1.Influence of acute hypervolemic hemodilution combined with controlled hypotension on glomerular filtration rate and blood gases and electrolytes in patients undergoing spinal surgery
Weiping YU ; Xuzhong XU ; Wenwen LOU
Chinese Journal of Anesthesiology 1995;0(10):-
20% . In both groups CH was induced with infusion of 0.01% sodium nitroprusside (NTP) to maintain MAP at 55-65 mm Hg. MAP, HR, CVP cardiac output were continuously monitored. Arterial blood samples were taken before (T0 ) and after AHH (T1 ) , 30 min after CH was induced (T2 ) and 30 min after tennination of CH (T3 ) for blood gas analysis and determination of plasma levels of electrolytes and ?2-microglobulin.Results The two groups were comparable with respect to the demographic data including age, body weight and height. In group Ⅰ pH was significantly decreased after AHH and CH (T1-3) compared to the baseline (T0 ) and was significantly lower than that in group Ⅱ . There was no significant difference in plasma K+ , Na+ , Ca2+ , Cl- and BE between the two groups. Plasma?2- MG decreased significantly after AHH (at T1 ) compared to the baseline value before AHH (T0) in group Ⅰ and was significantly lower than that ingroup Ⅱ at T1-3 . Conclusion Glomerular filtration rate decreases during controlled hypotension as shown by increased plasma?2-MG. AHH combined with CH can improve glomerular filtration rate while exerts no significant effects on blood gases and electrolytes.
2.Ultrasound-guided supraclavicular brachial plexus block for upper extremity operation
Ting LI ; Daozhu WU ; Xuzhong XU
Chinese Journal of Anesthesiology 1995;0(02):-
Objective To compare the effectiveness of supraclavicular brachial plexus block guided by ultrasound with that guided by nerve stimulator or anatomical landmarks. Methods One hundred and twenty ASA Ⅰ-Ⅲ patients (81 male, 39 female) aged 16-62 yrs weighing 40-75 kg scheduled for upper extremity operation under brachial plexus block via supraclavicular approach were randomized into 3 groups ( n = 40 each) : In group U block was guided by ultrasound; in group N nerve stimulator was used to locate the brachial plexus and in group T block was performed in the traditional way based on anatomical landmarks. A mixture of equal volumes of 0.75% ropivacaine and 2% lidocaine (0.4 ml?kg-1) was injected in the 3 groups. The onset and intensity of sensory block of musculocutaneous, median, radial and ulnar nerves were measured and analgesia was rated as excellent, effective and failure.Results The rate of satisfactory block of ulnar nerve was significantly lower than that of musculocutaneous and radial nerves in group N and T ( P
3.Application of ultrasound-guided interscalenus brachial plexus Mock for emergency surgery
Xuebin JIANG ; Suzhen ZHU ; Yi JIANG ; Qianhuang CHEN ; Xuzhong XU
Chinese Journal of Emergency Medicine 2009;18(9):960-963
Objective To investigate the feasibility of ultrasound-guided interscalenus brachial plexus block used for the emergency surgery.Method From August to December 2007 80 patients from the Integrated Traditional Chinese and Western Medicine Hospital of Wenzhou,ASA Ⅰ to Ⅲ,age 18 to 68 years old,weight 45 to 75 kg,without deformity on the shoulder or neck,without limb paresthesia,without contraindications of interscalenus brachial plexus block,were scheduled for emergency surgery of upper limb.They were randomly divided into two groups:interscalenus block guided by ultrasound group(group U,re =40)and nerve stimulator group(group N,re = 40).Patients of both groups received 20 mL mixture of 0.75%ropivacaine and 2%lidocaine.The onset time,and the analgesic efficacy of axillary nerve,lateral antebrachial cutaneous nerve,radial nerve,median nerve,median cutaneous nerve of arm,median antebrachial cutaneous nerve and ulnar nerve,and duration of anesthesia were observed.Statistical analysis was performed by t test,rank sum test and X2 test.Results The onset time of analgesia after nerve block was shorter in group U than that in group N(P<0.01).The rate of perfect analgesia after nerve block in group U was higher than that in group N(100%vs.87.5%,X2 = 5.267,P = 0.027).The duration of anesthesia lasted in group U was(378 ± 151)minutes and that in group N was(365 ± 163)minutes(t= 0.363,P = 0.718).ConclusionsCompared with the method of nerve block guided by nerve stimulator,the ultrasound-guided interscalenus block offers faster onset and better analgesic efficacy.It is an ideal technique of brachial plexus block for the emergency surgery.
4.The anesthesia efficacy of remifentanil-propofol or remifentanil-desflurance in patients undergoing video-assisted thoracoscopic surgery
Jianxia MIAO ; Xiaofen JIANG ; Minglun HU ; Xuzhong XU ; Lielie JIN
Chinese Journal of Postgraduates of Medicine 2008;31(12):22-24
Objective To assess the anesthesia efficacy of remifentanil-propofol or remifentanil-desflurance in patients undergoing video-assisted thoracoscopic surgery(VATS).Methods Forty ASA Ⅰ-Ⅱpatients. undergoing VATS were randomly divided into remifentanil-propofol group(group P,n=20)and remifentanil-desflurance group (group D,n=20).MAP and HR were monitered during the entire procedures. Conscious recovery, spontaneous breathing recovery, the endotracheal extubation time and OAAS score were recorded and compared between two groups. Results During the operation, MAP was decreased significantly in group D (P<0.05).There was no significant difference in conscious recovery, spontaneous breathing recovery, the endotracheal extubation time and OAAS score between two groups. Conclusions The anesthesia efficacy of remifentanil-propofol or remifentanil-desflurance in patients undergoing VATS were both with quick recovery, but the fronter has more stable hemodynamics.
5.Comparison of HC visual laryngoscopy and fiberoptic bronchoscope guided endotracheal intubation in patients undergoing cervical surgery
Hongfei CHEN ; Yiquan WU ; Yujian ZHANG ; Kejian SHI ; Xuzhong XU
Journal of Chinese Physician 2016;(z1):26-29
Objective To compare the clinical effects of HC video laryngoscope and fiberoptic bronchoscope (FOB)in guidance of endotracheal intubation for patients undergoing cervical surgery.Meth-ods A total of 50 patients (ASA I or II)with cervical vertebra injury,nerve root cervical spondylopathy or cervical spondylotic myelopathy in the first affiliated hospital of Wenzhou medical university were selected, all of whom were undergone selective cervical operations between March 2014 and June 2015.The patients were randomly divided into two groups (n =25):HC video laryngoscope group (group H)and FOB group (group F).After induction of anesthesia,HC video laryngoscope and FOB were used for tracheal intuba-tion.⑴ Intubation time and success rates of intubation were recorded,and visual analogue scale (VAS) was used to evaluate the difficulty of intubation;⑵ Mean arterial pressure (MAP),heart rate (HR),and rate-pressure product (RPP)before incubation (Tb),immediate after intubation (T0),and 1min after in-cubation (T1)were recorded;(3)Intubation-related complications were recorded.Results ⑴ The dura-tion of intubation (19.7 ±7.1 )s in the group H was significantly shorter than that of group F (51.9 ± 19.2)s (P <0.05).The one-time success rate of intubation in group H (92%)was higher than that of group F (64%),with statistically significant differences (P <0.05).Intubation was easier in group H (P <0.05).⑵ MAP,HR and RPP of group H at T0 were higher than those of group F.And at T1,there were no statistical differences between groups in MAP,HR and RPP (P >0.05).⑶ The incidence of complications (sore throat)was lower in group H (P <0.05).Conclusions Compared to FOB,HC vid-eo laryngoscope-guided selective cervical operation has the characteristics of higher success rate of intubat-ion,shorter operation time,and easier operation,more stable hemodynamics and lower incidence of intuba-tion complications.Therefore,HC video laryngoscope is a safe and effective method in the intubation for pa-tients undergoing cervical surgery.
6.Ultrasound-guided posterior approach to intercostal block for herpetic neuralgia
Hai LIN ; Quanguang WANG ; Huiling ZHANG ; Le LIU ; Zhibing PI ; Xuzhong XU
Chinese Journal of Anesthesiology 2011;31(1):47-49
Objective To evaluate ultrasound-guided posterior approach to intercostal block for herpetic neuralgia. Methods Forty-eight patients with herpetic neuralgia after appearance of rashes on the back of chest (the coursc < 30 days) aged 56-84 yr received intercostal block performed via posterior approach under the guidance of ultrasound with a mixture of 0.75% ropivacaine, glucocorticoid and methylene blue. Pain was assessed with visual analogue scale (VAS) before block and at 1, 2, 4 and 8 weeks after block. Pain relief (PAR) was cal-culated (PAR= (VAS score before block- VAS score after block) ÷ VAS score before block × 100%). Results No patient developed dyspnea and pneumothorax. VAS scores were reduced significantly, quality of life was improved and PAR increased at 1, 2, 4 ancl 8 weeks after block ( P < 0.05 or 0.01). Concluslon Ultracound-guided posterior approach to intercostal block is safe and effective for the treatment of herpetic neuralgia.
7.Comparison of degree of pain in patients after radical gastrectomy under different anesthetic regimens
Yiquan WU ; Zhousheng JIN ; Qimin LIU ; Fangfang XIA ; Fuli LIU ; Xili DING ; Huimin DONG ; Xuzhong XU
Chinese Journal of Anesthesiology 2012;32(1):74-77
Objective To compare the degree of pain in patients after radical gastrectomy under different anesthetic regimens.Methods One hundred and two ASA Ⅰ or Ⅱ patients of both sexes,aged 50-75 yr,weighing 45-70 kg,undergoing elective radical gastrectomy,were randomly divided into 3 groups ( n =34 each):general anesthesia (GA) group,combined general-subcostal transversus abdominis plane block (CGTA) group and combined general-epidural anesthesia (CGEA) group.The patients were sent to the postanesthesia care unit (PACU) after tracheal extubation,and the VAS score on arrival in the PACU was recorded.The degree of pain was evaluated by VAS score,and when VAS scores > 3,the patients received intravenous morphine titration.When VAS scores ≤ 3,morphine titration was stopped and all the patients were connected to patient-controlled intravenous analgesia and/or epidural analgesia pump.The total amount of morphine consumed was recorded at the end of titration,and the occurrence of adverse reactions was also observed.Results Compared with groups GA and CGTA,the incidence of moderate to severe postoperative pain was significantly decreased in group CGEA (P <0.01).The incidence of severe postoperative pain,the VAS score on arrival in the PACU and the total amount of morphine consumed were decreased gradually in groups GA,CGTA and CGEA ( P < 0.01 ).The incidence of sedation was significantly lower in group CGEA than in group GA (P < 0.01 ).There were no significant differences in the other adverse reactions among the three groups ( P > 0.05 ).Conclusion The degree of pain is reduced gradually in patients after radical gastrectomy under GA,CGTA and CGEA.
8.Efficacy of continuous lumbar plexus block combined with a bolus dose added at night for postoperative analgesia in patients undergoing hip arthroplasty
Quanguang WANG ; Chanjuan CHEN ; Limei CHEN ; Le LIU ; Jianwu NI ; Xuezheng ZHANG ; Xuzhong XU
Chinese Journal of Anesthesiology 2012;(12):1441-1444
Objective To evaluate the efficacy of continuous lumbar plexus block (CLPB) combined with a bolus dose added at night for postoperative analgesia in patients undergoing hip arthroplasty.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 51-75 yr,weighing 47-77 kg,with body height 150-180 cm,scheduled for hip arthroplasty,were randomized to receive either CLPB (group CLPB) or patient-controlled intravenous analgesia (PCIA) (PCIA group) for postoperative analgesia (n =30 each).Spinal anesthesia was performed at L3,4 interspace.Postoperative analgesia was performed at 30 min before the end of surgery.PCIA solution contained morphine 100 mg in 100 ml of normal saline.The PCA pump was set up with a 2 mg bolus dose and a 5 min lockout interval.CLPB solution contained 0.125 % ropivacaine hydrochloride 200 ml.CLPB pump was set up to deliver a 4 ml bolus dose with a 30-min lockout interval and background infusion at 8 ml/h after a loading dose of 0.125% ropivacaine 30 ml.In addition the patients received 0.25% ropivacaine 30 ml at 8 o' clock every night after surgery in group CLPB.VAS scores at rest and during activity were recorded at 6,12,18,24,30,36,42 and 48h after operation.The side effect such as nausea and vomiting,pruritus and urinary retention were recorded within 48 h after operation.The patient' s satisfaction was assessed.The maximal hip flexion and abduction ranges of motion were recorded at 12,24,36 and 48 h after operation.The times of sleep interruption resulted from pain during nighttime were also recorded.Results Compared with group PCIA,the VAS scores during activity,severity of nausea and vomiting,pruritus and urinary retention,and times of sleep interruption resulted from pain during nighttime were significantly decreased,and the overall satisfaction score and maximal hip flexion and abduction ranges of motion were increased in group CLPB (P < 0.05).Conclusion CLPB combined with a bolus dose added at night can provide better efficacy for postoperative analgesia in patients undergoing hip arthroplasty than PCIA,with fewer complications.
9.Effects of age factors on pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block
Jiaojiao DONG ; Shishi ZHAO ; Shengxian LIN ; Limei CHEN ; Quanguang WANG ; Xuzhong XU
Chinese Journal of Anesthesiology 2016;36(7):839-842
Objective To evaluate the effects of age factors on the pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block in patients.Methods Twenty patients of both sexes,aged ≥ 18 yr,weighing 50-75 kg,of American Society of Anesthesiology physical status Ⅰ or Ⅱ,scheduled for elective lower extremity surgery,were divided into 2 groups (n=10 each) according to age:young and middle-aged group (18-59 yr) and elderly group (≥ 60 yr).Combined lumbar plexus-sciatic never block was performed using an ultrasonic instrument and a nerve stimulator.Lumbar plexus block was performed with 0.5% ropivacaine 30 ml.Sciatic never block was performed with 2% lidocaine 10 ml plus 0.75% ropivacaine 10 ml.Before administration and at 5,10,15,20,30,45,60,120,180 and 360 min after administration,blood samples were collected from the radial artery for determination of the blood concentration of ropivacaine by high-performance liquid chromatography.The area under the concentrationtime curve,maximum concentration (Cmax),time to C terminal elimination half-life and clearance were calculated.Results Compared with young and middle-aged group,the blood concentration of ropivacaine was significantly decreased at 5-45 min after administration,the Cmax was significantly decreased,terminal elimination half-life was significantly prolonged (P<0.05),and no significant change was found in area under the concentration-time curve,the time to C and clearance in elderly group (P> 0.05).Conclusion Age factors can affect the pharmacokinetics of ropivacaine during combined lumbar plexus-sciatic nerve block,and both absorption and metabolism of ropivacaine are slower in elderly patients than in young and middle-aged patients.
10.Efficacy of anterior approach to quadratus lumborum block in each abdominal and back region
Yang LU ; Quanguang WANG ; Kejian SHI ; Zhousheng JIN ; Riyong ZHOU ; Haiyan ZHENG ; Xuzhong XU
Chinese Journal of Anesthesiology 2017;37(6):697-699
Objective To evaluate the efficacy of the anterior approach to quadratus lumborum block in each abdominal and back region.Methods Twelve healthy volunteers of both sexes,aged 18-45 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,with body mass index of 18-30 kg/m2,were enrolled in the study.Quadratus lumborum block was performed via the anterior approach under the guidance of ultrasound with 0.375% ropivacaine 20 ml.The block was assessed by cold stimulation (ice cake) in each abdominal and back region (the right side of the body was divided into 15 regions using the anatomical landmarks on the body surface).The positive condition in each region was recorded at 30 min after administration.Results The region in which the positive rate ≤ 5% was 0.The regions in which the positive rate >5%-20% were 1 and 13 regions.The regions in which the positive rate >20%-50% were 2,3 and 4 regions.The regions in which the positive rate >50%-70% were 6,7 and 10 regions.The regions in which the positive rate >70%-<95% were 5,14 and 15 regions.The regions in which the positive rate ≥95% were 8,9,11 and 12 regions.Conclusion The anterior approach to quadratus lumborum block is effective in the middle-lower region of the anterior abdominal wall on the blocked side.