目的：采用Rastelli术治疗合并室间隔缺损、肺动脉狭窄、完全性大动脉转位病人，探讨围手术期麻醉管理特点。方法：选用大剂量芬太尼静脉复合麻醉方案，在深低温、低流量体外循环下实施Rastelli手术并进行多指标监测和临床观察。结果：麻醉经过平稳，围手术期患者生命体征稳定。结论：选择恰当的麻醉方案，有效的心脏保护,保持酸碱平衡和水、电解质稳定是成功进行麻醉管理的必要条件。
ObjectiveTo discuss the intraoperative anesthesia management for complete thoracoscopic surgical atrial fibrillation (AF) ablation via the left chest. MethodsWe retrospectively analyzed the clinical data of 201 patients (106 males and 95 females aged 58.7±15.4 years) with AF underwent complete thoracoscopic surgical ablation via the left chest in Department of Cardiothoracic surgery, Xinhua Hospital From September 2010 through December 2013. ResultsAll the patients successfully underwent the minimally invasive ablation procedure. No patient required conversion to sternotomy during the surgery. The average time of operation was 104.9±37.2 min. During the ablation procedure, the patients' blood pressure and arterial oxygen saturation (SpO2) reduced at different levels. The average minimum arterial blood pressure was 44-79 (62.4±8.4) mm Hg. The average minimum SpO2 was 83%-95% (88.8%±3.1%). After the ablation, the patients' respiratory function and hemodynamic gradually recovered. The average heart rate was 40-108 (70.0±16.6) bpm when sinus rhythm was restored. The maintenance of sinus rhythm rate was 94.5% (190/201) at discharge. There was no early death, stroke, hemorrhage or permanent pacemaker implantation during perioperation. ConclusionComplete thoracoscopic surgical AF ablation via the left chest has some influence on patients' respiratory function and hemodynamic. Reasonable anesthetic management can ensure the minimally invasive ablation procedure safe and effective.
Objective To explore the safety and feasibility of general anesthesia with tracheal intubation in transcatheter aortic valve implantation (TAVI), and the key points in anesthetic management. Methods Twenty-five patients with aortic stenosis treated by TAVI in West China Hospital of Sichuan University between September 2012 and June 2013 were included in this study. General anesthesia with tracheal intubation was chosen. We recorded and analyzed the hemodynamics, blood gas, oxygen saturation data before and after anesthesia induction, before surgery, during rapid ventricular pacing, before and after aortic valve implantation. Besides, the incidence of perioperative complications and 30-day mortality were also recorded. Results All the 25 patients underwent the implantation surgery successfully. Two patients had the second implantation surgery due to moderate reflux. All the subjects in this study tolerated general anesthesia well without any anesthesia-related complications. There were 19 cases of newly developed or aggravated heart blocks, 7 of permanent pace maker, 2 of perioperative hemorrhage, 2 of cerebral vascular events, and 1 death case. Conclusioins General anesthesia with tracheal intubation can be utilized safely in patients undergoing TAVI. TAVI is a challenging technique in need of precise collaborations of multi-disciplines, in which anesthetists should play more as a leader in evaluation and decision-making during the surgery.
Objective To introduce the surgical and perioperative strategy for giant mediastinal mass. Methods The clinical data of 21 patients with giant mediastinal mass who underwent surgical treatment in Xinhua Hospital of Shanghai from January 2007 to July 2016 were retrospectively reviewed. There were 14 males and 7 females, with a mean age of 34.62 ± 22.95 years (range: 11 months to 79 years), and mean weight of 58.07±22.24 kg (range: 10.8 to 90.5 kg). Their clinical manifestation, anesthesia methods, surgical treatment and the prognosis were analyzed. Results The tumor volume ranged from 8 cm×6 cm×6 cm to 25 cm×25 cm×8 cm. For surgical approach, 12 patients received median sternotomy, 5 anterior lateral incision, 1 posterior lateral incision, 2 "L"-shape sternotomy, 1 cervical and thoracic "]"-shape incision. All patients were given mass radical resection, except one patient with two-stage resection. Twelve patients needed other tissues resection besides the single tomor resection. The operation time was 55-480 (207.86±87.67) min, blood loss volume 700 (10-4 000) ml, intraoperative blood transfusion 800 (0-4 100) ml, postoperative mechanical ventilation time 4.75 (0-87) h, postoperative drainage time 3-12 (7.43±2.66) d, the total drainage volume 295-4 940 (1 584.76±1 173.98) ml, average daily drainage volume 62-494 (204.90±105.76) ml, and postoperative hospital stay 7-47 (11.86±8.51) d. The postoperative complications included pericardial effusion in 1 patient, Horner syndrome in 1, left recurrent laryngeal nerve injury with the left phrenic nerve injury in 1, right phrenic nerve injury in 1 and delayed wound healing in 1. The remaining patients recovered well. All patients were followed up for 1 month to 9 years. Till September 1, 2016, 5 patients died and 2 suffered recurrent tumor. Conclusion It is safe to perform surgical treatment after comprehensive evaluation of patients with giant mediastinal mass, perioperative mortality is low, and prognosis in patients with benign tumor is good.
Objective To discuss the key points of anesthesia for patients undergoing transcatheter aortic valve implantation (TAVI) surgery. Methods We retrospectively collected and analyzed the data of 70 patients who underwent TAVI in the Department of Cardiovascular Surgery, West China Hospital from March 2014 to October 2015. There were 39 males and 31 females with an average age of 73.7±4.5 years. The perioperative preparation and anesthesia points of TAVI were summarized. Results All of the 70 included patients were aged and at high risk severe comorbidities such as ischemic heart disease and stroke. The aortic stenosis and regurgitation occurred in 39 and 31 patients respectively. No patients died during the surgery. The total success rate was 95.7%. Conclusion TAVI is a complex procedure for high risk patients and need more attention during anesthesia. The successful conduction of the procedure requires the whole team to prepare carefully and cooperate closely.
Lung transplantation is the only treatment for patients with end-stage lung diseases. And this field is also a research hotspot in the international field at presen. Relevant researches not only promote the progress and development of lung transplantation, but also improve the life quality of patients after transplantation. With the development of lung transplantation technology, the guidelines for identifying candidates are constantly being revised, and the source of donor lungs has always been an urgent problem for all transplantation centers. The standardized management during transplantation period involves anesthesia induction, intraoperative fluid management, airway management, management of important operative steps and postoperative pain management. Extracorporeal life support (ECLS) includes cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO). With the progress and development of ECLS technology, the advantages of ECMO as a bridge for lung transplantation, intraoperative and postoperative circulatory support are becoming more and more prominent, enabling recipient patients to successfully pass the period of lung transplantation. Although lung transplantation in basic science and clinical researches has got a lot of progress, to improve the survival rate after transplantation, we must overcome many challenges including how to successfully perform lung transplantation, expand lung donor library, induce tolerance, and prevent complications after transplantation, primary graft dysfunction (PGD), cell and antibody mediated rejection and infection.
ObjectiveTo investigate the anesthesia management of transcatheter ultrasound-guided percutaneous interventional therapy for pediatric patients with congenital heart disease at a mobile surgical platform. Methods From March to July 2023, 13 patients in remote areas underwent interventional surgery on the mobile truck operating platform. The patients undergoing general anesthesia using non-tracheal intubation were collected. ResultsFinally, 8 patients received monitored anesthesia care (MAC) with local anesthesia-assisted sedation and analgesia drugs under the supervision of anesthesiologists (general anesthesia using non-tracheal intubation), due to the patients having difficulty cooperating with the surgery (young age, nervous mood, and crying), including 5 males and 3 females with an average age of 6.95±3.29 years and an average weight of 19.50±6.04 kg. There were 6 patients diagnosed with atrial septal defect, 1 patient with residual shunt after patent ductus arteriosus ligation, and 1 patient with severe pulmonary stenosis by transthoracic ultrasonography. The surgical process was smooth, analgesia was perfect, anesthesia and surgical effect were satisfactory, postoperative recovery was satisfactory, and there were no surgical or anesthesia complications. The anesthesia time was 41.53±8.62 min, the operation time was 39.88±8.52 min, and the recovery time was 41.50±14.56 min. Conclusion Transthoracic ultrasound-guided interventional surgery is a minimally invasive approach for congenital heart disease, offering the advantages of zero radiation exposure. Non-tracheal general anesthesia preserved spontaneous breathing can be safely and effectively administered to pediatric patients who cannot cooperate in mobile operating platform.
We reviewed the research progress of anesthesia management in hepatic echinococcosis surgery in recent years, including the key technologies, practical experience, and research progress of anesthesia management in hepatic echinococcosis surgery, so as to guide clinical practice. Firstly, in the selection of anesthesia, the general anesthesia combined with epidural block or regional nerve block is recommended to improve surgical safety and patients’ comfort. At the same time, the importance of intraoperative continuous monitoring, including key indicators such as hemodynamics and respiratory function, is emphasized, and transesophageal echocardiography and brain function monitoring techniques are introduced to optimize anesthesia management. Finally, the concept of enhanced recovery after surgery is promoted, and measures such as preoperative optimization, intraoperative heat preservation, refined fluid management, and postoperative analgesic management are implemented to promote the rapid recovery of patients. At the same time, some challenges and unsolved problems in the current research also are pointed out, such as complex case evaluation, complications prevention, and teamwork, etc., which need to be further studied in the future to optimize the anesthesia strategy.