Abstract: Objective To investigate the feasibility of the diagnosis and treatment of pleurallung diseases by minithoracotomy and videoassisted thoracic surgery(VATS) under local anesthesia. Methods From February 2002 to March 2005,30 cases were performed by thoracotomy under local anesthesia,which were divided into two groups including minithoracotomy group and VATS group according to the different approaches; inithoracotomy group was used just for the biopsy of thicken pleura and diffuse pulmonary diseases on the state of open pneumothorax, and VATS group was for the diagnosis and treatment of malignant effusion and recurrent pneumothorax on the state of closed pneumothorax,all of them were ompleted under local anesthesia. Results Minithoracotomy group: biopsy of pleura were performed on 13 cases, 10 cases of which has been diagnosed with metastasis, one case was amyloidosis of pleura, two cases were proliferation of pleura.Three cases on diffuse pulmonary diseases were done for biopsy, 2 of which were pulmonary interstitial fibrosis, 1 of which was pulmonary tuberculosis (type Ⅱ). VATS group: Except one was converted to general anesthesia and minithoracotomy to resect the lesion due to heavy pleural adhesion, other patients who had thicken pleura and diffuse pulmonary diseases were performed operation for biopsy, bullarectomy was done on recurrent pneumothorax,and pleurodesis was done on ntractable pleuaral effusion under local anesthesia. 4 cases on pleural effusion were done by diagnostic thoracoscope under local anesthesia, 1 of which was liverrelated pleural effusion. 14 cases has been done by remedial thoracoscope, 8 cases of which malignant pleural effusion were done for pleurodesis, the other cases which have recurrent pneumothorax were given bullaectomy and pleurodesis. Spontaneous breathing and hemodynamics was maintained well during the operation. There was neither severe complication nor mortality in two groups. Conclusion Videoassisted thoracoscopic resection of peripheral pulmonary nodule and biopsy of pleura through minithoracotomy can be performed safely under local anesthesia. The novel approach will be the cost-effective procedure for management of pulmonary nodules in the present time.
Objective To investigate the applied significance of adjustable low-concentration of mixed oxygenand nitrous oxide inhalation sedation combined with lidocaine local anesthesia in anorectal surgery. Methods Three hundreds patients underwent anorectal surgery in our hospital were divided into control group （n=154） and observation group （n=146）. Patients of control group underwent pure lidocaine local anesthesia， and patients of observation group underwent mixed oxygen and nitrous oxide sedation analgesia combined with lidocaine local anesthesia. Vital signs before and after operation as well as results of sedation and analgesia were compared between the 2 groups. Results Anorectal surgeries of all patients were performed successfully. There were no significant differences on change of heart rate， blood pressure， and oxygen saturation between the 2 groups before and after operation （P＞0.05）. The operation time between the control group 〔（36.3±6.8） min〕 and observation group 〔（35.4±6.5） min〕 had no statistically significant difference（t=-0.607， P=0.544）. The analgesic effects （Z=-6.859， P=0.000） and sedative effects （Z=-5.275， P=0.000） of obser-vation group were both better than those of control group. Conclusions Low-concentration of mixed oxygen and nitrous oxide inhalation sedation combined with lidocaine local anesthesia can relieve the discomfort of fear and pain， no side-impacts on vital sign before and after operation were observed，and it has better effects of sedation and analgesia， therefore it can be recommended to clinical application.
ObjectiveTo evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. MethodsBetween June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. ResultsAll incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ2=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ2=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). ConclusionCompared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.
ObjectiveTo investigate the feasibility, safety and effectiveness of video-assisted thoracic surgery (VATS) sympathectomy under monitored anesthesia care (MAC) and local anesthesia (LA) without endotracheal intubation as a new fast track recovery surgical strategy for the treatment of palmar hyperhidrosis. MethodsA total of 124 patients with intermediate or severe hyperhidrosis who were admitted to Guangdong General Hospital were enrolled in this study. With SPSS18 random number generator, all the patients were divided into MAC+LA group and general anesthesia (GA) group with 62 patients in each group. There were 43 males and 19 females in MAC+LA group with their age of 22.25±6.22 years, and 42 males and 20 females in GA group with their age of 23.98±6.67 years. During the surgery, MAC+LA group patients received MAC and oxygen via nasal tube or face mask instead of endotracheal intubation, and GA group patients received GA, endotracheal intubation and controlled ventilation. Clinical outcomes were compared between the 2 groups. ResultsAll the patients received their operations safely. None of MAC+LA group patients received conversion to GA and controlled ventilation. There was statistical difference in operation time (47.18±12.06 minutes vs. 39.33±13.21 minutes, P=0.002) and length of theatre stay 84.52±22.56 minutes vs. 134.68±26.12 minutes, P=0.000) between MAC+LA and GA group patients. There was no statistical difference in blood loss, incidence of intraoperative SpO2 lower than 95% (2 patients vs. 0 patient), postoperative hospital stay, incidence of postoperative compensatory sweating (86.5% vs. 89.0%) and patient satisfaction rate (94.59% vs.95.12%) between the 2 groups. No intraoperative pain, postoperative complication or symptom recurrence was observed in either group. There was statistical difference in anesthetic preparation time (20.52±10.55 minutes vs. 36.47±12.16 minutes), duration between operation finish and returning to ward (11.26±7.09 minutes vs. 59.39±19.89) minutes and hospitalization cost (RMB 6 376.86±746.00 yuan vs. RMB 8 812.04±867.93 yuan) between the 2 groups. The incidence of postoperative sore throat (0% vs. 100%), monitor time (4 hours vs. 12 hours) and time to resume oral intake (2 hours vs. 6 hours) of MAC+LA group were significantly lower or shorter than those of GA group. ConclusionVATS sympathectomy under MAC and LA can avoid complications of GA and endotracheal intubation, and provide a safe, feasible, effective and more minimally invasive fast track alternative for the treatment of palmar hyperhidrosis.
ObjectiveTo evaluate the efficiency and clinical outcomes of endoscopic thoracic sympathectomy (ETS) with flexible thoracoscopy under local anesthesia with monitored anesthesia care in primary palmar hyperhidrosis. MethodsFrom March 2011 to March 2013, we performed ETS with flexible thoracoscopy under local anesthesia with monitored anesthesia in 23 patients with primary palmar hyperhidrosis (PH), including 10 males and 13 females with their age of 25.6±7.2 years (range, 17-32 years). T3 sympathectomy was performed with flexible endoscopy under local anesthesia with monitored anesthesia care. All patients were followed up until May 2014. ResultsDuring surgery, the vital signs of the patients remained stable. Operation time was 30-40 minites. The symptom of PH disappeared right in the surgery. All patients were discharged from the hospital on the 2nd postoperative day. One patient received unilateral sympathectomy because of pleural adhesion. Other 22 patients received follow-up to May 2014 and no reoccurrence was reported. ConclusionETS with flexible thoracoscopy under local anesthesia with monitored anesthesia is a safe, microinvasive and effective method.
ObjectiveTo compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement (TAVR).MethodsA total of 399 severe aortic stenosis patients were included, who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019. The baseline characteristics, procedural details, postprocedural outcomes, and ultrasound data of those patients were collected. All patients were followed up and the end date of follow-up was June 20th 2020. According to anesthetic mode, the patients were divided into local anesthesia group and general anesthesia group. The differences between the two groups in incidence of postprocedural complications, hemodynamics, postprocedural 30-day mortality, and postprocedural 1-year mortality were retrospectively analyzed.ResultsOf the 399 patients, 206 (51.6%) received local anesthesia and 193 (48.4%) received general anesthesia. There was no statistical difference between the two groups in baseline characteristics. The symptoms of both groups were relieved. But the incidences of mild bleeding events (12.4% vs. 1.5%, P<0.001), severe bleeding events (10.4% vs. 0.5%, P<0.001), major vascular complications (0.5% vs. 3.6%, P=0.032), and postprocedural 30-day all causes mortality (1.9% vs. 6.7%, P=0.018) were significantly lower in the local anesthesia group than those in the general anesthesia group.ConclusionIn TAVR, compared with general anesthesia, local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.
ObjectiveTo systematically evaluate the efficacy and safety of local anesthesia for venipuncture in children, and to provide evidence for related nursing practice.MethodsWeb of Science, PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, Wanfang Data, Chinese Biomedical Database and VIP databases were searched for randomized controlled trials (RCTs) about the application of local anesthesia in venipuncture in children till June 25th, 2021. Two reviewers independently reviewed the literature, extracted data, and assessed the risk of bias of included RCTs. RevMan 5.3 software was used for meta-analysis.ResultsA total of 19 RCTs were included, comprising 2 566 patients. All of them were high-quality English articles included in SCI or Medline. The results of meta-analysis showed that: the painless rate [odds ratio (OR)=3.80, 95% confidence interval (CI) (1.88, 7.66), P=0.000 2] and satisfaction rate of venipuncture [OR=2.12, 95%CI (1.27, 3.54), P=0.004] in the local anesthesia group were higher than those in the non-anesthesia group, and the pain score [mean difference=−0.62, 95%CI (−0.77, −0.48), P<0.000 01] in the local anesthesia group was lower than that in the non-anesthesia group. There was no statistically significant difference between the two groups in the success rate of the first puncture [OR=1.14, 95%CI (0.77, 1.68), P=0.52], the incidence of transient skin reactions [OR=1.15, 95%CI (0.67, 1.95), P=0.62], the incidence of paleness [OR=1.11, 95%CI (0.57, 2.15), P=0.76], or the incidence of edema at the puncture site [OR=0.64, 95%CI (0.21, 1.96), P=0.44].ConclusionsLocal anesthesia can effectively reduce pain and improve the satisfaction of children with venipuncture, and has good clinical safety. It can be used by nursing staff in clinical practice.
ObjectiveTo systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). MethodsElectronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. ResultsA total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P＜0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P＜0.001], ICU stay time [RR=−6.86, 95%CI (−12.31, −1.42), P=0.013], and total hospital stay time [RR=−2.02, 95%CI (−2.59, −1.45), P＜0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. ConclusionLA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.