BACKGROUND Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels.This drug may potentially interact with neuromu...BACKGROUND Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels.This drug may potentially interact with neuromuscular blocking agents(NMBAs)that act on muscular acetylcholine receptors during general anesthesia.Herein,we present a case of inadequate neuromuscular blockade with rocuronium,a nondepolarizing NMBA,in a dementia patient who had taken donepezil.CASE SUMMARY A 71-year-old man was scheduled for laparoscopic gastrectomy.He had been taking donepezil 5 mg for dementia.General anesthesia was induced with propofol and remifentanil.The depth of neuromuscular blockade was monitored by train-of-four(TOF)stimulation.After the administration of rocuronium,the TOF ratio decreased at an unusually slow rate,and a TOF count of 0 was detected 7 min later.After intubation,a TOF count of 1 was detected within 1 min,and a TOF ratio of 12%was detected within 2 min.The TOF count remained at 4 even with an additional bolus and continuous infusion of rocuronium,suggesting resistance to this NMBA.Instead of propofol,an inhalation anesthetic was administered alongside another NMBA(cisatracurium).Then,the quality of neuromuscular blockade improved,and the TOF count remained at 0-1 for the next 70 min.No further problems were encountered with respect to surgery or anesthesia.CONCLUSION Donepezil may be responsible for inadequate neuromuscular blockade during anesthesia,especially when total intravenous anesthesia is used.展开更多
Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree ...Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree of muscle relaxation according to clinical signs when after using rocuronium or cis-atracurium in general anesthesia.Methods: 500 adults were implemented with propofol-remifentanil intravenous anesthesia or sevoflurane inhalation anesthesia. Rocuronium and cis-atracurium were given, respectively. The TOFr was observed with blind method by TOF Watch SX monitor during anesthesia.Results: The mean TOFr=0.53±0.38 at the end of operation,including 275 cases of 0<TOFr<0.9 and 112 cases of TOFr=0. The mean TOFr=0.97±0.12 at extubation, including 60 cases of TOFr<0.9. The incidence of residual neuromuscular blockade at extubation showed an increasing trend with the increase of age or body mass index. The average TOFr value at extubation, which interval time over 10 min after neostigmine administration to extubation was significant higher than that of interval time less than 10 min.Conclusions:There has 12% patients with TOFr<0.9 when extubation by estimating rocuronium and cis-atracurium effect with clinical signs and experience, it has a hidden danger of residual neuromuscular blockade. The main risk factors to increasing the incidence of residual neuromuscular blockade are growing old and the short time of administrating muscle relaxants or neostigmine to extubation.展开更多
BACKGROUND Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARY Th...BACKGROUND Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARY This report established that hip surgical procedures can be performed with a fascia iliaca compartment block(FICB)and monitored anesthesia care(MAC)while avoiding neuraxial or general anesthesia.This was a preliminary experience with two geriatric patients with hip fracture,American Society of Anesthesiologists status III,and with many comorbidities.Neither patient could be operated on within 48 h after admission.Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications.Hence,we chose nerve block combined with a small amount of sedation.Intraoperative analgesia was provided by single-injection ultrasound-guided FICB.Light intravenous sedation was added.Surgical exposure was satisfactory,and neither patient complained of any symptoms during the procedure.CONCLUSION This report showed that hip surgery for geriatric patients can be performed with FICB and MAC,although complications and contraindications are common.The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.展开更多
In order to study the present crustal movement and geodynamics in China's continent, a countrywide GPS monitoring network consisting of 22 stations was set up evenly on major tectonic blocks in China's contine...In order to study the present crustal movement and geodynamics in China's continent, a countrywide GPS monitoring network consisting of 22 stations was set up evenly on major tectonic blocks in China's continent in the early 1990s. Three-phase observations using the network were carried out in 1992, 1994, and 1996, respectively. In this paper, the data processing and accuracy of the three-phase observations are examined and the basic characteristics of present block movement in China's continent are analyzed based on the data of three-phase repeated observations. The study result indicates that the accuracy of data obtained in three-phase observations on the GPS network reaches 10-8 ～ 10-9, which is adequate to the need of monitoring of crustal movement. A model for block movement in China's continent constructed based on the result of the three-phase observations has effectively tested the results of geological and geophysical studies. In global framework, China's continent as a whole shows its clear eastward motion and its regional movement relative to Siberian block is characterized by that the western China is mainly affected by northward subduction and pushing of Indian Plate. Qinghai-Xizang Plateau shows clear eastward lateral slip simultaneously with longitudinal compression. It is more favorable to the escape model for the continent. Block movement of eastern China is under the combined effect of Indian, Pacific,and Philippine plates, resulting in northeastern and eastern motions of eastern China up to southeastern coastal region where the effect of Philippine Plate strengthens.展开更多
The paper introduces a monitoring system of muscle relaxant actionduring the anaesthesia operation,which is based on measurement of acceleration.The monitor consists of an acceleration transducer,a nerve stimlation an...The paper introduces a monitoring system of muscle relaxant actionduring the anaesthesia operation,which is based on measurement of acceleration.The monitor consists of an acceleration transducer,a nerve stimlation and a microcomputer unit.The transducer can be fastened to the thumb,and the signal of thethumb movement in response to ulnar nerve stimulation is measured and registeredin the computing unit. In daily clinical practice it has proved possible,using this newapparatus, to achieve reliable evaluation of nuromuscular transimission functionand to contribute to improve anesthesia quality and patient care.展开更多
2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南...2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南)。与2017版指南相比,2023版指南增加了“定义”和“表型”两个领域,但只是进行了阐述,并未给出推荐意见;针对“呼吸支持策略”,2023版指南增加了“经鼻高流量氧疗(high flow nasal cannula oxygen,HFNO)”“无创通气(noninvasive ventilation,NIV)”“神经肌肉阻滞剂”和“体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)”四个模块,对呼吸支持策略给出了相应的推荐意见;同时还针对2019年新型冠状病毒感染(COVID-19)患者给出了额外的推荐意见。但2023版指南并未明确给出ARDS新定义,2023年7月24日《美国呼吸与危重病医学杂志(American Journal of Respiratory and Critical Care Medicine,AJRCCM)》给出了ARDS的全球新定义,填补了2023版指南的定义部分。本文结合2023版指南及ARDS全球新定义对指南进行了解读,以供重症同仁参考。展开更多
文摘BACKGROUND Donepezil is an acetylcholinesterase inhibitor used to improve cognition and delay disease progression in dementia patients by increasing acetylcholine levels.This drug may potentially interact with neuromuscular blocking agents(NMBAs)that act on muscular acetylcholine receptors during general anesthesia.Herein,we present a case of inadequate neuromuscular blockade with rocuronium,a nondepolarizing NMBA,in a dementia patient who had taken donepezil.CASE SUMMARY A 71-year-old man was scheduled for laparoscopic gastrectomy.He had been taking donepezil 5 mg for dementia.General anesthesia was induced with propofol and remifentanil.The depth of neuromuscular blockade was monitored by train-of-four(TOF)stimulation.After the administration of rocuronium,the TOF ratio decreased at an unusually slow rate,and a TOF count of 0 was detected 7 min later.After intubation,a TOF count of 1 was detected within 1 min,and a TOF ratio of 12%was detected within 2 min.The TOF count remained at 4 even with an additional bolus and continuous infusion of rocuronium,suggesting resistance to this NMBA.Instead of propofol,an inhalation anesthetic was administered alongside another NMBA(cisatracurium).Then,the quality of neuromuscular blockade improved,and the TOF count remained at 0-1 for the next 70 min.No further problems were encountered with respect to surgery or anesthesia.CONCLUSION Donepezil may be responsible for inadequate neuromuscular blockade during anesthesia,especially when total intravenous anesthesia is used.
基金Guangdong science and technology plan project (2013B31800248).
文摘Objective:To observe the incidence of residual neuromuscular blockade at the end of operation and during tracheal extubation, and analyze the risk factors causing residual neuromuscular blockade by judging the degree of muscle relaxation according to clinical signs when after using rocuronium or cis-atracurium in general anesthesia.Methods: 500 adults were implemented with propofol-remifentanil intravenous anesthesia or sevoflurane inhalation anesthesia. Rocuronium and cis-atracurium were given, respectively. The TOFr was observed with blind method by TOF Watch SX monitor during anesthesia.Results: The mean TOFr=0.53±0.38 at the end of operation,including 275 cases of 0<TOFr<0.9 and 112 cases of TOFr=0. The mean TOFr=0.97±0.12 at extubation, including 60 cases of TOFr<0.9. The incidence of residual neuromuscular blockade at extubation showed an increasing trend with the increase of age or body mass index. The average TOFr value at extubation, which interval time over 10 min after neostigmine administration to extubation was significant higher than that of interval time less than 10 min.Conclusions:There has 12% patients with TOFr<0.9 when extubation by estimating rocuronium and cis-atracurium effect with clinical signs and experience, it has a hidden danger of residual neuromuscular blockade. The main risk factors to increasing the incidence of residual neuromuscular blockade are growing old and the short time of administrating muscle relaxants or neostigmine to extubation.
文摘BACKGROUND Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.CASE SUMMARY This report established that hip surgical procedures can be performed with a fascia iliaca compartment block(FICB)and monitored anesthesia care(MAC)while avoiding neuraxial or general anesthesia.This was a preliminary experience with two geriatric patients with hip fracture,American Society of Anesthesiologists status III,and with many comorbidities.Neither patient could be operated on within 48 h after admission.Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications.Hence,we chose nerve block combined with a small amount of sedation.Intraoperative analgesia was provided by single-injection ultrasound-guided FICB.Light intravenous sedation was added.Surgical exposure was satisfactory,and neither patient complained of any symptoms during the procedure.CONCLUSION This report showed that hip surgery for geriatric patients can be performed with FICB and MAC,although complications and contraindications are common.The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.
基金the National Natural Science Foundation ( No. 49074005) China and the paper is a result of the scaling scientific research project of " Study on Recent Crustal Movement and Geodynamics .
文摘In order to study the present crustal movement and geodynamics in China's continent, a countrywide GPS monitoring network consisting of 22 stations was set up evenly on major tectonic blocks in China's continent in the early 1990s. Three-phase observations using the network were carried out in 1992, 1994, and 1996, respectively. In this paper, the data processing and accuracy of the three-phase observations are examined and the basic characteristics of present block movement in China's continent are analyzed based on the data of three-phase repeated observations. The study result indicates that the accuracy of data obtained in three-phase observations on the GPS network reaches 10-8 ～ 10-9, which is adequate to the need of monitoring of crustal movement. A model for block movement in China's continent constructed based on the result of the three-phase observations has effectively tested the results of geological and geophysical studies. In global framework, China's continent as a whole shows its clear eastward motion and its regional movement relative to Siberian block is characterized by that the western China is mainly affected by northward subduction and pushing of Indian Plate. Qinghai-Xizang Plateau shows clear eastward lateral slip simultaneously with longitudinal compression. It is more favorable to the escape model for the continent. Block movement of eastern China is under the combined effect of Indian, Pacific,and Philippine plates, resulting in northeastern and eastern motions of eastern China up to southeastern coastal region where the effect of Philippine Plate strengthens.
文摘The paper introduces a monitoring system of muscle relaxant actionduring the anaesthesia operation,which is based on measurement of acceleration.The monitor consists of an acceleration transducer,a nerve stimlation and a microcomputer unit.The transducer can be fastened to the thumb,and the signal of thethumb movement in response to ulnar nerve stimulation is measured and registeredin the computing unit. In daily clinical practice it has proved possible,using this newapparatus, to achieve reliable evaluation of nuromuscular transimission functionand to contribute to improve anesthesia quality and patient care.
文摘2023年6月16日,欧洲危重症医学会(the European Society of Intensive Care Medicine,ESICM)在《重症监护医学杂志(Intensive Care Medicine,ICM)》发布了《ESICM急性呼吸窘迫综合征指南:定义、表型和呼吸支持策略》(以下简称2023版指南)。与2017版指南相比,2023版指南增加了“定义”和“表型”两个领域,但只是进行了阐述,并未给出推荐意见;针对“呼吸支持策略”,2023版指南增加了“经鼻高流量氧疗(high flow nasal cannula oxygen,HFNO)”“无创通气(noninvasive ventilation,NIV)”“神经肌肉阻滞剂”和“体外二氧化碳清除(extracorporeal carbon dioxide removal,ECCO_(2)R)”四个模块,对呼吸支持策略给出了相应的推荐意见;同时还针对2019年新型冠状病毒感染(COVID-19)患者给出了额外的推荐意见。但2023版指南并未明确给出ARDS新定义,2023年7月24日《美国呼吸与危重病医学杂志(American Journal of Respiratory and Critical Care Medicine,AJRCCM)》给出了ARDS的全球新定义,填补了2023版指南的定义部分。本文结合2023版指南及ARDS全球新定义对指南进行了解读,以供重症同仁参考。
