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Objective To compare the effects of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement. Methods The demographic, preoperative and postoperative data of 478 patients, aged 18-95 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅳ, who underwent elective unilateral hip joint replacement in Tongji Hospital from May 2014 to December 2016, were retrospectively analyzed. Patients were divided into general anesthesia group (group GA, n=197), peripheral nerve block group ( group PNB, n=147) and peripheral nerve block combined with general an-esthesia group ( group PNB+GA, n=134) . The amount of crystalloid solution and colloid solution infused, consumption of sufentanil and requirement for vasoactive agents were recorded during operation. The dura-tion of anesthetic recovery room stay, length of hospital stay before and after operation and total length of hospital stay were recorded. The development of complications within 48 h after operation, therapy after ad-mission to intensive care unit and in-hospital fatality were also recorded. Results Compared with group GA, the intraoperative consumption of sufentanil was significantly decreased in group PNB+GA, and the a-mount of crystalloid solution infused, urine output, consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB+GA ( P<0. 05) . Compared with group PNB+GA, the consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infec-tion and acute cerebral infarction were significantly decreased in group PNB (P<0. 05). Conclusion Compared with general anesthesia or with peripheral nerve block-general anesthesia, peripheral nerve block is more helpful in improving early prognosis in patients undergoing hip joint replacement.
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Objective To evaluate the efficacy of preoperative transversus abdominis plane block (TAPB)for analgesia after kidney transplantation. Methods Forty American Society of Anesthesiologists physical status ⅡorⅢpatients, aged 18-64 yr, with body mass index of 18-24 kg∕m2, scheduled for e-lective kidney transplantation, were divided into 2 groups(n=20 each)using a random number table:TAPB group and routine analgesia control group(group C). After induction of anesthesia, ultrasound-guided TAPB was performed on the operated side with 0.5% ropivacaine 20 ml in group TAPB. Patient-controlled intravenous analgesia with sufentanil was provided to all the patients after surgery. Tramadol 50 mg was intravenously injected as a rescue analgesic to maintain visual analogue scale score within 24 h after surgery≤3. The consumption of anesthetics during surgery and amount of sufentanil consumed and require-ment for rescue analgesic within 24 h after surgery were recorded. Ramsay sedation scores were recorded at 2, 4, 6, 12 and 24 h after surgery. The occurrence of nausea and vomiting, pruritus and respiratory de-pression within 24 h after surgery were recorded. TAPB-related complications were also recorded in group TAPB. Results Compared with group C, the consumption of remifentanil was significantly reduced during surgery, and the amount of sufentanil consumed within 24 h after surgery was decreased(P<0.05), and no significant change was found in the incidence of Ramsay sedation scores, nausea and vomiting, pruritus or respiratory depression in group TAPB(P>0.05). No patients required rescue analgesic in two groups. TAPB-related complications were not found in group TAPB. Conclusion Preoperative TAPB reduces the perioperative opioid consumption and enhances the efficacy of postoperative analgesia in the patients under-going kidney transplantation.
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Objective To investigate the alternation of mitochondrial oxidative phosphorylation post-ischemia/reperfusion myocardial injury in mice. Methods The C57BL/6 mice were randomly divided into five groups. The mouse hearts in the time control group (TC) were perfused for 45 min in identical Krebs-Henseleit buffer without any treatment. In the ischemia/reperfusion groups, the mouse hearts were treated with different reperfusion time including 5, 10, 15 or 30 min, following by the same ischemia period of 25 min. The mitochondria were extracted from the left ventricular post-reperfusion. The respiratory function including R3, R4, RCR, and the maximal rate of state 3 respiration (2 mmol/L ADP) were measured. Results The R3, RCR and P/O of mitochondria, using glutamate + malate as substrates, were decreased significantly at 10 min, 15 min and 30 min post-ischemia/reperfusion (P < 0.05, respectively), but not in the 5-min-reperfusion group compared with the time control group. And the respiratory function, using succinate, and TMPD-ascorbate as substrates, decreased significantly in different ischemia/reperfusion groups compared with the time control (P < 0.05, respectively). Conclusions The mitochondrial respiratory function changes differently in different complex at the early stage of reperfusion after ischemia. So different ischemia/reperfusion time should be chosen to detect the alternations of different mitochondrial complex after heart injury.
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AIM:To look for a way of produ cing mild therapeutic hypothermia through regulating transient re-ceptor potential cation channel subfamily V member 1 (TRPV1) pathway by dihydrocapsaicin (DHC).METHODS:Mice were subcutaneously injected with DHC at different doses (2 mg/kg, 3 mg/kg and 4 mg/kg) in order to find the best dose for reaching the target temperature (32~34℃).20%DMSO dissolved in normal saline was used as control group .After a single subcutaneous injection of DHC at an optimal dose was given , awaken CD1 mice were continuously infused with DHC at dose of 1 mg? kg-1? h-1 for providing a more rapid and stable temperature drop and duration of therapeutic mild hypothermia.The adult mice (9~10 weeks) and aged mice (24~27 months) were subcutaneously injected with DHC at the same dose, and the changes of the body temperature were monitored .RESULTS:DHC at 2 mg/kg resulted in a de-crease in the core temperature within the target therapeutic range (32~34 °C).After a bolus dose (2 mg/kg) was deliv-ered at 0 min followed by continuous infusion (1 mg? kg-1? h-1 ) beginning at 30 min, a rapid drop of body temperature to 34 ℃was achieved and the body temperature was maintained within the ranges of 32 to 34℃for the duration of the 6 h continuous infusion .DHC-mediated hypothermia did not lose its effectiveness in the adult and aged models .CONCLU-SION:DHC-induced activation of TRPV1 pathway produces mild therapeutic hypothermia .Besides, this method achieves stronger and longer center hypothermia and is suitable for the animals at different ages .
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Objective To investigate the effectiveness of the combination of general anesthesia ( GA) and single-shot bilateral thoracic paravertebral block ( TPVB) by ropivacaine in the patients undergoing off-pump coronary artery bypass surgery ( OPCAB) . Methods Forty patients with coronary heart disease scheduled for elective OPCAB surgery were randomly divided into two groups:general anesthesia group (group A, n=20) and general anesthesia combined with bilateral thoracic paravertebral block group (group B, n=20). The frequency of hemodynamic abnormalities and dosage of vasoactive drugs during the period of operation were recorded. Meanwhile, other reference data were recorded, such as the consumption of sufentanil during operation and postoperative analgesia, the time of endotracheal tube retention and intensive care unit ( ICU) stay. Results Two cases were excluded from the study in group B for failure block. Compared with group A, the frequency of hypertension and the amount of nicardipine was lower during operation in group B (P<0. 05), the consumption of sufentanil was less both during operation (P<0. 01) and postoperative analgesia (P<0. 05). Moreover, the time of tracheal tube retention and ICU stay were shorter in group B (P<0. 05). Conclusion The findings of this study indicate that GA combined with single-shot TPVB is superior to GA alone in improving haemodynamic stability in patients undergoing OPCAB surgery. The combination therapy can also reduce the use of opiates and shorten the time of recovery.
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Objective To evaluate the effect of clonidine as an adjuvant of PCEA with morphine and ropivacaine in patients with essential hypertension and it' s effects on hemodynamics and plasma concentrations of endothelin-1 ( ET-1) and calcium gene-related peptide ( CGRP) . Methods Sixty ASAⅠ - Ⅱ patients of both sexes (24 males, 36 females) with a history of essential hypertension for 1-2 years were included in this study. The patients ranged in age from 45-72 yrs and in body weight 55-70 kg and were scheduled for elective pelvic surgery under combined general-epidural anesthesia. An epidural catheter was placed at T12-L1 or L1-2 interspace before induction of general anesthesia. Anesthesia was induced with fentanyl 4 ?g ? kg-1 , propofol 2 mg?kg-1 and vecuronium 0.1 mg?kg-1 and maintained with isoflurane and epidural analgesia. The patients received PCEA after operation. The PCEA regimen included a loading dose of 5 ml followed by background infusion at 2 ml?h-1 with an 1 ml bolus dose and a 15 min lockout interval. The PCEA solution contained morphine 2 mg + ropivacaine 75 mg in group A (n = 20); clonidine 150 ?g + morphine 2 mg + ropivacaine 75 mg in group B ( n = 20) ; clonidine 300 ?g + morphine 2 mg + ropivacaine 75 mg in group C ( n = 20) in 60 ml of normal saline. BP, HR, VAS pain score (0 = no pain, 10 worst pain) and Ramsay sedation score (1 = wide awake, 5-6 over sedated) were recorded one day before operation (T0), before induction of anesthesia (T1 ), 0, 5, 15, 30, 60 min, 2, 4, 8, 20, 24 h (T2-11 ) after PCEA was commenced. Blood samples were taken before induction of anesthesia (baseline) and 6 and 24 h after operation for determination of plasma concentrations of ET-1 and CGRP. The total number of button pressing (D1) and the number of actual delivery of bolus dose (D2) and the consumption of PCEA solution were also recorded. Results VAS pain score was significantly higher in group A than that in group B and C ( P