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Objective:To evaluate the effect of pectoral nerve block type Ⅱ combined with esketamine on anxiety and depression in the patients with breast cancer undergoing modified radical mastectomy under general anesthesia.Methods:Eighty-four female patients, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 18-25 kg/m 2, undergoing elective first-time modified radical mastectomy for unilateral breast cancer, were divided into 2 groups ( n=42 each) using a random number table method: routine group (R group) and pectoral nerve block type Ⅱ combined with esketamine group (PS group). Sufentanil was used for anesthesia induction and postoperative patient-controlled intravenous analgesia (PCIA) in group R, esketamine was used for anesthesia induction and postoperative PCIA, and type Ⅱ thoracic nerve block was performed under ultrasound guidance after anesthesia induction in group PS, and the rest of the drugs used were the same in both groups.The observer′s assessment of awareness/sedation scale score was recorded at the end of surgery, 30 min after the end of surgery, and at 6, 12 and 24 h after surgery.The Hospital Anxiety and Depression Scale was used to assess patients′ anxiety and depression at 1 day before surgery and at discharge.The intraoperative consumption of anesthetics, emergence time, postanesthesia care unit stay time, pressing times of PCIA, requirement for rescue analgesia, hospital costs, length of postoperative hospital stay, satisfaction scores of surgeons and patients were recorded at discharge.The occurrence of adverse reactions was also recorded after operation. Results:Compared with group R, the observer′s assessment of awareness/sedation scale score were significantly increased at the end of surgery and 30 min after surgery, the consumption of propofol and remifentanil was decreased, the emergence time and postanesthesia care unit stay time were shortened, the incidence of nausea and vomiting was decreased, the Hospital Anxiety and Depression Scale score was decreased at discharge, the incidence of anxiety and depression was decreased, the satisfaction scores of surgeons and patients were increased, and the length of postoperative hospital stay was shortened in group PS ( P<0.05). Conclusions:Pectoral nerve block type Ⅱ combined with esketamine can optimize the efficacy of anesthesia and relieve early postoperative anxiety and depression in the patients undergoing modified radical mastectomy for breast cancer under general anesthesia.
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Objective:To evaluate the role of stimulator of interferon genes (STING) signaling pathway in carbon monoxide (CO)-releasing molecule-3 (CORM-3)-induced reduction of hepatocyte pyroptosis and apoptosis in a rat model of hepatic ischemia-reperfusion.Methods:Forty-eight clean-grade healthy male Sprague-Dawley rats, aged 9-11 weeks, weighing 320-380 g, were divided into 4 groups ( n=12 each) using a random number table method: sham operation group (S group), ischemia-reperfusion group (IR group), CORM-3 group (C group) and STING agonist ADU-S100 group (A group).Hepatic ischemia-reperfusion injury models were developed by reversible ligation of left middle hepatic artery, portal vein and bile duct branches for 45 min, followed by reperfusion in anesthetized animals in IR, C and A groups.In group C, CORM-3 4 mg/kg was injected into the femoral vein immediately after reperfusion.The equal volume of normal saline containing dimethyl sulfoxide was injected into the femoral vein in S, IR and A groups.At 1.5 h after injection into the femoral vein, ADU-S100 10 mg/kg was intraperitoneally injected in A group, and the equal volume of normal saline was given instead in S, IR and C groups.The serum alanine transaminase (ALT) and aspartate transaminase (AST) concentrations were determined at 3 h of reperfusion.The rats were sacrificed at 12 h of reperfusion, and liver tissues were collected for determination of the content of CO (by colorimetry), expression of interleukin-1beta (IL-1β), IL-18, Bcl-2, Bax, interferon regulatory factor 3 (IRF3), phosphorylated IRF3 (p-IRF3), STING, NOD-like receptor protein 3 (NLRP3), aspirin D (GSDMD) and activated caspase-1 (by Western blot), and pyroptosis and apoptosis rates of hepatocytes (by immunofluorescence staining).The liver injury was scored. Results:Compared with group S, the serum ALT and AST concentrations, liver injury score, CO content, and pyroptosis and apoptosis rates of hepatocytes were significantly increased, and the expression of IL-1β, IL-18, p-IRF3, STING, NLRP3, GSDMD and activated caspase-1 was up-regulated, and the Bcl-2/Bax ratio was decreased in group IR ( P<0.05).Compared with group IR, the serum ALT and AST concentrations, liver injury score, and pyroptosis and apoptosis rates of hepatocytes were significantly decreased, the CO content was increased, the expression of IL-1β, IL-18, p-IRF3, STING, NLRP3, GSDMD and activated caspase-1 was down-regulated, and the Bcl-2/Bax ratio was increased in group C ( P<0.05).Compared with group C, the serum ALT and AST concentrations, liver injury score, and pyroptosis and apoptosis rates of hepatocytes were significantly increased, the CO content was decreased, the expression of IL-1β, IL-18, p-IRF3, STING, NLRP3, GSDMD and activated caspase-1 was up-regulated, and the Bcl-2/Bax ratio was decreased in group A ( P<0.05). Conclusions:The mechanism by which CORM-3 attenuates hepatocyte pyroptosis and apoptosis may be related to the inhibition of activation of STING signaling pathway in a rat model of hepatic ischemia-reperfusion.
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Objective:To evaluate the improved efficacy of transversus abdominal plane (TAP)-rectus sheath (RS) block combined with general anesthesia in the patients undergoing laparoscopic pancreaticoduodenectomy.Methods:Fifty-six American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 45-64 yr, with body mass index of 18-25 kg/m 2, scheduled for elective laparoscopic pancreaticoduodenectomy, were divided into 2 groups ( n=28 each) using a random number table method: general anesthesia group (group G) and TAP-RS block plus general anesthesia group (group TRG). In group TRG, after induction of general anesthesia, bilateral TAP-RS block was performed with 0.375% ropivacaine mixed with 0.5 μg/kg dexmedetomidine under ultrasound guidance, 20 ml was injected into the plane of bilateral transverse abdominis, and 10 ml was injected into the posterior sheath of the bilateral rectus abdominis, and the tube was placed on the plane of the transverse abdominis, and 5 ml/h was continuously pumped after operation.In both groups, anesthesia was induced with IV midazolam, sufentanil, etomiddate and cisatracurium besylate and maintained using combined intravenous-inhalational anesthesia, and patient-controlled intravenous analgesia (PCIA) was performed after operation.Pulmonary function indexes were measured before induction of anesthesia (T 0) and at 6, 12 and 24 h after removal of the tracheal tube (T 1-3). Blood gas analysis was performed at T 0, T 2 and T 3.The occurrence of high/low blood pressure, tachycardia/bradycardia, consumption of opioids, PACU stay time, pressing times of PCIA within 24 h after surgery, rescue analgesia, time of passing the first flatus, the first postoperative off-bed time, length of postoperative hospital stay, and 48 h quality of recovery-40 (QoR-40) were recorded.The occurrence of adverse reactions and nerve block-related complications were recorded within 48 h after operation. Results:Conversion to laparotomy during operation was found in 4 patients, changing the scope of resection in 2 patients, and a total of 50 patients were enrolled in this study.Compared with group G, the pressing times of PCIA was significantly reduced, the requirement for postoperative rescue analgesia was decreased, the intraoperative consumption of sufentanil and remifentanil was reduced, the incidence of intraoperative hypertension and tachycardia was decreased, the FEV1, FVC and PEFR were increased at T 2, 3, the 48 h QoR-40 score was increased, the time of passing the first flatus, the first postoperative off-bed time, and length of postoperative hospital stay were shortened, the incidence of nausea, agitation, somnolence, and hypoxemia was decreased ( P<0.05), and no significant change was found in the indicators of blood gas analysis at each time point in group TRG ( P>0.05). Nerve block-related complications were not found in group TRG. Conclusion:Compared with general anesthesia alone, TAP-RS block combined with general anesthesia is helpful in carrying out anesthetic model of low-consumption opioids and improving the quality of early postoperative recovery when used in the patients undergoing laparoscopic pancreaticoduodenectomy.
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Objective To investigate the effectiveness of predicting the incidence of supine hy-potension syndrome (SHS)after spinal anesthesia measured by ultrasonic measurement of the varia-tion of brachial artery peak velocity in different positions of parturient.Methods Parturient scheduled for elective cesarean section,ASA physical status Ⅰ or Ⅱ,were divided into SHS group and no-SHS group (SBP in the upper extremity decreased by > 30 mm Hg or decreased to < 80 mm Hg)after spinal anesthesia.HR,SBP,DBP of supine position and left lateral position before anesthesia were re-corded,and brachial artery peak velocity were measured by Ultrasonic.The differences of the above indexs before and after the transformation position were calculated.The receiver operating characteris-tic curve (ROC)was plotted by indexs of which P values were less than 0.05,to evaluate the predic-tive effect of each index on SHS after spinal anesthesia.Results Among the 196 patients,89 cases (45.4%)developed SHS after spinal anesthesia.SBP,DBP,peak velocity of brachial artery (Vpmin) and brachial artery peak velocity variation (ΔVp)were different before and after the transformation position (P<0.05).The difference in SHS group was significantly higher than no-SHS group.The areas under ROC curve (AUC)of ΔSBP,ΔDBP,ΔVpmin,ΔΔVp were 0.711 (95%CI 0.575-0.846), 0.573 (95%CI 0.419-0.727),0.948 (95% CI 0.895-0.987),0.864 (95% CI 0.770-0.958),and the cut-off values were 17.5 mm Hg,7.6 mm Hg,17.8 cm/s,and 13.1%.Conclusion The differ-ence of brachial artery peak velocity measured by ultrasonic in different positions of parturient can ef-fectively predict the occurrence of SHS,in which ΔVpmin≥ 17.8 cm/s has better predictive effect.
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Objective To evaluate the efficacy of acupuncture combined with tropisetron in treating nausea and vomiting induced by carboprost tromethamine in cesarean section. Methods Sixty-six patients aged 22-40 yr who received carboprost tromethamine and developed nausea and vomiting during cesarean section under lumbar anesthesia, were randomly divided into 3 groups(n=22 each): acupuncture group (group A), tropisetron group(group T)and acupuncture+ tropisetron group(group AT). In group A, 09% normal saline 2 ml was intravenously injected immediately, acupuncture was given at Renzhong, Neiguan and Hegu acupoints with lifting thrusting twirling the acupuncture needle for 10 min. In group T, tropisetron 10 mg was intravenously injected immediately, the needle was placed on Renzhong, Neiguan and Hegu skin surface. In group AT, tropisetron 10 mg was intravenously injected immediately, acupunc-ture was given at Renzhong, Neiguan and Hegu acupoints with lifting thrusting twirling the acupuncture nee-dle for 10 min. The nausea and vomiting score was assessed before anesthesia induction(T0), when nause-a or vomiting occurred(T1)and at 1, 3, 5 and 15 min after acupuncture or administration(T1-5). The degree of patient′s satisfaction with therapeutic effect was recorded. Results Compared with group A, the nausea and vomiting scores were significantly decreased at T4, and the patient's satisfaction score was in-creased in group AT(P<005). Compared with group T, the nausea and vomiting scores were significantly decreased at T2-4and the patient's satisfaction score was increased in group AT(P <005). Conclusion Acupuncture combined with ondansetron can quickly and effectively relieve the nausea and vomiting induced by carboprost tromethamine during cesarean section.
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Objective To evaluate the effects of penehyclidine hydrochloride on synthesis and release of high mobility group protein box 1 (HMGB1) in macrophages induced by lipopolysaccharide (LPS) in mice.Methods RAW264.7 cells obtained from mice were seeded in the culture dishes.After being cultured for 24 h,the cells were randomly divided into 5 groups (n =6 each) using a random number table.The cells were incubated routinely in group C.The cells were incubated in the presence of LPS 500 ng/ml (group LPS),LPS 500 ng/ml + penehyclidine hydrochloride 0.5 μg/ml (group P1),LPS 500 ng/ml + penehyclidine hydrochloride 2 μg/ml (group P2),or LPS 500 ng/ml + penehyclidine hydrochloride 5 μg/ml (group P3).All the cells were incubated for 24 h.The cells and supernatant were collected.The proliferation of the cells was measured by CCK-8 assay,HMGB1 mRNA expression in the cells was detected by RT-PCR,NF-κBp65 protein expression in the cells was detected by Western blot and the concentration of HMGB1 in the supernatant was detected by ELISA.Results Compared with group C,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly upregulated,and the concentration of HMGB1 in the supernatant was increased in LPS,P1,P2 and P3 groups (P ＜ 0.05).Compared with group LPS,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly down-regulated,and the concentration of HMGB1 in the supernatant was decreased in P2 and P3 groups (P ＜ 0.05).Compared with group P1,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly down-regulated,and the concentration of HMGB1 in the supernatant was decreased in P2 and P3 groups (P ＜ 0.05).There was no significant difference in the indicators mentioned above between group P2 and group P3 (P ＞ 0.05).There was no significant difference in the proliferation of the cells among the 5 groups (P ＞ 0.05).Conclusion Penehyclidine hydrochloride can reduce the synthesis and release of HMGB1 in macrophages induced by LPS through inhibiting NF-κB activation in mice.