目的 探讨在局部麻醉下行痔上黏膜环形切除钉合术（procedure for prolapse and hemorrhoids，PPH）治疗重度内痔的可行性及临床应用价值。方法 笔者所在医院科室从2005年起对32例Ⅲ度及Ⅳ度脱垂性内痔（含1例混合痔）患者均采用苯巴比妥＋氢溴酸东莨菪碱＋利多卡因肛管直肠环形局部浸润麻醉行PPH术，对其麻醉效果、手术时间、术中及术后疼痛、尿潴留、术后感染、肛门狭窄、住院时间、治疗满意度等进行分析。结果 32例患者均顺利完成手术，有1例术中改行低位连续硬膜外麻醉，1例辅加镇静剂及镇痛剂。术后28例对疼痛能耐受，4例需镇痛药物；1例患者有肛门坠胀感；所有患者伤口均一期愈合，无尿潴留、术后感染、出血、肛门狭窄等并发症发生；31例对疗效满意，有1例感肛门坠胀，行温水坐浴及痔疮膏纳肛治疗1周后缓解。住院时间3～6d，平均4d。32例患者均进行有效随访，随访时间2～4个月，平均3个月，无大便失禁或复发，肛门控便能力均可。结论 局部麻醉下行PPH术治疗重度内痔是一种安全可行的手术方法，麻醉操作护理简单，疗效确切，术后并发症少，术后恢复快，并可减少医疗费用。
目的：比较常规鼻胃管置入法与鼻咽部局部喷雾麻醉后置胃管法对喉癌患者的影响。方法：将需要安置胃管的100例患者随机分成两组，每组50例。实验组行鼻咽部喷雾麻醉，对照组按常规操作，比较两组患者流泪、恶心、呕吐、咳嗽反应，一次成功率及插管所需要时间、插入中暂停次数。结果：实验组一次成功率高，患者反应轻，插管所需时间有显著差异。结论：常规置胃管常因病员难受而中途暂停置管，实验组置胃管前先作鼻咽部局部喷雾麻醉，可明显减轻患者的痛苦，提高插胃管的一次成功率，插管过程中因病员难受暂停次数也明显减少，使临床护理工作时间缩短，对临床护理工作有积极意义。
ObjectiveTo compare the outcomes of local anesthesia and general anesthesia in transcatheter aortic valve replacement (TAVR).MethodsA total of 399 severe aortic stenosis patients were included, who underwent TAVR successfully in West China Hospital of Sichuan University between April 2012 and January 2019. The baseline characteristics, procedural details, postprocedural outcomes, and ultrasound data of those patients were collected. All patients were followed up and the end date of follow-up was June 20th 2020. According to anesthetic mode, the patients were divided into local anesthesia group and general anesthesia group. The differences between the two groups in incidence of postprocedural complications, hemodynamics, postprocedural 30-day mortality, and postprocedural 1-year mortality were retrospectively analyzed.ResultsOf the 399 patients, 206 (51.6%) received local anesthesia and 193 (48.4%) received general anesthesia. There was no statistical difference between the two groups in baseline characteristics. The symptoms of both groups were relieved. But the incidences of mild bleeding events (12.4% vs. 1.5%, P<0.001), severe bleeding events (10.4% vs. 0.5%, P<0.001), major vascular complications (0.5% vs. 3.6%, P=0.032), and postprocedural 30-day all causes mortality (1.9% vs. 6.7%, P=0.018) were significantly lower in the local anesthesia group than those in the general anesthesia group.ConclusionIn TAVR, compared with general anesthesia, local anesthesia is safer to use with lower incidence of postprocedural complications and postprocedural 30-day all causes mortality.
ObjectiveTo systematically review the efficacy and safety of transfemoral transcatheter aortic valve replacement (TFTAVR) under local anesthesia (LA) and general anesthesia (GA). MethodsElectronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang and CBM were searched to collect randomized controlled trial and cohort studies on clinical outcomes of TFTAVR under LA and GA from inception to September 2020. Two authors independently screened literature, extracted data and assessed the quality of studies, and a meta-analysis was performed by using Stata 16.0 software. ResultsA total of 30 studies involving 52 087 patients were included in this study. There were 18 719 patients in the LA group and 33 368 patients in the GA group. The results of meta-analysis showed that the in-hospital all-cause mortality rate [RR=0.65, 95%CI (0.45, 0.94), P=0.021], 30-day all-cause mortality rate [RR=0.73, 95%CI (0.62, 0.86), P＜0.001], 30-day stroke [RR=0.82, 95%CI (0.68, 0.98), P=0.025], cardiac arrest [RR=0.50, 95%CI (0.34, 0.73), P＜0.001], ICU stay time [RR=−6.86, 95%CI (−12.31, −1.42), P=0.013], and total hospital stay time [RR=−2.02, 95%CI (−2.59, −1.45), P＜0.001] in the LA group were all better than those in the GA group. There was no significant difference in the in-hospital stroke [RR=0.83, 95%CI (0.69, 1.00), P=0.053], in-hospital myocardial infarction (MI) [RR=1.74, 95%CI (0.43, 7.00), P=0.434], or 30-day MI [RR=0.77, 95%CI (0.42, 1.42), P=0.404] between the two groups. ConclusionLA provides a safe and effective way to induce sedation without intubation, and may be a good alternative to GA for TFTAVR.
Objective To assess efficacy of mepivacaine on local anesthesia in dentistry and oral surgery and its safety. Methods Parallel group, stratified randomization, double blinded, muti-center clinical trial was designed. Two percent lidocaine with adrenaline in same cartridge was as control. Healthy patients with deep decay, pulpitis needed operative dentistry, or indication for extraction of the teeth, which located in the maxilla or front part of the mandible were included. Results Except 17 cases, 127 patients fulfilled inclusion criteria: 66 in treatment group and 61 in control group, dental filling for 60 and extraction for 67 cases, male 55 and female 72, average at 38.84 + 12.06 years. Submucous infiltration of 1.5 ml mepivacaine at labial or buccal side of the alveolar process produced onset of anesthesia in the median of 60 seconds which was same as that of lidocaine, anesthesia duration for 146.7 minutes with the median of 125 minutes, permitting painless filling or extractions. In the treatment group 81.82% freed of pain, while 15.15% had slight pain but received no extra local anesthetic for implementation of the treatment procedures, making the successful rate of 96.97%. In the mepivacaine group, 13.64% of the cases had transient elevation of the systolic pressure to the level of 145-162 mmHg, 8.33% diastolic pressure to the level of 91-93 mmHg. Only one case had transient palpitation in half minute after one minute injection of the drug with no medical care needed. All the cardiovascular reactions might result from adrenaline containing in the injections. Conclusion Mepivacaine is an effective, safe and reliable anesthetic agent for dentistry and oral surgery.
ObjectiveTo evaluate the arthroscopic treatment effectiveness of popliteal cyst excision in combination with debridement of the knee under local anesthesia by comparing with continuous epidural anesthesia. MethodsBetween June 2002 and January 2013,145 patients with popliteal cyst underwent arthroscopic popliteal cyst excision in combination with debridement of the knee under local anesthesia (local anesthesia group).In addition,51 patients with popliteal cyst were treated with the same surgery under continuous epidural anesthesia between February 2000 and August 2005 served as control group.No significant difference was found in gender,age,side,disease duration,or cyst size between 2 groups (P>0.05).Then,anesthesia time,analgesia effect,anesthesia satisfaction,operation time,bleeding volume,and anesthesia complication were compared between 2 groups.The guidelines of Rauschning and Lindgren were used to assess the effectiveness,and recurrence rate was recorded. ResultsAll incisions healed primarily,no neurological or vascular injury was found.The patients were followed up 1 year and 1 month to 8 years (mean,3.7 years) in local anesthesia group,and 8 years to 13 years and 7 months (mean,10.8 years) in control group.Local anesthesia group had shorter anesthesia time,higher visual analogue scale (VAS) score,shorter operation time,and lower bleeding volume (P<0.05) than control group.Anesthesia satisfaction was reduced in local anesthesia group,but there was no significant difference (χ2=0.071,P=1.000).The anesthesia complication incidence of control group (15.7%,8/51) was significantly higher than that of local anesthesia group (0) (P=0.000).Recurrence was found in 12 patients of local anesthesia group (curative ratio 91.7%) and in 5 patients of control group (curative ratio 90.2%),showing no significant difference (χ2=0.111,P=0.774).According to the guidelines of Rauschning and Lindgren,there were 131 cases of grade 0,13 cases of grade I,and 1 case of grade Ⅱ in local anesthesia group,and 37 cases of grade 0,12 cases of grade I,and 2 cases of grade Ⅱ in control group; significant differences in grading were shown between at pre- and post-operation in 2 groups (Z=-10.683,P=0.000; Z=-6.385,P=0.000),and between 2 groups at post-operation (Z=-3.145,P=0.002). ConclusionCompared with under continuous epidural anesthesia,arthroscopic treatment of popliteal cyst excision under local anesthesia can obtain better results.Under local anesthesia,the condition of nerve and vessel can be timely and dynamically observed.Arthroscopic treatment of popliteal cyst excision in combination with debridement of the knee has the advantages of less trauma,lower recurrence rate,and satisfactory results.