Objective:To investigate the anesthetic management of thymectomy for the patients with myasthenia gravis.Methods:Sixty-two patients with myasthenia gravis who underwent thymectomy in our hospital from 1984 to 2003 were retrospectively studied.Of these patients,21 cases received peroral endotracheal intubation and 41 cases pernasal intubation.Intravenous-inhalation combined anesthesia was taken during operation.All of 62 patients with endobronchial tube were transferred to ICU and received mechanical ventilation.Results:Twenty-one patients with perora endotracheal intubation were extubated at 4h-6h after operation.Of these 21 patients,five cases had to be intubated again because of repeated occurrence of myasthenia crisis.Forty-one patients with pernasal intubation did not extubated until mechanical ventilation for 6 hrs to 5 days,and none needed for intubation again,pernasal intubation cases were significantly different with peroral endotracheal intubation cases.The statistics have no difference betwen the trachea incisioned and the dead cases.Conclusion:In anesthetic management of thymectomy for the patients with myasthenia gravis,pernasal endotracheal intubation is convenient for prolonged mechanical ventilation,it can effectively prevent the occurrence of postoperative myasthenia crisis.The perioperative safety precautions,intravenous-inhalation combined anesthesia during operation and strengthening management of respriratory tract are very important.

Objective:To summarize the experiences of perianesthesia management of pheochromocytoma treated with esmolol.Methods:HR,SBP,DBP,MAP,CVP of 28 patients with pheochromocytoma treated with esmolol during anesthesia induction and operation were analysed.Results:Hemodynamics of the patients during operation were kept steady,and the differences were not significant compared with the basic data.Conclusion:Esmolol is safe and effective when applied in pheochromocytoma resection for the cardiovascular effects can be prevented and hemodynamics can be kept steady.

Objective:The purpose of this study is to evaluate the clinical efficacy of remifentanil combined with proopofol in the course of anesthesia induction and analepsia. Methods: 90 ASAⅠ～Ⅱpatients excision of tumor of the ovary and salphingectomy undergoing gynaecologic laparoscopy were randomly divided into two groups:R group (propofol and vemifentanil n=45) and F group (propofol and fentanil n=45).MAP and HR were observed at the time of anesthesia induction tracheal intubation;the time of spontaneuusly breathing,awakeness,extubation,orientation force and the time of PACU were record;we view the patient of conscious state,cognition functional and the degree of pain;and observe the side effects of nausea and vomitting,intraoperative awareness and degree of patients'satisfaction. Result:There was no significant diference in decrease of two group of MAP in the course of anesthesia. The rate of cardiovascular response to tracheal intubation in F group is higher than that in R group, and hemobynamics was stabler. There was significantly diference in the time of spontaneously breathing,awakeness and extubation. At the time instant extubation and departing PACU were shorter, VAS after extubation 1h in R group was higher than that in F group. There was no significant diference in incidence rate of postoperative nausea and vomitting. Conclusion: Awake qualily of intravenous anesthesia with Propofol and remifentanil was better than that with Propofol and fentanil in excision of tumor of the ovary and salpingectomy undergoing gynaecologic laparoscopy. As half life of remifentanil was short, patients felt pain soon after operation and pestoperative analgesia should be performed promptly.

0.05),and that in group 3 or group 4 was obviously shorter than in group 1(P

Objective:To compare the cardiovascular responses to orotracheal intubation with GlideScope videolaryngoscope and with normol laryngoscope in hypertensive patients. Methods:84 hypertensive patients aged 50~70 years,blood pressure controlled,ASA physical status Ⅰ~Ⅱ,scheduled for selected non-heart surgery under general anesthesia reguiring orotracheal intubation were randomly allocated to either GlideScope videolaryngoscope (G,n=42)or normol laryngoscope (N,n=42)group. The following data were recorded and analyzed:glottic exposure time,tracheal intubation time,blood pressure(BP)and heart rate(HR)before and after anesthetic induction,at intubation and thereafter at 1 minute interval for 5 minuts. The rate pressure produc(tRPP)at each measuring time point was calculated. Results:There was no significant difference in the glottic exposure time between the two groups,but the intubation time in G group were significantly longer than that in N group.Compared with base value preinduction,BP,HR,and RPP were significantly decreased in both groups. Glottic exposure and tracheal intubation caused significant increases in BP,HR,and RPP as compared with postinduction values. The index at glottic exposure in group N were higher than that in group G. There was no significant difference in BP,HR,and RPP at other time points between two groups. Conclusion:There was no significant difference in cardiovascular responses to orotracheal intubation between GlideScope videolaryngoscope and normol laryngoscope groups. Under clinical depth of anesthesia,myocardial ischemia did not occur during orotracheal intubation with either laryngoscope in hypertensive patients.

Anesthesia related skills training is an important component of standardized residency training plan.Attention should be paid to the clinical thinking ability,preoperative assessment capacity,sterile concepts and technologies,cardiopulmonary brain recovery skills and teamwork ability cultivation during the rotation of resident physieians and resident surgeons,and comprehensive and scientific examination system should be established

Tracheal intubation is an important part in clinical teaching of anesthesiology,it is also the basic skill that each anesthesiologist must master.The distinctive feature of visual technology is intuitive visual,meaning operation process and anatomical structure can be seen directly and clearly.Our department tried to teach tracheal intubation with visual technology.Teachers firstly demonstrated standard incubation with video laryngoscope and explained the related basic theoretical knowledge.Then students practiced the intubation in models until becoming skilled,finally students can practice in real patients.The teaching effect of the modified method was better compared with that of traditional method.

Objective To investigate the effect of sevoflurane preconditioning on lung compliance and oxygenation index during one lung ventilation( OLV) . Methods In this study, sixty patients, ASAⅠorⅡ, scheduled for pul-monary surgeries were enrolled, and randomly divided into two groups:sevoflurane preconditioning group(n=30) and total intravenous group( n=30 ) . For preconditioning, patients in sevoflurane preconditioning group were ad-ministrated with one minimal alveolar concentration(1MAC) sevoflurane for 30 min after general anesthesia induc-tion and then followed with total intravenous anesthesia. While in total intravenous group, only intravenous anes-thetic agents were administrated for maintenane of anesthesia after induction. The indexes of hemodynamics, pulse oximeter( SpO2 ) , plateau pressure( Pplat) and lung compliance( Cdyn) were recorded at the following time points:before anesthesia( T0 ) , after anesthesia induction at laternal position TLV 30 min( T1 ) ,30 min after OLV( T2 ) , 60 min after OLV( T3 ) and recovering TLV 20 min( T4 ) . Arterial blood samples were taken to measure partial pressure of carbon dioxide( PaCO2 ) , partial pressure of oxygen( PaO2 ) , pH, oxygenation index( PaO2/FiO2 ) at the follow-ing time points: T1 , T2 , T3 , T4 . Results Compared with T1 , the oxygenation index and lung compliance de-creased significantly at T2 ,T3 ( P<0. 05 ); compared with total intravenous group, the lung compliance was obvi-ously higher than that in sevoflurane preconditioning group at T2,T3(P<0. 05). There were no significantly differ-ences in the oxygenation index between total intravenous group and sevoflurane preconditioning group at all time points. Conclusion Compared with total intravenous anesthesia with propofol , sevoflurane preconditioning can im-prove lung compliance, but does not make contribute to improve oxygenation index.

0.05).The CSFP before and after opening dura mater was obviously lower than the baseline value (P0.05).The total dose of propofol in group T was smaller than in group C.CONCLUSION:Target controlled infusion of propofol is better than continuous pump injection in lowering the ICP during neurological surgery.

Ultrasound-guided peripheral nerve block is widely used in clinical practice because of its high accuracy and safety. Residents must pass formal training to master this technique. However, residents are not familiar with the related anatomical structure of nerve block, and lack of basic ultrasonic knowledge, operation skills, simulation training, understanding of the corresponding complications, the optimal concentration and dose of local anesthetic drugs. In order to solve the above problems, we have taken measures such as basic theoretical knowledge learning, application of anatomy and ultrasound software, simulation training and grading training so that residents in standardized training of anesthesiology could fully grasp the clinical application of ultrasound-guided peripheral nerve block techniques.