Objective To study the effect of the allogeneic bone sheet that has been treated by the freezedrying and radiation sterilization in preventing the epidural adhesion after laminectomy in sheep. Methods Laminectomy was performed on L3,4and L4,5 of 12 adult male sheep. Afteroperation, one site of L3,4 or L4,5was covered by the allogeneicbone sheet in “H” shape after the freeze-drying and radiation sterilization treatment; and the other site was used as a control. The sheep were killed and the specimens were retrieved at 4，8，12，16，20 and 24 weeks after operation to observe the scar formation process. X-ray andCT scan were performed in the segments of L3,4and L4,5at 4 and 24weeks. Results Four weeks after operation, the position and the shape of the allogeneic bone sheet were good in condition, and no lumbar spinal stenosis or compression of the dura was found in the experimental sections. Twentyfour weeks after operation theexamination on the experimental sections revealed that the vertebral canal reconstruction was completed, the allograft was absorbed almost completely, and inosculation with the lamina of the vertebra and the shape of the lumbar spine were good, with no fibroid tissues found in the epidural area. Compared with the control segment, the dura adhesion degree in the laminoplasty segment was significantly decreased (Plt;0.01), and the dura sac remained in a good shape. There was no obvious compression on the dura. Conclusion The allogeneic bone sheet after the treatment of freeze-drying and radiation sterilization can effectively reduce the scar formation after laminectomy and prevent postoperative recurrence of the spinal stenosis.
Objective To explore anesthetic quality of epidural anesthesia with general anesthesia applied for surgery of rectal cancer. Methods One hundred and seventy-eight patients who were diagnosed as rectal cancer and received operation in the Central Hospital of Bazhong City from June 2010 to June 2012 were included retrospectively. These patients were divided into two groups according to the type of anesthesia， and the patients who received general anesthesia only were defined as group A， the patients who received epidural anesthesia with general anesthesia were defined as group B. The anesthetic quality and anesthetic adverse reaction were observed in two groups. Results The differences of baseline characteristics in two groups were not significant （P＞0.05）. The difference of anesthetic quality in two groups was not significant （P＞0.05）. In terms of anesthetic adverse reaction， the incidence rate of hypertension， hypotension，tachycardia， or postoperative nausea and vomiting of the group B was significantly lower than those of the group A （P＜0.05）. The incidence rate of bradycardia， premature ventricular contractions， or time of gastrointestinal function recovery had no significant differences （P＞0.05）. There was no nerve dysfunction of lower limb in two groups. Conclusion Epidural anesthesia with general anesthesia applied for surgery of rectal cancer as compared with general anesthesia only not only has the same anesthetic quality， but also has obvious advantages in decreasing anesthetic adverse reaction.
Objective To compare the effects of epidural anesthesia with intubated anesthesia in the postoperative recovery of patients with thoracoscopic resection of lung bullae. Methods Sixty patients (53 males, 7 females, aged 16-65 years) undergoing thoracoscopic resection of unilateral pulmonary bullae in our hospital from December 2014 to December 2015 were randomly divided into two groups: a group A (epidural anesthesia group) received thoracic epidural block combined with intraoperative interthoracic vagus nerve block; a group B (general anesthesia group) received general anesthesia with double lumen endobronchial intubation and pulmonary sequestration. Postoperative anesthesia-related complications and postoperative recovery were recorded. Results Both of the two anesthesia methods could meet the requirements of operation. The patients with the vocal cord injury and sore throat in the group B were more than those in the group A. The difference was statistically significant in the incidence of sore throat (P<0.01) . Arterial partial pressure of oxygen (PaO2) in the group A was significantly higher than that of group B before lung recruitment (P<0.01). Compared with the group B, the group A had less visual analogue scale (VAS) score (P<0.05), earlier activity and feeding, less postoperative ICU and hospital stay (P<0.01). Conclusion Epidural anesthesia combined with intraoperative interthoracic vagus nerve block can meet thoracoscopic bullectomy surgery requirements with few complications and fast postoperative recovery.
Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.
ObjectiveTo compare the anesthetic potency and influence on maternal hemodynamics among spinal anesthesia (SA), epidural anesthesia (EA) and combined spinal epidural anesthesia (CSEA) for women undergoing cesarean sections. MethodsA total of 180 singleton term nulliparous pregnancies of American Sociaty of Anethesiologists physical status Ⅰor Ⅱ for cesarean sections in Guangyuan Central Hospital from January to December 2012 were allocated into three groups using the method of random number table. Patients in group SA received SA (n=60), group EA underwent EA (n=60) and patients in group CSEA accepted CSEA (n=60). Patients wderwent punere all placed in left lateral position. Group EA patients unctures at the L1-2 interspace and the volume of carbonated lidocaine used initially was 12-15 mL. Group SA and CSEA accepted the anesthesia at either L2-3 or L3-4 interspace. The volume for group SA was 0.75% bupivacaine 1.2 mL with 10% glucose solution 1 mL, and for group CSEA was 0.5% bupivacaine 1.4 mL with 10% glucose solution 0.8 mL. A catheter was inserted into the epidural space for 3-4 cm after spinal needle exit so as to add additional epidural medication according to the block level and the level of anesthesia subsidence. The values of the basis of blood pressure and heart rate, the lowest blood pressure and heart rate, umbilical venous blood gas, start effect and induction time of anesthesia and the highest block level of anesthesia were record. ResultsThere were statistically significant differences in terms of start effect time of anesthesia among the three groups (F=24.642, P<0.001). The start effect time of anesthesia in group SA and CSEA was significantly shorter than that in group EA (t=8.076, 7.996; P<0.05). The induction time of anesthesia in group SA was significantly shorter than those in group EA and CSEA (P<0.05). The lowest blood pressure and heart rate in group SA and CSEA were significantly lower than the values of basis (P<0.05). The lowest blood pressure and heart rate in group SA was significantly lower than that in group EA (P<0.05). The incidence of hypotension and bradycardia in group SA and CSEA was significantly higher than that in group EA (P<0.05). The block level of anesthesia in the three groups were at thoracic 8.12±1.22, 8.36±1.88 and 8.52±1.92 respectively, and there was no significant difference among the three groups (F=0.081, P=0.923). ConclusionEA and CSEA surpass SA in the choice of neuraxial anesthesia for cesarean sections, and 1.73% carbonated lidocaine for EA can improve anesthetic potency and better maintain relatively stable hemodynamic indexes.
Objective To explore the effect of epidural analgesia for labor on maternal temperature and the newborns. Methods This randomized trial was performed in West China Second Hospital between December 2015 and July 2016. Fifty puerperants were randomly divided into epidural analgesia (EA) group (natural labor under EA, n=25) or the control group (natural labor using Ramaze breathing method, n=25). Maternal tympanic temperature was recorded once per hour after treating with painless labor or blank control. The serum interleukin-1 beta (IL-1β) and heat shock protein 70 (HSP70) level were measured from the blood of the umbilical cord after the delivery. Apgar scores of the newborns were also recorded. Results There was a significant difference in the temperature between EA and control group one hour after the treatment of painless labor [ (36.9±0.7) and (36.4±0.5)℃]. The level of serum IL-1β and HSP70 were significantly higher in EA group [IL-1β: (0.308±0.036) ng/mL; HSP70: 1.175±0.196] than those in the control group [IL-1β: (0.244±0.031) ng/mL; HSP70: 0.935±0.308] (P<0.05). However, no significant difference was found in the neonatal Apgar score (P>0.05). Conclusions The increase of maternal temperature is greater in the EA labor puerperants compared with that in the controls, which may be related to the increase of IL-1β and HSP70. No adverse effect of labor analgesia on new borns is found
Objective To observe the effects of epidural anaesthesia (EA) and general anaesthesia (GA) on the changes of plasma epinephrine (E) and norepinephrine (NE) during laparoscopic cholecystectomy (LC). Methods Thirty patients undergoing elective LC were randomly divided into GA group (n＝15) and EA group (n＝15). The concentrations of plasma NE and E were measured at the following phases: before anaesthesia, before introducing pneumoperitoneum, during pneumoperitoneum, and at the end of operation. Results In EA group, the concentrations of NE weren′t significantly different at each phase, the concentrations of E significantly increased before and during pneumoperitoneum (Ｐ＜0.05) and returned to the baseline at the end of operation (Ｐ＞0.05). In GA group, the concentrations of NE and E didn′t change significantly before pneumoperitoneum, but increased during pneumoperitoneum (Ｐ＜0.05) and E didn′t return to the baseline at the end of operation (Ｐ＜0.05). The E concentrations of EA group was higher than that of GA group before pneumoperitoneum, but the NE concentration of EA group was lower than that of GA group during pneumoperitoneum (Ｐ＜0.05). Conclusion Both groups has significant stress reaction, but the stress reaction of EA group is weaker than that of GA group during LC.
ObjectiveTo systematically review the protection effect of epidural anesthesia combined with general anesthesia versus general anesthesia alone in patients underwent cardiac surgery, so as to provide evidence for reducing complications of cardiac surgery. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2015), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about epidural anesthesia combined with general anesthesia versus general anesthesia alone for patients underwent cardiac surgery from inception to February 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. ResultsA total of 35 RCTs involving 3 311 patients were included. The results of meta-analysis showed that, compared with the general anesthesia group, the combination anesthesia group had lower incidence of supraventricular tachycardias (RR=0.63, 95%CI 0.48 to 0.83, P=0.001) and shorter ICU stay time (SMD=-0.57, 95%CI -1.02 to-0.12, P=0.01), but there were no significant differences in the incidences of respiratory complications, myocardial infarction, stroke and mortality between the two groups (all P values >0.05). ConclusionCurrent evidence shows that the combination of epidural anesthesia and general anesthesia has better protection effect than general anesthesia alone in cardiac surgery, but the influence on long-term prognosis still needs to be assessed. Due to the limited quality of included studies, the above conclusion still needs to be verified by more high quality studies．
Objective To investigate the clinical effect of polylactic acid membrane in prevention of epidural scar and adhesion. Methods From July 1998 to April 2000, 62 patients with lumbar disc herniation were randomly assigned into two groups. All were treated surgically with discectomy by fenestration or laminectomy.One group were placed with a thin of polylactic acid membrane covering the interlaminar space(n=32). The thickness of the film was 0.1mm. The other group was blank control(n=30). After 2 weeks of operation, we observed the local and systemic reactions. After 6 months clinical symptoms were revaluated and the degrees of epidural scar and adhesion were determined by CT scans. Results After 2 weeks, we found no adverse systemic reactions in all patients. Wound healing was excellent. No abnormalities of hepatic and renal functions as well as blood for routine were found. Temperature after operation was normal. After 6 months, the curative effects were as follows in experimental group and in control group: excellent in 27 patients and in 24 patients, good in 4 patients and in 4 patients, fair in 1 patient and in 1 patient, and poor in 0 patient and in 1 patient, respectively. There are no significant difference between two groups. The CT scans showed no adhesion between the epidural scar and the dural sac in all patients of experimental group. There existed various extents of adhesion in control group. Conclusion The results demonstrate that the polylactic acidmembrane can effectively prevent the epidural scar adhesion with a good biocompatibility and no toxity. Its clinical application was promising.