2011 Vol. 2, No. 4

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Original Contributions
Abstract:
  Objective  To evaluate the hemodynamic status by transesophageal echocardiography (TEE) during one-lung ventilation with low tidal volume and positive end-expiratory pressure (PEEP) in left lateral position.  Methods  Ten American Society of Anesthesiologists (ASA) class Ⅰ or Ⅱ patients undergoing elective right lung lobectomy in left lateral position were included in the study. After induction of anesthesia, ventilation parameters were set at TV 4-6 ml/kg, PEEP 4-6 cm H2O, and RR 12-16/min, maintaining (end-tidal carbon dioxide, EtCO2) at 35-40 mmHg and SpO2 > 96%. Thirty min later (about 15 min after central venous line insertion), heart rate (HR), blood pressure (BP), and central venous pressure (CVP) were recorded. Left ventricular ejection fraction (EF), stroke volume (SV), cardiac output (CO), cardiac index (CI), stroke index (SI), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular dimension fractional shortening (LVDFS), and systemic vascular resistance (SVR) were measured by TEE through transgastric left ventricle short axis view during two-lung ventilation in supine position. Then, the patient was turned to left lateral position. One-lung ventilation was set just before thoracic cavity was opened and all the same hemodynamic data were repeatedly measured 15 min later.  Results  There were no significant difference in HR, SBP, DBP, CVP, EF, CO, CI, LVESV, LVEDV, LVDFS, and SVR between left lateral one-lung ventilation and supine two-lung ventilation with low tidal volume and PEEP. However, the SV and SI significantly increased in left lateral one-lung ventilation, (69.23±20.01) ml vs. (56.97±22.02) ml and (40.67±8.35) ml/m2 vs. (32.45±8.78) ml/m2 (P < 0.05).  Conclusion  When ventilated with low tidal volume and PEEP, one-way ventilation in left lateral position will not remarkably influence the hemodynamic status and cardiac function.
Abstract:
  Objective  To investigate the incidence of delirium after noncardiac surgery among elderly patients and explore the possible perioperative risk factors.  Methods  In this cross-sectional study using cluster sampling, totally 718 patients aged 65 or older who had undergone elective noncardiac surgeries in our hospital from August to December 2006 were enrolled. Patients were interviewed at the day before surgery and an informed consent was obtained. The same interviewer evaluated the patients prospectively for delirium with the Confusion Assessment Method (CAM) on the preoperative day 1, postoperative day 1, day 2, and day 3. Other information including previous medical history, comorbidities, anesthetics, and perioperative medications were also recorded.  Results  Delirium occurred in 80 patients (11.1%) at during the first three postoperative days, among whom transient symptoms were more frequent than continuous delirium status (68, 85% vs. 12, 15%). The Logistic stepwise regression analysis indicated that the perioperative risk factors of delirium included advanced age (OR:1.480, 95% CI:1.070-2.046), history of stroke (OR:2.862, 95% CI:1.432-5.720), use of meperidine (OR:3.196, 95% CI:1.574-6.488) or scopolamine (OR:2.537, 95% CI:1.523-4.227), hypotention during the operation (OR:1.780, 95% CI:1.070-2.960), long-duration operations (≥ 3 h) (OR:2.610, 95% CI:1.538-4.431), and ICU admission after surgeries (OR:2.187, 95% CI:1.077-4.442).  Conclusions  Advanced age or previous history of stroke are the most important risk factors of postoperative delirium. The incidence of postoperative delirium may be decreased by avoiding other risk factors such as perioperative hypotension, usage of meperidine and scopolamine, and long-duration operation.
Abstract:
  Objective  To evaluate the value of lumber plexus + sciatic nerve + paravertebral nerve block as an anesthesia technique for hip arthroplasty surgery.  Methods  We retrospectively analyzed the perioperative data of 34 patients scheduled for a hip arthroplasty surgery. According to the different anesthesia techniques applied, patients were divided into 3 groups:general anesthesia (GA) group, epidural anesthesia (EA) group, and nerve block (NB) group. Patients in NB group were further divided into lumber plexus + sciatic nerve block (LS) group and lumber plexus + sciatic nerve + paravertebral nerve block (PVB) group.  Results  The average age and the incidence of coexisting disease in NB group were significantly higher than those in GA and EA group (P < 0.05). Significant decreases in the variation of systolic blood pressure, diastolic blood pressure and heart rate in NB group were observed compared with GA group (13.9%±6.1% vs. 21.6%±7.0%, 15.8%±8.2% vs. 23.3%±7.2%, 14.0%±4.7% vs. 23.3%±7.8%, all P < 0.05), and the intra-operative dosage of fentanyl was significantly lower[(103.8±42.7) μg vs. (295.0±55.4) μg, P < 0.05]. Compared with LS group, the variations of systolic blood pressure and diastolic blood pressure significantly reduced in PVB group (9.0%±3.4% vs. 18.8%±3.3%; 9.0%±4.1% vs. 22.5%±4.2%, P < 0.05), and the fentanyl consumption was lower but without a significant difference[(87.5±47.9) μg vs. (120.0±35.6) μg, P > 0.05].  Conclusions  Peripheral nerve block combined with small-dose intravenous anesthesia is a safe and effective anesthetic technique for hip arthroplasty surgery, and lumbar plexus + sciatic nerve + paravertebral nerve block probably can be a more effective regional anesthetic technique.
Abstract:
  Objective  To perform a preliminary survey on airway management in China.  Methods  The postal questionnaires were sent to anesthesiologists in 78 hospitals of 27 provinces/municipalities/autonomous regions. The questionnaire contained four parts which included the general information of respondents, the knowledge and usage of various airway tools, the practical patterns to different clinical airway scenarios, and the administrative management of the anesthesiology department. Chi-square analysis was performed for categorical variable (teaching hospital or non-teaching hospital).  Results  The response rate was 60.7%. Direct laryngoscope using Macintosh blade with standard handle, oral airway, and malleable stylet were the most familiar airway tools for all the respondents. Anesthesiologists in teaching hospitals had better knowledge and more frequent usage of Glidescope, seeing stylet, intubating laryngeal mask airway, and fiberoptical bronchoscope than those in non-teaching hospitals (P < 0.01). There were large variations between teaching and non-teaching hospitals in the knowledge and usage for other airway tools including emergency tools. Nearly half of respondents (46.9%) preferred to choose awake fiberopitcal intubation as their first choices for definite difficult intubation patients. When encountering unexpected difficult intubation, 79.2% of anesthesiologists would attempt alternative tools to intubate only if they could maintain the airway. For patients who were unable to be intubated or ventilated, 47.6% of the responders preferred to improve ventilation using larngeal mask airway as first choice while 52.4% preferred to establish an emergency airway via cricothyrotomy. For suspected difficult intubation, most respondents (92.6%) would attempt to paralyze patient and intubate with direct laryngoscopy. Teaching hospitals were better than nonteaching hospitals in terms of establishing simple airway management algorithm, subspecialty development, and staff training (P < 0.01).  Conclusions  Although the knowledge and usage of airway tools differ among anesthesiologists in China, most of them well follow the airway management algorithm in different airway scenarios. However, the administrative management of the anesthesiology department requires further improvement.
Abstract:
  Objective  To compare the effects of different manual airway maneuvers on Bonfils intubation fiberscope-guided tracheal intubation.  Methods  Totally 90 adult patients with ASA class Ⅰ-Ⅱ who were planning to undergo elective plastic surgery and requiring orotracheal intubation were allocated into three groups:Group A (routine operation), Group B (chin lift), and Group C (external jaw thrust). After intravenous anesthesia induction, all patients were intubated with Bonfils intubation fiberscope. The number of intubation attempts, duration of each intubation attempt, hemodynamic changes, incidence of intubation-related intraoral injury, and postoperative sore throat and other complaints were recorded.  Results  All patients were successfully intubated at the first attempt. The duration of intubation was significantly short in Group C (18.9±10.3)s than in Group A (44.6±38.9)s and Group B (33.7±29.4)s (P < 0.05). The hemodynamic changes were similar among three groups. The incidence of postoperative sore throat and hoarseness in Group A, B, and C were 12, 11, and 7 patients, respectively. One patient in Group A suffered from injury to the upper lip.  Conclusions  Bonfils intubating fiberscope is easy to manipulate with high success rate. Both chin lift and external jaw thrust can shorten intubation time, whereas external jaw thrust can help to achieve the shortest intubation time with minimal injury to oral cavity.
Abstract:
  Objective  Postsynaptic density protein 95 (PSD-95) gene specific siRNAs were introduced in vitro or in vivo to determine its succedent influence on neuropathic pain relief, neuron viability and postsynaptic calcium/calmodulin-dependent protein kinase Ⅱ (CaMKII) phosphorylation.  Methods  siRNAs of rat PSD-95 gene were synthesized for in vitro transfection into NG108-15 neuronal cells. The siRNA to PSD-95, or a mismatch RNA, was mixed with the transfection reagent, i-FectTM (vehicle), and delivered as repeated daily bolus doses (2 μg) via implanted intrathecal catheter to the lumbar spinal cord of rats which received chronic constriction injury (CCI) of sciatic nerve. Both mechanical allodynia and thermal hyperalgesia were measured on the post-operative day 3 and 7. PSD95 gene silenced NG108-15 cells were further stimulated by glutamate, with either the cell viability or the expression and phosphorylation of CaMKIIα to be assayed.  Results  The siRNAs suppressed PSD-95 gene expression level by 91.5% under the appropriate condition in vitro. High level glutamate induced neurotoxicity, which was partially eliminated by PSD-95 gene silencing. Glutamate also induced the postsynaptic expression and phosphorylation of CaMKIIα. PSD-95 siRNA injected intrathecally in normal rats lowered the expression level of PSD-95 mRNA at cornu dorsale medullae spinalis by 38% (P < 0.05) but had no remarkable effect on the pain threshold. Intrathecal injection of PSD-95 siRNA remarkably alleviated neuropathic pain.  Conclusions  PSD-95 gene plays an important role in the development of neuropathic pain. Intrathecal injection of PSD-95 siRNA can remarkably alleviate mechanical and thermal hyperalgesia. PSD-95 siRNA may be a promising gene therapy for neuropathic pain.
Abstract:
  Objective  To explore the feasibility of establishing a rat model of tibial cancer pain with Walker 256 mammary gland carcinoma cells.  Methods  Totally 36 female SD rats were randomly divided into 4 groups:Sarcoma group (n=8), Sham 1 group (n=10); Sham 2 group (n=10); and Naïve group (n=8). In each treatment group, 105 syngenenic Walker 256 mammary gland carcinoma cells, ascetic fluid without tumor cells, and normal saline were respectively injected into the tibia medullary cavity via intercondylar eminence. The pain behaviors including mechanical paw withdrawal threshold (MWT) and paw withdrawal thermal latency (PWTL), bone radiology, and bone histology were evaluated.  Results  Observational results via pain behaviors, radiology, and histology demonstrated that rat model of tibial cancer pain was successfully established with Walker 256 mammary gland carcinoma cells. MWT significantly decreased to 37.59±2.02g on the 7th day after tumor cell injection in the Sarcoma group (P < 0.01 compared with Sham 1 group, Sham 2 group, and Naïve group). PWTL significantly decreased to 6.87±1.00s on the 11th day (P < 0.01 compared with Sham 1 group, Sham 2 group, and Naïve group).  Conclusion  Rat model of tibial cancer pain can be successfully established with Walker 256 mammary gland carcinoma cells.
Abstract:
  Objective  To explore the efficiency and complications of minimal scleral buckling surgery without sub-retinal drainage for rhegmatogenous retinal detachment.  Methods  The clinical data of 28 patients (30 eyes) who received minimal scleral buckling surgery without sub-retinal drainage for their rhegmatogenous retinal detachment were retrospectively analyzed. Best corrected visual acuity (BCVA), retinal attachment condition, and complications were observed before and after surgery.  Results  Among these 30 eyes, 13 eyes were buckled by silicone sponge with only one scleral stitch, 14 eyes with two scleral stitches, and 3 eyes with three or more stitches. The preoperative BVCA was < 0.1 in 14 eyes, 0.1-0.3 in 8 eyes, and > 0.3 in 8 eyes. After (9.4±2.5) months of follow-up, the postoperative BVCA was < 0.1 in 5 eyes, 0.1-0.3 in 9 eyes, and > 0.3 in 16 eyes (P < 0.05). The retina was reattached by 24h for 20 eyes and by 72h for 8 eyes; three eyes were reoperated. The success rate was 90% for the first surgery and 100% after a second operation. Only one eye suffered from exposure of silicone sponge.  Conclusion  Minimal scleral buckling without subretinal drainage is an effective method to treat rhegamatogenous retinal detachment.
2011, 2(4): Ⅰ-Ⅰ, 403.
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2011, 2(4): 295-296. doi: 10.3969/j.issn.1674-9081.2011.04.001
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