Objective:To compare the efficacy of sugammadex versus neostigmine on reversal of rocuronium-induced residual neuromuscular blockade in patients undergoing renal transplantation. Methods:The clinical data of patients undergoing kidney transplantation from donation after cardiac death in our hospital from January 2018 to December 2020 were retrospectively analyzed.Patients were divided into sugammadex group (group S) and neostigmine group (group N) according to the use of muscle relaxant antagonists.The onset time of antagonism, time of tracheal extubation, and time of postanesthesia care unit stay were recorded.The creatinine clearance rate was recorded before operation and at 1, 3, 5 and 7 days after operation.The occurrence of postoperative complications was recorded.Results:A total of 603 patients were enrolled in this study, with 278 patients in group S and 325 patients in group N. Compared with group N, the onset time of antagonism, time of extubation , and time of postanesthesia care unit stay were significantly shortened, the incidence of hypoxemia within 24 h after surgery and pulmonary infection occurred within 7 days after surgery was decreased ( P<0.05), and no significant change was found in the creatinine clearance rate at each time point and incidence of postoperative cardiovascular complications and graft complications in group S ( P>0.05). Conclusion:Compared with neostigmine, sugammadex can reverse rocuronium-induced residual neuromuscular blockade more quickly, which is helpful for early recovery with a higher safety when applied in the patients undergoing renal transplantation.

Objective:To evaluate the effect of sugammadex on the long-term prognosis in the patients undergoing kidney transplantation.Methods:American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳ patients of either sex, aged 18-64 yr, underwent donation after cardiac death renal transplantation from January 1, 2018 to October 31, 2021, were included in this study. Their clinical data were retrospectively analyzed, and then the patients were divided into 2 groups: sugammadex group (group S) and control group (group C). The complications at 1 yr after surgery and patient/graft survival at 1 and 3 yr after surgery were recorded.Results:A total of 645 patients were finally enrolled in this study, with 319 patients in group S and 326 patients in group C. There was no significant difference in the incidence of postoperative complications within 1 yr after surgery between two groups ( P>0.05). The overall patient survival rate at 1 and 3 yr after surgery were 94.7% and 92.8% respectively, and the death-censored graft survival at 1 and 3 yr after surgery were 94.4% and 89.4% respectively in group S. The overall patient survival rate at 1 and 3 yr after surgery were 96.6% and 94.7% respectively, and the death-censored graft survival at 1 and 3 yr after surgery were 93.9% and 88.6% respectively in group C. There was no significant difference in patient/graft survival rate between two groups ( P>0.05). Conclusions:Sugammadex has no obvious effect on the long-term prognosis in the patients undergoing kidney transplantation.

Objective:To evaluate the effect of controlled low central venous pressure with milrinone on laparoscopic hepatectomy in the patients.Methods:Fifty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients of both sexes, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of Child-Pugh grade A or B, undergoing elective laparoscopic hepatectomy, were divided into 2 groups ( n=25 each) using a random number table method: milrinone group (group M) and nitroglycerin group (group NG). After the start of surgery, milrinone 0.5 μg·kg -1·min -1 was continuously infused in group M, and nitroglycerin was continuously infused with the initial dose of 0.5 μg·kg -1·min -1 to maintain central venous pressure (CVP)≤5 mmHg in group NG.Mean arterial pressure and heart rate were recorded on admission to the operation room (T 0), at skin incision (T 1), at the beginning of liver resection (T 2), at completion of liver resection (T 3), at the end of operation (T 4), and CVP, cardiac index and stroke volume variation were recorded at T 1-4.Internal jugular vein blood samples were collected to determine the concentrations of hemogloblin, blood lactate at T 1 and T 4, and serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations at 1, 3 and 7 days after surgery.The score of blood oozing in hepatic surgical field, amount of norepinephrine used, blood loss, postoperative recovery and occurrence of complications within 7 days after operation were recorded. Results:Compared with group NG, cardiac index was significantly increased at T 2, 3, the CVP was decreased at T 2, the blood oozing score, blood loss, consumption of norepinephrine, and concentrations of blood lactate were decreased, and the postoperative drainage indwelling time was shortened in group M ( P<0.05). There was no significant difference in the serum alanine aminotransferase, aspartate aminotransferase and creatinine concentrations and incidence of postoperative complications at 1, 3 and 7 days after operation between the two groups ( P>0.05). Conclusions:Milrinone is better than nitroglycerin in decreasing central venous pressure, reducing blood loss, maintaining stable circulatory function and tissue perfusion in laparoscopic hepatectomy.

Objective:To explore the risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (upper tract urothelial carcinoma, UTUC).Methods:We retrospectively analyzed the data of 815 patients underwent radical nephroureterectomy for upper tract urothelial carcinoma between June 2009 to June 2019.There were 519 males and 340 females, aged from 26-93 years old(average 66.5±9.6 years old). 396 patients were renal pelvic caicinoma.463 patients were ureteral caicinoma.675 patients were accompanied with hydronephrosis.664 patients were accompanied with preoperative gross hematuria. Preoperative diagnostic ureteroscopy was performed in 323 cases.283 patients had the history of smoking.48 patients were con-comitant with bladder carcinoma at the first diagnosis. Univariate analysis and logistic multivariate regression analysis were used to investigate the risk factors for bladder recurrence after UTUC radical surgery.Results:Among the 859 patients, 407 (47.4%) had low-stage tumor (T is/T a/T 1), 452 (52.6%) had high-stage tumor (T 2-T 4), 110 (12.8%) had low-stage tumor (G 1/G 2), and 749 (87.2%) had high-stage tumor (G 3). 126 (17.2%) of 859 patients had relapse during the follow-up period, the average follow-up time was 17 months, the median recurrence time was 12 months, 101(80.1%) of the relapse occurred within 2 years after operation. In univariate analysis, lower tumor stage ( P=0.047), higher tumor grade ( P=0.043), preoperative hematuria symptom ( P=0.023) and preoperative diagnostic ureteroscopy ( P=0.002) were closely related to bladder recurrence. Taking the above factors into the logistic multivariate regression analysis showed that tumor staging T is/T s/T 1 ( B=0.476, P=0.019), tumor grade G 3( B=0.848, P=0.024), preoperative hematuria symptom ( B=0.521, P=0.048), preoperative diagnostic ureteroscopy( B=0.521, P=0.002) were independent risk factors of postoperative recurrence of bladder. Conclusion:lower tumor stage, higher tumor grade, preoperative hematuria symptom and preoperative diagnostic ureteroscopy are the independent risk factors of postoperative bladder recurrence in patients with UTUC. Routine intravesical chemotherapy should be performed in patients with UTUC with the above risk factors, and routine diagnostic ureteroscopy is not recommended.