Objective:To explore the half-effective dose(ED_(50))of remazolam toluenesulfonate combined with subthreshold amounts of esketamine for inhibiting cardiovascular response to tracheal intubation in elderly patients.Met...Objective:To explore the half-effective dose(ED_(50))of remazolam toluenesulfonate combined with subthreshold amounts of esketamine for inhibiting cardiovascular response to tracheal intubation in elderly patients.Method:We included 42 patients,aged 65-75,who required general anesthesia and single-lumen endotracheal intubation for elective surgery.The first patient was administered remazolam toluenesulfonate at a dose of 0.20 mg/kg.Once the patient lost consciousness,their alertness/sedation score(OAA/S score)was≤1,and their BIS score was≤60,and a subthreshold dose(0.3 mg/kg)of esketamine was given.The subsequent doses were adjusted using a sequential approach based on the cardiovascular response to tracheal intubation observed in the previous patient.The dose was modified in increments or decrements of 0.01 mg/kg.The ED_(50)and 95%CI of remazolam toluenesulfonate were calculated using the Dixon and Massey sequential distribution test method.Result:The inhibition of endotracheal intubation response was positively correlated with the dose of remazolam toluenesulfonate,and the depth of sedation could not be achieved when the amount was≤0.22 mg/kg.The ED_(50)of remazolam toluenesulfonate combined with a subthreshold dose of esketamine in inhibiting cardiovascular response to tracheal intubation in elderly patients was 0.30(0.28,0.33)mg/kg.There was no statistically significant difference in blood pressure between the induction of anesthesia and before the operation.Conclusion:When compounded with 0.3 mg/kg esketamine,the ED_(50)of Remazolam toluenesulfonate in inhibiting cardiovascular response to endotracheal intubation in elderly patients was 0.30 mg/kg(95%CI0.28-0.33 mg/kg).展开更多
Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divid...Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.展开更多
Objective:To explore the effects of different infusion schemes on colloid osmotic pressure during major abdominal surgery and perioperative albumin in elderly patients.Methods:140 elderly patients of 65-80 years old u...Objective:To explore the effects of different infusion schemes on colloid osmotic pressure during major abdominal surgery and perioperative albumin in elderly patients.Methods:140 elderly patients of 65-80 years old undergoing major abdominal surgery were divided into 4 groups according to the method of random number table,and different proportions of crystals and colloids were given to different groups(group A:full crystal,group B:crystal-colloid ratio 1:1,group C:crystal-colloid ratio 2:1,Group D:crystalcolloid ratio 1:2).The plasma colloid osmotic pressure and level of albumin during perioperative period were monitored.Simultaneously observe the arterial blood pH,blood glucose,extubating time of endotracheal tube,postoperative feeding time,et al.Results:The total amount of liquid infusion in the group of whole crystal was 3056ml(3056±253),which was significantly more than other groups(P<0.01).At the same time,the colloid osmotic pressure decreased by 11.9 mmHg(11.9±2.8),which was more obviously decreased than that of the other groups(B group3.9±1.3,C group 1.5±0.3,D group 4.7±2.1).The difference was a statistically significant(P<0.01).On the next day after surgery,the level of albumin decreased by an average of 4.3 g/L(4.5±1.9)compared with that in group B before surgery,and group C decreased by 2.9 g/L(2.9±1.2)in average,which was significantly different(P<0.05)from group A 10.2 g/L(10.2±1.8).There was no statistically significant difference between group A and group D(P>0.05).And the other indexes were not significantly different between the two groups.Conclusion:This study found that different infusion solutions with different crystal-colloid ratios had an effect on perioperative colloid osmotic pressure and level of albumin.展开更多
Objective:To explore the effects of different positions on supine hypotensive syndrome in cesarean section after lumbar anesthesia.Methods:600 fullterm parturient were randomly divided into 4 groups.The patented posit...Objective:To explore the effects of different positions on supine hypotensive syndrome in cesarean section after lumbar anesthesia.Methods:600 fullterm parturient were randomly divided into 4 groups.The patented positioning pads(patent number:ZL 201720618886.5)in our department was used when the left-leaning position was placed.The parturient lied in a supine position for anesthesia,and then the group of positioning pads was placed after turning into the lateral position.The parturient were divided into group A(supine position),group B(left-leaning to 10°),group C(left-leaning to 20°),and group D(30°).Observation index:Main index:Comparison of maternal blood pressure changes and neonatal blood gas analysis in the supine position without using position pad and with the use of patent positioning pads in different tilt angles(10°,20°,30°).Minor index:1)the use and frequency of vasoactive drugs,whether a left-leaning operating bed or uterine displacement is required;2)the selffeeling of the parturient;3)newborn’s Apgar scores of 1 minute,5 minutes,and 10 minutes after birth;4)whether the obstetrician can perform the operation smoothly in the corresponding left leaning position.Results:The blood pressure at the supine position after anesthesia,the beginning of surgery and the time when the newborn was delivered in group A and group B were significantly different from those in group C(P<0.05).There were significant differences at different timings in group A and group B,and the decline was more significant at the supine position after anesthesia,the beginning of surgery and the time when the newborn was delivered(P<0.05).The pH of blood gas of newborns in group A,group B and group C was between 7.25 and 7.37,and there was no significant difference among the three groups(P>0.05).Conclusion:The use of positioning pads can prevent the adverse effects of supine hypotensive syndrome on parturient and newborns to a certain extent.展开更多
文摘Objective:To explore the half-effective dose(ED_(50))of remazolam toluenesulfonate combined with subthreshold amounts of esketamine for inhibiting cardiovascular response to tracheal intubation in elderly patients.Method:We included 42 patients,aged 65-75,who required general anesthesia and single-lumen endotracheal intubation for elective surgery.The first patient was administered remazolam toluenesulfonate at a dose of 0.20 mg/kg.Once the patient lost consciousness,their alertness/sedation score(OAA/S score)was≤1,and their BIS score was≤60,and a subthreshold dose(0.3 mg/kg)of esketamine was given.The subsequent doses were adjusted using a sequential approach based on the cardiovascular response to tracheal intubation observed in the previous patient.The dose was modified in increments or decrements of 0.01 mg/kg.The ED_(50)and 95%CI of remazolam toluenesulfonate were calculated using the Dixon and Massey sequential distribution test method.Result:The inhibition of endotracheal intubation response was positively correlated with the dose of remazolam toluenesulfonate,and the depth of sedation could not be achieved when the amount was≤0.22 mg/kg.The ED_(50)of remazolam toluenesulfonate combined with a subthreshold dose of esketamine in inhibiting cardiovascular response to tracheal intubation in elderly patients was 0.30(0.28,0.33)mg/kg.There was no statistically significant difference in blood pressure between the induction of anesthesia and before the operation.Conclusion:When compounded with 0.3 mg/kg esketamine,the ED_(50)of Remazolam toluenesulfonate in inhibiting cardiovascular response to endotracheal intubation in elderly patients was 0.30 mg/kg(95%CI0.28-0.33 mg/kg).
文摘Objective:To explore the effect of continuous non-invasive blood pressure monitoring on intraoperative hemodynamics and postoperative myocardial injury in craniotomy.Methods:120 cases of elective craniotomy were divided into the self-control group(continuous non-invasive blood pressure monitoring and intermittent cuff non-invasive blood pressure monitoring,CNAP group)and propensity score matching group(only intermittent cuff non-invasive blood pressure measurement in previous craniotomy,PSM group);Goal-directed hemodynamic management in CNAP group included heart rate(HR),blood pressure(BP),stroke volume(SV),stroke variability(SVV),and systemic vascular resistance index(SVRI).The main index is to compare the troponin level within 72 hours after operation between the CNAP group and the PSM group;The secondary indicators are the comparison of the hemodynamic conditions between the CNAP group and the PSM at 10 specific time points.Results:The incidence of postoperative myocardial injury in the CNAP group was significantly lower than that in the PSM group(12%vs.30%,P=0.01);in the CNAP group hypotensive episodes(6 vs.3,P=0.01),positive balance of fluid therapy(700 vs.500 mL,P<0.001),more use of vasoactive drugs(29 vs.18,P=0.04),more stable hemodynamics medical status(P=0.03)were recorded.Conclusion:The hemodynamic management strategy based on continuous non-invasive blood pressure monitoring can reduce the incidence of myocardial injury after elective craniotomy and maintain a more stable hemodynamic state.
文摘Objective:To explore the effects of different infusion schemes on colloid osmotic pressure during major abdominal surgery and perioperative albumin in elderly patients.Methods:140 elderly patients of 65-80 years old undergoing major abdominal surgery were divided into 4 groups according to the method of random number table,and different proportions of crystals and colloids were given to different groups(group A:full crystal,group B:crystal-colloid ratio 1:1,group C:crystal-colloid ratio 2:1,Group D:crystalcolloid ratio 1:2).The plasma colloid osmotic pressure and level of albumin during perioperative period were monitored.Simultaneously observe the arterial blood pH,blood glucose,extubating time of endotracheal tube,postoperative feeding time,et al.Results:The total amount of liquid infusion in the group of whole crystal was 3056ml(3056±253),which was significantly more than other groups(P<0.01).At the same time,the colloid osmotic pressure decreased by 11.9 mmHg(11.9±2.8),which was more obviously decreased than that of the other groups(B group3.9±1.3,C group 1.5±0.3,D group 4.7±2.1).The difference was a statistically significant(P<0.01).On the next day after surgery,the level of albumin decreased by an average of 4.3 g/L(4.5±1.9)compared with that in group B before surgery,and group C decreased by 2.9 g/L(2.9±1.2)in average,which was significantly different(P<0.05)from group A 10.2 g/L(10.2±1.8).There was no statistically significant difference between group A and group D(P>0.05).And the other indexes were not significantly different between the two groups.Conclusion:This study found that different infusion solutions with different crystal-colloid ratios had an effect on perioperative colloid osmotic pressure and level of albumin.
文摘Objective:To explore the effects of different positions on supine hypotensive syndrome in cesarean section after lumbar anesthesia.Methods:600 fullterm parturient were randomly divided into 4 groups.The patented positioning pads(patent number:ZL 201720618886.5)in our department was used when the left-leaning position was placed.The parturient lied in a supine position for anesthesia,and then the group of positioning pads was placed after turning into the lateral position.The parturient were divided into group A(supine position),group B(left-leaning to 10°),group C(left-leaning to 20°),and group D(30°).Observation index:Main index:Comparison of maternal blood pressure changes and neonatal blood gas analysis in the supine position without using position pad and with the use of patent positioning pads in different tilt angles(10°,20°,30°).Minor index:1)the use and frequency of vasoactive drugs,whether a left-leaning operating bed or uterine displacement is required;2)the selffeeling of the parturient;3)newborn’s Apgar scores of 1 minute,5 minutes,and 10 minutes after birth;4)whether the obstetrician can perform the operation smoothly in the corresponding left leaning position.Results:The blood pressure at the supine position after anesthesia,the beginning of surgery and the time when the newborn was delivered in group A and group B were significantly different from those in group C(P<0.05).There were significant differences at different timings in group A and group B,and the decline was more significant at the supine position after anesthesia,the beginning of surgery and the time when the newborn was delivered(P<0.05).The pH of blood gas of newborns in group A,group B and group C was between 7.25 and 7.37,and there was no significant difference among the three groups(P>0.05).Conclusion:The use of positioning pads can prevent the adverse effects of supine hypotensive syndrome on parturient and newborns to a certain extent.
