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Objective:To evaluate the effect of stellate ganglion block on nighttime sleep quality in the patients with primary sleep disorders.Methods:Sixty patients of both sexes with primary sleep disorders, of American Society of Anesthesiology physical status Ⅰ or Ⅱ, aged 18-64 yr, weighing 40-75 kg, were randomized to 2 groups ( n=30 each): control group (group C) and stellate ganglion block group (group S). In group S, 0.2% ropivacaine 5 ml was injected into the surface of the right longus colli muscle where the the stellate ganglion was located under ultrasound guidance once a day for 7 consecutive days starting from 1 h before bedtime.While the equal volume of normal saline was given instead in group C. Patients′ Subjective Sleep Quality was assessed using the Pittsburgh Sleep Quality Index Questionnaire before treatment (T 0) and 1-7 days after treatment.The objective sleep quality was evaluated with polysomnography.A bispectral index(BIS)monitor and a cerebral and regional blood oxygen monitoring system were used to monitor the BIS value and regional cerebral oxygen saturation (rSO 2) during sleep, which were recorded once every 30 min, and the 7-day average was calculated.The patients′ daytime advanced cognitive function was assessed for 3 consecutive days after the end of treatment (T 8-10), including the Continuous Attention Test and the Behavioral Test for Performing Defect Syndrome, and the 3-day average value was calculated.Venous blood samples were collected at T 0 and T 8 to measure the plasma noradrenaline, cortisol, and serotonin concentrations by high-performance liquid chromatography. Results:Compared with group C, the individual and total scores of Pittsburgh Sleep Quality Index were significantly decreased, the sleep latency, awakening time and fast wave sleep latency were shortened, the number of awakening was increased, the total sleep time was prolonged, the sleep efficiency and proportion of fast wave sleep were increased, S 1-S 2 ratio in slow-wave sleep was decreased, S 3-S 4 ratio was increased, BIS value was decreased, rSO 2 was increased, each parameter of Continuous Attention Test was decreased and each parameter of Behavioral Test for Performing Defect Syndrome was increased after treatment, and plasma noradrenaline level was decreased at T 8 in group S ( P<0.05). Conclusion:Stellate ganglion block can improve nighttime sleep quality in patients with primary sleep disorders.
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Objective To evaluate the effect of intraoperative application of dexmedetomidine on acute post-traumatic stress disorder (PTSD) in female patients with lower limb fracture.Methods Ninety female patients with lower limb fractures caused by traffic accident,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 20-35 yr,weighing 40-72 kg,scheduled for elective internal fixation,were divided into 3 groups (n =30 each) using a random number table:control group (group C),low-dose dexmedetomidine group (group D1) and high-dose dexmedetomidine group (group D2).Ropivacaine (0.75％) 10-15 ml was injected into the epidural space,and operation was started after pain disappeared at the plane T8-10.Two percent lidocaine 5-10 ml was intermittently injected to maintain the anesthetic plane at T10.After successful epidural anesthesia,dexmedetomidine 0.5 and 1.0 μg/kg were intravenously infused over 30 min in D1 and D2 groups,respectively,while the equal volume of normal saline was given in group C.Patient-controlled epidural analgesia was performed with 0.15％ ropivacaine after operation and lasted until 48 h postoperatively,maintaining visual analogue scale score ≤ 3 (baseline).Morphine 3 mg was intravenously injected for rescue analgesia when visual analogue scale score＞3.The requirement for rescue analgesia within 48 h after operation was recorded.Acute Stress Disorder Scale (ASDS),Self-Rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) scores were assessed at 1 h before operation and on 1,3 and 7 days after operation.The patients were followed up for 3 months by telephone,and the PTSD Checklist-Civilian Version score was evaluated.The occurrence of acute PTSD (PTSD Checklist-Civilian Version score ＞ 38) was recorded.Results Compared with group C,the ASDS,SAS and SDS scores were significantly decreased on 1,3 and 7 days after operation,and the incidence of acute PTSD was decreased in D1 and D2 groups (P＜0.05).Compared with group D1,the ASDS scores were significantly decreased on 1,3 and 7 days after operation,and the incidence of acute PTSD was decreased (P＜0.05),and no significant change was found in SAS or SDS scores at each time point in group D2 (P＞ 0.05).There was no significant difference in the requirement for rescue analgesia between the three groups (P＞0.05).Conclusion Intraoperative application of dexmedetomidine can reduce the occurrence of acute PTSD and it is dose-related in female patients.
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Objective To compare the baroreflex sensitivity (BRS) when controlled hypotension was performed with sevoflurane versus isoflurane in the pediatric patients.Methods Sixty male American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,aged 3-16 yr,with body mass index of 20-28 kg/m2,scheduled for elective scoliosis surgery under general anesthesia,were randomly divided into 2 groups (n=30 each) using a random number table:sevoflurane-induced hypotension group (group Sev) and isoflurane-induced hypotension group (group Iso).Anesthesia was induced with midazolam,sufentanil and propofol.Endotracheal intubation was facilitated with rocuronium.Anesthesia was maintained with closed-circuit low flow anesthesia with either sevoflurane or isoflurane,maintaining mean arterial pressure at 55-65 mmHg and bispectral index values at 40-60 during surgery.Cardiovascular BRS was measured before induction of anesthesia (T0),immediately after intubation (T1),immediately after the end-tidal inhalational anesthetic concentration reached 1 minimal alveolar concentration (T2),and at 10,20 and 30 min after target hypotension (mean arterial pressure 55-65 mmHg) was achieved (T3-5).Results There was no significant difference in BRS at T0-2 between the two groups (P＞0.05).Compared with the value at To,the BRS was significantly decreased at the other time points in the two groups (P＜0.05).Compared with the value at T1,the BRS was significantly increased at T2,and decreased at T3-5 in the two groups (P＜0.05).The BRS was significantly lower at T3-5 than at T2 in the two groups (P＜0.05).The BRS was significantly lower at T3-5 in group Sev than in group Iso in the two groups (P＜0.05).Conclusion Sevoflurane produces better efficacy than isoflurane when used for controlled hypotension in the pediatric patients.
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Objective To compare dexmedetomidine versus lidocaine for suppression of fentanyl-induced coughing during induction of general anesthesia in patients.Methods Two hundred ASA physical status Ⅰ or Ⅱ patients,aged 36-50 yr,undergoing elective gynecological operations under total intravenous anesthesia,were randomized into 2 groups (n =100 each):dexmedetomidine group (group D) and lidocaine group (group L).Dexmedetomidine 0.5 μg/kg was intravenously infused over 10 min at a rate of 0.05 μg· kg-1· min-1 starting from 20 min before induction of anesthesia in group D.Lidocaine 0.5 mg/kg was injected intravenously at 1 min before induction of anesthesia in group L.For induction of anesthesia,fentanyl was given first,and 2 min later the other drugs were given.The development and degree of coughing were recorded within 1 min after fentanyl injection.The occurrence of adverse events was recorded.Results The incidence of coughing was significantly higher and the degree of coughing was severer in group L than in group D (P ＜ 0.05).There was no signihicant difference in the incidences of hypotension and severe sinus bradycardia between groups D and L (P ＞ 0.05).Conclusion Dexmedetomidine 0.5 μg/kg injected before induction of anesthesia has better suppressive effect on fentanyl-induced coughing during induction of general anesthesia than lidocaine 0.5 mg/kg in patients.
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Objective To investigate the effect of dexmedetomidine and small dose of ketamine on the hyperalgesia and brain-derived neurotrophic factor (BDNF) mRNA in the spinal cord of rats with neuropathic pain.Methods Forty-five male Sprague-Dawley rats,weighing 240-270 g,were randomly divided into 5 groups (n =9 each):sham operation group (group S),spinal nerve injury (SNI) group,ketamine group (group K),dexmedetomidine group (group D) and dexmedetomidine + ketamine group (group K+ D).The animals were anesthetized with intraperitoneal 10% chloral hydrate 400 mg/kg.SNI was produced by exposing the sciatic nerve and its branches and ligation and transection of tibial nerve and common fibular nerve in groups SNI,K,D and K + D.In S group,the sciatic nerves and its branches were only exposed but not ligated.In groups D,K and K + D,dexmedetomidine 40 μg/kg (2 ml),ketamine 10 mg/kg (2 ml) and mixture of dexmedetomidine 20μg/kg + ketamine 5 mg/kg (2 ml) were injected intraperitoneally,respectively,once a day for 21 consecutive days starting from 24 h after successful SNI surgery.While the equal volume of normal saline 2 ml was injected instead in S and SNI groups.The paw withdrawal threshold to mechanical stimuli (PWT) was measured at 1 day before surgery,and 3,7,14 and 21 days after surgery.Three rats were sacrificed after measurement of pain threshold at 1 day before surgery,and 7 and 21 days after surgery and the lumbar segments (L4-6) of the spinal cord were removed for determination of BDNF mRNA expression in spinal dorsal horn by real time PCR.Results Compared with group S,the PWT was significantly decreased,and the expression of BDNF mRNA in spinal dorsal horn was up-regulated after surgery in groups SNI,K,D and K + D (P ＜ 0.05).The PWT was significantly higher,and the expression of BDNF mRNA in spinal dorsal horn was lower after surgery in groups K,D and K + D than in group SNI,and in group K + D than in groups K and D (P ＜ 0.05).Conclusion The combination of dexmedetomidine and small dose of ketamine produces a synergistic antinociception in rats with neuropathic pain,and direct or indirect inhibition of BDNF mRNA expression in spinal dorsal horn is involved in the underlying mechanism.
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ObjectiveTo compare inhalational anesthesia with sevoflurane and intravenous anesthesia with propofol-sufentanil in patients undergoing gynecological outpatient surgery.MethodsOne hundred and forty ASA Ⅰ or Ⅱ patients,aged 18-35 yr,weighing45-65 kg,undergoing outpatient painless abortion,were randomly divided into 2 groups ( n =70 each):intravenous anesthesia with propofol-sufentanil group (group Ⅰ ) and inhalational anesthesia with sevoflurane group (group Ⅱ ).In group Ⅰ,sufentanil 0.2 μg/kg was injected intravenously,and 1％ propofol was infused at 2-3 mg·kg-1 ·min-1,followed by a rate of 3-4 mg·kg-1 ·h-1 after loss of eyelash reflex.In group Ⅱ,8％ sevoflurane was inhaled and the oxygen flow rate was 6 L/min,and after loss of eyelash reflex,the oxygen flow rate was adjusted to 3 L/min,and the concentration of sevoflurane was adjusted to 2％-3％.The time of induction of anesthesia,emergence time,operation time,intraoperative hypoxemia,body movement and related adverse events were recorded.ResultsCompared with group Ⅰ,the time of induction of anesthesia was significantly prolonged,the incidence of agitation,nausea and vomiting was significantly increased,and the incidence of sexual hallucinations was significantly decreased ( P ＜ 0.05),while no significant change was found in the operation time,emergence time,and incidence of shivering,intraoperative hypoxemia and body movement in group Ⅱ ( P ＞ 0.05 ).ConclusionIntravenous anesthesia with propofol-sufentanil is more helpful in improving the quality of emergence from anesthesia and more suitable for gynecological outpatient surgery than inhalational anesthesia with sevoflurane.
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Objective To compare the effects of patient-controlled intravenous analgesia (PCIA) and patient-controlled epidural analgesia (PCEA) on platelet activation in patients undergoing radical colon cancer operation.Methods Sixty-four ASA Ⅰ or Ⅱ patients,aged 43-65 yr,weighing 45-68 kg,undergoing radical operation for colon cancer,were randomly divided into 2 groups ( n =32 each):PCIA group and PCEA group.PCA pumps were connected at the end of operation.The PCIA solution c6ntained sufentanil 3 μg/kg,tropisetron 5 mg and vitamin B6 100 mg in 130 ml of normal saline.The PCIA pump was set up to deliver a 1.8 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.The PCEA solution contained sufentanil 0.5 μg/kg and 0.125％ ropivacaine in 300 ml of normal saline.The PCEA pump was set up to deliver a 2.5 ml bolus dose with a 20-min lockout interval and background infusion at 5 ml/h after a loading dose of 5 ml. VAS was maintained ≤ 3 after operation.Venous blood samples were taken before anesthesia,at 60 min after beginning of operation,and at the end of operation to determine the concentrations of plasma insulin and cortisol and blood glucose.Venous blood samples were taken at 30 min before operation,1 h after beginning of operation,and at 30 min and 4,12,24 and 48 h after operation (T0-6) to measure the concentration of serum platelet α-granzyme membrane protein-140 (GMP-140).The side effects were recorded after operation.Results Thirty and 29 patients completed the study in groups PCEA and PCIA respectively.There was no significant difference in the concentrations of plasma insulin and cortisol and blood glucose at each time point between the two groups ( P ＞ 0.05 ).The concentration of serum GMP-140 was significantly higher at T1-6 than the baseline value at T0 (P ＜ 0.05).The concentration of serum GMP-140 and incidence of nausea and vomiting were significantly lower at T3-6 in group PCEA than in group PCIA (P ＜ 0.05).One case happened pruritus in group PCIA,and respiratory depression and local anesthetic intoxication were not observed in the two groups.Conclusion PCEA has better inhibitory effect on the overactivation of platelet than PCIA,which may be helpful for preventing metastases of cancer ceils or postoperative thrombosis,and it is more suitable for postoperative analgesia in patients undergoing radical colon cancer operation.