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Objective:To evaluate the effects of remazolam and propofol on the hemodynamics during induction of anaesthesia in elderly patients using the area under curve (AUC) method.Methods:Eighty elderly patients of either sex, aged 65-75 yr, with body mass index of 20-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective non-cardiac surgery, were divided into 2 groups ( n=40 each) by using a random number table method: remazolam group (R group) and propofol group (P group). Remazolam 1 mg/ml or propofol 10 mg/ml was slowly and intravenously injected through titration to achieve loss of responsiveness to verbal command. The accumulative areas under the curve below (AUC MAP-) or above (AUC MAP+ ) baseline mean arterial pressure and under the curve below or above 10% of baseline heart rate at the same time (AUC HR-, AUC HR+ ) were calculated within the first 10 min after administration of propofol or remazolam. The use of vasoactive drugs and injection pain were recorded during this period. The intraoperative awareness during the 24-h follow-up after surgery and development of cardiovascular complications, cerebral infarction and oliguria or anuria within 30 days after surgery were recorded. Results:Compared with R group, AUC MAP- was significantly enlarged (the mean difference 59.375 mmHg·min, 95% confidence interval 26.763-91.987 mmHg·min), AUC HR- was enlarged ( P<0.05), and no significant change was found in AUC MAP+, AUC HR+, requirement for vasoactive drugs, frequency of vasoactive drugs, and postoperative complications in P group ( P>0.05). No injection pain or intraoperative awareness was found in two groups. Conclusions:Remazolam is superior to propofol in maintaining hemodynamic stability during anesthesia induction in elderly patients.
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Objective:To identify the risk factors for adverse cardiac events after thoracic surgery in the patients with coronary heart disease.Methods:Perioperative data of patients with coronary heart disease who underwent elective thoracic surgery and had undergone coronary CT angiography before surgery from January 2020 to June 2022 were retrospectively collected. The number and stenosis score of coronary artery were obtained from preoperative coronary artery CT angiography. The patients were divided into cardiac adverse event group and non-cardiac adverse event group according to the occurrence of cardiac adverse events after thoracic surgery from the end of surgery to discharge. Multivariate logistic regression analysis was used to identify the risk factors for adverse cardiac events after thoracic surgery in the patients with coronary heart disease.Results:A total of 786 patients were finally enrolled, and the incidence of cardiac adverse events was 19.6% after thoracic surgery in the patients with coronary heart disease. The results of logistic regression analysis showed that age, preoperative arrhythmia, preoperative coronary stenosis score >7, coronary stent implantation, intraoperative infusion volume, intraoperative red blood cell infusion were risk factors for adverse cardiac events after thoracic surgery in the patients with coronary heart disease ( P<0.05). Conclusions:Age, preoperative arrhythmia, preoperative coronary stenosis score>7, coronary stent implantation, intraoperative infusion volume, intraoperative red blood cell infusion are risk factors for cardiac adverse events after thoracic surgery in the patients with coronary heart disease.
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Objective:To evaluate the efficacy of scalp nerve block combined with general anesthesia in optimizing anesthesia in the patients with moyamoya disease undergoing revascularization.Methods:A total of 154 patients with moyamoya disease, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective revascularization, were divided into 2 groups ( n=77 each) using a random nunber table method: scalp nerve block combined with general anesthesia group (GN group) and general anaesthesia group (G group). Anesthesia was induced with intravenous midazolam 0.05 mg/kg, sufentanil 0.5-1.0 μg/kg, rocuronium 0.6 mg/kg and etomidate 0.2-0.3 mg/kg.After the patients were tracheally intubated after anesthesia induction, ipsilateral scalp nerve block (2 ml for supraorbital nerve block, 2 ml for supratrochlear nerve block; 3 ml for auriculotemporal nerve block, 3 ml for greater occipital nerve block, 3 ml for less occipital nerve block) was performed with 0.5% ropivacaine in GN group.The equal volume of normal saline was locally injected in G group.Anesthesia was maintained by inhalation of sevoflurane and intravenous infusion of remifentanil 0.05-0.10 μg·kg -1·min -1 and cisatracurium 0.1 mg·kg -1·h -1.The consumption of intraoperative remifentanil, requirement for postoperative rescue analgesia, nausea and vomiting, length of postoperative hospital stay, and early neurological complications were recorded.The modified Rankin Scale scores were evaluated before operation, at discharge and at 6 months after operation. Results:Compared with G group, the consumption of intraoperative remifentanil and requirement for postoperative rescue analgesia were significantly decreased ( P<0.05), and no significant change was found in the incidence of postoperative nausea and vomiting, incidence of neurological complications, length of postoperative hospital stay, and modified Rankin Scale scores at each time point in GN group ( P>0.05). Conclusions:Scalp nerve block combined with general anesthesia can increase the perioperative analgesic efficacy and is helpful in achieving a low-opioid anesthesia mode when used in the patients with moyamoya disease undergoing revascularization.
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Objective:To evaluate the value of implementing strict aseptic operation procedures in preventing central venous catheter-related infections.Methods:This retrospective cohort study consisting of non-surgical patients who underwent central venous catheterization from 2015 to 2019 were conducted.The patients were divided into 2 groups according to routine aseptic procedures and strict aseptic procedures, the patients between 2015 and 2017 served as routine aseptic procedure group (group C), and the patients between 2017 and 2019 served as strict aseptic procedure group (group E ). The occurrence of central venous catheter-related infections (local infection, bloodstream infection) was recorded within 6 days after catheterization.Results:Compared with group C, the incidence of central venous catheter-related local infection was significantly decreased (1.79% vs. 0.48%, P<0.001; the rate ratio being 0.27 ranged in 0.10-0.30), while no significant change was found in the incidence of central venous catheter-related bloodstream infection in group E (0.29% vs. 0.19%, P>0.05). The cumulative incidence of central venous catheter-related infections was 0.67%(<1.00%) in group E. Conclusions:Implementation of strict aseptic procedures during central venous catheterization can further reduce the occurrence of central venous catheter-related infections, which has significant clinical value.
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Objective:To investigate the mechanism of dexmedetomidine preventing sevoflurane-indued neurotoxicity to neonatal mice and the relationship with Tau phosphorylation.Methods:Seventy-two SPF healthy newly born C57BL/6 wild-type mice of both sexes, aged 6 days, were divided into 4 groups ( n=18 each) using a random number table method: normal control group (C group), dexmedetomidine control group (D group), sevoflurane-induced neurotoxicity group (S group), and dexmedetomidine prevention group (SD group). Mice inhaled 2.1%-3.3% sevoflurane 2 h daily on postnatal days 6, 9 and 12, and dexmedetomidine 10 μg/kg was intraperitoneally injected at 30 min before anesthesia in group SD.Six mice were randomly selected after the end of injection, and the hippocampus tissues were removed for determination of the expression of phosphorylated Tau protein (AT8) and Tau46 protein at Tau-PS202 and Tau-PT205 sites by Western blot.The new object recognition test was performed on postnatal days 29-30 (the discrimination ratio of new objects was observed), and the Morris water maze test was performed from postnatal day 31 to 37 (the escape latency and the times of crossing the platform were observed). The hippocampi were harvested under anesthesia to detect the expression of postsynapatic density-95 by Western blot. Results:Compared with group C, the expression of AT8 was significantly up-regulated, the expression of PSD-95 was down-regulated, the number of crossing the platform and new object discrimination ratio were decreased ( P<0.05), and no significant change was found in Tau46 protein expression or escape latency in group S ( P>0.05). There was no significant difference in the indexes mentioned above between group D and group SD ( P>0.05). Compared with group S, the expression of AT8 was significantly down-regulated, the expression of postsynapatic density-95 was up-regulated, the number of crossing the platform and new object discrimination ratio were increased ( P<0.05), and no significant change was found in Tau46 protein expression and escape latency in group SD ( P>0.05). Conclusions:The mechanism of dexmedetomidine preventing sevoflurane-induced neurotoxicity to neonatal mice is related to the inhibition of Tau phosphorylation.
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Objective:To evaluate the role of hypothalamic aromatase in sevoflurane anesthesia-induced epileptic waves in neonatal rats.Methods:Thirty clean-grade healthy neonatal Sprague-Dawley rats of both sexes, aged 5 days, weighing 10-15 g, were divided into 3 groups ( n=10 each) according to a random number table method: control group (group C), sevoflurane group (group S), and aromatase inhibitor formestane plus sevoflurane group (group F). The electroencephalogram (EEG) in the neonatal rat cortex was monitored, 30 min later formestane 2 mg/kg was subcutaneously injected in F group, while the equal volume of normal saline was given instead in C and S groups.At 30 min after subcutaneous administration, 6% sevoflurane was inhaled to induce anesthesia for 3 min, and then the concentration was adjusted to 2.1% to maintain anesthesia for 57 min in S and F groups.The total duration and single duration of epileptic waves and the number of seizure during sevoflurane anesthesia were recorded.After the end of EEG recording, the laparotomy was performed, the left ventricular puncture was performed, and blood samples were collected for blood gas analysis and for determination of corticosterone levels (by enzyme-linked immunosorbent assay). Brain tissues were obtained, and then the hypothalamus was rapidly isolated for determination of the expression of aromatase mRNA, Na + -K + -2Cl - cotransporter-1 (NKCC1) mRNA and K + -Cl - cotransporter-2 (KCC2) mRNA (by polymerase chain reaction). Results:No epileptic waves were found in group C. Compared with group C, the total duration and single duration of cortical epileptic waves were significantly prolonged, and the number of seizures was increased, the serum corticosterone concentration was increased, the expression of aromatase mRNA was up-regulated, and NKCC1/KCC2 mRNA ratios were increased in S and F groups ( P<0.05). Compared with group S, the total duration and single duration of cortical epileptic waves were significantly shortened, and the number of seizures was decreased, the serum corticosterone concentration was decreased, the expression of aromatase mRNA was down-regulated, and NKCC1/KCC2 mRNA ratios were decreased in group F ( P<0.05). Conclusion:Up-regulation of hypothalamic aromatase expression is involved in the development of sevoflurane anesthesia-induced epileptic waves in newborn rats.
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Objective:To investigate the effect of sevoflurane anesthesia on electroencephalographic (EEG) seizures and long-term behavior and possible mechanism in neonatal rats.Methods:A total of 141 postnatal days 4-6 Sprague-Dawley rats (66 male, 75 female) were divided into 3 groups ( n=47 in each group) according to random number table method: control group, sevoflurane group, and NKCC1 inhibitor group, with 22 males and 25 females in each group. Rats in the control group were fed in normal cage without anesthesia; rats in the sevoflurane group were anesthetized with 2.1% sevoflurane for 6 hours; rats in the NKCC1 blocker group received intraperitoneal injection of 1.82 mg / kg bumetanide 30 minutes before anesthesia with 2.1% sevoflurane. The rats in the control group and sevoflurane group were injected subcutaneously with the same dose of DMSO at the same time when the NKCC1 blocker group received the drug intervention, so as to eliminate the influence caused by the solvent. The rats were observed for 30 minutes after recovery from anesthesia and then continued to breastfeed normally. Some of the new born rats received EEG monitoring from 9 to 11 days after being raised; the other rats received EPM and PPI respectively at 60 and 70 days after being raised. Results:The results of EEG showed that, compared with the control group, the number of epileptic waves((0.429±0.787), (1.571±0.787), t=2.753, P<0.01), the average duration of single epileptic wave ((1.575±2.349), (6.392±3.374), t=3.880, P< 0.01), the total duration increased significantly ((1.800±3.617), (10.957±6.028), t= 3.929, P<0.01) were all increased, the differences were statistically significant. Compared with sevoflurane group, the number of epileptic waves in EEG of male rats in NKCC1 blocker group decreased, the average duration of single epileptic wave decreased, and the total duration of epileptic wave shortened significantly, with statistical significance ((0.286±0.756), (0.925±1.733), (1.043±2.759), t=3.097, 4.404, 4.254, all P<0.01). There were no significant differences in female rat among the three groups (all P>0.05). Compared with male rats, the average duration of female rats in sevoflurane group decreased ((6.392±3.374), (2.515±2.992), t=3.044, P<0.01), the total duration shortened ((10.957±6.028), (3.270±5.883), t=2.626, P<0.01), the difference was statistically significant.The behavioral results showed that, compared with the control group, the open arm dwell time of male rats in sevoflurane group was significantly shorter ( P<0.05), and the panic response in PPI group was significantly lower ( P<0.05), the difference was statistically significant.Compared with the sevoflurane group, the open arm dwell time in NKCC1 blocker group was significantly longer ( P<0.05), and the panic response in PPI group was significantly increased.The difference was statistically significant ( P<0.05). The change trend in female rats of each group was similar to that of male rats, but there was no significant difference (all P>0.05). Comparison between male and female rats: compared with male rats in sevoflurane group, the female rats in sevoflurane group had a longer open arm stay time in EPM experiment ( P<0.05), the difference was statistically significant. Conclusion:Sevoflurane anesthesia for 6 hours can significantly increase the generation of epileptic waves in EEG of male newborn rats, and cause behavioral abnormalities in adult male rats, which may be related to NKCC1.And male rats are more vulnerable to the negative effects of sevoflurane anesthesia on brain nerve development.
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Objective To investigate the effect of estradiol on sevoflurane-induced epileptiform cor-tical EEG waves in neonatal rats. Methods Forty neonatal rats,aged 4-6 days,weighting 8-15 g,were di-vided into 5 groups according to random number table:normal saline control group (group C),estradiol group (group E),ICI182780 (group I),Formestane group (group O) and estradiol +ICI182780 (group EI). Af-ter establishing the monitoring model of cortical electroencephalogram in neonatal rats, EEG was recorded continuously for 30 minutes, then different treatment drugs were given according to different groups. After 30 minutes of continuous recording of EEG, anesthesia induction was started with inhalation of 6% sevoflurane for 3 minutes, followed by inhalation of 2. 1% sevoflurane to maintain anesthesia. Sevoflurane anesthesia las-ted for 1 hour. The righting reflex disappearance time was recorded after sevoflurane anesthesia. The total du-ration,single duration and frequency of EEG convulsion waves were recorded. Spike frequencies were recor-ded at different periods. Animal respiratory rate was recorded after sevoflurane induction. Results One rat in group I and one rat in group EI showed convulsion wave before treatment,which were excluded from the study. The righting reflex disappearance time of group S,group E,group I,group O and group EI were (24. 4 ±2. 5)s,(16. 4±4. 2)s,(31. 8±5. 2) s,(29. 8±1. 8) s,(24. 8±2. 7) s respectively,and there were statisti-cally significant differences among the 5 groups (F=16. 693,P<0. 01). There were no significant difference in respiratory frequency among the 5 groups (F=0. 276,P>0. 05). Compared with group S,the total dura-tion,single duration and frequency of convulsion wave were significantly increased in group E during anesthe-sia,and the differences were statistically significant (P<0. 05). Compared with group E and group S,the total duration,single duration and frequency of convulsion wave during anesthesia were significantly reduced in group I,group O and group EI,and the differences were statistically significant (P<0. 05). Compared with group S,the spike frequency of group E increased significantly in each period,and the differences were statis-tically significant (P<0. 05). The frequency of spike wave in group I,group O and group EI at 65-70 min and 90-95 min were lower than that in group S,and the differences were statistically significant (P<0. 05). The frequency of spike wave between group O and group EI during 115-120 min was statistically different with group S and group E(P<0. 05). Conclusion The mechanism of epileptiform EEG wave induced by sevoflu-rane anesthesia may be related with neuroactive steroidal estradiol.
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Objective@#To explore the relationship among osteopontin(OPN), Interleukin-17A(IL-17A), anti-MBP auto-antibody and autism spectrum disorder(ASD), and to provide the theoretical basis for the etiology and pathogenesis of ASD.@*Methods@#Forty autistic children and forty matched healthy children were enrolled in this case-control study. The levels of OPN, IL-17A, anti-MBP autoantibody in serum were measured by enzyme-linked immunosorbent assay (ELISA). The associations between those metabolic levels and the severity and intelligence of ASD children were performed by Pearson or Spearman correlation.@*Results@#Children with ASD had higher serum levels of OPN, IL-17A [(296.89±162.95),0.93] pg/mL compared to healthy control[(217.98±113.39), 0.62] pg/mL(P<0.05). Serum OPN, IL-17A, and anti-MBP auto-antibody levels in ASD group were not correlated with the scores of ABC, CARS, and PPVT(P>0.05). However, anti-MBP auto-antibodies level in children with ASD were positively correlated with OPN and IL-17A levels, respectively(r=0.35, 0.34, P<0.05).@*Conclusion@#It was obvious that the ASD children were found with neuroimmunologic abnormality, and the underlying mechanism needs to be further explored.
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Objective To evaluate the modifying efficacy of thoracic paravertebral block ( TPVB) combined with general anesthesia in the patients undergoing single-port video-assisted thoracoscopic radical operation for lung cancer. Methods Sixty-six American Society of Anesthesiologists physical status Ⅰ orⅡ patients of both sexes, aged 18-64 yr, with body mass index of 20-24 kg∕m2 , undergoing elective sin-gle-port video-assisted thoracoscopic radical resection of lung cancer, were divided into TPVB plus general anesthesia group ( group TPVB+GA, n=33) and general anesthesia group ( group GA, n=33) using a random number table method. Ultrasound-guided TPVB was performed at T4 and T7 before induction of gen-eral anesthesia, and 0. 5％ ropivacaine 10 ml was injected into the two sites. General anesthesia was in-duced with midazolam, etomidate, sufentanil and rocuronium. Anesthesia was maintained by inhaling sevoflurane and infusing remifentanil. Patient-controlled intravenous analgesia ( PCIA ) with fentanyl 2μg∕kg, flurbiprofen 100 mg and 10 mg in 100 ml of normal saline. Sufentanil 0. 1μg∕kg was intravenously injected when VAS score≥4 during postanesthesia care unit ( PACU) . Propofol 0. 5-1. 0 mg∕kg was intra-venously injected when Sedation-Agitation Scale scores>5 during PACU. Nicardipine 0. 2 mg was injected intravenously when mean arterial pressureheart was increased by 30％ of baseline value during PACU. Es-molol 20 mg was given inravenously when heart rate was>100 bpm during PACU. The end-tidal concentra-tion of sevoflurane was recorded at 5 min after incision and at 5, 20, 30 and 60 min after inserting thoraco-scopic cannula. Venous blood samples were collected before operation, at 5 min after inserting thoracoscop-ic cannula, at closing chest and at 6 and 24 h after operation for determination of plasma norepinephrine concentrations by enzyme-linked immunosorbent assay. The consumption of remifentanil during opertion, requirement for sufentanil, propofol, nicardipine and esmolol during PACU, duration of PACU stay and development of postoperative nausea and vomiting were recorded. Results Compared with group GA, the intraoperative end-tidal concentration of sevoflurane and consumption of remifentanil were significantly re-duced, the concentration of norepinephrine was decreased at each time point during and after surgery, and the requirement for sufentanil, propofol, nicardipine and esmolol was decreased during PACU, and dura-tion of PACU stay was shortened during stay in PACU in group TPVB+GA ( P<0. 05) . Postoperative nause-a and vomiting was not found in the two groups. Conclusion TPVB combined with general anesthesia is helpful in carrying out anesthetic model of low-consumption opioids and in improving the quality of recovery from anesthesia and is more helpful in inhibiting intraoperative and postoperative stress responses and post-operative pain responses than general anesthesia alone when used for the single-port video-assisted thoraco-scopic radical operation for lung cancer.
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Objective To explore the application value of videolaryngoscope and Macintosh la ryngoscope in double-lumen endobronchial intubation.Methods Eighty patients (50 males,30 females,aged 18-70 years,ASA grade Ⅰ-Ⅲ) of both sexes,scheduled for thoracic surgery and double lumen endobronchial intubation were randomly divided into two groups using a random number table:videolaryngoscope group and Macintosh laryngoscope group.The intubation time,the success rate of intubation,the views of glottis,the hemodynamics during the first 4 minutes of intubation,the number of positive responses to intubation and the incidence of pharyngalgia at 24 h after the operation were observed and compared between the two groups,the condition of oral hemorrhage and the injury of the tracheal walls were recorded as well.Results Compared with videolaryngoscope group,the C-L grade and the success rate of the first intubation of Macintosh laryngoscope group was significantly higher,the intubation time of Macintosh laryngoscope group was significantly shor ter (P＜0.05).In addition,the positive cases of responses to intubation and the incidence of pharyngalgia at 24 h after the operation of Macintosh laryngoscope group were obviously less than those of videolaryngoscope group (P＜0.05).There was no significant difference between the two groups of oral injury bleeding and the injury of tracheal wall and protuberance.At T2,T3,the two groups of MAP were significantly lower than that of T1,and the MAP of videolaryngoscope group was significantly lower than that of t Macintosh laryngoscope group at T2,T3 (P ＜ 0.05).Conclusion Compared with videolaryngoscope,Macintosh laryngoscope is more suitable for the doublelumen endobronchial intubation in patients predicted without difficulty in intubating.
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Nine pediatric patients (4 females,5 males) with huge hemangioma of head and neck complicated with Kasabach-Merritt phenomenon,aged 15-135 days,undergoing elective radical resection for huge hemangioma of head and neck,were selected from June 2012 to June 2016 in our hospital.Two pediatric patients were sensitive to preoperative hormone treatment,the platelet count almost increased to the normal value,7 pediatric patients were not sensitive to preoperative hormone treatment,and the increase in platelet count was not obvious.When the platelet count ＜ 40× 109/L,platelet was infused at 12 h before operation until the platelet count ＞ 100× 109/L.Two pediatric patients with larger haemangioma in maxillofacial region kept spontaneous breathing,and anesthesia was induced by inhaling high-concentration of sevoflurane.Anesthesia was induced with intravenous midazolam,sufentanil and cisatracurium in the other seven pediatric patients.Pediatric patients were mechanically ventilated in pressure-controlled mode after endotracheal intubation with airway pressure of 9-12 cmH2O.All pediatric patients inhaled sevoflurane,and anesthesia was maintained by infusing remifentanil.Heart rate and systolic blood pressure were maintained within the normal range during operation.Fluid and blood products were infused according to the blood loss,urine volume,physiological requirement and central venous pressure,etc.Pediatric patients were transferred to pediatric intensive care unit (PICU) at the end of operation,and the endotracheal tube was removed after the patients were completely awake.One pediatric patient developed pulmonary infection after operation,was discharged from PICU on day 7 after operation,then cured and discharged from hospital after healing on day 20 after operation.The other eight pediatric patients were discharged from PICU on day 2 after operation,then cured and discharged from hospital on days 5-10 after operation.After a followup period of 1 yr,the pediatric patients recovered well,the platelet count was normal,and the tumor recurrence was not found.
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Objective To investigate the effect of anesthesia factor on lung injury in patients un?dergoing thoracoscopic radical lung cancer surgery and to evaluate efficacy of combination of thoracic para?vertebral block(TPVB)with dexmedetomidine mixed with ropivacaine and general anesthesia. Methods One hundred patients of both sexes, aged 18-64 yr, with body mass index of 18-25 kg∕m2, of American Society of Anesthesiologists physical statusⅡorⅢ, scheduled for elective thoracoscopic radical lung cancer surgery, were divided into 5 groups(n=20 each)using a random number table: general anesthesia group (group G), TPVB with ropivacaine combined with general anesthesia group(group R), intravenously in?fused dexmedetomidine combined with general anesthesia group(group Div), intravenously infused dexme?detomidine plus TPVB with ropivacaine combined with general anesthesia group(group Div+R), and TPVB with dexmedetomidine mixed with ropivacaine combined with general anesthesia group(group Dtp+R). In group R, TPVB was performed under ultrasound guidance, two?point method was selected accord?ing to the position of intercostal space at surgical incision, and 0.5% ropivacaine 10 ml was injected into each puncture site. Dexmedetomidine 0.5 μg∕kg was intravenously infused over 10 min in group Div. Dexmedetomidine was intravenously infused for TPVB in group Div+R. TPVB solution contained dexmedeto?midine 0.5 μg∕kg and ropivacaine in group Dtp+R. Anesthesia was then induced and maintained by IV in?fusion of propofol and remifentanil. The intraoperative consumption of propofol and remifentanil and develop?ment of adverse reactions such as hypoxemia, hypotension and bradycardia were recorded. Normal lung tis?sues around the tumor margin were obtained immediately after tumor resection for determination of the ex?pression of hypoxia?inducible factor 1 alpha(HIF?1α), BCL2∕adenovirus E1B 19kDa interacting protein 3 (BNIP3)and microtubule?associated protein 1 light chain 3Ⅱ(LC3Ⅱ)(by Western blot), contents of tumor necrosis factor?alpha(TNF?α)and interleukin?6(IL?6)in lung tissues(by enzyme?linked immu?nosorbent assay)and cell apoptosis(by TUNEL)and for examination of the pathological changes(with a light microscope)which were scored. Apoptosis index was calculated. Results The amount of propofol consumed was significantly lower in Div+R and Dtp+R groups than in the other three groups, and the a?mount of remifentanil consumed was significantly higher in G and Div groups than in the other three groups (P<0.05). The incidence of hypertension and tachycardia was significantly lower in R and Div groups than in group G(P<0.05). The incidence of hypotension was significantly lower in R, Div and Dtp+R groups than in group Div+R(P<0.05). The incidence of bradycardia was significantly higher in Div and Div+R groups than in group R(P<0.05). Compared with G and R groups, apoptosis index, contents of TNF?α and IL?6 and lung injury scores were significantly decreased, and the expression of HIF?1α, BNIP3 and LC3Ⅱ was up?regulated in Div, Div+R and Dtp+R groups(P<0.05). Compared with group Div, the TNF?α content and lung injury scores were significantly decreased, and the expression of HIF?1α and LC3Ⅱwas up?regulated in Div+R and Dtp+R groups, and the IL?6 content was significantly decreased in group Dtp+R(P<0.05). Conclusion Combination of TPVB with dexmedetomidine mixed with ropivacaine and general anesthesia produces better efficacy in reducing lung injury in patients undergoing thoracoscopic radi?cal lung cancer surgery.
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Objective To evaluate the role of Na+-K+-2Cl-cotransporter isoform 1 (NKCC1) in neurons in sevoflurane-induced epileptiform electroencephalogram (EEG) activity in the cortex of neonatal rats.Methods Twenty-four neonatal Sprague-Dawley rats,aged 4-6 days,weighing 8-15 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),sevoflurane group (group S),and NKCC1 inhibitor bumetanide + sevoflurane group (group B).After electrodes were placed correctly,EEG was monitored continuously.At 30 min of monitoring,normal saline 3 μl/g was injected intraperitoneally in D and S groups,and bumetanide 10 μg/g was injected intraperitoneally in group B.At 60 min after the end of intraperitoneal administration,anesthesia was induced with inhalation of 6％ sevoflurane for 3 min and maintained with inhalation of 2.1％ sevoflurane for 1 h in group S and group B.The total duration of seizures,the duration of a single episode,the number of episodes of electroencephalographic seizures,and the amplitude and frequency of spike-and-wave were recorded.Results Seizures were not detected in group C,and no spike-and-wave was found in group B.Compared with group C,the incidence of seizures in S and B groups (75％ and 25％,respectively) and incidence of spike-and-wave in group S (100％) were significantly increased (P＜0.05).Compared with group S,the incidence of seizures and spike-and-wave was significantly decreased,the total duration of seizures,and duration of a single episode were significantly shortened,and the number of episodes of electroencephalographic seizures was significantly decreased in group B (P＜0.05).Conclusion NKCC1 in neurons may be involved in the formation of sevoflurane-induced epileptiform EEG activity in the cortex of neonatal rats.
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Objectives To investigate the methods of protecting external branch of the superior laryngeal nerve (EBSLN)in carotid endarterectomy and to observe the effect of using these methods in clinical surgery. Methods EBSLN (20 sides)of 10 heads of corpse were studied by using microanatomy from January 2013 to December 2013. The occurrence probability of EBSLN on the lower edge of posterior belly of digastric muscle,medial edge of external carotid artery and upper edge of superior thyroid artery in anatomy triangle was analyzed. The distances from the midpoint of the EBSLN to carotid bifurcation, mandibular angle and mastoid tip were measured. Sixty-five patients with carotid endarterectomy in Tianjin Huanhu Hospital from December 2013 to November 2014 were treated with the protective methods of the relevant EBSLN by using anatomy triangle as a mark. Whether the patients had injury symptoms of EBSLN were followed up after procedure. Results (1)The occurrence probability of 20-side EBSLN in anatomy triangle was 95%(19 sides). The midpoint of EBSLN in the anatomy triangle at the posterior mandibular angle was median 0. 34 (-1. 62 to 2. 43)cm,at the inferior mandibular angle was 1. 28 (-1. 33 to 3. 42) cm,at anterior mastoid tip was 2. 84 (0. 51 to 5. 14)cm,at inferior was 4. 51 (2. 82 to 6. 39)cm,and at anterior superior of the carotid bifurcation was 1. 64 (0. 57 to 3. 78)cm. (2)65 patients who underwent carotid endarterectomy used the protective methods of intraoperative EBSLN. There was no manifestation of EBSLN injury at 3 weeks to 9 months after procedure. Conclusion In carotid endarterectomy,taking an anatomic triangle as a symbol,it is no more than 2 cm of the anterior superior of carotid bifurcation during the separation process. As for the patients with higher or lower position of carotid bifurcation,in the range of crossing rear mandibular angle 0. 50 cm or below the mastoid tip 4. 50 cm for arterial separation should be avoided,and this can effectively protect EBSLN.
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Objective:To explore whether perioperative intravenous flurbiprofen axetil can reduce the incidence and intensity of chronic pain for breast cancer atfer surgical treatment. Methods:This randomized, double-blind, controlled trial enrolled 60 patients undergoing mastectomy and axillary lymph node dissection under general anesthesia. All patients accepted Hospital Anxiety and Depression Scale (HAD) tests the day before the surgery to evaluate depression and anxiety. hTe patients were randomly assigned to receive either 50 mg lfurbiprofen axetil intravenously 15 minutes before the surgical incision and 6 hours later (group F) or intravenous 5 mL intralipid as a control (group C). All patients received patient-controlled intravenous analgesia (PCIA) with fentanyl postoperatively. Peripheral venous blood samples were drawn before the surgery, at 4 and 24 h atfer the surgery to detect the plasma level of PGE2 and tumor necrosis factor-α(TNF-α). Postoperative fentanyl consumption, Numerical Rating Scale (NRS) scores and adverse effects were recorded at 2, 6, 12, 24 and 48 h after the surgery. hTe duration and intensity of pain were followed up by telephone at the 2nd-12th month atfer the surgery. Results:The incidence of pain at 2, 4, 6, and 12 months after the breast surgery was 33%, 20%, 15%, and 10%, respectively, and the average pain score was 0.77, 0.57, 0.28, and 0.18, respectively. Compared with group C, the scores of pain in group F were significantly lower at 2, 4, 6 and 12 months postoperatively (F=7.758, P=0.007). The incidence of pain in group F was significantly lower at 2, 4 and 6 months postoperatively (P0.05). Preoperatively and at 4 and 24 h atfer the surgery, there was no signiifcant difference in the level of TNF-αbetween the two groups (F=0.530, P=0.470);but plasma concentration of PGE2 in group F was significantly lower than that in group C (F=5.646, P=0.021). No patients developed abnormal bleeding, peptic ulcer, impaired liver or renal function and respiratory depression. Conclusion:Perioperative intravenous infusion of 100 mg flurbiprofen axetil can decrease the intensity and incidence of chronic pain for breast cancer atfer surgical treatment.