ABSTRACT
@# Objective To explore the effect of preoperative local blocking with compound lidocaine hydrochloride (CLH) on postoperative pain of patients undergoing craniotomy.Methods40 patients suffered from superatentorial occupying lesion and scheduled for craniotomy were randomly divided into the CLH group and control group with 20 cases in each group. In the CLH group, local blocking with CLH was performed just before craniotomy, while in control group local blocking with 0.5% procaine was performed preoperatively and all patients of two groups used patient-controlled intravenous analgesia (PCIA) with fentanyl postoperatively. Postoperative pain was assessed for 48 hours according to visual analogue scale (VAS), and the comparison of analgesia-related postoperative complications of the two groups was demonstrated.ResultsThere was no significant difference in VAS postoperatively and incidence rate of complications between two groups ( P>0.05).ConclusionCompound lidocaine hydrochloride local infiltration may provide a safe and effective analgesia for postoperative pain in patients after craniotomy.
ABSTRACT
BACKGROUND: At present, the proof of the cerebral protective effects of desflurane on morphology is insufficient and the mechanism is unclear.OBJECTIVE: To investigate the cerebral protective effects of desflurane on complete cerebral ischemia-reperfusion injury and its impacts on gene expression related with apoptosis and stress response.DESIGN: A randomized controlled trial based on the experimental animals.SETTING: Departments of anesthesiology and neurosurgery in a university hospital.MATERIALS: The study was conducted in Beijing Neurosurgery Institute Affiliated with Capital University of Medical Sciences between February 2003and February 2004. Seventeen adult male Wister rats were randomly divided into ischemia group ( n = 7), desflurane group ( n = 7) and sham-operation group ( n = 3 ).INTERVENTIONS: Rat complete cerebral ischemia-reperfusion model was established. Desflurane was immediately inhaled for 1 hour after the beginning of reperfusion in rats of desflurane group. Brains of were harvested from 3 rats of either ischemia group or desflurane group after 1 hour of reperfusion (after 1 hour of operation in sham-operation group) and the cortical ultrastructural changes were observed under electron microscope. The rest 4 rats of either ischemia group or desflurane group were used for the analysis of the variable expression of genes related with apoptosis and stress response by gene chip combined image analysis technique.variable expression of genes related with apoptosis and stress response analyzed by gene chip.RESULTS: Compared with ischemia group, desflurane group had less neuronal pyknosis with almost normal cell organs and ultrastructure in neurons. Compared with ischemia group, the apoptotic protease activating factor 1 (APAF1) of desflurane group down-regulated.CONCLUSION: Desflurane might have protective effects on neurons and cell skeleton and its mechanism might be related with APAF1 down-regulation.
ABSTRACT
BACKGROUND: Very satisfactory clinical effects have been achieved in treatment of osteoarthritis of knee with intraarticular injection of sodium hyaluronate (SH) allied with steroid hormones for nerve block. How will such allied treatment be used for periarthritis of shoulder?OBJECTIVE: To probe into the improvement of pain and joint function in periarthritis of shoulder treated with integration of intraarticular injection of SH with nerve and pain block with betamethasone.DESIGN: Self-control was designed before and after experiment.SETTING: Beijing Tiantan Hospital, Capital University of Medical Sciences PARTICIPANTS: Twenty patients with periarthritis of shoulder were included, aged from 40 to 65 years from Pain Clinic of Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences from January to October 2004.METHODS: Integration of intraarticular injection of SH with nerve and pain block with betamethasone was applied to treat 20 cases of periarthritis of shoulder and the record was done before treatment and 1in which, "no any pain sensation" was 0 score, "unable to bear pain with imagination" was 10 scores. Pain score was recorded during quiet involved. 4 scores indicated being impossible completely, 3 scores indicate being possible with help, 2 scores indicate being possibled reluctantly and mostly feeling inconvenient, 1 score indicated being possible reluctantly without inconvenience and 0 score indicated being possible as healthy person.of daily life activity.RESULTS: According to practical management and analysis, 20 cases enment compared with that before treatment [(4.34±1.33),(8.27±1.37)scores,compared with that before treatment [(4.73±1.31), (8.49±1.35)scores,ment compared with that before treatment [ ( 1.10 ±0.74), (3.30 ±0.48 )scores, P ＜ 0.01]. CONCLUSION: Integration of intraarticular injection of SH with nerve and pain block with betamethasone treats effectively periarthritis of shoulder, without remarkably harmful reaction and it is worth in popularization in treatment of pain.
ABSTRACT
BACKGROUND: Conservative treatment of osseous gonarthritis (OG) is mainly to reduce the loading of knee joint and maintain muscle exercise,and non-steroidal anti-inflammatory drugs serve as supplements in case of acute occurrence.OBJECTIVE: To investigate the effect of combination of intraarticular in jection of hyaluronate and pain-point injection of betamethasone in improving the pain symptom in patients with OG.DESIGN: Open experiment.SETTING: Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences.PARTICIPANTS: We selected 45 OG patients, who were aged 40 to 85years and received treatment in the clinic of Beijing Tiantan Hospital affiliated to Capital University of Medical Sciences between January 2004 and October 2004.METHODS: OG parenteral solution was intraarticularly injected into the knee joint, 2.5 mL once a week, 5 weeks set as a disease course. Pain points around knee joint were searched for following thorough physical examination. Anti-inflammatory analgesic solution of 2.0-3.0 mL was injected at each pain point. Physical examination was repeated before treatment in each week. Injection at pain points was maintained if they were still present. Intraarticular injection of hyaluronate was performed only when the pain points disappeared after treatment.MAIN OUTCOME MEASURES: ① Pain score at rest and at exercise.② Time when pain disappeared and times of betamethasone administration.RESULTS: Totally 45 patients entered the result analysis. ① Pain at rest and at exercise 1 week after combination treatment of intraarticular injection of hyaluronate and pain-point injection of betamethasone was ignificantly lessened compared to that before treatment (P ＜ 0.01). Pain relief was more significant at rest than at exercise (P ＜ 0.01). ② Pain disappeared at (17.07±6.00)days after treatment on average. The average times of betamethasone administration was (2.42±0.78) times. ③ No local joint pain and other adverse reactions occurred after administration in any case.CONCLUSION: Combination of intraarticular injection of hyaluronate and pain-point injection of betamethasone can effectively relieve the pain symptom of osseous gonarthritis, with no obvious adverse reactions.
ABSTRACT
90 bpm and nicardipine 10?g?kg-1 when MAP increased by 20% of the baseline value. Radial artery was cannulated for continuous BP monitoring and blood sampling. MAP, ECG, HR, SpO2 , PET CO2 and body temperature were continuously monitored during anesthesia. Blood samples were taken before induction of anesthesia (T1), when dura was cut (T2), when aneurysm was clipped (T3 ) and 30 min after clipping (T4 ) for determination of plasma concentrations of AT- Ⅱ , ET and CGRP by radioimmuno-assay.Results Plasma concentration of AT- Ⅱ and HR did not change significantly through out the study. Plasma CGRP concentration and MAP decreased significantly during operation at T2-4 as compared to the baseline values (T1 ) . Plasma ET concentration increased significantly at clipping (T3 ) as compared to that at T2. Conclusion The action of vaso-constrictors (AT- Ⅱ , ET) predominates over that of vaso-dilator during operation. It is important to prevent acute cerebral vasospasm during intracranial aneurysm clipping.
ABSTRACT
0 05) HR in group A was faster than that in group B at T 3 (P
ABSTRACT
Objective To study the effects of arterial carbon dioxide tension(PaCO 2)on the quantitative electroencephalogram(qEEG)during isoflurane anesthesia Methods Fifteen ASA grade Ⅰ Ⅱ patients,scheduled for intraspinal or transspphenoidal surgery, were studied during 1MAC steady state isoflurane anesthesia qEEG were recorded continuously, while PaCO 2 approached approximately 26 5 mmHg, 35 2mmHg or 45 7 mmHg respectively randomly by regulating the minute volume Results Hypocapnia caused significant increases in all power bands (P
ABSTRACT
Objective:To determine whether mild hypothermia,isoflurane and propofol reduce gultamate release in rat hippocampus brain slices after hypoxia. Method: Brain slices preparations were separated and incubated from rat hippocampus. Glutamate released from rat brain slices during chemical anoxia(100?M KCN)were measured with a fluorescence assay,at 28℃,31℃ and 37℃ after anoxia and after administration of 1 MAC of isoflurane and 200 ?m propofol respectively. Result: Glutamate release was significantly reduced at 28℃ or 31℃ compare with that at 37℃ (P
ABSTRACT
To evaluate the effects of sevoflurane and isoflurane at 1.0 minimum alveolar concentration (MAC) on intracranial pressure(ICP) in patients undergoing craniotomy.Method:Sixteen patients without pre-existing increased ICP subjected to craniotomy for pituitary adenoma or craniopharyngioma were intubated with midazolam, fentanyl and atracurium.After intubation,midazolam and atracurium were pumped intravenously for 30 min.Then,sevoflurane or isoflurane was inhaled and the patients were randomly divided into two groups:A:1.0 MAC sevoflurane:B:1.0 MAC isoflurane.In the whole procedure,PaCO_2 with an average of 5.3 kPa was maintained. ICP was measured continuously by placement of a catheter into lumbar subarachoid space.Result:Sevoflurane maintained cerebral perfusion pressure slightly better than equipotent dose of isoflurane. During sevoflurane administration at 1.0 MAC.ICP decreased slighly,then increased gradually.However,ICP remained stable in group B.Conclusion:Sevoflurane and isoflurane at 1.0 MAC,Combined with midazolam and fentanyl,can be administered safely to the patients without preexisting increased ICP.
ABSTRACT
Objective To compare the effects of 0.9% NaCl (normal saline, NS), 10% hydroxyethyl starch (HES, 200/0.5) and hypertonic-hyperoncotic solution (HHS, 7.5% NaCl-10% HES 1:1) on cerebral extracellular excitatory amino acids (EAA) and inhibitory amino acids (IAA) in a rat model of traumatic head injury (THI) combined with acute hemorrhagic shock (AHS). Methods Nineteen healthy adult male SD rats weighing 300-350 g were randomized into 3 groups: NS group (n = 7); HES group ( n = 6) and HHS group ( n = 6). THI was produced by modified Feeney method (a 20g weight drops from a height of 40 cm on the parietal region) and AHS was induced by modified Wiggers method (Blood was removed from femoral artery and MAP was maintained at 40 mm Hg for 1 hour). Fluid resuscitation was started at 1 hour of AHS with 0.9% NS (3 times the volume of the removed whole blood) or 10% HES (in a one to one ratio) or HHS 4 ml?kg-1 administered over 15 min. The extracellular fluid of injured brain tissue was collected using intracerebral microdialysis before head injury (baseline) during THI + AHS (1h) and resuscitatin (2h) for determination of the levels of EAA (glutamate, aspartate) and IAA (glycine, GABA, taurine) by HPLC.Results The 5 amino acids were significantly increased during THI + AHS as compared with their baseline values. Glutamate level was further increased during resuscitation with NS. GABA and taurine concentrations were maintained at high level during resuscitation with HES or HHS. The increase in glutamate was inhibited by resuscitation with HES and the increase in glutamate, aspartate and glycine were inhibited by HHS. Conclusions In a rat model of THI combined with AHS, resuscitation with NS can increase cerebral extracellular EAA. Both HES and HHS resuscitation can inhibit the increase in cerebral extracellulaar EAA and HHS is more effective.
ABSTRACT
Objective: To observe the effects of total intravenous anesthesia(TIVA)and spontaneous respiration on brain oxygen balance status in patients undergoing brain stem neoplasm resection. Method: Thirty patients,ASA grade Ⅰ-Ⅱ, received endotracheal intubation with spontaneous respiration and TIVA. TIVA was maintained with intravenous 0.2% lidocaine 2-3mg?kg~(-1). h~(-1),0.4% propofol 4-6mg?kg~(-1),h~(-1)and 1% ketamine 1-1.5mg?kg~(-1). h~(-1). Arterial and jugular bulb blood samples were taken before and after induction,sawing skull and removing trmor seperately to analyse blood gas. According to Fick principle, the level of CaO_2,CjvO_2 and C (a-jv)O_2 were calculated. Result:The hymodynamics, SaO_2 and CaO_2 remained stable during whole procedure. In comparison with the baselines. respiratory rate, minute volume, arterial blood pH and C(a-jv)O_2 were decreased, and PaCO_2.SjvO_2, and CjvO_2 were increased significantly (P
ABSTRACT
Cerebral topographic map (CTM) and electroencephalogram (EEG) can evaluate the functional activity of brain, and the purpose of this study was to objectively compare the effect of intravenous anesthetics on brain. Forty-five patients, ASA grade Ⅰ-Ⅱ, undergoing neurosurgery,were randomly divided into three groups after administration of Innovar 2 ml, and then equivalent effective dose of propofol(2～2.5 mg/kg)(Ⅰ),sodium thiopental (4～6mg/kg)(Ⅰ) or gama hydroxybutyrate sodium (70～80mg/kg)(Ⅲ) was intravenously given respectively. All patients were monitored continuously during induction. The high frequent excitative activities of ? rhythm appeared immediately after each anesthestic was injected. During the most effective period: in group Ⅰ, there were no ? rhythm in EEG and obvious power change on CTM; in group Ⅱ irregular ? rhythm took place in EEG occasionally and great increase in top power on CTM occured, which showed evident elevation compared with group Ⅰ (P
ABSTRACT
Twenty-two neurosurgical patients were randomly divided into two groups:Group 1 iv drip midazolam and isoflurane inhalation;Group 2 isoflurane inhalation only. The hemodynamic indices and concentration of isoflurane were studied. The results showed that the blood pressure of all the patients were significantly decreased(PMO.01). The concentration of isoflurane in group 1 were .signicantly lowered by 27% than in group 2(P
ABSTRACT
To observe correlation between the cerebral blood flow (CBF)and plasma concentration of propofol. Method: Twenty two patients, ASA grade I, were given propofol 2mg/kg. Before and after the administra tion, the velocity of MCA(middle cerebral artery), PI(pulsaltility index) and RI(resistance index) were tested simultaneously, and the plasma concentration of propofol were measured with high performance liquid chromatography. Resuit: The mean velocity of MCA(Vmca)decreased significantly and RI increased after propofol administration(P
ABSTRACT
The effect of transcutaneous stimulation to Hegu, Fengchi and Yuyao points with Han's Acupoint Nerve Stimulator on enflurane anesthsia and the hemodynamic changes during craniotomy were studied in 80 neurosurgical patients. The results showed that acupoint electric stimulation decreased the inhalating concentration and consumption of enflurane. The expired concentration of enflurane in HANS group was significantly lower than that in control group by a reduction of 37.8 % -47. 0%. The cardiovascular depression was lesser during operation, and the patients recovered faster and more stable after operation in HANS group. It was concluded that acupoint stimulation with HANS significantly potentiated the anesthetic effect and decraesed the side effect of enflurane.