ABSTRACT
Objective To investigate the effects of stellate ganglion block(SGB)on attention and executive function in middle-aged and elderly patients after surgery.Methods Middle-aged and elderly patients aged 55-75 years who underwent hip replacement surgery under lumbar anesthesia were randomized into a control group and an SGB group.Patients in the SGB group received ultrasound-guided stellate ganglion block 30 min before surgery,and patients in the control group were given no additional treatment before surgery.All patients were tested with a modified version of the Trail Making Test-Part A (TMT-A)and a modified version of the Symbol Digit Modalities Test (SDMT)1 day before surgery and 7 days after surgery.The Z-score method was used to diagnose postoperative attention and/or executive function impairment.Results The modified versions of TMT-A and SDMT had good reliability and validity among Chinese middle-aged and elderly people aged 55-75 years.Age was the main influencing factor for the two tests,and their two parallel versions had good alternate-form reliability.There was no significant difference between the control group and the SGB group in scores of modified TMT-A and SDMT at 7 days after surgery(P＞0.1).However,the incidence of attention and/or executive function impairment was lower in the SGB group than in the control group(19.3％ vs.36.6％,P＜0.05).Conclusions The modified TMT-A and SDMT have good reliability and validity among Chinese middle-aged and elderly people aged 55-75 years.Preoperative SGB may protect attention and executive function in middle-aged and elderly patients.
ABSTRACT
Objective To evaluate the effects of dexmedetomidine on the development of perioperative cardiovascular events in elderly patients.Methods Forty-eight patients of both sexes,aged 65-85 yr,with body mass index of 19.5-25.3 kg/m2,of American Society Anesthesiologists physical status Ⅱ or Ⅲ,scheduled for elective abdomninal or lower limb surgery under general anesthesia,were divided into 2 groups (n =24 each) using a random number table:general anesthesia group (group G) and dexmedetomidine plus general anesthesia group (group D).In group D,dexmedetomidine was intravenously infused in a loading dose of 0.25 μg/kg over 10 min and then continuously infused at 0.2 μg · kg-1 · h-1 until 30 min before the end of surgery.The equal volume of normal saline was intravenously infused instead in group G.At 1 day before surgery and 1 and 2 days after surgery,dynamic electrocardiogram was used to monitor heart rate variability including standard deviation of normal-to-normal intervals,standard deviation of the average 5-min normal-to-normal intervals,and root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals.The development of intraoperative cardiovascular events and requirement for vasoactive drugs were recorded,and the development of cardiovascular events within 2 days after surgery was also recorded.Results Compared with group G,standard deviation of normal-to-normal intervals and standard deviation of the average 5-min normal-to-normal intervals at 1 and 2 days after surgery and root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals at 2 days after surgery were significantly increased,the total incidence of intraoperative cardiovascular events and requirement for vasoactive drugs were decreased,and the total incidence of cardiovascular events within 2 days after surgery was decreased in group D (P ＜0.05).Conclusion Dexmedetomidine can reduce the development of perioperative cardiovascular events in elderly patients.
ABSTRACT
Objective To determine the risk factors for perioperative cardiovascular events (PCEs) in patients with diabetes mellitus undergoing noncardiac surgery.Methods From June 2011 to October 2012 in our hospital,500 diabetic patients scheduled for elective non-cardiac surgery were divided into 2 groups according to the development of PCEs:PCE group and non-PCE group.The general data of patients,anesthetic methods,anesthesia time,blood glucose level during surgery and fluctuation of hemodynamics were recorded.The risk factors of which P values were less than 0.05 would enter the binary logistic regression analysis to stratify PCE-related risk factors.Results Seventy-nine patients developed PCEs (15.8 ％) during perioperative period.There was significant difference between the two groups in age,levels of triglyceride and hs-CRP,fluctuation of hemodynamics,and abnormality in ECG (P ＜ 0.05).Logistic regression analysis showed that the risk factors for PCEs included triglyceride level ≥ 1.7 mmol/L,age ≥ 65yr,hs-CRP level ≥ 8 mg/L and fluctuation of hemodynamics during surgery ≥ 30％ of the baseline value.Conclusion High triglyceride levels,advanced age,high hs-CRP levels and fluctuation of hemodynamics during surgery (≥ 30％ of the baseline value) are the risk factors for PCE in diabetic patients undergoing noncardiac surgery.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the effects of curcumin on the behavior of chronic constrictive injury (CCI) rats and the CX3CR1 expression in spinal cord dorsal horn and dorsal root ganglia (DRG).</p><p><b>METHOD</b>Seventy-two male SD rats were randomly divided into 4 groups: 1) Sham operation group (Sham); 2) Chronic constrictive injury group (CCI); 3) Curcumin treated group (Cur), administrated with curcumin 100 mg x kg(-1) x d(-1) ip for 14 days after CCI; 4) Solvent contrast group (SC), administrated with an equal volume of solvent for 14 days after CCI. Paw thermal withdrawal (PTWL) and paw mechanical withdrawal threshold (PMWT) were measured on 2 pre-operative and 1, 3, 5, 7, 10, 14 post-operative days respectively. The lumbar segments L4-5 of the spinal cord and the L4, L5 DRG were removed at 3, 7, 14 days after surgery. The expression of CX3CR1 was determined by immunohistochemical staining.</p><p><b>RESULT</b>Compared with Sham group, PTWL and PMWT in CCI group were significantly lower on each post-operative day (P<0.01), which reached a nadir on the 3rd day after CCI (PTWL was 6.5 +/- 1.1, PMWT was 22.6 +/- 5.1), and the expression of CX3CR1 were markedly increased in spinal cord dorsal horn and DRG. In Cur group, PTWL were higher than in CCI group on 7, 10, 14 post-operative day (P<0.05), and PMWT were higher than those in CCI group on 10 and 14 post-operative day (P<0.05). The administration of curcumin could significantly attenuate the activation of CX3CR1 induced by CCI.</p><p><b>CONCLUSION</b>The study suggests that curcumin ameliorates the CCI-induced neuropathic pain, probably by attenuating the expression of CX3CR1 in spinal cord dorsal horn and dorsal root ganglia.</p>