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Objective:To evaluate the status of position management of anesthesia specialist nurses in China.Methods:From January 2022 to March 2022, a cross-sectional survey was conducted using a self-made questionnaire through convenience sampling to assess the current situation of position management of anesthesia specialist nurses in tertiary hospitals in mainland China.Results:A total of 154 questionnaires were distributed, 137 of which were recovered, the response rate was 89%, and 36 questionnaires were excluded. The survey involved 101 tertiary hospitals in 25 provincial administrative regions in China, and 90% of hospitals were general hospitals. Eighty-three percent of hospitals had separate anesthesia care units, anesthesia specialist nurses accounted for ≥ 10% of nurse anesthetists in 53% of hospitals. Ninety-four percent of hospitals had the position management system of specialist nurses, more than 50% of hospitals had position responsibility and hierarchical management systems and showed difference in position benefits. Less than 50% of hospitals had employed and full-time anesthesia specialist nurses. Fifty percent of hospitals conformed to the advocacy scope of anesthesia specialist nurse service. Fifty-five percent of hospitals carried out the qualification certification of anesthesia specialist nurses, and 37% of hospitals were the training bases for anesthesia specialist nurses. Ninety-six percent of hospitals formulated the development plan of anesthesia specialist nurses.Conclusions:The position management of anesthesia specialist nurses has begun to take shape in tertiary hospitals in China at present, but the institutional system of position management and specialized management need to be strengthened.
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Objective:To evaluate the relationship between the mechanism underlying the antidepressant effect of S-ketamine and hippocampal gamma-aminobutyric acid B receptor (GABA BR) in mice. Methods:A total of 54 male C57BL/6(B6) mice, aged 8 weeks, weighing 25-30 g, were used in this study. Forty mice were selected to develop the depression model by chronic social defeat stress. Twenty-six depression-susceptible mice were screened out by social avoidance test at day 11 after developing the model and divided into 2 groups ( n=13 each) by a random number table method: depression-susceptible group (Sus group) and depression-susceptible + S-ketamine group (Sus + S-ket group). The remaining 14 mice served as control group (C group). Starting from day 12 after developing the model, S-ketamine 10 mg/kg was intraperitoneally injected every day for 3 consecutive days in Sus+ S-ket group, while the equal volume of normal saline was given instead in C group and Sus group. The open field test was performed at 1 h after the last administration, and the total distance of movement was recorded. The forced swimming test was performed at 1 day after the open field test, and the immobile time was recorded. The sucrose preference test was performed to calculate the proportion of sucrose consumption at 1 day after the forced swimming test. One hour after the end of behavioral test, mice were sacrificed, and the hippocampal tissues were removed. Western blot was used to detect the expression of GABA BR1, GABA BR2, mammalian target of rapamycin (mTOR), phosphorylated mTOR (p-mTOR), brain-derived neurotrophic factor (BDNF), tyrosine kinase receptor B (TrkB), phosphorylated TrkB (p-TrkB), glutamate receptor 1 (GluR1) and postsynaptic dense protein 95 (PSD95). The p-mTOR/mTOR ratio and p-TrkB/TrkB ratio were calculated. The fluorescence intensity of BDNF in hippocampal CA1 region was detected by immunofluorescence. The number of dendritic spines in hippocampal CA1 region was measured by Golgi staining. Results:In the open field test, no statistically significant difference in the total distance was detected among the three groups ( P>0.05). Compared with C group, the immobile time in the forced swimming test was significantly prolonged, the proportion of sucrose consumption was decreased, the expression of hippocampal GABA BR1, GABA BR2, BDNF, GluR1 and PSD95 was down-regulated, and the ratios of p-mTOR/mTOR and p-TrkB/TrkB were decreased, the fluorescence intensity of BDNF and total number of dendritic spines in the hippocampal CA1 region were decreased in Sus group ( P<0.05), and no significant change was found in the parameters mentioned above in Sus+ S-ket group ( P>0.05). Compared with Sus group, the immobile time in the forced swimming test was significantly shortened, the proportion of sucrose consumption was increased, the expression of hippocampal GABA BR1, GABA BR2, BDNF, GluR1 and PSD95 was up-regulated, the ratios of p-mTOR/mTOR and p-TrkB/TrkB were increased, and the fluorescence intensity of BDNF and total number of dendritic spines in the hippocampal CA1 region were increased in Sus+ S-ket group ( P<0.05). Conclusions:The mechanism underlying the antidepressant effect of S-ketamine may be related to up-regulation of hippocampal GABA BR expression, activation of mTOR-BDNF signaling pathway, and improvement in synaptic plasticity in mice.
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Objective:To evaluate the effect of gender factor on efficacy of remimazolam combined with alfentanil in the patients undergoing gastrointestinal endoscopy.Methods:Two hundred patients, aged 18-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classificationⅠor Ⅱ, scheduled for elective gastrointestinal endoscopy, were divided into 2 groups ( n=100 each) according to gender: male group (group M) and female group (group F). Remimazolam 0.2-0.3 mg/kg and alfentanil 5-7 μg/kg were intravenously injected, remimazolam 0.5-0.7 mg·kg -1·h -1 was continuously infused during operation to maintain the modified observer′s assessment of alert/sedation score<3 points, and alfentanil 2 μg/kg was administered when necessary. The consumption of remimazolam and alfentanil, examination time, recovery time and time of post-anesthesia care unit stay were recorded. The satisfaction scores of examination physicians and patients were recorded. The occurrence of adverse reactions such as injection pain, intraoperative body movement, respiratory depression, hypotension, bradycardia and hiccups and postoperative dizziness, nausea, vomiting, fatigue, abdominal pain and abdominal distension were recorded. Results:There was no significant difference in the consumption of remimazolam and alfentanil, examination time, recovery time, satisfaction scores of examination physicians and patients between the two groups ( P>0.05). There was no significant difference in the incidence of respiratory depression, hypotension, bradycardia, injection pain, body movement, hiccups, abdominal pain, abdominal distension, and fatigue between the two groups ( P>0.05). Compared with group M, the time of post-anesthesia care unit stay was significantly prolonged, and the incidence of postoperative dizziness, nausea and vomiting was increased in group F ( P<0.05). Conclusions:Remimazolam combined with alfentanil provides better efficacy in male patients than in female patients undergoing gastrointestinal endoscopy.
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Objective:To evaluate the optimization efficacy of low-dose esketamine combined with propofol in the patients with major depressive disorder undergoing modified electroconvulsive therapy (MECT).Methods:Fifty-six American Society of Anesthesiologists physical statusⅠor Ⅱ patients, aged 18-64 yr, scheduled for MECT for the first time, were assigned into esketamine plus propofol group (group EP, n=28) and propofol group (group P, n=28) according to a ratio of 1∶1 by the random number table method.Esketamine 0.25 mg/kg was intravenously injected before anesthesia induction in group EP, while the equal volume of normal saline was given instead in group P. Propofol and succinylcholine were then intravenously injected to perform MECT in two groups.The primary outcomes were the remission rate and response rate, and the secondary outcomes included the number of MECT required for response and remission, the seizure duration, energy inhibition index and consumption of propofol for each MECT, and the occurrence of therapy-related adverse reactions and relapse. Results:Compared with group P, the remission rate and response rate were significantly increased, and the number of MECT required for response and remission was decreased, the seizure duration was prolonged, and energy inhibition index was increased, the consumption of propofol was reduced ( P<0.05), and no significant change was found in the incidence of therapy-related adverse reactions and relapse in group EP ( P>0.05). Conclusions:Low-dose esketamine combined with propofol can enhance the efficacy of MECT and shorten the course of therapy without increasing therapy-related adverse reactions in the patients with major depression.
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Objective:To evaluate the reliability and validity of the Chinese version of concise health status questionnaire (SF-36 scale) in evaluating the quality of life of patients with chronic Keshan disease, and to provide a scientific basis for studying the quality of life and the evaluation of treatment and rehabilitation of this population.Methods:In the August 2017, using cluster random sampling method, 175 patients with chronic Keshan disease treated by self-management of family beds in Pingliang City, Gansu Province in 2017 were selected as survey subjects, and demographic and disease data were collected. The Chinese version of SF-36 scale was used to investigate the quality of life. Split-half reliability and Cronbach's α coefficient were used to evaluate the reliability of the SF-36 scale; the factor analysis, correlation and differences between groups were used to evaluate the validity of the SF-36 scale.Results:The split-half reliability value of SF-36 scale was 0.916, and the Cronbach's α coefficient was 0.869. Factor analysis extracted 3 common factors from 8 dimensions of SF-36 scale, and the cumulative contribution rate of the 3 common factors to the total variance was 72.08%. In addition to the correlation coefficient ( r) between Role-Emotional and Bodily Pain dimension, the r value between total score and the scores of each dimension, and the scores of each dimension of SF-36 scale were 0.140 - 0.769. Except for the Bodily Pain dimension, there were statistically significant differences in the scores of Physiological Functioning, Role-Physical, General Health, Vitality, Social Functioning, Role-Emotional, and Mental Health dimension of the quality of life of patients with different grades of cardiac function ( F = 4.66, 10.73, 6.77, 14.61, 5.58, 9.57, 7.10, P < 0.05). Conclusion:The Chinese version of SF-36 scale has good reliability and validity in evaluating the quality of life of patients with chronic Keshan disease, and can be used to evaluate the quality of life of the patients.
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Objective:To evaluate the effects of sugammadex on the quality of recovery after laparoscopic bariatric surgery in severely obese patients.Methods:One hundred and eighty patients, aged 18-65 yr, with body mass index ≥ 40 kg/m 2, undergoing elective laparoscopic bariatric surgery, of American Society of Anesthesiologists physical status Ⅲ, were enrolled and divided into 2 groups ( n=90 each) by the random number table method: sugammadex group (S group) and neostigmine group (N group). Before anesthesia, bilateral T 6 and T 9 paravertebral nerve blocks were performed, and 0.33% ropivacaine 15 ml was injected on each side.When the reappearance of T 2 was monitored under train-of-four (TOF) stimulation after the end of surgery, and sugammadex 2 mg/kg was intravenously injected in S group, and neostigmine 0.04 mg/kg and atropine 0.02 mg/kg were intravenously injected in N group.After the patient was transferred to the general ward, flurbiprofen axetil 50 mg was injected intravenously every 12 h, and oxycodone and flurbiprofen axetil were used for patient-controlled intravenous analgesia at the same time.When the numerical rating scale (NRS) score ≥4 and the analgesic pump was ineffective, bilateral T 7 paravertebral nerve block was performed for rescue analgesia, and 0.33% ropivacaine 15 ml was injected on each side.The postoperative quality of recovery was assessed by the 15-item Quality-of-Recovery scale before operation and at 24 h after operation.The TOF ratio ≥ 0.9 and extubation time were recorded.The SpO 2 at the time of transfer to post-anesthesia care unit (PACU), the lowest SpO 2 and occurrence of SpO 2 < 92% during PACU were recorded.The occurrence of residual muscle relaxation and Ramsay sedation score were recorded at 30 min after entering PACU.The time of PACU stay, time to the first off-bed activity and length of hospital stay were recorded.The cumulative consumption of oxycodone, requirement for rescue analgesia, dizziness, nausea and vomiting, hypoxemia, and pulmonary complications were recorded within 48 h after operation. Results:There were no significant differences in the total score of 15-item Quality-of-Recovery scale before surgery and at 24 h after surgery, cumulative consumption of oxycodone within 48 h after surgery, rate of rescue analgesia, and incidence of dizziness, nausea and vomiting, hypoxemia and pulmonary complications between the two groups ( P>0.05). Compared with N group, the scores of the three recovery indicators (feel energized with enough rest, engagement in work or family activities, and tension and anxiety) were significanatly increased, time to TOF ratio ≥ 0.9, extubation time, time of PACU stay, time to the first off-bed activity and length of hospital stay were shortened, and the incidence of residual muscle relaxation was decreased in S group ( P<0.05). Conclusions:Antagonizing residual muscle relaxation with sugammadex is helpful for the recovery of severely obese patients after laparoscopic bariatric surgery.
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Objective:To evaluate the efficacy of remimazolam combined with alfentanil for gastroscopy in frail elderly patients.Methods:Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ elderly patients, aged 65-85 yr, with body mass index of 18-30 kg/m 2, of Clinical Frailty Scale score≥5, scheduled for elective painless gastroscopy, were divided into 2 groups ( n=30 each) using a random number table method: remimazolam combined with alfentanil group (group R) and propofol combined with remifentanil group (group P). A combination of alfentanil 10 μg/kg and remimazolam 0.2 mg/kg was intravenously injected until loss of consciousness in group R. Remifentanil 0.5 μg/kg combined with propofol 1.0-2.0 mg/kg was intravenously injected until loss of consciousness in group P. According to the intraoperative conditions, 1/4 of the initial dose of remimazolam was intravenously injected in group R, and 1/4 of the initial dose of propofol was intravenously injected in group P. The time for gastroscopy, requirement for additional remimazolam or propofol, onset time of anesthesia, emergence time and time of post-anesthesia care unit stay were recorded.Physician′s satisfaction scores, patient′s satisfaction scores and Verbal Pain Scale scores were recorded.The occurrence of injection pain, respiratory depression, bradycardia, hypotension and nausea and vomit was recorded. Results:There was no significant difference in the requirement for additional remimazolam or propofol, onset time of anesthesia, time for gastroscopy, physician′s satisfaction scores, and patient′s satisfaction scores, Verbal Pain Scale scores and incidence of nausea and vomit between two groups ( P>0.05). Compared with P group, the emergence time and time of post-anesthesia care unit stay were significantly shortened, and the incidence of injection pain (0 vs.33%), respiratory depression (0 vs.20%), hypotension (3% vs.23%) and bradycardia (3% vs.23%) was decreased in R group ( P<0.05). Conclusions:Remimazolam combined with alfentanil is safe and effective, with rapid recovery from anesthesia, and provides better efficacy than the combination of propofol and remifentanil when used for gastroscopy in frail elderly patients.
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Objective:To evaluate the efficacy of S-ketamine mixed with hydromorphone for improving patient-controlled intravenous analgesia (PCIA) after lumbar spinal surgery.Methods:Ninety-six American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 18-64 yr, with body mass index of 18.5-29.9 kg/m 2, scheduled for elective lumbar fusion surgery under general anesthesia, were divided into 2 groups ( n=48 each) using a random number table method: hydromorphone for PCIA group (group H) and S-ketamine mixed with hydromorphone for PCIA group (group S+ H). PCIA was performed at the end of operation.PCIA solution contained hydromorphone 0.05 mg/ml mixed with S-ketamine 0.25 mg/ml in group S+ H and hydromorphone 0.05 mg/ml in group H. The PCIA pump was set up to deliver a 2 ml bolus dose with a 10-min lockout interval, background infusion at 2 ml/h and total volume of 200 ml.When the numerical rating scale score ≥4 and analgesia was ineffective by pressing the PCA pump for 3 consecutive times, hydromorphone 0.2 mg was intravenously injected as rescue analgesic.The cumulative consumption of hydromorphone (consumption for analgesic pump and consumption for rescue analgesia) and occurrence of adverse reactions such as pruritus, respiratory depression, nausea, vomiting, drowsiness, dizziness, headache, hallucinations and nightmares within 48 h after operation were recorded.The patients′ satisfaction with analgesia was recorded at 48 h after operation.The time to first flatus after operation and quality of recovery (QoR-15 scale) at 24 and 48 h after operation were recorded. Results:Compared with group H, the cumulative consumption of hydromorphone within 48 h after surgery were significantly reduced, the patients′ satisfaction with analgesia was increased, the time to first flatus after operation was shortened, QoR-15 scores were increased at 24 and 48 h after operation ( P<0.05), and no significant change was found in the requirement for rescue analgesia and incidence of adverse reactions within 48 h after surgery in group S+ H ( P>0.05). Conclusions:Compared with PCIA with hydromorphone, S-ketamine mixed with hydromorphone can reduce postoperative consumption of hydromorphone, increase satisfaction with analgesia, and promote early postoperative recovery after lumbar spinal surgery.
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Objective:To evaluate the effect of propofol on proliferation, invasion and migration of human melanoma cells and role of cyclooxygenase-2 (COX-2)/prostaglandin E2 (PGE2)/matrix metalloproteinase (MMP) signaling pathway.Methods:SKMEL-5 cells were cultured in vitro and divided into 4 groups ( n=36 each) using the random number table method: control group (group C), propofol group (group P), COX-2 overexpression group (group COX-2), and COX-2 overexpression plus propofol group (group COX-2+ P). Propofol at the final concentration of 60 μmol/L was added in group P. The COX-2 overexpression plasmid pcDNA3.1-COX-2 was transfected into SKMEL-5 cells in group COX-2 and group COX-2+ P, and propofol at the final concentration of 60 μmol/L was added in group COX-2+ P.After incubation for 48 h, the cell proliferation rate was determined by CCK-8 method, the cell invasion and migration ability was determined by Transwell assay, the expression of COX-2 in cells was detected by Western blot, the expression of COX-2 mRNA in cells was detected by quantitative real-time polymerase chain reaction, and the concentrations of serum PGE2, MMP-2 and MMP-9 were determined by enzyme-linked immunosorbent assay. Results:Compared with group C, the cell proliferation rate was significantly decreased, the number of cell invasion and migration was decreased, the expression of COX-2 protein and mRNA was down-regulated, and the concentrations of PGE2, MMP-2 and MMP-9 in the supernatant were decreased in group P, and the cell proliferation rate was significantly increased, and the number of cell invasion and migration was increased, the expression of COX-2 protein and mRNA was up-regulated, and the concentrations of PGE2, MMP-2 and MMP-9 in the supernatant were increased in group COX-2 ( P<0.05). Compared with group P, the cell proliferation rate was significantly increased, and the number of cell invasion and migration was increased, the expression of COX-2 protein and mRNA was up-regulated, and the concentrations of PGE2, MMP-2 and MMP-9 in the supernatant were increased in group COX-2+ P ( P<0.05). Conclusions:Propofol can inhibit the proliferation, invasion and migration of human melanoma cells, and the mechanism may be related to inhibition of the COX-2/PGE2/MMP signaling pathway.
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Objective:To evaluate the sedative efficacy of S-ketamine combined with propofol for MRI examination in pediatric patients.Methods:One hundred children of both sexes, aged 1-6 yr, weighing 10-30 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, who underwent MRI from February to June 2021, were selected and divided into 2 groups ( n=50 each) by a random number table method: propofol group (P group) and S-ketamine plus propofol group (K+ P group). Anesthesia induction: propofol 2.5 mg/kg was intravenously injected in group P, and S-ketamine 0.5 mg/kg and propofol 1.5 mg/kg were intravenously injected in group K+ P.Anesthesia maintenance: propofol 100 μg·kg -1·min -1 was intravenously infused, and the infusion rate of propofol was adjusted to maintain Ramsay sedation score ≥5.Propofol 0.5-1.0 mg/kg was intravenously injected and/or increasing the infusion rate of propofol when moderate and severe movement occurred.The quality of MRI images was evaluated during the examination, and the occurrence and degree of movement, airway-related adverse events (hypoxemia, apnea, upper airway obstruction, hypersalivation), hypotension and bradycardia were recorded.The average infusion rate, consumption of additional propofol for intravenous administration and total consumption of propofol were recorded.The emergence time and time of anesthesia recovery room stay were recorded.The occurrence of adverse events (vomiting, diplopia and agitation) and the parents′ satisfaction with sedative efficacy and recovery were recorded during observation in the recovery room. Results:Compared with group P, the average infusion rate of propofol, total consumption of propofol, airway-related adverse events and incidence of hypotension and bradycardia were significantly decreased ( P<0.05), and no significant change was found in the incidence and degree of body movement, quality of MRI images, emergence time and time of anesthesia recovery room stay and incidence of adverse events during recovery from anesthesia in group K+ P ( P>0.05). Conclusion:S-ketamine combined with propofol can be safely and effectively used in MRI examination in pediatric patients.
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Objective:To compare the efficacy of mivacurium versus cisatracurium in patients undergoing painless fiberoptic bronchoscopy.Methods:A total of 100 patients of both sexes, aged 18-64 yr, of American Society of Anesthesiology physical status I or Ⅱ, scheduled for elective fiberoptic bronchoscopy were divided into 2 groups ( n=50 each) using a random number table method: mivacurium group (M group) and cisatracurium group (C group). Mivacurium 0.15 mg/kg was injected intravenously in group M, and cisatracurium 0.1 mg/kg was injected intravenously in group C. The onset time of neuromuscular block (ThD95), the duration of neuromuscular block (TOFR25), recovery index (RI), recovery time of autonomous respiration, extubation time and time of discharge from postanesthesia care unit (PACU) were recorded.The occurrence of intraoperative and postoperative adverse reactions and complications were recorded.The mean arterial pressure (MAP), heart rate (HR) and SpO 2 at restlessness at 10 min after entering the operating room (T 1), at loss of consciousness (T 2), when laryngeal mask airway was inserted (T 3), at the end of surgery (T 4), when laryngel mask airway was removed (T 5), and when the patients left the operating room (T 6). Results:Compared with group C, TOFR25, RI, recovery time of autonomous respiration, extubation time and time of discharge from PACU were significantly shortened, the total incidence of adverse reactions was decreased ( P<0.05), and no significant change was found in ThD95 in group M ( P>0.05). There was no significant difference in MAP, HR and SpO 2 at each time point between the 2 groups ( P>0.05). Conclusion:Mivacurium provides better efficacy than cisatracurium when used for painless fiberoptic bronchoscopy.
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Objective:To evaluate the role of spinal ninjurin 2 (NINJ2) in the neuropathic pain (NP) and the relationship with nuclear factor kappa B (NF-κB) signaling pathway in rats.Methods:Thirty-two clean-grade healthy male Sprague-Dawley rats, weighing 230-260 g, aged 7-8 weeks, were divided into 4 groups ( n=8 each) using a random number table method: sham operation group (Sham group), NP group, NP plus NINJ2 interfering virus group (NP+ siRNA group) and NP plus control virus group (NP+ scrRNA group). After intrathecal catheterization, rats in sham group and NP group received normal saline 10 μl, while NP+ NINJ2 siRNA group and NP+ scrRNA group received NINJ2 siRNA 10 μl and scrRNA 10 μl, respectively.NP model was developed via ligation of tibial nerve and common peroneal nerve one week later.Sham group only exposed the sciatic nerve and its branches.The mechanical paw withdrawal threshold (MWT) on the operated side was measured on preoperative days 3 and 1 and postoperative days 1, 3, 5, 7, 10 and 14.The rats were sacrificed at postoperative day 14, and the lumbar enlargement segments of the spinal cord were harvested for determination of the expression of NINJ2 and phosphorylated NF-κB p65 (p-NF-κB p65) (by Western blot) and contents of tumor necrosis factor-alpha (TNF-α), interleukin-1beta (IL-1β) and IL-6 (by enzyme-linked immunosorbent assay). Results:Compared with Sham group, the MWT on the operated side was significantly decreased, the expression of NINJ2 and p-NF-κB p65 in spinal cord was up-regulated, and contents of TNF-α, IL-1β and IL-6 were increased on the postoperative days 3, 5, 7, 10 and 14 in the other three groups ( P<0.05). Compared with NP group, the MWT on the operated side was significantly increased, the expression of NINJ2 and p-NF-κB p65 in spinal cord was down-regulated, and contents of TNF-α, IL-1β and IL-6 were decreased on the postoperative days 3, 5, 7, 10 and 14 in NP+ siRNA group ( P<0.05), and no significant change was found in each parameter mentioned above at different time points in NP+ scrRNA group ( P>0.05). Conclusion:NINJ2 is involved in NP, which is related to activation of NF-κB signaling pathway in rats.
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Objective:To compare the impact of remimazolam and propofol on the quality of postoperative recovery in aged patients with goal-directed hemodynamic management strategies.Methods:Ninety patients of either sex, aged 65-80 yr, with body mass index of 18-28 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective laparoscopic gastrointestinal tumor surgery, were divided into 2 groups ( n=45 each) using a random number table method: remimazolam group (group R) and propofol group (group P). Anesthesia was induced as follows: remimazolam 6 mg·kg -1·h -1 was intravenously infused in group R, and propofol 2 mg/kg was intravenously injected in group P. Anesthesia was maintained as follows: remimazolam 0.5-1.0 mg·kg -1·h -1 was intravenously infused in group R, propofol 4-12 mg·kg -1·h -1 was intravenously infused in group P, and BIS values were maintained at 40-60 during operation.Both groups adopted a goal-directed hemodynamic management strategy during operation, and the volume infused and vasoactive drugs were adjusted according to stroke volume variation of 4%-12% and cardiac index of 2.5-4.0 L ·min -1·m -2.The 40-item Quality-of-Recovery scale (QoR-40) was used to assess the quality of postoperative recovery.QoR-40 score was performed 1 day before surgery, 3 days after surgery and 30 days after surgery.The intraoperative consumption of vasoactive drugs and occurrence of intraoperative hypotension and bradycardia were recorded, and the concentration of lactic acid was measured before operation, after operation and 24 h after operation in the two groups.The recovery time of consciousness, tracheal extubation time, duration of postanesthesia care unit stay and postoperative length of hospital stay were recorded.The occurrence of postoperative complications was also recorded. Results:Compared with P group, the incidence of intraoperative hypotension and bradycardia was significantly decreased, the consumption of dopamine and norepinephrine was reduced, the concentration of lactic acid was decreased, QoR-40 scores were increased at 3 and 30 days after operation, the postoperative length of hospital stay was shortened, and the incidence of postoperative complications was decreased in group R ( P<0.05). Conclusion:Remimazolam provides better efficacy than propofol in improving the quality of postoperative recovery in elderly patients with goal-directed hemodynamic management strategy.
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Objective:To evaluate the efficacy of remazolam combined with remifentanil anesthesia for radical surgery for gastric cancer in frail aged patients.Methods:One hundred and twenty patients of either sex, aged 65-75 yr, with body mass index 18-28 kg/m 2, with simple frailty questionnaire score 3-5 points, undergoing elective laparoscopic radical gastric cancer surgery, were divided into 3 groups ( n=40 each) according to the random number table method: propofol combined with remifentanil group (P group), low-dose remazolam combined with remifentanil group (B1 group) and high-dose remazolam combined with remifentanil group (B2 group). Induction of anesthesia was as follows: propofol 2 mg/kg was intravenously injected in group P, remazolam 6 and 12 mg·kg -1·h -1 were intravenously infused in group B1 and group B2, respectively, and alfentanil and rocuronium were intravenously injected after loss of consciousness in three groups.Anesthesia maintenance was as follows: propofol 4-12 mg·kg -1·h -1 was intravenously infused in group P, remazolam 0.5-1.0 mg·kg -1·h -1 was intravenously infused in B1 and B2 groups, remifentanil 0.05-0.20 μg·kg -1·h -1 was intravenously infused in three groups, and intravenous rocuronium was injected intermittently to maintain the BIS value at 45-55 intraoperatively.The time to loss of consciousness, recovery time of consciousness and time of tracheal extubation were recorded.The occurrence of injection pain during induction of anesthesia, intraoperative cardiovascular events, intraoperative awareness, and respiratory depression, nausea and vomiting, and drowsiness during postanesthesia care unit were recorded. Results:Compared with group P, the time to loss of consciousness was significantly prolonged, the incidence of injection pain, intraoperative hypotension and bradycardia was decreased, and the incidence of postoperative somnolence was increased in B1 and B2 groups ( P<0.05). The time to loss of consciousness was significantly shorter in group B2 than in group B1 ( P<0.05). There was no statistically significant difference in the recovery time of consciousness, time of tracheal extubation, postoperative respiratory depression and incidence of nausea and vomiting among the three groups ( P>0.05). Conclusion:Remazolam combined with remifentanil anesthesia can be safely and effectively used for radical surgery for gastric cancer in frail aged patients.
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Objective:To observe early postoperative changes in body composition in patients receiving laparoscopic sleeve gastrectomy (LSG) and to explore the relationship between body composition and glycolipid metabolism, so as to provide stage-specific information for doctors in the weight loss team on metabolic surgery effect assessment and postoperative follow-up and guidance.Methods:The study was a retrospective cohort study. According to inclusion and exclusion criteria, a total of 44 patients who underwent LSG in the Department of Gastrointestinal Surgery, General Hospital of Ningxia Medical University from December 1, 2017 to May 30, 2021 were included. Body composition was measured using bio-electrical impedance analysis at baseline and after surgery.Results:The patients' body composition changed significantly at 1 month and 3 months after surgery, and glucose and lipid metabolism indicators improved significantly. Body composition indicators, including body mass index (BMI), the amount of moisture in the body, inorganic salts, body fat, skeletal muscle mass, fat free mass, body fat percentage, waist-to-hip fat ratio, visceral fat, basal metabolic rate and bone mineral content, decreased significantly within 3 months after surgery ( P<0.05). The ratio of upper and lower limb muscle to body weight (U/W, L/W) increased significantly after surgery ( P<0.05). The ratio of trunk muscle to body weight (T/W) decreased within 3 months after surgery ( P<0.05). Pearson and Spearman correlation analyses showed that skeletal muscle mass and U/W were positively correlated with triglyceride ( r=0.637 and 0.304, respectively, both P<0.05) in 3 months after operation. L/W was positively correlated with fasting blood glucose ( r=0.454, P<0.05). T/W was negatively correlated with triglyceride ( r=-0.643, P<0.05). Conclusions:Patients undergoing LSG displayed significant changes in body composition in the early postoperative period. Changes in muscle mass of different body parts varies and showed different effects on glucose and lipid metabolism parameters. The trunk muscle mass is negatively correlated with glucose and lipid metabolism indicators, while limb muscle mass and skeletal muscle mass are positively. It is suggested that the changes of body composition in different parts should be observed when evaluating patient outcomes after LSG and the trunk body mass should be preserved as far as possible.
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ObjectiveTo investigate the protective effect of Lycium barbarum polysaccharide (LBP) combined with aerobic exercise (AE) on the liver of rats with nonalcoholic steatohepatitis (NASH) induced by high-fat diet based on the p38 mitogen-activated protein kinase (p38 MAPK)-nuclear factor-κB (NF-κB) pathway. MethodsAfter 1 week of adaptive feeding, 45 Sprague-Dawley rats, aged 8 weeks, were randomly divided into control group (10 rats fed with normal diet) and high-fat group (35 rats fed with high-fat diet). At the end of week 28, the high-fat group was randomly divided into model group, LBP group, AE group, and LBP+AE group, with 8 rats in each group, and intervention was performed for 10 weeks. At the end of the experiment, fasting blood glucose was measure for all rats, and serum samples, liver tissue, and visceral fat were collected. Biochemical kits were used to measure the serum levels of triglyceride (TG), total cholesterol (TC), alanine aminotransferase (ALT), and aspartate aminotransferase (AST); ELISA kits were used to measure the serum levels of fasting insulin (FINS), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and monocyte chemotactic protein-1 (MCP-1); quantitative real-time PCR and Western blot were used to measure the mRNA and protein expression levels of Toll-like receptor 4 (TLR4), p38 MAPK, and NF-κB in liver tissue. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the control group, the model group had significant increases in TG, TC, AST, ALT, FINS, and homeostasis model assessment of insulin resistance (HOMA-IR) (all P ＜0.05), a tendency of increases in the serum levels of the inflammatory factors MCP-1, TNF-α, and IL-6 (all P ＜0.05), and significant increases in the mRNA and protein expression levels of TLR4, p38 MAPK, and NF-κB in liver tissue (all P ＜0.05). Compared with the model group, each intervention group had significant reductions in TG, TC, AST, ALT, FINS, and HOMA-IR (all P ＜0.05), a tendency of reductions in the serum levels of the inflammatory factors MCP-1, TNF-α, and IL-6 (all P ＜0.05), and significant reductions in the mRNA and protein expression levels of TLR4, p38 MAPK, and NF-κB (all P ＜0.05). Compared with LBP group, the LBP+AE group had significant reductions in TG, ALT, FINS, HOMA-IR, MCP-1, the mRNA expression level of TLR4, protein expression levels of p38 MAPK and NF-κB(all P＜0.05). Compared with Ae group, the LBP+AE group had significant reductions in FINS, HOMA-IR, IL-6, MCP-1, the mRNA expression level of TLR4 (all P＜0.05). ConclusionLBP combined with AE may improve inflammation in NASH rats by regulating the p38 MAPK/NF-κB pathway.
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Objective:To explore the clinical effects of uncut Roux-en-Y anastomosis versus Roux-en-Y anastomosis in laparoscopic distal gastrectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 194 patients who underwent laparoscopic distal gastrectomy in the First Affiliated Hospital of Air Force Military Medical University from January 2017 to May 2019 were collected. There were 130 males and 64 females, aged (57±10)years, with a range from 27 to 78 years. Of 194 patients, 62 undergoing uncut Roux-en-Y anastomosis digestive tract reconstruction in laparoscopic distal gastrectomy and 132 undergoing Roux-en-Y anastomosis digestive tract reconstruction in laparoscopic distal gastrectomy were allocated into uncut group and traditional group, respectively. Observation indicators: (1) the propensity score matching conditions and comparison of general data between the two groups after propensity score matching; (2) intraoperative and postoperative situations; (3) follow-up. Follow-up using outpatient examination and telephone interview was conducted at the postoperative 3 months and 6 months to detect Roux stasis syndrome (RSS), tumor recurrence, readmission, and survival of patients. The propensity score matching was conducted by 1∶1 matching using the nearest neighbor method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was done using the t test. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test Fisher exact probability. Comparison of ordinal data between groups was analyzed using the nonparametric rank sum test. Results:(1) The propensity score matching conditions and comparison of general data between the two groups after propensity score matching: 104 of 194 patients had successful matching, including 52 in the uncut group and 52 in the traditional group respectively. Before propensity score matching, cases with age ≤60 years or >60 years, cases in stage Ⅰ, Ⅱ, Ⅲ of American Society of Anesthesiologists were 43, 19, 27, 28, 7 for the uncut group, respectively, versus 63, 69, 24, 92, 16 for the traditional group, showing significant differences between the two groups ( χ2=1.279, Z=2.818, P<0.05). After propensity score matching, the above indicators were 33, 19, 20, 25, 7 for the uncut group, versus 34, 18, 15, 33, 4 for the traditional group, showing no significant difference between the two groups ( χ2=0.000, Z=0.500, P>0.05). (2) Intraoperative and postoperative situations: 104 patients underwent laparoscopic distal gastrectomy successfully and received R 0 resection, without intraoperative complications or conversion to open surgery. After propensity score matching, the time of digestive tract reconstruction was (41±10)minutes for the uncut group, versus (52±15)minutes for the traditional group, showing a significant difference between the two groups ( t=4.511, P<0.05). (3) Follow-up: 104 patients were followed up at the postoperative 3 months and 6 months. The incidence of RSS at the postoperative 3 months was 0 for the uncut group, versus 30.8%(16/52) for the traditional group, showing a significant difference between the two groups ( P<0.05). The incidence of RSS at the postoperative 6 months was 0 for the uncut group, versus 9.6%(5/52) for the traditional group, showing no significant difference between the two groups ( P>0.05). There was no tumor recurrence, readmission, death within postoperative 30 days, or cancer-related death in the 104 patients. Conclusion:Uncut Roux-en-Y anastomosis is safe and feasible in the laparoscopic distal gastrectomy, which can effectively shorten the time of digestive tract reconstruction and reduce the occurrence of RSS after 3 months surgery.
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Objective:To evaluate the role of connexin43 (Cx43) in sevoflurane anesthesia-induced cognitive dysfunction in aged rats.Methods:Fifty-two healthy male Sprague-Dawley rats, aged 18 months, weighing 400-500 g, were divided into 4 groups ( n=13 each) using a random number table method: control group (C group), sevoflurane group (SEV group), sevoflurane plus sh-NC group (SEV+ sh-NC group) and sevoflurane plus sh-Cx43 group (SEV+ sh-Cx43 group). Sevoflurane anesthesia model was established by inhaling 3% sevoflurane for 6 h. In SEV+ sh-NC group and SEV+ sh-CX43 group, sh-NC 5 nmol and sh-CX43 5 nmol were transfected into the lateral ventricles, respectively, at 1 day before sevoflurane anesthesia.Morris water maze test was performed at 30 min before anesthesia and 1, 2 and 3 days after the end of anesthesia, and the rats were sacrificed at each time point after Morris water maze test, the brains were removed, and the hippocampi were isolated for microscopic examination of the pathological changes and for determination of the expression of Cx43, cleaved caspase-3 and cleaved caspase-9 (by using Western blot), and contents of interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α) and IL-6 (by enzyme-linked immunosorbent assay). Results:Compared with group C, the escape latency was significantly prolonged, and the number of crossing the original platform was reduced, and the expression of CX43, cleaved caspase-3 and cleaved caspase-9 was up-regulated, and the contents of IL-1β, TNF-α and IL-6 were increased in group SEV ( P<0.05). Compared with group SEV, the escape latency was significantly shortened, the number of crossing the original platform was increased, and the expression of CX43, cleaved caspase-3 and cleaved caspase-9 was down-regulated, the contents of IL-1β, TNF-α and IL-6 were decreased ( P<0.05), and the hippocampal pathological injury was reduced in group SEV+ sh-CX43, and no significant change was found in the indicators mentioned above in group SEV+ sh-NC ( P>0.05). Conclusion:Cx43 is involved in the pathophysiological mechanism of sevoflurane-induced cognitive dysfunction probably by inducing neuroinflammatory responses and cell apoptosis in aged rats.
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Objective To evaluate the effect of dexmedetomidine on the long-term sensorimotor gating system after sevoflurane anaesthesia in neonatal rats.Methods One hundred forty-four clean-grade healthy male Sprague-Dawley rats,aged 4-6 days,weighing 8-15 g,were divided into 4 groups (n =36 each) using a random number table method:control group (group C),sevofluraue group (group S),dexmedetomidine plus sevoflurane group (group D + S),and dexmedetomidine plus α2 receptor antagonist atipamezole plus sevoflurane group (group D+A+S).In group S,anesthesia was induced with 6％ sevofluraue for 3 min and maintained with 2.1％ sevoflurane,and the anesthesia time was 6 h in total.Dexmedetomidine 25 μg/kg was intraperitoneally injected in group D.In group D +A+ S,dexmedetomidine 25 μg/kg and atipamezole 250 μg/kg were intraperitoneally injected,and the other treatments were similar to those previously described in group S.Twelve rats in each group were randomly selected after anesthesia and sacrificed,and blood samples were collected for determination of serum corticosterone concentrations by enzyme-linked immunosorbent assay.Twenty-four rats were randomly selected in each group,and prepulse inhibition (PPI) of startle test was performed at 70 days after birth.PPI rate (PP3％,PP6％,PP12％) was calculated.The serum corticosterone concentration was measured by restraint stress test on 80 days after birth.Results There was no significant difference in PP6％ or PP12％ among the four groups (P＞0.05).Compared with group C,PP3％ was significantly decreased,and the serum corticosterone concentration was increased after the end of anesthesia and during restraint stress test at 80 days after birth in S and D+A+ S groups (P＜0.05),and no significant change was found in the parameters mentioned above in group D (P＞0.05).Compared with group S,PP3％ was significantly increased,and the serum corticosterone concentration was decreased after the end of anesthesia and during restraint stress test at 80 days after birth in group D (P＜0.05),and no significant change was found in the parameters mentioned above in group D+ A+S (P＞0.05).Compared with group D,PP3％ was significantly decreased,and the serum corticosterone concentration was increased after the end of anesthesia and during restraint stress test at 80 days after birth in group D+A+S (P＜0.05).Conclusion Dexmedetomidine can alleviate the damage to long-term sensorimotor gating system after sevoflurane anesthesia in neonatal rats,and the mechanism may be related to activating central α2 receptors and improving hypothalamic-pituitary-adrenal axis hyperfunction.
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Objective To explore changes in the functional network in an animal model of SAE induced by lipopolysaccharide (LPS) challenge.Methods Thirty male Sprague-Dawley rats were randomly allocated into control group and group SAE.SAE model was established by intraperitoneal injection of LPS 1 mg/kg in group SAE, while the same amount of saline.was injected in the control group.Firstly, we used regional homogeneity (ReHo) method to exam abnormal brain regions between the control and SAE groups and then considered them as seeds for functional connectivity analysis, and behavioral tests were performed at 48 hours after LPS intraperitoneal injection.Results Compared with the control group, our study showed LPS impaired mood function, as reflected by depression-like behavior of prolonged immobility[ (38.93± 13.84) s vs (22.06± 6.75) s, P<0.05]in the forced swim test;LPS induced significantly increased ReHo values in the anterior cingulate cortex (ACC) and caudate putamen (CPu) of (1.21±0.07 vs 0.97±0.12, P<0.05) and (1.34±0.09 vs 1.17±0.16, P<0.05) respectively;the ACC seed showed increased functional connectivity with the retrosplenial cortex (0.45 ± 0.06 vs 0.11 ± 0.02, P<0.05) ;the right CPu seed showed increased functional connectivity with the left Cpu (0.33±0.07 vs 0.07±0.01, P<0.05) ;the depression-like behavior was associated with increased ReHo values in the ACC and right CPu as well as increased functional connectivity between the right CPu and left CPu.Conclusion This study suggests that the impaired mood function in SAE is associated with increased ReHo values in the ACC and right CPu as well as increased functional connectivity between the right CPu and left CPu, indicating that the abnormality of resting-state functional network may be a potential mechanism involved in SAE.