Gender Affects the Median Effective Dose and 95% Effective Dose of Oxycodone for Blunting the Hemodynamic Response to Tracheal Intubation in Narcotic-Naïve Adult Patients / 中华医学杂志(英文版)

Background@#Intravenous (IV) oxycodone has been used at induction to prevent an intubation reaction. The aims of the current study were to calculate the median effective dose (ED) and the 95% effective dose (ED) of an IV bolus of oxycodone that blunts the hemodynamic response to tracheal intubation with propofol according to gender and to observe the adverse events of induction-dose oxycodone.@*Methods@#Adult patients who required general anesthesia and tracheal intubation were enrolled. Tracheal intubation was performed using unified TD-C-IV video laryngoscopy and an ordinary common endotracheal tube. Dixon's up-and-down method was used to obtain EDdata for women and men separately. The initial dose of oxycodone was 0.2 mg/kg for women and 0.3 mg/kg for men (step size was 0.01 mg/kg). Next, a dose-response curve from the probit analysis was generated to determine the EDand EDto blunt the intubation reaction in female and male patients. Adverse events following oxycodone injection were observed for 5 min before propofol injection.@*Results@#Sixty-three patients were analyzed, including 29 females and 34 males. According to the probit analysis, the ED and EDof oxycodone required to blunt the intubation reaction in women were 0.254 mg/kg (95% confidence interval [CI], 0.220-0.328 mg/kg) and 0.357 mg/kg (95% CI, 0.297-2.563 mg/kg), respectively. In men, the ED and EDwere 0.324 mg/kg (95% CI, 0.274-0.381 mg/kg) and 0.454 mg/kg (95% CI, 0.384-2.862 mg/kg), respectively. Men required 28% more oxycodone than women for induction (P < 0.01). The most common adverse events were dizziness (87.3%), vertigo (66.7%), sedation (74.6%), and respiratory depression (66.7%).@*Conclusions@#Oxycodone can be used for induction to prevent intubation reactions. Gender affected the EDand EDof oxycodone for blunting the tracheal intubation reaction.

Out-of-hospital cardiopulmonary resuscitation needs the ventilation / 浙江大学学报·医学版

Cardiopulmonary resuscitation (CPR) is series of rescue measures for saving cardiac arrest patients. Early initiation and good quality of CPR is crucial for increasing chance of survival from out-of-hospital cardiac arrest. In recent years, the CPR guidelines have changed a lot, especially in basic life support. The guideline now pays more attention on chest compression and less to ventilation. CPR with chest compression only and without mouth-to-mouth ventilation is more popular. In this article, we outline the development and recent researches of CPR. As depriving oxygen from a collapsed patient for 6 min may result in poor outcome, the average time for ambulance transport is longer (about 10 to 16 min) in China, which makes rescuers easy to feel fatigue, chest compression only CPR is not suitable in China. Though non-professional rescuers have difficulty to perform mouth-to-mouth ventilation, they generally show a willingness to do so. To strengthen public standard CPR training including mouth-to-mouth ventilation and chest compression, is most important to promote CPR in China.

Determination of propofol in cerebral spinal fluid by HPLC with fluorescence detection / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To establish a method for determining propofol in human cerebrospinal fluid (CSF).</p><p><b>METHODS</b>Reverse phase high-performance liquid chromatography (HPLC) with fluorescence detection was applied to quantitative analysis. CSF samples were centrifuged (12,500 r/min for 3 min) and filtered (the diameter of the filter is 0.45 microm). Twenty mul of supernatant was directly injected and separated by Supelco Discovery C(18)column. The mobile phase was composed of methanol-water (80:20); the flow rate was 1 ml/min, and the column temperature was 30 degree. The fluorescence detective waves were: lambda ex=276 nm and lambda em=310 nm.</p><p><b>RESULTS</b>The linear range of propofol in CSF was 5-200 ng/ml (r=0.9994). The recovery rates for high, intermediate and low concentrations were 101.2%, 99.8%, 98.8%, respectively. The RSD of inter-day assay was 1.55%, 1.73%, 6.01% and it of intra-day assay was 1.69%, 2.37%, 8.60%. The limit of detection proved to be 2 ng/ml.</p><p><b>CONCLUSION</b>The method is rapid, simple, accurate and sensitive for measurement of propofol concentration in CSF.</p>

Dynamics of vascular volume and hemodilution of lactated Ringer's solution in patients during induction of general and epidural anesthesia / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

<p><b>OBJECTIVE</b>To investigate the dynamics of vascular volume and the plasma dilution of lactated Ringer's solution in patients during the induction of general and epidural anesthesia.</p><p><b>METHODS</b>The hemodilution of i.v. infusion of 1000 ml of lactated Ringer's solution over 60 min was studied in patients undergoing general (n=31) and epidural (n=22) anesthesia. Heart rate, arterial blood pressure and hemoglobin (Hb) concentration were measured every 5 min during the study. Surgery was not started until the study period had been completed.</p><p><b>RESULTS</b>General anesthesia caused the greater decrease of mean arterial blood pressure (MAP) (mean 15% versus 9%; P<0.01) and thereby followed by a more pronounced plasma dilution, blood volume expansion (VE) and blood volume expansion efficiency (VEE). A strong linear correlation between hemodilution and the reduction in MAP (r=-0.50; P<0.01) was found. At the end of infusion, patients undergoing general anesthesia retained 47% (SD 19%) of the infused fluid in the circulation, while epidural anesthesia retained 29% (SD 13%) (P<0.001). Correspondingly, a fewer urine output (mean 89 ml versus 156 ml; P<0.05) and extravascular expansion (454 ml versus 551 ml; P<0.05) were found during general anesthesia.</p><p><b>CONCLUSION</b>We concluded that the induction of general anesthesia caused more hemodilution, volume expansion and volume expansion efficiency than epidural anesthesia, which was triggered only by the lower MAP.</p>