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Remimazolam （toluenesulfonate） is a new type of ultra short-acting water-soluble benzodiazepine sedative-hypnotic drug， which was launched in China on December 26， 2019， for sedation during routine gastroscopy and colonoscopy as well as induction and maintenance under general anesthesia， breaking a 30-year period in which no innovative sedation drugs were marketed in China. This article reviewed the pharmacological characteristics， safety and combined use of remimazolam. Remimazolam had the advantages of high clearance rate， short action time， rapid recovery， stable hemodynamics， and low respiratory inhibition. It is independent of liver and kidney metabolism， and can be quickly antagonized by flumazenil， with little impact on the cognitive function of patients. Remimazolam has shown good respiratory and circulatory stability in combination with intravenous anesthetics such as propofol and esketamine， and opioid analgesics such as sufentanil， remifentanil， and alfentanil， as well as advantages such as rapid awakening and recovery. However， its safety still needs to be further monitored and explored during clinical use.
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Objective To investigate the effects of different concentration and inhalation duration time of isoflurane on cognitive performance and the expression of GABAR1 and NMDAR2B in aged SD rat cerebral temporal lopes.Methods Aged male SD rats (9 months) were randomly divided into control group (n=10) and test group (n=80).The control group received air at room tempreture.Test groups were divided into four groups: group S1 (1.5%-2 h),group S2 (2.5%-2 h),group S3 (1.5%-4 h),group S4 (2.5%-4 h)according to isoflurane concentration and inhalation duration time.Every group was equally divided into two groups and Morris water maze test was performed day 1 and day 7 after isoflurane inhalation.Then the right temporal lobe was gathered and the mRNA transcription and protein expression of GABAR1 and NMDAR2B were detected by RT-PCR and Immunofluorescence technique.Results One day after isoflurane inhalation, accompanied with increased isoflurane concentration and inhalation duration, the spatial memory ability of every test group decreased continually, and the mRNA transcription and protein expression of GABAR1 increased and the mRNA transcription and protein expression of NMDAR2B decreased compared with control group (P<0.01).Seven days after isoflurane inhalation, the spatial memory ability of group S4 decreased, the mRNA transcription and protein expression of both GABAR1 increased, the mRNA transcription and protein expression of NMDAR2B decreased compared with control group and the other test groups (P<0.01).There was no significant difference between the control group and groups S1, S2, S3.Conclusion Continuous inhalation of isoflurane has great effects on spatial memory ability.And impaired spatial memory by isoflurane inhalation of high concentration with long duration is present in a long time.Thoses are related with the mRNA transcription and protein expressions of GABAR1 and NMDAR2B in cerebral temporal lope.
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Objective To observe the changes of learning and memory ability and the expression of GRP8,ATF4 and CHOP in the frontal lobe neurons of rats after isoflurane anesthesia.Methods Male SD aged rats were randomly divided into 4 groups with 15 in each group.Rats in ISO group received 1.5% isoflurane 2 h,SAL group received intraperitoneal injection Salubrinal(1 mg/kg),ISO+SAL group received 1.5% 2 h after intraperitoneal injection Salubrinal(1 mg/kg),C group only inhaled 30% air and oxygen mixture.Morris water maze (MWM) test was performed 24 hours after isoflurane anesthesia,and then the left frontal lobe of rats was collected,gene transcription and protein expression changes of 78-kDa glucose-regulated protein(GRP78),activating transcription factor 4(ATF4),C/EBP homologous protein(CHOP) were evaluated by real-time fluorescence quantitative PCR and immunofluorescence.Results Compared with the C group,the latent time of ISO group was significantly prolonged(ISO group(19.10±2.98)s vs C group (10.54±2.05)s,P<0.05);the number of times passing through the target platform of ISO group was decreased significantly(ISO group (6.78±1.47) vs Cgroup (9.03±1.69),P<0.05);protein expression level of GRP78 was significantly increased in group ISO (ISO group (965.8±86.5) vs C group(247.5±46.3),P<0.05);protein expression level of ATF4 was significantly increased in group ISO(ISO group (470±69.4) vs C group (275.4±56.3),P<0.05) protein expression level of CHOP was significantly increased in group ISO(ISO group (618.7±83.3) vs C group(174.5±71.2),P<0.05).The transcription trends of GRP78,ATF4,CHOP were consistent with their protein expression.Conclusion The decrease of short-term memory ability after isoflurane anesthesia may be related to the activation of endoplasmic reticulum stress pathway in frontal lobe neurons.
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Objective To analyze the internal and external environment of nursing scientific research management by using SWOT analysis method,so as to promote the improvement of nursing scientific research work in our hospital.Methods Based on the analysis of the strength,weakness,opportunities and threats of nursing staff in scientific research activities in our hospital,this paper draws some conclusions and puts forward corresponding measures according to the analysis results.Results With the continuous development of nursing discipline in our hospital,the construction of the platform was improved,and the nursing scientific research work was improved.However,funding,personnel,consciousness and so on,have become the bottleneck restricting the development of nursing research in our hospital.Combined with the opportunities and challenges,a number of improvement measures are put forward.Conclusions We should strengthen the management of nursing scientific research,improve the relevant systems and measures to improve the internal and external environment,and promote the level and quality of nursing research activities in our hospital.
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Objective Cardiac valve replacement with cardiopulmonary bypass ( CPB ) can induce myocardial ischemia-reperfusion injury , which is bad for cardiac function recovery .The aim of the study was to evaluate the myocardial ischemia-reperfusion injury effect of breviscapine intravenously injected before CPB in patients undergoing cardiac valve replacement with CPB . Methods 40 patients scheduled for cardiac valve replacement were randomly divided into two groups :control group and breviscapine group ( n=20).Normal saline 15 mL and breviscapine 0.75 mg/kg was administered with pump within 30 mins after the induction of anesthesia in control group and breviscapine group respectively .Blood samples were taken from jugular vein at each of the five time points: before surgical incision (T0) and at 30mins, at 6, 12, 24h after aortic unclamping (T1-T4) for determination of plasma concentration of car-diac troponin-I (cTnI), creatine kinase isoenzyme (CK-MB) and superoxide dismutase (SOD). Results Compared with T0, the cTnI and CK-MB in both groups significantly increased at T 1-T4 and peaked at T 2 , the SOD in both groups significantly decreased at T 1-T4(P<0.05).Compared with control group, cTnI and CK-MB significantly decreased, while SOD activity significantly increased at T1-T4in breviscapine group (P<0.05). Conclusion The intravenous infusion of breviscapine 0.75 mg/kg before the staring of CPB can relieve myocardial ischemia-reperfusion injury in patients undergoing cardiac valve replacement with CPB , and the mechanism may be related to the anti-oxidative stress effect .
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Objective To investigate the effect of pentazocine combined with midazolam on intubation stress response in slow induction of anesthesia. Mtheods Forty ASAⅠ~Ⅱpatients were divided into two groups. Anesthesia was induced with midazolam 0.03 mg/kg in both groups,and pentazocine 0.8 mg/kg (i.v.) was given in pentazocine group or fentanyl 2 μg/kg (i.v.) in fentanyl group. Five minutes later, 2 mL of 1% decicaine was administered by cricothyroid membrane puncture to facilitate the intubation.The SpO2, circulatory indexes (HR, SBP, DBP, BIS) and sedation level were measured at T0, T1, T2, T3, T4, T5, T6. Results Both pentazocine and fentanyl can inhibit stress responses to tracheal intubation effectively,but pentazocine group is better than fentanyl group on the cardiovascular stability during slow induction of anesthesia. Conclusion Pentazocine 0.8 mg/kg can inhibit stress responses to tracheal intubation effectively with a low incidence of adverse reactions in the slow induction of anesthesia.
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Objective To evaluate the effect of dexmedetomidine on inflammatory response and the changes of serum inflamma-tory mediator caused by cardiopulmonary bypass(CPB)in cardiac valve replacement surgery.Methods 30 patients scheduled for cardiac valve replacement were randomly divided into two groups:experimental group(n=15)and control group(n=15).For the experimental group,dexmedetomidine was infused intravenously with the dose of 2.0μg·kg-1 ·h-1 after induction of anesthesia. In control group,normal saline was given instead of dexmedetomidine.Blood samples were taken from radial artery in each of the following five time points:after induction of anesthesia(T1 ),the beginning of CPB(T2 ),after beginning of CPB 40 min(T3 ),after the termination of CPB 2 h(T4 )and 24 h(T5 )for determination of TNF-α、IL-6、IL-10.Results The concentration of TNF-α、IL-6、IL-10 levels showed no significantly difference between the two groups before CPB(P>0.05).But serum TNF-α、IL-6 levels of ex-perimental group were significantly lower and IL-10 were significantly higher than control group(P0.05)while TNF-αremained heigh level(P<0.05 or P<0.01)in both groups. Conclusion dexmedetomidine can regulate the release of the serum inflammatory mediator which suggest that dexmedetomidine may alleviate the systemic inflammatory reaction resulting from cardiopulmonary bypass in cardiac valve replacement surgery.