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Objective:To evaluate the effects of different rates of compliance with the enhanced recovery after surgery (ERAS) protocol on postoperative recovery in patients undergoing hysterectomy.Methods:A total of 312 patients, aged 18-60 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ-Ⅲ, scheduled for hysterectomy, were enrolled in the study.ERAS protocol was implemented.The patients were divided into 3 groups based on compliance rates: compliance rate<70% group (group A), 70%≤compliance rate<85% group (group B) and compliance rate≥85% group (group C). The development of postoperative complications, hospitalization time, patients′ satisfaction score and hospitalization cost were recorded. Results:Compared with group A ( n=88) and group B ( n=118), the total incidence of complications was significantly decreased in group C ( n=96) ( P<0.05). The patients′ satisfaction scores were gradually increased in A, B, and C groups on the day of discharge and at 30 days after discharge ( P<0.05). Conclusions:Higher compliance with the ERAS protocol is helpful for postoperative recovery in patients undergoing hysterectomy.
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Objective To investigate the effect of intravenous injection of 20% lipid emulsion on neurotransmitters imbalance in central nerve system induced by local anesthetics.Methods Thirty adult Sprague-Dawley rats were randomly divided into two groups:normal group (group C,n =10) and local anesthetics group (group L,n =20).Based on different treatment,the rats in group L were assigned into two subgroup:control group (group S,n =10)and 20% long-chain lipid emulsion in-jection group (group I,n =10).The rats of group L were injected with 0.75% levobupivacaine at 50μl/min from the right ventricle of brain.When convulsions wave of electroencephalogram EEG ap-peared,20% long-chain lipid emulsion was administrated continuously 0.25 ml·kg-1 ·min-1 (group I)or normal saline (group S).The rats in group C were without any treatment.All the rats were con-tinously monitored by EEG,ECG and SpO 2 .The primary outcome included seizure duration and threshold and rats’mortality of postoperative 24 h.Secondary outcome included the concentrations of neurotransmitters GABA and Glu in cerebrospinal fluid,expression of NMDAR1 in cortex,Glu/GA-BA concentration ratio (Glu/GABA),and analysis the correlation between expression of Glu and NMDAR1.Results The convulsion time and mortality of rats in group S were significantly increased compared with those in group I (P <0.05).The seizure threshold of levobupivacaine was much lower in group S than group I (P <0.05).Compared with group C,the concentrations of Glu and GABA in cerebrospinal fluid,expression of NMDAR1 in hippocampus and Glu/GABA significantly increased in groups S and I(P < 0.05 ),and at same time these data in group S were significantly higher than group I (P < 0.05 ).There is a positive correlation between concentration of Glu in CSF and expression of NMDAR1 in hippocampus (r =0.884,P <0.01 ).Conclusion Intravenous infusion of 20% long-chain lipid emulsion can effectively improve neurotransmitters imbalance in central nerve system induced by intraventricular injection of local anesthetics.
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Objective To evaluate the the protectice effect of dexmedetomidine combined limb remote ischemic postcondition on alleviating focal cerebral ischemic reperfusion injury in rats .Methods 48 healthy adult male SD rats were randomly divided into 4 groups(n= 12) :control group(C) ,limb remote ischemic postcondition group(R) and dexmedetomidine postconditioning group(D) and combination group(R/D) .The rat model of focal cerebral ischemic reperfusion injury was induced by middle cerebral artery oc‐clusion(MCAO) .The group C only received MCAO ,the left femoral artery was isolated without blocking ;the group R received 120 min brain ischemia ,the left femoral artery was occluded by 3 cycles of 10 min occlusion/10 min reperfusion before brain reperfu‐sion ;the group D received dexmedetomidine 3 μg/kg by intraperitoneal injection before brain reperfusion .The group R/D combined the above two kinds of processing method .The neurologic function was evaluated at 24 h of reperfusion and then the rats were sac‐rificed at 48 h of reperfusion .The brain was removed for determining the cerebral infarct volume .Results The neurologic function scores after 24 h reperfusion in the group D ,R and R/D were superior to those in the group C (P< 0 .01) .The rat cerebral infarct volume percentages after 48 h reperfusion in the group D ,R and R/D were significantly lower than those in the group C ( P <0 .01) .The infarct area volume percentage in the group R/D was significantly lower than that in the group R ,the difference showed statitistical significance(P< 0 .01) .The infarct volume percentage in group R/D was significantly decreased compared with the group D(P< 0 .05) .Conclusion Both dexmedetomidine and limb remote ischemic postcondition can attenuate the focal cerebral is‐chemic reperfusion injury in rats .Their combination can significantly reduce the cerebral infarction volume and has synergic protec‐tion effect .
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Objective To investigate the effects of hydrogen gas inhalation on cerebral oxidative stress and inflammation after intestinal ischemia/reperfusion (I/R) in rats and to understand the mechanism of(I/R neuroprotection.Method Forty-eight healthy male SD rats weighing 285-350 g were randomly allocated to one of 3 groups (n =16 each group):sham operation group (Sham),intestinal I/R group (I/R) and intestinal IR plus hydrogen gas inhalation group (IR + H2).The I/R model was produced by occlusion of superior mesenteric artery (SMA) for 90 min followed by reperfusion.Inhalation of 2％ hydrogen gas was performed immediately after I/R for 3 h.All animals were sacrificed at 24 h after reperfusion in each group.Brain tissues of 8 animals in each group were harvested for detection of microglia by immunohistochemistry.The remaining 8 rats in each group were used for the following indicators analysis.The protein level of ionized calcium-binding adaptor molecular 1 (Iba-1,a marker of microglia) in the cortex was detected by Western blotting.The concentrations of ROS,MDA,IL-1β,IL-6,TNF-α,T-NOS,iNOS and NO in the cortex were measured.The MPO content and SOD activity were also measured.Result The Iba-1 staining was light in Sham group.However,the expression of Iba-1 was increased in I/R group,and H2 inhibited the expression of Iba-l.As compared with Sham group,the Iba-1 protein expression and the number of Iba-1 positive cells were increased significantly in I/R and I/R+ H2groups (P＜0.01 or 0.05).As compared with Sham group,ROS,MDA,IL-1β,IL-6,TNF-α,T-NOS,iNOS and NO levels,and MPO activity were also increased in I/R and I/R + H2groups (P＜0.01 or 0.05).As compared with I/R group,the above indicators in I/R + H2 group were markedly improved (P＜0.05 or 0.01).Conclusion The inhalation H2 could inhibit intestinal I/R-induced activation of microglia and reduce cerebral oxidative stress and inflarnmatory response in rats.
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Objective To investigate the proper anesthetic administration schemes in pediatric patients undergoing surgery of transcatheter ventricular septal defect closure .Methods A total of 120 pediatric patients with congenital heart diseases of ventricu-lar septal defect ,aged 3-9 years old with ASA physiological status Ⅰ or Ⅱ ,undergoing surgery of transcatheter ventricular septal defect closure were randomly divided into 4 groups with 30 each :ketamine group( K group) ,propofol group( P group) ,ketamine associate with propofol ( KP group) ,sevoflurane group( S group) .Spontaneous respiration were maintained in K ,P ,PK groups ,but mechanical ventilation was adopted after endotracheal tube intubation in S group .The values of MAP ,HR ,SpO2 ,RR were recorded at the following time points :before anesthesia ,incision immediate ,procedure in heart ,completion of operation ,and 30min after oper-ation .awaking time and adverse reactions were recorded .Results Anesthesia and operation were carried out successfully in all pa-tients .Awaking time in P group and KP group markedly shorter than K group (P<0 .01) .The incidence rate of adverse reactions such as cough ,asphyxia and body motion in pediatric patients by mechanical ventilation and sevoflurane inhaled markedly less than other groups(P<0 .01) .Conclusion It is safe that pediatric patients received mechanical ventilation and sevoflurane inhaled after endotracheal intubation undergoing surgery of transcatheter ventricular septal defect closure .
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Objective:To investigate the efficacy and security of the propofol compounding the SumianxinⅡ for high intensity focusing ultrasound irradiating goats liver in vivo. Methods:thirty Nanjiang yellow goats were randomly divided into two groups,the propofol compounding SumianxinⅡ group(group A,n=15)and the SumianxinⅡgroup(group C,n=15).In group A, the animals were anesthetized with 0.05ml/kg of SumianxinⅡby croup intramuscular injection and 2mg/kg of propofol by intravenous injection,then propofol at rate of 50～150?g/(kg?min) were infused continuously in the whole operation. In group C, the animals were anesthetized with 0.1ml/kg of SumianxinⅡby croup intramuscular injection,and SumianxinⅡwere injected by intravenous injection in the operation. The bucking response in intratracheal intubation,the perioperative hemodynamic changes and recovery profil were observed. Results:Group A restrianed the bucking resonse better than group C(P