Objective:To investigate perioperative management of anesthesia for septic shock.Methods:Anesthesia performed on an elderly patient with septic shock who underwent emergency surgery in Beijing Hospital was analyzed and summarized, with a literature review.Results:Etomidate, Ketamine, cis Atracurium and Remifentanil are preferred for anesthesia induction, and Remifentanil and Sevoflurane are the first choices for anesthesia maintenance.Combined application with Dexmedetomidine may improve patients' prognosis.For septic shock patients with new-onset atrial fibrillation, β-blockers are preferred for perioperative anti-arrhythmia.If necessary, propafenone or amiodarone can be used for cardioversion.Perioperative ultrasound evaluation may be used to guide perioperative fluid therapy and vasoactive drug administration for septic shock in the future.Conclusions:Anesthesiologists should place a high value on and have a good command of the main aspects of perioperative management of anesthesia for septic shock.

Objective:To investigate the effects of different mechanical ventilation methods on respiratory function in elderly patients in the steep Trendelenburg position undergoing general anesthesia.Methods:This was a randomized controlled study.Sixty patients scheduled for elective laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia were randomly divided into the lung protective ventilation strategy group(the P group)and the traditional ventilation strategy group(the T group)(n=30, each group). The setting for the P group included FiO 2 at 50%, tidal volume at 6 ml/kg, respiratory rate at 14-16/min, positive end expiratory pressure(PEEP)at 5 cmH 2O, with sustained lung inflation by pressure control every 30 min and the pressure at 30 cmH 2O for 30 s. The setting for the T group included FiO 2 at 50%, tidal volume at 10 ml/kg, and respiratory rate at 10-12/min.Anesthesia was maintained by sevoflurane, remifentanil and cis-atracurium.Driving pressure(DP), mean airway pressure(P mean)and end-tidal carbon dioxide(EtCO 2)were recorded at T1(5 mins after intubation), T2(after pneumoperitoneum), T3(30 mins after pneumoperitoneum), T4(1h after pneumoperitoneum), T5(2h after pneumoperitoneum), T6(3h after pneumoperitoneum)and T7(end of surgery). Arterial blood partial pressure of carbon dioxide(PaCO 2), alveolar-arterial oxygen partial pressure difference[P(A-a)O 2]and oxygenation index(OI)were recorded at T0(entering the operating room), T1, T3, T4, T5, T6, T8(after extubation)and T9(24h after operation). Arterial-end-tidal carbon dioxide partial pressure difference[P(a-et)CO 2]was recorded at T3, T4, T5 and T6. Results:DP in the P group was lower than in the T group at each time point( P<0.01). The P mean in the P group at each time point was higher than in the T group( P<0.01). EtCO 2 was higher in the P group than in the T group at T1( t=0.751, P<0.01)and T2( t=2.830, P<0.01). PaCO 2 was higher in the P group than in the T group at T1( t=1.435, P<0.01), T3( t=2.469, P<0.01)and T4( t=1.359, P<0.05). There were no statistic differences in P(A-a)O 2, OI and P(a-et)CO 2 between the two groups at any time point( P>0.05). Conclusions:Compared with the traditional ventilation strategy, the lung protective ventilation strategy has lower DP and higher P mean during laparoscopic radical prostatectomy, while it has no advantage in lung oxygenation.The lung protection ventilation strategy can be safely used in laparoscopic radical prostatectomy in the steep Trendelenburg position under general anesthesia.

OBJECTIVES: Bispectral index (BIS) can reflect the depth of propofol sedation. This study aims to compare the anesthetic satisfaction, anesthetic dose, and hemodynamic changes between closed-loop target controlled infusion (CLTCI) and open-loop target controlled infusion (OLTCI) during abdominal surgery. METHODS: From December 2016 to December 2018, 70 patients undergoing abdominal surgery under general anesthesia were selected in Beijing Hospital, including 51 males and 19 females, at the age from 49 to 65 years old. They were classified as grade I-II by the American Society of anesthesiologists (ASA) and were randomly divided into the CLTCI group and the OLTCI group ( RESULTS: In the induction stage, the percentage of adequate anesthesia time in the CLTCI group was higher than that in the OLTCI group, and the percentage of deep anesthesia time in the CLTCI group was significantly lower than that in the OLTCI group (both CONCLUSIONS Compared with propofol OLTCI, anesthesia with propofol CLTCI under BIS guidance can maintain a more appropriate depth of anesthesia sedation and more stable hemodynamics.
Abdomen/surgery* ; Aged ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics, Intravenous ; Electroencephalography ; Female ; Humans ; Male ; Middle Aged ; Propofol ; Remifentanil ; Surgical Procedures, Operative

Objective:To analyze the incidence of postoperative pulmonary complications and related factors in elderly patients after major abdominal surgery.Methods:Clinical data of elderly patients undergone major abdominal surgeries at Beijing Hospital were retrospectively analyzed.The incidence of postoperative pulmonary complications was studied, and related factors were analyzed using Logistic regression analysis.Results:A total of 96 cases were included.The incidence of postoperative pulmonary complications was 53.1%(51/96)in elderly patients after major abdominal surgery.Logistic regression analysis showed laparoscopy was a protective factor for postoperative pulmonary complications( OR=0.293, 95% CI: 0.100-0.865, P=0.026), while driving pressure > 18 cmH 2O(1 cmH 2O=0.098 kPa)( OR=3.300, 95% CI: 1.148-9.434, P=0.027)and intraoperative bleeding volume > 500 ml( OR=4.444, 95% CI: 1.091-18.180, P=0.037)were risk factors for postoperative pulmonary complications. Conclusions:Attention should be paid to the incidence of postoperative pulmonary complications in elderly patients after major abdominal surgery.Laparoscopy is a protective factor for postoperative pulmonary complications, while driving pressure more than 18 cmH 2O and intraoperative bleeding volume more than 500 ml can increase the risk of postoperative pulmonary complications.

Safe airway management is the primary task of anesthesiologists.Anesthesiologists must have good airway management skills including dealing with all kinds of difficult airway in time and effectively to ensure the ventilation and oxygenation of patients and to avoid regurgitation and aspiration.The second World Airway Management Meeting held in Netherlands in November 2019 discussed fourteen topics related to airway management.This article will focus on six hot issues in this session, namely, 1.Human factors and safe airway management; 2.Management of patients with full stomach; 3.Difficult Airway Society (DAS) Awake Tracheal Intubation (ATI) guidelines; 4.Whether awake tracheal intubation can solve all the difficult airway, and whether succinylcholine is out of date; 5.The Universal Management of Airways Guidelines; 6.Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE). The purpose of interpreting and analyzing the above hot issues is to timely update the knowledge of airway management for anesthesiologists, and to improve the understanding and mastery of airway management, especially difficult airway management.

Objective:To evaluate the accuracy of point-of-care ultrasound in diagnosis of guidewire tip misplacement during central venous catheterization.Methods:Ninety patients of both sexes, aged 18-90 yr, with body mass index of 15.5-44.8 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅳ, scheduled for elective surgery with general anesthesia requiring central venous catheter (CVC) insertion through bilateral internal jugular veins or subclavian veins, were enrolled.The ultrasound probe was used, and the target vessel was selected.Anesthesia was induced with propofol, sufentanil and cisatracurium, and positive pressure ventilation was applied after endotracheal intubation.After central venous puncture was successfully performed under ultrasound guidance, the guidewire was inserted to a predetermined length, and the tips of the guidewire were confirmed with X-ray film and with point-of-care ultrasound including a phased array probe and linear array probe, and the results were recorded.The CVC was inserted after confirming the guidewire tip position.Agreement between the guidewire tip misplacement confirmed with point-of-care ultrasound and with bedside X-ray film was analyzed using Kappa statistics.The sensitivity, specificity, and total coincidence rate, rate of misdiagnosis, rate of missed diagnosis, Youden index, odds product, positive predictive value and negative predictive value of the guidewire tip misplacement were calculated during central venous catheterization confirmed using point-of-care ultrasound. Results:Among the 90 patients, 17 cases had guidewire tip misplacement, and the incidence of guidewire tip misplacement was 19%.Point-of-care ultrasound and bedside X-ray film were consistent in the diagnosis of guidewire tip misplacement during CVC insertion (Kappa value 0.945, P<0.05). The sensitivity of point-of-care ultrasound in diagnosing guidewire tip misplacement during CVC insertion was 97.44 %, specificity 97.78%, total coincidence rate 97.67%, rate of misdiagnosis 2.22%, rate of missed diagnosis 2.56%, Youden index 95.22%, odds product 1 672, positive predictive value 95.00%, and negative predictive value 98.88%. Conclusion:Point-of-care ultrasound can be used to diagnose guidewire tip malposition during central venous catheterization.

Data of patients underwent thoracic surgeries were retrospectively collected in our center from November 2016 to January 2019.The last recorded tidal volume and driving pressure before two-lung ventilation were selected.Patents were classified into driving pressure increase group (>15 cmH 2O) and normal group.The baseline characteristics, parameters of pulmonary function, left one-lung ventilation and protective ventilation strategies were recorded.Logistic regression analysis was used to identify the risk factors for driving pressure increase, correlation analyses between predicted body weight and total lung capacity and between forced vital capacity and total lung capacity were performed.The Receiver Operating Characteristic (ROC) curve was used to analyze the accuracy of the ratio of tidal volume to corrected forced vital capacity in predicting driving pressure increase.Sixty-two patients were included in this study.Body mass index, left one-lung ventilation and the ratio of tidal volume to corrected forced vital capacity ratio were the risk factors for driving pressure increase ( P<0.05 or 0.01). Predicted body weight (correlation coefficient was 0.66, P<0.01) and forced vital capacity (correlation coefficient was 0.75, P<0.01)were both positively correlated with total lung capacity, but the two coefficients were statistically significant difference ( P<0.05). The area under the ROC curve of the ratio of tidal volume to corrected forced vital capacity in predicting driving pressure increase was 0.846 (95% CI 0.749-0.943) ( P<0.01), the diagnostic threshold was 0.312, the sensitivity and specificity of this threshold were 0.800 and 0.781 respectively, so the boundary of tidal volume during one-lung ventilation should be either forced vital capacity×0.149 for left one-long ventilation or forced vital capacity×0.163 for right one-lung ventilation.In conclusion, the ratio of tidal volume to corrected forced vital capacity has a higher predictive value for driving pressure increase during one-lung ventilation, and forced vital capacity can be used as a reference while calculating tidal volume.

Objective: To observe whether the active forced-air warming has the same efficacy on the prevention of perioperative hypothermia in the elderly as compared with young patients. Methods: This was a prospective, randomized, controlled clinical trial.Forty patients scheduled for abdominal surgery under general anesthesia were allocated to two groups: the elderly group and the young group(n=20, each). All patients received active forced-air warming at 20-30 min before induction of anaesthesia till leaving the operation room.Blood products and peritoneal lavage fluids were warmed to 37℃, and other intravenous fluids were at room-temperature.The core temperatures were recorded after entering the operation room(baseline), before induction of anaesthesia, at 15 min intervals after induction of anaesthesia, at the end of surgery and before leaving the operation room.The postoperative shivering and adverse reactions were also recorded. Results: The core temperature was lower in elderly patients than in young patients at baseline and at each time points after 30 min of induction of anaesthesia(P<0.05). In elderly patients, the core temperature was significantly lower before leaving operation room than at the baseline(t=2.353, P=0.03), but in young patients, no significant difference was found in the core temperature between at the baseline and before leaving operation room(t=0.233, P=0.818). The incidence of intra-operative hypothermia was higher in elderly patients than in young patients(40.0% or 8/20 vs.5.0% or 1/20, c²=7.025, P=0.008). Conclusions During abdominal surgery under general anesthesia, active forced-air warming cannot effectively prevent perioperative hypothermia in elderly patients as compared with young patients.

Objective To investigate the efficiency and safety of Dexmedetomidine as adjuvant to local anesthetics in elderly patient undergoing transurethral resection of the prostate.Methods Sixty elderly patients undergoing selective transurethral resection of the prostate were randomly divided into the Dexmedetomidine group and the Propofol group(n =30,each).After block level of spinal anesthesia was determined,Dexmedetomidine(a bolus dose of 0.5 μg/kg for 10 minutes,then continuous injection of 0.2-0.4 μg· kg-1 · h-1)or Propofol(initial plasma concentration of 0.5 mg/L,after getting equal to an effect compartment drug concentration,plasma concentration was gradually increased by 0.1 mg/L)was injected with an infusion pump.Observation items were recorded,including the onset time [observer's assessment of alertness/sedation (OAA/S) ≤ 3 points],blood pressure,heart rate,respiratory rate,pulse oxygen saturation,end-tidal carbon dioxide partial pressure,bispectral index value(BIS),and OAA/S score as well as adverse events and patients' satisfaction to sedation.Results The OAA/S score after 20 minutes of drug injection was lower in the Propofol group than in the Dexmedetomidine group(3.0 ± 0.5 scores vs.3.5 ± 0.6 scores,t =2.300,P =0.030).The systolic pressure levels were lower in the Propofol group than in the Dexmedetomidine group after 30 minutes and 40 minutes of drug injection(107.6 ± 11.2 mmHg vs.119.2 ± 16.4 mmHg,106.7±9.6 mmHg vs.121.2±18.3 mmHg,1 mmHg=0.133 kPa,t =2.151 and 2.555,P=0.041 and 0.017).The diastolic pressure was lower in the Propofol group than in the Dexmedetomidine group after 10 minutes of drug injection(69.8±6.7 mmHg vs.78.0±10.1 mmHg,t =2.462,P =0.021).The incidence of bradycardia was higher in the Dexmedetomidine group than in the Propofol group(20.0％ or 6/30 vs.0.0％ or 0/30,x2 =6.667,P=0.010).The incidences of respiratory depression and involuntary movement were lower in the Dexmedetomidine group than in the Propofol group(0.0％ or 0/30 vs.13.3％ or 4/30,0.0％ or 0/30 vs.30.0％ or 9/30,x2 =4.286 and 10.588,P =0.038 and 0.001).Conclusions Compared with the conventional Propofol,Dexmedetomidine has a definite sedative effect in elderly patients undergoing transurethral resection of the prostate under spinal anesthesia,with peace and cooperation,greater stability of blood pressure,without breath depression,but with higher incidence of bradycardia.

Objective To evaluate the efficacy of dexmedetomidine in preventing agitation during recovery from general anesthesia in patients undergoing uvulopalatopharyngoplasty (UPPP).Methods Sixty adults patients with obstructive sleep apnea syndrome,of American Society of Anesthesiology physical status Ⅰ or Ⅱ,aged 24-62 yr,with body mass index of 24-37 kg/m2,undergoing elective UPPP,were divided into dexmedetomidine group (group D) and conventional group (group C) using a random number table method,with 30 patients in each group.Dexmedetomidine was infused in a loading dose of 0.8 μg/kg over 10 min starting from 10 min before anesthesia induction,followed by a continuous infusion of 0.4 μg · kg-1 · h-1 for 30 min in group D,while the equal volume of normal saline was given instead of dexmedetomidine in group C.Anesthesia was induced and maintained by target-controlled infusion of propofol and remifentanil,and bispectral index value was maintained at 40-60 during surgery.Patients were extubated after they restored spontaneous breathing completely,opened eyes on verbal command and responded to verbal command,and then the patients were transferred to the recovery room,and oxygen was inhaled by mask.The emergence time,extubation time and development of agitation were recorded.Verbal rating scale was used to assess pain at 30 min after patients were transferred to the recovery room.Results Compared with group C,the incidence of agitation was significantly decreased,pain was reduced,and the emergence time was prolonged in group D (P＜0.05).There was no significant difference in extubation time between two groups (P＞0.05).Conclusion Dexmedetomidine can effectively prevent the occurrence of agitation during recovery from general anesthesia in patients undergoing UPPP.