ObjectiveGiven high risks of major bleeding during retroperitoneal sarcoma(RPS) surgeries, severe complications and deaths are common to see perioperatively. Thus, effective anesthetic management is the key point to ensuring the safety of patients. This study aimed to introduce anesthesia management and mortalities in RPS patients receiving massive blood transfusions during surgeries.MethodsRecords of RPS surgeries under general anesthesia from January 2016 through December 2021 were retrospectively retrieved from our database. Patients who received massive blood transfusions (MBT) exceeding 20 units in 24h duration of operations were finally included in this study. Demographics, modalities of anesthesia management, blood loss, transfusion, peri-anesthesia biochemical tests as well as morbidities and mortalities were collected. Risk factors of postoperative 60d mortality were determined through logistic regression in uni-and multi-variety analysis using the statistics software STATA 17.0.ResultsA total of 70 patients (male 31) were included. The mean age was 50.1 ± 15.8 years. All patients received combined resections of sarcoma with involved organs under general anesthesia. Mean operation time and anesthesia time were 491.7 ± 131.1mins and 553.9 ± 132.6mins, respectively. The median intraoperative blood loss was 7000ml (IQR 5500,10000ml). Median red blood cells (RBC) and fresh frozen plasma (FFP) transfusion were 25.3u (IQR 20,28u), and 2400ml (IQR 2000,3000ml), respectively. Other blood products infusions included prothrombin complex concentrate (PCCs), fibrinogen concentrate (FC), platelet(plt) and albumin(alb) in 82.9% (58/70), 88.6% (62/70), 81.4% (57/70) and 12.9% (9/70) of patients. The postoperative severe complication rate(Clavien-Dindo grade≥3a) was 35.7%(25/70). A total of 7 patients (10%) died during the postoperative 60-day period. BMI, volumes of crystalloid infusion in anesthesia, and hemoglobin and lactate levels at the termination of operation were found significantly associated with postoperative occurrence of death in univariate analysis. In logistic multivariate analysis, extended anesthesia duration was found associated with postoperative venous thrombosis embolism (VTE) and severe complication. The lactate level at the immediate termination of the operation was the only risk factor related to perioperative death (p<0.05).ConclusionRPS patients who endure MBT in surgeries face higher risks of death postoperatively, which needs precise and effective anesthesia management in high-volume RPS centers. Increased blood lactate levels might be predictors of postoperative deaths which should be noted.

Objective:To investigate the perioperative alterations and management of coagulation function in patients of massive blood transfusion during retroperitoneal tumor (RT)resection.Methods:Fourty-seven RT patients at Peking University International Hospital from Jan 2016 to Dec 2021 undergoing resection with massive blood transfusion more than 20 U within 24 h were reviewed for coagulation function before and after surgery.Results:Intraoperative bleeding was 3 000-25 800 ml, 10 patients had blood loss ≥10 000 ml. During the operation, (25.3±9.9) U of red blood cells were transfused, (2 720±1 369) ml plasma transfused, and (2.4±3.3) U platelets were transfused in 6 patients. Fourty-five patients received intraoperative albumin of (79.5±46.5) g; All 47 patients received fibrinogen of (2.3±1.3) g; Prothrombin complex was given in 45 patients (1 205±807) U. Preoperative hemoglobin was statistically different compared to postoperatively and days 1, 3 and 5 ( W=1 790, P<0.001; W=1 672, P<0.001; W=1 704, P<0.001; W=1 486, P=0.004);As with platelets, the difference was also statistically significant compared to postoperative days 1, 3, and 5 ( W=2 153, P<0.001; W=2 092, P<0.001; W=1 732, P<0.001); Preoperative albumin was different compared to postoperative days 1 and 3 ( W=1 568, P<0.001; W=1 578, P<0.001,); Preoperative fibrinogen was different compared to postoperative day 1 ( W=1 964, P<0.001). PT and APTT were prolonged on postoperative days 1 and 3 ( W=628, P<0.001, W=804, P=0.023) ( W=661, P<0.001, W=796, P=0.02). Patient's preoperative fibrin degradation products and D-dimer were above the normal value and were higher on postoperative days 3 and 5 ( W=498, P<0.001, W=345, P<0.001). Conclusions:Coagulation disorders occur perioperatively in patients with massive transfusion while undergoing surgery for RT.The implementation of ratiional transfusion strategy and close postoperative survey and management of coagulation dysfunction help avoid the coagulation related morbidities.

One patient with trigeminal neuralgia combined with sphenopalatine neuralgia treated by radioffequency thermocoagulation therapy under the guidance of CT was reported.The literature reviewed this seldom case.It showed that the pain of trigeminal and sphenopalatine neuralgia can be relieved together by radiofrequency thermocoagulation in the trigeminal ganglion.

内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)常导致各种不良刺激,使患者不能耐受而中断操作,甚至拒绝再次诊疗,在老年患者还可导致呼吸循环系统的意外,因此有必要寻求一种安全可靠的麻醉方式满足临床需要.清醒镇静是采用某些麻醉药物来缓解焦虑、恐惧情绪和不适感,消除患者的部分或全部术中记忆,减轻疼痛和其他伤害性感受,该方法能增加操作成功率,改善患者围术期的舒适程度和提高安全性[1-2].瑞芬太尼是一种新型阿片类镇痛药,镇痛作用强、作用时间短、副作用小和可控性好,适合内镜操作的麻醉.

目的 研究单独持续输注瑞芬太尼用于高龄患者内镜逆行胰管造影术(endoscopic retrograde cholangio pancreatic,ERCP)患者清醒镇静的临床效果和安全性.方法 选择89例ASAⅠ～Ⅲ级、年龄70～89岁拟在清醒镇静下实施ERCP的患者,首先以0.2 μg/(kg·min)速率持续输注瑞芬太尼5 min,手术开始后减为0.15 μg/(kg·min),未复合其他麻醉药物.观察患者麻醉前(T0)、手术开始即刻(T1)、手术开始后5 min(T2)、和10 min(T3)以及术毕(T4)时血压、心率、呼吸频率、血氧饱和度(SpO2)、脑电双频指数(BIS)以及术后改良Aldrete镇静评分、操作者满意度评分和不良反应发生情况,并记录手术操作时间和麻醉时间.结果 与麻醉诱导前基础值相比较,患者在T2时的血压明显升高,心率在T1、T2、T3、T4时升高显著,SpO2值T4时降低明显,BIS值在T1、T2、T3和T4时均明显降低.所有患者均顺利完成操作,操作过程中5例患者血氧饱和度降至90%以下,无1例需要面罩辅助通气或气管插管发生.插入十二指肠镜时发生恶心5例,取石操作中引起轻微疼痛但能忍受的6例,疼痛评分小于3分.8例对镜干入口和取石操作无记忆,19例对镜干入口有记忆,62例对镜干入口和取石操作都存在记忆.术毕取出镜干时9例处于睡眠状态,其他患者均清醒;术后恶心、呕吐的25例,操作者满意度评分为97.1±2.8.结论 单独持续输注瑞芬太尼用于高龄ERCP患者清醒镇静可获得满意的麻醉效果,且安全性好.

目的 观察帕瑞昔布分次静脉注射用于混合痔切除术后的镇痛效果和不良反应.方法 择期混合痔切除术患者90例,随机分为3组:帕瑞昔布镇痛组手术结束前15 min静脉给予帕瑞昔布40 mg,每间隔12 h追加40 mg,48 h后停药;另两组为芬太尼静脉自控镇痛组与生理盐水对照组.记录术后6、12、24、48 h镇痛评分、舒适度评分和不良反应.结果 观察组与生理盐水对照组各时点VAS评分差异有统计学意义(P＜0.01),与芬太尼组的差异无统计学意义(P＞0.05);舒适度评分观察组明显优于生理盐水对照组(P＜0.05或0.01);不良反应对照组明显多于观察组(P＜0.05).结论 帕瑞昔布分次静脉注射用于混合痔切除术后的镇痛效果确切,不良反应少,患者镇痛满意度高.

【Objective】To investigate the effect of tracheal mucosal surface anaesthetic tracheal tube on tracheal extubation response of tracheal tube in geriatric hypertensive.【Methods】One hundred and eighty geriatric hypertensive undergoing selective operations were randomly divided into 6 groups with 30 patients each group.Each patient was intubated with a surface anaesthetic tracheal tube and squirted 2% lidocaine 2 ml before extubation in group A and A′,with a commonly tracheal tube smeared 2% lidocaine gel over its balloon in group B and B′,in group C and C′was no surface anesthesia as control group.The operation duration was short of 2 hours in group A、B 、C and the duration was longer than 2 hours in group A′、B′、C′.Mean arterial pressure(MAP)and heart rate(HR)were recorded before intubation.RPP(HR×SBP)was computed.【Results】There were much different degrees on protection effection against Hemodynamic fluctuation among two surface anaesthetic groups with control group(P0.01) and surface anaesthetic tracheal tube group with lidocaine gel group.【Conclusions】Tobe used surface anaesthetic tracheal tube in geriatric hypertensive is the most ideal methods of avoiding Hemodynamic fluctuation.

Objective To study the efficacy of ramosetron for preventing postoperative nausea and vomiting. Methods A total of 75 patients performing selective surgery were divided into three groups:ramosetron group,ondensetron group and placebo group.Before anesthesia induction,the patients were given 0.3 mg ramosetron in ramosetron group,4 mg ondensetron in ondensetron group,while 10 ml normal saline in placebo group.The nausea and vomiting were observed and recorded after surgery for 24 h. Results The postoperative nausea and vomiting was significantly lower in ramosetron group(8%)and ondensetron group(12%)than that in placebo group(48%,P0.05). Conclusion Ramosetron could effectively prevent postoperative nausea and vomiting.

我院于2000年11月至2001年8月在气管内插管静吸复合全麻下,为8例单心室合并肺动脉瓣狭窄患者实行双向格林手术,麻醉处理报告如下.

硬膜外应用吗啡术后镇痛常常伴随并发症状,如恶心呕吐、皮肤瘙痒、嗜睡、尿潴溜等.因而常复合一些药物,如氟哌利多等减少并发症的发生,本文旨在研究硬膜外腔应用地塞米松对于预防吗啡术后镇痛所致并发症的影响.

硬膜外腔注入少量吗啡行术后镇痛常伴随恶心呕吐、皮肤瘙痒、嗜睡、尿潴留等并发症.本文旨在观察硬膜外腔应用地塞米松预防吗啡术后镇痛所致并发症的作用. 资料与方法