OBJECTIVE To evaluate the clinical efficacy and safety of extending the administration time of meropenem in the treatment of moderate and severe bacterial infections in surgical intensive care uint(SICU) patients.METHODS Fifty patients with moderate and severe bacterial infections admitted to SICU were randomized to two groups: meropenem 30 min infusion group(n=25) and meropenem 3 h infusion group(n=25),the clinical efficacy and side-effects were observed between two groups.RESULTS Twenty-five patients were enrolled in meropenem 30 min infusion group with an effective rate of 48%,bacterial clearance rate of 26.9%.On the other hand,twenty-five patients were enrolled in meropenem 3 h infusion group with an effective rate of 60%,bacterial clearance rate of 43.5%.There were no significant differences between two groups(P=0.375,P=0.224,separately).CONCLUSIONS There are no significant differences between two groups on effective rate and bacterial clearance rate.

Objective To analyze the diagnosis and treatment of cervical spinal cord injury without fracture or dislocation.Methods 38 patients were analyzed retrospectively.Results and Conclusion According to the manifestation of MRI and the symptoms,6 cases accepted conservation treatment,and the other 32 cases accepted surgery with different styles.All the patients recovered in some degrees.

Objective To explore the diagnosis and treatment of supinator syndrome.Methods 11 patients with supinator syndrome definitely diagnosed were treated with conservation treatment, 4 ineffective cases with conservation treatment were treated with operation. The following-up was performed for 6～12 months to evaluate the therapeutic effect.Results Among the total 7 patients received conservation treatment, 5 cases recovered completely, the other 2 cases recovered partially; among the total 4 patients who received operations, 3 cases recovered completely, and the other one recovered partially.Conclusion At present, supinator syndrome can be diagnosed definitely according to the clinical symptom, and the examination with electromyogram is beneficial to diagnose this disease, but it has not specificity. Most patients of supinator syndrome often get satisfactory effects after conservation treatment, and the ones who are failed can get the improvement from surgical treatment timely.

Objective To evaluate the effect and safety of small dose ketamine combined with morphine for postoperative analgesia in elderly patients undergoing total knee replacement.Methods Sixty-two elderly (≥ 65 years old) patients undergoing total knee replacement under combined spinal-epidural anesthesia were randomly divided into two groups.In group MK,morphine (0.4 mg/ml) and ketamine (0.4 mg/ml) were used for postoperative analgesia.While in group MO,only morphine (0.4 mg/ml) was used for postoperative analgesia.Visual analogue scale (VAS) pain score,comfort level,Ramsay sedation level,cumulative morphine consumption,changes in vital signs (blood pressure,heart rate,respiration,blood oxygen saturation,etc) and occurrence of side-effects (pruritus,nausea and vomiting,psychiatric symptoms,etc) were recorded up to 48 h after surgery.Results The VAS pain scores were significantly lower in group MK than in group MO at time points of 4,8,12,24,36,48 h (Wald x2=16.713,P＜0.05),while the comfort levels were significantly higher in group MK than in group MO after surgery (Wald x2 11.238,P＜0.05).The total morphine consumption after 48 h was significantly lower in group MK than in group MO (t=3.807,P＜0.001).The incidence of postoperative nausea and vomiting was significantly lower in group MK than in group MO (x2 =4.356,P＝0.036).There were no significant differences in sedation level (Wald x2＝ 3.303,P＞0.05) and changes in vital signs (P＞0.05) between the two groups.No case with psychiatric symptoms was found in both groups.Conclusions When used for postoperative intravenous analgesia in elderly patients after total knee replacement,small-dose ketamine combined with morphine can provide better analgesic effects,decrease total consumption of morphine and the incidence of side-effects.

The latest advance of sedation for critically ill adult patients in intensive care unit (ICU) was reviewed in order to provide certain clinical information for the ICU physicians about sedation. Guidelines, clinical research, Meta-analysis, and reviews in recent years were collected using electronic data base. Discussions included: ① the definition of light sedation, and its effects on clinical outcome, stress, sleep and delirium; ② light sedation strategies included: the target population, the target sedation strategy and daily sedation interruption, clinical assessment and monitoring of sedation, selection of sedative drugs, light sedation extenuation; ③ light sedation strategies and pain, agitation, delirium control bundles; ④ the problems and prospects of light sedation. Light sedation is the main principle of currently ICU sedation strategy in critically ill adult patients. Goal-directed light sedation should be considered as a routine therapy in most clinical situation, and its goal should be achieved as early as possible in the early stage of sedation. Routine use of benzodiazepines should be avoided, especially in patients with or at a risk of delirium. Prevention and treatment of agitation with a combination of non-pharmacologic or pharmacologic methods; ICU specification rules for pain, agitation and delirium prevention and treatment should be made. Light sedation is the main ICU sedation strategy in adult patients now, but must be individualized for each patient.

Objective:To evaluate the effect of intraoperative dexmedetomidine (DEX)infusion during propofol intravenous anesthesia on postoperative recovery after major spinal surgery.Methods:Sixty pa-tients aged 1 8 to 65 (American Society of Anesthesiologists,ASA Ⅰ -Ⅱ),scheduled for spinal surgery from January 201 4 to May 201 4 were randomized into two groups.The DEX group (n =30)received 0.5 μg/kg of DEX ten minutes before anesthesic induction,followed by an infusion of DEX at 0.2 μg/(kg·h)intraoperatively and the control group (n =30)was given identical amounts of normal saline. At the end of surgery,the patients of both groups received patient-controlled intravenous analgesia (PCIA)with morphine 0.5 mg/h (1 mg demand dose and 8 min lockout).Heart rate and mean arterial pressure (MAP) were continually monitored during operation and in the post-anesthesia care unit (PACU).The propofol and sufentanil consumptions during operation and the morphine consumption 48 h after surgery were recorded.The time for recovery and extubation were recorded.The followed-up evalua-tions were performed to assess Ramsay scores,visual analogue scale (VAS)pain scores as well as side effects in PACU and 48 h after surgery.Results:Heart rate of DEX group was lower than that of control group after intubation and extubation and in PACU 1 0 min (P <0.05).MAP was lower in DEX group than that in control group after extubation and in PACU (P <0.05).Compared with control group,the propofol consumption during anesthesic induction,the sufentanil consumption during operation and the cumulative consumption of morphine 2 h and 6 h after surgery were decreased (P <0.05).There were no differences between the two groups as to the time for recovery or extubation.Compared with control group,the VAS pain scores were significantly decreased (P <0.01 ),the incidence of postoperative nau-sea and vomiting in DEX group were significantly decreased (P <0.05)48 h after surgery.Conclusion:Intraoperative infusion of DEX improved quality of recovery,provided good analgesia,and decreased morphine use and the incidence of postoperative nausea and vomiting after major spinal surgery.

Among 13 331 parturients from January 2011 to December 2013 in Peking University First Hospital, 6 162 cases required cesarean section, and the rate of cesarean section was 46.223％.The constituent ratio of cesarean section under general anesthesia was 1.75％, the constituent ratio of emergency cesarean section under general anesthesia was 60.2％, and the constituent ratio of the critically ill patients of ASA physical status ≥ Ⅲ was 16.7％.The main indication for general anesthesia was contraindication to neuraxial anesthesia or failure of neuraxial anesthesia.Of the 108 parturients who underwent cesarean section under general anesthesia, 33 cases were in laryngeal mask airway (LMA) group and 75 cases in intubation group.There was no statistically significant difference between intubation group and LMA group in terms of general data, emergency rate, percentage of patients or neonates admitted to intensive care unit, and neonatal Apgar score (P＞0.05).There were no airway-related complications such as difficult airway, aspiration or regurgitation in either group.In summary, general anesthesia was mainly suitable for cesarean section contraindicating neuraxial anesthesia and failed cesarean section, and the proportion of emergency operations was higher;LMA could be used for airway management in cesarean section under general anesthesia, but it must be placed correctly ensuring good airway sealing to prevent aspiration.

Objective To investigate the effect of the different phases of menstrual cycle on the incidence of post-operative nausea and vomiting (PONV)after laparoscopic gynecological surger-ies.Methods A total of 228 women undergoing laparoscopic gynecological surgeries were enrolled from Mar 2016 to Feb 2017 in our hospital.They were classified into three groups according to the different phases of menstrual cycle at the time of surgeries:group follicular phase (n =98),group o-vulatory phase (n =79),and group luteal phase (n =59).The incidence of PONV and the use of res-cue antiemetic drugs were recorded within 0-2 h,0-24 h periods after surgeries.Multivariate Logistic regression analysis was applied to identify independent risk factors of PONV.Results The incidence of 0-2 h PONV and 0-24 h PONV were 23.2% (53/228)and 54.8% (125/228)respectively.Univa-riate analysis showed that the incidence of PONV in the different phases of menstrual cycle was not statistically significant,as well as 0-24 h.Multivariate logistic regression analysis showed that the risk of 0-2 h PONV in group luteal phase might be higher than that in group follicular phase,however, the difference was not statistically significant (OR =2.289,95%CI 0.979-5.355,P =0.056).And two independent risk factors of 0-2 h PONV were identified:duration of operation > 1 h (OR =3.176,95% CI 1.567-6.436,P = 0.001 )and history of PONV (OR = 5.711,95% CI 1.710-19.080,P =0.005).Three independent risk factors of 0-24 h PONV were identified:duration of op-eration>1 h (OR = 2.714,95%CI 1.525-4.829,P = 0.001 ),postoperative PCA (OR = 2.717, 95%CI 1.233-5.986,P = 0.013 )and application of metronidazole (OR = 3.926,95%CI 1.808-8.527,P =0.001).Conclusion There was no significant effect of different phases of menstrual cycle on the incidence of nausea and vomiting after gynecologic laparoscopic surgeries.

Objective: To determine if different methods of anesthesia and analgesia will influence the incidence of early postoperative cognitive dysfunction (POCD) after non-cardiac surgery in the elderly. Methods: One hundred and three elderly patients undergoing elective abdominal surgery were randomly allocated to receive either general anesthesia followed with postoperative intravenous analgesia (general anesthesia group, 53 cases) or combined general-epidural anesthesia followed with postoperative epidural analgesia (combined general-epidural anesthesia group, 50 cases). Cognitive function was assessed preoperatively and 7 days postoperatively using a battery of nine neuropsychological tests. A postoperative deficit in any test was defined when decline by more than or equal to 20% of the preoperative value of that test occurred. Any patient showing deficit in 2 or more tests was defined as having postoperative cognitive dysfunction. Results: Ninety-two patients completed both preoperative and postoperative neuropsychological tests. On day 7, POCD occurred in 20/45 patients (44.4%) in the general anesthesia group and in 23/47 patients (48.9%) in the combined general-epidural anesthesia group. No significant difference was found between the two groups. Logistic regression analysis showed that short duration of education and operation of general surgery were independent risk factors of the occurrence of early POCD. Conclusion: Early POCD occurred in 46.7% of the elderly patients undergoing abdominal surgery. However, there was no significant difference between the effects of two different methods of anesthesia and postoperative analgesia on the incidence of POCD. Short duration of education and operation of general surgery were risk factors of early POCD.

Objective The purpose of our study is to analyze the effects of different ways of anesthesia on the prognosis of these patients.Methods Our study was a retrospective study,enrolling elderly patients (≥65 years)undergoing pheochromocytoma resection surgery from Jan 2004 to Feb 201 5 in our hospital.We recorded perioperative data including demography,primary disease,com-bined disease,preoperative management,anesthesiology,surgery,and prognosis.Then we divided the patients into two groups,general anesthesia (group G)and general anesthesia combined with epi-dural anesthesia (group GE),to make further statistical analysis.Results There were 33 patients en-rolled,totally undergoing 35 cases of surgery accounting for 13.4% of pheochromocytoma resection surgery in the same period in our hospital.The maintenance of analgesia during surgery by using remifentanyl (18.2% vs 79.2%,P = 0.001 )and sufentanyl (45.5% vs 79.2%,P = 0.046 )were significantly lower in group of general anesthesia combined with epidural anesthesia.However hemo-dynamic parameters didn’t show statistical difference between groups.There were no patients dead during perioperative period.In group GE,the duration of mechanical ventilation (P =0.039),post-operative hospital stay (P =0.013)and total hospital stay (P =0.01 5)were much shorter than those in group G.Multivariable Cox model analysis showed that general anesthesia combined with epidural anesthesia was an independent protective factor for shorter postoperative hospital stay (RR=0.245, 95% CI 0.106-0.564,P =0.001),and combination of vasopressors during operation were the inde-pendent predictors of longer postoperative hospital stay (RR= 4.184,95% CI 1.146-1 5.281,P =0.030).Conclusion During pheochromocytoma resection surgery in elderly patients,general anesthe-sia combined with epidural anesthesia had lower rate of using intravenous analgesic drugs,shorter du-ration of mechanical ventilation,postoperative hospital stay and total hospital stay.