Search

BackgroundDifficult airway has always been one of the greatest challenges for anesthesiologists. Patients with difficult airways and severe obstructive sleep apnea-hypopnea syndrome (OSAHS) often find themselves in life-threatening danger before their artificial airway is established and after their artificial airway is removed.Case presentationThe study reported a case of nasal polyps shedding into the tracheal tube when nasotracheal intubation in a patient diagnosed with a difficult airway and OSAHS; the patient was being prepared for a transoral tonsillectomy under general anesthesia. The uniqueness of this case was that nasal polyps were scraped off using the tracheal tube during nasotracheal intubation, and detected in real-time; this ultimately prevented an airway foreign body obstruction. Reviewing the literature on intubation methods for difficult airways, awake endotracheal intubation guided by fiberoptic bronchoscopy remains to be the gold standard for airway management. Additionally, nasotracheal intubation can provide more operating space for oral surgery. In this case, the unexpected nasal polyp fell off into the tracheal tube during intubation, as is visualized on the following pictures. This fortunate event prevented the nasal polyp from falling into the trachea and bronchus.ConclusionIt is necessary to rule out any nasal abnormalities in patients requiring nasotracheal intubation; otherwise, blind nasal intubation may be dangerous.

Background Alveolar recruitment maneuvers (ARMs) is an important part of lung-protective ventilation strategies (LPVSs), but the optimal duration and interval Remain unclear. Methods Patients:252 patients who underwent holmium laser lithotripsy surgery and meet inclusion criteria were included and randomized into three groups based on the duration and frequency of ARMs (Regular, one 30 s ARM (RARMs); Improved and intermittent, three 10s ARMs (IARMs); and Control (C), no ARMs).Interventions: Groups R and I received ARMs at 20 cmH2O pressures every 30 min. All patients received the same anesthesia and mechanical ventilation. Measurements:Outcomes included heart rate and mean arterial pressure changes during ARMs and postoperative pulmonary complications (PPCs) within the first 7 postoperative days. Main results Incidences of PPCs in groups R(7.1%) and I (5.0%)were slightly lower than those in group C (8.9%).This indicated the potential to reduce lung injury. Heart rate and mean arterial pressure fluctuations during ARMs were significantly higher in groups R and I than in group C (P P Conclusions IARMs can reduce cycle fluctuations than RARMs in patients Undergoing holmium laser lithotripsy surgery with laryngeal mask general anesthesia. Low tidal volume ventilation and low PEEP combined with ARM did not significantly reduce the incidence of PPCs in healthy lung patients, but tended to reduce lung injury. Trial registration The study was registered on the Chinese Clinical Trial Registry. (ChiCTR2000030815,15/03/2020). This study was approved by the ethics committee of Chengdu Fifth People’s Hospital with approval number(2020–005(Study)-1).

In this paper, the merit and disadvantage of existing measurement methods for battery internal resistance are firstly analyzed. Then an online internal resistance measurement based on AC impedance method is proposed, which can increase the stability of the excitation source and enhance the performance of the filtered feedback signal. The method can be used to measure the small resistance of lithium-ion battery precisely. Experimental results show that the proposed method is accurate.

Catheter-related bladder discomfort (CRBD) is a distressing symptom complex after surgery, especially in male patients who have had urinary catheterization under general anesthesia. In this prospective, randomized, controlled trial, we compared dorsal penile nerve block (DPNB) with 0.33% ropivacaine with intravenous tramadol 1.5 mg kg−1 in prevention of CRBD, as well as the incidences of postoperative side effects. Fifty-eight male patients aged 18 to 50 years, undergoing elective liver surgery and limb surgery with urinary catheterization, were enrolled and divided randomly into 2 groups. In the DPNB group, patients were given dorsal penile nerve block with 15 mL of 0.33% ropivacaine, and in the tramadol intravenous administration (TRAM) group, patients were given 1.5 mg kg−1 tramadol after the completion of surgery before extubation. The primary outcome was the incidence of CRBD, and the secondary outcomes included the severity of CRBD, postoperative side effects, postoperative pain, and the acceptance of urinary catheterization. Patients were evaluated upon arrival to postanesthetic care unit (PACU), at 0.5, 1, 2, 4, and 6 hours after patients’ arrival in the PACU for outcomes. The incidence of CRBD was significantly lower in the DPNB group than in the TRAM group, either upon arrival to PACU (10.3% vs 37.9%, P = 0.015), or at 0.5 hours (3.4% vs 34.5%, P = 0.003), 1 hours (3.4% vs 37.9%, P = 0.001), 2 hours (6.9% vs 34.5%, P = 0.010), and 4 hours (6.9% vs 27.6%, P = 0.039) after patients’ arrival in PACU. Compared with the TRAM group, the severity of postoperative CRBD upon arrival to PACU (P = 0.011) and at 0.5 hours (P = 0.005), 1 hours (P = 0.002), 2 hours (P = 0.005), 4 hours (P = 0.017), and 6 hours (P = 0.047) after patients’ arrival in PACU were all significantly reduced in the DPNB group. The incidences of postoperative nausea, vomiting, dizziness, and sedation were decreased significantly in the DPNB group compared with the TRAM group (P

Ischemia/reperfusion (I/R) injury mainly caused by oxidative stress plays a major role in cardiac damage. The extent of the I/R injury is also an important factor that determines the function of a transplanted heart. This study first examined whether hemoglobin-based oxygen carriers (HBOCs) could protect isolated rat heart from I/R injury and then elucidated the underlying mechanism. Using the Langendorff model, isolated Sprague-Dawley rat hearts were arrested and stored at 4 degrees C for 8 h and then reperfused for 2 h. Compared with St. Thomas' solution (STS) and rat self blood in STS, polymerized placenta hemoglobin (PolyPHb) in STS greatly improved heart contraction and decreased infarction size. The extent of myocardial apoptosis was also significantly decreased, which was related to reduced iNOS-derived nitric oxide production, increased protein ratio of Bcl-2/Bax, and reduced caspase-3 activity and cleavage level. Furthermore, PolyPHb in STS did not increase malondialdehyde, peroxynitrite, or mitochondrial hydrogen peroxide formation, but greatly elevated superoxide dismutase activity and preserved mitochondrial ATP synthesis, which served to maintain redox homeostasis in I/R heart. In conclusion, our results demonstrate that HBOCs protected isolated heart from I/R injury and this protection was associated with attenuation of NO-mediated myocardial apoptosis and restoration of the nitroso-redox balance.

To explore the effect of fentanyl on 50% effective dose (ED50) of emulsified isoflurane for hypnosis and to define the type of interaction between fentanyl and emulsified isoflurane during rat hypnosis.125 male adult Sprague-Dawley rats (240-300 g) were divided into 5 groups depending on the drugs administered via the tail vein. The up-and-down sequential allocation technique was used to determine ED50 of fentanyl in the loss of righting reflex. According to above experiment results, the up-and-down sequential allocation technique was also used to determine ED50 of emulsified isoflurane combined with different fentanyl dose of 7.2 microg/kg (1/4 ED50), 14.3 microg/kg (1/2 ED50) or 21.5 microg/kg (3/4 ED50), respectively, and also without the fentanyl in the loss of righting reflex. Fentanyl was administered intravenously for 20 s followed by emulsified isoflurane for 10 s. The interval between the two was 1.5 min in groups administered with both. ED50 was calculated by using Dixon-Mood method. The isobolographic and algebraic analyses were used to define the type of interaction between fentanyl and emulsified isoflurane.The body weight and sex of rats was not significantly different between the 5 groups. ED50 was (28.7 +/- 2.1) microg/kg (26.5-30.8 microg/kg) in the fentanyl group, (0.525 +/- 0.032) mL/kg in the fentanyl 7.2 microg/kg +/- isoflurane group, (0.108 +/- 0.019) mL/kg in the fentanyl 14.3 microg/kg+isoflurane group, (0.075 +/- 0.011) mL/kg in the fentanyl 21.5 microg/kg+isoflurane group and (0.670 +/- 0.054) mL/kg in the isoflurane group. The isobolographic analysis indicated that ED50 of isoflurane decreased progressively in a non-linear fashion in the presence of increasing dose of fentanyl. The isobolographic and algebraic analyses demonstrated that the combination use of fentanyl and emulsified isoflurane could produce a synergistic effect on hypnosis.Fentanyl enhances the hypnotic effect induced by emulsified isoflurane. The administration of associating fentanyl with emulsified isoflurane produces a synergistic effect on rat hypnosis.