We reviewed the research progress of anesthesia in hepatic echinococcosis surgery in recent years, including the key technologies, practical experience, and research progress of anesthesia in hepatic echinococcosis surgery, so as to guide clinical practice. Firstly, in the selection of anesthesia, general anesthesia combined with epidural block or regional nerve block was recommended to improve surgical safety and patient comfort. At the same time, the importance of intraoperative continuous monitoring, including key indicators such as hemodynamics and respiratory function, was emphasized, and transesophageal echocardiography and brain function monitoring techniques were introduced to optimize anesthesia management. Finally, the concept of enhancend recovery after surgery was promoted, and measures such as preoperative optimization, intraoperative heat preservation, refined fluid management, and postoperative analgesic management were implemented to promote the rapid recovery of patients. At the same time, some challenges and unsolved problems in the current research also were pointed out, such as complex case evaluation, complication prevention, and teamwork, etc., which need to be further studied in the future to optimize the anesthesia strategy.
ObjectivesTo systematically review the teaching efficacy of cardiac ultrasound simulation.MethodsCNKI, VIP, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on cardiac ultrasound simulation from inception to March 7th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 7 RCTs involving 300 trainees were included. The results of meta-analysis showed that: compared with traditional teaching method, trainees who received cardiac ultrasound simulation obtained higher cardiac ultrasonic structure image recognition score (SMD=1.38, 95%CI 0.81 to 1.94, P<0.000 01), higher ultrasonic image quality score (SMD=2.08, 95%CI 1.71 to 2.44, P<0.000 01), and shorter time required to obtain the correct ultrasound image (SMD=−1.19, 95%CI −1.55 to −0.83, P<0.000 01).ConclusionsThe current evidence shows that trainees who received cardiac ultrasound simulation have superior teaching effect immediately after the training compared with those who received traditional teaching method. However, further high-quality researches are needed to confirm whether there is a difference between the two training methods in long-term teaching effect.
Ion channels are involved in the mechanism of anesthetic action and side effect. The transcription and expression of ion channel genes can be modulated by general anesthetics. The adverse effect of continuous infusion of etomidate has been concerned. However, the effects of etomidate on mRNA expressions of ion channel genes remain unclear. In this study, we exposed Daphnia pulex in 250 μmol/L of etomidate for 240 min and observed the change of heart rate, phototactic behavior and blood glucose during the period of exposure, as well as the mRNA expressions of 120 ion channel genes at the end of the experiment. Compared to the controls, heart rate, phototactic behavior and blood glucose were not influenced by 250 μmol/L of etomidate. According to the quantitative PCR results, 18 of 120 Daphnia pulex ion channel genes transcripts were affected by persistent 240 min exposure to 250 μmol/L of etomidate: 2 genes were upregulated and 16 genes were down-regulated, suggesting that etomidate showed effects on many different ion channels in transcription level. Systematical exploration of transcriptional changes of ion channels could contribute to understanding of the pharmacological mechanism of etomidate.
Objective To explore the effect of preoperative hypothyroidism on postoperative cognition dysfunction (POCD) in elderly patients after on-pump cardiac surgery. Methods Patients who were no younger than 50 years and scheduled to have on-pump cardiac surgeries were selected in West China Hospital from March 2016 to December 2017. Based on hormone levels, patients were divided into two groups: a hypo group (hypothyroidism group, thyroid stimulating hormone (TSH) >4.2 mU/L or free triiodothyronine 3 (FT3) <3.60 pmol/L or FT4 <12.0 pmol/L) and an eu group (euthyroidism group, normal TSH, FT3 and FT4). The mini-mental state examination (MMSE) test and a battery of neuropsychological tests were used by a fixed researcher to assess cognitive function on 1 day before operation and 7 days after operation. Primer outcome was the incidence of POCD. Secondary outcomes were the incidence of cognitive degradation, scores or time cost in every aspect of cognitive function. Results No matter cognitive function was assessed by MMSE or a battery of neuropsychological tests, the incidence of POCD in the hypo group was higher than that of the eu group. The statistical significance existed when using MMSE (55.56% vs. 26.67%, P=0.014) but was absent when using a battery of neuropsychological tests (55.56% vs. 44.44%, P=0.361). The incidence of cognitive deterioration in the hypo group was higher than that in the eu group in verbal fluency test (48.15% vs. 20.00%, P=0.012). The cognitive deterioration incidence between the hypo group and the eu group was not statistically different in the other aspects of cognitive function. There was no statistical difference about scores or time cost between the hypo group and the eu group in all the aspects of cognitive function before surgery. After surgery, the scores between the hypo group and the eu group was statistically different in verbal fluency test (26.26±6.55 vs. 30.23±8.00, P=0.023) while was not statistically significant in other aspects of cognitive function. Conclusion The incidence of POCD is high in the elderly patients complicated with hypothyroidism after on-pump cardiac surgery and words reserve, fluency, and classification of cognitive function are significantly impacted by hypothyroidism over than other domains, which indicates hypothyroidism may have close relationship with POCD in this kind of patients.
ObjectiveTo explore modified methods and outcomes of collection of donor blood from donation after citizen death (DCD). MethodThe clinicopathologic data of 26 DCD donors underwent phase Ⅰ clinical trials and 6 patients who received donor blood by modified collection technique from May 2020 to November 2021 in the West China Hospital of Sichuan University were collected retrospectively. ResultsCompared with the data of 26 DCD donors at phase Ⅰ clinical trials, after the modified collection technique, the blood collection volume, the concentrated red blood cells following filtration, centrifugation, and the amount of concentrated red blood cell/kg body mass were more (P<0.05). In addition, compared with the components of stored red blood cell suspension, the pH value, sodium and chloride ions concentrations of the red blood cell suspension obtained after modified collection technique were higher (P<0.05), the potassium ion concentration was <1 mmol/L, and the lactic acid concentration of none of blood was >15 mmol/L. ConclusionThe adoption of the modified collection technique increases the amount of donor red blood collected, and its biochemical and electrolyte indicators are more in line with physiological requirements than those of stored blood.