ABSTRACT
Objective To investigate effects of penehyclidine hydrochloride (PHC)protects a-gainst acute lung injury (ALI)in heart valve replacement patients with cardiopulmonary bypass (CPB).Methods Thirty rheumatic heart disease patients,eighteen males and twelve females with NYHA Ⅱ or Ⅲ,with cardiac valve replacement undergoing CPB were enrolled in the study.All pa-tients were randomly divided into group P and group C (fifteen in each group).Patients in group P re-ceived an intravenous injection of 0.03 mg/kg PHC before anesthesia induction and those in group C received the same volume of normal saline.Blood samples were collected to monitor the concentrations of IL-6,TNF-αand NF-κB at the following time points:before anesthesia induction (T0 ),the end of the operation (T1 ),6 hours (T2 ),12 hours (T3 )and 24 hours(T4 )postoperatively,arterial blood gas analyses were detected and oxygenation index (OI)was calculated at the time of T0 ,T1 and T4 , as well as lung dynamic compliance of patients adopt at the time of soon after anesthesia induction and the end of the operation.The outcomes included duration of intubation (DOI),length of intensive care unit stay (LOI)and length of hospital stay after the surgery (LOH).Results The DOI,LOI and LOH in group P were shorter than those in group C,but there was no statistical significance between groups.The plasma levels of IL-6,TNF-α and NF-κB were higher at T1-T4 than T0 in both groups (P <0.05),and those in group P were statistically lower than group C at T1-T4 (P <0.05).The val-ues of OI at T0 and T1 were obviously lower than T4 in both groups (P <0.05),and that in group P was slightly higher than group C at T4 but without statistical significance.The lung dynamic compli-ance of patients in group P at the end of operation was obviously higher than that in group C (P <0.05).Conclusion PHC inhibits systemic inflammatory response,improves lung compliance,amel-iorates tissue oxygen supply and encourages postoperative rehabilitation in valve heart replacement pa-tients with CPB,and its mechanisms is relevant to the regulation of NF-κB signal way on the produc-tion of such proinflammatory cytokines as IL-6 and TNF-α.
ABSTRACT
Objective To evaluate the effects of ulinastatin on hemorrhagic shock and resuscitation ( HS∕R)?induced acute lung injury in rats. Methods Fifteen SPF adult Sprague?Dawley rats, aged 2-3 months, weighing 300-400 g, were divided into 3 groups ( n=5 each) using a random number table:sham operation group ( group S ) , HS∕R group and ulinastatin group ( group U ) . Carotid arteries were cannulated for blood pressure monitoring and blood?letting. HS∕R was induced by blood?letting and maintained for 1 h, followed by resuscitation with autologous blood transfusion and infusion of normal saline. After cannulation of carotid arteries ( T0 ) , at 5 min after hemorrhagic shock ( T1 ) , before resuscitation ( T2 ) , at 5 min after the expected blood pressure was achieved following resuscitation ( T3 ) , and at 30 min, 1?5 h and 2?5 h after resuscitation ( T4?6 ) , arterial blood samples were collected for determination of interleukin?6 ( IL?6 ) and tumor necrosis factor?α ( TNF?α) concentrations ( by enzyme?linked immunosorbent assay) . Arterial blood samples were collected at T0 , T2 and T6 for blood gas analysis. The pH value, partial pressure of arterial carbon dioxide ( PaCO2 ) , HCO-3 and base excess ( BE) value were recorded, and oxygenation index ( PaO2∕FiO2 ) was calculated. Lungs were removed at T6 , and pulmonary specimens were obtained for examination of pathological changes which were scored, and nucleus was extracted for determination of nuclear factor?kappa B ( NF?κB ) p65 expression by enzyme?linked immunosorbent assay. Results Compared with group S, the pH values, HCO-3 , BE values and OI were significantly decreased, and PaCO2 , plasma IL?6 and TNF?α concentrations, expression of NF?κB p65 in lung tissues, and pathological scores were increased in U and HS∕R groups. Compared with group HS∕R, the plasma concentrations of IL?6 and TNF?α, expression of NF?κB p65 in lung tissues, and pathological scores were significantly decreased, and no significant changes were found in parameters of blood gas analysis in group U. Conclusion Although ulinastatin can alleviate HS∕R?induced acute lung injury, it is insufficient to improve lung oxygenation in rats.
ABSTRACT
Objective To observe the sedative effectiveness of dexmedetomidine (DEX) in digital subtraction angiography (DSA),and to investigate the optimal and safe administration dose.Methods Seventy-five patients undergoing DSA were divided into three groups by random digits table with 25 cases each group.Three groups were treated with constant infusion of DEX by micro-pump 10 min before surgery with the same dose of saline.Then group A,B,C respectively were given 0.3,0.5,0.7 μg/ (kg·h) of the maintenance infusion rate,and stop infusion 10 min before the end of the surgery.At administration (T0),10 (T1),20 (T2) and 30 (T3) min after administration,10 min after surgery (T4),the heart rate (HR),mean arterial pressure (MAP),peripheral oxygen saturation (SpO2),Ramsay score,number of cases that appeared body movement were recorded,and their forgotten degree of operating memory were compared.Results The HR,MAP in three groups at T1-T3 was significandy lower than that at T0 (P＜ 0.05),T4 levels returned to T0 (P＞ 0.05).The HR,MAP in group C at T2,T3 was significantly lower than that in group A and group B at the same time (P ＜ 0.05).The Ramsay score in three groups at T2,T3 was significantly higher than that at T0(P ＜0.05),group B and group C at T2,T3 was significantly higher than that in group A at the same time (P ＜0.05).The SpO2 in three groups at each time point compared within and among groups was no significant difference (P ＞ 0.05).Group B and group C intraoperative involuntary movement in response patients were significantly less than in group A (5,3 cases vs.10 cases).Group A and group C surgery requires intervention patients was significantly more than in group B (8,10 cases vs.3 cases).Group B and group C amnesia grade Ⅲ rate was significantly higher than that in group A [64％ (16/25),72％ (18/25) vs.40％(10/25),P ＜ 0.05].Conclusion Infusion with 0.5 μ g/(kg· h) DEX 10 min after intravenous injection with 0.5 μ g/kg can get a better sedative effect,stable vital signs and less intraoperative adverse memory,and it can also improve patients' comfortable degree,which is safe and appropriate sedative dosage in DSA.
ABSTRACT
Objective To investigate the effects of cardiopulmonary bypass (CPB) with mild hypothermia on the pharmacodynamics of rocuronium in infants undergoing cardiac surgery.Methods Fifty ASA Ⅰ or Ⅱ and NYHA class Ⅰ or Ⅱ infants,aged 6 months-3 yr,weighing6-15 kg,undergoing repair ofventricular septal defect or atrial septal defect under CPB,were randomly divided into 2 groups ( n =25 each):profound hypothermia group and mild hypothermia group.The target temperature was controlled at 28-30 ℃ during CPB in profound hypothermia group,and at 32-34 ℃ during CPB in mild hypothermia group.Neuromuscular block was assessed by TOF-stimulation of ulnar nerve using with TOF-Watch accelerometer.Anesthesia was induced with midazolam O.1 mg/kg,propofol 2 mg/kg,fentanyl 6-8 μg/kg and rocuronium 600 μg/kg,and maintained with intermittent iv boluses of fentanyl and midazolam.The patients was tracheal intubated and mechanically venti1ated when the maximal depression of T1 was achieved.PETCO2 was maintained at 30-40 mm Hg.When T1 returned to 75％ of the control twitch,rocuronium 200 μg/kg was injected intravenously.The onset time,maximal N-M block time,clinical muscle relaxation time,and recovery index were recorded before CPB,during CPB and after CPB.Results Compared with profound hypothermia group,the onset time,maximal N-M block time and clinical muscle relaxation time were significantly shortened during CBP in mild hypothermia group ( P ＜ 0.05).Conclusion Compared with profound hypothermic CBP,mild hypothermic CBP can shorten the onset time and muscle relaxation time of rocuronium in infants undergoing cardiac surgery.
ABSTRACT
ObjectiveTo observe the effect of nerve block combined with sequential analgesia in peri-operative knee arthroscopy.Methods Two hundred patients undergoing knee arthroscopy,were performed lumbar plexus and sciatic nerve block anesthesia by nerve stimulator with ultrasound guidance.Celecoxib was combined for sequential analgesia.The vital signs,the effect of anesthesia in the surgery,the duration of postoperative analgesia,and patient's satisfaction to analgesia were observed to evaluate the clinical effects.ResultsThe vital signs of the patients in the surgery were stable,the effect of anesthesia was good,180 cases of excellent,16 cases of good,4 cases of poor.The duration of postoperative analgesia was 6-10 (8.2 ± 0.5) h.Combined with sequential analgesia program,there was high patient's satisfaction [ excellent 75％ (150/200),good 10％ (20/200),general 10％ (20/200),poor 5％ ( 10/200 ) ].Conclusion The nerve block combined with sequential analgesia is safe and effective in knee arthroscopy,it achieves high patient's satisfaction,this maybe a routine in knee arthroscopy.
ABSTRACT
Objective To investigate the pharmacodynamics characteristics of continuously infused cisatracurium besylate during total intravenous anesthesia. Methods Sixty ASA Ⅰ - Ⅱ patients undergoing elective oromaxillo-facial region surgeon were randomly divided into 4 groups. 1.0, 2.0, 3.0 μg/ (kg · min ) of cisatracurium besylate was continuously infused differently in group Ⅰ, group Ⅱ and group Ⅲ, and 0.1 mg/kg of cisatracurinm besylate was injured interruptedly into group Ⅳ after anesthesia induction. Neuromuscular function was assessed using an accelerometer with train-of-four (TOF) stimulation, the maximum depression of T1and times to T1 recovered to 25%(the clinic time), 75%, 90%(the vivo time) were noted. The recovery index (time of T1 recovery from 25% to 75%) was also calculated. Results The drug consumptions of cisatracurium besylate in group Ⅰ and group Ⅱ were diminished than those in group Ⅲ and group Ⅳ [(59.1±9.6),(116.7±11.5)μg/kg vs (174.9±23.1), (177.2±20.4) μg/kg](P<0.01), and group Ⅲ and group Ⅳ were nearly (P>0.05 ). The maximum depression of T1, the clinic time and the vivo time in group Ⅰ, Ⅱ,Ⅲ were smaller than those in group Ⅳ [ ( 18.5±3.6)%, (6.4±2.7)%, 0 vs (25.0±0.0)% ] (P < 0.01 ), but there were. No significant differences in recovery index in 4 groups. The maximum depression was diminished (P< 0.01 ) and the clinic time and the vivo time were prolonged (P<0.05) with the inerease of the dosage of cisatracurium besylate in group Ⅰ, Ⅱ, Ⅲ. Conclusions With no cumulative effect, the duration of recovery of muscle relaxation is shortened and the recovery index of continuously infused eisatracurium besylate is prolonged. It indicates that the cisatracurium besylate is suitable for the continuously infusion for surgeon patients.
ABSTRACT
Objective:To study the time-course effect and postoperative residual curarization of rocuronium(ROC) in patients with obstructive jaundice.Methods: Forty patients(with normal renal function and without muscle or nerves diseases) receiving elective surgery under general anesthesia were divided into 2 groups: trial group(group Ⅰ) included 20 ASA(American Society of Anesthesiologists) Ⅲ patients with obstructive jaundice and control group(groupⅡ) included 20 ASA Ⅰ-Ⅱpatients without obstructive jaundice.All patients received total intravenous anesthesia with pentothal sodium,fentainyl and propofol.Neuromuscular blockade was evaluated with train-of-four(TOF) stimuli of the ulnsar nerve during operation.The 3?ED_(95)((0.9 mg/kg)) of ROC was given during anesthesia induction.As TOF rate(TOFR) reached 25%,1?ED_(95)(0.3 mg/kg)of ROC was added.Postoperation neuromuscular blockade was continuously evaluated until TOFR reached 90%.Tracheal extubation trigger was defined as that patient was able to open his/her eyes and to raise his/her arm or head for 5 s.The onset time,effect time of ROC,the time of TOFR from 0 to 70% and from 70% to 90%,and the TOFR at the time of tracheal extubation were observed.The blood gas analysis was done at the same time.Results: The effect duration in groupⅠwas longer than that in group Ⅱ(P
ABSTRACT
Objective To explore the clinical effects of ropivacaine in combined spinal-epidural anesthesia (CSEA) in the aged patients undergoing lower limb surgery. Methods Sixty patients, aged 65 and over, in American Society of Anesthesiologists (ASA) physical status Ⅱ-Ⅲ, and undergoing internal fixation surgery for lower limb bone fracture, were randomly assigned to three groups in equal number: group R1 (hypobaric ropivacaine for lumbar anesthesia), group R2 (hyperbaric ropivacaine for lumbar anesthesia) and group B (bupivacaine for lumbar anesthesia). The observed variables included the changes in blood pressure and heart rate, sensory block level and motor block status. The drug consumption in epidural anesthesia and the peri-operative side effects were noted. Results The anesthetic efficacy was satisfactory in all patients. The onset time of anesthesia in group B (54.05?3.80 s) was obviously shorter than that in group R1 and group R2 (61.10?4.96 and 60.95?3.94 s, respectively, P