ABSTRACT
Objective:To compare the sedative and analgesic effect and safety of dexmedetomidine at different doses combined with lidocaine with intravenous administration after modified radical mastectomy for breast cancer. Methods:Sixty ASAⅠ-Ⅱpatients aged from 18 to 65 years with body weight index of 18-30 kg·m-2 were treated by modified radical mastectomy. The patients were randomly divided into 3 groups:lidocaine group (group L, n=20), low dosage dexmedetomidine and lidocaine group (group D1, n=20) and high dosage dexmedetomidine and lidocaine group (group D2, n=20). Group L was intravenously given lidocaine 1. 5 mg·kg-1 before the operation and intravenously infused lidocaine 1. 5 mg·kg-1 ·h-1 during the whole operation process. Group D1 was intravenously infused dexme-detomidine 0. 3μg·kg-1 in 10min before the operation, and intravenously infused lidocaine 1. 5 mg·kg-1 ·h-1 during the whole opera-tion process. Group D2 was intravenously infused dexmedetomidine 0. 6 μg·kg-1 in 10min before the operation, and intravenously in-fused lidocaine 1. 5 mg·kg-1 ·h-1 during the whole operation process. The propofol Ce was recorded when the modified OAA/S reached 3 (Ce3) and BIS reached 80 (Ce80) during the up period, the VAS in the 1st, 6th and 24th hour after the surgery (VAS1-24), and nausea and vomiting in the first postoperative day were also recorded and observed. Results:No difference was found in the demographic data among the 3 groups with modified OAA/S of 3 (Ce3) and BIS of 80 (Ce80). VAS of group D1 and D2 was significantly decreased when compared with group L in the 1st postoperative hour(P<0. 05). In the 6th and 24th postoperative hour, VAS of group D2 was much lower than that of group L and D1(P<0. 05), however, no difference was found between group L and D1. There was no significant difference in the propofol Ce during the up period and the adverse reactions in the 1st postoperative day among the 3 groups. Conclusion:Dexmedetomidine at the dosage of 0. 6 μg·kg-1 combined with lidocaine can significantly reduce the pain and optimize the short-term prognosis after modified radical mastectomy.
ABSTRACT
Objectives To investigate the effect of carbon dioxide pneumoperitoneum on postoperative cognitive dysfunction and the level of serum NSE and S-100β protein in female patients undergoing gynecological laparoscopy. Methods 60 ASA physical status Ⅰ patients were divided two groups, group Ⅰ received no insufflation andconventional abdominal surgery ( n = 30) and group Ⅱ received abdominal insufflation and gynecological laparoscopy ( n =30). MMSE was recorded at several different time points, including one day before operation, 1, 6, 24, 48, 72h after operation, and before discharge. Serum S-100β protein and NSE was measured by ELISA before the beginning of operation ( or carbon dioxide pneumoperitoneum) and 1h after operation (or carbon dioxide pneumoperitoneum). Results MMSE values at 1,6,24,48,72h decreased significantly in group Ⅱ (24. 67 ± 1.47,25.97 ± 1.50,26. 77 ± 1.61,27.07 ± 1.87,27.37 ± 2. 06) after operation, compared with group Ⅰ (27.63 ± 1. 33,27.27 ± 0. 87,28.37 ± 0. 85,28.73 ±0. 78,29. 23 ±0. 86, P <0. 01 ). And the baseline value (29. 17 ±0. 76) of serum S-100β[(0. 114 ±0. 012,0. 086 ±0. 009) μg/L] protein and NSE [( 13. 720 ± 1. 330,12. 093 ±0. 697) μg/L] increased significantly at 1h after operation in group Ⅰ and Ⅱ compared with before operation [(0. 035 ±0. 030,0. 035 ±0.024;5.753±0.889,5.831 ±0.967)μg/L, P <0.01]. Serum S-100 β protein[(0. 114 ±0.012) μg/L] increased significantly at 1h after operation in group Ⅱ, compared with group Ⅰ [(0. 086 ±0. 009) μg/L,P < 0. 05], whereas NSE showed not difference [( 12. 093 ± 0. 697,13. 720 ± 1. 330) μg/L, P > 0. 05].Serum of S-100β protein and MMSE were significantly correlated w group Ⅰ and Ⅱ ( r = 0. 6412,0. 8126, P <0.01). Serum NSE was not correlated with the MMSE score in group Ⅰ ( r =0.4397, P >0.05),whereas NSE and MMSE had significant correlation in group Ⅱ ( r = 0. 7111, P <0. 01 ). Conclusions Carbon dioxide pneumoperitoneum in patients with gynecological surgery might affect postoperative cognitive function, and MMSE score was negatively correlated with serum S-100β and NSE proteins.
ABSTRACT
Aim To study the effect of two racemic ketamine, S(+)-ketamine and R(-)-ketamine on stimulus-induced superoxide generation and intracellular calcium in vitro. Methods The stimulus-induced superoxide generation in human neutrophils was determined by using method of cytochrome C reduction. The intracellular calcium in human neutrophils was measured by chemiluminescence with Fura-2 loading. The phosphorylation of p47phox of NADPH oxidase in neutrophils was detected by Western blotting. Results S(+)-Ket and R(-)-Ket inhibited fMLP-induced superoxide generation in neutrophils in a concentration-dependent manner. In the case of PMA, S(+)-Ket inhibited PMA-induced superoxide generation and elevation of intracellular calcium of neutrophils in a concentration-dependent manner, whereas R(-)-Ket slightly increased PMA-induced superoxide generation and elevation of intracellular calcium of neutrophils. On the other hand S(+)-Ket inhibited the phosphorytion of p47phox of NADPH oxidase subunit,which R(-)-Ket was increased. EGTA can abolished the inhibition of S(+)-Ket on PMA-induced phosphorytion of p47phox.Conclusion S(+)-Ket inhibits the phosphorylation of p47phox of NADPH oxidase subunit and the superoxide generation in human neutrophils via PKC-calcium signal pathway.