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Objective To evaluate the training quality of anaesthesiology residents in different hospitals. Methods The scores of 125 residents,attending Shanghai resident clinic skill examination from 2005 to 2007,were analyzed. ResultsThe scores of examinees from municipal hospitals were higher than those from district hospitals,municipal specialized hospitals and traditional Chinese medicine hospitals.The scores of practice part were higher than those of theory part in all groups. Conclusion The training quality is related to the comprehensive strength of the hospital in which examinees work,but the training of theory knowledge still need to be strengthened.
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Objective To explore the correlation between the two methods of pulmonary arterial thermodilution technique(ThDCO)and pulse indicator continuous cardiac output(PiCCO)in determining hemodynamic changes in patients undergoing orthotopic liver transplantation(OLT).Methods Eighteen patients with end-stage liver disease(ASAⅡ-IV)were performed OLT and monitored hemodynamic changes by PiCCO method and ThDCO method simultaneously.The hemodynamic parameters including mean arterial pressure(MAP),cardiac output(CO)and systemic vascular resistance(SVR)were measured at different time points before anesthesia induction,after tracheal intubation,after the beginning of operation,at anhepatic phase,at neohepatic phase,at the end of operation,and after operation.Results Good correlation was found between the two methods for the determination of CO and SVR(r=0.987,P0.05).Conclusion The hemodynamics change dramatically in patients undergoing OLT.There is good correlation between the two methods of PiCCO and ThDCO for perioperative hemodynamic monitoring in patients undergone OLT,and PiCCO detection can be used conveniently for real-time continuous monitoring.
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Objective To investigate the effects of lipopolysaccharide(LPS) on the expression of hypoxia inducible factor-1?(HIF-1?) and its target gene glucose transpoter-1(GLUT-1)in human monocyte lines THP-1. Methods THP-1 cells were stimulated with 1 ?g/mL LPS for 0,2,4,6 or 8 h.The expression of HIF-1? protein of THP-1 cells was detected by Western blotting,and RT-PCR was employed to detect the expression of HIF-1? mRNA and GLUT-1 mRNA.THP-1 cells were exposed to different concentrations of LPS(0,0.01,0.1 and 1 ?g/mL) for 6 h,and the expression of HIF-1? protein of THP-1 cells was detected by Western blotting. Results The expression of HIF-1? protein of THP-1 cells began to increase 2 h after being treated with 1?g/mL LPS,significantly increased after exposure for 4 h(P
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Objective To observe the hemodynamic effects of open-loop target controlled infusion (OLTCI) and closed-loop target controlled infusion (CLTCI) of propofol and fentanyl for general anesthesia induction. Methods Twenty-four female patients with ASA grade I-II who were performed thyroidectomy were randomly allocated into two groups: OLTCI group and CLTCI group(n=12). In OLTCI group, anesthesia induction and maintenance were performed with propofol and fentanyl at the target concentrations of 3 ?g/mL and 3 ng/mL, respectively. In CLTCI group, double CLTCI were performed. Titrations of propofol and fentanyl were guided with bispectral index (BIS) and product of systolic pressure and heart rate (HR). Initiative concentrations of this closed-loop system were 3 ?g/mL and 3 ng/mL, step-up or step-down concentrations were 0.5 ?g/mL and 0.5 ng/mL, and the highest concentrations were 6 ?g/mL and 5 ng/mL, respectively. HR, mean arterial pressure (MAP), HR variability, BIS value and the dosages of propofol and fentanyl in various time of the two groups were recorded. Results One min after intubation and simulative incision stimulation, BIS value of both groups were increased, but the BIS value in CLTCI group was less increased than OLTCI group(P
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Objective To investigate the apoptosis response to mechanical stretch in human alveolar type Ⅱ epithelial cells A549.Methods First,A549 cells were given different stretch(0%,5%,15%,30%) at frequency of 0.5 Hz for 4 h.Then,A549 cells were stretched for different periods(0 h,2 h,4 h,8 h) at stretch 15%,0.5 Hz.Last,A549 cells were stretched for different frequency(0 Hz,0.2 Hz,0.5 Hz and 1 Hz) at stretch 15% for 4 h.The early apoptosis was detected by flow cytometry. Results A549 cells submitted to cyclic stretch caused the early apoptosis in a time-,stretch-and frequency-dependent manner.In details,at 0.5 Hz and 4 h stretch-dependence occurred,at 15% stretch and 0.5 Hz time-dependence occurred,and at 15% stretch and 4 h frequency-dependence occurred. Conclusion Mechanical stretch can induce the early apoptosis in human alveolar type Ⅱ epithelial cells A549,which may be one of the mechanisms of ventilator-induced lung injury.
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Objective To evaluate the clinical application of GlideScope~ video laryngoscope in anesthetic endotracheal intubation.Methods Two hundred patients who received surgery under general anesthesia with ASA I or II were involved in this study.One hundred patients were assigned to be intubated with GlideScope~(GS group) and the other 100 with size 3 Macintosh laryngoscope(ML group).The following data were recorded and analyzed: noninvasive blood pressure(NBP),heart rate(HR) at the different time points of intubation process,glottic exposure time,CormarkLehane grade,tracheal intubation time and total intubation attempts. Results The rise of NBP and HR in ML group were significantly higher than those in GS group(P
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Objective To evaluate the methods of postoperative respiratory management and complications prevention of patients with myasthenia gravis who received thymectomy. Methods According to the accumulated scores of myasthenic crisis prediction, the patients with myasthenia gravis who underwent thymectomy in the past 5 years were divided into 2 groups: high risk group(12, n=11). The time of mechanical ventilation, restoration of muscle strength and spontaneously breathing during extubation, results of arterial blood gas analysis, body temperature, chest X-ray examination and sputum culture of each patient were analyzed. Results The time of mechanical ventilation in high risk group (18~30 h, 26 h in average) was longer than that in control group(4~28 h, 14 h in average)(P
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<p><b>OBJECTIVE</b>To observe the effect of electroacupuncture (EA) on cytokines in the cardiac surgical patient and to evaluate the application of combined acupuncture anesthesia to cardiac surgery.</p><p><b>METHODS</b>Thirty patients with atrial septal defect were divided into 3 groups, general anesthesia group (A), acupuncture anesthesia group (B) and combined general anesthesia and EA group (C). Peripheral blood samples were collected before anesthesia, before cardiopulmonary bypass (CPB), 30 min after CPB and 24 h after operation to determine the levels of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), IL-6 and IL-10.</p><p><b>RESULTS</b>The levels of IFN-gamma and IL-2 decreased in the 3 groups after CPB and further decreased 24 h after operation, and in the group C were higher than those in the group B. The levels of IL-6 and IL-10 significantly increased 24 h after operation in the 3 groups with no significant difference among the 3 groups.</p><p><b>CONCLUSION</b>The general anesthesia combined with EA can not completely improve the decrease of IFN-gamma and IL-2 induced by CPB, indicating that the good response of the general anesthesia combined with EA to stress can partially improve the immunosupression induced by CPB. Acupuncture does not have significant effect on inflammatory cytokine reaction induced by cardiac surgery.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Acupuncture Analgesia , Cardiac Surgical Procedures , Electroacupuncture , Interferon-gamma , Blood , Interleukin-10 , Blood , Interleukin-2 , Blood , Interleukin-6 , BloodABSTRACT
Objective To assess the anticonvulsant effect of midazolam, thiopental and propofol on the convulsion induced by ropivacaine in rats and the underlying mechanism.Methods Fifty male SD rats, 4-6 months of age, weighing 250-300 g were randomly divided into five groups of 10 animals each : (1) control group (C); (2) ropivacaine group; (R) (3) midazolam-ropivacaine group (MR); (4) thiopental-ropivacaine group (SR) and (5) propofol-ropivacaine group (PR) . In control group normal saline 2 ml was infused i.v. . In ropivacaine group (R) 0.75% ropivacaine was infused i.v. at 0.5 ml?min-1 until convulsion occurred. In midazolam - ropivacaine group (MR) midazolam 0.23 mg?kg-1 was injected i.v. 3 min before 0.75% ropivacaine infusion. In SR and PR groups thiopental 2 mg?kg-1 or propofol 1 mg?kg-1 was injected i.v. 1 min before 0.75% ropivacaine infusion. As soon as convulsion occurred ropivacaine infusion was stopped. The animals were decapitated and their brains were removed and kept in liquid nitrogen for determination of the contents of excitatory ammo-acids (aspartic acid and glutamic acid) and the inhibitory amino-acids [glycine and ?-amino butyric acid (GABA)] by high-performance liquid chromatography . The amount of ropivacaine infused in each group was recorded and calculated.Results The dose of ropivacaine needed to produce convulsion was 4.6?0.5 mg?kg-1 in group R and was significantly increased in the 3 groups pretreated with general anesthetics and was 2.96 times the dose in group R in MR group, 2.84 times in SR group and 1.54 times in PR group. The 4 amino-acid concentrations in the brain were significantly higher in group R than in control group. Compared to group R the Asp, Gly and GABA concentrations were significantly lower in group MR and PR but in group SR only Asp concentration was significantly lower. There was no significant difference in glutamic acid concentration among the4 roopivacaine groups (group 2-5).Conclusion Midazolam, thiopental and propofol can all increase the dose of ropivacaine needed to induce convulsion and midazolam and thiopental are more effective than propofol.
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Objective To estimate the value for the plasma-effect site equilibration rate constant(Ke0)of propofol using the time to peak effect(Tpeak)method and two pharmacokinetic models for propofol.Methods The Tpeak after a submaximal bolus dose 1.5 mg?kg~(-1) of propofol was measured with AAI A-line auditory evoked potential monitor in 36 patients scheduled for elective surgery under general anesthesia.Using Tpeak and two sets of pharmacokinetic parameters for propofol reported by Marsh and Shafer,the Ke0 was estimated according to the method described by Minto.Results The mean Tpeak was(142?62)s in 30 patients.The Ke0 was 0.626 min~(-1) with the model by Marsh and 0.914 min~(-1) with the model by Shafer.The corresponding t_(1/2) Ke0 values were 1.107 min and 0.759 min respectively(P＜0.01).Conclusion The Ke0 value of propofol estimated depends on the pharmacokinetic models used.The values we estimated in Chinese patients are significantly different from the values reported by foreign authors