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Objective To investigate the effect of intravenous lidocaine on the efficacy of sevoflurane combined with remifentanil for tracheal intubation without neuromuscular relaxants. Methods Seventy-five ASA Ⅰor Ⅱ patients, aged 18-64 yr, scheduled for elective surgery, needing tracheal intubation under general anesthesia, were randomly divided into 3 groups ( n = 25 each) : sevoflurane + remifentanil 1 μg/kg group (group A) ;sevoflurane + remifentanil 1 μg/kg + lidocaine 1 mg/kg group (group B); sevoflurane + remifentanil 2 μg/kg group (group C) . Two minutes after inhalation of 8% sevoflurane for anesthesia induction, remifentanil 1 μg/kg, remifentanil 1 μg/kg + lidocaine 1 mg/kg, and remifentanil 2 μg/kg were injected intravenously in groups A, B and C respectively. Tracheal intubation was performed after completion of remifentanil injection. Intubating conditions were assessed based on ease of laryngoscopy, position of vocal cords, activity of vocal cords, degree of coughing and limb movement. MAP and HR were also recorded before induction and immediately before and after intubation. Results Tracheal intubations were successful in all patients. The satisfactory rates of coughing were significantly higher in groups B and C, and MAP and HR were significantly lower immediately before and after intubation in group C than in group A ( P ＜ 0.05) . The satisfactory rate of coughing was significantly higher in group B than in group C ( P ＜ 0.05) . During intubation, 3 cases developed hypotension and 1 case bradycardia in group C. Conclusion When sevoflurane combined with remifentanil is used for tracheal intubation without neuromuscular relaxants, intravenous lidocaine 1 mg/kg can not only improve intubating conditions, but also decrease the consumption of remifentanil.
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Objective To discuss the tendency of related complication of PICC among chemotherapeutic patients with lung cancer. Methods 67 cases patients with chemotherapy for lung cancer of our hospital were selected to be treated with PICC. Then the treatment effect was analyzed. Results 63 cases succeeded through puncture operation, occupying 94.0% of total amount,2 cases had bleeding at puncture spot, accounting for 22.2%;1 (11.1% ) case showed sign of skin allergies;3 cases with catheter block, accounting for 33.3%; 1 (11.1% ) case with catheter out;1 (11.1%) case showed mechanical phlebitis;1(11.1%)case with infection at the puncture spot. Through analysis of the causes of the disease, proper care measures were adopted and seriously implemented, all of these complications disappear, 67 patients successfully completed the chemotherapy. Conclusions PICC not only can reduce the recurrence of complication, prolonging the time of disposing catheter, but also can relieve the patients' sufferings and improve patients' life quality.
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Objective To investigate pharmacodynamics of propofol for smooth exchange of tracheal tube for u laryngeal mask airway after surgery in elderly patients. Methods Twenty elderly patients, ASA Ⅰ or Ⅱ, aged 65-70 yr, scheduled for elective laparoscopic cholecystectomy were enrolled in this study. Anesthesia was induced with propofol, atracurium and remifentanil. The patients were mechanically ventilated after the trachea was intubated. Anesthesia was maintained with propofol combined with remifentanil. After surgery, a predetermined propofol concentration was achieved and a steady state maintained for at least 5 min. The target plasma concentration of propofol at which the laryngeal mask airway following tracheal extubation was attempted was determined by Dixon's up-and-down method with 0.5 μg/ml as the step size, The probit model was used to calculate the EC_(50) and EC_(95) and 95% confidence interval (95% CI) of propofol for inhibiting patient's response induced by smooth excharge of tracheal tube. Results The EC50 of propofol to achieve laryngeal mask airway following tracheal extubation was 2.79 μg/ml (95% CI 2.44-3.04 μg/ml) and EC_(50) 3.61 μg/ml (95% CI 3.27-4.78 μg/ml). Conclusion The target plasma concentration of propofol for laryngeal mask airway following tracheal extubation in elderly patients is 3.61 μg/ml.
ABSTRACT
Objective The purpose of this study was to investigate the role of p38 mitogen-activated protein kinase ( p38 MAPK) in the lung injury induced by mechanical ventilation.Methods Fifteen healthy 80 day-old pigs weighing (22.5 ? 1.5)kg were randomly divided into three groups according to the tidal volume(VT) and PEEP of mechanical ventilation: group A (VT = 16ml?kg-1, PEEP = 0) ; group B (VT = 6 ml?kg-1, PEEP= 16cm H2O) and group C(VT = 16ml?kg-1, PEEP = 8cm H2O). The animals were mechanically ventilated for 3h, then sacrificed by exsanguination. Right lower lobe was immediately removed for identification of intercellular adhesion molecule-1 ( ICAM-1 ) expression using immunohistological technique, determination of phosphorylated p38 MAPK content using Western Blot and microscopic examination. Results There was significant histological changes in the lung tissue in group A and B, but no significant histological changes were found in group C. The expression of ICAM-1 was positive in the lung in group A and B but negative in group C. The level of phosphorylated p38 MAPK among the 3 groups. Conclusion Acute lung injury can be induced by mechanical ventilation with high tidal volume or low tidal volume plus high PEEP, p38 MAPK may mediate the inflammatory response-induced lung injury.