ObjectiveTo investigate the effects of alcohol consumption status and labor intensity on the tolerance of patients undergoing bronchoscopy under mild to moderate sedation anesthesia. MethodsAdult patients scheduled for bronchoscopy under local anesthesia or mild to moderate sedation were included, and their clinical characteristics and bronchoscopy tolerance were recorded. The study compared changes in vital signs, severity of coughing, and procedure failure rates during bronchoscopy among patients with different drinking statuses (non-drinkers, former drinkers, and current drinkers) and different labor intensities (light, moderate, and heavy labor intensity) to assess the impact of drinking status and labor intensity on bronchoscopy tolerance.ResultsA total of 142 subjects were included in the study, with 50 patients receiving local anesthesia and 92 patients receiving mild to moderate sedation. Current drinkers had a higher procedure failure rate (2.9% vs. 1.9% vs. 25.0%, P<0.01, for non-drinkers, former drinkers, and current drinkers, respectively) and more significant intraoperative blood pressure drops (systolic pressure change, −3.5±9.1 vs. −0.2±8.1 vs. −9.3±17.9 mm Hg, P<0.01; diastolic pressure change, −0.5±5.6 vs. 2.9±7.9 vs. −3.2±12.4, P<0.05). Patients with moderate to heavy labor intensity also had higher procedure failure rates and more pronounced intraoperative blood pressure drops (procedure failure rate, 1.1% vs. 13.2% vs. 22.2%, P<0.01, for light, moderate, and heavy labor intensity, respectively; intraoperative systolic pressure change, −1.8±8.5 vs. 2.8±8.5 vs. −17.2±24.7 mm Hg, P<0.001; intraoperative diastolic pressure change, 1.3±6.4 vs. 0.2±6.7 vs. −8.1±17.2 mm Hg, P<0.01). The impact of drinking status and labor intensity on procedure tolerance was only observed in patients receiving mild to moderate sedation. After controlling for relevant confounding factors, current drinking and moderate to heavy labor intensity were identified as independent risk factors for procedure failure (current drinkers compared to non-drinkers or former drinkers, OR 47.2, 95%CI: 3.1-232.2, P<0.05; moderate to heavy labor intensity compared to low labor intensity, OR 25.7, 95%CI: 2.8-67.7, P<0.05).ConclusionsCurrent drinkers engaged in moderate to heavy labor intensity are less likely to tolerate bronchoscopy under mild to moderate sedation. It is essential to pay attention to the selection and evaluation of anesthesia methods, procedure types, and intraoperative monitoring for this population.
Objective To systematically review the effectiveness of forced air warming for the maintenance of perioperative core temperature, so as to provide clinical evidence for an appropriate warming plan during the perioperative period. Methods We electronically searched PubMed, The Cochrane Library, EMbase, Web of Science, CBM and CNKI from 2000 to 2012, so as to comprehensively collect randomized controlled trials (RCTs) about the effectiveness of different warming methods for the maintenance of perioperative core temperature (including forced air warming, resistive-heating blanket/electric heating pad, circulating water mattress, and infrared ray radiant heating system) for maintenance of perioperative core temperature. References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Eleven RCTs involving 577 patients were included. The results of meta-analysis indicated that, in the maintenance of core temperature during the perioperative period, forced air warming was superior to resistive-heating blanket/electric heating pad (SMD= –0.40, 95%CI –0.73 to –0.06), circulating water mattress (SMD= –1.10, 95%CI –1.55 to –0.66), and infrared ray radiant heating system (SMD= –0.69, 95%CI –1.06 to –0.32). In the incidence of hypothermia during the perioperative period, the group of forced air warming was lower than the group of blanket/electric heating pad (RR=1.76, 95%CI 1.15 to 2.69), but it was the same as the group of infrared ray radiant heating system (RR=1.37, 95%CI 0.83 to 2.27). In the incidence of shivering during the perioperative period, the group of forced air warming was the same as the group of blanket/electric heating pad (RR=0.75, 95%CI 0.18 to 3.21) and the group of infrared ray radiant heating system (RR=0.8, 95%CI 0.19 to 3.36). Conclusion Compared with resistive-heating blanket/electric heating pad, circulating water mattress, and infrared ray radiant heating system, forced air warming maintains patients’ core temperature better during the perioperative period, with a lower incidences of hypothermia. Due to the limited quantity and quality of the included studies, more high quality RCTs with large sample size are needed to verify the above conclusion.
ObjectiveTo investigate the value of endoscopic sphincterotomy (EST) on treating sphincter of Oddi dysfunction (SOD). MethodsForty-two patients with SOD according to Rome Ⅱ diagnostic criteria were retrospectively summarized. Bile duct residual stone, tumor or biliopancreatic duct obstruction diseases were excluded by B ultrasound, CT, and MRCP examination. Total 42 patients underwent EST. ResultsEST was done successfully in 42 cases, success rate was 100%. Postoperative acute pancreatitis occurred in 5 patients (11.90%), which were cured by 3－7 d conservative treatment. There were no complications of severe acute pancreatitis, digestive tract perforation, hemorrhage, and cholangitis. Follow-up 12-45 months (mean 23.8 months), symptoms of abdominal pain in all cases were improved or relieved, the effective rate was 100%. There were 2 cases treated conservatively because of hyperlipemic pancreatitis. ConclusionEST has become the primary treatment procedure for SOD because of definite outcome, less suffering, safety, less complications, and reproducibility, which are concordant with the requirements of minimally invasive surgery.