With the rapid development of thoracic surgery, the proportion of difficult operation has been gradually increasing, which stimulates staff capacity building and technology development of anesthesiology. Also, the contents of thoracic anesthesia training for residents are getting more complicated. The theory, standards and techniques involved are constantly updated, so it is of great value to establish a standardized thoracic anesthetic training program. It should include airway management, ventilation strategy, multimodal analgesia and post-operative enhanced recovery management. This paper reviews the current situation of thoracic anesthesia training to fill the gap in this field. The research focuses on the development of a competent faculty, the training cycle, evaluation and feedback mechanism. By establishing a standardized training program which may achieve the goal of training qualified anesthesiologists, improve peri-operative safety and accelerate post-operative rehabilitation.

Objective: To investigate the effect of intraoperative warming on the postoperative relaxation recovery of cisatracurium in patients undergoing gastrointestinal surgery. Methods: Sixty ASA Ⅰ-Ⅱ patients, aged 20 to 60, undergoing elective gastrointestinal surgery in Cancer Hospital Chinese Academy of Medical Sciences from October, 2016 to March, 2019 were selected and they were randomly divided into two groups (n=30), N group and H group by random number table. N group was non-heat preserving group, and H group was heat preserving group. Tracheal intubation was induced by general anesthesia with cisatracurium 0.15 mg/kg, and the nasopharyngeal temperature were continuously monitored and recorded. Cisatracurium were infused 1-3 μg·kg(-1)·min(-1) by venous pump during operation with T1 at 1%-10% and stopped infusion 30 minutes before the end of surgery. The time when T1 recovered from 25% to 75%(muscle relaxation recovery index), and the time of T1 recovered to 25% to TOF ratios (TOFR, the ratio of the fourth muscle twitch height to T1 in TOF) recovery to 90% (full recovery time), cumulative drug use and surgery time were recorded. Results: There was no significant difference between the two groups in the cumulative drug dosage and operation time (P>0.05).The body temperature N group (35.7±0.2) ℃ was significantly lower than the H group (36.2±0.1) ℃ (t=13.940, P<0.01). The recovery index of N group (16.5±1.8) min was significantlyhigher than H group (10.5±2.1) min (t=12.094, P<0.01) and complete recovery time in N group (26.9±4.1) min was obviously longer than those in H group (15.0±2.9) (t=13.082, P<0.01). Conclusions: Patients with open gastrointestinal surgery are prone to hypothermia during surgery and heat protection is helpful to muscle relaxation recovery of cisatracurium.

Objective To observe the incidence of residual neuromuscular block(RNMB)in the post anesthesia care unit(PACU), analyze the factors that may affect the RNMB. Method All patients were transported to the PACU after extubation, TOF ratio at the time of their arrivals at PACU was recorded by one independent doctor using the TOF-Watch SX acceleration muscle relaxation monitor. The train of 4 stimulation ratio TOFr≥0.9 and TOFr<0.9 as the judgment standard of complete and incomplete recovery of neuromuscular blockade. Patients were divided into two groups RNMB group (group Ⅰ: TOFr<0.9) and adequate recovery group (group Ⅱ:TOFr≥0.9). Recorded related surgical information, patient information, adverse events and drug treatment, and analyze the factors that may influence the incidence of RNMB. Result The incidence of RNMB was 55.9% when 261 cases transported into PACU after extubation. The incidence of RNMB was similar in the patients using different muscle relaxants. There was no significant difference between the two groups in application of muscle relaxant antagonists. Compared with group Ⅱ, the incidence of upper airway obstruction and mild hypoxia was higher in groupⅠ(P<0.05), the difference was statistically significant (P<0.05). Conclusion The incidence of RNMB after general anesthesia patients in the PACU is 55.9%. It is important of the application of muscle relaxation monitor in PACU.

Objective To investigate the analgesic efficacy and safety of decozine combined with sufentanil on patients after laparoscopic radical gastrectomy.Methods Sixty patients undergoing laparoscopic radical gastrectomy,American Society of Anesthesiologists (ASA) Ⅰ ～ Ⅱ,were selected,and were randomly divided into two groups.All of the patients were treated with intravenous-inhalation combined anesthesia,and was given patient controlled intraveous analgesia (PCIA) when the patient was awoken.PCIA was administered with subsequent bolus of 0.5 ml with lockout time 15 minutes and background infusion of 2 ml/h.A ratio (3 μg/kg) of sufentanil and 0.5 mg palonosetron were mixed in PCIA pump in sufentanil group (S group);and 1.5 μg/kg sufentanil,0.3 mg/kg dezocine,and 0.5 mg palonosetron in PCIA were mixed in dezocine combined with sufentainl group (DS group),they were diluted to 100 ml with saline.The visual analogue scale (VAS),Bruggrmann comfort scale (BCS),Ramsay and incidence of adverse reactions of two groups were observed in 2 h (T1),6 h (T2),12 h (T3),24 h (T4),48 h(T5) after operation.Results There was no significant difference of VAS and BCS between two groups at each time point after operation (P ＞ 0.05);The Ramsay score of S group was significantly higher than that of DS group at T1,T2,and T3 (P ＜ 0.05).The Ramsay scores of two groups at T4,T5 were lower than those of T1,T2,and T3.The incidence of nausea,vomiting of DS group was significantly lower than that of S group (P ＜0.05).Conclusions Dezocine combined with sufentainl used in PCIA on postoperative gastric cancer patients can obtain satisfactory analgesic effects,but has fewer side effects than single sufentainl.

Objective To observe the effects of invert sugar and electrolytes injection on the blood glucose and elec-trolyte of patients with colorectal cancer during operation. Method 60 patients with colorectal cancer operation( ASAⅠ~Ⅱ) were randomly divided into the observation group and the control group,30 cases in each group. Blood glu-cose and electrolytes before drops and 0 min, 30min,1 h and 2 h after drops were recorded. Result The level of blood glucose increased in observation group in T1、T2、T3 after infusion(P<0. 05), but it almost recovered to the normal level in T4 . The blood glucose of the control group were not significant change after infusion. Na+level in ob-servation group after drops were significantly lower than those before infusion and those in control group(P<0. 05);K+ level in observation group were not significant change after infusion, but higher than those in control group( P<0. 05). Conclusion The invert sugar injection is effective in providing energy and regulating electrolyte balance for patients with colorectal cancer during operation.

Objective To observe the change of carbon dioxide pneumoperitoneum on the arterial blood gas of the patient which undergoing gynecological laparoscopic tumor resection. Method 40 ASA gradeⅠ~IIpatients with gy-necologic tumor undergoing laparoscopic surgery without known cerebral or cardiovascular system disease were selected. All the patients were under general anesthesia. Arterial blood gas analysis were did before insufflation and 20 min after the insufflation in the Trendelenburg position. Result Compare to those before pneumoperitoneum, pH、BE were significantly lower after the insufflation(P<0. 05),PaCO2 was significantly higher 20 min after the insuffla-tion(P<0. 05). PaO2 was not statistically significantly 20 min after the insufflation(P=0. 65). HCO-3 was not statis-tically significantly 20 min after the insufflation(P=0. 71). Conclusion The CO2 pneumoperitoneum have some effect on the change of the arterial blood gas during the operation of gynecology laparoscopy,but the change was in the normal range.

Objective To observe the effects of carbon dioxide pneumoperitoneum on the cerebral blood flow of the patient which undergoing gynecological laparoscopic tumor resection.Methods 40 ASA Ⅰ-Ⅱ patients with gynecologic tumor undergoing laparoscopic surgery without known cerebral or cardiovascular system disease were selected.PaO2,PaCO2,SaO2,PjvO2,SjvO2 values were recorded before and 20 ain after the instrfllation in the trendelenburg position.Results Before pneumoperitoneum,the SjvO2,CjvO2,PaCO2 was(66±7)％,(9.4±1.6)％ and (4.2±0.4) kPa respectively.And after insufflation,the SjvO2,CjvO2,PaCO2 was (84±6)％,(11.6±1.8)％ and (5.3±0.4) kPa respectively.PaCO2 increased obviously (P＜0.01).Ca-jvDO2 was decreased significantly before and after insufflation,whichwas (5.1±1.2)％ vs (2.4±0.9)％ (P＜0.01).Conclusions The CO2 pneumoperitoneum has obvious effect on the change of the cerebral blood circulation during the operation of gynecology laparoscopy,cerebral blood flow increased remarkably and Ca-jvDO2 decreased significantly.This kind of change implied anoxia of brain.

目的:通过比较观察老年食管癌患者麻醉前输注适量晶体、万汶(6%中分子羟乙基淀粉130/0.4)后麻醉诱导过程血流动力学变化,评价万汶在老年食管癌患者麻醉诱导中的临床作用。方法:40例食管癌患者分为两组,即乳酸钠林格氏液组(R组)和万汶组(V组),每组20例,R组,术前1h输注乳酸钠林格氏液10mL/kg;V组,术前1h输注万汶10mL/kg。观察患者入室输液前(T0)、气管插管前1min(T1)及插管后1min(T2)、5min(T3)、10min(T4)的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、BIS值。计算各血流动力学参数的变化并进行统计学处理。结果:两组患者在麻醉后MAP、CVP均有降低趋势,HR加快(P>0.05);但V组患者的MAP、HR、CVP在T2、T3、T4观察点的变化幅度较R组小(P<0.05)。结论:在老年食管癌患者全麻诱导前输注适量的羟乙基淀粉有助于稳定诱导期血流动力学。