Journal of clinical medicine research最新文献

{"title":"Intubation Time, Lung Mechanics and Outcome in COVID-19 Patients Suffering Acute Respiratory Distress Syndrome: A Single-Center Study.","authors":"Diamanto Aretha, Sotiria Kefala, Alexandra Nikolopoulou, Vasilios Karamouzos, Maria Valta, Virginia Mplani, Alexandra Georgakopoulou, Chrysavgi Papamichail, Christina Sklavou, Fotini Fligou","doi":"10.14740/jocmr4984","DOIUrl":"10.14740/jocmr4984","url":null,"abstract":"<p><strong>Background: </strong>We examined the effect of intubation time and the lung mechanics on clinical outcomes in coronavirus disease 2019 (COVID-19) patients.</p><p><strong>Methods: </strong>Based on the patient's hospital admission, intubation time was defined as early (≤ 2 days) or late (> 2 days). Patients were further divided into three groups; early (≤ 3 days), late (4 - 6 days), and very late (> 6 days) intubated.</p><p><strong>Results: </strong>A total of 194 patients were included; 66.5% male, median age 65 years. Fifty-eight patients (29.9%) were intubated early and 136 (70.1%) late. Early intubated patients revealed lower mortality (44.8% vs. 72%, P < 0.001), were younger (60 vs. 67, P = 0.002), had lower sequential organ failure assessment (SOFA) scores (6 vs. 8, P = 0.002) and higher lung compliance on admission days 1, 6 and 12 (42 vs. 36, P = 0.006; 40 vs. 33, P < 0.001; and 37.5 vs. 32, P < 0.001, respectively). Older age (adjusted odds ratio (aOR) = 1.15, P < 0.001), intubation time (aOR = 1.15, P = 0.004), high SOFA scores (aOR = 1.81, P < 0.001), low partial pressure of oxygen (PaO₂)/fractional inspired oxygen tension (FiO₂) ratio (aOR = 0.96, P = 0.001), and low lung compliance on admission days 1 and 12 (aOR = 1.12, P = 0.012 and aOR = 1.14, P < 0.001, respectively) were associated with higher mortality. Very late and late intubated patients had higher mortality rates than patients intubated early (78.4% vs. 63.4% vs. 44.6%, respectively, P < 0.001).</p><p><strong>Conclusions: </strong>Among COVID-19 intubated patients, age, late intubation, high SOFA scores, low PaO₂/FiO₂ ratio, and low lung compliance are associated with higher intensive care unit (ICU) mortality.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 1","pages":"15-23"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RAM Cannula Versus Bi-Nasal Prongs as Respiratory Device Interfaces in Neonates of Thirty-Two or More Weeks of Gestation With Respiratory Distress: The First \"ProRAM\" Randomized Trial Report.","authors":"Manar Al-Lawama, Bayan Alaraj, Mahmoud Abu Zahra, Ibtehal AlHasanat, Heba Habash, AbdelKareem Alhyari, Leen Alshajrawi, Sallam Jaafreh","doi":"10.14740/jocmr5077","DOIUrl":"10.14740/jocmr5077","url":null,"abstract":"<p><strong>Background: </strong>Using bilateral short nasal prongs as an interface for noninvasive respiratory support is challenging, and it is associated with nasal injury. We aimed to compare RAM cannula with nasal prongs in delivering noninvasive ventilation to newborn infants.</p><p><strong>Methods: </strong>This is a single-center randomized trial (trial registry: ISRCTN10561691). The setting involves a tertiary neonatal unit with a capacity of 30 beds and more than 13 years of experience in neonatal noninvasive ventilation. We included 50 infants born at ≥ 32 weeks of gestation, who had respiratory distress at birth. We excluded those with major congenital anomalies and those who required intubation in the delivery room. Primary outcomes were intubation rate and use of noninvasive positive-pressure ventilation (NIPPV); other outcomes included air leak and nasal injury rate. The infants were assigned using randomly generated numbers into bi-nasal prong and RAM canula groups in a 1:1 ratio.</p><p><strong>Results: </strong>Two and four babies in the RAM and prong groups, respectively, were upgraded to NIPPV (P = 0.600). One versus no baby in the RAM vs. prong groups was intubated (P = 1.000). Newborns in the prong group required oxygen support for a longer period (mean duration: 154.6 ± 255.2 h) than those in the RAM group (40.7 ± 72.6 h, P = 0.030). None of the patients in the RAM group had traumatic nasal injury compared to five babies in the prong group (P = 0.050). Four babies in our study developed air leaks, with two in each group.</p><p><strong>Conclusions: </strong>The use of RAM cannula in delivering noninvasive ventilation to newborns ≥ 32 weeks of age did not affect the noninvasive ventilation failure rate or incidence of air leak. The use was associated with a shorter duration of respiratory support and a reduced risk of nasal septal injury.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"16 1","pages":"24-30"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10846486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Rational Management Methods for Medical Consumables","authors":"Shu Liu","doi":"10.32629/jcmr.v4i3.1309","DOIUrl":"https://doi.org/10.32629/jcmr.v4i3.1309","url":null,"abstract":"Purpose—The purpose of this article is to explore methods for the rational management of medical consumables, with the aim of providing reference for the future management of medical consumables. Methods—The hospital where the author is affiliated implemented a classification coding consumables management model in January 2021. Statistical analysis was conducted on the usage data of medical consumables for the full year of 2020 and 2021. The application effectiveness of the classification coding consumables management model in the workplace was evaluated. Results—In the third quarter and fourth quarter of 2021, the percentage of medical consumables usage per hundred yuan was 24.6% and 18.4%, respectively, both lower than 26.0% and 26.3% in 2020, with statistically significant differences (P<0.05). Compared to the year 2020, the total amount of medical consumables in 2021 increased by 21.2%, and the amount of high-value consumables increased by 40.4%, with an increase of 4.5% in the number of high-value consumable types. After comparing 300 cases of medical consumables sampled for each quarter, the rates of irrational usage in the second, third, and fourth quarters of 2021 were 14.0%, 12.7%, 11.7%, and 7.0%, respectively, all lower than 18.7% in 2020, with statistically significant differences (P<0.05). Conclusion—The management of medical consumables through classification coding can effectively control the percentage of medical consumables usage per hundred yuan, facilitate the control of various types of consumables, and increase the total revenue of medical consumables while reducing the rate of irrational usage.","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135322354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Use of Monopolar Low-Temperature Plasma Electrode in Lumbar Spinal Canal Expansion, Decompression, Bone Grafting, and Fusion Internal Fixation Surgery","authors":"Yuchao Liu, Xiucheng Li","doi":"10.32629/jcmr.v4i3.1307","DOIUrl":"https://doi.org/10.32629/jcmr.v4i3.1307","url":null,"abstract":"Objective: This study aims to explore the therapeutic effects of using a monopolar low-temperature plasma electrode and a high-frequency electrotome during lumbar spinal canal expansion, decompression, bone grafting, and fusion internal fixation surgery. The study also investigates the impact of these techniques on inflammatory indicators and quality of life in patients. Methods: A total of 100 patients with lumbar spondylolisthesis treated between June (January) 2022 and July (March) 2023 were selected for this study. They were randomly divided into a control group and an observation group, with 50 cases in each group. Both groups underwent lumbar spinal canal expansion, decompression, bone grafting, and fusion internal fixation surgery. The control group used a high-frequency electrotome during surgery, while the observation group used a monopolar low-temperature plasma electrode. Surgical indicators (operation time, intraoperative blood loss), inflammatory indicators, pain levels, and quality of life were compared between the two groups. Results: The operation time in the observation group was shorter than that in the control group (P<0.05). Postoperative levels of TNF-α and CRP were lower in the observation group than in the control group (P<0.05). The observation group had lower VAS scores and higher SF-36 scores compared to the control group (P<0.05). Conclusion: The use of a monopolar low-temperature plasma electrode in lumbar spinal canal expansion, decompression, bone grafting, and fusion internal fixation surgery yields positive therapeutic outcomes. It effectively reduces operation time, alleviates patient's inflammatory responses and pain levels, aids in postoperative recovery, and enhances quality of life. These results suggest the potential for wider adoption.","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135317206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics Analysis of Hospitalized Patients Infected with the Omicron Variant of the Novel Coronavirus","authors":"Chao Rui, Liyun Chen, Hui He, Fen Huang, Zhi Zhang","doi":"10.32629/jcmr.v4i3.1310","DOIUrl":"https://doi.org/10.32629/jcmr.v4i3.1310","url":null,"abstract":"Objective: It’s to analyze the clinical characteristics of hospitalized patients infected with the Omicron variant of the novel coronavirus. Methods: This study retrospectively analyzed the clinical data of 374 Omicron-infected patients admitted to The Third People's Hospital of Wuhu City from January 1, 2022, to December 31, 2022. Clinical characteristics were analyzed. Results: The mean time to nucleic acid conversion was 10.93±3.55 days, with a median of 10 days. There was no statistically significant difference in the infection rate between females and males (P>0.05). The highest proportion of patients was in the age group of 0-44 years (P<0.05). Among patients, those without underlying diseases were more prevalent (P<0.05). The majority of patients had no symptoms or mild symptoms (P<0.05). Regarding vaccination status, most patients had completed the primary immunization or booster immunization (P<0.05). The main symptoms were fever and respiratory symptoms (P<0.05). In laboratory tests, some patients showed a decrease in lymphocyte count (31.82%), elevated C-reactive protein (21.93%), elevated alanine transaminase (18.18%), and elevated creatine kinase (12.30%). Most patients had no lesions on chest CT scans (P<0.05). Traditional Chinese medicine was the primary treatment used (P<0.05). The recovery rate was 100.00%. Conclusion: During this epidemic, the nucleic acid conversion for infected patients occurred around 10 days. Female patients had a higher infection rate, and the majority of cases were asymptomatic or mild. Most patients had completed either primary or booster immunization, indicating some resistance of the Omicron variant to vaccines. The main symptoms were fever and respiratory symptoms, and patients had significantly elevated white blood cell counts, neutrophil counts, and lymphocyte counts, indicating significant infection symptoms. Traditional Chinese medicine was the primary treatment used, and the recovery rate was 100.00%, suggesting that treatment with Traditional Chinese medicine was effective for the Omicron variant.","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"135 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135322006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application Prospect of Monopolar Low-temperature Plasma Knife in Oral and Maxillofacial Surgery","authors":"Chengwei Li, Xiaosheng Fan, Yixuan Zhang, Lan Wang, Kuangzheng Li","doi":"10.32629/jcmr.v4i3.1308","DOIUrl":"https://doi.org/10.32629/jcmr.v4i3.1308","url":null,"abstract":"Oral and maxillofacial surgery is primarily responsible for the treatment of oral and maxillofacial tumors, jaw fractures, maxillary sinusitis, and other temporomandibular joint diseases using surgical techniques. With improvements in living conditions and dietary changes, the demand for diagnosis and treatment in oral and maxillofacial surgery has been steadily increasing. Simultaneously, both patients and healthcare providers have higher expectations for intraoperative effectiveness and postoperative recovery. With the advancement of technology, surgical knives in oral and maxillofacial surgery have gradually transitioned from traditional physical blades to high-frequency electric scalpels. However, high-frequency electric scalpels have drawbacks, including substantial tissue damage, the generation of intraoperative smoke, electrode adhesion, imprecise cutting, and reliance on traditional surgical blades. This paper proposes the idea of using a monopolar low-temperature plasma knife in oral and maxillofacial surgery, with a focus on research utilizing the monopolar low-temperature plasma surgical system produced by Jingyi Medical (Host Model: PSG-60A; Electrode Model: PS-01) as an example. This equipment disrupts tissue molecular bonds through the low-temperature plasma layer formed around the knife tip, allowing for tissue cutting and separation. This approach significantly reduces tissue damage compared to traditional surgical blades and high-frequency electric scalpels, while also simplifying surgical procedures, improving cutting precision, and enhancing postoperative recovery. Through this research, it can be observed that the monopolar low-temperature plasma knife has significant potential for widespread application in oral and maxillofacial surgery.","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"63 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135317205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Efficacy of Different Doses of Intensity-modulated Radiation Therapy After Breast-conserving Surgery for Early-stage Breast Cancer","authors":"Juan Deng, Chuou Yin, Hao Cheng, Gaoyuan Liu","doi":"10.32629/jcmr.v4i3.1256","DOIUrl":"https://doi.org/10.32629/jcmr.v4i3.1256","url":null,"abstract":"Objective — To investigate the efficacy of different doses of intensity modulated radiation therapy in patients with early breast cancer after breast conserving surgery in order to provide more accurate treatment guidelines for clinical practice to further improve treatment outcomes and quality of life in breast cancer patients. Methods — The main objective of this study was to evaluate the effects of different radiotherapy regimens after breast conserving surgery for early stage breast cancer. The study included 96 patients with early-stage breast cancer who were treated in our oncology department between January 2020 and May 2021. Patients were self-divided into group A and Group B by double-blind method, with 48 patients in each group. Group A received radiation therapy of 50Gy/25Fx for the whole breast after surgery, and an additional dose of 60Gy/25Fx was added to irradiate the tumor bed. Group B received whole breast radiation therapy of 50Gy/25Fx and tumor bed push of 10Gy/5Fx at the same time. The study will compare the differences between the two groups in treatment outcomes, three-year survival, and various adverse events that occur within six months of radiotherapy. Results — When comparing the two groups with different doses of IMRT, the authors focused on the difference in the percentage of the combined volume of prescription dose exposure above the percentage measurement line and the target dose uniformity index. The results showed very significant statistical differences between the two groups for both measures. In addition, it is worth noting that the probability of adverse reactions in group B patients exceeded that in group A, with a statistically significant difference. Conclusion — For patients undergoing breast conserving surgery for early stage breast cancer, receiving radiation therapy with a total dose of 60Gy can significantly improve treatment outcomes. Compared with other dosing regimens, the use of 60Gy intensity modulated radiation therapy can significantly reduce the incidence of adverse reactions while achieving the same therapeutic effect.","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"EM-11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135322007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypernatremia: Epidemiology and Predictive Role in Emerging and Established Acute Kidney Injury.","authors":"Clara Jansch,&nbsp;Igor Matyukhin,&nbsp;Marahrens Marahrens,&nbsp;Rebecca Lehmann,&nbsp;Baschar Khader,&nbsp;Oliver Ritter,&nbsp;Susann Patschan,&nbsp;Daniel Patschan","doi":"10.14740/jocmr4990","DOIUrl":"10.14740/jocmr4990","url":null,"abstract":"<p><p>Hypernatremia (plasma sodium > 145 mmol/L) reflects impaired water balance, and affected patients can suffer from severe neurologic symptoms. Hyponatremia, on the other hand, is the most frequent electrolyte disorder in hospitals. It may be diagnosed in acute kidney injury (AKI), but hyponatremia prior to the diagnosis of AKI has also predictive or prognostic value in the short term. Aim of the article was to summarize data on both, epidemiology and outcomes of in-hospital acquired hypernatremia (\"In-hospital acquired\" refers to the diagnosis of either hypo- or hypernatremia in patients, who did not exhibit any of these electrolyte imbalances upon admission to the hospital). It also aimed to discuss its predictive role in patients with emerging or established AKI. Five databases were searched for references: PubMed, Medline, Google Scholar, Scopus, and Cochrane Library. Studies published between 2000 and 2023 were screened. The following keywords were used: \"hypernatremia\", \"mortality\", \"pathophysiology\", \"acute kidney injury\", \"AKI\", \"risk prediction\", \"kidney replacement therapy\", \"KRT\", \"renal replacement therapy\", \"RRT\", \"hyponatremia\", and \"heart failure\". A total of 16 studies were deemed eligible for inclusion. Among these, 13 studies had a retrospective design, two investigations were published as secondary analyses from prospective trial cohorts, and one study was prospective in nature. Out of the 16 studies, 11 focused on the epidemiology and outcomes of hypernatremia, while five investigations were related to AKI and/or AKI-associated endpoints. The prevalence of hypernatremia diagnosed during hospitalization varied from 1.9% to 6.8%, with one exception where it was 30.8%. All studies demonstrated associations between hypernatremia and mortality, even over extended periods after discharge. In AKI patients, hypernatremia shows potential for predicting in-hospital death. In conclusion, hypernatremic individuals are at higher risk of death during in-hospital therapy. Also, the electrolyte disorder potentially qualifies as a future biomarker for AKI onset and AKI-associated mortality.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"15 8-9","pages":"399-405"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/84/jocmr-15-399.PMC10563820.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Human Limits: Harnessing Artificial Intelligence to Optimize Immunosuppression in Kidney Transplantation.","authors":"Debargha Basuli,&nbsp;Sasmit Roy","doi":"10.14740/jocmr5012","DOIUrl":"10.14740/jocmr5012","url":null,"abstract":"<p><p>The field of kidney transplantation is being revolutionized by the integration of artificial intelligence (AI) and machine learning (ML) techniques. AI equips machines with human-like cognitive abilities, while ML enables computers to learn from data. Challenges in transplantation, such as organ allocation and prediction of allograft function or rejection, can be addressed through AI-powered algorithms. These algorithms can optimize immunosuppression protocols and improve patient care. This comprehensive literature review provides an overview of all the recent studies on the utilization of AI and ML techniques in the optimization of immunosuppression in kidney transplantation. By developing personalized and data-driven immunosuppression protocols, clinicians can make informed decisions and enhance patient care. However, there are limitations, such as data quality, small sample sizes, validation, computational complexity, and interpretability of ML models. Future research should validate and refine AI models for different populations and treatment durations. AI and ML have the potential to revolutionize kidney transplantation by optimizing immunosuppression and improving outcomes. AI-powered algorithms enable personalized and data-driven immunosuppression protocols, enhancing patient care and decision-making. Limitations include data quality, small sample sizes, validation, computational complexity, and interpretability of ML models. Further research is needed to validate and enhance AI models for different populations and longer-term dosing decisions.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"15 8-9","pages":"391-398"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/d4/jocmr-15-391.PMC10563819.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid Free Total Intravenous Anesthesia With Dexmedetomidine-Esketamine-Lidocaine for Patients Undergoing Lumpectomy.","authors":"Xia Li Qian, Ping Li, Ya Jie Chen, Shi Qin Xu, Xian Wang, Shan Wu Feng","doi":"10.14740/jocmr5000","DOIUrl":"10.14740/jocmr5000","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study was to evaluate the feasibility of the opioid-free anesthesia (OFA) technique with dexmedetomidine, esketamine, and lidocaine among patients diagnosed with benign breast mass and scheduled for lumpectomy.</p><p><strong>Methods: </strong>We enrolled 80 female patients who were aged from 18 to 60 years, graded with American Society of Anesthesiologists physical status I or II, diagnosed with benign breast mass, and scheduled for lumpectomy. These patients were randomly treated with OFA or opioid-based anesthesia (OBA). Dexmedetomidine-esketamine-lidocaine and sufentanil-remifentanil were administered in OFA and OBA group, respectively. We mainly compared the analgesic efficacy of OFA and OBA technique, as well as intraoperative hemodynamics, the quality of recovery, and satisfaction score of patients.</p><p><strong>Results: </strong>There was no significant difference between the two groups with regard to visual analogue scale (VAS) score at 2, 12, and 24 h after extubation. However, the time to first rescue analgesic was prolonged in OFA group than that in OFB group (6.18 ± 1.00 min vs. 7.40 ± 0.92 min, P = 0.000). Further, mean arterial pressure and heart rate at T0 (entering operating room), T1 (before anesthesia induction), T2 (immediately after intubation), T3, T4, and T5 (1, 5, and 10 min after surgical incision, respectively) were significantly higher in OFA group than that in OBA group. Incidence of hypotension and bradycardia was lower in OFA group. Consistently, fewer patients in OFA group consumed atropine (8% vs. 32%, P = 0.019) and ephedrine (5% vs. 38%, P = 0.001) compared to OBA group. Furthermore, patients in OFA group had a longer awakening time (7.14 ± 2.63 min vs. 4.54 ± 1.14 min, P = 0.000) and recovery time of orientation (11.76 ± 3.15 min vs. 6.92 ± 1.19 min, P = 0.000). Fewer patients in the OFA group experienced postoperative nausea and vomiting (PONV) (11% vs. 51%, P = 0.000) and consumed ondansetron (5% vs. 35%, P = 0.003) compared to OBA group. And patients in OFA group had a higher satisfaction score than those in OBA group (9 (8 - 9) vs. 7 (7 - 8), P = 0.000).</p><p><strong>Conclusion: </strong>For patients undergoing lumpectomy, OFA technique with dexmedetomidine-esketamine-lidocaine showed a better postoperative analgesic efficacy, a more stable hemodynamics, and a lower incidence of PONV. However, such advantage of OFA technique should be weighed against a longer awakening time and recovery time of orientation in clinical practice.</p>","PeriodicalId":94329,"journal":{"name":"Journal of clinical medicine research","volume":"15 8-9","pages":"415-422"},"PeriodicalIF":1.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e9/cb/jocmr-15-415.PMC10563822.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41224814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}