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Objective:To evaluate the effects of patient-controlled intravenous analgesia (PCIA) with esketamine on postpartum depression (PPD) in puerpera undergoing cesarean section.Methods:A total of 300 American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 25-35 yr, with body mass index≤35 kg/m 2, scheduled for elective cesarean section under spinal anesthesia, were divided into 2 groups ( n=150 each) by a random number table method: control group (group C) and esketamine group (group E). PCIA was performed at the end of surgery.In group C, the PCIA solution contained sufentanil citrate 50 μg, butorphanol tartrate 12 mg and metoclopramide injection 20 mg in 200 ml of 0.9% normal saline.In group E, the PCIA solution contained esketamine 1 mg/kg, sufentanil citrate 50 μg, butorphanol tartrate 12 mg and metoclopramide injection 20 mg in 200 ml of 0.9% normal saline.The PCA pump was set to deliver a background infusion of 4 ml/h and a bolus dose of 4 ml at 30 min lockout interval.The analgesia lasted for 48 h after surgery, and the visual analog scale (VAS) score was maintained<4 points.Acetaminophen 0.5 g was administered orally as a rescue analgesic when VAS score≥4 points and pain was still unrelieved after PCA pump was pressed twice in a row.The Edinburgh Postnatal Depression Scale (EPDS) was performed at 1 day before and at 3, 7 and 42 days after surgery.Depression was classified on EPDS as mild (score≥10) and severe (score≥13). The patients with preoperative depression were excluded from the study.The occurrence and degree of depression were recorded.The requirement for rescue analgesia within 0-6 h, 6-12 h, 12-24 h and 24-48 h after surgery and development of adverse effects within 3 days after surgery were recorded. Results:Compared with group C, the incidence of PPD was significantly decreased and degree was reduced at 3 and 7 days after surgery, incidence of rescue analgesia was decreased in different time periods ( P<0.05), and no significant change was found in the incidence of adverse effects in group E ( P>0.05). Conclusion:Esketamine can not only provide good postoperative analgesia but also improve PPD in puerpera when it is used for PCIA after cesarean section.
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Objective To compare the effects of sevoflurane and propofol anesthesia on endothelial glycocalyx degradation in the patients undergoing abdominal surgery.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 25-75 yr,weigbing 45-80 kg,scheduled for elective open colon or rectal surgery,were divided into 2 groups (n =30 each) using a random number table method:sevoflurane anesthesia group (group S) and propofol anesthesia group (group P).In group S,1.5％-2.5％ sevoflurane was inhaled for maintenance of anesthesia.In group P,propofol was intravenously infused at 50-150 μg · kg-1 · m-1 to maintain the bispectral index value at 40-60.The concentrations of heparan sulfate (HS),syndecan-1 and vascular cell adhesion molecule-1 (VCAM-1) in serum were determined after tracheal intubation (T0),at 1 h after skin incision (T1),at 2 h after skin incision (T2),at the end of operation (T3) and at 24 h after operation (T4).Blood gas analysis and blood biochemical test were performed at T0 and T4,and strong ion gap (SIG) was calculated.Results Compared with the baseline at T0,the concentrations of serum HS at T2-4 and syndecan-1 at T3-4 and SIG at T4 were significantly increased,and the concentrations of serum ALB at T4 were decreased in S and P groups (P＜0.05).Compared with group P,the concentrations of serum HS at T3,4 and syndecan-1 at T4 and SIG at T4 were significantly decreased,the concentrations of serum ALB at T4 were increased (P＜0.05),and no significant change was found in the serum concentrations of VACM-1 and lactate in group S (P＞0.05).Conclusion Compared with propofol anesthesia,sevoflurane anesthesia is more helpful in decreasing endothelial glycocalyx degradation and in reducing vascular endothelial damage in the patients undergoing abdominal surgery.
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Objective To evaluate the accuracy of interleukin-6 (IL-6) and IL-8 concentrations in exhaled breath condensate (EBC) in predicting postoperative acute respiratory distress syndrome (ARDS) in the patients undergoing cardiac surgery under cardiopulmonary bypass (CPB).Methods Forty-two American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 18-64 yr,scheduled for elective cardiac valve replacement under CPB,were selected.EBC samples were collected for determination of the concentrations of IL-6 and IL-8 by enzyme-linked immunosorbent assay.The patients were divided into either ARDS group or non-ARDS group according to whether the patients developed ARDS after surgery.The receiver operating characteristic curve for IL-6 and IL-8 concentrations in EBC in diagnosing postoperative ARDS was plotted,and the area under the curve and 95％ confidence interval (CI) were calculated.The critical value,sensitivity and specificity were calculated according to the corresponding concentrations of IL-6 and IL-8 in EBC when Youden index reached the maximal value.Results Twenty-two patients developed postoperative ARDS,and the incidence was 52％.The concentrations of IL-6 and IL-8 in EBC were significantly higher at T2-4 than at T1 in two groups (P＜0.05).Compared with group nonARDS,the concentrations of IL-6 and IL-8 in EBC were significantly increased at T2-4 in group ARDS (P＜0.05).The area under the curve (95％ CI) of IL-6 concentrations in EBC measured at T2-4 in predicting postoperative ARDS was 0.822 (0.673-0.922),0.850 (0.706-0.941) and 0.906 (0.775-0.974),respectively,the critical value was 2.92,5.04 and 2.64 pg/ml,respectively,the sensitivity was 95.5％,68.2％ and 77.3％,respectively,and the specificity was 70.0％,90.0％ and 90.0％,respectively.The area under the curve (95％ CI) of IL-8 concentrations in EBC measured at Y24 in predicting postoperative ARDS was 0.700 (0.539-0.831),0.851 (0.707-0.942) and 0.737 (0.579-0.861),respectively,the critical value was 26.75,42.73 and 21.86 pg/ml,respectively,the sensitivity was 68.2％,77.3％ and 72.7％,respectively,and the specificity was 65.0％,80.0％ and 70.0％,respectively.Conclusion The concentrations of IL-6 and IL-8 in EBC can accurately predict the occurrence of postoperative ARDS in the patients undergoing cardiac surgery under CPB.
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Objective To determine if the cardiac index (Cl) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).Methods Forty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midazolam,sufentanil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.Cl was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.Results Bland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:Cl (2.8 ± 0.6) L·min-1 ·m-2,bias was 0.23 L·min-1 ·m-2 and limit of agreement was (-0.57,1.02) L·min-1 ·m-2,resulting in κ =0.546 and an overall percentage error of 28.6％.Conclusion Cl values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.
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ObjectiveTo investigate the effect of patient-controlled epidural analgesia(PCEA) with opioids on serous myelin basic protein(MBP) and somatosensory evoked potential(SEP) of lower limbs in puerperants.MethodsA total of 120 puerperants,after receiving cesarean section,were divided into four groups by random number table method as group B,BR,MR and R randomly,and each group included 30 cases.After surgery,each case received PCEA:group B received 0.008％ butrophanol;group BR received 0.008％ butrophanol + 0.2％ ropivacaine;group MR received 0.004％ morphine +0.2％ ropivacaine and group R received 0.2％ ropivacaine only.VAS score,OAA/S score,adverse effect occurrence,concentration changes of serous MBP,SEP of both lower limbs and neurological function were observed at 2h(T1 ),4h(T2),8 h(T3),12h(T4),24 h(T5) and 48h (T6) after surgery.ResultsVASscoresofgroupBR(1.64±0.38,1.86±0.62,1.93±0.67) and MR( 1.74 ±0.39,1.91±0.58,1.98 ±0.63) at T3,T4,T5 were lower than those of group B(4.6 ±0.5,4.6 ±0.3,4.7 ±0.3)and R(2.64 ±0.41,2.83 ±0.91,3.37 ±0.87) (P＜0.05).There was no significance in four groups in OAA/S score at each point (P ＞ 0.05 ).Incidence of nausea ( 6 cases),vomiting ( 2 cases) and abdominal distention ( 5cases) of group M was higher than that of other three groups(P＜0.05).There was no significant difference in concentrations of serous MBP,SEP and neurological function in all four groups between preoperative time and 48h after operation(P＞0.05).ConclusionLower-dose and lower- concentration opioids used for PCEA have no influence on serum MBP and SEP.
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ObjectiveTo determine ff the cardiac index (CI) measured with FloTrac-Vigileo system agrees with that measured with pulmonary artery catheter (PAC).MethodsForty-three ASA Ⅱ or Ⅲ patients aged 53-75 yr weighing 46-100 kg undergoing off-pump coronary artery bypass grafting were included in this study.Anesthesia was induced with midasolam,sufentunil,propofol and rocuronium and maintained with propofol,remifentanil and atracurium.One MAC sevoflurane was inhaled at breast bone splitting and closing.CI was measured with FloTrac-Vigileo system and PAC before,and at 5,15 min of sevoflurane inhalation and recorded.All data were compared by Bland-Altman analysis and with kappa coefficient for agreement and percentage error was calculated.ResultsBland-Altman comparison of FloTrac-Vigileo system and PAC:matching data of 258 measurements:CI (2.8 ± 0.6 ) L· min - 1 · m- 2,bias was 0.23 L* min- 1 · m - 2 and limit of agreement was ( - 0.57,1.02)L · min- 1 · m- 2,resulting in κ ＝ 0.546 and an overall percentage error of 28.6 ％.ConclusionCI values obtained by FloTrac-Vigileo system agrees well with that obtained by thermodilution technique using PAC in patients undergoing off-pump coronary artery bypass grafting.
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Objective To evaluate the effect of sevoflurane on left ventricular function in patients undergoing elective coronary artery bypass grafting (CABG) .Methods Thirty-five ASA Ⅱ or Ⅲ patients of both sexes (30 males, 5 females) aged 53-75 yr weighing 46-100 kg undergoing CABG were enrolled in this study. Transesophageal echocardiography (TEE) probe was placed. The TEE variables including cardiac index (CI), left ventricular short axis shortening (FS), left ventricular ejection fraction (LVEF), low propagation velocity ( Vp), E wave velocity (E) , A wave velocity ( A) , systolic wave velocity ( S) , diastolic wave velocity ( D), AR wave velocity, E/A ratio and S/D ratio were recorded before inhalation of sevoflurane (T_1 ) , and 5 min (T_2) and 15 rain ( T_3) after inhalation of sevoflurane after splitting of sternum, and before inhalation of sevoflurane (T_4 ), 5 min (T_5) and 15 min (T_6) after inhalation of sevoflurane after the closure of sternum. The end-tidal concentration of sevoflurane corresponded to 1 MAC. Anesthesia was induced with midazolam 0.05 nig/kg, sufentanil 0.5μg/kg and rocuronium 0.9 mg/kg and maintained with infusion of propofol at 4-6 mg·kg~(-1) ·h~(-1), remifentanil at 0.2-0.4μgkg~(-1)·h~(-1) and atracurium at 0.5 mg·kg~(-1)·h~(-1). The patients were mechanically ventilated after tracheal intubation (V_T 8 ml/kg, RR 12 bpm, I:E 1:2, FiO_2 70%-80% ) .Results (1) MAP and CI were significantly decreased at 5 and 15 min after sevoflurane inhalation. LVEF and FS were also decreased. (2) There was no significant change in diastolic function indexes after sevoflurane inhalation including E and A wave velocity, systolic wave velocity, diastolic wave velocity, E/A ratio and S/D ratio. (3) Cardiac function improved after CABG. CI, LVEF and FS were significantly increased after CABG as compared with preoperative values. Conclusion In patients undergoing elective CABG, sevoflurane (the end-tidal concentration corresponding to 1 MAC) can depress left ventricular systolic function but does not affect left ventricular diastolic function.