Clinical application of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block in right-thoracoscopic minimally invasive cardiac surgery: a retrospective cohort study

Objectives: This study aimed to investigate the effects of ultrafast channel cardiac anesthesia assisted by serratus anterior plane block on the post-operative rehabilitation of patients undergoing right-sided thoracoscopic minimally invasive cardiac surgery, as well as the safety and feasibility of the clinical application of this technique. Background: Regional nerve block has previously been used in cardiac surgery to reduce intraoperative opioid use and promote anesthesia in fast-track and ultra-fast-track cardiac surgery. However, the clinical application of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) in minimally invasive cardiac surgery under thoracoscopy has not been reported. Methods: A total of 102 patients who underwent right-sided thoracoscopic minimally invasive heart valve surgery in our center from January 2021 to August 2021 were enrolled and divided into two groups: an ultrafast channel cardiac anesthesia assisted by serratus anterior plane block (SAPB-GA) group (n=40) and a conventional general anesthesia (GA) group (n=62). The effects of ultrafast cardiac anesthesia assisted by serratus anterior plane block (SAPB) on post-operative rapid recovery as well as the safety and feasibility of its clinical application were compared and analyzed. Results: Compared to the GA group, the intraoperative use of sufentanil in the SAPB-GA group was significantly reduced (66.25±1.025, 283.31±11.362, P<0.001); the incidence of postoperative analgesia in ICU was significantly decreased (17%, 48.8%, P<0.001); the incidence of postoperative NRS≥3 in ICU was significantly decreased (15%, 37.1%, P = 0.016); and the postoperative extubation time (1(1-1), 13.84 (10.25-18.36), P<0.001), ICU stay time (28.58±2.838, 61.69±4.125, P<0.001) and postoperative hospital stay (8.08±0.313, 9.74±0.356, P=0.02) were significantly shortened; and the 24 h postoperative thoracic blood drainage was significantly reduced (209.63±25.645, 318.23±20.713, P<0.001). No statistical difference was observed in the incidence of postoperative nausea, vomiting and atelectasis between the two groups (all P>0.05). Both of the groups reported no postoperative cardiovascular events. Conclusions: Ultrafast channel cardiac anesthesia assisted by SAPB could promote the rapid postoperative recovery of patients undergoing minimally invasive cardiac surgery under a thoracoscope. This approach is safe and feasible in the clinic.

Effects of Propofol and Sevoflurane on Cellular Immune Function and Postoperative Complications in Patients with NSCLC Undergoing Surgery

Objective We explore the effects of propofol and sevoflurane on the immunity and postoperative complications of patients undergoing thoracoscopic NSCLC radical surgery. Methods 61 patients were selected. They were divided into two groups. Patients take the same drugs for induction of anesthesia. Propofol was used for maintenance of anesthesia in Group P. Sevoflurane was used for another group. Hemodynamics and related anesthesia doses and laboratory data were recorded during the perioperative period. Immune Functio,, postoperative complication rate were evaluated in two groups. Results Comparisons of MAP and HR under anesthesia in patients, Group P were more smoothly than Group S at OLV 1h and TLV 30min. The recovery time and extubation time were significantly longer in the Group S than Group P. NEU: Group P were significantly lower at T3. LYM : Group P were significantly higher at T1 and T2. CD8+ : Group P were significantly higher at T1, T2 and T3. NK cells were significantly higher in Group P at T3. CD4+/CD8+: Group P were significantly lower at T2 and T3. The incidence of pleural effusion: Group P were significantly higher at T3. The postoperative hospital stays were significantly shorter in the Group S. Conclusions Propofol anesthesia has more stable hemodynamics and better resuscitation effect. The immune system of patients in the perioperative period was suppressed to varying degrees after surgery, and the propofol group was less severe than the sevoflurane group. Houever, the postoperative hospital stay depends more on whether postoperative complications occur.

Application Analysis of Omental Flap Isolation and Modified Pancreaticojejunostomy in Pancreaticoduodenectomy (175 Cases)

Background: To explore the application value of free omentum wrapping and modified pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods: The clinical data of 175 patients who underwent pancreaticoduodenectomy from January 2015 to December 2020 were retrospectively analyzed. All patients were divided into 86 cases in group A (omental wrapping and modified pancreaticojejunostomy) and 89 cases in group B (control group). The incidence of pancreatic fistula and other related complications, inflammatory factors and survival rate were compared between the two groups.Results: The incidences of B/C pancreatic fistula, bile leakage, delayed bleeding, and reoperation in group A were lower than those in group B, and the difference was statistically significant (P <0.05). The free omentum wrapping isolation and the modified pancreaticojejunostomy group drainage tube extubation time, open diet time and postoperative hospital stay were earlier than the control group (P <0.05). There were also statistically significant differences in CRP, IL-6, PCT inflammatory factors 1, 3, and 7 days after surgery as well as in postoperative survival rate.Univariate analysis showed that BMI, pancreatic duct diameter, greater omental flap isolation and modified pancreaticojejunostomy were related to the occurrence of pancreatic fistula after PD. Multivariate analysis showed that BMI≥24, pancreatic duct diameter less than 3mm, no greater omental flap isolation method and modified pancreaticojejunostomy were independent risk factors for pancreatic fistula (P<0.05).Conclusions: Wrapping and isolating with free greater omentum plus modified pancreaticojejunostomy can significantly reduce the incidence of postoperative pancreatic fistula and related complications, inhibit the development of inflammation, and is conducive to the prognosis.

Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions

Objective. To explore the application of different doses of dexmedetomidine combined with general anesthesia in patients with traumatic tibiofibular fractures. Methods. A total of 120 patients with traumatic tibiofibular fractures treated in our hospital (January 2018–January 2021) were selected as the research subjects and equally grouped into group A, group B, group C, and group D according to the dosage of dexmedetomidine. Group B, group C, and group D were pumped with 0.3 μg/kg, 0.5 μg/kg, and 0.8 μg/kg load doses of dexmedetomidine before anesthesia induction, with the same doses for maintenance during surgery. Group A was intravenously pumped with the same amount of normal saline and received tracheal intubation after anesthesia induction, with propofol and remifentanil to maintain general anesthesia during surgery. Results. No notable differences in general data were observed among the groups ( P > 0.05). Ramsay sedation scores of all groups showed a downward trend after drug withdrawal. At 10 min, 30 min, and 60 min, the scores of groups C and D were markedly higher than those of groups A and B ( P < 0.05), and the scores were higher in group D than those in group C ( P < 0.05). The HR changes at each period were close between groups A and B ( P > 0.05). The HRs at T1 and T2 in group C were slightly lower than those in group D ( P > 0.05), and the HRs at T1 in groups A and B were remarkably higher than those in groups C and D, and were higher than those at T0 and T2 ( P < 0.05). The SBP levels of all groups began to rise at T0, peaked at T1, and decreased to a lower level at T2 than that at T0. Moreover, the SBP levels of groups C and D at T1 and T2 were notably lower compared with groups A and B ( P < 0.05). With a lower DBP level in group C than the other three groups at T1, the DBP levels were notably lower in groups C and D than those in groups A and B at T2 ( P < 0.05). With no statistical difference in the MAP levels at T0 among the four groups ( P > 0.05), the MAP levels in group A at T1 and T2 were obviously higher compared with groups C and D ( P < 0.05). The extubation time in group A was notably longer than that that in groups B, C, and D ( P < 0.05), with longer extubation time in group B than that in groups C and D ( P < 0.05). The orientation recovery time in group D was markedly shorter than that in groups A, B, and C ( P < 0.05). The incidence of cognitive dysfunction, chills, and restlessness in groups C and D was notably lower compared with groups A and B ( P < 0.05), with a higher incidence of chills, intraoperative hypotension, and delayed awakening in group D than in group C ( P < 0.05). Conclusion. Dexmedetomidine at doses of 0.5 μg/kg and 0.8 μg/kg has a better effect in the maintenance of general anesthesia for patients with traumatic tibiofibular fractures, with faster orientation recovery, better recovery of postoperative cognitive function, and a lower incidence of adverse reactions. Dexmedetomidine at 0.5 μg/kg is recommended in view of the increased risk of excessive sedation, chills, restlessness, and intraoperative hypotension in patients at 0.8 μg/kg.

A comparative study of propofol based total intravenous anesthesia and sevoflurane based volatile induction and maintenance anesthesia on post-operative recovery profile in elective tonsillectomy

Background: Tonsillectomies are common surgeries in day-to-day surgery practice particularly in pediatric age group. Recent trend is to conduct tonsillectomy surgery on a day care basis. It is important to use the best anesthetic option with the least recovery time to reduce the hospital stay of patient. Aims and Objectives: The aim of the study was to compare recovery profile and side effects of Sevoflurane and Propofol as an anesthetic agent for tonsillectomy. Materials and Methods: A total of 60 patients undergoing elective tonsillectomy were selected for the study. Each patient was randomly allocated to either the propofol (Group P) or the sevoflurane group (Group S). Time of surgery (From start to end of surgery), time of anesthesia (From the start of induction to end of surgery), time between the end of anesthesia and the spontaneous eye opening, and time between the end of anesthesia and the following of verbal commands. Time to extubation, time between the end of anesthesia, and the orientation to his or her name and the incidence of post-operative nausea and vomiting were compared in both the groups. Results: The eye opening in Group P patients was found to be 8.9+1.21 min and that in Group S was 6.6+1.25 which was found to be statistically significant. The following of verbal commands in Group P was found to occur at 10.13+1.28 min, while that in Group S was found to be at 7.63+1.25 min, which was statistically significant. The time for extubation in Group P was found to be 11.17+1.29 min, while that in Group S was found to be 8.67+1.24 min, which was statistically significant. The duration for complete orientation in Group P was found to be 12.2+1.27 min, while that in Group S was found to be 9.43+1.04 min, which came out to be statistically significant. Hemodynamic parameters were found to be comparable in both the groups with no statistically significant difference in between then at any point of time (P>0.05). Conclusion: Sevoflurane is a useful alternative to propofol in providing anesthesia where rapid emergence and recovery of cognitive functions are desired.

A Study of The Effect of Aminophylline on Clinical Recovery and Bis Readings After Total Intravenous Anesthesia

Background: In anesthesia and intensive care we face a lot of respiratory problems that require the use of bronchodilators such as aminophylline which is accused of antagonizing of the action of adenosine which acts as neuromodulator in the CNS. Objective: To test the hypothesis that aminophylline increases BIS readings and decreases recovery time after total intravenous anesthesia. Methods: We tested the hypothesis on 50 patients who were to be operated upon for orthopedic procedures. We induced anesthesia using bollous dose of propofol 2.5 mg/kg and bollous remifentanil 1.5 mcg/kg and didn't use any muscle relaxant. Anesthesia was maintained using propofol and remifentanil infusion in the rate of 100 mcg/kg/min and 0.2 mcg/kg/min respectively with 100% O2 with BIS readings in the range of 40 – 60. After skin closure, patients were divided into group A (given aminophylline 4 mg/kg), and group P (given same volume of normal saline). Vital signs and BIS values were recorded. Time to eye opening and extubation time and time to reach BIS value of 95 were measured. Results: Significant difference was found in BIS readings (p value < 0.001). Time to eye opening and extubation times were significantly shorter in group A than group P (p value < 0.001). Conclusion: Aminophylline decreases recovery time and increases BIS readings after TIVA.

Effects of different doses of dexmedetomidine on postsurgical emergence agitation and oxidative stress in children

Purpose: To study the effects of various dexmedetomidine (DEX) doses on post-surgical emergence agitation (EA) and oxidative stress in children.Methods: At various times, mean arterial pressure (MAP) and heart rate (HR) were measured: prior to anesthesia (T0), during intubation (T1), at onset of operation (T2), and at the end of surgery (T3). The incidence of post-surgical EA was estimated, and the extent of agitation were determined based on pediatric anesthesia emergence delirium (PAED). Post-surgical pain was determined using facial pain scale (FPS). Serum levels of cortisol (Cor), epinephrine (E), and norepinephrine (NE) were quantified at T0 and T3. Extubation time and awakening time, as well as postoperative complications were recorded.Results: At T1, T2 and T3, levels of HR and MAP were significantly increased in all three groups, when compared to the corresponding values at T0, with group C having peak values, followed by A and B. Group B had a lower incidence of EA than groups A and C, but EA incidence was lower in group A than in group C. The lowest scores for PAED and FPS were in group B (p < 0.05). Blood levels of Cor, E and NE at T0 were comparable amongst the three groups. However, at T3, serum levels of these parameters were lower in group B than in each of the other 2 groups.Conclusion: At a dose of 0.5 μg/kg, DEX effectively reduces the incidence of post-surgical EA, improves hemodynamics, and alleviates oxidative stress responses in pediatric anesthesia.

Application of Dexmedetomidine combined with Propofol Intravenous Anesthesia in Laparoscopic Day Surgery in Pediatric Urology

Objectives: To evaluate the sedative and analgesic effects of dexmedetomidine combined with propofol intravenous anesthesia in laparoscopic day surgery in pediatric urology. Methods: Eighty male children with cryptorchidism and hydrocele who underwent laparoscopic daytime surgery in our hospital from January 2019 to January 2021 were selected and randomly divided into two groups: the experimental group and the control group. Children in the experimental group ranged in age from 5.7 to 11.3, with an average of 8.52±2.17 years old, while those in the control group ranged in age from 5.3 to 12.0, with an average of 8.60±2.07 years old. There were 12 cases of cryptorchidism and 28 cases of hydrocele in the experimental group, and 14 cases of cryptorchidism and 26 cases of hydrocele in the control group. Children in the control group received conventional propofol intravenous combined anesthesia, while those in the experimental group were given dexmedetomidine (2-5 ug/kg) intranasally on the basis of conventional propofol intravenous anesthesia. The anesthetic effect, analgesic effect, serum levels of inflammatory cytokines before and after surgery and adverse drug reactions in the two groups were compared and analyzed. Results: The awakening time, extubation time and retention time in the resuscitation room of the experimental group were shorter than those of the control group, with a statistically significant difference (P<0.05); The VAS pain scores of the experimental group were significantly lower than those of the control group at 15minutes, 12hour and 24hour after awakening, with a statistically significant difference (P<0.05). In addition, the levels of TNF-a, CRP, IL-6 and other inflammatory factors in the control group were significantly higher compared with those in the experimental group 24h after surgery, with a statistical significance (TNF-a, P=0.02; CRP, P=0.00; IL-6, P=0.03); The incidence of adverse drug reactions in the experimental group was 17.5%, while that in the control group was 12.5%, which was not statistically significant (P=0.53). Conclusion: Dexmedetomidine combined with intravenous propofol anesthesia may be helpful to shorten the extubation time, the recovery time and the stay time in the anesthesia resuscative room, improve the analgesic effect, and may reduce the inflammatory response and the expression of serum inflammatory cytokines, with no significant increase in side effects. doi: https://doi.org/10.12669/pjms.38.1.4378 How to cite this:Wang X, Yang B, Fan L, Guo N, Song H. Application of Dexmedetomidine combined with Propofol Intravenous Anesthesia in Laparoscopic Day Surgery in Pediatric Urology. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4378 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.