Objective To study the effects of hemodilution on oxygenation during one-lung ventilation(OLV).Methods Forty patients undergoing lung surgery with or without chronic obstructive pulmonary disease（COPD）were enrolled.The study was performed in the supine position before surgery.The tracheas were intubated with a double-lumen tube.OLV was initiated for 15 min.After 15 min of OLV，arterial and venous blood gas samples were collected and analyzed.The cardiac output (CO) was measured.Two-lung ventilation was reinstituted，and hemodilution was performed (6% hydroxyethyl starch，10 mL/kg).Subsequently，OLV was performed again for 15 min.Then arterial and venous blood gas samples were collected and analyzed.The cardiac output (CO) was measured.Results Hemodilution resulted in a significant and similar decrease in HB concentration in patients both with or without COPD.However，hemodilution resulted in a significant decrease in PaO2 in COPD patients rather than subjects without COPD.Conclusion Mild hemodilution impairs gas exchange during OLV in COPD patients.
Objective To evaluate the effects of prophylactic ondansetron for preventing intrathecal opioid induced pruritus. Methods According to the Cochrane Handbook, such databases as The Cochrane Library, OVID, EMbase, PubMed, CNKI and CBM were searched to collect the randomized controlled trials (RCTs) about ondansetron for preventing intrathecal opioid induced pruritus. According to the predefined inclusion and exclusion criteria, the literatures were screened, and meta-analysis was conducted by using RevMan 5.0 software. Results Eight RCTs involving 577 patients were included. The quality evaluation showed the bias of all studies was unclear. Meta-analysis showed that because the heterogeneity of the included studies was so large (P=0.0001, I2=80%), subgroup analyses were performed. The subgroup analyses on surgery methods showed no statistical heterogeneity among all subgroups. a) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in arthroscopic knee or urologic surgery (RR=0.49, 95%CI 0.35 to 0.67); b) There was no significant difference in incidence rate of pruritus between the ondansetron group and the control group in obstetric surgery (RR=0.98, 95%CI 0.86 to 1.12); c) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in gynecologic surgery (RR=0.51, 95%CI 0.34 to 0.76); and d) There was no significant difference in the incidence rate of pruritus between the ondansetron group and the control group in outpatient surgery (RR=0.49, 95%CI 0.35 to 0.67). Conclusion The subgroup analyses performed because of the large heterogeneity of the included studies indicate that ondansetron can prevent the intrathecal opioid induced pruritus in arthroscopic knee, urologic and gynecological surgeries rather than obstetric and outpatient surgeries. Due to the small scale, large heterogeneity and unclear quality evaluation of the included studies, more high quality RCTs are required to provide reliable evidence.
Objective To assess the effectiveness and safety of local versus systemic application of opioids for labor analgesia. Methods We searched PubMed (1966 to January 2008), EMBASE (1980 to January 2008), The Cochrane Library (Issue 1, 2008), CBM (1978 to January 2008), CNKI (1979 to January 2008) for randomized controlled trials (RCTs) involving local versus systemic application of opioids for labor analgesia. Quality assessment and data extraction were conducted by two reviewers independently. Meta-analyses were conducted with The Cochrane Collaboration’s RevMan 4.2.10 software. Results A total of 12 trials involving 5909 participants met the inclusion criteria. Meta-analyses showed that local application of opioids was superior to systemic application in terms of maternal satisfaction with pain relief during labor (RR 1.63, 95% CI 1.27 to 2.09). No significant difference was found between the two groups in the incidence of low neonatal Apgar score at 5 minutes (RR 0.63, 95% CI 0.40 to 1.01). Conclusion Local application of opioids for labor analgesia appears to be more effective than systematic use in reducing pain during labor. But as for safety concerns, maternal and neonatal adverse effects are observed in both groups. Thus, more high-quality and large-scale RCTs are needed.
Objective To evaluate the evidence-based prevention and treatment of post-dural puncture headache (PDPH) for parturient women. Methods We searched The Cochrane Library (Issue 3, 2006), Medline (Jan. 1980 to Oct. 2006) and CBM-disc (Jan. 1980 to Oct. 2006) to identify current best evidence on the prevention and treatment of PDPH for parturient women. The quality of available evidence was critically appraised.Results We identified 2 Cochrane systematic reviews, 2 meta-analyses and 9 randomized controlled trials. Evidence indicated that posture, fluid, and pharmacological managements had no significant effect on PDPH except epidural blood patch. The selection of appropriate spinal needle and the technique of needle insertion may reduce the incidence of PDPH, whereas the effect of intrathecal saline infusion and catheter insertion need further clinical validation. Conclusions Epidural blood patch has definite therapeutic effect on PDPH. Appropriate spinal needle and insertion technique may effectively prevent PDPH for parturient women.
Objective To assess the effects on labour, maternal, and neonatal outcomes of different techniques and drugs for analgesia during labour. Methods We searched The Cochrane Library (Issue 4, 2006) , MEDLINE (Jan. 1978 to Oct. 2006) and CBMdisc (Jan. 1980 to Oct. 2006) to collect the current best evidence of labor analgesia. Results We included eight Cochrane systematic reviews and six other meta-analyses. The evidence showed that epidural analgesia was associated with a longer second stage of labour, more frequent oxytocin augmentation, higher incidence of instrumental vaginal delivery and maternal fever. But it was unlikely to increase the risk of caesarean section. Conclusion Epidural analgesia is superior to other approaches.
Objective To discuss the operative method and therapeutic effect of correcting nasal deformity after prothesis of unilateral complete harel ip with design of nasal subunits. Methods From January 2006 to December 2008, 18 patients with nasal deformity after prothesis of unilateral complete harel ip were treated. There were 7 males and 11 femalesaged 6-26 years old. The deformity located on the left side in 11 cases and the right side in 7 cases with major manifestations of deviation and crispation towards normal side of nasal columella, applanation and collapse of nasal ala, lenity and dyssymmetry of nostrils, malposition of basement of nasal ala. Time between harel ip prothesis and secondary epithesis was 4-21 years (average 8 years). During epithesis, nasal columella were extended, collapse nasal alar cartilages were l iberated and fixed in symmetrical positions, injured upper l ip was extended with nasolabial flap or to “tongue-l ike” flap on nasal base. Eleven cases were implanted L-type sil icone prothesis to hump nose. Results For 1 case suffered postoperative rejection, the implant of L-type sil icone prothesis was taken out promptly, and reimplant of prothesis was performed 6 months later without postoperative rejection. The incision of the other patients all healed by first intention without any postoperative compl ications. The effect of epithesis was good with such manifestations as the eminence of injured nasal ala, normal radian, and symmetrical nostils. All patients werefollowed up for 3 months-2 years (average 8 months). The incision was hidden with well-maintained appearance and no obvious scar. Conclusion Based on feature of nasal subunits and formation causes of deformity, individual-orientated epithesis design of nasal ala margin, nasal columella basement incisions, reset and fix nasal alar cartilages and tissues values can provide the patients suffering the secondary nasal deformity with satisfied appearance.