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Objective To evaluate the agreement of bispectral index values recorded from tumor side and the contralateral areas during supratentorial craniotomy.Methods Thirty-five patients (16 males, 19 females, aged 18-65 years, ASA physical status Ⅱ or Ⅲ) scheduled for supratentorial tumor resection were enrolled in this study.Bispectral index (BIS) sensors were placed at bilateral frontal areas.The patients were anesthetized with propofol.From each BIS monitor, we collected data at each of four time stages: before the induction of anesthesia, before dura opening, removal of tumor and recovery of conscious.These data were compared using Bland-Altman analysis.Results Bland and Altman analysis revealed a BIS negative-bias (limits of agreement) of before induction-0.8(-7.2-5.7), before dura opening 0.6 (-8.3-9.5), and removal of tumor 1.5(-6.9-9.9), recovery of conscious 0.2 (-9.3-9.8).Conclusion There are significant agreement for BIS values between the frontal area of tumor side and the contralateral areas.BIS values can be used interchangeably between bilateral frontal.
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Objective To investigate the characteristics of postoperative complications and related risk factors in neurosurgery patients. Methods A retrospective study was carried out in neurosurgery patients during anesthesia recovery period from March, 2009 to November, 2013. The recorded complications included respiratory and circulatory system complications, pain, shivering, nausea and vomiting, agitation and delaying recovery. Multivariate logistic regression analysis was performed to screen the risk factors for these complications. Results Da-ta of 13,495 patients were available for analysis. The general incidence was 48.8%. Post-operative complications included post-operative nausea and vomiting (PONV) (14.5%), agitation (13.5%), hypertension (13.4%), arrhythmia (9.3%), shivering (8.9%), pain (5.9%), hypox-emia (2.5%), delayed recovery (1.9%), airway obstruction (1.7%) and hypotension (0.3%). Regression analysis showed that the risk factors for hypoxemia included male,<59 years old and infratentorial tumor (P<0.05);the risk factors for PONV included male, supratentorial tu-mor, infratentorial tumor, cerebrovascular disease, inhalation anesthesia, the use of muscle relaxants antagonism and tramadol (P<0.05);and the risk factors for postoperative restlessness included male, infratentorial tumor and cerebrovascular disease, inhalation anesthesia, the use of muscle relaxants antagonism and no use of patient-controlled analgesia (PCA) pump (P<0.05). Conclusion Patients with different neuro-logical diseases showed different post-operative complications and exhibited different risk factors for these complications. Anesthesiologists should closely monitor patients receiving various neurosurgery and provide timely treatment.
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Objective To investigate the effect of lidocaine on plasma S100β protein in patients with supratentorial tumor surgery.Methods Thirty patients with supratentorial tumor surgery were selected,ASA grade Ⅰ-Ⅱ grade.The patients were divided into lidocaine group and control group by random digits table with 15 cases each.In lidocaine group,a dose of 2％ lidocaine was administered as an intravenous bolus (1.5 mg/kg) after induction,followed by an intravenous infusion at rate of 2 mg/ (kg ·h) until the end of surgery.In control group,0.9％ sodium chloride was given in the same volume and the same rate.Bloods were sampled from bulb of jugular vein to measure the plasma S100β protein before surgery,end of surgery and 1 day after surgery.Results The plasma S100 β protein before surgery,end of surgery and 1 day after surgery in lidocaine group were (21.03 ± 11.67),(32.63 ± 10.14) and (34.16 ± 17.59) ng/L,in control group were (23.04 ± 13.32),(44.98 ± 16.63) and (39.85 ± 21.99) ng/L.There were no statistical differences in the plasma S100 β protein before surgery and 1 day after surgery between the 2 groups (P ＞ 0.05),but there was statistical difference end of surgery between the 2 groups (P ＜ 0.05).Conclusion Intraoperative infusion of lidocaine can decrease the plasma S100β protein end of supratentorial tumor surgery.
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@#Objective To observe the effects of repeated dosing of 6% hydroxyethyl starch (130/0.4) or 7.5% sodium chloride on brain edema after experimental intracerebral hemorrhage (ICH) in rats. Methods 167 male SD rats were divided into four groups randomly: Sham operation group (S, n=20), ICH control group (M, n=38), 7.5% sodium chloride group (N, n=55) and 6% hydroxyethyl starch group (H, n=54). The model of the ICH was established with stereotactically infusing 50 μl of the autologous femoral artery blood into the right caudate nucleus. group N and group H received 7.5% sodium chloride 5 ml/kg and 6% hydroxyethyl starch 30 ml/kg at 2 h, 24 h, 48 h and 72 h after operation respectively. The tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), superoxide dismutase (SOD) and malondialdehyde (MDA) in the tissue around the hemorrhage were measured at different time point. Results The IL-6 in group N was significantly more than that in group M at 24 h and 72 h after infusion (P<0.05), and the TNF-α in group H was less than that in group M at 24 h and 48 h after infusion (P<0.05). The SOD in group M decreased to the bottom at 48 h and 72h after ICH. SOD in group N and group H at 24 h, 48 h and 72 h after infusion was both significant more than that in group M (P<0.05). MDA in group H at 72 h after infusion was less than that in group M (P<0.05). Conclusion Repeated infusion of 6% hydroxyethyl starch (130/0.4) or 7.5% sodium chloride can decrease inflammatory response of brain tissue after ICH, which may protect brain from oxidative damage.
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Objective To investigate the effects of repeated administrations of 6% hydroxyethy] starch (HES) 130/0.4 or 7.5 % NaCl (NS) on brain water content (BWC) after experimental intracerebral hemorrhage (ICH) in rats.Methods One hundred and sixty-seven male SD mrs weighing 260-300 g were randomly divided into 4 groups: group Ⅰ sham operation (S) (n = 20) ;group Ⅱ ICH (n = 38) ;group Ⅲ NS + ICH (n = 55) and group Ⅳ HES + 1CH (n = 54). The animals were anesthetized with intraperitoneal 10% chloral hydrate 400 mg/kg. Experimental ICH was produced by injection of fresh autologous blood 50 μl into right caudate nucleus. In group NS (group Ⅲ) 7.5% NaCl 5 ml/kg and in group HES (group Ⅳ) 6% HES 30 ml/kg were injected at 2, 24, 48 and 72 h after ICH. In group S and ICH (group Ⅰ and Ⅱ) 5 animals were killed at 2, 24, 48 and 72 h after ICH, while in group Ⅲ (NS) and Ⅳ (HES) 5 animals were killed at 2, 24, 48 and 72 h after ICH, immediately before and after NS/HES infusion for determination of ipsilateral and contralateral cerebral cortex and basal ganglion, weight and W/D weight ratio. Rosenberger behavior scores and survival rates were also recorded. Results In group Ⅲ (NS + ICH) and Ⅳ (HES + ICH) the water content of ipsilateral cerebral cortex and basal ganglion was significantly lower than in group Ⅱ (ICH). Rosenberger behavior scores at 24 h and 48 h after ICH were significantly lower in group NS and HES than in group Ⅱ (ICH) . The survival rates at 24, 48 and 72 h after ICH were significandy lower in group Ⅱ than in group NS and HES, especially at 72 h in group HES. Conclusion Repeated administrations of 6% HES 130/0.4 or 7.5% NaCl can ameliorate brain edema after ICH.
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Objective To evaluate the performance of bispectral index (BIS),auditory evoked potential index (AEPI) and cardiovascular response to electrical tetanus stimulus (ETS) for monitoring depth of sedation induced by propofol , analgesia produced by fenanyl and depth of isoflurane anesthesia. Methods Twenty ASA Ⅰ or Ⅱ patients of both sexes (11 males,9 females) aged 18-56 yr, weighing 50-80 kg undergoing elective brain surgery were studied. The patients were unpremedicated. The baseline BIS, AEPI, BP(SP, DP) and HR were measured before anesthesia. Propofol was infused at 0.25 mg?kg-1?min-1 and the infusion was stopped when the total amount of propofol infused reached 5 mg?kg-1 at the end of 20 min infusion. Fentanyl 2 ?g?kg-1 was then given i.v. Three minutes later the patients were intubated and mechanically ventilated. Tracheal intubation was facilitated by vecuronium 0.1 mg?kg-1. Anesthesia was maintained with isoflurane. Depth of sedation was measured using OAA/S scale during propofol infusion. ETS was given at the following time points: when the amount of propofol infused reached 2.5, 3.0, 3.5, 4.0, 4.5, 5.0 mg?kg-1,2 min after fentanyl administration and at 0.7, 1.0, 1.3 MAC isoflurane (end-tidal isoflurane concentration). BIS and AEPI values before and after ETS and changes in BP and HR (ABP, AHR) after ETS and the time for BP and HR to return to the pre-ETS value in 50% and 90% of the patients (TBP50%,TBP90%,THR50%,THR90% ) were recorded. Results BIS and AEPI were positively correlated with sedation depth. There were no significant changes in BIS and AEPI after ETS, but SP, DP and HR increased significantly after ETS( P