ABSTRACT
Objective:To observe whether intraoperative application of Dexmedetomidine combined with Ulinastatin has protective effect on postoperative pulmonary function in elderly patients with acute abdomen.Methods:80 cases of elderly patients with acute abdomen were divided into 4 groups randomly:Control group (group C);Dexmedetomidine group (group D);Ulinastatin group (group U) and Dexmedetomidine combined with Ulinastatin group (group D+U),20 cases in each group.In group D,before induction of anesthesia,a loading dose of Dexmedetomidine 1.0 μ g/kg was infused over 10 min,followed by continuous infusion of Dexmedetomidine at a rate of 0.5 μ g/ (kg·h) until the last 0.5 h before the end of surgery.Group U received Ulinastatin 10000 U/kg after induction of anesthesia.The patients in group D+U group were treated with the above two methods;and the patients in group C were given normal saline as control.General anesthesia was used in each group.Arterial blood gas analysis,oxygenation index,serum TNF-α and IL-8 levels were observed in all patients in preoperative 1 d and postoperative 1,3 and 5 d.All patients were back to ICU with intubation after operation.The duration of intubation,ICU treatment days,total hospitalization period and postoperative pulmonary complications were recorded.Results:For the oxygenation index,there was no significant difference between each group at TO (P＞0.05).But at T1,T2 or T3,the oxygenation index in group D+U is better than group D,group U or group C (P＜0.05).The comparison of serum TNF-α and IL-8 concentration in each group was almost the same as the oxygenation index.As for Duration of intubation,ICU treatment days,total hospitalization period,those in Group D+U are shorter than in other three groups (P＜0.05).In the incidence of postoperative pulmonary complications (atelectasis,pulmonary infection,etc),group D+U (18％) was significantly lower than C group(26％),group D(32％) and U group(38％,P＜0.05).Conclusion:The combination of dexmedetomidine and ulinastatin in elderly patients with acute abdomen can reduce the perioperative inflammatory response and improve the postoperative lung function.
ABSTRACT
Se ha demostrado que la ketamina, una anestésico general, produce una respuesta de choque térmico (HSR) en algunos animales experimentales. Examinamos si la ketamina mejora la supervivencia en lesión por quemadura severa en ratas, a través de la expresión de la proteína de choque 70. Un total de 124 ratas Wistar machos se dividieron aleatoriamente en 3 grupos: un grupo de control (grupo C, n = 20), un grupo quemado (grupo B, n = 52) y un grupo quemado + ketamina (grupo K, n = 52). Las ratas de los grupos B y K presentaban quemaduras de espesor completo en el 30% del total de su superficie corporal. Las ratas del grupo K se trataron con ketamina (40mg/kg, i.m.) a los 15min después de la lesión y las del grupo B se inyectaron con igual volumen de solución salina. Luego de practicar la eutanasia a las ratas, se examinó la expresión de HSP70 en muestras del miocardio y del cerebro con análisis Western blot. En las ratas que no se sacrificaron se evaluó el estado de supervivencia. Luego de 10 días, la tasa de supervivencia en las ratas del grupo K era superior a las del grupo B (70% versus 30%). Los análisis Western blot mostraron que la expresión de proteína HSP70 en el miocardio en respuesta a la administración de ketamina es más fuerte que en respuesta a la administración de solución salina a las 3 h (158% versus 65%) y a las 6h (165% versus 68%). En comparación con el grupo B, la ketamina aumentó marcadamente el nivel de expresión de la proteína HSP70 en tejido cerebral a las 3h y a las 6 h (79% versus 51% a las 3 h; 123% versus 98% a las 6 h). Concluimos que el tratamiento con ketamina mejora la supervivencia en lesión por quemadura severa, mediante la expresión de la proteína de choque 70 en los tejidos del miocardio y del cerebro.
Ketamine, a general anesthetic, has been shown to elicit the heat-shock response (HSR) in some of the animal models. We examined whether ketamine improves survival in severe burn injury in rats via the expression of heat shock protein 70. 124 male Wistar rats were randomly divided into three groups: a control group (group C, n = 20), burned group (group B, n = 52), and burned + ketamine group (group K, n = 52). The rats in groups B and K had full-thickness burns of 30% of their total body surface. The rats in group K were treated with ketamine (40 mg/kg, i.m.) 15 min after injury, and those in group B were injected with saline at the same volume. After the rats were euthanized, HSP70 expression in myocardium and brain samples was examined by Western blot analysis. Survival status was evaluated for the rats not euthanized. After 10 days, survival rate of rats in group K was higher than that of group B (70% versus 30%). Western blot analyses revealed that HSP70 protein expression in myocardium in response to ketamine administration is stronger than that in response to saline administration at 3 h (158% versus 65%) and 6 h (165% versus 68%). Compared with that in group B, ketamine strongly increased HSP70 protein expression level in cerebral tissue at 3 h and 6 h (79% versus 51%, at 3 h; 123% versus 98%, at 6 h). We concluded that ketamine therapy improves survival in severe burn injury via the expression of heat shock protein 70 in myocardial and cerebral tissues.
Subject(s)
HumansABSTRACT
<p><b>BACKGROUND</b>Systemic non-steroidal anti-inflammatory drugs have been evaluated for their possible preemptive analgesic effects. The efficacy of flurbiprofen axetil for preemptive analgesia in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach needs further investigation. The aim of this study was to research the preemptive analgesic effects of flurbiprofen axetil in thoracic surgery, and the influence of preoperative administration on postoperative respiratory function.</p><p><b>METHODS</b>This randomized, double-blind, controlled trial enrolled 60 patients undergoing radical resection of esophageal carcinoma via the left thoracic approach. Anesthesia management was standardized. Each patient was randomly assigned to receive either 100 mg flurbiprofen axetil intravenously 15 minutes before incision (PA group) or intravenous normal saline as a control (C group). Postoperative analgesia was with sufentanil delivered by patient-controlled analgesia pump. Postoperative sufentanil consumption, visual analog scale pain scores, plasma levels of interleukin-8, and oxygenation index were measured.</p><p><b>RESULTS</b>Compared with the preoperative baseline, postoperative patients in the PA group had no obvious increase in pain scores (P > 0.05), but patients in the C group had significantly increased pain scores (P < 0.05). Pain scores in the C group were significantly higher at 24 hours postoperatively than preoperatively. Intergroup comparisons showed lower visual analog scale scores at 2 - 24 hours postoperatively in the PA group than the C group (P < 0.05). Sufentanil consumption and plasma interleukin-8 levels at 2 and 12 hours postoperatively were significantly lower in the PA group than the C group (P < 0.05). The oxygenation index at 2 and 12 hours postoperatively was significantly higher in the PA group than the C group (P < 0.05).</p><p><b>CONCLUSIONS</b>Intravenous flurbiprofen axetil appears to have a preemptive analgesic effect in patients undergoing radical resection of esophageal carcinoma via the left thoracic approach, and appears to contribute to recovery of respiratory function and to reduction of the postoperative inflammatory reaction.</p>
Subject(s)
Humans , Analgesia, Patient-Controlled , Methods , Double-Blind Method , Esophageal Neoplasms , General Surgery , Flurbiprofen , Therapeutic UsesABSTRACT
<p><b>BACKGROUND</b>NR2B containing N-methyl-D-aspartate (NMDA) receptor plays an important role in the facilitation and maintenance of neuropathic pain. The discrete distribution of NR2B subunit in the central nervous system (CNS) may support reduced side effects of agents that act selectively at this site. Therefore, we investigated the hypothesis that a humoral autoimmune response targeting the NR2B subunit of NMDA receptor relieves pain like behaviours produced by peripheral injury.</p><p><b>METHODS</b>Rats were immunized subcutaneously with NR2B-Keyhole Limpet Hemocyanin (NR2B-KLH) three times at two-week intervals. NR2B specific IgG titres in sera and cerebrospinal fluid were determined by indirect ELISA. Seven days after the third immunization, 2 of the 3 terminal branches of the sciatic nerve (tibial and common peroneal nerves) were tightly ligated. Behavioural testing was carried out on every other day after surgery, until 7 days after surgery. The lumbar spinal cord (L4-6) was removed on day 7 after ligation. The expression of NR2B protein in the lumbar spinal cord was determined using Western blotting.</p><p><b>RESULTS</b>After the second vaccination, NR2B specific IgG in sera was detected to be > 0.5 microg/ml in six of nine rats. After the third vaccination, all the immunized rats had > 2.2 microg/ml. Titres of NR2B specific IgG in sera peaked 42 days post initial immunization and persisted for over 70 days. No NR2B specific IgG was detected in sera from PBS or KLH group. The behavioural thresholds in NR2B group were significantly higher than those in PBS and KLH groups on day 7 after ligation. NR2B specific IgG in CSF in NR2B group could not be detected on day 1 before spinal dissection; but could be detected on day 7 after surgery. The expression of NR2B protein in group NR2B was significantly lower than in PBS and KLH groups on day 7 after surgery.</p><p><b>CONCLUSION</b>The NR2B peptide could be used as a vaccine against neuropathic pain, which could be associated with reduction of NR2B protein in the lumbar spinal cord.</p>