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Objective To compare the effects of propofol intravenous balanced anesthesia with infusion of remifentanil combined with fentanyl to simple infusion of remifentanil or fentanyl during laparoscopic cholecystectomy(LC).Methods Sixty patients scheduled for LC were randomly divided into three groups(n=20): simple remifentanil group(R),remifentanil combined with fentanyl group(RF) and simple fentanyl group(F).Mean arterial pressure(MAP),heart rate(HR) and SpO2 during the anesthesia induction phage,maintenance phage and analepsia phage,the recovery time of spontaneously breathing and consciousness from withdrawal,extubation time,pain score(verbral report score,VRS) and conscious state score(observers assessment of alertness/sedation scale,OAAS) at instant,1 h,3 h,7 h,12 h after extubation and complications of analepsia phage were recorded.Results As compared with the RF Group,the F Group and pre-induction intro-group,the R Group showed lower MAP and quicker HR when induction intubation,higher MPA and quicker HR after operation,and no obvious difference in maintenance phage was found.MAP and HR showed no obvious difference between the RF and F Group as well as within groups in induction and maintenance phage.MAP increased and HR became quicker in the RF Group when extubating and leaving operating room.All observed index at every time showed no significant differences between the R and RF Group after operation,but it prolonged significantly in the F Group.Complications of the three groups showed no statistical difference.VRS of the R Group was significantly higher than that of RF and F groups after operation(P
ABSTRACT
BACKGROUND: Stellate ganglion block has many functions by improving brain circulation, modulating immunity, reducing plasmic catecholamine content, interleukin-6 is one of the most sensitive and important predictors and mediators for acute organic stress response, playing neuroprotective and neurotoxic double roles in brain ischemic injury.OBJECTIVE: To observe the effect of stellate ganglion block in rat brain during ischemic-reperfusion period on the changes of serum interleukin-6,in order to probe the role of stellate ganglion block in brain ischemicreperfusional injury.DESIGN: Randomized controlled experimentation.SETTING: Anaesthesia Department of Taihe Hospital Mfiliated to Yunyang Medical College, and Anaesthesia Department of Renmin Hospital Affiliated to Yunyang Medical College.MATERIALS: This experiment on animals was carried out at the Experimental Center of Taihe Hospital Affiliated to Yunyang Medical College at March 2003, interleukin-6 reagent kit and determination was provided and conducted by the immunity research institute of Chinese People's Liberation Army General Hospital. Totally 28 big-ear healthy rabbits in which male or female was not limited were selected and randomly divided into stellate ganglion group, saline comparison group, blank comparison group and sham operation group with 7 rabbits in each group.METHODS: A pipe was set approximate to the stellate ganglion of all animals by operative method, six-vessels block method was used to simulate whole brain ischemic-reperfusion model, in stellate ganglion block group,artery clamp was lossen for reperfusiion at 15 minutes after ischemia, simultaneously 2.5 g/L bupivacaine was continuously pumped into left side of stellate ganglion for nerve block, which replaced by physical saline and nothing in respectively physical saline comparison group and blank comparison group, while rabbits in sham operation group were only subjected to surgery without artery clamp. RIA was used to determine serum interleukin-6 content at before ischemia, reperfusion of 10 minutes, 4 hours, 10hours, when 20 hours and 30 hours individually.MAIN OUTCOME MEASURES: Serum interleukin-6 content in each group at various post-reperfusional time points.RESULTS: Totally 28 big-ears white rabbits were enrolled in this experiment and all data was entered the result analysis. Interleukin-6 content was on an increasing tendency in all groups, while was higher in stellate ganglion block group than in sham operation group only at reperfusion 30time point, the difference has significance [(321±52) and (299±45) ng/L,P ＜ 0.05]; Comparing to pre-ischemic group, interleukin-6 in physical saline group began increase remarkably from onset of reperfusion 4 hours[(365±46) ng/L], but began obviously increase at reperfusion 10 hours in blank comparison group [(368±31) ng/L, P ＜ 0.05]. The difference of interleukin-6 among stellate ganglion block group, sham operation group,physical saline group and blank comparison group does not have statistical significance (P＞0.05); the level of interleukin-6 in physical saline group and blank comparison group were higher than in sham at all reperfusion 4-30 hours, and even higher than in stellate ganglion group after reperfusion 10 hours, the difference has significant meaning (P ＜ 0.05). Moreover the increase of interleukin-6 content in stellate ganglion block group was remarkably lower than physical saline comparison group and blank comparison group (P ＜ 0.05).CONCLUSION: Stellate ganglion block may obviously reduce serum interleukin-6 level in rabbit brain during ischemic-reperfusion period, implying stellate ganglion block has a certain protective and curative function on the whole brain ischemic-reperfusion damage, and considered as a promising way in the treatment of brain ischemic-reperfusion damage.
ABSTRACT
Objective To investigate the effects of unilateral stellate ganglion block (SGB) on the expression of heat shock protein 70(HSP70) in bilateral hippocampus and temporal lobe induced by global cerebral ischemia-reperfusion in rabbits. Methods Twenty-eight healthy Japanese long-ear rabbits of either sex weighing 2.5-3.0 kg were anesthetized with intravenous 1.5% pentobarbital, intubated and mechanically ventilated. Global cerebral ischemia was produced by clamping bilateral external and internal carotid arteries and vertebral arteries for 10 min. Global cerebral ischemia was confirmed by blanching of lips and conjunctival, respiratory and EGG changes. The arteries were then declamped for reperfusion. The animals were randomly divided into 4 equal groups ( n = 7) : SGB group, NS control group, blank control group and sham operation group. In SGB group left stellate ganglion was blocked by 0.25% bupivacaine 0.5 ml injected through an epidural catheter with its tip placed close to left stellate ganglion when reperfusion was started followed by continuous infusion of 0.25 % bupivacaine at a rate of 0.5 ml ? h -1 . SGB was confirmed by ptosis and miosis. In NS control group normal saline was used instead of 0.25 % bupivacaine. In blank control group no medication was give. In sham operation group the six arteries were exposed but not occluded. The HSP70 expression in the neurons in hippocampus CA1 section and cortex of temporal lobe was detected by immunohistochemistry using an antibody specific for HSP70 30h after reperfusion was started. Results HSP 70 expression in bilateral hippocampus CA1 section and cortex of temporal lobe was significantly lower in SGB group compared with the two control groups ( P 0.05) . Conclusion Left SGB can depress the over-expression of HSP 70 in bilateral hippocampus and temporal lobe induced by global cerebral ischemia-reperfusion.