ABSTRACT
Objective:To observe the effect of transdermal fentanyl combined with gabapentin for the treatment of malignant neu-ropathic pain (MNP). Methods:A total of 60 patients with MNP were randomly divided into two groups. A total of 30 cases in the con-trol group received transdermal fentanyl according to the dosages of opioid medicine that patients used. Such dosages were gradually in-creased until the pain relief visual analogue scale (VAS) fell below 3 or until the times of breakthrough pain became less than 3. For the combined group, gabapentin was co-administered with transdermal fentanyl, similar to the control group. Initially, 100 mg of gabapen-tin was administered thrice a day. This dosage was gradually increased until pain relief. However, gabapentin dosages were kept below 2,400 mg a day. VAS, quality of life (QOL), degree of pain relief, dosages of fentanyl and morphine, and side effects were evaluated be-fore treatment and at one, two, three, and four weeks after the treatment. Results:Both groups exhibited lower VAS after treatment (P<0.05), but the difference was observed to be more significant in the combined group than that in the control group (P<0.05). Both groups exhibited improved QOL (P<0.05), which was observed to be more significant in the combined group than in the control group (P<0.05). The effective rate was 96.7%in the combined group and 83.3%in the control group. The dosage of opioid medicine and the side effects in the combined group were less than those in the control group. Conclusion:Transdermal fentanyl combined with gabapen-tin is effective for the treatment of malignant neuropathic pain.
ABSTRACT
Objective To investigate the effect of sevoflurane pretreatment on the expression of cystathionine β-synthase(CBS)and heme oxygerase-1(HO-1)during myocardial ischemia-reperfusion(I/R)injury in rats.Methods Thirty adult male SD rats,weighing 180-220 g,were randomly divided into 3 groups(n =10each):sham operation group(group S),I/R group and sevoflurane group(group Sev).Myocardial I/R injury was produced by ligation of the left anterior descending branch of coronary artery for 30 min followed by 2 h reperfusioo.In group Sev,sevoflurane was inhaled before ischemia,the end-tidal concentration was 1.5％-1.7％ and myocardial I/R was produced 60 min later.The rats were sacrificed at 2 h of reperfusion and myocardial tissues were taken for determination of the contents of MDA,GSH,H2S and CO,SOD activity and expression of CBS mRNA and HO-I mRNA.The ultrastructure of myocardium was examined with electron microscope.Results Compared with group S,the contents of MDA,H2S and CO were significantly increased,the expression of CBS mRNA and HO-1 mRNA was up-regulated,and SOD activity and GSH content were significantly decreased in groups I/R and Sev(P ＜ 0.05).Compared with group I/R,the contents of MDA,H2S and CO were significanfly decreased,the expression of CBS mRNA and HO-1 mRNA was down-regulated,SOD activity and GSH content were significantly increased in group Sev.The damage to mitochondrial structure induced by I/R was mitigated by pretreatment with sevoflurane.Conclusion The mechanism by which sevoflurane pretreatment reduces myocardial I/R injury is related to down-regulation of the expression of CBS and HO-1 and decrease in the activities in rats.
ABSTRACT
Objective To evaluate the accuracy of bispectral index(BIS)and entropy index in monitoring the depth of anesthesia in patients during target-controlled infusion(TCI)of propofol on induction of anesthesia.Methods Fifty ASA grade Ⅰ-Ⅱ of chronic sinusitis patients who performed the surgery of nasal sinus patency were enrolled in this study.After into operation room(T0),anesthesia was induced with TCI of propofol,and it was added 0.3 μ g/ml after 30 seconds once the plasma drug level was 2.1 μ g/ml(T1)until loss of consciousness(T2),and added 0.5 μg/ml(T3).When tracheal intubation,the patients was injected 0.6 mg/kg rocuronium in their intravenous at the prospective plasma drug level(T4).Each case was monitored with BIS,state entropy index(SE)and response entropy index(RE).The data at following time were recorded:T0-T4,tracheal intubation(T5),1 minute and 3 minutes after tracheal intubation(T6,T7),skin incision(T8).Results The value of BIS,SE and RE were significantly decreased compared with T0 (P ＜0.05).Mean arterial pressure(MAP)and heart rate were in normal range.The value of RE was significantly higher than SE at all the time points(93 ± 9 vs.87 ± 5,88 ± 12 vs.82 ± 12,73 ± 25 vs.72 ± 21,57±21 vs.56±22,46± 16vs.43 ± 17,39± 14 vs.37± 12,36± 14vs.34± 11,35 ± 11 vs.32±9,39±15 vs.36 ± 12)(P ＜ 0.05),but there was no significantly difference between BIS and SE at all the time points(P ＞ 0.05).The value of BIS had significantly positive correlation with SE and RE(r =0.887,0.901 ;P ＜ 0.01).Conclusions During deep hypnosis,BIS,SE and RE all can provide information about the level of consciousness during TCI of propofol on induction of anesthesia.RE is more preponderant as a monitor than BIS and SE.