ABSTRACT
Objective To investigate the clinical efficacy and safety of dexmedetomidine combined with sevoflurane in elderly patient undergoing percutaneous nephrolithotomy.Methods Forty ASA Ⅰ ～ Ⅱ elderly patients of both sexes,aged 65 ～ 76 (71.0 ± 6.0)yr,scheduled for elective surgery of percutaneous nephrolithotomy under general anesthesia,were randomly divided into two groups (n =20 each):dexmedetomidine/sevoflurane group (group D) and propofol/sevoflurane group (group P).All patients received fentanyl,propofol,and cisatracurium for anesthesia induction.After endotracheal intubation,patients in group D received an initial loading dose of 0.5 μg/kg (4 μg/ml) of dexmedetomidine over 10 min,followed by a continuous infusion of 0.3 ～ 0.6 μg/(kg · h).Patients in group P received an initial loading dose of 1 mg/kg of propofol over 10 min,followed by a continuous infusion of 3 ～ 6 mg/(kg · h).All patients received the inhalation of sevoflurane for maintenance.Bispectral index was used to maintain a similar level of hypnosis in both groups (40 ～ 60).The heart rate (HR),blood pressure (BP) [systolic blood pressure (SBP)/diastolic blood pressure (DBP)],oxygen saturation (SpO2),end-tidal carbon dioxide partial pressure (PETCO2) at different time points before anesthesia (T0),10 min after prone position (T1),30 and 60 min started lithotripsy (T2-3),and at the end of operation (T4) were recorded,respectively.The operation time,amount of blood loss,and volume of fluid infusion were recorded.Recovery time of spontaneous ventilation,awaking time (open eyes by calling),extubation time,staying time at postanesthesia care unit (PACU),and relevant complications were also recorded.Results Compared to the baseline value at T0,SBP and DBP were significantly decreased at T1 in both groups(P ＜0.05),and no significant differences in the SBP,DBP,SpO2,and PETCO2 were found between two groups(P ＞ 0.05).Compared to the baseline value at T0,the HR was significantly decreased at T1 ～ T4 in group D (P ＜ 0.05),the HR was significantly lower at T1 ～ T4 in group D than that of group P (P ＜ 0.05).No significant differences in operation time,amount of blood loss,and volume of fluid infusion were found between two groups (P ＞ 0.05).No significant differences in recovery time of spontaneous ventilation,staying time at PACU,nausea,vomit,and agitation were found between two groups (P ＞ 0.05),while awaking time and extubation time were significantly longer in group D than that of group P(P ＜ 0.05).The shivering was significantly less in group D than that of group P (P ＜ 0.05).Conclusions Both dexmedetomidine/sevoflurane and propofol/sevoflurane anesthesia are suitable for elderly patients undergoing percutaneous nephrolithotomy.Dexmedetomidine/sevoflurane makes time of awake and extubation longer,but dexmedetomidine can reduce the shivering and the attendant complications caused by shivering.
ABSTRACT
Objective To observe the effect of ephedrine combined propofol and fentanyl in painless induced abortion.Methods Eighty cases of patients (ASA Ⅰ) who apply painless induced abortion were randomly divided into two groups:observation group and control group,each group with 40 cases.Both of the groups were given fentanyl 1 μ g/kg and propofol 2 mg/kg with 2 mg/ml lidocaine; then observation group was given 0.08-0.15 mg/kg ephedrine according to the blood pressure.The heart rate,blood pressure and pulse oximetry (SpO2) of preinduction,3 min and 5 min after induction and 3 min after surgery and the recovery time was observed.Results There was no significant difference about heart rate,blood pressure and SpO2 preinduction,but there was significant difference on 3 min and 5 min after induction in control group in contrast to preinduction [(69.80 ± 7.08),(65.18 ± 5.16) times/min vs.(83.65 ± 8.12)times/min and (86.65 ± 8.60),(90.73 ± 8.35) mmHg (1 mmHg =0.133 kPa) vs.(128.45 ± 11.83) mmHg] (P ＜ 0.05),while observation group kept stable; there was no significant difference about SpO2 and recovery time in both groups.Conclusion It is safe and effective to use ephedrine combined propofol and fentanyl in painless induced abortion.
ABSTRACT
Objective To evaluate the effect of captopril and isoflurane preconditioning on cell apoptosis during myocardial ischemia/reperfusion (I/R) in rabbits.Methods Forty New Zealand white rabbits of both sexes,weighing 1.8-2.5 kg,were randomly divided into 5 groups (n =8 each) using a random number table:sham operation group (group S),group I/R,isoflurane preconditioning group (group I),captopril preconditioning group (group C) and captopril and isoflurane preconditioning group (group C + I).The animals were anesthetized with 3％ pentobarbital sodium 30 mg/kg.Myocardial ischemia was induced by occlusion of the left anterior descending branch of coronary artery for 30 min followed by 120 min of reperfusion.1.1％ isoflurane was inhaled for 30 min followed by 15 min washout before myocardial ischemia in group I.Captopril 25 mg/kg was given through a gastric tube into the stomach at 24 h before myocardial ischemia in group C.Captopril 25 mg/kg was given through a gastric tube into the stomach,24 h later 1.1％ isoflurane was inhaled for 30 min followed by 15 min washout,and then myocardial ischemia was performed in group C + I.The rabbits were sacrificed at the end of reperfusion and myocardial specimens were removed for microscopic examination and observation of ultrastructure,and for determination of the expression of Bcl-2 and Bax proteins (by Western blot).The apoptosis rate was detected by flow cytometry.Bcl-2/Bax ratio was calculated.Results Compared with group S,the apoptosis rate was significantly increased,the expression of Bcl-2 and Bax proteins was up-regulated,and Bel-2/Bax ratio was decreased in I/R,I,C and C + I groups (P ＜ 0.05).Compared with I/R,I and C groups,the apoptosis rate was significantly decreased,Bcl-2 protein expression was up-regulated,Bax protein expression was down-regulated,and Bcl-2/Bax ratio was increased (P ＜ 0.05),and the pathological changes were significantly attenuated in group C + I.Conclusion Regulation of Bcl-2/Bax ratio and inhibition of apoptosis in myocardial cells are involved in the mechanism by which isoflurane and captopril preconditioning reduces I/R injury in rabbits.