ObjectiveTo systematically review the protection effect of epidural anesthesia combined with general anesthesia versus general anesthesia alone in patients underwent cardiac surgery, so as to provide evidence for reducing complications of cardiac surgery. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2, 2015), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about epidural anesthesia combined with general anesthesia versus general anesthesia alone for patients underwent cardiac surgery from inception to February 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by RevMan 5.3 software. ResultsA total of 35 RCTs involving 3 311 patients were included. The results of meta-analysis showed that, compared with the general anesthesia group, the combination anesthesia group had lower incidence of supraventricular tachycardias (RR=0.63, 95%CI 0.48 to 0.83, P=0.001) and shorter ICU stay time (SMD=-0.57, 95%CI -1.02 to-0.12, P=0.01), but there were no significant differences in the incidences of respiratory complications, myocardial infarction, stroke and mortality between the two groups (all P values >0.05). ConclusionCurrent evidence shows that the combination of epidural anesthesia and general anesthesia has better protection effect than general anesthesia alone in cardiac surgery, but the influence on long-term prognosis still needs to be assessed. Due to the limited quality of included studies, the above conclusion still needs to be verified by more high quality studies．
Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.
ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.
Objective To study the effect of the allogeneic bone sheet that has been treated by the freezedrying and radiation sterilization in preventing the epidural adhesion after laminectomy in sheep. Methods Laminectomy was performed on L3,4and L4,5 of 12 adult male sheep. Afteroperation, one site of L3,4 or L4,5was covered by the allogeneicbone sheet in “H” shape after the freeze-drying and radiation sterilization treatment; and the other site was used as a control. The sheep were killed and the specimens were retrieved at 4，8，12，16，20 and 24 weeks after operation to observe the scar formation process. X-ray andCT scan were performed in the segments of L3,4and L4,5at 4 and 24weeks. Results Four weeks after operation, the position and the shape of the allogeneic bone sheet were good in condition, and no lumbar spinal stenosis or compression of the dura was found in the experimental sections. Twentyfour weeks after operation theexamination on the experimental sections revealed that the vertebral canal reconstruction was completed, the allograft was absorbed almost completely, and inosculation with the lamina of the vertebra and the shape of the lumbar spine were good, with no fibroid tissues found in the epidural area. Compared with the control segment, the dura adhesion degree in the laminoplasty segment was significantly decreased (Plt;0.01), and the dura sac remained in a good shape. There was no obvious compression on the dura. Conclusion The allogeneic bone sheet after the treatment of freeze-drying and radiation sterilization can effectively reduce the scar formation after laminectomy and prevent postoperative recurrence of the spinal stenosis.
Objective To evaluate the effectiveness of intravenous patient-controlled analgesia versus epidural patient-controlled analgesia for postoperative analgesia, sedation, and the incidence of side effects. Methods We searched the specialized trials registered in the Cochrane anesthesia group, The Cochrane Library (CCTR), MEDLINE (1966 to Sept. 2008), EMbase (1966 to Sept. 2008), PubMed (1966 to Sept. 2008), and handsearched some Chinese anesthesia Journals and Clinical anesthesia journals. Randomized controlled trials (RCTs) and quasi-RCTs of intravenous versus epidural analgesia for post-operation were included. The quality of the trials was critically assessed. RevMan 4.2.8 software was used for meta-analyses. Results Thirteen RCTs involving 580 patients of intravenous versus epidural analgesia for post-operation were included. The results of meta-analyses showed that there were no significant differences in postoperative analgesia and sedation at the hour-points of 2nd, 4th, 8th, 12th, and 24th hours after operation. There were no significant differences in plasma fentanyl concentration in the two groups on the same analgesia effects. There were also no significant differences in side effects. Conclusion Both intravenous patient-controlled analgesia and epidural patient-controlled analgesia have the same clinical effects. Compared with epidural patient-controlled analgesia, intravenous patient-controlled analgesia has fewer side effects and is more convenient. At the same time, it can reduce more costs of hospitalization. But because of the low quality and small sample size of the included studies, more well-designed, large scale, randomized controlled trials are needed.
Objective?To systematically evaluate the effects of thoracic epidural anesthesia on outcome after coronary artery bypass surgery. Methods?We searched PubMed, EBSCO, Springer, Ovid, and CNKI databases from 1990 through Oct. 2009 to identify randomized controlled trials (RCTs) about thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone on outcome after coronary artery bypass surgery. The methodological quality of the included RCTs was assessed and the data was extracted according to the Cochrane Reviewer’s Handbook. The homogeneous RCTs were pooled using RavMan 4.2.10 software. Results?Sixteen RCTs involving 1 316 patients met the inclusion criteria. The results of meta-analyses showed that thoracic epidural anesthesia significantly reduced time to tracheal extubation (MD= –332.43, 95%CI –640.19 to –24.68, P=0.03), visual analog scale (VAS) scores at rest on postoperation day 1 (MD= –1.23, 95%CI –2.19 to –0.27, P=0.01), VAS scores with movement on postoperation day 1 (MD= –2.52, 95%CI –4.65 to –0.39, P=0.02) and day 2 (MD= –1.5, 95%CI –2.56 to –0.43, P=0.006), and incidences of myocardial ischemia (RR=0.53, 95%CI 0.29 to 0.97, P=0.04). There were no significant differences between the two groups in postoperative pulmonary function, incidences of myocardial infarction, atrial fibrillation, and mortality. Conclusions?Thoracic epidural anesthesia could reduce postoperative time to tracheal extubation, VAS score, and incidences of myocardial ischemia, but it does not affect postoperative pulmonary function, incidences of myocardial infarction, atrial fibrillation, and mortality. More high-quality RCTs are required.