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Objective:To evaluate the effect of general anesthesia on microelectrode recording (MER) during deep brain stimulation (DBS) of subthalamic nucleus (STN) in the patients with primary Parkinson′s disease (PD).Methods:Forty-four patients of both sexes with primary PD (duration of disease ≥ 5 yr and/or obvious symptom fluctuation), undergoing bilateral STN DBS from March 2008 to March 2018, aged<80 yr, were selected and divided into 2 groups by a random number table method: awake group ( n=26) and general anesthesia group ( n=18). In awake group, 0.5% ropivacaine was used for incision infiltration at skin incision.Patients in GA group received propofol and remifentanil by target-controlled infusion with Narcotrend to monitor the depth of anesthesia, and 0.5% ropivacaine was used for incision infiltration at skin incision.The total number of trajectories and length of STN were recorded during MER.Movement disorders were evaluated at 1 week before surgery and 6 months after surgery, and the improvement rate of dyskinesia was calculated.The postoperative anesthesia-, hardware- and stimulation-related complications were recorded. Results:There were no significant differences between the two groups in the total number of trajectories, length of STN and improvement rate of postoperative movement disorders ( P>0.05). Conclusion:General anesthesia does not affect the MER during STN DBS in the patients with primary PD.
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Objective To observe the action of narcotrend monitoring for perioperative anesthesia management in donor and acceptor with living donor renal transplantation. Methods 80 pairs of receptor and donor haing electie living donor renal transplantation surgery, 28 ~ 56 years. The ASA of receptor Ⅲ ~ Ⅳ, and the donerⅠ ~ Ⅱ. The receptor and donor were randomly divided into four groups , the narcotrend monitoring receptor group (R-N), the clinical experience receptor group (R-C), the narcotrend monitoring donor group (D-N), and the clinical experience donor group (D-C). Record the vital signs, the last time of anesthesia induction, operation , extract the endotracheal catheter , and the observation time in post anesthesia care unit , the dosage of propofol and dopamine, the adverse reaction, and postoperative visual analogue scale. Results The dosage of propofol in R-N group is less then the R-C group (P < 0.05). The time of extract the endotracheal catheter,and the observation time in post anesthesia care unit in R-N group was shorter then the R-C group (P < 0.05). No statistical differences between the D-N group and D-C group. Conclusions Narcotrend monitoring can significantly reduce the dosage of propofol , the observation time in post anesthesia care unit , and the postoperative adverse reactions. But there is little effect to the donor.
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Objective To evaluate the reliability of mannitol for fluid responsiveness test in the patients undergoing intracranial surgery.Methods Sixty-two ASA physical status Ⅰ or Ⅱ patients,aged 18-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective intracranial surgery,were enrolled in the study.The patients were mechanically ventilated after induction of anesthesia.The radial artery and central vein were cannulated,and FloTracTM/VigileoTM system was connected for stroke volume variation monitoring.Before infusion of mannitol,effective circulating blood volume was confirmed according to stroke volume variation.20％ mannitol 250 ml was infused over 20 min starting from onset of craniotomy.The fluid responsiveness test was recorded at the end of mannitol infusion.Results The sensitivity of fluid responsiveness test was 43％,and the specificity of fluid responsiveness test was 44％.Conclusion Mannitol can not be used for fluid responsiveness test in the patients undergoing intracranial surgery.
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Objective To investigate the effects of different dose of tranexamic acid in fibrinolysis during liver transplantation. Methods Sixty ASA Ⅱ~ Ⅳ liver transplant recipients, were randomly, double-blind assigned to one of 3 groups (n = 20): group control (group C), group tranexamic acid 1 (group T1) and group tranexamic acid 2 (group T2). The patients in group C received a loading dose of normal saline 10 mL, then continued infuse normal saline at 20 mL/h until neohepatic phase 120 min, while in other two groups, patients received a loading dose of tranexamic acid 1 g, totally 10 mL, followed by continuous infusion at 10 mg/(kg·h) in group T1 or 20 mg/(kg·h) in group T2 until neohepatic phase 120 min. Prothrombin time, fibrinogen, fibrin degradation product and D-dimers were measured before operation (T0), 120 min after the skin incision (T1), nonhepatic phase 30 min (T2), neohepatic phase 120 min (T3). Blood loss, fresh frozen plasma dosage, fibrinogen dosage and thromboembolic events were recorded. Results The plasma concentration of fibrin degradation product and plasma concentration of D-dimers were different in the 3 groups, group T2 0.05). Conclusions Continuous infusion of tranexamic acid can inhibit fibrinolysis during liver transplantation. No adverse event of thrombosis was detected. Larger dose of tranexamic acid can reduce blood loss and fresh frozen plasma transfusion.
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Objective To evaluate the impact of epidural anesthesia with levobupivacaine combined with general anesthesia on colon surgery. Methods Sixty patients undergoing elective radical procedure for colon carcinoma were randomLy divided into four groups: saline group (group S), 0.125% levobupivacaine group (group L1), 0.25% levobupivacaine group (group L2), and 0.5% levobupivacaine group (group L3). Group S received normal saline of 10 mL epidurally and then infusion of 5 mL·h-1 until the procedure was finished; groups L1, L2, and L3 received levobupivacaine instead. Anesthetic induction was performed after epidural puncture. Mean blood pressure and heart rate were recorded at 8 time points including 5 min after entering into the operation room, 1 min after intubation, skin incision, abdominal exploration, 1 h after skin incision, completion of operation, extubation, and leaving PACU; meanwhile blood glucose and cortisol were detected, anesthesia time, time to PACU stay, bleeding, transfusion volume, adverse reaction, and doses of propofol, remifentanil, ephedrine, and fentanyl were noted. Results Time to PACU stay was longer in S group than in other 3 groups. Doses of remifentanil and fentanyl were larger in L1 group than in L2 group and L3 group. Ephedrine dose in L3 group was larger than in other 3 groups. Blood sugar in L1 group was higher than L2 group and L3 group. Cortisol in S group was higher than in other 3 group. Cortisol in L1 group was higher than in L3 group. The number of patients with hypotension was greater in L3 group than other 3 groups. Conclusions Continue epidural infusion of 0.25%levobupivacaine can reduce stress response and opioid uses, shorten PACU stay, whereas it does not increase use of ephedrine.
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Objective T0 investigate the effects of transforming growth factorβ1 ( TGFβ1 ) and its receptorβ2 (TGFβR2) gene single nucleotide polymorphisms on the risk of intracranial hemorrhage in patients with brain arteriovenous malformation (BAVM).Methods Fifty-three BAVM patients of both sexes aged 18-64 yr who were genetically unrelated native HAN of Guangdong province were divided into 2 groups:patients with and without intracranial hemorrhage ( n =30:23).Venous blood samples were collected and anti-coagulated with ethylene diaminetetraacetic acid for genomic DNA extraction.TGFβ1-509C/T (rs1800469) and TGFβR2 875A/G (rs3087465) gene SNPs were genotyped by using PCR-RFLP.Results There were no significant differences in genotype and frequency between the 2 groups.The G carrier frequency of the TGFβR2 genotype was significantly higher in patients with intracranial hemorrhage than in patients without intracranial hemonrhage.The G carrier of the TGFβR2 genotype was associated with intrarcranial hemorrhage in patients with BAVM.Conclusion TGFβ1 gene polymorphism is not relevant to the intracranial hemorrhage in patients with BAVM,but polymorphisms of TGFβR2 could be a risk factor.
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Objective To investigate the effect of mild hypothermia on the expression of hypoxia-inducible factor-1α (HIF-1α) and glucose transporter-1 (GLUT-1) in a rat model of chronic cerebral ischemia-reperfusion.Methods Thirty-six female SD rats weighing 170-210 g were randomly divided into 3 groups (n = 12 each):sham operation group (group S), normal body temperature group (group NT ) and mild hypothermia group (group MH). Arterio-venous fistula was established by end-to-end anastomosis between the right common carotid artery and right external jugular vein for 6 weeks followed by reperfusion. In group MH, mild hypothermia was induced at the initiation of reperfusion and the rectal temperature was reduced to 31.5-32.5 ℃. In group S and NT, the rectal temperature was maintained at 37-38 ℃. Six rats in each group were sacrificed at 3 and 48 h of reperfusion. The brains were immediately removed for determination of the expression of HIF-1α, GLUT-1, HIF-1α mRNA and GLUT-1 mRNA and microscopic examination. Results Compared with group S, the expression of HIF-1α and HIF-1α mRNA at 3 and 48 h of reperfusion and GLUT-1 mRNA at 3 h of reperfusion was up-regulated, while the expression of GLUT-1 and GLUT-1 mRNA at 48 h of reperfusion was down-regulated in group NT (P ＜ 0.05).Compared with group NT, the expression of HIF-1α and HIF-1α mRNA at 48 h of reperfusion and HIF-1α mRNA and GLUT-1 mRNA at 3 h of reperfusion was down-regulated, while the expression of GLUT-1 and GLUT-1 mRNA at 48 h of reperfusion was up-regulated in group MH (P ＜ 0.05).Microscopic examination showed that the injury to the ultrastructure of blood-brain barrier was significantly attenuated in group MH compared with group NT. Conclusion Mild hypothermia can attenuate chronic ischemia-reperfusion injury by down-regulating the expression of HIF-1α and up-regulating the expression of GLUT-1.
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Objective To investigate the effect of mild hypothermia on cerebral oxygen metabolism in a rat model of chronic cerebral hypoperfusion and reperfusion. Methods Twelve healthy SD rats weighing 170-210 g were randomly divided into normal body temperature group (group NT, n = 6) and mild hypothermia group (group MH, n = 6). Arterio-venous fistula was established by end-to-end anastomosis between the right common carotid artery and right external jugular vein according to Yassari. Mild hypothermia was induced in group MH before reperfusion and maintained for 3 h. The rectal temperature was reduced to 32 ℃ while in group NT rectal temperature was maintained at about 37 ℃ . Cerebral blood perfusion (CBP) was assessed by using a lasser Doppler perfusion image system before reperfusion (T_1), immediately after reperfusion (T_2) and 24 h after reperfusion (T_3). Venous and arterial blood samples were collected from superior sagittal sinus and femoral artery respectively for blood gas analysis at T_(1-3) . Cerebral arterial venous O_2 saturation difference (Sa-vO_2), cerebral O_2 extraction rate (CERO_2) and cerebral arterial-venous lactic acid concentration difference ( Da-vL) were calculated. Results In NT group left CBP was significantly decreased at T_2 as compared with the baseline value at T_1 , while at T_3 bilateral CBP was decreased. In MH group bilateral CBP was significantly decreased at T_2 but returned to baseline level at T_3. CERO_2 was significantly decreased at T_2 as compared with the baseline value at T_1 in MH group. Da-vL was significantly increased at T_3 in NT group. Compared with group NT, bilateral CBP was significantly decreased, CERO_ and Da-vL were significantly decreased at T_2 ,while no significant change was found in Sa-vO_2 in group MH. Conclusion Mild hypothermia is beneficial for the balance of cerebral oxygen metabolism in the rats with chronic cerebral hypoperfusion and reperfusion.
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24 h. The operation was performed under continuous epidural block. Right subclavian or internal jugular vein was cannulated for blood sampling. Exclusion criteria included acute bleeding, acute thrombosis, patients who had received any drug which may affect platelet function or coagulation within a month. TEG was performed before operation, 10min after release of cross-clamping of artery and vein of the translated kidney and at the end of operation. The measured TED variables included the reaction time (r) representing the rate of initial fibrin formation; k(coagulation) time and alpha angle reflecting fibrin-platelet interaction and maximal amplitude (MA) indicating qualitative platelet function. Results Before operation in group A r and k values were both significantly smaller than normal values and alpha angle, MA and coagulation index (CI) significantly increased, indicating increased coagulability, while group C exhibited decreased coagulability with r-value larger than normal and MA smaller than normal. 10min after release of cross-clamping of artery and vein of the transplanted kidney in group B and C r-value decreased and MA, CI increased as compared with the preoperative values. There were no significant differences in TEG variables at the end of operation among the three groups. Conclusions TEG shows that hypercoagulability may exist within 6 h after hemodialysis, and there is likelihood of fibrinolysis after 24 h. The venous blood is hypercoagulable after the release of cross-clamping of artery and vein of the transplanted kidney, indicating the risk of potential thrombosis.