ObjectiveTo investigate the feasibility, safety and effectiveness of video-assisted thoracic surgery (VATS) sympathectomy under monitored anesthesia care (MAC) and local anesthesia (LA) without endotracheal intubation as a new fast track recovery surgical strategy for the treatment of palmar hyperhidrosis.
MethodsA total of 124 patients with intermediate or severe hyperhidrosis who were admitted to Guangdong General Hospital were enrolled in this study. With SPSS18 random number generator, all the patients were divided into MAC+LA group and general anesthesia (GA) group with 62 patients in each group. There were 43 males and 19 females in MAC+LA group with their age of 22.25±6.22 years, and 42 males and 20 females in GA group with their age of 23.98±6.67 years. During the surgery, MAC+LA group patients received MAC and oxygen via nasal tube or face mask instead of endotracheal intubation, and GA group patients received GA, endotracheal intubation and controlled ventilation. Clinical outcomes were compared between the 2 groups.
ResultsAll the patients received their operations safely. None of MAC+LA group patients received conversion to GA and controlled ventilation. There was statistical difference in operation time (47.18±12.06 minutes vs. 39.33±13.21 minutes, P=0.002) and length of theatre stay 84.52±22.56 minutes vs. 134.68±26.12 minutes, P=0.000) between MAC+LA and GA group patients. There was no statistical difference in blood loss, incidence of intraoperative SpO2 lower than 95% (2 patients vs. 0 patient), postoperative hospital stay, incidence of postoperative compensatory sweating (86.5% vs. 89.0%) and patient satisfaction rate (94.59% vs.95.12%) between the 2 groups. No intraoperative pain, postoperative complication or symptom recurrence was observed in either group. There was statistical difference in anesthetic preparation time (20.52±10.55 minutes vs. 36.47±12.16 minutes), duration between operation finish and returning to ward (11.26±7.09 minutes vs. 59.39±19.89) minutes and hospitalization cost (RMB 6 376.86±746.00 yuan vs. RMB 8 812.04±867.93 yuan) between the 2 groups. The incidence of postoperative sore throat (0% vs. 100%), monitor time (4 hours vs. 12 hours) and time to resume oral intake (2 hours vs. 6 hours) of MAC+LA group were significantly lower or shorter than those of GA group.
ConclusionVATS sympathectomy under MAC and LA can avoid complications of GA and endotracheal intubation, and provide a safe, feasible, effective and more minimally invasive fast track alternative for the treatment of palmar hyperhidrosis.
ObjectiveTo investigate the application of tension-free herniarepair under local anesthesia in senile inguinal hernia.
MethodsClinical data of 163 cases of senile inguinal hernias with herniorrhaphy under local anesthesia in our department from October 2011 to October 2014 were analyzed retrospectively, including epidural anesthesia 90 patients and local anesthesia 73 patients.
ResultsAll patients were successfully completed surgery. Hospital charges in local anesthesia were much cheaper than that in epidural anesthesia group (P=0.002). Hospital days in local anesthesia were much shorter than that in epidural anesthesia group (P=0.035). Lung complication in local anesthesia were much less than that in epidural anesthesia group (P=0.015). Other indicators were no significant difference between the two groups (P > 0.05).
ConclusionTension-free herniorrhaphy under local anesthesia in elderly patients is safe, reliable, less invasive method with low costs, slight postoperative pain, and worthy of promotion.
ObjectiveTo evaluate the efficiency and clinical outcomes of endoscopic thoracic sympathectomy (ETS) with flexible thoracoscopy under local anesthesia with monitored anesthesia care in primary palmar hyperhidrosis.
MethodsFrom March 2011 to March 2013, we performed ETS with flexible thoracoscopy under local anesthesia with monitored anesthesia in 23 patients with primary palmar hyperhidrosis (PH), including 10 males and 13 females with their age of 25.6±7.2 years (range, 17-32 years). T3 sympathectomy was performed with flexible endoscopy under local anesthesia with monitored anesthesia care. All patients were followed up until May 2014.
ResultsDuring surgery, the vital signs of the patients remained stable. Operation time was 30-40 minites. The symptom of PH disappeared right in the surgery. All patients were discharged from the hospital on the 2nd postoperative day. One patient received unilateral sympathectomy because of pleural adhesion. Other 22 patients received follow-up to May 2014 and no reoccurrence was reported.
ConclusionETS with flexible thoracoscopy under local anesthesia with monitored anesthesia is a safe, microinvasive and effective method.
Objective To evaluate the reliability and validity of the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in preoperative anxiety in patients with local anesthesia. Methods From May to December 2020, a convenient sampling method was used to conduct an APAIS questionnaire survey on patients undergoing percutaneous renal biopsy in the Department of Nephrology, West China Hospital, Sichuan University, and the reliability and validity of the scale were analyzed. ResultsA total of 460 questionnaires were distributed and 444 valid questionnaires were returned, with a valid response rate of 96.5%. The Cronbach α of APAIS was 0.896, the Guttman split-half reliability was 0.811, and the content validity index was 0.891. The model fit was 12.122 for the chi-square fit index/degree of freedom, 0.916 for the goodness-of-fit index, 0.902 for the value-added fit index, 0.079 for the root mean square error of approximation, and 0.946 for the comparative fit index. The APAIS anxiety subscale score was positively correlated with the 7-item Generalized Anxiety Disorder Scale score (r=0.518, P<0.001). Conclusion The APAIS has good reliability and validity for evaluating the level of preoperative anxiety in patients with local anesthesia, but the application of the scale in other conditions requires further testing.
