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0.05), but pretreatment with yohimbine 10 ug significantly reduced the antinociceptive effect of tramadol ( 10ug) at 35 min and 40 min and the nociception score increased by 56% and 41 % respectively ( P 0.05). Scatchard analysis of the saturation isotherms showed that H-yohimbine was bound to a single binding site with a Kd value of 1.79 nM. The competition curve of tramadol was sigmoidal with a Ki value of 34.14 uM and an IC50 value of 68.25 uM. Tramadol was 19 000-fold less potent for binding to a2-adrenoceptor of the spinal cord as compared to H-yahimbine. Conclusion Intrathecal tramadol produces time-dependent antinociception. Tramadol has very low affinity with a2-adrenoceptor of the spinal cord. A part of its intrathecal antinociceptive effect was related to indirect a2-adrenoceptor effect of the spinal cord.
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Objective: To observe two methods of cardioplegia under intrograde and retrograde, using mixed hypothemic blood in 59 patients receiving coronary artery bypass graft (CABG). Method:During perioperation and postoperation 24 hours,hemodynamie parameters were recorded. Myocardial enzyme level,the changes of ECG on 12 leads in postoperation,the frequency of using inotrope,time of staying in ICU and automatical reovery heart beat rate after openning aortic clamp were tested. Result: Cardioplegia by mixed hypothemie blood had better protective effects to the heart function, all patients could left the ICU safely,without significant differences between the two methods of cardioplegia,but in the retrograde group,there was obvious reduce in the change of myocardial enzyme level and less change of ECG in postoperation compared with those in the intrograde group. Conclusion:Both methods of mixed hypothemic blood for cardioplegia in CABG can protect effetively myocardium, but retrograde eardiaoplegia has better effect.
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12g/dl. The patients were premedicated with intramuscular atropine 0.01 mg ? kg-1 and midazolam 0.06 mg?kg-1 . Anesthesia was induced with fentanyl 3-5?g?kg-1, propofol 1.5-2.0 mg?kg-1 and vecuronium 0.1 mg ? kg-1 and maintained with inhalation of 60%-65% N2O-O2 and 1%-3% isoflurane. The patients were mechanically ventilated after tracheal intubation and PETCO2 was maintained at 4.67-5.33 kPa. Radial artery was cannulated for intra-arterial pressure monitoring and blood sampling and internal jugular or subclavian vein was cannulated for CVP monitoring and blood sampling. Before anesthesia 5% glucose-normal saline 6-8 ml?kg-1 was infused to compensate for preoperative fluid restriction after midnight. 6% HES 200/0.5 15 ml?kg-1 was infused before operation in 25 min. The inhalation concentration of isoflurane was adjusted to maintain CVP, BP and HR and avoid circulatory overload. Small dose of nitroglycerin (NTG) was given iv if necessary. During operation blood loss was replaced with equal volume of 6 % HES 200/0.5. Blood transfusion was considered when Hb 25% . Diureties was used at the end of surgery. ECG, BP, CVP, SaO2 and cardiac output (using non-invasive NCCOM-3) were continuously monitored throughout operation. Arterial and centralvenous blood samples were taken for blood gas analysis and determination of lactic acid concentration (LA) before (T0) and 15 min (T1) after AHHD, before homologous blood transfusion (T2 ) and at the end of surgery (T3) . Oxygen consumption (VO2 ) and oxygen extraction ratio (ERO2) were calculated. Results (1) There were no significant changes in BP and HR after AHHD and during operation. CVP increased significantly after AHHD at T1-3 but within normal range. Cardiac output increased by 22.9% (T1), 17.0% (T2) and 30.5% (T3) after AHHD. (2)Hct and Hb decreased gradually after AHHD as hemodilution continued and five patients received homologous RBC transfusion because of low Hb. DO2 increased by 11% after AHHD. In five patients DO2 and VO2 prior to homologous RBC transfusion were lower than baseline value (T0). ERO2 increased by 13.5% (T1), 34.9% (T2) and 24.9% (T3) respectively. (3) Electrolytes, pH and LA were kept stable throughout operation. Conclusions 6% HES 200/0.5 can be used safely for AHHD in terms of hemodynamic changes and oxygen transport and ERO2.
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Objective To assess the lung inflammatory response to cardiopulmonary bypass (CPB). Methods Twenty ASAⅡ-Ⅲ patients of either sex (9 male, 11 female) aged (43 ? 12)yr, undergoing elective cardiac valve replacement were studied. Patients with liver or kidney dysfunction and lung inflammatory diseases were excluded. Premedication included intramuscular morphine 5mg and atropine 0.1mg. Anesthesia was induced with propofol 1.5-2.0mg? kg-1, fentanyl 5?g?kg-1 and vecuronium 0. 1mg?kg-1 and maintained with isoflurane (
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Objective To investigate the peri operative changes and anesthetic management during orthotopic liver transplantation (OLT) Methods General anesthesia or general anesthesia combined with epidural anesthesia was applied During the anhepatic phase, extracorporeal veno venous bypass (EVVB) was established Hemodynamics, respiratory function, blood gas, biochemistry, blood coagulation function, body temperature, blood glucose, urinary output and bleeding output were monitored According to the different characteristics of the pre anheptic phase, anheptic phase and neoheptic phase during OLT, the corresponding anesthetic management was supplied Results Applying EVVB during the anheptic phase could keep hemodynamics stable, but in 15 min of the primary anheptic and neoheptic stages a transient circulatory instablity occurred,and the rapid blood volume expansion was required Through comprehensive management, there was no obvious acid base disturbance during the phases The hypocalcemia, hypokalemia and hyperglycemia occurred and thebody temperature changed greatly,to require timly corrective measures Certain coagulative disturbances occurred, to require the supplement of coagulation factors, proper hemostatic drugs and protamine for neutralizing heparin Intraoperatively, anti rejection drugs were required Peri operatively, the blood glucose levels were higher than normal Conclusions Utilizing EVVB during the anheptic phase can be helpful to maintain hemodynamics stable, prevent obvious acidosis and hyperkalemia The anesthetic management during the neoheptic phase should be required to correcte hypothermia, hypocalcemia, hypokalemia, hyperglycemia and disturbence of coagulation
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Objective: To study the effect of the bolus propofol on myocardial ? adrenergic receptor. Method: Twenty-one,aging 4-6 weeks,male health SD rats,were divided randomly into three groups:low dose group (L)with propofol of 5mg/kg,high dose group(H)with 12mg/kg of propofol and control group(C) with NS alone. The drugs were administered through the rat's tail vein in conscious state. 3 minutes after administration,the raps heart were totally taken out to investigate rat's myocardial ? adrenergic receptors with radioligand binding assay. Result:Compared with those in control group,in L group there was a decrease in ? adrenergic receptor density(Bmax),but no change in the affinity of ? adrenergic receptor (KD); In H group,Bmax decreased,KD value increased. The Bmax and KD were significantly different between L and H group. Conclusion:Intravenous bolus doses of propofol may cause down-regulation on myocardial ? adrenergic receptor of rats in dose-related way.
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Objective To investigate the effect of astragalus membranaceus on the ultrastructure of small intestinal epithelial cells in rabbits with hemorrhagic shock. Methods Twenty-four New Zealand white rabbits of both sexes weighing 2-3 kg were randomly divided into 3 equal groups : (A) control group received normal saline iv ( n = 8); (B) group HI received astragalus membranaceus 20 mg? kg-1 iv ( n = 8); ( C) group H2 received astragalus membranaceus 10 mg?kg-1 iv ( n = 8 ). Animal model of hemorrhagic shock-resuscitation was established according to Wigger's. A strip of small intestine, 10 cm in length was taken from distal end of ileum for electron microscopic examination. The two-dimensional structural parameters and three-dimensional structural parameters of mitochondria were calculated. Results (1) Morphological changes of small intestine : in group H1 epithelial cells were orderly arranged, with relatively normal mitochondria and intestinal villi were slender and orderly; in group H2 the nuclei in epithelial cells were dwindled, the intestinal villi were thin and short and unorderly arranged with slightly swelled mitochondria and blurring ridges. Endoplasmatic reticulum was dilated; in group C the gaps between epithelial cells widened. There were a lot of apoptotic cells. Microvilli were thin and short and swelled. Mitochondria were swelled with broken ridges. Endoplasmatic reticulum was severely dilated. (2) Structural parameters of mitochondria : in group C there were least mitochondria and the swelling of mitochondria was severe; in group H1 there were plenty of mitochondria and the swelling was slightest; in group H2 the changes in mitochondria were between group C and H1. Conclusion Astragalus membranaceus can protect small intestine from ischemia/reperfusion injury in a dose-dependent manner.
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Objective To evaluate the effect of clonidine added to ropivacaine for epidural anesthesia. Methods Sixty ASA Ⅰ - Ⅱ patients aged 24-62 yr, weighing 50-76 kg, scheduled for elective gynecological surgery under epidural anesthesia were randomly assigned to one of four equal groups of 15 patients each, according to the dose of clonidine added to ropivacaine solution: group 1 (R) received no clonidine and served as control; group 2-4 in which clonidine 50, 100 or 150 ug was added to 0.75% ropivacaine 25 ml (R-C 50, R-C 100, R-C 150). Epidural anesthesia was performed at L2-3. Epidural catheter was inserted into epidural space and advanced in cephalad direction for 3.5 cm. Ropivacaine solution was prepared and provided by a specially designated person. A test dose of 5 ml of ropivacaine was given. 5 min later when epidural placement of catheter was confirmed, the rest 20 ml of ropivacaine was given in fractions of 5 ml every 2-3 min. At the beginning of operation midazolam 2.5-3.5 mg was given iv. During operation if the patient felt uncomfortable when viscera were being pulled, ketamine 0.5 mg? kg-1 was given iv. The onset and duration of analgesia, the height of black, the degree of motor block as well as adverse effects were recorded. Results The onset time of motor block was significantly shorter, the duration of analgesia was significantly longer, the incidences of visceral pain and shivering were significantly lower and ketamine requirement was significantly reduced in group R-C 100 and R-C 150 as compared with group R. However the incidence of hypotension, the amount of fluid infused and epinedrine requirement were significantly increased in group R-C 150. Conclusion The addition of clonidine 100 ug to 0.75 % ropivacaine 25 ml improves the effect of epidural block without increasing adverse effects.
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Objective To evaluate the efficacy and safety of 0.75% ropivacaine versus 0.75% bupivicaine for combined spinal and epidural anesthesia(CSEA) for cesarean section. Methods Forty primiparae(ASA Ⅰ-Ⅱ) scheduled for elective cesarean section were divided into two groups: ropivacaine group received 0.75% ropivacaine 1 .2-1 . 4ml(9-10. 5mg) for spinal anesthesia and bupivicaine group received same amount of 0.75% bupivicaine. During operation when spinal analgesia was inadequate, 1.6% lidocaine was supplemented via epidural catheter. Blood pressure , heart rate and SpO2 were monitored. Sensory block(pin prick), motor block(modified Bromage scale), quality of analgesia and relaxation of abdominal wall were assessed. Apgar score of the neonates and umbilical artery blood gas as well as side effects were recorded. Results There was no significant difference between the two groups in age, height, body weight of the patients and duration of operation. The height of block was comparable between the two groups but the onset time was longer and duration of block was shorter in ropivacaine group. Analgesia and muscle relaxation were satisfactory and Apger score was 10 at 1 mm and 5mm in both groups. Blood gas values were within normal range in both groups. Motor block was weaker with ropivacaine than that with bupivacaine(P
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To observe the effects pf propofol combined with fentanyl on metabolic rate of energy cxpen diture in anesthesia. Method: Thirty-one elective neurosurgical adult patients, ASA class Ⅰ-Ⅱ, received tolal intravenous anesthesia with propofol combined with fentanyh Oxygen consumption (VO_2), carbon dioxide production (VCO_2), respiratory quotient(RQ), metabolic rate(MR)were measured. Resuh: VO_2 and MR increased when patients' posture changed or there existed strong operative stimulation. VO_2 and MR during post induction were 91.09% and 91.29% of the level before anesthesia respectively(P