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Objective:To explore whether the simulation training system for transesophageal echocardiography (TEE) can improve the effectiveness of standardized training of resident anesthesiologists.Methods:A total of 72 resident anesthesiologists without experience in cardiac ultrasound were randomly divided into traditional teaching group (36 residents) and simulation training group (36 residents). Before and after the teaching, theoretical examinations of 5 knowledge points related to cardiac ultrasound were conducted. After a standardized rotation of 2 months, the students were re-examined for both theories and operations, and clinical indicators were recorded. SPSS 23.0 was used for the t-test, rank sum test, chi-square test, or Fisher's exact test. Results:There was no significant difference in scores of theoretical examinations between the two groups of students before teaching. After teaching, the scores of the simulation training group were higher than those of the traditional teaching group, and the differences were significant in cross-sectional recognition and image diagnosis ( P<0.05). After rotation, there was no significant difference in theoretical examination between the two groups of students, but the score of operation was significantly higher in the simulation training group than in the traditional teaching group ( P<0.05). During the rotation period, the incidence of TEE-related complications was relatively low and the quantitative score of clinical operational skill assessment was relatively high in the simulation training group ( P<0.05). Conclusion:Anesthesia residents who receive training with the simulation system before TEE training can quickly acquire operational skills, reduce related complications, and more accurately identify and obtain standard TEE sections, which has significant value for clinical teaching.
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Objective:To observe the effects of bilateral thoracic paravertebral block (TPVB) on left ventricular myocardial work using pressure-strain loop(PSL) in patients before off-pump coronary artery bypass graft(OPCABG).Methods:A total of 24 patients with coronary heart disease undergoing selective OPCABG were recruited in the First Affiliated Hospital of Nanjing Medical University from May to August 2021. All patients underwent ultrasound-guided TPVB preoperatively. Left ventricular global work, including global longitudinal strain(GLS), global work index(GWI), global constructive work(GCW), global waste work(GWW), global work efficiency(GWE), and regional work, including myocardial work index(MWI), myocardial work efficiency(MWE) were observed before TPVB and 20 minutes after TPVB.Results:The parameters of heart rate and left ventricular outflow tract blood flow were decreased [(69.13±10.72)bpm vs (65.46±9.66)bpm, P=0.010; (13.86±2.83)ml vs (12.72±2.60)ml, P=0.017]. The MWI in regional segments of hypokinesis and akinesis were significantly improved [hypokinesis: (1 175.76±206.64)mmHg% vs (1 349.38±462.35)mmHg%, P=0.004; akinesis: (684.94±251.39)mmHg% vs (965.35±384.33)mmHg%, P=0.001] and the MWE in regional segments of hypokinesis and akinesis were improved [hypokinesis: (87.79±7.46)% vs (90.35±6.39)%, P=0.029; akinesis: (70.24±18.03)% vs (80.15±16.65)%, P=0.021]. There were no significant changes in MWI, MWE, LVEF, GLS, GWI, GCW, GWW and GWE(all P>0.05). Conclusions:Based on PSL, the changes of left ventricular work in patients with OPCABG before and after TPVB show that TPVB can improve the blood supply of the ischemic myocardium, which provides a reliable basis for optimizing the perioperative anesthesia management.
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Objective:To evaluate the left ventricular myocardial work parameters of the animal models with left bundle branch block (LBBB) and evaluate the effects of LBBB on left ventricular function and motion pattern by pressure-strain loops (PSL) of speckle tracking imaging (STI).Methods:In Twenty-four healthy male beagles, LBBB was induced by radio frequency ablation under anesthesia, and blood pressure was measured at the same time. Electrocardiograms and echocardiography images were acquired before (baseline), 30 minutes after (acute-LBBB) and 3 months after(chronic-LBBB) the creation of LBBB respectively. STI was applied to measure the left ventricular global longitudinal strain (GLS) and obtain the the PSL of each time point to evaluate the left ventricular global and segmental myocardial work parameters.Results:Compared to the baseline, the global work efficiencies(GWE) were obviously reduced ( P<0.05) and global wasted works(GWW) were significantly increased ( P<0.01) in the acute-LBBB and chronic-LBBB, significant differences were observed in GLS between acute-LBBB and baseline( P=0.04). In baseline, the work efficiency (WEsept) and the constructive work (CWsept) in the basal and middle segments of the septal wall were both obviously higher than the corresponding segments of left ventricular lateral wall( P<0.01), while the distribution of the wasted work(WWsept) was opposite( P<0.01). In acute-LBBB, the WEsept of all segments were significantly decreased ( P<0.05), the WWsept were obviously increased( P<0.05), the CWsept of basal segment was significantly reduced( P=0.01), while the wasted work in the basal segment of lateral wall(WWlat) was increased( P=0.04) compared with the baseline. Compared with the acute-LBBB, the WEsept of basal and middle segments were mildly recovery( P=0.03) in chronic-LBBB, but were still lower than the baseline ( P=0.001), the changes of the other myocardial work parameters of septal and lateral wall were similar to the acute-LBBB. Conclusions:Both acute-LBBB and chronic-LBBB can lead to the changes of left ventricular global and segmental myocardial work parameters. The myocardial work parameters of left ventricle can quantitatively analyze the changes of left ventricular function and motion pattern of the LBBB.
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Objective To compare clinical effect and safety of left-double-lumen tube and bron-chial blocker in vedio-assisted atrial fibrillation ablation.Methods Forty-eight patients,26 males and 22 females,aged 45-65 years,ASA physical status Ⅰ or Ⅱ,who underwent vedio-assisted atrial fi-brillation ablation were randomly divided into double-lumen tube (group A)and bronchial blocker (group B),with 24 patients in each group.The tube type of group A was left-double-lumen tube. Bronchofiberscope was used for location in every patient.The mean artery pressure (MAP)and heart rate (HR)before intubation,intubation positioning time,peak airway pressure (Ppeak)after 5 min of one-lung ventilation,lung collapse,incidences of hoarseness,pharyngalgia and choke were ob-served.Results Intubation positioning time between two groups was not statistically significant. MAP and HR were significantly increased at intubation positioning time in both groups,to be specif-ic,they were significantly in group A than in group B (P <0.05 ).When left lungs blocked,Ppeak and qualities of lung collapse were not statistically different between the two groups.When right lungs blocked,group A was higher than that in group B (P < 0.05 ).Cough,hoarseness and sore throat were more frequently seen in group A than in group B.Conclusion Both double-lumen tube and bron-chial blocker can be used in video-assisted atrial fibrillation ablation with satisfying effects.As for the quality of lung isolation,double-lumen tube was better than bronchial blocker.However,compared with bronchial blocker,double-lumen tube results in more unstable hemodynamics and higher occur-rence of hoarseness,pharyngalgia and choke.