Abstract:As the population aging and prolonged life expectancy, there would be more and more surgical operations for the elderly in China. Besides organ dysfunction, the elderly also simultaneously suffered many comorbidities, such as stroke, cardiac ischemic disease, hypertension and diabetes. The specific characteristic of the elderly increases the incidence of postoperative complications and mortality, and presents a big challenge for perioperative management. Anesthesiologists may play important role in improving outcome of the elderly patients by optimizing perioperative management.

Abstract:Objective To determine the effect of hepatic portal occlusion with Pringle maneuver on intraoperative peripheral perfusion index (PI) and accuracy of non-invasive hemoglobin (SpHb) in the elderly patients. Methods Forty-three patients (over 60 years old) undergoing elective liver surgery under general anesthesia in our hospital from June 2013 to January 2014 were enrolled in this study. Time-matched PI, non-invasive hemoglobin (SpHb) and invasive hemoglobin (Hb) before and after Pringle maneuver were recorded. Bland-Altman analysis and linear regression model were used to evaluate the change of PI and difference between SpHb and Hb before and after Pringle maneuver. Results Before hepatic portal occlusion, there were 44 pairs valid test data collected. The percentage of data pairs with PI>1.4 covered 77.3%, that with difference between SpHb and Hb below 1 g/dl took 75.0%, bias of SpHb was 0.62 g/dl, 95% confidence interval was -1.15 to 2.38 g/dl. After hepatic portal occlusion, there were 73 pairs valid test data collected, the percentage of data pairs with PI>1.4 was 67.1%, that with difference between SpHb and Hb below 1 g/dl was 35.6%, bias of SpHb was 1.12 g/dl, 95% confidence interval was -0.98 to 3.23 g/dl. The linear regression showed that the absolute value of difference between SpHb and Hb was negatively correlated with PI (r=-0.32, P<0.05). Conclusion Hepatic portal occlusion with Pringle maneuver decreases accuracy of SpHb in elderly patients by reducing peripheral PI. Invasive testing for Hb should be more reliable to guide blood transfusion decisions after hepatic portal occlusion.

Abstract:Objective To determine the median effective background volume (MEBV₅₀) of 0.2% ropivacaine in ultrasound-guided continuous sciatic nerve block in the elderly patients with knee ankylosing after surgery releasing. Methods Twenty-two elderly patients (aged 65-79 years, weighed 58-90 kg, ASA Ⅰ-Ⅲ) who underwent arthrolysis of knee joint after total knee arthroplasty in our department from January 2014 to May 2016 were recruited in this study. All patients received ultrasound-guided continuous sciatic nerve block by means of subgluteal approach after manipulation with intravenous general anesthesia. After catheter placement, the volume of the injected solution was varied for consecutive patients using the Dixon’s up-and-down stair-case method according to the response of the previous patient (initial volume:5 ml/h; up-and-down steps:0.5 ml/h). We recorded the blockade situation of sensory at 24 and 48 h after the placement of the stimulation catheter. Results For ultrasound-guided continuous sciatic nerve block with subgluteal approach, the MEBV₅₀ of 0.2% ropivacaine was 4.3 ml/h (95% confidence interval:4.0-4.6 ml/h) for analgesia in the elderly after arthrolysis of knee joint. Conclusion When 0.2% ropivacaine is used for ultrasound-guided subgluteal continuous sciatic nerve block in elderly patients after knee arthrolysis, the MEBV₅₀ is 4.3 ml/h.

Abstract:Objective To determine the value of preoperative electrocardiogram (ECG) in the prediction of postoperative cardiovascular complications in elderly patients undergoing schedualed non-cardiac surgery. Methods A retrospective cohort study was carried out on the patients aged 60 years or older undergoing elective non-cardiac surgery in our department from November 15,2 to January 15,3. The results of preoperative ECG, perioperative data and postoperative complications during the hospital stay were recorded and analyzed. Results There were 784 patients included in the final analysis, and 275 of them (35.1%) were found having cardiac abnormality according to the results of ECG. There was no difference in the incidence of postoperative cardiovascular complications between those patients with and without normal ECG preoperatively (3.7% vs 3.6%, P=0.946). The area under ROC curve for postoperative cardiovascular complications predicted by abnormal preoperative ECG was 0.547 (95%CI:0.447-0.581, P=0.351). Multivariate logistic regression analysis showed that female gender (OR=3.164,5%CI:1.365-7.335, P=0.007), older age (OR=1.131, 95%CI:1.068-1.198, P<0.001), higher grade of American Society of Anesthesiologists Classification (OR=3.067, 95%CI:1.394-6.750,P=0.005) and prolonged duration of surgery (OR=1.284,5%CI:1.045-1.489, P=0.014) were independent predictors of postoperative cardiovascular complications. Conclusion Preoperative ECG is of limited value in the prediction of postoperative cardiovascular complications in the elderly patients undergoing schedualed non-cardiac surgery.

Abstract:Objective To determine the effect of preventative infusion of low-dose dexmedetomidine (DEX) on the incidence of postoperative delirium among the elderly patients with a history of cerebral stroke. Methods Based on our previous random, double-blind, pracebo control study, a total of 161 elderly patients (≥65 years old) with a history of cerebral stroke who were admitted to the intensive care unit (ICU) of our hospital after surgery from May 2011 to November 2013 were enrolled in this study. They were randomly assigned into DEX group [an infusion of 0.1 μg/(kg·h) DEX, n=82] and placebo group (saline, n=79) in the morning from the second day after operation. Delirium was assessed twice daily with the Confusion Assessment Method for the ICU (CAM-ICU) within 7 d after surgery. Results The incidence of postoperative delirium was significantly lower in the DEX group than the placebo group [12/82 (14.6%) vs 23/79(29.1%), P=0.026]. After adjustment of confounding factors, multivariate logistic regression analysis showed that low-dose DEX infusion was an independent influencing factor for postoperative delirium (OR=0.36,5%CI:0.15-0.89, P=0.027). But the occurrence of hypotension was obviously higher in the DEX group than in the placebo group [42.7%(35/82) vs 24.1%(19/79), P=0.012], but no such difference was found between those who had the hypotension intervention from the 2 groups. Conclusion For the elderly patients with a history of cerebral stroke and transferred to ICU after surgery, postoperative prophylactic infusion of low-dose DEX could reduce the incidence of postoperative delirium, but hypotension should be monitored in the duration.

Abstract:Objective To compare the effects of sevoflurane inhalational anesthesia and propofol intravenous anesthesia on the plasma levels of vascular endothelial growth factor (VEGF), vascular cell adhesion molecule-1 (VCAM-1), matrix metalloproteinase-2 (MMP-2) and MMP-9 in the elderly patients undergoing radical surgery for lung cancer, and provide further reference for the options of clinical anesthesia. Methods Sixty ASA Ⅰor Ⅱ lung cancer patients at the grade of American Society of Anesthesiologists (ASA) Ⅰ or Ⅱand aged 60 to 75 years undergoing radical surgery for lung cancer in our hospital were recruited in this study, and randomly divided into 2 groups (n=30):sevoflurane group (group S) and propofol group (group P). After tracheal intubation, 1.7%-3.4% sevoflurane were given to the group S, and maintained its end-tidal of 1-2 MAC until the end of surgery, while, 1.5-3.0 μg /ml target effect-site concentration of propofol was given through controlled infusion in group P until the end. Venous blood samples of 2 ml were harvested at just before induction of anesthesia (T0), 1 h after surgery beginning (T1), 2 h after surgery beginning (T2), 1 h after the end of surgery (T3), and 2 h after the end of surgery (T4) for the levels of VEGF, VCAM-1, MMP-2 and MMP-9 by enzyme linked immunosorbent assay (ELISA). Results Compared with T0, the plasma levels of VEGF and VCAM-1 were significantly decreased in group S at T1-T4 (P<0.05), and those of MMP-2 and MMP-9 were also reduced at T2-T4 (P<0.05). But no such differences were found in group P at T1-T4 (P>0.05). The levels of above indicators were obviously lower in group S than in group P at the period (P<0.05). Conclusion Compared with propofol intravenous anesthesia, sevoflurane inhalation can inhibit the expression of VEGF, VCAM-1, MMP-2 and MMP-9 in the elderly patients undergoing radical surgery for lung cancer.

Abstract:Postoperative cognitive dysfunction(POCD) is a common neurological complication after operation under general anesthesia, and its serious condition will affect the prognosis and quality of life in the patients. The pathogenesis of POCD is a complicated pathophysiologic progress, and influenced by many factors. Awareness of the influencing factors for POCD is helpful to communicate among the anesthesiologists, surgeons, patients and their relatives in order to promote early recovery and improve prognosis for the patients. This article reviewed the influential factors for POCD and summarized its possible mechanisms.

Abstract:Objective To systematically evaluate the relationship of different types of obesity with dyslipidemia in Chinese elderly population over 60 years old. Methods The studies concerning the relationship of obesity and dyslipidemia were retrieved in available Chinese and English databases, and the literatures meeting our inclusion criteria were enrolled, and then quantitative meta-analysis was performed to study the relationship. Results There were 19 cross-sectional studies enrolled in this study, containing totally 63 844 aged people. Random effects model was used because of the considerably high heterogeneity (I²>50%). Compared with the people with normal body mass index (BMI), the multivariate pooled OR was 1.92 (95%CI:1.21-3.05) and 2.13 (95%CI:1.41-3.22) respectively for the overweight and obese people. And the risk of dyslipidemia was significantly higher in the elderly with central obesity than those with normal waist circumference (OR=2.00,5%CI:1.47-2.72). Conclusion Obesity will significantly increase the risk of dyslipidemia in the Chinese elderly population, and more clinical attention should be paid to the problem.

Abstract:Objective To investigate the spectrum of disease in the elderly males by physical examination and analyze the increase of detection rate of major chronic diseases among them. Methods A total of 658 elderly males who took regular physical examination in a military upper first-class hospital during March to July 2015 were enrolled in this study. They were divided into 3 groups according to their age, that is 60-69 years group (n=313), 70-79 years group (n=182) and ≥80 years group (n=163). Their demographic characteristics, history of chronic diseases, lifestyle and other information were collected and analyzed. Results In the subjects, the prevalence of chronic diseases was up to 86.2%, and the average types of chronic diseases were 2.4±1.7. There were 67.0% of the participants having 2 or more chronic diseases, and 41.9% having 3 or more. The prevalence went up to 92.0% among those participants aged ≥80 years. The top 5 chronic diseases were dyslipidemia (37.1%), prostatic hyperplasia (32.9%), hypertension (32.5%), fatty liver (28.5%) and cataract (17.5%). With the increase of age, the subjects had more chronic diseases (P<0.001). Through this physical examination, the detection rate of hypertension, diabetes and dyslipidemia were increased by 7.6%, 0.1% and 10.0% respectively. Conclusion The prevalence of major chronic diseases is high in the subjects by physical examination. The comorbidity of many chronic diseases is common, and a variety of health risk factors coexist. Annual routine physical examination and comprehensive assessment can improve the detection rate of major chronic diseases, and provide scientific data for early diagnosis and treatment.

Abstract:Objective To determine the effect of gastroesophageal reflux disease (GERD) on pulmonary function in the elderly male patients with chronic obstructive pulmonary disease (COPD). Methods A retrospective study was carried out on 158 elderly male COPD patients (≥65 years old) with whole results of pulmonary function test and clinical data who admitted in Geriatric Department of our hospital from February 2002 to January 2016. According to complicated with GERD or not, they were divided into GERD group (n=41) and non-GERD group (n=117). The pulmonary functions were compared between the 2 groups. Results The severity of COPD was significantly severer in the GERD group than the non-GERD group (P<0.05). Compared with the non-GERD group, the forced vital capacity (FVC), forced expiratory volume in 1 second (FEV₁), peak expiratory flow (PEF), the forced mid-expiratory flow (FEF25%-75%), forced expiratory flow after 25% of FVC has been exhaled (FEF25%), forced expiratory flow rate at 50% vital capacity (FEF50%) and forced expiratory flow after 75% of FVC has been exhaled (FEF75%) were significantly lower in the GERD group (P<0.05). Conclusion Complication of GERD affects the pulmonary function and severity in the COPD patients.

Abstract:Objective To determine the effect of using entropy index (EI) for monitoring anesthesia depth on the quality and anesthetic dose of laryngeal mask anesthesia in the elderly patients undergoing fiberoptic bronchoscopy. Methods Sixty-four elderly patients (29 males and 35 females, over 64 years old) who underwent elective fiberoptic bronchoscopy in our hospital were randomized into control (Group C) and EI monitoring group (Group EI), with 32 cases in each group. The drug used in Group C were adjusted according to the results of conventional anesthetic depth monitoring, while those of Group EI were under the guidance of EI. Propofol and remifentanil dual channel target controlled infusion was applied for the both groups. Heart rate (HR), mean arterial pressure (MAP) and oxygen saturation at each time point and the doses of propofol and remifentanil were detected. The time for checking, eye opening, extubation and awakening was also recorded. The adverse reactions such as nausea, vomitting and restless within 24 h postoperatively and intraoperative awareness were observed. Patient’s and bronchoscopy physicians’ satisfaction scores were evaluated. Results Compared with Group C, Group EI had less amounts of propofol and remifentanil, shorter time of eye opening, extubation and awakening, lower incidences of nausea and vomitting in 24 h after operation (P<0.05), and higher patient’s and physician’s satisfaction scores (P<0.05). Conclusion EI monitoring can improve the quality and save the cost of laryngeal mask anesthesia in the elderly patients undergoing fiberoptic bronchoscopy.

Abstract:Objective To investigate the efficacy of coronary rotational atherectomy in the treatment of severe coronary artery calcification in the elderly. Methods Eighty patients with coronary heart diseases admitted in our department from January 2014 to January 2016 were recruited in this study. They were randomly divided into 2 groups, rotational atherectomy group (n=40) and non-rotational atherectomy group (control, n=40). Their operation and perioperative complications were observed and compared between the 2 groups. Results The immediate success rate was significantly higher in the rotational atherectomy group than in the control group (92.50% vs 70.00%, P<0.05). The postoperative left ventricular ejection fraction were significantly increased when compared with that before treatment (P<0.05). There were 2 cases of ventricular fibrillation and 1 case of cardiac arrest in the rotational atherectomy group, but no acute myocardial infarction, cardiac death, coronary perforation or other complications were found. No perioperative complication was observed in the control group. Conclusion Rotational atherectomy has good efficacy in the treatment of severe coronary artery calcification in the elderly.

Abstract:Objective To determine the protective effect of conditioned medium from mesenchymal stem cells (MSCs) on the diabetic nephropathy (DN) rats after intraperitoneal osmotic mini-pump implantation. Methods Thirty Sprasue-Dawley (SD) male rats were randomly divided into 3 groups, these are, normal control group, DN model group and MSCs conditioned medium group, with 10 rats in each group. The rats of the normal control group were fed common food, while those in DN group and MSCs group were fed a high-fat high-sucrose diet. The MSCs group was implanted with Alzet osmotic pump after DN models were confirmed. Blood glucose, serum insulin, triglycerides and other indices were tested in the 3 groups of rats. Renal structural damage was evaluated by periodic acid-Schiff (PAS) staining. Expression of nephrin in the renal tissues was detected by Western blotting. Results The blood glucose, serum insulin, 24-hour urinary protein, serum creatinine and blood urea nitrogen were significantly higher in the MSCs group than in the DN group (P<0.05), and the glomerular mesangial area and the glomerular volume were obviously decreased (P<0.05). The MSCs group had significantly decreased expression of nephrin protein than the normal control group (P<0.05), but the level was higher in comparison with that of the DN group (P<0.05). Conclusion Continuous pumping of conditioned medium from mesenchymal stem cells into abdominal cavity exerts a protective effect on the renal function of DN rats.

Abstract:With the population aging, the problem of comorbidity is becoming more and more serious. Comorbidities affect the life quality of patients and increase the risk of poor prognosis. However, due to limited study and evidence, clinical decision-making becomes difficult and complicated. How to assess the comorbid condition and to guide clinical practice has become an urgent problem to be solved. This review summarized the assessment tools of comorbidity and their clinical applications in order to provide a basis for the future study of comorbidity assessment and comorbid management.

Abstract:Fungi are considered important colonizers of the microbial community, and their proportions and quantities are affected by age, sex, diet, race, region, drugs, diseases and other factors. Intestinal fungi are involved in the human body’s pathophysiological process, and are closely associated with health. In recent years, more and more studies have focused on the colonization of fungi in the digestive tract and their roles in related diseases. At present, evidence shows that the proportions and quantities of intestinal fungi were quite different between healthy people and the patients suffering from tumor,hepatitis, inflammatory bowel disease (IBD), antibiotic-associated diarrhea (AAD), and other disorders. These findings provide new ideas for the further study of intestinal fungi in the diagnosis and treatment of related diseases.

Abstract:Postoperative cognitive dysfunction (POCD) is a common postoperative complication in the elderly patients. It significantly increases morbidity and mortality, elevates medical costs, and reduces the life quality of the patients. Evidence shows there are certain anesthesia risk factors having been proven to be associated with POCD, including the duration, type, drugs and depth of anesthesia, and postoperative analgesia. In this article, we reviewed the studies of anesthetic factors related to POCD in the elderly patients, and hoped to provide the theoretical basis for making sensible choices of high-risk patients so as to reduce its incidence.