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[Objective] To evaluate the effect of hydromorphone for postoperative analgesia on residual carbon dioxide during recovery after laparoscopic colorectal surgery.[Methods] A total of 100 patients performed with elective laparoscopic colorectal surgery were randomly allocated into two groups according to different patient controlled intravenous analgesia (PCIA) formula:Group H contained hydromorphone 8 mg and Group M contained morphine 40 mg.Total PCIA volume was 100 mL saline with loading volume 2 mL,background volume 2 mL/h,and lockout time was set on 15 min.Analgesia infusion pump was used in the two groups half an hour before the end of surgery.Surgery time,pneumoperitoneum time,anesthesia time,extubation time,recovery time and retention time in postanesthesia care unit (PACU) were rccordcd,rcspcctively.PaCO2,the pain Visual Analogue Scale (VAS) score,Ramsay sedation score,at 30 min (T0) after pneumoperitoneum,extubation time (T1),30 min (T2),1 h (T3),2 h (T4),and 24 h (T5) after extubation,the times of PCA compressions were recorded.Anesthesia complications during waking-up period such as postoperative nausea and vomiting (PONV),shoulder pain,hypersomnia,pruritus and satisfaction degree after surgery were also recorded.[Results] Compared with group H,PaCO2 was higher at T2 ～ T4 (P ＜ 0.05);Recovery time,extubation time and the retention time in PACU were longer after surgery (P ＜ 0.05);The incidence of postoperative nausea and vomiting,shoulder pain were higher in group M (P ＜ 0.05).Compared with group M,VAS score at T1 ～ T3,and Ramsay sedation score T1 ～ T4 were decreased in group H (P ＜ 0.05).[Conclusion] Compared with morphine,hydromorphone can increase fewer residual carbon dioxide during recovery and fewer side effects for the patients caused by that after laparoscopic colorectal surgery.Hydromorphone was a safer and more effective analgesic for postoperative analgesia than morphine.
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Aim Toinvestigatetheanalgesiceffectsof epidural osthole application on the mechanical allodyn-ia and the ERK/MAPK signaling pathway and the expression of COX-2 mRNA in the spinal dorsal horn.Methods 125adultmaleSDratswererandomizedin-to five groups( n=25 each) :Blank, Sham, NP, Ost and vehicle. At postoperative day 6, 1mg/rat osthole 50 μl was injected epidurally into group Ost and the same volume of vehicle was given into group vehicle. The mechanical pain threshold was measured by 50%MWT at 1 day before operation and the 3 rd,6 th,7 th, 14 th,21 st day after operation. After the measurement of pain threshold on postoperative day 14 , the L4-6 segment of spinal dorsal horn was removed for determi-nation of the expression of ERK, pERK and COX-2 mRNAbyWesternblotandRT-PCR.Results Com-pared with blank group, the mechanical pain threshold was only down-regulated at day 1 after operation in sham group, the expression of pERK and COX-2 mR-NA in sham group showed no significant difference ( P>0. 05 ); the mechanical pain threshold was signifi-cantly down-regulated after operation in NP, Ost and vehicle groups( P0. 05). The correla-tion analysis on pERK1/2 and COX-2 mRNA revealed the Pearson correlation coefficient was 0 . 878 and 0 . 910 , suggesting a strong positive correlation between pERKandCOX-2mRNA.Conclusions Ostholead-ministrated in the early stage after surgery can alleviate the nucleus pulposus-induced radicular inflammatory pain probably by inhibiting the expression of pERK and COX-2 mRNA in spinal dorsal horn.
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Objective To compare the efficacy of dexmedetomidine versus remifentanil in combination with sevoflurane for gynecological laparoscopy. Methods Forty ASA Ⅰ or Ⅱ patients aged 18-64 yr with body mass index of 18-30 kg/m2 undergoing gynecological laparoscopy were randomly assigned to one of two groups ( n =20 each): dexmedetomidine group (group D) and remifentanil group (group R). Starting from 5 min before induction of anesthesia, dexmedetomidine was infused at 0.05 μg · kg - 1 · min- 1 in group D and remifentanil at 0.1 μg· kg- 1· min-1 in group R for 10 min, then dexmedetomidine infusion rate was increased to 0. 3 μg· kg-1 · h-1 and remifentanil infusion rate was increased to 0.15 μg· kg-1 · min-1 . Anesthesia was induced with propofol 1.5-2.0 mg/kg and fentanyl 2 μg/kg. Tracheal intubation was facilitated with cis-atracurium 0.15 mg/kg. Anesthesia was maintained with sevoflurane and fentanyl 1 μg/kg and intermittent iv boluses of cis-atracurium. Narcotrend index was maintained at 40-50. Blood sample was taken from external jugular vein for blood gas analysis and determination of serum concentrations of corticosteroid, norepinephrine and epinephrine before administration, at 5 min after intubation, at 10 min of aeroperitoneum and at 5 min after extubation. The pH value and concentrations of lactic acid and glucose were recorded. The time for recovery of spontaneous breathing, eye-opening time, extubation time, orientation time and perioperative side-effects were recorded. Numeric rating scale was used to assess the intensity of pain during 2 h after operation. The analgesics used were also recorded. Results The serum concentrations of norepinephrine and epinephrine were significanfly lower at 10 min of aeroperitoneum, the time for recovery of spontaneous breathing was shorter, eye-opening time longer and the incidence of shivering and nausea and vomiting lower, the percentage of patients requiring rescue opioids lower in group D than in group R ( P ＜ 0.05). Conclusion The efficacy of dexmedetomidine combined with sevoflurane anesthesia is better than remifentanil combined with sevoflurane anesthesia for gynecological laparoscopy.
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Objective To investigate the effect and clinical valve of target-controlled infusion of remifentanil for conscious intubation of patients under fibrobronchoscopy.Methods Forty patients were randomly divided into two groups(F and R),each group contained 20 cases.All of the patients were intubated on regional anaesthesia,as the first step,then the patients in F group were given fentanyl 2?g/kg by vein.In remifentanil target-controlled infusion group(R group),the patients were kept infusing remifentanil 2ng/ml.Results (1)Haemodynamics:in R group,SBP and HR kept steadily;In F group,while the two indices increased significantly.(2)Static pulmonary function:in R group,RR,VT deceased remarkablely.There were no difference between two groups in SpO_2 and P_ ET CO_2.(3)Tracheal intubating condition and Ramsay score in R group were better than in F group;Cardiovascular response in R group was lower.Conclusion Target-controlled infusion of remifentanil for conscious intubation can achieve excellent result,with less cardiovascular response.
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Objective To investigate the status of fragile histidine triad (FHIT) gene in human esophageal, gastric and colorectal carcinomas. Methods Ninety six samples of digestive tract cancer (including 21 esophageal carcinomas, 43 gastric carcinomas and 32 colorectal carcinomas) tissues and their adjacent non carcinoma tissues and 18 samples of normal tissue were examined by nested RT PCR for FHIT gene alteration. Results Aberrant transcripts were observed in 33.3% esophageal cancers, 51.7% gastric cancers and 31.3% colorectal cancers. In the adjacent esophageal,gastric and colorectal non carcinoma tissues the rate of aberrant transcripts were 4.8%,20.9% and 9.4%, respectively ( P
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Objective To investigate the effects of thoracic epidural analgesia on postoperative rebound hypertension after ligation of patent ductus arteriosus (PDA) . Methods Forty-eight ASA Ⅰ -Ⅱpatients undergoing ligation of PDA were studied. There were 20 male and 28 female. The age ranged from 4-30 years and body weight 15-56 kg. The patients were randomly divided into two groups: general anesthesia group (group C, n= 22) and combined general-epidural anesthesia group (group TEA, n = 26). In group C combined intravenous-inhalational anesthesia was used and intermittent intramuscular pethidine 1 mg?kg-1 was given for postoperative pain relief. In TEA group epidural catheter was placed at T8-9 before induction of general anesthesia and a loading dose of 3-6 ml of a mixture of 0. 125 %-0. 15% bupivacaine + 0.0001% fentanyl + 0.005% droperidol was given 20 min before the end of surgery followed by infusion of the mixture at a rate of 2 ml?h-1. ECG, BP, HR, RR and SpO2 were monitored during and after operation. VAS pain score was evaluated and compared between the two groups. Results Better analgesia was achieved in TEA group. Postoperative blood pressure was significantly higher in group C than that in TEA group (P
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Objective To evaluate the effect of clonidine added to ropivacaine for epidural anesthesia. Methods Sixty ASA Ⅰ - Ⅱ patients aged 24-62 yr, weighing 50-76 kg, scheduled for elective gynecological surgery under epidural anesthesia were randomly assigned to one of four equal groups of 15 patients each, according to the dose of clonidine added to ropivacaine solution: group 1 (R) received no clonidine and served as control; group 2-4 in which clonidine 50, 100 or 150 ug was added to 0.75% ropivacaine 25 ml (R-C 50, R-C 100, R-C 150). Epidural anesthesia was performed at L2-3. Epidural catheter was inserted into epidural space and advanced in cephalad direction for 3.5 cm. Ropivacaine solution was prepared and provided by a specially designated person. A test dose of 5 ml of ropivacaine was given. 5 min later when epidural placement of catheter was confirmed, the rest 20 ml of ropivacaine was given in fractions of 5 ml every 2-3 min. At the beginning of operation midazolam 2.5-3.5 mg was given iv. During operation if the patient felt uncomfortable when viscera were being pulled, ketamine 0.5 mg? kg-1 was given iv. The onset and duration of analgesia, the height of black, the degree of motor block as well as adverse effects were recorded. Results The onset time of motor block was significantly shorter, the duration of analgesia was significantly longer, the incidences of visceral pain and shivering were significantly lower and ketamine requirement was significantly reduced in group R-C 100 and R-C 150 as compared with group R. However the incidence of hypotension, the amount of fluid infused and epinedrine requirement were significantly increased in group R-C 150. Conclusion The addition of clonidine 100 ug to 0.75 % ropivacaine 25 ml improves the effect of epidural block without increasing adverse effects.