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Objective To evaluate the effect of low-flow sevoflurane anesthesia on the early postoperative renal function in patients.Methods Sixty patients of both sexes,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 18-64 yr,scheduled for elective non-urological surgery with general anesthesia,with an expected surgical duration＞4 h,were divided into 2 groups (n =30 each) using a random number table method:middle-flow anesthesia group (group Ⅰ) and low-flow anesthesia group (group Ⅱ).Anesthesia was induced with Ⅳ midazolam,sufentanil,propofol and cisatracurium besylate.Mechanical ventilation was performed after tracheal intubation.Pure oxygen served as carrier,the fresh gas flow of oxygen was set at 4-5 L/min,sevoflurane was inhaled for 10-15 min,and then fresh gas flow was decreased to 2 L/min (group Ⅰ) and 0.5 L/min (group Ⅱ).End-tidal pressure of carbon dioxide was maintained at 35-45 mmHg.The end-tidal concentration of sevoflurane was set at 2.0％-2.4％,remifentanil and cisatracurium besylate were infused intravenously,and sufentanill or propofol was injected intermittently to maintain anesthesia.Bispectral index value was maintained at 40-60 during operation.Before anesthesia induction (T0),at 1,2,3 and 4 h after anesthesia induction (T1-4),immediately after operation (T5) and at 24 h after operation (T6),peripheral venous blood samples were collected for determination of serum fluoride ion concentrations.Peripheral venous blood samples and urine specimens were collected at T0,T5,T6,48 h after operation (T7) and 72 h after operation (T8) for determination of creatinine (Cr),blood urea nitrogen (BUN) and cystatin C (Cys C) and serum and urine β2-microglobulin (β2-MG) concentrations.Results Compared with the baseline at T0,serum fluoride ion concentrations were significantly increased at T1-6 in two groups,the serum Cys C concentration was increased at T5,and serum and urine β2-MG concentrations were increased at T5 and T6 in group Ⅰ,serum Cr and BUN concentrations and serum and urine β2-MG concentrations were increased at T5 and T6,and the serum Cys C concentration was increased at T5-T7 in group Ⅱ (P＜0.05).Compared with group Ⅰ,serum fluoride concentrations were significantly increased at T1-6,serum Cr and BUN concentrations and serum and urine β2-MG concentrations were increased at T5,and serum Cys C concentrations at T5-T7 and urine β2-MG concentrations at T5 and T6 were increased in group Ⅱ (P＜0.05).Conclusion Low-flow sevoflurane anesthesia produces no marked effect on early postoperative renal function in patients.
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Objective To evaluate the effects of penehyclidine hydrochloride (PHCD) combined with high-frequency jet ventilation (HFJV) of the operated lungs on pulmonary function and inflammatory response during one-lung ventilation (OLV) in patients with chronic obstructive pulmonary disease (COPD).Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes with COPD,aged 40-64 yr,with body mass index of 17-26 kg/m2,scheduled for elective video-assisted thoracoscopic surgery under general anesthesia,were divided into 4 groups (n =15 each) using a random number table method:conventional group (group C),PHCD group (group P),HFJV group (group H) and PHCD combined with HFJV group (group PH).After induction of anesthesia,the patients were intubated with a double-lumen tube and then mechanically ventilated,with inspired oxygen concentration 100％,oxygen flow rate 2 L/min,tidal volume 6-8 ml/kg,respiratory rate 10-14 breaths/min,and respiratory rate was set at 12-16 breaths/min and PETCO2 was maintained at 40-45 mmHg during OLV.PHCD 0.01 mg/kg was intravenously injected before intubation in P and PH groups.The ventilation mode was changed to OLV after beginning of skin incision in each group.Ventilation of the lung on the operated side was performed by means of HFJV (driving pressure 0.5 kg/cm2) during OLV in P and PH groups.The pneumodynamic parameters such as airway peak pressure (Ppeak),airway plateau pressure (Pplat),airway resistance (Raw) and dynamic lung compliance (Cdyn) were monitored immediately before skin incision (T1) and at 60 and 120 min of OLV (T2,3).Arterial blood samples were obtained at T2 for blood gas analysis,and oxygenation index (OI),respiratory index (RI),physiologic dead space fraction (VD/Vr)and alveolar-arterial oxygen gradiant (A-aDO2) were calculated.Venous blood samples were drawn at T3 for determination of the serum concentrations of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6)and IL-8 by enzyme-linked immunosorbent assay.The occurrence of pulmonary complications was recorded within 72 h after operation.Results Compared with group C,the serum concentrations of TNF-α,IL-6 and IL-8,Ppeak,Pplat,Raw,RI,VD/VT,A-aDO2 and incidence of pulmonary complications were significantly decreased,and Cdyn and OI were increased in group P and group PH (P＜0.05),and the serum concentrations of TNF-α,IL-6 and IL-8,RI,VD/VT,A-aDO2 and incidence of pulmonary complications were significantly decreased,and OI was increased in group H (P＜0.05).Compared with group P or group H,the serum concentrations of TNF-α,IL-6 and IL-8,RI,VD/VT,A-aDO2 and incidence of pulmonary complications were significantly decreased,and OI was increased in group PH (P＜0.05).Conclusion PHCD combined with HFJV of the operated lung produces better efficacy in improving respiratory function,inhibiting inflammatory responses,reducing lung injury and is more helpful in improving prognosis than either alone in the patients with COPD.
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Objective To evaluate liver protection provided by ulinastatin in rats with liver fibrosis.Methods Fifty pathogen-free male Sprague-Dawley rats,weighing 180-220 g,aged 6-8 weeks,were randomly divided into 5 groups (n =10 each) using a random number table:control group (group C),carbon tetrachloride (CCl4) group,low-dose ulinastatin group (group L),medium-dose ulinastatin group (group M),and high-dose ulinastatin group (group H).Hepatic fibrosis was produced by subcutaneous injection of 50％ CCl4 peanut oil solution two times a week for 8 weeks.After hepatic fibrosis was produced (at 9th week),ulinastatin 2.5× 104,5.0× 104 and 10.0× 104 U/kg were injected via the caudal vein in L,M and H groups,respectively,once a day for 7 days.Blood samples were collected after 24 h of fast on 8th day for determination of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations by ELISA.The rats were then sacrificed and livers were removed for microscopic examination of pathologic changes with light microscope.The expression of interleukin-1β (IL-1β),IL-2,IL-6,IL-8,Toll-like receptor 4 (TLR4),and tumor necrosis factor-alpha (TNF-α) mRNA and protein was detected by RT-PCR and Western blot.Results Compared with group C,the serum AST and ALT concentrations were significantly increased in CCl4,L and M groups,the expression of IL-1β,IL-2,IL-6,IL-8,TLR4 and TNF-α mRNA and protein was up-regulated in CCl4 group,and no significant change was found in the parameters mentioned above in group H.Compared with group CCl4,the serum AST and ALT concentrations were significantly decreased in M and H groups,no significant change was found in the serum AST and ALT conccntrations in group L,and the expression of IL-1β,IL-2,IL-6,IL-8,TLR4 and TNF-α mRNA and protein was down-regulated in group H.The pathologic changes of hepatic tissues were attenuated in M and H groups as compared with group CCl4.The pathologic changes of hepatic tissues were almost recovered to the normal structure in group H.Conclusion Ulinastatin can produce liver protection in rats with liver fibrosis.
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Objective To evaluate the efficacy of dexmedetomidine and dezocine used to supplement awake tracheal intubation assisted by fiberoptic bronchoscope (FOB) in elderly patients.Methods Sixty elderly patients aged 65-77 yr,of ASA physical status Ⅱ or Ⅲ (Mallampati grade Ⅰ or Ⅱ),scheduled for elective surgery under general anesthesia,were randomly divided into 3 groups (n =20 each) using a random number table:dezocine group (group DEZ),dexmedetomidine group (group DEX) and dezocine combined with dexmedetomidine group (group DEZ+DEX).Dezocine 0.1 mg/kg was injected intravenously in group DEZ.Dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min in group DEX.In group DEZ+DEX,dexmedetomidine 0.4 μg/kg was infused intravenously over 10-15 min,and dezocine 0.1 mg/kg was injected simultaneously.Laryngeal mucous membrane was sprayed with 2％ lidocaine for topical anesthesia during infusion in all the three groups.In addition,1％ tetracaine 3 ml was injected into trachea through cricothyroid membrane.Awake tracheal intubation was performed and assisted by FOB after the end of administration in all the three groups.Cardiovascular response (MAP or HR＞30％ of baseline values) and respiratory depression (SpO2＜90％ and RR＜8 bpm) were recorded during the period between induction of anesthesia and 3 min after intubation was completed.The intubation time was recorded.The tolerance of tracheal tube was assessed in the patients.At the time of topical anesthesia,when epiglottis came into view,immediately after tracheal tube was successfully inserted into trachea,and at 3 min after successful intubation,perfusion index and Ramsay sedation score,and patients' satisfaction with the sedation (Ramsay sedation score 2-4) were recorded.Results Compared with group DEZ or DEX,the tolerance of tracheal tube was significantly enhanced,intubation time was shortened,the rate of satisfactory sedation was increased,perfusion index and the incidence of cardiovascular response were decreased in DEZ+DEX group.There was no significant difference in respiratory depression among the three groups.Conclusion Dexmedetomidine and dezocine can provide better condition for awake tracheal intubation assisted by FOB than dexmedetomidine or dezocine alone in elderly patients.
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Objective To investigate the effects of sevoflurane preconditioning on autophagy after traumatic brain injury (TBI) in rats and the role of C-Jun N-terminal kinase (JNK) signaling pathway.Methods Sixty adult male Sprague-Dawley rats,weighing 220-250 g,were randomly divided into 4 groups (n =15 each) using a random number table:sham operation group (group S),group TBI,TBI + sevoflurane preconditioning group (group TBI + Sevo) and TBI + sevoflurane preconditioning + JNK inhibitor SP600125 group (group TBI + Sev + SP).TBI models were established using Feeney' s method.In TBI + Sev and TBI + Sev + SP groups,the rats inhaled 2.4％ sevoflurane for 30 min once a day for 4 concecutive days,and TBI was produced at 24 h after the end of sevoflurane preconditioning.In TBI + Sev + SP group,SP600125 (6 mg/kg) was injected intrapetitoneally at 30 min after TBI.Five rats were chosen at day 1,3,and 7 after TBI,and neurological deficit score (NDS) was measured.The rats were then sacrificed and brains were removed to measure brain water content,expression of LC3 lⅡ and Beclin-1 mRNA (using PCR),and expression of LC3 Ⅱ,Beclin-1,JNK and phosphorylated JNK (p-JNK) (by Western blot).Results Compared with group S,brain water content and NDS were significantly increased,and the expression of LC3 Ⅱ and Beclin-1 protein and mRNA,JNK,and p-JNK was up-regulated in the other three groups.Brain water content and NDS were significantly decreased,and the expression of LC3 Ⅱ and Beclin-1 protein and mRNA,JNK,and p-JNK was down-regulated in TBI + Sev and TBI + Sev + SP groups as compared with group TBI,and in TBI + Sev + SP group as compared with TBI + Sev group.Conclusion The mechanism by which sevoflurane preconditioning mitigates TBI is related to inhibiton of activation of JNK signaling pathway and decreased autophagy in rats.
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Objective To evaluate the effects of dexmedetomidine on the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.Methods Sixty patients of both sexes,of ASA physical status Ⅰ or Ⅱ,after radical resection for esophageal cancer under general anesthesia,were randomly divided into 2 groups (n =30 each) using a random number table:control group (group C) and dexmedetomidine group (group Dex).Patient-controlled intravenous analgesia (PCIA) was performed immediately after operation in the two groups.In group C,the PCIA solution (150 ml) contained morphine 0.48 mg/kg.In group Dex,the PCIA solution (150 ml) contained morphine 0.48 mg/kg and dexmedetomidine 1 μg/kg.The postoperative visual analogue scale (VAS) scores were maintained ≤ 3.The consumption of morphine was recorded within 24,48 and 72 h after operation.The adverse effects such as nausea,vomiting,pruritus,bradycardia,hypotension,oversedation and respiratory depression were also recorded after operation.Before induction of anesthesia (T0),immediately after extubation (T1),and at 24,48 and 72 h after operation (T2-4),venous blood samples were obtained for determination of the levels of T-lymphocyte subsets (CD3+,CD4+,CD8+) and natural killer (NK) cells by flow cytometry.CD4+/CD8+ ratio was calculated.Results Compared with group C,the consumption of morphine within 24,48 and 72 h after operation and incidence of nausea,vomiting and pruritus after operation were significantly decreased in group Dex.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly lower at T1-4 than at T0 in the two groups.The levels of CD3+,CD4+,CD4+/CD8+ ratio and NK cells were significantly higher at T1-4 in group Dex than in group C.Conclusion Dexmedetomidine can improve the cellular immune function during analgesia with morphine after radical resection for esophageal cancer in the patients.
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Objective To evaluate the accuracy of auditory evoked potential index (AAI) in monitoring the depth of sevoflurane anesthesia in infants.Methods Fifty ASA Ⅰ or Ⅱ pediatric patients,aged 1-3 yr,scheduled for elective surgery under general anesthesia,were enrolled in this study.Anesthesia was induced with propofol,cisatracurium and remifentanil.The patients were tracheal intubated and mechanically ventilated.PET CO2 was maintained at 35-45 mm Hg.Anesthesia was maintained with inhalation of sevoflurane.Fresh gas flow was first set at 6 L/min for 15 min and then reduced to 3 L/min.The end-tidal sevoflurane concentration (CETSev) was maintained at 2.5%,2.8%,3.0%,3.5%,3.7% and 4.0%.Each CETSev was maintained for 3 min.AAI was continuously monitored before induction of anesthesia,after induction,immediately before sevoflurane inhalation,and at the 6 CET Sev.Results AAI was negatively correlated with CET Sev (r =-0.872,P ＜ 0.01).Conclusion AAI can accurately reflect the depth of sevoflurane anesthesia in infants.
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ObjectiveTo evaluate the efficacy of fiberoptic bronchoscope( FOB )-guided tracheal intubation with laryngeal mask airway (LMA) in patients undergoing anterior cervical spine surgery.MethodsForty ASA Ⅰ or Ⅱ patients of both sexes,aged 18-55 yr,weighing 50-75 kg,mallampatis Ⅰ or Ⅱ,scheduled for anterior cervical spine surgery under general anesthesia,were randomly divided into 2 groups( n =20 each): FOBguide tracheal intubation (group FOB) and FOB-guided tracheal intubation with LMA group (group LMA).Anesthesia was induced with mindazolam 0.04 mg/kg,fentany 3-4 μg/kg,cis-atracuriun 0.2 mg/kg and propofol 2 mg/kg.Tracheal intubation was performed at 3 min after cis-artracurium iv.Auditory evoked potential index was maintained at 10-20.The intubation time,the number of successful intubation,hypertension,tachycardia and hypoxemia were recorded.The number of successful LMA placement,LMA placement time and LMA shift after extubation were recorded.Blood stain at LMA removal and complications were also recorded.ResultsThe rate of successful LMA placement at first attempt was 90％ and placement time was ( 13 ± 3) s.The rate of successful intubation in the both groups was 100％.The intubation time was significantly shorter and the rate of successful intubation at first attempt was higher in group LMA than in group FOB ( P ＜ 0.05).Hypertension,tachycardia and hypoxemia were not found in the two groups.The number of LMA shift was 8 (40％).The number of blood stain and slight sore throat was 1 respectively in group LMA.There was no other complications in the both groups.Conclusion FOB-guided tracheal intubation with LMA can provide effective ventilation during operation,improve the success rate at first attempt and shorten the intubation time in patients undergoing cervical spine surgery.
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Objective To evaluate the efficacy of fiberoptic bronchoscope(FOB)-guided orotracheal intubation with Glidescope videolaryngoscopy in elderly patients.Methods Forty ASA Ⅰ or Ⅱ patients,agaed 65-77yr,weighing 43-82 kg,scheduled for abdominal surgery under general anesthesia with trcheal intubation,were randomly divided into 2 groups ( n =20 each):group FOB and FOB-guided tracheal intubation with Glidescope videolaryngoscopy(group Glidescope).Anesthesia was induced with mideazolam 0.04 mg/kg,cis-atracutium 0.2 mg/kg,fentany 2-3 μg/kg and propofol 1.5 mg/kg,orotracheal intubation was performed 3 min after intravenous cis-artracurium.The intubation time,success rate of orotracheal intubation and hypoxemia were recorded.The number of glottic exposure,epiglottic exposure with Glidescope videolargngoscopy were recorded in group Glidescope.Results The intubation time was shorter and success rate of orotracheal intubation at first attempt was higher in group Glidescope than in group FOB ( P ＜ 0.05).The number of glottic exposure with Glideseope videolaryngoscopy was 15 patients(75％ ) and epiglottic exposure was 5 patients(25％ ) in group Glidescope.Hypoxemia was not found in the two groups.Conclusion FOB-guided orotracheal intubation with Glidescope videolaryngoscopy shorten the intubation time and higher success rate,and can be used effectively in the elderly patients.
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Objective To investigate the effects of intravenous penehyclidine hydrochloride or doxofylline on respiratory mechanics during non-thoracotomy in patients with chronic obstructive pulmonary disease (COPD).Methods One hundred and thirty-five ASA Ⅱ or Ⅲ patients with COPD, aged 55-86 yr, weighing 44-78 kg,scheduled for elective non-thoracotomy under general anesthesia, were randomly divided into 3 groups ( n = 45 each): control group (group C), penehyclidine hydrochloride group (group P) and doxofylline group (group D).Anesthesia was induced with fentanyl 4 μg/kg, propofol 1.5 rg/kg and cis-atracurium 0.2 mg/kg. The patients were tracheal intubated and mechanically ventilated. PETCO2 was maintained at 40 mm Hg. At 5 rin after tracheal intubation, penehyclidine hydrochloride 0.01 mg/kg was injected intravenously in group P, and doxofylline 4 mg/kg was injected intravenously in group D. The equal volume of normal saline was injected intravenously in group C. Anesthesia was maintained with propofol 5 mg· kg- 1 · h- 1, eis-atracurium 0.2 mg· kg- 1 · h- 1, and intermittent iv boluses of fentsnyl. The auditory evoked potential index was maintained at 15-20 during operation. The peak airway pressure, airway plateau pressure, lung compliance and airway resistance were recorded immediately before administration, and at 30, 45 and 60 rin after administration. Results Compared with group C, the peak airway pressure, airway plateau pressure and airway resistance were significantly decreased, while the lung compliance was significantly increased at each time point after administration in groups P and D ( P ＜ 0.05 ). There was no significant difference in the parameters of respiratory mechanics at each time point between group P and group D ( P ＞ 0.05). Conclusion Both intravenous penehyclidine hydrochloride and doxofylline can improve respiratory mechanics during non-thoracotomy in patients with COPD.