OBJECTIVETo investigate the effect of flurbiprofen preemptive analgesia combined with intravenous propofol anesthesia in induced abortion.

METHODSTotally 175 women (ASA class I) undergoing induced abortion were randomized into 5 groups. In K10, K5, and K1 groups, the patients were given 50 mg flurbiprofen 10, 5 and 1 min before the operation, respectively, and in F group, 1 microg/kg of fentanyl was administered 10 min before the operation. All the 4 groups had intravenous induction with 2 mg/kg propofo1. The patients in P group received propofol at 2 mg/kg as the control group. The heart rate (HR), mean arterial pressure (MAP) and SpO2 were monitored during the operation, and the induction time, recovery time, propofol dosage and adverse effect were recorded. The anesthetic effect of the protocols was assessed according to the visual analogue scale (VAS) and the overall patient satisfaction.

RESULTSHR, MAP, propofol consumption and the incidences of adverse effects during the operation were significantly higher in P group than in the other groups. F group had the highest incidence of respiratory depression among the 5 groups. The VAS in K10 group was significantly lower than that in K5 and K1 groups (P<0.05), but similar to that in F group (P>0.05). The overall patients' satisfaction was significantly higher than that in the other 4 groups.

CONCLUSIONFlurbiprofen preemptive analgesia combined with intravenous propofol is safe and effective for anesthesia during induced abortion.

Abortion, Induced ; Adolescent ; Adult ; Analgesics ; administration & dosage ; therapeutic use ; Anesthesia ; methods ; Anesthetics, Intravenous ; administration & dosage ; therapeutic use ; Drug Therapy, Combination ; Female ; Flurbiprofen ; administration & dosage ; therapeutic use ; Humans ; Propofol ; administration & dosage ; therapeutic use ; Time Factors ; Treatment Outcome

OBJECTIVETo evaluate the effect of epidural anesthesia and patient-controlled epidural analgesia (PCEA) on hemorheology and the incidence of deep venous thrombosis in patients undergoing gynecological laparoscopy.

METHODSOne hundred ASA I-II patients undergoing gynecological laparoscopy were randomly allocated into 2 groups to receive general-epidural anesthesia combined with PCEA (GE group) and general anesthesia (G group). Blood samples were taken before anesthesia (T(0)), before operation (T(1)), 30 min after pneumoperitoneum (T(2)), 30 min after pneumoperitoneum cease (T(3)), and 24 and 48 h after the operation (T(4), T(5)) for hemorheological tests.

RESULTSIn GE group, the blood viscosity, plasma viscosity and RBC aggregation decreased significantly at T(1) (P<0.05), but no significant variations were detected at the other time points. In G group, blood viscosity and plasma viscosity increased significantly from T(2) to T(5), and were significantly higher than those of GE group. The incidence of deep venous thrombosis of GE group (2%) was significantly lower than that of the G group (8%).

CONCLUSIONThe blood viscosity, plasma viscosity and RBC aggregation increase during gynecological laparoscopy, and can be reduced by epidural anesthesia and PCEA to lower the incidence of deep venous thrombosis.

Adolescent ; Adult ; Analgesia, Patient-Controlled ; methods ; Anesthesia, Epidural ; methods ; Female ; Gynecologic Surgical Procedures ; Hemorheology ; Humans ; Laparoscopy ; Middle Aged ; Ovarian Cysts ; blood ; surgery ; Pregnancy ; Uterine Neoplasms ; blood ; surgery ; Young Adult

OBJECTIVETo compare efficacy and side effects of patient-controlled epidural analgesia (PCEA) with levobupivacaine, ropivacaine and racemic bupivacaine after cesarean section.

METHODSIn this prospective, randomized double-blind study, 90 ASA I-II full-term nulliparous women (aged 25-38 years with body weight of 59-87 kg) undergoing elective cesarean section under spinal-epidural anesthesia equally allocated into 3 groups. PCEA was administered with 0.125% levobupivacaine and 20 microg/ml morphine (group L, n=30), 0.125% ropivacaine and 20 microg/ml morphine (group R, n=30), and 0.125% bupivacaine and 20 microg/ml morphine (group B, n=30), respectively. The Visual Analog Scale (VAS) score, satisfaction rate, patients' overall impression of treatment, modified Bromage motor score, and incidence of side effects were recorded at regular intervals after operation.

RESULTSThe three groups were comparable with respect to the efficacy of analgesia, patients' overall impression of treatment, motor blockade and side effects. There was significant difference in patients' satisfaction rate between group R (70%) and the other two groups (93.3% in group L and 96.6% in group B, P<0.05).

CONCLUSIONPCEA with 0.125% levobupivacaine and morphine 20 microg/ml produces better analgesic effect with little side effects after cesarean section.

Adult ; Amides ; administration & dosage ; adverse effects ; Analgesia, Epidural ; Analgesia, Obstetrical ; Analgesia, Patient-Controlled ; Bupivacaine ; administration & dosage ; adverse effects ; analogs & derivatives ; Cesarean Section ; Double-Blind Method ; Drug Therapy, Combination ; Female ; Humans ; Morphine ; administration & dosage ; Nausea ; chemically induced ; Pregnancy ; Prospective Studies ; Pruritus ; chemically induced ; Treatment Outcome ; Vomiting ; chemically induced

OBJECTIVETo investigate the effect of sufentanil administered intrathecally at different doses on the clinical effect of bupivacaine spinal anesthesia in gynecologic laparoscopy.

METHODSSixty patients with ectopic pregnancy undergoing elective laparoscopy (ASA class I-II) were randomized into 4 groups (groups A, B, C and D), and received spinal anesthesia with 15 mg bupivacaine and sufentanil at 0, 2.5, 5 and 7.5 microg, respectively. When the patients complained of discomforts, showed bodily movements, had heart rate over 100 beats/min, or showed blood pressure increment by 20%, additional doses of propofol were given. The onset time of sensory block, time to Bromage scale 3 motor block, time to the highest sensory block level, time of operation and recovery from anesthesia, and the total dosages of propofol were recorded along with the sedative score and the side effects.

RESULTSThe 4 groups were comparable for age, body weight, height and operation time (range 60-65 min) (P>0.05). Both the onset time of sensory block and the time of Bromage scale 3 motor block in groups C and D were significantly shorter than those in groups A and B (P<0.05). The time of the highest sensory block in group D was shorter than that in group A (P<0.05). Compared to the group A, the dose of propofol was reduced in groups B, C, and D by 7.1%, 28.1%, and 34.8%, respectively; propofol doses in groups C and D were significantly lower than those in groups A and B (P<0.05). Pruritus associated with the spinal anesthesia occurred in 4 (26.7%), 3 (20%), and 6 (40%) cases in groups B, C and D, respectively.

CONCLUSIONSIntrathecal sufentanil dose-dependently affect the effect of bupivacaine spinal anesthesia, and larger sufentanil dose produces better effects but more side effects. According to our results, 5.0 microg is the optimal dose for sufentanil.

Adult ; Analgesics, Opioid ; administration & dosage ; Anesthesia, Obstetrical ; methods ; Anesthesia, Spinal ; methods ; Anesthetics, Local ; administration & dosage ; Bupivacaine ; administration & dosage ; Female ; Humans ; Injections, Spinal ; Laparoscopy ; methods ; Pregnancy ; Pregnancy, Ectopic ; surgery ; Sufentanil ; administration & dosage ; Treatment Outcome ; Young Adult

BACKGROUNDDrug treatment for secondary hyperparathyroidism caused by chronic renal failure may be available at the early stage of the disease, but it is not as effective for serious patients. The aim of the study was to evaluate the effect of total parathyroidectomy combined with forearm autotransplantation in the uremic patients with secondary hyperparathyroidism.

METHODSFrom September 1999 through September 2006, parathroidectomy and autotransplantation was performed in 20 patients. The coherence between the results of preoperative parathyroid ultrasonography and surgical exploration were compared. The serum calcium concentration and intact parathyroid hormone (iPTH) were monitored preoperatively, intraoperatively, and postoperatively.

RESULTSA total of 71 hyperplastic parathyroid glands were resected in the 20 patients. The accordance rate of parathyroid localization between B-ultrasonography and intraoperative exploration was 94.4%. The average iPTH value was (110.90 +/- 67.42) ng/L, (433.80 +/- 243.72) ng/L, (48.80 +/- 42.69) ng/L, (229.04 +/- 172.68) ng/L and (232.39 +/- 224.05) ng/L at day 1, 2, 3, 7, 30 after operation respectively. The clinical symptoms were ameliorated and the levels of serum calcium concentration were controlled within the normal range after operation. Recurrent secondary hyperparathyroidism had happened in 1 case, 4 years postoperatively because of the development of autograft hyperplasia, and in another case 2 years postoperatively due to remnant of neck parathyroid glands. The clinical symptoms were all alleviated after re-operation. No surgical complication had occurred in any of the patients.

CONCLUSIONSThe total parathyroidectomy with forearm autotransplantation is feasible, safe, and effective for patients with secondary hyperparathyroidism in the short term. The long-term effects should be further investigated.

Adult ; Aged ; Calcium ; blood ; Female ; Follow-Up Studies ; Forearm ; Humans ; Hyperparathyroidism, Secondary ; blood ; surgery ; Male ; Middle Aged ; Parathyroid Glands ; diagnostic imaging ; transplantation ; Parathyroid Hormone ; blood ; Parathyroidectomy ; methods ; Transplantation, Autologous ; Ultrasonography

BACKGROUNDMajor atrial coronary arteries, including the sinus node artery (SNA), were commonly found in the areas involved in atrial fibrillation (AF) ablation and could cause difficulties in achieving linear block at the left atrial (LA) roof. The SNA is a major atrial coronary artery of the atrial coronary circulation. This study aimed to determine impact of the origin of SNA on recurrence of AF after pulmonary vein isolation (PVI) in patients with paroxysmal AF.

METHODSSeventy-eight patients underwent coronary angiography for suspected coronary heart disease, followed by catheter ablation for paroxysmal AF. According to the origin of SNA from angiographic findings, they were divided into right SNA group (SNA originating from the right coronary artery) and left SNA group (SNA originating from the left circumflex artery). Guided by an electroanatomic mapping system, circumferential pulmonary vein ablation (CPVA) was performed in both groups and PVI was the procedural endpoint. All patients were followed up at 1, 3, 6, 9 and 12 months post-ablation. Recurrence was defined as any episode of atrial tachyarrhythmias (ATAs), including AF, atrial flutter or atrial tachycardia, that lasted longer than 30 seconds after a blanking period of 3 months.

RESULTSThe SNA originated from the right coronary artery in 34 patients (43.6%) and the left circumflex artery in 44 patients (56.4%). Freedom from AF and antiarrhythmic drugs (AADs) at 1 year was 67.9% (53/78) for all patients. After 1 year follow-up, 79.4% (27/34) in right SNA group and 59.1% (26/44) in left SNA group (P = 0.042) were in sinus rhythm. On multivariate analysis, left atrium size (HR = 1.451, 95%CI: 1.240 - 1.697, P < 0.001) and a left SNA (HR = 6.22, 95%CI: 2.01 - 19.25, P = 0.002) were the independent predictors of AF recurrence.

CONCLUSIONSThe left SNA is more frequent in the patients with paroxysmal AF. After one year follow-up, the presence of a left SNA was identified as an independent predictor of AF recurrence after CPVA in paroxysmal AF.

Aged ; Atrial Fibrillation ; physiopathology ; surgery ; Catheter Ablation ; Coronary Vessels ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Pulmonary Veins ; surgery ; Recurrence