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Objective:To evaluate the role of autophagy in electroacupuncture (EA)-induced improvement in sepsis-associated encephalopathy (SAE) in mice.Methods:A total of 135 healthy adult male mice, aged 8-12 weeks, weighing 22-25 g, were used in this study. Ten mice were randomly selected to prepare caecal slurry after anesthesia. The remaining 125 mice were divided into 5 groups ( n=25 each) using a random number table method: sham operation group (group Sham), SAE group, SAE+ EA group (group EA), SEA+ EA+ autophagy agonist rapamycin group (group SAE+ EA+ R), and SAE+ EA+ autophagy inhibitor 3-methyladenine group (group SAE+ EA+ MA). SAE was induced by intraperitoneal injection of cecal slurry 200 μl. Bilateral Zusanli (ST36) acupoints were stimulated at 2, 24, 48 and 72 h after surgery in group SAE+ EA, group SAE+ EA+ R and group SAE+ EA+ MA. Autophagy agonist rapamycin 10 mg/kg and autophagy inhibitor 3-methyladenine 15 mg/kg were intraperitoneally injected at 30 min before EA in SAE+ EA+ R group and SAE+ EA+ MA group, respectively. The survival of mice was recorded at 7 days after developing the model. Ten mice were selected from each group at 8-12 days after developing the model, and the learning and memory ability was assessed by Morris water maze test. Five mice from each group were sacrificed after anesthesia, brains were removed, and hippocampal tissues were obtained for determination of contents of interleukin-1beta (IL-1β), IL-18 and tumor necrosis factor-α (TNF-α) (by enzyme-linked immunosorbent assay) and expression of p62, autophagy-related protein 16 like protein 1 (ATG16L1), and nucleotide like receptor protein 3 (NLRP3) (by Western blot). Results:Compared with Sham group, the survival rate at 7 days after developing the model was significantly decreased in the other 4 groups ( P<0.01). There was no significant difference in the survival rate at 7 days after developing the model among SAE group, SAE+ EA group, SAE+ EA+ R group and SAE+ EA+ MA group ( P>0.05). Compared with Sham group, the activity time at the target quadrant was significantly shortened, the escape latency was prolonged, the number of crossing the original platform was reduced, the contents of TNF-α, IL-1β and IL-18 were increased, the expression of ATG16L1 was down-regulated, and the expression of p62 and NLRP3 was up-regulated in SAE group ( P<0.05). Compared with SAE group, the escape latency was significantly shortened, the activity time at the target quadrant was prolonged, the number of crossing the original platform was increased, the contents of TNF-α, IL-1β and IL-18 were decreased, the expression of ATG16L1 was up-regulated, and the expression of p62 and NLRP3 was down-regulated in SAE+ EA group ( P<0.05). Compared with SAE+ EA group, no significant change was found in the parameters of Morris water maze test ( P>0.05), the contents of TNF-α, IL-1β and IL-18 were significantly decreased, the expression of ATG16L1 was up-regulated, and the expression of NLRP3 and P62 was down-regulated in SAE+ EA+ R group, and the expression of ATG16L1 was significantly down-regulated, and the expression of p62 and NLRP3 was up-regulated in SAE+ EA+ MA group ( P<0.05). Conclusions:The mechanism by which EA improves SAE is related to promotion of autophagy in hippocampal neurons, inhibition of NLRP3 inflammasome activation, and alleviation of neuroinflammatory responses in mice.
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Cognitive impairment seriously affects the quality of life of patients. Clinically, it is common in cerebral ischemia, sepsis and postoperative. Its etiology includes abnormal expression of regulatory molecules in the brain, ischemic injury of brain tissue and abnormal expression of genes and proteins in brain tissues. However, there is no effective treatment at present. Electroacupuncture has a certain effect on cognitive impairment. Its mechanism mainly includes inhibiting oxidative stress response, enhancing synaptic plasticity, inhibiting neuroinflammation, regulating glial cell activity, regulating excitatory amino acids, and improving glucose metabolism.
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Objective:To evaluate the role of NIMA-related kinase 7 (NEK7)/Nod-like receptor family pyrin domain-containing protein 3 (NLRP3) signaling pathway in sepsis-associated encephalopathy in mice.Methods:A total of 150 healthy adult male C57BL/6 mice, aged 8-12 weeks, weighing 20-25 g, were divided into 5 groups ( n=30 each) by a random number table method: sham operation group (Sham group), sepsis group (CLP group), sepsis+ NLRP3 inhibitor MCC950 group (CLP+ MCC950 group), sepsis+ NEK7 siRNA group (CLP+ NEK7 siRNA group), and sepsis+ NC siRNA group (CLP+ NC siRNA group). Sepsis was induced by classic cecal ligation and puncture (CLP) in anesthetized animals.MCC950 10 mg/kg was intraperitoneally injected for 3 consecutive days after operation in CLP+ MCC950 group, while the equal volume of normal saline was given instead in Sham group.Immediately after operation and on 3rd day after operation, NEK7 siRNA 3 nmol/20 g was injected into the ventricle in CLP+ NEK7 siRNA group, and the equal dose of NC siRNA was injected into the ventricle instead in Sham group.The survival of mice was recorded on 4th postoperative day.On 4th and 7th days after operation, 10 mice in each group were selected for Y maze space recognition experiment.On 7th day after operation, 5 mice in each group were randomly sacrificed and hippocampal tissues were taken for determination of the contents of interleukin-1beta (IL-1β), interleukin-18 (IL-18) and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay), and 6 mice in each group were sacrificed and hippocampal tissues were taken for determination of the expression of NEK7, NLRP3, cleaved-caspase-1 and apoptosis-associated speck-like protein containing a caspase-1 recruitment domain (ASC) (by Western blot). Results:The survival rates were 100%, 50%, 73%, 60% and 53% in Sham, CLP, CLP+ MCC950, CLP+ NEK7 siRNA, and CLP+ NC siRNA groups, respectively, on day 4 after surgery.Compared with Sham group, the frequency of entries into novel arm was significantly reduced, and the time spent in the novel arm was shortened at 4th and 7th days after operation, and the contents of IL-1β, IL-18 and TNF-α in hippocampus were increased, and the expression of NEK7, NLRP3, cleaved-caspase-1 and ASC was up-regulated at 7th day after operation in CLP group ( P<0.05). Compared with CLP group, the frequency of entries into novel arm was significantly increased, and the time spent in the novel arm was prolonged at 4th and 7th days after operation, and the contents of IL-1β, IL-18 and TNF-α in hippocampus were decreased at 7th day after operation in CLP+ MCC950 and CLP+ NEK7 siRNA groups, the expression of NLRP3, cleaved-caspase-1 and ASC was significantly down-regulated at 7th day after operation in CLP+ MCC950 group, the expression of NEK7, NLRP3, cleaved-caspase-1 and ASC was significantly down-regulated in CLP+ NEK7 siRNA group ( P<0.05), and no significant change was found in the parameters mentioned above in CLP+ NC siRNA group ( P>0.05). Conclusions:NEK7/NLRP3 signaling pathway is involved in SAE in mice, and the underlying mechanism may be related to promotion of inflammatory responses.
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Objective:To evaluate the efficacy of continuous infusion of lidocaine via urinary catheter for postoperative analgesia in patients undergoing urological surgery.Methods:Forty male American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-75 yr, with body mass index of 18-25 kg/m 2, scheduled for elective percutaneous nephrolithotomy, were divided into 2 groups ( n=20 each) using a random number table method: continuous infusion of lidocaine through urinary catheter group (group L) and patient controlled intravenous analgesia (PCIA) group (group PCIA). All the patients underwent total intravenous anesthesia, and a matched type of sterile urethral irrigation catheter was inserted after the operation.In group L, 0.5% lidocaine was continuously infused at a rate of 5 ml/h via the urinary catheter, while the equal volume of 0.9% normal saline was continuously infused via the urinary catheter, and PCIA was connected in group PCIA.PCIA solution contained sufentanil 125 μg (diluted to 250 ml in normal saline), and the PCA pump was set up with a 5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 5 ml/h.When visual analogue score was>4, sufentanil 0.05 μg/kg was injected intravenously as rescue analgesic.The development and severity of catheter-related bladder discomfort (CRBD) were recorded immediately at the end of the operation (T 1), and at 6 h (T 2), 24 h (T 3) and 48 h (T 4) after the operation, respectively.Riker sedation-agitation scale (SAS) score was recorded at T 1, 2, and QoR-9 scale was recorded at T 3, 4.The concentrations of serum cortisol (Cor), norepinephrine (NE), epinephrine (E) and blood glucose (Glu) were measured by enzyme linked immunosorbent assay.First off-bed time, exhaust time, length of hospital stay after surgery, and the requirement for rescue analgesia and adverse reactions (nausea and vomiting, respiratory depression, hypotension, skin itching) within 48 h after the operation were recorded. Results:Compared with group PCIA, the incidence of CRBD and the severity were significantly decreased at T 1-4, SAS score was decreased at T 1, 2, QoR-9 score was increased at T 3, 4, Cor, NE, E and Glu concentrations were decreased at T 1-4, the incidence of postoperative rescue analgesia was decreased, first off-bed time, exhaust time and length of hospital stay after surgery was shortened, and the incidence of postoperative nausea and vomiting, respiratory depression, hypotension, skin itching was decreased in group L ( P<0.05). Conclusion:Continuous infusion of lidocaine through the urinary catheter can provide good postoperative analgesia, reduce postoperative stress response and adverse reactions, and facilitate early postoperative recovery in patients undergoing urological surgery.
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Objective:To evaluate the effect of electroacupuncture (EA) on pyroptosis of hippocampal neurons in mice with sepsis-associated encephalopathy (SAE).Methods:Ninety male C57BL/6 mice, aged 8-12 weeks, weighing 22-25 g, were divided into 3 groups ( n=30 each) by a random number table method: sham operation group (Sham group), SAE group and EA treatment group (EA group). Sepsis model was established by cecal ligation and puncture in anesthetized animals.Bilateral acupoints Zusanli (ST36) were stimulated at 2, 24, 48 and 72 h after surgery in group EA.The survival was observed on day 7 after surgery.Cognitive function was assessed by Morris water maze.Then the animals were sacrificed, and hippocampal tissues were obtained for determination of the expression of nucleotide-binding oligomerization domain-like receptor protein 1 (NLRP1), cysteine-containing aspartate-specific protease 1 (caspase-1), and Gasdermin D (GSDMD) in hippocampal neurons (by Western blot) and content of activated caspase-1 (by enzyme-linked immunosorbent assay). Results:Compared with group Sham, the survival rate was significantly decreased, postoperative escape latency was prolonged, the activity time spent in the target quadrant was shortened, the number of crossing the original platform was decreased, the expression of NLRP1, caspase-1 and GSDMD was up-regulated, and the content of activated caspase-1 was increased in group SAE ( P<0.05). Compared with group SAE, the survival rate was significantly increased, postoperative escape latency was shortened, the activity time spent in the target quadrant was prolonged, the number of crossing the original platform was increased, the expression of NLRP1, caspase-1 and GSDMD was down-regulated, and the content of activated caspase-1 was decreased in group EA ( P<0.05). Conclusion:The mechanism by which EA reduces SAE may be related to inhibiting pyrolysis in hippocampal neurons of mice.
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Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on inflammatory responses during intestinal mucosal barrier damage caused by gastrointestinal surgery in the rats.Methods:Forty-five healthy male Sprague-Dawley rats, aged 7-8 weeks, weighing 220-260 g, were divided into 3 groups ( n=15 each) by a random number table method: control group (C group), gastrointestinal surgery group (S group), and TEAS group (T group). Rats underwent pylorectomy and Roux-en-Y gastrojejunal anastomosis to establish gastrointestinal surgery models in S and T groups, while group C received no treatment.In group T, bilateral Zusanli and Hegu acupoints were stimulated with disperse-dense waves, current intensity 5 mA, frequency 2 Hz, from 30 min before surgery until the end of operation.Only electrode patches were applied, but no stimulation was applied in group S. Five rats were randomly selected from each group and sacrificed at 12, 24 and 48 h after surgery (T 1-3), and ileal tissues were taken after anesthesia.The pathological changes of ileal tissues were observed with a light microscope and scored according to Chiu.Enzyme-linked immunosorbent assay was used to determine contents of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), diamine oxidase (DAO) and intestinal fatty acid-binding protein (I-FABP). Western blot was used to detect the expression of occludin, claudin-3 and ZO-1.The immunohistochemical method was used to determine the percentage of occludin, claudin and zonula occludens-1 (ZO-1) positive cells. Results:Compared with group C, Chiu′s scores and contents of ileal IL-6, TNF-α, DAO and I-FABP were significantly increased, the percentage of occludin, claudin-3 and ZO-1 protein positive cells was decreased, and the expression of occludin, claudin-3 and ZO-1 was down-regulated at T 1-3 in group S and group T ( P<0.05). Compared with group S, Chiu′s scores and contents of ileal IL-6, TNF-α, DAO and I-FABP were significantly decreased, the percentage of occludin, claudin-3 and ZO-1 protein positive cells was increased, and the expression of occludin, claudin-3 and ZO-1 was up-regulated at T 1-3 in group T ( P<0.05). Conclusion:TEAS can reduce the intestinal mucosal barrier damage caused by gastrointestinal surgery by inhibiting the inflammatory response in rats.
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Objective@#To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.@*Methods@#Forty patients of both sexes, aged 18-67 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with Mallampati physical status Ⅰ or Ⅱ, scheduled for elective thoracoscopic lobectomy, were divided into 2 groups (n=20 each) using a random number table method: general anesthesia preserving spontaneous breathing group (group GS) and TEAS plus general anesthesia preserving spontaneous breathing group (group TE+ GS). Anesthesia was routinely induced and maintained, a laryngeal mask was placed, and patients kept spontaneous breathing in two groups.The bispectral index value was maintained at 45-60.Patient-controlled intravenous analgesia was used after operation, and visual analogue scale score was maintained<4 points.In group TE+ GS, Xinshu and Feishu acupoints ipsilateral to the operated side and bilateral Hegu and Neiguan acupoints were stimulated with a disperse-dense wave, frequency 2/100 Hz and intensity 5-15 mA starting from 30 min before anesthesia induction until the end of surgery.The mean arterial pressure (MAP), heart rate (HR) and respiratory rate (RR) were recorded before induction of anesthesia, immediately after start of operation, during thoracic exploration, immediate after lobectomy , and at 30 min and 1 h after lobectomy.The intraoperative MAP, HR, and RR were recorded when clinically significant events occurred in two groups.Central venous blood samples were simultaneously collected for determination of concentrations of cortisol, norepinephrine, epinephrine, and blood glucose in serum (by enzyme-linked immunosorbent assay). The highest value of PETCO2, the lowest value of SpO2, and consumption of anesthetic drugs were recorded.Duration of post-anesthesia care unit stay, time to first flatus, ambulation time, occurrence of nausea and vomiting, chest tube drainage time, development of surgical complications, length of postoperative hospital stay and hospitalization expenses were recorded.@*Results@#MAP, HR and RR all fluctuated within the normal range, and no clinically significant events occurred in two groups.Compared with group GS, the highest value of PETCO2 was significantly decreased, the lowest value of SpO2 was increased, the MAP and HR were decreased, the consumption of propofol and remifentanil was decreased, the cortisol, norepinephrine, epinephrine, and blood glucose concentrations in serum were decreased, the time to first flatus, ambulation time, chest tube drainage time and length of postoperative hospital stay were shortened, and the incidence of nausea and vomiting and hospitalization expenses were decreased in group TE+ GS (P<0.05).@*Conclusion@#TEAS can reduce the amount of opioids consumed in the perioperative period, effectively inhibits intraoperative stress responses, and is helpful in improving the early outcomes when used for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.
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Objective To evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.Methods Forty patients of both sexes,aged 18-67 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with Mallampati physical status Ⅰ or Ⅱ,scheduled for elective thoracoscopic lobectomy,were divided into 2 groups (n =20 each) using a random number table method:general anesthesia preserving spontaneous breathing group (group GS) and TEAS plus general anesthesia preserving spontaneous breathing group (group TE+GS).Anesthesia was routinely induced and maintained,a laryngeal mask was placed,and patients kept spontaneous breathing in two groups.The bispectral index value was maintained at 45-60.Patient-controlled intravenous analgesia was used after operation,and visual analogue scale score was maintained＜4 points.In group TE+GS,Xinshu and Feishu acupoints ipsilateral to the operated side and bilateral Hegu and Neiguan acupoints were stimulated with a disperse-dense wave,frequency 2/100 Hz and intensity 5-15 mA starting from 30 min before anesthesia induction until the end of surgery.The mean arterial pressure (MAP),heart rate (HR) and respiratory rate (RR) were recorded before induction of anesthesia,immediately after start of operation,during thoracic exploration,immediate after lobectomy,and at 30 min and 1 h after lobectomy.The intraoperative MAP,HR,and RR were recorded when clinically significant events occurred in two groups.Central venous blood samples were simultaneously collected for determination of concentrations of cortisol,norepinephrine,epinephrine,and blood glucose in serum (by enzyme-linked immunosorbent assay).The highest value of PETCO2,the lowest value of SpO2,and consumption of anesthetic drugs were recorded.Duration of post-anesthesia care unit stay,time to first flatus,ambulation time,occurrence of nausea and vomiting,chest tube drainage time,development of surgical complications,length of postoperative hospital stay and hospitalization expenses were recorded.Results MAP,HR and RR all fluctuated within the normal range,and no clinically significant events occurred in two groups.Compared with group GS,the highest value of PETCO2 was significantly decreased,the lowest value of SpO2 was increased,the MAP and HR were decreased,the consumption of propofol and remifentanil was decreased,the cortisol,norepinephrine,epinephrine,and blood glucose concentrations in serum were decreased,the time to first flatus,ambulation time,chest tube drainage time and length of postoperative hospital stay were shortened,and the incidence of nausea and vomiting and hospitalization expenses were decreased in group TE +GS (P＜0.05).Conclusion TEAS can reduce the amount of opioids consumed in the perioperative period,effectively inhibits intraoperative stress responses,and is helpful in improving the early outcomes when used for general anesthesia preserving spontaneous breathing in the patients undergoing thoracoscopic surgery.
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Objective To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on intestinal mucosal injury in patients undergoing laparoscopic radical resection of colorectal cancer.Methods Fifty-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients,aged 35-64 yr,with body mass index of 18-25 kg/m2,scheduled for elective laparoscopic radical resection of colorectal cancer,were selected and divided into 2 groups (n =28 each) using a random number table method:general anesthesia group (group G) and TEAS combined with general anesthesia group (group TG).In group TG,patients received continuous TEAS at bilateral Neiguan,Hegu,Zusanli,Shangjuxu and Xiajuxu acupoints from 30 min before anesthesia induction until the end of surgery,with a frequency 2/100HZ,disperse dense waves,intensity the maximum current that could be tolerated (3-8 mA).After induction of anesthesia,the patients were endotracheally intubated and mechanically ventilated,and combined intravenous-inhalational anesthesia was used to maintain anesthesia in both groups.Peripheral venous blood samples were collected when entering the operating room (T1),at the end of operation (T2),and at 24 and 72 h after operation (T3,4) for determination of intestinal fatty acid binding protein (I-FABP) and diamine oxidase (DAO) in palsma using enzyme-linked immunosorbent assay.Quality of Recovery-9 (QoR9) was used to assess the postoperative quality of recovery at 24 h before surgery (T0),T3 and T4.Results The concentrations of plasma I-FABP and DAO were significantly higher at T2 and T3 than at T1 in G and TG groups (P＜0.05).Compared with the baseline at T0,QoR-9 scores were significantly decreased at T3 and T4 in G and TG groups (P＜0.05).Compared with group G,the concentrations of plasma I-FABP at T2-T4 and DAO at T2 and T3 were significantly decreased,and QoR-9 scores were increased at T3 and T4 in group TG (P＜0.05).Conclusion TEAS can attenuate intestinal mucosal injury in patients undergoing laparoscopic radical resection of colorectal cancer.
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Objective To evaluate the cardioprotection of electroacupuncture (EA) in the patients undergoing heart surgery with cardiopulmonary bypass (CPB).Methods Forty American Society of Anesthesiologists physical status Ⅲ patients,aged 18-55 yr,of New York Heart Association Ⅱ-Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =20 each) using a random number table:control group (group C) and group EA.In group EA,bilateral Neiguan,Ximen,Shenmen and Baihui acupoints were stimulated with an electrie stimulator with the frequency of 2 Hz from 20 min before anesthesia induction until the end of operation,and the optimal intensity was selected according to the patient's tolerance when awake.Before EA and at 30 min of CPB,30 min,1 h and 2 h after termination of CPB and 6 and 24 h after operation,blood samples were taken from the central vein for determination of concentrations of heart-type fatty acid binding protein and cardiac troponin Ⅰ in plasma (by enzymelinked immunosorbent assay) and concentrations of malondialdehyde (using hydroxylamine method).Cardiac contractility was scored at 1,6 and 24 h after operation,and arrhythmia was scored at 24 h after operation.Results Compared with group C,the plasma concentrations of malondialdehyde at 30 min and 1 and 2 h after termination of CPB and 6 h after operation,plasma concentrations of cardiac troponin Ⅰ at 24 h after operation,and plasma concentrations of heart-type fatty acid binding protein at 30 min of CPB and 24 h after operation were significantly decreased,and the arrhythmia score and cardiac contractility score at 6 and 24 h after operation were decreased in group EA (P＜0.05).Conclusion EA can inhibit lipid peroxidation and exerts cardioprotection in the patients undergoing heart surgery with CPB.
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Objective To evaluate the effect of isoflurane preconditioning on brain injury in pa?tients undergoing cardiac valve replacement with cardiopulmonary bypass(CPB). Methods Forty patients of both sexes, aged 35-55 yr, with body mass index of 18-25 kg∕m2, of American Society of Anesthesiol?ogists physical statusⅡorⅢ(New York Heart Association classⅡorⅢ), scheduled for elective cardiac valve replacement with CPB, were divided into 2 groups(n=20 each)using a random number table:control group(group C)and isoflurane preconditioning group(group P). After induction of anesthesia, 1.5% isoflurane was inhaled for 30 min followed by 15?min washout, and the end?tidal isoflurane concen?tration was less than 0.1% at the end of washout in group P. Immediately after internal jugular vein punc?ture(T1), immediately before beginning of CPB(T2), at 30 min after beginning of CPB(T3), imme?diately after the end of CPB(T4)and at 6 h and 1 day after the end of CPB(T5,6), blood samples were collected for determination of serum S100β protein concentrations(by enzyme?linked immunosorbent assay) and the concentration of glutamic acid in serum(by ion exchange chromatography). Mini?Mental State Exam?ination scores were recorded at 1 day before operation and 7 days after operation, and the occurrence of post?operative cognitive dysfunction was recorded. Results The serum concentrations of S100β protein and glu?tamic acid in the two groups are significantly higher at T3?5than at T1(P<0.05). Compared with group C, the concentration of S100β protein in serum was significantly decreased at T3?5, and serum glutamic acid con?centration was decreased at T4,5in group P(P<0.05). No postoperative cognitive dysfunction was found in the two groups. Conclusion Isoflurane preconditioning can reduce brain injury in patients undergoing cardi?ac valve replacement under CPB, and the mechanism may be related to inhibiting glutamic acid release.
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Objective To compare the effects of transcutaneous electrical acupoint stimulation ( TEAS) combined with general anesthesia and epidural block combined with general anesthesia on the re-covery of patients undergoing laparoscopic radical resection of colorectal cancer. Methods Eighty-four pa-tients of both sexes, aged 35-64 yr, with body mass index of 18-25 kg∕m2 , of American Society of Anes-thesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic radical resection of colorectal cancer, were divided into 3 groups (n=28 each) using a random number table method: general anesthesia group (group G), TEAS combined with general anesthesia group (group TG), and epidural block com-bined with general anesthesia group ( group EG) . In group TG, patients received continuous TEAS of bilat-eral Neiguan, Hegu, Zusanli, Shangjuxu and Xiajuxu acupoints starting from 30 min before anesthesia in-duction until the end of surgery at a frequency of 2∕100 HZ and intensity of 3-8 mA with disperse-dense waves. In group EG, an epidural catheter was placed at L1,2 and advanced for 3 cm in the epidural space in cephalad direction, 2％ lidocaine 3 ml was given as a test dose, 0. 375％ ropivacaine 6-10 ml was injected into the epidural space, the level of anesthesia was adjusted to T6 , and then 0. 375％ ropivacaine 5 ml∕h was infused to the epidural space until the end of operation. Patients were endotracheally intubated after rou-tine induction of general anesthesia and mechanically ventilated, and combined intravenous-inhalational an-esthesia was used to maintain anesthesia. The Quality of Recovery ( QoR-15) score was recorded on 1 day before surgery and 1-3 days after surgery. The development of nausea and vomiting, cognitive decline and requirement for rescue analgesics was recorded within 3 days postoperatively. The intraoperative consump-tion of remifentanil and propofol, vasoactive drugs, extubation time, time of PACU stay, time of passing flatus and length of postoperative hospital stay were recorded. Results Compared with group G, the con-sumption of remifentanil was significantly decreased, the QoR-15 scores were increased at 1-3 days after surgery, the incidence of nausea and vomiting and cognitive decline was decreased, and the extubation time, time of passing flatus and length of postoperative hospital stay were shortened in group TG and group EG ( P<0. 05) . Compared with group TG, the intraoperative requirement for vasoactive drugs was signifi-cantly increased in group EG ( P<0. 05) . Conclusion TEAS combined with general anesthesia and epi-dural block combined with general anesthesia have the comparable effect on the recovery of patients undergo-ing laparoscopic radical resection of colorectal cancer, however, the former one provides more stable hemo-dynamics during surgery.
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Objective To determine the median effective concentration (EC50) of ropivacaine blocking the motor nerve in aged patients of different age stratification.Methods Ninety-six patients of both sexes,aged 66-85 yr,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,with body mass index of 20-27 kg/m2,scheduled for elective hip replacement,were divided into 4 groups (n=24 each) according to the age:group Ⅰ 66-70 yr,group Ⅱ 71-75 yr,group Ⅲ 76-80 yr and group Ⅳ 81-85 yr.The concentration of ropivacaine was determined by up-and-down sequential trial.In each group,0.2％ ropivacaine 10 ml was epidurally injected in the first patient,and the difference between two successive concentrations was 0.025％.Each time the concentration of ropivacaine increased or decreased in the next patient depending on whether or not the Bromage score was 0 at 30 min after epidural injection.The EC50 and 95％ confidence interval of epidurally administered ropivacaine blocking the motor nerve were determined using probit analysis.The sensory block level and development of intraoperative hypotension and nausea and vomiting were recorded.Results The EC50 (95％ confidence interval) of ropivacaine was 0.24％ (0.19％-0.29％),0.22％ (0.17％-0.26％),0.19％ (0.15％-0.24％) and 0.17％(0.14％-0.22％) in Ⅰ,Ⅱ,Ⅲ and Ⅳ groups,respectively,and the EC50 of epidurally administered ropivacaine blocking the motor nerve was gradually decreased with increasing age stratification (P＜0.05).The sensory block level was all at T7.8-S1 in the four groups.There were no significant differences between the four groups in the incidence of intraoperative hypotension or nausea and vomiting (P＞0.05).Conclusion For aged patients of different age stratification,the EC50 of epidurally administered ropivacaine blocking the motor nerve is as follows:0.24％ in patients aged 66-70 yr;0.22％ in patients aged 71-75 yr;0.19％ in patients aged 76-80 yr;0.17％ in patients aged 81-85 yr.
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Objective To evaluate the effect of isoflurane preconditioning on the expression of hippocampal GluR1 subunits-containing α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate(AMPA)receptors in a rat model of focal cerebral ischemia-reperfusion(I/R).Methods Forty-eight pathogen-free healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups(n=16 each)using a random number table:sham operation group(group S),focal cerebral I/R group(group I/R)and isoflurane preconditioning group(group IPC).Focal cerebral I/R was induced by occlusion of the middle cerebral artery for 2 h followed by reperfusion to induce cognitive decline in I/R and IPC groups. Rats were exposed to 1.5% isoflurane for 1 h every day for 5 consecutive days,and the model was established at 24 h after the last exposure in group IPC. Eight rats in each group were selected to perform Morris water maze test for 6 consecutive days starting from 9 or 23 days after operation. The rats were sacrificed at 14 and 28 days after operation,and the hippocampal tissues were obtained for determination of the expression of GluR1 mRNA(by using real-time polymerase chain reaction)and GluR1 protein(by Western blot).Results Compared with group S,the escape latency was significantly prolonged at each time point after operation,the frequency of crossing the original platform quadrant and percentage of swimming distance at the original platform quadrant were decreased at 14 and 28 days after operation,and the expression of GluR1 protein and mRNA was down-regulated at 14 days after operation in I/R and IPC groups(P<0.05).Compared with group I/R,the escape latency was significantly shortened at 10-13 days after operation,the percentage of swimming distance at the original platform quadrant and frequency of crossing the original platform quadrant were increased at 14 days after the operation,and the expression of GluR1 protein and mRNA was up-regulated at 14 days after operation in group IPC(P<0.05).Conclusion The mechanism by which isoflurane preconditioninig improves the cognitive function is related to up-regulation of the expression of hippocampal GluR1 subunits-containing AMPA receptors in a rat model of focal cerebral I/R.
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Objective To investigate the clinical efficacy of dexmedetomidine combined with ropivacaine for ilioinguinal and iliohypogastric nerve block in elderly patients undergoing inguinal her-nia surgery.Methods Sixty elderly patients undergoing inguinal hernia surgery were randomly divided into dexmedetomidine group (group D)and control group (group C),30 patients in each group.All patients received ilioinguinal and iliohypogastric nerve block by the same anesthesiologist. 0.375% ropivacaine and dexmedetomidine 1 μg/kg 20 ml were used in ilioinguinal and iliohypogastric nerve block in group D,while 0.375% ropivacaine 20 ml were used in ilioinguinal and iliohypogastric nerve block in group C.Sensory block onset time and blockade duration were recorded.Side effects were recorded in both groups.Results Sensory block onset time in group D was significantly shorter than that in group C (10.6±4.3 min vs 14.4±5.1 min,P <0.05).Sensory block durations in group D was significantly longer than that in group C (832.7±136.6 min vs 669.8±140.1 min,P <0.05). There were two bradycardia cases in group D.No adverse reactions or anaesthesia complications oc-curred in all patients following postoperative follow-up.Conclusion Dexmedetomidine combined with ropivacaine can be used in ilioinguinal and iliohypogastric nerve block safely,and dexmedetomidine shortens the onset time and prolonged the duration of sensory block.
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Objective To compare the efficacy of continuous lumbar plexus block (LPB) with different concentrations of dexmedetomidine added to ropivacaine for postoperative analgesia in elderly patients undergoing hip replacement.Methods Sixty elderly patients of both sexes,aged 65-85 yr,weighing 50-71 kg,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective total hip replacement,were divided into 2 groups (n =30 each) using a random number table:0.5 μg/ml dexmedetomidine+0.1％ ropivacaine group (group D1) and 1.0 μg/ml dexmedetomidine + 0.1％ ropivacaine group (group D2).Lumbar-sacral plexus block combined with general anesthesia was used.At the end of operation,LPB pump was started and set up to deliver a 4 ml bolus dose with a 30 min lockout interval and background infusion at a rate of 8 ml/h.The analgesia solution contained 0.5 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D1 and 1.0 μg/ml dexmedetomidine and 0.1％ ropivacaine in group D2.Postoperative analgesia lasted for 48 h,and the visual analogue scale score was maintained ≤ 3.Patientcontrolled intravenous analgesia (PCIA) pump was connected when break-through pain happened.PCIA solution contained morphine 50 mg diluted to 50 ml in 0.9％ sodium chloride.PCIA pump was set up to deliver a 1 ml bolus dose with a 5 min lockout interval and no background infusion.When the visual analogue scale score ＞3,the patient-controlled LPB pump was used first,and 15 min later if analgesia was still ineffective,PCIA pump was applied.The number of patients in whom analgesia was effective and occurrence of adverse reactions were recorded.Results Compared with group D1,the rate of effective analgesia was significantly increased,and the incidence of nausea,vomiting and pruritus was decreased in group D2 (P＜ 0.05).No bradycardia,hypotension,over-sedation,respiratory depression,urinary retention or local skin infection was found in the two groups.Conclusion Continuous LPB with 1.0 μg/ml dexmedetomidine added to 0.1％ ropivacaine provides better efficacy for postoperative analgesia in elderly patients undergoing hip replacement.
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Objective To evaluate the effect of electroacupuncture (EA) on postoperative outcome in the patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods Forty-four patients of both sexes,aged 18-55 yr,with body mass index of 18-25 kg/m2,of American Society of Anesthesiologists physical status Ⅲ,with New York Heart Association Ⅱ[or Ⅲ,scheduled for elective cardiac valve replacement with CPB,were divided into 2 groups (n =22 each) using a random number table:control group (group C) and group EA.In group EA,patients received EA stimulation with needles at bilateral Neiguan,Ximen,Shenmen and Baihui acupoints (disperse-dense waves,frequency 2 Hz,intensity 1.0-1.2 mA) from 20 min before anesthesia induction to the end of surgery.After induction of general anesthesia,the patients were endotracheally intubated and mechanically ventilated,and combined intravenous-inhalational anesthesia was used to maintain anesthesia.Quality of Recovery 9 and Minimum Mental State Examination scores were assessed on the day before surgery and 1 and 3 days after surgery.The development of nausea and vomiting,postoperative cognitive dysfunction,requirement for rescue analgesics and ventricular arrhythmia was recorded within 3 days after surgery.The consumption of sufentanil in surgery,extubation time,the first flatus time,the first postoperative off-bed time,duration of stay in the intensive care unit and length of hospital stay after sugery were recorded.Results Compared with group C,the consumption of sufentanil in surgery was significantly decreased,Quality of Recovery 9 scores were increased at 1 and 3 days after surgery,the incidence of nausea and vomiting,postoperative cognitive dysfunction and ventricular arrhythmia was decreased within 3 days after surgery,and the extubation time,the first flatus time,the first postoperative off-bed time and length of hospital stay after surgery were significantly shortened in group EA (P＜0.05).Conclusion EA can promote postoperative outcome in the patients undergoing cardiac valve replacement with CPB.
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Objective To investigate the effect of isoflurane preconditioning on rat learning and memory in cerebral ischemia-reperfusion injury and its possible mechanism.Methods Thirty-six adult male Sprague-Daw ley rats w ere randomly divided into a sham operation group, a cerebral ischemia-reperfusion group, and an isoflurane preconditioning group (n=12 in each group). A model of middle cerebral artery occlusion and ischemic-reperfusion w as induced by a modified intraluminal suture method. The rats of the isoflurane preconditioning group inhaled 1.5%isoflurane for 1 hour per day for 5 d. At 24 h after the last preconditioning, a model of MCAO w as made. At 24 h after MCAO, the infarct volume w as detected by using 2,3,5 chlorinated diphenyl tetrazolium staining. At day 1, 3, 7, and 14 after MCAO, the modified Neurological Severity Score (mNSS) were performed. At day 9 after MCAO, the Morris w ater maze test w as used to evaluate the learning and memory of rats. At day 14, Western blotting w as used to detect the protein expression level of hippocampal tissue glutamate receptor 1 (GluR1) on the side of ischemia. Results No obvious infarcts w ere observed in the rats of the sham operation group. The infarct volume in the isoflurane preconditioning group w as significantly smal er than that of the cerebral ischemia-reperfusion group (26.383%±3.128%vs.19.107%±1.661%;P<0.05). No neurological deficit w as observed in the sham operation group (score 0). The mNSS scores at day 1, 3, 7, and 14 after MCAO in the isoflurane preconditioning group w ere decreased significantly (day 1:9.000 ±1.195 vs.11.500 ±1.414;day 3:6.6250 ±1.407 vs.6.625 ±1.407vs.6.625 ±1.407; day 7: 5.875 ±0.707 vs.7.375 ±1.407; and day 14:3.375 ±1.187 vs.5.125 ±1.246;al P<0.05). The Morris w ater maze show ed that the escape latencies at day 1-5 after MCAO in the isoflurane preconditioning group w ere al significantly shorter than those in the cerebral ischemia-reperfusion group (day 1: 95.992 ±15.734 s vs.103.008 ±11.654 s; day 2: 70.949 ±14.708 s vs. 94.705 ±14.709 s;day 3:39.660 ±7.413 s vs.65.716 ±10.155 s;day 4:22.692 ±5.778 s vs.35.240 ±8.553 s;day 5: 14.906 ±4.336 s vs.22.890 ±10.381 s; al P<0.05). The numbers of crossing platform (4.556 ± 1.333 vs.2.889 ±1.536 ) and the percentages of time spent in the target quadrant ( 33.014%±5.223%vs. 21.978%±6.697%) in the isoflurane preconditioning group w ere significantly increased than in the cerebral ischemia-reperfusion group (al P<0.01). The levels of hippocampal GluR1 protein on the ischemic sides in the sham operation group, ischemia-reperfusion group, and isoflurane preconditioning group w ere 0.871 ±0.153, 0.456 ±0.130, and 0.689 ±0.126, respectively. There w ere significant differences among the 3 groups ( F=18.329, P<0.001) and the isoflurane preconditioning group w as significantly higher than the ischemia-reperfusion group (P<0.05). Conclusions Isoflurane preconditioning can improve the learning and memory in cerebral ischemia-reperfusion in rats, its mechanism may be associated w ith the uprelagating GluR1 expression in the hippocampus.
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Objective To explore the effect of dexmedetomidine combined with ropivacaine for continuous lumbar plexus block on the quality of early recovery in patients undergoing total hip ar-throplasty.Methods Sixty patients (35 males and 25 females)with ASA physical status Ⅱ or Ⅲ, aged 65-84 years,undergoing total hip replacement were randomly assigned to dexmedetomidine com-bined with ropivacaine group (group D)or ropivacaine group (group C).All patients received ropiva-caine which was administered via continuous lumbar plexus block as patient-controlled analgesia (PCA)after surgery.The PCA were programmed with a background infusion 8 ml/h of ropivacaine, bolus dose was 4 m1 and the block time was 30 min;the patients in group C received 0.2% ropiva-caine,and the patients in group D received 0.1% ropivaciane combined with 1 μg/ml of dexmedeto-midine by the way of intravenous infusion.In addition,all patients received another patient-controlled intravenous analgesia (PCIA)with 1 mg/ml of morphine for relieving the explosive pain.The PCIA was programmed with a lobus dose of morphine 1 mg without background dose,the block time was 5 min.Consumption of morphine and visual analog scale (VAS)score,muscle strength and maximum flexion and abduction of hip joint were recorded at the time points of 6,12,24 and 48 h after opera-tion.The side-effect reactions such as nausea,vomiting,drowsiness and itching were recorded.The sleep quality was assessed with Pittsburgh sleep quality index (PSQI)on day 1 before operation,day 1 and day 7 after operation.Results The consumption of morphine in group D was significantly fewer than group C (P <0.05).Compared with group C,muscle strength and maximum flexion and abduc-tion of hip joint in group D were increased at 6,12,24 and 48 h after operation (P <0.05 ).PSQI scores were decreased on the day 1 and day 7 after operation.The incidence of delirium,nausea and vomiting,drowsiness and itching in group D were decreased (P <0.05).Conclusion 0.1% ropiva-ciane continuous lumbar plexus block combined with 1 μg/ml of dexmedetomidine by the way of in-travenous infusion could provide satisfied analgesia for the operation of total hip arthroplasty;the sleep quality is improved,the functional exercise of hip joint is promoted.
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Objective To evaluate the effect of isoflurane preconditioning on autophagy during focal cerebral ischemia-reperfusion (I/R) injury in rats.Methods Thirty-six healthy male Sprague-Dawley rats,weighing 250-280 g,aged 7-8 weeks,were divided into 3 groups (n =12 each) using a random number table:sham operation group (group S),cerebral I/R group (group I/R) and isoflurane preconditioning group (group IP).Focal cerebral I/R was induced by 2 h middle cerebral artery occlusion followed by 24 reperfusion.Group IP inhaled 1.5％ isoflurane for 1 h per day for 5 consecutive days,the other two groups only inhaled 30％ oxygen,and focal cerebral I/R was induced at 24 h after the last inhalation.At 24 h of reperfusion,neurologic deficit was assessed and scored,the rats were then sacrificed,and brains were removed for determination of cerebral infarct size (using triphenyl tetrazolium chloride staining) and expression of microtubule-associated protein 1 light chain 3-Ⅱ (LC3-Ⅱ) and Beclin-1 (by Western blot).Results Compared with group S,the neurologic deficit scores and cerebral infarct size were significantly increased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly up-regulated in I/R and IP groups (P＜0.05).Compared with group I/R,the neurologic deficit scores and cerebral infarct size were significantly decreased,and the expression of hippocampal LC3-Ⅱ and Beclin-1 was significantly upregulated in group IP (P ＜ 0.05).Conclusion The mechanism by which isoflurane preconditioning ameliorates focal cerebral I/R injury is related to enhancement of autophagy in the rats.