Objective To observe the degree of arterial oxygenation and the incidence of hypoxaemia by different antalgic modes in elderly patients postoperatively, and to investigate the way of prophylaxis and treatment. Methods Sixty elderly patients by different postoperative antalgic modes were randomly divided into three groups with 20 in each: patient-controlled epidural analgesia group, continuously intravenous infusion analgesia group and intramuscular injection analgesia group. The oxygen saturation was monitored during 24 hours and the arterial blood gases were measured immediately before and 4, 24 and 48 hour after operation. Results The rates of hypoxaemia occurring once or more in patient-controlled epidural analgesia group, continuously intravenous infusion analgesia group and intramuscular injection analgesia group were 21%, 36% and 32% respectively . There were no significant differences in PaO 2 (arterial PO 2) and PaCO 2 (arterial PCO 2) between postoperative 48 hour and immediately before operation in patient-controlled epidural analgesia group. PaO 2 and PaCO 2 at 4 and 24 hour after operation were significantly lower than those immediately before operation, and all were over 70 mmHg. Conclusions Patient-controlled epidural analgesia may improve the degree of arterial oxygenation and lower the incidence of hypoxaemia after operation in elderly patients.

Objective To evaluate the safety of intrvenous balanced propofol sedation with fentanyl in elderly patients during combined gastroscopy and colonoscopy procedures.Methods Totally 877 elderly patients aged (76.4 ± 8.5) years received intravenous propofol and fentanyl sedation during gastroscopy or/and colonoscopy procedures were assigned to groups:294 cases with only gastroscopy,257 cases with only colonoscopy and 326 cases with combined gastroscopy and colonoscopy.50 g Fentanyl and 0.5-1.0 mg/kg propofol were intravenously administered in the patients.The peripheral oxygen saturation,arterial pressure and heart rate were monitored and recorded during procedures.Results There were no procedure-related perforations and sedationassociated severe complications and mortalities,and no one need stop endoscopy procedures in all the patients.The average dosage of propofol in combined,gastroscopy and colonoscopy groups were (100.4±38.5) mg,(130.4±50.5)mg and (170.3± 60.3)mg,respectively.There were no significant differences in heart rate,arterial pressure and rate of cardiovascular events among groups (P＞0.05).The rate of respiration events in the above groups were 9 cases(3.1％),6 cases(2.3％)and 13 cases(4.0％),respectively (P＞0.05).Decrease of peripheral oxygen saturation was mainly induced by the aspiration of oral secretions and snoring.Conclusions Intravenous balanced propofol sedation provides safe and effective sedation in the elderly undergoing combined gastroscopy and colonoscopy.

Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing laparoscopic surgery. Methods One hundred and twenty ASA I or Ⅱ patients of both sexes aged 35-60 yr weighing 48-85 kg undergoing elective laparoscopic surgery were randomized to 2 groups ( n = 60 each): LMA Supreme group (group S) and tracheal intubation group (group T). Mallampati test was performed before operation in both groups. The patients were classified as I - Ⅲ . In group S the LMA Supreme was inserted after induction of anesthesia with sufentanil 0.2 fig/kg, propofol 2-3 mg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA Supreme. In group T the patients were intubated under direct laryngoscopy. The success rate, LMA placement/intubation time, success rate of gastric tube placement, airway seal pressure, SpO2, PETCO2 , peak airway pressure and complications (hypoxemia, nausea and vomiting, choking hoarseness, sore throat and regurgitation of gastric contents) were recorded. The duration of surgery, anesthesia time, extubation time and emergence time were also recorded. Results There was no significant difference in the success rate between the two groups. The placement and removal time and recovery time were significantly shorter in group S than in group T. The airway seal pressure was (25 ±4) cm H2O in group S. SpO2, PETCO2 and peak pressure were within normal range in both groups. The incidence of postoperative hypoxemia, choking and sore throat were significantly lower in group S than in group T. Conclusion LMA Supreme can provide adequate ventilation during operation with less complications and can be used effectively for laparoscopic surgery.

Objective To observe the onset time,cardiovascular system reactions and side effects of anesthetic introduction with sevoflurane and to explore its reliability and safety in elderly patients. Methods Sixty American Society Anesthesiologists(ASA)Ⅰ～Ⅲ patients aged 65～78 years who were scheduled for selective operation were selected in the study.They were randomly divided into sevoflurane inhalation induction group(sevoflurane group)and propofol induction group (control group).In sevoflurane group,the concentration of inhaled sevoflurane was regulated according to downgrading method during the induction,and it was decreased by 1% every 30 seconds from the initial concentration of 7% to the maintained concentration of 4%.In control group,propofol was titrated by 1.5～2.5 mg/kg.When bispectral index(BIS)was≤60,sufentanil was administered intravenously and the patients were paralyzed with rocuronium and intubated.The extinction time of lash reflex and the achievement time of BIS≤60 in two groups were recorded.The mean arterial blood pressure(AMBP),heart rate(HR),oxygen saturation(Sp02)and BIS of the basic values before intubation,and 1 min,3 min,5 min after intubation were also recorded,respectively.The side effects during intubation such as laryngeal spasm,body movements,irritating cough,restless movement during intubation were noted.The consciousness during intubation and satisfaction with induction were followed in patients after operation. Results The extinction time of lash reflex and the achievement time of BIS≤60 were significantly longer in sevoflurane group than those in control group (both P＜0.01).In sevoflurane group.there were no differences in MBP and HR between 1 min postintubation and pre-intubation.Whereas,in control group,AMBP and HR were lower before intubation than basic values,and were higher 1 rain post-intubation than pre-intubation(P＜0.05).There were irritating cough cases both in sevoflurane group and in control group(5 vs.3),and there was no laryngeal spasm case.All patients were satisfied with the anesthesia and had no consciousness during intubation. Conclusions　Sevoflurane is a safe and effective induction agent and has little side effects.It is an ideal choice for elderly patients.

Objective To investigate the states of psychological condition and the quality of life in patients with functional constipation (FC) by comparing with those of healthy controls.Methods Symptom Checklist-90(SCL-90)and Patient Assessment Constipation-Quality of Life(PAC-QOL)were tested by self-report questionnaire in sixty patients with FC and thirty healthy controls with corresponding age and gender.Results (1)There was no difierence in age,body mass index and sex ratio between the FC patients and healthy controls,but the scores of stool form and frequency of defecation were significantly different between the two groups.(2)The following items of SCL-90 i.e.total scores,total symptomatic index.the number of positive items and positive symptom distress level were obviously higher in the FC patients than in controls (P＜0.05).The scores of the nine factors of SCL-90 except terror were also higher in the FC patients than in controls.(3)The average total score and scores of four sections (physical discomfort,psychological discomfort,anxiety,satisfaction) of PAC-QOL in FC patients were higher than those in basal level.(4)The average score of PAC-QOL was significantly correlated with the scores of SCL-90,especially in anxiety and depression.(5)The severity of symptoms in the FC patients was significantly correlated with the average score of PAC-QOL and the total score of SCL-90.Conclusioils FC patients have obviously psychological abnormality,which affects the quality of life significantly.The scores of quality of life is a better parameter to reflect the healthy status of the FC patients than the laboratory tests and the clinical symptoms.

Objective To assess the efficacy of the laryngeal mask airway i-gel (LMA i-gel) in patients umdergoing laparoscopic cholecystectomy. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients of both sexes,aged 34-62 yr, weighing 45-90 kg, undergoing elective cholecystectomy using fiberoptic laparoscope, were randomized into 2 groups (n =60 each): LMA i-gel group (group I) and LMA ProSeal group (group P). After induction of anesthesia with sufentanil 0.2 μg/kg, propofol 2.5 mg/kg and vecuronium 0.1 mg/kg, LMA i-gel and LMA ProSeal were inserted in group I and P respectively. A gastric tube was inserted through the drain tube of the LMAs. The number of attempts, success rate, success rate of gastric tube placement, airway seal pressure, SpO2 ,PETCO2, peak airway pressure and complications (hypoxemia, nausea and vomiting, choking hoarseness, sore throat and regurgitation of gastric contents) were recorded. The fiberoptic laryngoscope scores were assessed after sccessful LMA placement. The anesthesia time, duration of surgery, extubation time and emergence time were also recorded. Results There was no significant difference in the anesthesia time, duration of surgery, extubation time and emergence time between the two groups ( P ＞ 0.05). The SpO2, PETCO2 and peak airway pressure were within the normal range during operation in both groups. The first attempt success rate of LMA placement and fiberoptic bronchoscopic scores were significantly higher, and the LMA placement time was significantly shorter in group Ⅰ than in group P (P ＜ 0.05). The success rate of LMA and gastric tube placement was 100% in both groups. The incidence of sore throat was significantly lower in group I than in group P ( P ＜ 0.05). Conclusion LMA i-gel can provide adequate ventilation during operation with less complications and can be used effectively for cholecystic laparoscopic surgery.

Objective To evaluate the efficacy of streamline liner of pharyngeal airway ( SLIPA) in airway management of general anesthesia. Methods Sixty ASA Ⅰ -Ⅱ patients undergoing elective breast surgery were randomized into 2 groups (30 cases each): SLIPA group (group S) and laryngeal mask airway (LMA) classic group (group L). Anesthesia was induced with propofol 2 mg/kg, sufentanil 0.15 μ g/kg and vecurium 0.08 mg/kg. SLIPA or LMA was inserted with digital manipulation. Anesthesia was maintained with 1% - 2% sevofluran and 50% N2O in 50% oxygen. The parameters of controlled ventilation were same in both groups. The attempt times, seal pressure and grade of fiberoptic (FOB ) laryngoscopy were measured. SpO2, PErCO2 and peak airway pressure were monitored every 15 minutes after successful laryngeal mask insertion. The complications such as regurgitation of gastric contents and sore throat were assessed by anesthesiologist after surgery. Surgery time, anesthesia time, extubation time and emergence time were recorded. Results Success rate of LMA insertion in both groups were 100%. The first attempt success rates were 90%( 27/30) in group S and 60%( 18/30) in group L (P< 0.05), the FOB grade 4 were 67%(20/30) in group S and 37% (ll/30)in group L(P< 0.05), the maximum seal pressures were (23.6 ± 4.7)cmH2O (1 cm H2O = 0.098 kPa) in group S and (18.8 ± 4.5) cm H2O in group L (P<0.05). SpO2, PErCO2 and peak airway pressure were within normal ranges. The occurrence of sore throat was similar in group S and group L (7 cases vs 6 cases). No signs of regurgitation were detected. Conclusion The SLIPA proved to be a simple, safe and effective airway instrument with little complications during the course of general anesthesia.

Objective To compare the efficacy of laryngeal mask airway Guardian (GLMA) and laryngeal mask airway Supreme (SLMA) in patients undergoing gynecological surgery. Methods One hundred and twenty ASA Ⅰ or Ⅱ patients aged 19-80 yr weighing 50-70 kg undergoing gynecological surgery were randomly divided into 2 groups: SLMA group (group S, n = 59) and GLMA group (group G, n =61). LMA was inserted after induction of anesthesia with propofol 2.0-2.5 mg/kg, sufentanil 0.2 μg/kg and rocuronium 0.6 mg/kg. All the patients were mechanically ventilated. BP, HR, SpO2, PETCO2 and Ppeak were monitored during operation. The rate of successful placement, placement time, fiberoptic bronchoscope grade, airway sealing pressure, airway pressure during normal ventilation with tidal volume of 8 ml/kg, airway pressure and air leakage during ventilation with large tidal volume of 20 ml/kg, air leakage during opertion, complications, anesthesia time, duration of surgery, extubation time and emergence time were recorded. Results There was no significant difference in the rate of successful placement, placement time, airway pressure during normal ventilation and during ventilation with large tidal volume, blood stain at LMA removal, incidence of sore throat, choking hoarseness and dysphagia, anesthesia time, duration of surgery, extubation time, and emergence time between the two groups (P ＜ 0.05). The BP,HR, SpO2, Ppeak and PETCO2 were within the normal range during operation in both groups. The fiberoptic bronchoscope grade and airway sealing pressure were significantly higher, and the incidence of air leakage during ventilation with large tidal volume and during operation was significantly lower in group G than in group S (P ＜ 0.01).Conclusion GLMA and SLMA can provide adequate ventilation during operation with fewer complications and can be used effectively for gynecological surgery. The efficacy of GLMA is better.

Objective To summarize the clinical experience in treatment of the Lisfranc joint injury with open reduction and internal fixation at early stage. Methods Twelve patients ( including ten males and two females at average age of 34 years) with early stage Lisfranc joint injury received open reduction and screw/wire fixation from 2005 to 2010. According to the Myerson classification, there were two patients with type A, eight with type B and two with type C. All the patients received open reduction and internal fixation with screw or Kirschner wire within 17 days after injury. The post-operative function was estimated by mid-foot scoring scale of AOFAS. X-ray and CT scan were used in radiography estimation. Results All the patients were followed up for average 33 months ( range, 6-60 months). The mean score of post-operative mid-foot scoring scale of AOFAS was 74.5 points ( range, 53-96 points), with excellent result in eight patients, good in two and fair in two. The anatomical reduction was observed in eight patients and all the patients obtained bony union according to the results of X-ray and CT scan.There was no any complication found.Conclusions Open reduction and internal fixation is a good choice for the treatment of Lisfranc joint injury at early stage. A preoperative comprehensive analysis combined with clinical X-ray and CT scan is necessary.