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Shen Y, Wang C, Zhong X, Wu Y, He X. Observation of Anesthetic Effect of Dexmedetomidine Combined With Intraspinal Anesthesia in Hip Arthroplasty and its Effect on Postoperative Delirium and Stress Response. Front Surg 2022; 9:928922. [PMID: 35846975 PMCID: PMC9286240 DOI: 10.3389/fsurg.2022.928922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To observe the anesthetic effect of dexmedetomidine combined with spinal anesthesia in hip arthroplasty, and to analyze the effects of dexmedetomidine on postoperative stress response, incidence of delirium, immune function and inflammatory indicators. Methods A total of 42 patients who underwent hip replacement in our hospital from March 2020 to June 2021 were selected as the research subjects and randomly divided into the control group and the observation group, 21 cases in each group. The control group was given intraspinal anesthesia, and the observation group was given dexmedetomidine on this basis. The onset time and maintenance time of sensory and motor nerve block were recorded. Stress response indexes [cortisol (Cor), blood glucose (Glu), adrenaline (E), noadrenaline (NE)], T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+), inflammatory indexes [tumor necrosis factor -α (TNF-α) and interleukin-6 (IL-6)] were detected before and after operation, and the incidence of postoperative delirium in both groups was recorded. Results The onset time of sensory nerve block and motor block in the observation group were lower than those in the control group, and the retention time of sensory nerve block and motor nerve block were higher than those in the control group (P < 0.05). After surgery, the levels of Cor, Glu, E and NE in the observation group were lower than those in the control group (P < 0.05). After surgery, the incidence of postoperative delirium in the observation group (4.79%) was lower than that in the control group (28.57%) (P < 0.05). After surgery, the levels of CD3+, CD4+, CD8+, and CD4+/CD8+ in the observation group were higher than those in the control group (P < 0.05). After surgery, the levels of TNF-α and IL-6 in the observation group were lower than those in the control group (P < 0.05). Conclusion The combined use of dexmedetomidine and intraspinal anesthesia has good anesthesia effect in hip joint replacement, which can greatly reduce the stress response of patients, reduce the incidence of postoperative delirium, and effectively restore the immune function of patients, reduce the level of inflammatory response, and has high clinical application value.
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Affiliation(s)
- Yading Shen
- Department of Anesthesiology, Yiwu Central Hospital, Yiwu, China
| | - Chenyu Wang
- Department of Anesthesiology, Yiwu Central Hospital, Yiwu, China
| | - Xiaoping Zhong
- Department of Anesthesiology, Yiwu Central Hospital, Yiwu, China
| | - Yandan Wu
- Department of Anesthesiology, Yiwu Central Hospital, Yiwu, China
| | - Xiaoxia He
- Department of Anesthesiology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China
- Correspondence: Xiaoxia He
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Spiral Computed Tomography Imaging Analysis of Positioning of Lumbar Spinal Nerve Anesthesia under the Concept of Enhanced Recovery after Surgery. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:1703250. [PMID: 35711532 PMCID: PMC9187486 DOI: 10.1155/2022/1703250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022]
Abstract
The objective of this research was to explore the effect of perioperative anesthesia management for patients based on the concept of enhanced recovery after surgery (ERAS) and the application value of the computed tomography (CT) localization method in lumbar spinal nerve anesthesia, reducing the damage caused by anesthesia. One hundred and twenty patients who underwent the lumbar spinal anesthesia in lower limb surgery were selected as the research subjects. According to puncture positioning and nursing intention, the patients were classified into the control group with 30 patients (method of anatomical landmarks), CT group with 50 patients (the CT localization), and ERAS group with 40 patients (the CT localization and the ERAS management). The effects of the anesthesia positioning method and the ERAS management were compared and analyzed. The results showed that d (0.32) and r (0.27) of exponential filtering function were notably smaller than those of R-L filtering function (d = 0.40, r = 0.39) and of S-R filtering function (d = 0.37, r = 0.36) (P < 0.05). Puncture time ((9.23 ± 0.32) min vs. (13.11 ± 0.45) min), puncture direction change (20% vs. 33.33%), abnormal puncture sensation (22% vs. 40%), and nerve root touch (4% vs. 23.33%) in the CT group were all lower than those in the control group. The proportion of Degree I anesthesia effect (94%) of the CT group was greatly higher than that of the control group (76.67%) (P < 0.05). The VAS score, time of activity and gastrointestinal function recovery, and the incidence of adverse reactions (2.5% vs. 28%) in the ERAS group were lower than those in the CT group (P < 0.05). All in all, the CT localization method can improve the difficulty of anesthesia puncture and improve the anesthetic effect; the ERAS nursing concept can improve the postoperative pain of patients and contribute to the prognosis of patients and have a good clinical value.
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Zheng T, Zheng CY, Yan LP, Guo HL, You Y, Ye P, Hu B, Zheng XC. Comparing the minimum local anesthetic dose of ropivacaine in real-time ultrasound-guided spinal anesthesia and traditional landmark-guided spinal anesthesia: a randomized controlled trial of knee surgery patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1492. [PMID: 34805354 PMCID: PMC8573435 DOI: 10.21037/atm-21-3888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Abstract
Background Through previous studies and clinical practice, we have found that real-time ultrasound-guided (UG) spinal anesthesia (SA) and traditional landmark-guided (LG) SA each require a different minimum local anesthetic dose (MLAD) of ropivacaine. For this study, we used Dixon’s up-and-down sequential method to analyze and compare the MLAD of different ropivacaine concentrations required for the UG and LG SA methods. Methods A total of 120 patients undergoing knee surgery were consecutively recruited and randomly divided into four groups (30 patients per group). These groups were categorized as follows: Group I: high ropivacaine ultrasound-guided (HRUG), Group II: low ropivacaine ultrasound-guided (LRUG), Group III: high ropivacaine landmark-guided (HRLG), and Group IV: low ropivacaine landmark-guided (LRLG). SA was established by a bolus administration of up-and-down doses of 0.75% or 0.5% plain ropivacaine. Initial doses of 16, 18, 12, and 14 mg were administered to groups I–IV, and after that, increased or decreased by 1.5 mg according to dose effectiveness. Upon identifying the intervertebral puncture level, a lumbar X-ray was performed with metal markers, and actual radiographic findings were identified and compared to the initial markings. Results For UG groups, the MLAD in the LRUG group was significantly higher than in the HRUG group [20.192 mg (95% CI, 19.256–21.174) versus 17.176 mg (95% CI, 16.276–18.124), respectively; P<0.001]. For LG groups, the MLAD in the LRLG group was significantly higher than in the HLRG group [14.478 mg (95% CI, 13.364–15.500) versus 13.201 mg (95% CI, 11.959–14.571), respectively; P=0.047]. When comparing both high ropivacaine groups (HRGs: I/III) to the low ropivacaine groups (LRGs: II/IV), we found that both UG subgroups (I/II) had a significantly higher MLAD than LG subgroups (III/IV) (P<0.001). US identified L4–5 in up to 90% of cases. Comparatively, palpation was successful in only 33.3% of patients. The rates of cephalad localization by US and palpation were 6.67% vs. 66.67%, respectively (P=0.002). Conclusions We found a higher MLAD of ropivacaine was required for UG SA at the L4–5 level due to the method providing a more accurate (less cephalad) localization than traditional LG SA. Trial Registration Chinese Clinical Trial Registry ChiCTR2000033158.
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Affiliation(s)
- Ting Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Chun-Ying Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Lai-Peng Yan
- Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Orthopedics, Fujian Provincial Hospital, Fuzhou, China
| | - Hui-Ling Guo
- Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Orthopedics, Fujian Provincial Hospital, Fuzhou, China
| | - Yi You
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Peng Ye
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Bin Hu
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiao-Chun Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fuzhou, China.,Emergency Department, Fujian Emergency Medical Center, Fujian Provincial Hospital, Fuzhou, China
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