet was released, severe hypotension ensued which responded to therapy. The patient, however, died 16 h later of a myocardial infarction. Because of this incident, the anaesthetic and haemodynamic data of 699 patients who underwent limb surgery with a pneumatic tourniquet inflated for at least an hour were retrospectively examined using multivariate analysis. A 30% increase in systolic and/or diastolic arterial blood pressure occurred in 27% of the total patient material and in 67% of those who had had a general anaesthetic. There was a higher frequency of the occurrence of "tourniquet hypertension" with older age, longer operations and the operation site being the lower rather than the upper limb. Tourniquet hypertension rarely occurred in patients with spinal anaesthesia (2.7%) and brachial plexus blockade (2.5%), while those with intravenous regional anesthesia had a higher incidence (19%) of hypertension.     

Monitoring, past, present, future

Summary A little over 40 years ago, anesthesiology in the United States became recognized as a specialty. At that time, its practice was largely that of an art, the science of which was yet to come. A finger on the pulse, observation of color, skin turgor, perspiration, and perhaps a blood pressure cuff in adults, and an estimation of the reflex signs of anesthesia were the standards for the assessment of the patient status and the depth of anesthesia. How far have we come in the intervening years? The journey, as reflected in the experience of one physician, will be held up to the looking-glass; easily as astounding as that through which Alice passed.Caught as we are in the socio-economic climate of the present, how shall we react? Has the gadgetry and electronics of this day given us a meaningful cost-effective handle on a decreased morbidity and mortality? What impact is there on decision-making and outcome? What indeed is the contribution of the machine versus the newer agents, techniques, and the advanced educational milieu.The first attempts at monitoring were clearly directed toward the cardiovascular system. The devices developed were simple and non-invasive. The Riva-rocci method of measuring blood pressure was first applied in anesthesia by Harvey Cushing at the turn of the century. But it was 40 years before the electrocardiogram was introduced as an instrument of potential importance. It took another 25 years for it to have general acceptance, and even later for the anesthesiologist to become comfortable with it as a diagnostic tool. In the early 40s, Peterson, at Pennsylvania, began the applications of invasive blood pressure monitoring for clinical purposes. Subsequently, the use of the central venous catheter, and finally the Swan-Ganz catheter, became acceptable. The application for the technology of cardiac output was a long time in gaining clinical credence. However, this last link surely depended on the computer to make it a clinically useful instrument. The measurement of the cardiovascular system was first, because the means were there.The assessment of respiratory function was more cumbersome, and while the pneumotachygraph was available 40 years ago, its vagaries made it a research tool. Meters for respiration also were available, but too cumbersome for clinical use. The integration of respiratory measurements and blood gas analysis have gone hand-in-hand, the latter far outstripping the former in clinical utility. Shall it be invasive or non-invasive, what is the price? Lastly, our technology has introduced the means for what is a meaningful clinical measurement of neurological and neuromuscular activity. Nerve-muscle stimulators, electromyography, processed electroencephalogram, and the evoked potential as devices for assessment are only the beginning. In all this technological advance there is the black box and the electronic marvels that are part of this age. While invasive techniques surely have a place, the utilization of non-invasive techniques like the measurement of oxygen, carbon dioxide, and all the agents that we employ have changed forever the nature of our practice. Finally, the need to document the anesthesia course objectively will, and has already begun, to impact on our practice. How did we get where we are and where are we going will be explored in this personal journey.     

Splanchnic blood flow during halothane-relaxant anaesthesia in elderly patients

We have previously found that halothane-relaxant anaesthesia in elderly patients causes a change towards a hyperkinetic circulation, with a decrease in the arterial-mixed venous oxygen content difference. This could be attributed to vasodilation. In the present study the splanchnic contribution to these changes was investigated. Nine patients were studied during halothane-relaxant anaesthesia prior to surgery. During anaesthesia splanchnic blood flow was markedly reduced, while splanchnic oxygen uptake decreased only moderately compared with the awake level. This resulted in an increase in splanchnic oxygen extraction. It is concluded that the splanchnic vascular bed does not contribute to the "hyperkinetic" circulation during halothane anaesthesia.     

Central mediation of the conditioned taste aversion induced in rats by harmaline

The assumption that drugs used as unconditioned stimuli in conditioned taste aversion (CTA) studies act centrally was tested by comparing the effects of systemic and intracerebral injections of harmaline hydrochloride (H) in 340 rats. Intraperitoneal injection of 5–20 mg/kg but not of 2.5 mg/kg H administered 5 min after 15-min saccharin (0.1%) drinking decreased saccharin-water preference in a two-choice retention test, performed 48 h later, from 55% to 20%. Since CTA was not diminished when H (10 mg/kg) was injected into rats anesthetised immediately after saccharin drinking by pentobarbital (40 mg/kg), H (1.7–50 g) was administered intracerebrally to anesthetised rats fixed in the stereotaxic apparatus. Injection of 3–6 g H into the inferior olive elicited CTA comparable to that of systemic injection of 10 mg/kg H. Injections of 6 and 50 g H into cerebellum and bulbar reticular formation elicited weaker CTA while neocortical, hypothalamic and mesencephalic applications were ineffective. CTA could also be elicited when 50 g but not 6 g H was injected into the inferior olive 1 or 2 h after saccharin drinking. This delay-dependent effect and failure of non-contingent H administration to change saccharin preference indicates that the H-induced CTA is not contaminated by a non-specific increase in neophobia. It is concluded that H probably elicits CTA by activation of caudal bulbar structures, including the nucleus of the solitary tract, area postrema and lateral reticular formation.     

腰硬联合麻醉与全麻对老年腹部手术患者术后短期认知功能的影响

目的 探讨腰硬联合麻醉(CSEA)与全麻对老年腹部手术患者术后认知功能的影响。方法 选取本院2018年5月—2019年5月收治的82例老年腹部手术患者,按随机数表法分为观察组和对照组,各41例。观察组应用CSEA,对照组则采用全身麻醉。比较两组的麻醉相关指标,术后6 h、12 h、24 h的精神功能状态以及患者术后短期认知功能障碍的发生率。结果 观察组麻醉起效时间(min)、完全清醒时间(min)分别为(8.19±1.04)、(28.67±5.60)与对照组的(10.17±2.12)、(37.25±6.12)比较差异有统计学意义(P<0.05);观察组视觉模拟评分(VAS)(3.51±1.12)与对照组的(4.27±1.15)比较差异有统计学意义(P<0.05);观察组患者术后6 h、12 h、24 h时的MMSE评分分别为(22.27±1.46)、(26.23±1.26)、(28.19±1.24),均高于对照组的(21.46±1.35)、(24.68±1.23)、(26.37±1.19)(P<0.05);观察组短期内POCD的发生率为4.88%,低于对照组的24.39%,差异有统计学意义(P<0.05)。结论 对老年腹部手术患者采用CSEA,不仅能缩短麻醉起效时间和完全清醒的时间,减轻疼痛,而且对患者精神功能的影响小,可有效减少短期内认知功能障碍发生率。     

基于循证的预警性护理干预对儿童全身麻醉患者压疮的预防效果

目的探讨基于循证的预警性护理干预对儿童全身麻醉患者压疮的预防效果。方法选择2020年1月至2020年6月我院收治的全身麻醉患儿288例,随机分为两组各144例。对照组给予常规护理,观察组在对照组基础上给予基于循证的预警性护理干预。比较两组的压疮发生率以及护理满意度。结果观察组的压疮发生率为4.17%,显著低于对照组的11.11%(P<0.05)。观察组的护理满意度为98.61%,显著高于对照组的90.97%(P<0.05)。结论基于循证的预警性护理干预可以降低儿童全身麻醉患者的压疮发生率,提高护理满意度。     

不同浓度地佐辛联合丙泊酚麻醉对无痛肠镜患者的临床研究

目的研究分析不同浓度地佐辛加丙泊酚麻醉对行无痛肠镜治疗患者苏醒质量的影响。方法选择2019年1月—2020年1月于我院行无痛肠镜治疗的80例患者为本次研究对象,将其按照随机分组的方式分为甲组和乙组,各40例,甲组予以0.05 mg/kg地佐辛+丙泊酚麻醉,乙组予以0.1 mg/kg地佐辛+丙泊酚麻醉,观察两组丙泊酚用量、苏醒时间和术中不良反应发生情况,并对数据进行分析统计。结果乙组丙泊酚用量低于甲组,且乙组苏醒时间短于甲组,差异具有统计学意义(P<0.05),乙组术中不良反应发生率为7.50%低于甲组25.00%,差异具有统计学意义(P<0.05)。结论地佐辛联合丙泊酚在无痛肠镜治疗患者的麻醉中效果显著,但0.1 mg/kg地佐辛+丙泊酚安全性更高,可有效降低丙泊酚用量,缩短苏醒时间,并降低不良反应发生率,可满足临床麻醉需求,有较高的临床应用价值。     

喉罩全麻通气用于妇产科临床麻醉的麻醉效果及安全性评价

目的:探究妇产科麻醉中采用喉罩全麻通气的麻醉效果与安全性。方法:选取本院收治的妇产科手术患者90例,按照通气方式的不同分为2组,对照组实施气管内插管通气,观察组实施喉罩全麻通气,比较两组患者置管成功率、收缩压、舒张压、平均动脉压、心率的变化。结果:对照组通气后收缩压与舒张压水平高于通气前(P<0.05);观察组通气后收缩压与舒张压水平均低于对照组(P<0.05);对照组通气后平均动脉压与心率水平均比通气前高(P<0.05);观察组通气后平均动脉压与心率水平均比对照组低(P<0.05)。结论:产科麻醉中采用喉罩全麻通气麻醉,麻醉效果与安全性都较高。     

不同给药方案喙突下臂丛麻醉效果比较

目的：比较不同给药方案上肢手术喙突下臂丛麻醉的效果。方法：喙突下臂丛麻醉患者64例,随机分为3组,3种方案给药,方案①20例1％利多卡因30ml;方案②24例1％利多卡因20ml＋0.25％布比卡因10ml;方案③20例1％利多卡因10ml＋0.25％布比卡因20ml。测定麻醉起效时间、完善时间、持续时间及运动阻滞程度。监测药物不良反应。结果：3组麻醉结果,优良率皆达100％,起效时间、完善时间方案②及③皆长于方案①;持续时间方案②及③皆较方案①明显延长,各为其2.8倍及5倍,3组皆无不良反应。结论：3种方案皆安全有效。方案①麻醉起效快、短;方案②及③起效稍慢但持久。为临床不同时间手术选择不同给药方案提供了依据。