Relationship between beta amyloid protein 1-40 and post-operative delirium after oral and maxillofacial surgery in elderly patients / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To determine the incidence of post-operative delirium after oral and maxillofacial surgery under general anesthesia in elderly patients, and to examine its association with plasma concentrations of beta amyloid protein 1-40 (Abeta1-40).</p><p><b>METHODS</b>Fifty patients underwent elective oral and maxillofacial surgery were divided into two groups: Group C (n=20) aged from 20 to 60 years old, and Group T (n=30) aged from 62 to 78 years old. The two group received the same general anesthesia. Delirium rating scale-revised-98 (DRS-R-98) was used as an instrument to diagnose and access the postoperative delirium of the two groups. The scores of DRS-R-98 were recorded before operation (T0) and at 24 h (T1), 48 h (T2), 72 h(T3) and 96 h(T4) after the operation. Serial measurements of serum concentrations of Abeta1-40 were also performed at the same time.</p><p><b>RESULTS</b>The incidence of post-operative delirium after oral and maxillofacial surgery in Group T was 20.0%. The concentrations of plasma Abeta1-40 in group T were much higher than group C at TO, T1, T2 and T3 significantly (P < 0.01). The concentrations of plasma Abeta1-40 at T1 and T2 were higher than those at TO in the same group (P < 0.05). The scores of DRS-R-98 in Group T at T3 and T4 were much higher than those at T1 and Group C significantly (P < 0.01).</p><p><b>CONCLUSION</b>The constant increase of plasma Abeta1-40 may be one of the important factors related to post-operative delirium in elderly patients underwent oral and maxillofacial surgery.</p>

A long-term evaluation of bibuccinator myomucosal island flap applying to elder patients suffered from wide cleft palate / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate a long-term effect on pronunciation and maxillary growth of elder patients with wide isolated cleft palate after bibuccinator myomucosal island flap palatoplasty.</p><p><b>METHODS</b>Twelve patients over eight years old with wide isolated cleft palate were selected in experiment group, who received bibuccinator myomucosal island flap palatoplasty. The common group comprised 20 age-matched patients with isolated cleft palate receiving traditional palatoplasty named double-flap method. Simultaneously, 30 randomly selected age-matched noncleft children were included in control group. Both preoperative and postoperative effects over five years on pronunciation and maxillary growth were evaluated using professional, clinical pronunciation system and cephalometric measurement between former two groups. The data of former two groups were compared with control group statistically.</p><p><b>RESULTS</b>The incisions of all patients in experiment group healed perfectly. After 5-years' follow-up, the patients' mouths opening were normal, no secondary hole on the palate, the flap tissue was softer and more colorful than palate mucosa. The long-term pronunciation effects of patients in experiment group were significantly better than that of preoperation (P < 0.05) and the common group (P < 0.05). The status of maxillary growth of patients in experiment group excelled that in common group significantly (P < 0.05), but no significant difference contrast to that in the control group (P > 0.05).</p><p><b>CONCLUSION</b>Bibuccinator myomucosal island flap palatoplasty is a good operative method for elder patients with wide isolated cleft palate to improve their pronunciation and decrease the affect on maxillary growth.</p>

Influence of propofol and isoflurane on cytokines response to cancer surgery during perioperative period / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To compare the influence of propofol and isoflurane on pro-inflammatory and anti-inflammatory cytokine response to perioperative period of tongue cancer surgery.</p><p><b>METHODS</b>Twenty-four adult patients undergone the operation of tongue cancer were assigned to two groups randomly, propofol group (Group P) and isoflurane group (Group I). In group P, anesthesia was induced with fentanyl 2-3 microg/kg, propofol 2 mg/kg, atracurium 0.6 mg/kg and maintained with propofol 5-8 mg x kg(-1) x h(-1) and inhalation of 50% nirous oxide (N2O:O2=50%:50%). In group I, anesthesia was induced with 3%-4% isoflurane, fentanyl 2-3 microg/kg, diazepam 0.06-0.1 mg/kg, atracurium 0.6 mg/kg and maintained with inhalation of 50% N2O and isoflurane (ended-tidal isoflurane was maintained at 0.6%), in two groups atracurium was given intermittently. Blood samples were taken from peripheral vein before anesthesia (TO), at the end of operation (T1), 24 h (T2) and 48 h (T3) after operation for determination of serum IL-6 and IL-10 concentrations. The mean arterial pressure (MAP) and body temperature in two groups were recorded.</p><p><b>RESULTS</b>IL-6 and IL-10 levels increased significantly in two groups at T1, T2 and T3 compared with T0 (P < 0.01). The increasing trend of IL-6 and IL-10 levels were similar in both groups, whereas the level of IL-6 at T1 in propofol group was lower than that of isoflurane group significantly (P < 0.01), however the level of IL-10 was much higher in propofol group than that of isoflurane group at T1 and T2 (P < 0.05).</p><p><b>CONCLUSION</b>The influence of total intravenous anesthesia of propofol on post-operation inflammatory response is much gentler than isoflurane.</p>

Comparison of the suppressive effects of tramadol and low-dose ketamine on the patients with postoperative hyperalgesia after remifentanil-based anaesthesia / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To compare the suppressive effects of tramadol and low-dose ketamine on postoperative hyperalgesia after remifentanil-based anaesthesia.</p><p><b>METHODS</b>A total number of sixty ASA I - II adult patients who undergone the operation of cranio-cervical region were assigned to three groups randomly, controlled group (Group C), tramadol group (Group T) and low-dose ketamine group (Group K). Before the end of surgery, Group T was given tramadol 0.3 mg/kg, Group K was given ketamine 0.5 mg/kg and Group C wasn't given any medicine. When the visual analogue scale (VAS) score of the group C was over five, tramadol 0.3 mg/kg was given to the patients. The four-level verbal rating scale after trachea extubation, VAS score, the time of requiring analgesia again by patients and adverse drug reactions such as nausea, vomit, diplopia and hallucination were recorded for 24 hours after surgery.</p><p><b>RESULTS</b>After operation, the VAS score of Group C was much higher than that of Group K in the first 4 hours and Group T was higher than Group K during 2, 3 and 4 hours (P < 0.05). The time of requiring analgesia by patients in Group C and Group T was earlier than Group K. The adverse drug reaction showed no significant difference in three groups.</p><p><b>CONCLUSION</b>Low-dose ketamine had significant suppressive effect on patients with postoperative hyperalgesia and acute opioid tolerance after remifentanil-based anaesthesia.</p>