ABSTRACT
Objective:To evaluate the relationship between preoperative long-term sleep disorder and postoperative hyperalgesia in the patients undergoing cardiac surgery.Methods:One hundred and eighty-one adult patients of both sexes, aged 18 yr, undergoing elective cardiac valve surgery under cardiopulmonary bypass with general anesthesia, were enrolled in this study.On 1st day before surgery, the Pittsburgh Sleep Quality Index questionnaire was used to assess the patient′s sleep quality in the last month.When Pittsburgh Sleep Quality Index score was more than 5, the patient was considered to have long-term sleep disorder.Postoperative analgesia was performed with sufentanil.Patients were divided into 2 groups according to the numeric rating scale (NRS) score: non-hyperalgesia group (NHA group, NRS score <4) and hyperalgesia group (HA group, NRS score ≥4). A multivariate logistic regression was used to identify the risk factors associated with postoperative hyperalgesia.Results:The results of logistic regression analysis found that smoking and preoperative long-term sleep disorder were independent risk factors for postoperative hyperalgesia.Conclusion:Preoperative long-term sleep disorder may induce hyperalgesia after cardiac surgery in patients.
ABSTRACT
Objective To investigate the appropriate compatibility of appropriate compatibility of sevoflurane and propofol for patients with mild cognitive impairment (MCI) undergoing posterior lumbar interbody fusion in order to protect their cognitive function.Methods Eighty patients, 41 males, 39 females, aged 65-75 years, BMI 17-26 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled to undergo elective posterior lumbar interbody fusion, were to be scored according to Montreal cognitive assessment (MoCA), mini mental state examination (MMSE), dementia scale (CDR) and daily living ability scale (ADL) to identify patients with MCI before the surgery.They were randomly assigned to 4 groups (n=20 each) using a random number table: TCI propofol 2.0-2.5 μg/ml group (group P), TCI propofol 1.2 μg/ml+sevoflurane 0.6 MAC group (group PS1), TCI propofol 0.6 μg/ml+sevoflurane 0.9 MAC group (group PS2), 1.0-1.5 MAC sevoflurane group (group S).MoCA and MMSE were used to evaluate the cognitive function of patients 1 d before the operation (T0), after patients become wide-awake (T1), 3 d and 7 d after operation (T2 and T3).Apolipoprotein J (ApoJ) concentration related to cognitive function in blood samples, which were drawn at T0-T3 would be measured with ELISA method.Results Compared with T0, the scores of MMSE and MoCA in four groups decreased significantly (P＜0.05) at T1, the scores of MMSE and MoCA in group S decreased significantly (P＜0.05) at T2;compared with T1, the score of MMSE in the four groups increased significantly at T2, T3 (P＜0.05).The scores of MMSE at T1, T3 in group S decreased significantly compared with groups P, PS1 and PS2 (P＜0.05).The scores of MoCA at T2, T3 in group S decreased significantly compared with groups P, PS1 and PS2 (P＜0.05).Compared with T0, the concentration of plasma ApoJ in the four groups increased significantly at T1 (P＜0.05).Compared with T1, the concentration of plasma ApoJ in the four groups decreased significantly at T2 and T3 (P＜0.05).Compared with group PS1, the concentration of plasma ApoJ at T1, T3 increased significantly in groups S and group PS2 (P＜0.05).Conclusion TCI propofol 1.2 μg/ml combined with 0.6 MAC sevoflurane group is the appropriate compatibility of sevoflurane and propofol for patients with MCI undergoing posterior lumbar interbody fusion,because it has less negative influence on cognitive function and lower concentration of plasma ApoJ.
ABSTRACT
Objective To evaluate the effects of different ratios of medicine dosage for propofol and sevoflurane on postoperative cognitive function in elderly patients with mild cognitive impairment.Methods Ninety-six patients of both sexes,aged 65-75 yr,weighing 60-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective lower limb fracture operation under general anesthesia,with mild cognitive impairment before surgery,were assigned into 4 groups (n =24 each) using a random number table:propofol group (group P),sevoflurane group (group S) and different ratios of medicine dosage for propofol and sevoflurane groups (group PS1 and group PS2).Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate the cognitive function of patients at 1 day before operation (T0) and 7 days after operation (T1).Venous blood samples were collected at T0 and T1 for determination of the concentrations of plasma apolipoprotein J (ApoJ) and soluble CD14 (sCD14) by enzyme-linked immunosorbent assay.Results Compared with group S,MMSE and MoCA scores were significantly increased and plasma concentrations of ApoJ and sCD14 were decreased at T1,and the incidence of postoperative cognitive dysfunction was decreased in P,PS1 and PS2 groups (P＜0.05).Compared with group PS1,MMSE and MoCA scores were significantly decreased and the plasma concentrations of ApoJ and sCD14 were increased at T1,and the incidence of postoperative cognitive dysfunction was increased in P and PS2 groups (P＜0.05).MMSE and MoCA scores were significantly lower and plasma concentrations of ApoJ and sCD14 were higher at T1 than at T0 in S,P and PS2 groups (P＜0.05),and there was no significant difference in the parameters mentioned above between T1 and T0 in group PS1 (P＞0.05).Conclusion Combination of propofol 1.2 μg/ml given by target-controlled infusion and 0.7-1.2％ sevoflurane inhalation for maintenance of anesthesia does not aggravate the postoperative cognitive dysfunction in elderly patients with mild cognitive impairment.
ABSTRACT
Objective To evaluate the effect of propofol on postoperative cognitive dysfunction induced by preoperative sleep deprivation in the rats.Methods A total of 126 healthy adult male SpragueDawley rats,weighing 200-250 g,were randomly divided into 3 groups (n =42 each) using a random number table:control group (group C),sleep deprivation group (group SD),and sleep deprivation + propofol group (group SD+P).The rats were kept for 96 h on a treadmill that moved for 3 s on/12 s off in SD and SD+P groups.Intramedullary nailing for right femoral shaft fractures was performed in the 3 groups.Propofol 20 mg · kg-1 · h-1 was infused for 2 h via the contralateral femoral vein starting from the end of operation in group SD+P,while the equal volume of normal saline was infused for 2 h starting from the end of operation in C and SD groups.The animals underwent Morris water maze test at 1-5 days after operation to assess the cognitive function,and the escape latency and time of staying at the original platform position were recorded.At 1,3 and 7 days after operation,hippocampal tissues were obtained,nissl staining was performed to determine neuron count in hippocampal CA1 area,and Golgi staining was performed to measure the density of dendritic spine in hippocampal CA1 area.Results Compared with group C,the escape latency was significantly prolonged,the time of staying at the original platform position was significantly shortened,and the neuron count and density of dendritic spine in hippocampal CA1 area were significantly decreased at each time point after operation in group SD (P＜0.05),and no significant change was found in each index mentioned above in group SD+P (P＞0.05).Compared with group SD,the escape latency was significantly shortened,the time of staying at the original platform position was significantly prolonged,and the neuron count and density of dendritic spine in hippocampal CA1 area were significantly increased at each time point after operation in group SD+P (P＜0.05).Conclusion Propofol can ameliorate postoperative cognitive dysfunction induced by preoperative sleep deprivation in the rats.
ABSTRACT
Objective To investigate the role of hippocampal protein kinase Mζ (PKMζ)/potassium-chloride cotransporter-2 (KCC2) pathway in propofol postconditioning-induced long-term cerebral protection following cerebral ischemia-reperfusion (I/R) in rats.Methods Sixty adult male Sprague-Dawley rats, weighing 250-280 g, were randomly divided into 5 groups (n =12 each): sham operation group (group S), cerebral I/R group (group I/R), propofol post-conditioning group (group P) , PKMζ inhibitor ZIP+cerebral I/R group (group Z+I/R) , and ZIP + propofol postconditioning group (group Z + P).Cerebral ischemia was induced by 1 h middle cerebral artery occlusion, followed by reperfusion in anesthetized rats.Propofol 20 mg · kg-1 · h-1was intravenously infused for 2 h in P and Z+P groups, and the equal volume of normal saline was given for 2 h in I/R and Z+I/R groups.In Z+P and Z+ I/R groups, ZIP 0.5 μmol/L was injected intravenously at 15 min before reperfusion.Modified Neurological Severity Score (mNSS) was assessed at 28 days of reperfusion.After the end of behavioral tests, the hippocampi were removed for determination of GABAergic interneurons GAD67/KCC2 positive neuron count in the hippocampal CA1 region (by using immunofluorescent staining), and PKMζ and phosphorylated KCC2 (p-KCC2) expression (by Western blot).Results Compared with group S, mNSS was significantly increased, GAD67/KCC2 positive neuron count was decreased, and the expression of PKMζ and p-KCC2 was down-regulated in I/R, P and Z+P groups (P＜0.05).Compared with group I/R, mNSS was significantly decreased, GAD67/KCC2 positive neuron count was increased, and the expression of PKMζ and p-KCC2 was up-regulated in group P, and mNSS was significantly increased, GAD67/KCC2 positive neuron count was decreased, and the expression of PKMζ and p-KCC2 was down-regulated in group Z+I/R (P＜0.05).Compared with group P, mNSS was significantly increased, GAD67/KCC2 positive neuron count was decreased, and the expression of PKMζ and p-KCC2 was down-regulated in group Z+P (P＜0.05).Conclusion The mechanism underlying propofol postconditioning-induced long-term cerebral protection following cerebral I/R may be related to activation of hippocampal PKMζ/KCC2 pathway in rats.
ABSTRACT
Objective To evaluate the effects of alcohol dependence (AD) on the expression of spinal neuronal K+-Cl cotransporter 2 (KCC2) in rats.Methods Forty-eight healthy male Sprague-Dawley rats,weighing 200-250 g,were randomly divided into 2 groups (n =24 each) using a random number table:control group (group C) and group AD.An orogastric tube was inserted and alcohol was administered through the tube into the stomach to establish the model of AD.The concentration of ethanol was 5％,10％ and 20％ at 1st,2nd and 3rd weeks,respectively,and the concentration of ethanol was 35％ at 4th week and later.Alcohol was given at 10 ml · kg-1 · d-1,lasting for 8 weeks.The rats received drinking water containing no ethanol at 10 ml · kg-1 · d-1 instead of alcohol in group C.All the rats were allowed ad libitum access to food and water.Before the last administration,an elevated plus-maze test was performed for all the rats to observe their state of anxiety,which was used to evaluate the success of AD model.At the end of the last administration,the model of incisional pain was established.A 1-cm longitudinal incision was made through skin,fascia and muscle of the plantar aspect of the hindpaw in sevoflurane-anesthetized rats.At 2,6,24 and 48 h after operation,the mechanical and thermal paw withdrawal thresholds were measured.At 48 h after operation,the lumbar segment of the spinal cord was removed for determination of the expression of KCC2 by using immunofluorescence and Western blot.Results Compared with group C,the number of open arm entries was significantly reduced,the time spent on the open arms was shortened,the number of closed arm entries was increased,the time spent on the closed arms was prolonged,the mechanical and thermal paw withdrawal thresholds were decreased,and the expression of KCC2 was down-regulated in group AD.Conclusion Down-regulated expression of spinal neuronal KCC2 is involved in the mechanism of hyperalgesia in rats with AD.
ABSTRACT
Objective To evaluate the effect of propofol post-conditioning on hippocampal neuronal K+-Cl-co-transporter 2 (KCC2) expression in the rats with cerebral ischemia/reperfusion (I/R) injury.Methods Seventy-two male Sprague-Dawley rats,aged 7-8 weeks,weighing 250-280 g,were randomly divided into 3 groups (n =24 each):sham operation group (group S),cerebral I/R (group I/R) and propofol post-conditioning group (group PP).The model of focal cerebral I/R injury was established by occlusion of the right middle cerebral artery.Propofol 20 mg· kg-1 · h-1 was infused over 2 h starting from the onset of reperfusion through the femoral vein in group PP.The equal volume of normal saline was given in S and I/R groups.Modified neurological severity score (mNSS) was used to evaluate the impairment of neurological function.The animals were then sacrificed and brains were removed for determination of the number of neurons (by Nissl' s staining) and expression of KCC2 (by immunofluorescence and Western blot) in hippocampal CA3 region.Results Compared with group S,the scores of mNSS were significantly increased,and the number of neurons and expression of KCC2 in hippocampal CA3 region were decreased in I/R group,and mNSS scores were increased,and no significant changes were found in the other parameters in group PP.Compared with group I/R,the mNSS scores were significantly decreased,and the number of neurons and expression of KCC2 in hippocampal CA3 region were increased in group PP.Conclusion The mechanism by which propofol post-conditioning reduces cerebral I/R injury is related to up-regulated expression of hippocampal KCC2 in rats.
ABSTRACT
OBJECTIVE To compare three surgical hand preparations for their effects on hand skin conditions.METHODS Three surgical hand antisepsis methods were selected to compare their immediate antimicrobial(efficacies) and effect on skin conditions,including 1% chlorhexidine gluconate(CHG)and 61% ethanol(pre-surgical) waterless,scrubless hand preparation,iodophor surgical scrub with sponge,and iodophor surgical scrub with brush.RESULTS All of the three methods could achieve satisfying immediate reduction in the normal(bacterial)(flora) of the hands.The alcohol-based surgical hand rub method was gentler to skin than the other two.(CONCLUSIONS) The alcohol-based surgical hand rub is recommended for surgical hand antisepsis.