Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

Effects of epidural block anesthesia combined with general anesthesia on inflammatory factors, cognitive function and postoperative pain in patients with lung cancer after thoracoscopic surgery

OBJECTIVE

To investigate the effects of epidural block anesthesia combined with general anesthesia on inflammatory factors, cognitive function and postoperative pain in patients with lung cancer after thoracoscopic surgery.

METHODS

A total of 144 lung cancer patients admitted to the Department of Cardiothoracic Surgery of Ganzi Tibetan Autonomous Prefecture People's Hospital from October 2017 to October 2019 were included in this retrospective cohort study. The patients were divided into an observation group and a control group, with 72 cases in each group. Observation group was treated with epidural block anesthesia plus general anesthesia under thoracoscopic surgery, while control group was treated with general anesthesia alone. General information of both groups was compared. Tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were measured by enzyme-linked immunosorbent assay before anesthesia (T0), before the end of operation (T1), 12 h after operation (T2) and 24 h after operation (T3). Calcium-binding protein (S-100β) content, mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) at T0, T3, the 3rd day after operation (T4), and the 5th day after operation (T5) were measured. And postoperative pain was recorded.

RESULTS

There were no significant differences in TNF-α, IL-6, MMSE and MoCA between the two groups at T0, and no significant differences were seen in S-100β between the two groups at T0 and T1 (all P>0.05). Compared with control group, observation group had lower TNF-α and IL-6 at T1, T2, T3, T4 and T5, and lower S-100β at T3, T4 and T5 (all P<0.001). Lower pain scores and higher MMSE and MoCA were found in the observation group at T3, T4 and T5 (all P<0.05).

CONCLUSION

Epidural block anesthesia combined with general anesthesia can effectively reduce levels of inflammatory factors, cognitive disorder and postoperative pain in patients with lung cancer after thoracoscopic surgery.

The Effects of Hydroxyethyl Starch 6% and Crystalloid on Volume Preloading Changes following Spinal Anesthesia

BACKGROUND

Hypotension is one of the most common complications after spinal anesthesia for cesarean delivery. Normally, preloading with fluids, especially crystalloids, is used to prevention of hypotension.

METHODS

In the present randomized clinical trial study, 120 parturients presenting for elective cesarean section with the American Society of Anesthesiologists Class I and II received either 15 cc normal saline or 7 cc/kg hydroxyethyl starch 6% (Voluven) fluid. Information regarding to systolic, diastolic, mean arterial pressure, and heart rate, incidence of hypotension, adverse effects, the total dose of atropine, and ephedrine were recorded in before and 3, 6, 9, 15, and 20 min after spinal anesthesia. Furthermore, Apgar score of newborn at the 1st and 5th min after birth was recorded.

RESULTS

There was no significant difference in mean arterial pressure at different stages such as: Exactly after spinal and 3, 6, 15, and 20 min after spinal anesthesia between two groups (P > 0.05). Total dose of ephedrine and atropine were similar between groups (P > 0.05), respectively. There was no significant difference in Apgar score at the 1st and 5th min after birth between two groups. There were not any adverse effects of drugs in two groups.

CONCLUSIONS

The results of this study show that hydroxyethyl starch 6% compared to normal saline are similar to prevent hypotension during spinal anesthesia for cesarean delivery.