Background: With the improvement of anesthesia and surgical techniques, supraglottic device with assist ventilation under general anesthesia (GA) combined with nerve block is gradually applied to video-assisted thoracoscopic surgery. However, the safety of assist ventilation has not been fully confirmed, and a large number of samples should be studied in clinical exploration. Methods: The subjects included 120 patients, undergoing elective thoracoscopic GA, with American Society of Anesthesiologists (ASA) physical status I or II, were randomly divided into 3 groups, 40 cases in each group. Group T: received double-lumen bronchial intubation, Group I: received intercostal nerve block using a supraglottic device, Group P: received paravertebral nerve block using a supraglottic device. Mean arterial pressure, heart rate, saturation of pulse oximetry and surgical field satisfaction, general anesthetic dosage and recovery time were recorded before induction of GA (T 0 ), at the start of the surgical procedure (T 1 ), 15 minutes later (T 2 ), 30 minutes later (T 3 ), and before the end of the surgical procedure (T 4 ). Static and dynamic pain rating (NRS) and Ramsay sedation score were recorded 2 hours after surgery (T 5 ), 12 hours after surgery (T 6 ), 24 hours after surgery (T 7 ), time to get out of bed, hospitalization time and cost, patient satisfaction and adverse reactions. Results: There was no significant difference with the surgical visual field of the 3 groups ( P > .05). The MAP, HR and SpO 2 of the 3 groups were decreased from T 2 to T 3 compared with T 0 ( P < .05). Compared with group T: the total dosage of GA was reduced in group I and group P, the recovery time was shorter, the time to get out of bed was earlier ( P < .05), the hospitalization time was shortened, the hospitalization cost was lower, and the patient satisfaction was higher ( P < .05). The static and dynamic NRS scores were lower from T 5 to T 7 ( P < .05). Ramsay sedation scores were higher ( P < .05), and the incidence of adverse reactions was lower ( P < .05). Comparison between group I and group P: Dynamic NRS score of group P was lower from T 6 to T 7 ( P < .05). Conclusion: ...
Background Pre-operative administration of methylprednisolone reduced circulating markers of endothelial activation. This randomized, double-blind was to evaluate whether a single pre-operative dose of methylprednisolone reduced the rate of postoperative delirium (POD) in older patients undergoing gastrointestinal surgery, and its association with the shedding of endothelial glycocalyx markers. Methods 168 patients, aged 65–80 years and scheduled for laparoscopic gastrointestinal surgery, were randomized to 2 mg·kg -1 methylprednisolone (Group M, n = 84); or equivalent dose of placebo (Group C, n = 84). The primary outcome was the incidence of delirium during the first 5 days after surgery, assessed by the confusion assessment method (CAM). POD severity was rated daily using CAM-Severity (CAM-S). Level of syndecan-1, heparan sulfate, tumor necrosis factor-α(TNF-α), and brain-derived neurotrophic factor (BDNF) were measured at baseline, 1-day, and 3-day after surgery. Results Compared with placebo, methylprednisolone greatly reduced the incidence of delirium at 72 h following surgery [9(10.7%) versus 20(23.8%), P =0.03, OR=2.22(95%CI 1.05-4.59)]. No between-group difference was found in the cumulative CAM-S score (P=0.14). The levels of heparan sulfate, syndecan-1, and TNF-α in Group M were lower than that in Group C (P <0.05 and P <0.01), while the level of BDNF in Group M was higher than that in Group C (P <0.01). Conclusions Pre-operative administration of methylprednisolone does not reduce the severity of POD, but may reduce the incidence of delirium after gastrointestinal surgery in elderly patients, which may be related to a reduction in circulating markers of endothelial degradation, followed by the increase of BNDF level.
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