ABSTRACT
Objective To evaluate the effect of MDR1 gene polymorphisms on the neuromuscular block of rocuronium. Methods One hundred thirty-five patients, aged 18-50 yr, with body mass index of 18-25 kg∕m2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing gynecologic laparoscopic operation under general anesthesia, were enrolled in the study. Anesthesia was induced with midazolam 006 mg∕kg, sufentanil 07 μg∕kg, propofol(target plasma concentration 6 μg∕ml)and remifentanil(target plasma concentration 6 ng∕ml). After the patients lost consciousness, neuromuscular block was assessed with TOF-Watch SX accelerometer, and rocuronium 06 mg∕kg was intravenously injec-ted. Anesthesia was maintained by target-controlled infusion of propofol(target plasma concentration 3-5 μg∕ml)and remifentanil(target plasma concentration 3-6 ng∕ml). Rocuronium 015 mg∕kg was added when T1reached 25% of control. The onset time of rocuronium, maintenance time of induction dose, main-tenance time of additional dose and recovery index were recorded. Peripheral venous blood samples were collected for MDR1 genotype(MDR1 1236 C>T and 3435 C>T)analysis using polymerase chain reaction-restriction fragment length polymorphism. Results For MDR1 1236 C>T genotype, there were 19 cases of MDR1 1236 CC genotype, 72 cases of MDR1 1236 TT genotype, 44 cases of MDR1 1236 CT genotype. Compared with patients of MDR1 1236 CC, the maintenance time of induction dose, maintenance time of additional dose and recovery index were significantly prolonged in patients of MDR1 1236 TT and CT geno-types(P<005). For MDR1 3435 C>T genotype, there were 58 cases of MDR1 3435 CC genotype, 55 cases of MDR1 3435 TT genotype, 22 cases of MDR1 3435 TC genotype. There was no significant differ-ence in maintenance time of induction dose, maintenance time of additional dose and recovery index among patients of different MDR1 3435 C>T genotypes(P>005). Conclusion MDR1 1236 C>T gene poly-morphisms affects the neuromuscular block of rocuronium, and the genetic factor may be one of the reasons contributing to the individual variation in the efficacy.
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Objective To investigate the effects of penehyclidine hydrochloride (PHCD)on cerebral ischemia-reperfusion injury induced by intrauterine distress in fetal rats.Methods Eighty mature fetal rats weighing 4.52-4.81 g were randomly divided into four groups (n =20):sham opera-tion group(group S),PHCD control group (group S+ P),cerebral IR group (group IR),PHCD treatment group(group IR+P).Fetal rat intrauterine distress model was set up by clamping bilateral uterine horn vessels of pregnant rats.PHCD 2 mg/kg was injected in pregnant rat’s gluteus at 30 min before intrauterine distress model was set up in group IR+P,the same volume saline was injected in pregnant rat’s gluteus before shame operation in group S,the same volume PHCD was injected in pregnant rat’s gluteus before shame operation in group S+P.Fetal rats were decapitated at 12 h after the reperfusion,the peripheral blood of fetal rats was detected by blood gas analysis (including PH, PaO 2 ,PaCO 2 ,Lac);the infarct volume and the infarct volume fraction were detected by TTC stai-ning;pathological changes in lung tissue were observed by HE staining;the TNF-α,IL-6 content in the brain were detected by ELISA;the expression of NF-κB mRNA was detected by quantitative Real-time PCR,the expression of NF-κB p65 protein was detected by Western-blotting.Results The blood PH,PaO 2 in group IR and IR+P were lower than group S and S+P,the blood PH,PaO 2 in group IR+P was higher than group IR.Compared with group S and group S+P,the blood PaCO 2 , Lac,the infarct volume and the infarct volume fraction,the concentration of TNF-αand IL-6,the ex-pression of NF-κB mRNA and protein were significantly increased in group IR and IR+P (P <0.05), and those in group IR+P were lower than group IR (P <0.05 ).The pathological changes in brain tissue were significantly attenuated in group IR + P (P < 0.05 ).Conclusion Pretreatment with PHCDcouldattenuatecerebralischemia-reperfusioninjuryoffetalratsinducedbyintrauterinedistress. ThemechanismscouldrelatetotheinhibitionofNF-κBsignalingpathwayinbraintissues.
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Objective To explore the impact of laparoscopic surgery and that of open surgery on the coagulation function and incidence of deep venous thrombosis(DVT) in lower limbs in patients undergoing hysterectomy .Methods From April 2014 to A‐pril 2015 ,110 eligible patients were recruited .There was 57 patients received laparoscopic surgery ,and 53 patients received open surgery for hysterectomy .All patients underwent surgery under the general anesthesia .The APTT ,PT ,FIB ,and D‐dimer was de‐tected at 5 time points:before surgery ,surgery completion ,24 h after surgery ,48 h after surgery ,and 72 h after surgery .All patients were scheduled to ultrasound exam in lower limbs to detect the DVT at 24 ,48 and 72 h after surgery .Results Both groups showed decreased PT at surgery completion as compared with other time points (P0 .05) .Both groups showed increased D‐dimer after surgery compared with that before surgery ;the laparoscopic group showed higher D‐dimer at 24 h after surgery ,and lower D‐dimer at 48 h after surgery than open group(P0 .05) .Conclusion Both the laparoscopic surgery and open surgery will activate the coagulation system , and lead to DVT ;as compared with open surgery ,the laparoscopic surgery could not reduce the incidence of DVT in lower limbs in patients undergoing hysterectomy .
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Objective To evaluate the feasibility of combining the sedation performed by propofol targeted concentration in-fusion with epidural anesthesia in patients undergoing total pelvic floor reconstruction.Methods A total of 80 eligible patients were recruited and were assigned randomly into the study group(n=40)and the control group(n=40).All patients in both groups were administered epidural anesthesia with the puncture and catheter placing in the space between the 2nd-3rd lumbar vertebras.After the epidural anesthesia,patients in the study group were administered propofol by targeted concentration infusion (TCI)system. The plasma concentration of propofol was modulated to obtain the BIS maintaining between 65-80,and the OAA/S maintaining at 3 scores.The propofol was continuously infused until closing the incision.Values of HR,MAP at different time points in the opera-tion were recorded,and the plasma concentrations of propofol,the incidences of adverse events were recorded.Results The HR and MAP of patients in the study group decreased at T1 (given the anesthetic),T2 (the beginning of the operation),T3 (the beginning of the operation),compared with those at T0 (before the anesthetic)and T4 (30 min after the operation)(P 0.05).BIS of study group was (73.3 ±4.8)-(76.1 ±3.4),and the plasma concentrations of propofol was(1.32 ± 0.29 )μg/mL - (1.52 ± 0.26 )μg/mL.Conclusion The combination of propofol sedation performed by TCI and epidural anesthesia could be safely and effectively used in patients undergoing total pelvic floor reconstruc-tion.