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Objective To observe the effect of different doses of mivacurium chloride on muscle relaxation time-course and hemodynamics in children with different ages. Methods One hundred children of selective inguinal hernia repair under general anesthesia with endotracheal intubation from January 2016 to January 2017 were enrolled, and the age was 0.5 to 6.0 years. The children were divided into low age group (0.5 to 3.0 years) and high age group (3.1 to 6.0 years) according to the age, then the children were divided into low dose group (mivacurium chloride 0.20 mg/kg) and high dose group (mivacurium chloride 0.25 mg/kg) according to the doses of mivacurium chloride. Therefore, the children were divided into low age low dose group, low age high dose group, high age low dose group and high age high dose group with 25 cases each. The mean arterial pressure (MAP) and heart rates before anesthesia (T0) and 1 min (T1), 3 min (T2), 5 min (T3), 10 min (T4) after intravenous injection of mivacurium chloride were recorded. The times of first intravenous injection of mivacurium chloride to neuromuscular block 75% (ThD75), 90% (ThD90) and maximum (ThDmax) were recorded. The recovery index (RI) was recorded. The times of last intravenous injection of mivacurium chloride to onset of muscle convulsions (Th) and muscle convulsions recovery 10% (ThR10), 25% (ThR25), 75% (ThR75), 90% (ThR90) were recorded. The times of ratio of the fourth muscle twitch to the first muscle twitch (TOFR) recovery 75% (TOFR75) and 90% (TOFR90) were recorded. Results There were no statistical difference in MAP and heart rate among 4 groups (P＞0.05). The ThD75, ThD90 and ThDmax in low age low dose group were (126 ± 40), (163 ± 59) and (192 ± 49) s, those in low age high dose group were (73 ± 15), (115 ± 41) and (142 ± 37) s, those in high age low dose group were (149 ± 38), (193 ± 44) and (221 ± 47)s, and those in high age high dose group were (105 ± 32), (138 ± 35) and (167 ± 44)s. The ThD75, ThD90 and ThDmax in low age high dose group were significantly shorter than those in low age low dose group, those in high age high dose group were significantly shorter than those in high age low dose group, those in high age low dose group were significantly longer than those in low age low dose group, those in high age high dose group were significantly longer than those in low age high dose group, and there were statistical differences (P＜0.05). There were no statistical differences in Th, ThR10, ThR25, ThD75, ThD90, RI, TOFR75 and TOFR90 among low age low dose group and low age high dose group, high age low dose group and high age high dose group (P＞0.05). Conclusions In the children of 0.5 to 3.0 years, the effect of mivacurium chloride is significantly faster than that in the children of aged 3.1 to 6.0 years. Compared with 0.20 mg/kg of mivacurium chloride, 0.25 mg/kg of mivacurium chloride has less time to display muscle relaxation effect. The recovery time is not affected by age and induction dose. Mivacurium chloride has no significant effect on hemodynamics.
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Objective To evaluate Effects of general anesthesia combined with thoracic paraver-tebral block(TPVB)on postoperative recovery after thoracoscopic pulmonary lobectomy. Methods Eighty patients were randomized into the general anesthesia group( G group)and general anesthesia combined TPVB group(GT group). Under the guidance of ultrasound,patients in the GT group received 20ml of 0. 5% ropivacaine for TPVB,and sevoflurane and propofol for combined anesthesia. Patients in the G group received sevoflurane,propofol and remifentanil for combined anesthesia. Extubation time,postoperative vis-ual analogue scale(VAS),quality of recovery(QoR)score,and adverse reaction were all recorded. Results Patients in the GT group had less extubation time and earlier ambulation time compared to the G group. Postoperatively,at the 1st,24th and 48th hour,patients in the G group had significantly higher VAS values both at rest and on movement than GT group(P < 0. 05). The opioid consumptions in GT group were lower than the G group(P < 0. 05). The QoR values of GT group at 24th and 48th hour[(152 ± 21)min and (175 ± 17)min]were significantly higher than the G group[(134 ± 25)min and(162 ± 20)min]respec-tively. There were significant differences in hospitalization expenses,the hospitalization stay and the inci-dence of complications between the two groups. Conclusion The ultrasound-guided paravertebral block can improve the quality of recovery in patients undergoing thoracoscopic pulmonary lobectomy.
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Objective To investigate the effect of minocycline on isoflurane-induced hippocampal neuroapoptosis and cognitive dysfunction in aged rats. Methods Forty-five male SD rats were randomly assigned into 3 groups ( n=15): blank control group ( group C) , 1.5% isoflurane group ( group I) and 50 mg??kg-1 minocycline+1.5% isoflurane group ( group M+I) . Minocycline was injected intraperitoneally 12 h before the start of anesthesia for group M+I.Group I and group M+I were exposed to 1.5% isoflurane for 4 h, while group C were exposed to 30% O2-70% N2.At the end of anesthesia, five rats in each group were randomized to analyse arterial blood gas. The other rats in each group were sent back to their home cage until they were fully awake.Fourteen days after anesthesia, Morris water maze was used to assess the cognitive function, and then hippocampi of rats were dissected for detection of the expression of cleaved caspase3, Bax and Bcl-2. Results No difference was found in arterial gas analysis among the 3 groups (P>0.05).Compared with group C, the rats in the group I spent more time locating the platform on the third and fourth training days and the time percentage that the rats in group I spent in the target quadrant was much less (P<0.05).However, these changes were reversed in group M+I (P<0.05).The isoflurane-induced increased level of Bax and cleaved caspase3 and decline of anti-apoptotic factor Bcl-2 were restored by minocycline pretreatment ( P<0.05) . Conclusion Minocycline could attenuate cognitive dysfunction induced by isofluranein aged rats.The mechanism is associated with inhibition of hippocampal neuroapoptosis which is increased by isoflurane.
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<p><b>OBJECTIVE</b>To compare the differences of postoperative patient-controlled intravenous analgesia for laparoscopic cholecystectomy and gynecological laparoscopy in female patients.</p><p><b>METHODS</b>This retrospective study included 645 female patients received laparoscopic cholecystectomy or gynecological laparoscopy (laparoscopic oophorocystectomy/myomectomy) between January 2011 and July 2012 in Tongji Hospital. Among them, 207 cases of sufentanil-tramadol patient-controlled intravenous analgesia (PCIA) were enrolled and divided into 2 groups:77 cases in laparoscopic cholecystectomy group, and 130 cases in gynecological laparoscopy group. The pressing frequency and consumption of PCIA, localization and quality of postoperative pain, visual analogue scale (VAS) at 4-6 h, 8-12 h, 18-24 h after surgery, and adverse effect were compared by t-test,χ(2) test, Fisher exact test or Mann-Whitney test.</p><p><b>RESULTS</b>There was no statistical difference of age, body mass index, and operation time between the two groups (all P > 0.05). As compared with the gynecological laparoscopy group (3 (4)), PCIA pressing frequency was higher in the laparoscopic cholecystectomy group (5 (7)), but there was no statistical difference (Z = -1.747, P = 0.081). PCIA consumption in the laparoscopic cholecystectomy group (79 (33) ml) was higher than that in the gynecological laparoscopy group (48 (30) ml) (Z = -6.267, P = 0.000). The postoperative pain localization and quality were different in the two groups, the patients in the laparoscopic cholecystectomy group experienced dull pain in lower abdomen, but the ones in the gynecological laparoscopy group had distending pain in upper abdomen and piercing pain around scapula. The differences of 4-6 h, 8-12 h, 18-24 h VAS scores in the two groups had no statistical significance (all P > 0.05). The total incidence of postoperative adverse effect between the two groups had no statistical significant difference (laparoscopic cholecystectomy group:11.7%, gynecological laparoscopy group:16.2%) (χ(2) = 0.778, P = 0.378). The incidence of dizziness was higher in the gynecological laparoscopy group (6.2%) than that in the laparoscopic cholecystectomy group (0) (Fisher exact test:P < 0.05).</p><p><b>CONCLUSION</b>In the case of sufentanil-tramadol PCIA, laparoscopic cholecystectomy needs more postoperative analgesia, while gynecological laparoscopy has higher incidence of dizziness.</p>
Subject(s)
Female , Humans , Analgesia, Patient-Controlled , Cholecystectomy, Laparoscopic , Gynecologic Surgical Procedures , Laparoscopy , Pain Measurement , Pain, Postoperative , Retrospective Studies , Sufentanil , TramadolABSTRACT
Objective To evaluate the effect of different intravenous analgesia methods on postoperative incisional and uterine contraction pain after cesarean section.Methods Four hundred parturients (ASA Ⅱ-Ⅱ) undergoing cesarean section were randomly allocated into 4 groups,including sufentanil group (group S,96 cases),sufentanil combined with flurbiprofen axetil group (group SK,99 cases),butorphanol group (group N,106 cases) and butorphanol combined with llurbiprofen axetil group (group NK,99 cases).All the parturients received the operation under epidural combined with spinal anesthesia,and received patient-controlled intravenous analgesia (PCIA) after cesarean section.Numerical rating scale (NRS) of postoperative rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and PCIA-related adverse events were recorded for 24 h after operation.Results All the parturients were finished this study.The age,body weight,gestational weeks and operative time in 4 groups had no significant difference (P ＞ 0.05).The NRS score of rest incisional pain was equivalent among the 4 groups (P ＞ 0.05).The NRS score of dynamic incisional pain after operative 13 h in group S was significantly lower than that in group N[(3.6 + 1.3) scores vs.(5.4 + 1.2) scores](P＜ 0.05).The NRS score of uterine contraction pain after operative 4,13 h in group N and group SK was lower than that in group S [(1.3 ± 1.0),(1.1 ± 0.9) scores vs.(2.5 ± 1.1) scores and (1.6 ± 1.0),(1.4 ± 0.9) scores vs.(2.9 ± 1.1) scores] (P ＜ 0.05).The RSS scores and incidence rate of dizziness were significantly higher in group N than those in group S (P ＜0.05).No abnormality of new-horn infant was recorded in 4 groups.Conclusion Sufentanil combined with nonsteroidal antiinflammatory drugs can perform effective and safe analgesia on postoperative incisional and uterine contraction pain after cesarean section.