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Objective:To evaluate the improved efficacy of nalbuphine combined with propofol in artificial abortion.Methods:One hundred American Society of Anesthesiologists physical status Ⅰor Ⅱ patients, aged 20-43 yr, weighing 50-80 kg, undergoing elective artificial abortion, were divided into 2 groups ( n=50 each) using a random number table method: propofol group (group P) and nalbuphine combined with propofol group (group NP). Phloroglucinol 40 mg was intramuscularly injected at 15 min before surgery.Propofol 2.0 mg/kg was intravenously injected in group P. In group NP, nalbuphine 0.1 mg/kg was intravenously injected, and 2 min later propofol 2.0 mg/kg was intravenously injected.The operation was started after the eyelash reflex disappeared.When operation was affected due to the body movement occurred during operation, an increment of propofol 0.5 mg/kg was given.Visual analogue scale (VAS) score was used to assess the degree of uterine contraction pain during the awake period and the highest degree of uterine contraction pain during the recovery period.The consumption of propofol, development of adverse effects and surgeon′s satisfaction with the anesthetic effect were recorded. Results:Compared with group P, the consumption of propofol was significantly reduced, VAS scores during the awake period and the highest VAS score during the recovery period were decreased, the incidence of body movement that affected operation was decreased (16%/2%), and the surgeon′s satisfaction with the anesthetic effect was increased in group NP ( P<0.05). No adverse cardiovascular events and respiratory depression during operation and postoperative nausea and vomiting was found in the two groups. Conclusion:Intravenous injection of nalbuphine 0.1 mg/kg combined with propofol 2.0 mg/kg can be safely and effectively used for the comfort medical treatment of artificial abortion, and the combination has a significant optimized effect than propofol alone.
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Objective To evaluate the effect of sleep dysfunction on sedation induced by propofol in the patients undergoing radical mastectomy.Methods One hundred breast cancer patients,aged 25-60 yr,with body mass index of 19-23 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective modified radical mastectomy,were randomly divided into 2 groups according to sleep quality.The patients with global Pittsburgh Sleep Quality Index (PSQI) score ≤7 served as regular sleep quality group (Ⅰ group,n =59).The patients with global PSQI score ＞ 7 served as sleep dysfunction group (group Ⅱ,n =41).Anesthesia was induced with propofol given by target-controlled infusion (target plasma concentration of 3.5 μg/ml),and then with remifentanil 4 μg/kg and rocuronium 0.6 mg/kg after loss of consciousness.The consumption of propofol at loss of consciousness was recorded.Results Compared with group Ⅰ,the consumption of propofol at loss of consciousness was significantly decreased in group Ⅱ.Conclusion Sleep dysfunction can enhance propofol-induced sedation in the patients undergoing radical mastectomy.
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Objective To evaluate the effect of chemotherapy on sedation with propofol in breast cancer patients.Methods One hundred female patients,of ASA physical status Ⅰ or Ⅱ,aged 20-60 yr,scheduled for elective modified radical mastectomy,were divided into 2 groups (n =50 each) according to whether receiving neoadjuvant chemotherapy before operation:non-chemotherapy group (group Ⅰ) and neoadjuvant chemotherapy group (group Ⅱ).The breast cancer patients received operation directly in group Ⅰ.The breast cancer patients received neoadjuvant chemotherapy in group Ⅱ.Epirubicin 75-100 mg/m2 was injected intravenously on 1st and 2nd days,docetaxel 75 mg/m2 was injected intravenously on 3rd day,and 3 weeks were considered as 1 course of treatment.The patients received operation at 3 weeks after the end of 4 courses of treatment in group 1.Anesthesia was induced with propofol given by target-controlled infusion and the target plasma concentration of propofol was 3.5 μg/ml.The time for loss of consciousness and consumption of propofol at loss of consciousness were recorded.Results Compared with group Ⅰ,the time for loss of consciousness was significantly shortened,and the consumption of propofol at loss of consciousness and BIS value were decreased in group Ⅱ.Conclusion Chemotherapy can enhance propofol-induced sedation and promote the onset of propofol in breast cancer patients.
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Objective To compare the effects of fentanyl,sufentanil and remifentanil on the immune function of dendritic cells in human umbilical cord blood.Methods Human umbilical cord blood mononuclear cells were obtained by density gradient centrifugation and seeded in 24-well plates with a density of 1 × 106/ml (2ml/hole).The cells were randomly divided into 7 groups (n =15 each):control group (group C),fentanyl 1.0 ng/ml group (group F1),fentanyl 5.0 ng/ml group (group F5),sufentanil 0.1 ng/ml group (group S1),sufentanil 0.5 ng/ml group (group S5),remifentanil 1.0 ng/ml group (group R1),and remifentanil 5.0 ng/ml group (group R5).The cells were incubated for 10 days in serum-free culture medium containing 50 ng/ml recombinant human granulocyte colony stimulating factor,10 ng/ml recombinant human interleukin-4 or the corresponding concentration of fentanyl,sufentanil or remifentanil,and then 50 ng/ml recombinant human tumor necrosis factor alpha was added to the culture medium and the cells were incubated for another 4 days in the seven groups.Three holes in each group were chosen and the cell morphology was examined with inverted microscope.Six holes in each group were chosen for determination of the concentration of IL-12 in the supernatant and expression of CD80/CD86.Six holes in each group were chosen for measurement of the cell viability.Results Compared with group C,the concentration of IL-12 and cell viability were significantly decreased and the expression of CD80/CD86 was down-regulated in groups F5,S1,S5,R1 and R5 (P ＜ 0.05).The concentration of IL-12,cell viability and expression of CD80/CD86 were significantly lower in groups S1 and R1 than in group F1 (P ＜ 0.05).Compared with group F5,the concentration of IL-12 was significantly decreased in group S5,and the concentration of IL-12 and cell viability were significantly decreased and the expression of CD80/CD86 was down-regulated in group R5 (P ＜ 0.05).The concentration of IL-12 and cell viability were significantly lower in group R1 than in group S1 (P ＜ 0.05).The concentration of IL-12,cell viability and expression of CD80/CD86 were significantly lower in group R5 than in group S5 (P ＜ 0.05).Conclusion Remifentanil has stronger inhibitory effect on the immunological function of dendritic cells in human umbilical cord blood than sufentanil,and the inhibitory effect of sufentanil is stronger than that of fentanyl.
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Objective To investigate the effects of fentanyl and remifentanil on the viability of human adenocarcinoma cell line A549.Methods Human adenocarcinoma A549 cells cultured in logarithmic growth phase were seeded in 75 ml culture bottles or 96-well plates.After being cultured for 24 h,the cells were randomly divided into 9 groups (n =30 each):4 fentanyl groups (groups F1-4 ),4 remifentanil groups (groups RF1-4 ) and control group (group C).Groups F1-4 were exposed to fentanyl with the final concentrations of 0.5,5.0,50.0 and 500.0 ng/ml respectively.Groups RF1-4 were exposed to remifentanil with the final concentrations of 0.5,5.0,50.0 and 500.0 ng/ml respectively.The viability of the cells was determined by methyl thiazolyl tetrazolium assay after being incubated for 24,48 and 72 h.The cell cycle progression and apoptosis were determined by flow cytometry after being incubated for 24 h.Results Compared with group C,the viability of A549 cells were gradually decreased at 72 h of incubation,the proportion of the cells in S phase was gradually decreased at 24 h of incubation,and the proportion of the cells in G2/M phase and apoptotic rate were gradually increased in groups F2-4 and in groups RF2-4 ( P ＜ 0.05).Conclusion Fentanyl and remifentanil with the final concentration ≥5 ng/ml can inhibit the viability of human adenocarcinoma cell line A549 in a dose-independent manner by inducing cell apoptosis and cell cycle arrest in G2/M phase.
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Aim To investigate the effects of 6% hydroxyethyl starch 130/0.4(6%HES 130/0.4)and Ringer's solution resuscitation on early lung injury in hemorrhagic shock rats and its mechanisms.Methods Twenty-four male SD rats were divided into 4 groups:sham,Ringer's solution(RS),two HES groups(H1,H2).Group H1,H2 received HES 33,50 ml·kg~(-1) and Ringer's solutions respectively after 90-minute shock(the dose of Ringer's solutions was 3 times as muchas the maximum shed blood volume minus the dose of HES).Blood samples were taken from artery for blood analysis and the expression of CD11b/CD18 at T_0,T_1,T_4,T_5.The lungs were removed for ultrastructure examination.Results PaO_2 increased in group H1 at T_(1～5) and group H2 at T_5 as compared with T_0.PaCO_2 decreased in all the resusitation groups.The ultrastructure was basically normal except that the mitochondria changed slightly in group H1.In group H2,the perinuclear space was dilated slightly and the rough endoplasmic reticulum expanded slightly,and the degranulation was observed.Compared with group RS,the expressions of CD11b and CD18 decreased at T_4,T_5;compared with group H1,the expressions of CD11b and CD18 in group H2 increased.Conclusions Treatment with 6%HES(130/0.4)33 ml·kg~(-1)and Ringer's solution can attenuate hemorrhagic shock,and the resuscitation reduces lung injury through inhibition of expressions of CD11b and CD18.
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Objective To evaluate the effects of volume therapy with different doses of 6% hydroxyethyl starch 130/0.4 (6% HES 130/0.4) on lung injury in a rat model of hemonhagic shock.Methods Twenty-four male SD rats weighing 220-300 g were randomly divided into 4 groups ( n = 6 each) : group I sham operation (group S); group II Ringer's solution (group RS); group HI and IV 2 HES groups (group H1, H2 ). The animals were anesthetized with intraperitoneal 1% sodium pentobarbital 45 ing/kg. Right common carotid artery (CCA) and left femoral vein were cannulated for blood letting, MAP monitoring, fluid administration and blood sampling. Hemonhagic shock was induced by withdrawing blood from right CCA in group II , III and IV . MAP was reduced to 35-45 mmHg which was maintained for 90 min. In group RS, hemorrhagic shock was resuscitated with Ringer's solution 3 times of the volume of blood withdrawn, while group H1 and H2 received HES 33 and 50 ml/kg respectively and Ringer' s solution (the total volume was equal to 3 times of the volume of blood removed) . Arterial blood samples were taken before blood letting (T0 , baseline), and at 2, 3 h after volume therapy (T1,2) for blood gas analysis and PaO2/FiO2 was calculated. The animals were then sacrificed by exsanguination and the lungs were immediately removed for microscopic examination and determination of protein concentration in broncho-alveolar lavage fuid (BALF), W/D lung weight ratio and TNF-α, IL-1 β and IL-10 contents in the lung.Results TNF-α, IL-1β and IL-10 content in the lung, protein concentration in BALF and W/D ratio were significantly higher in group RS, H1 and H2, while PaO2/FiO2 was significantly lower at T,2 in group RS and at T2 in group H2 than in group S (P < 0.05). TNF-α and IL-1β contents in the lung, protein concentration in BALF and W/D ratio were significantly lower in group H1 and H2 , while PaO2/FiO2 was significantly higher at T,i2 in group H1 and at T1 in group H2 than in group RS (P <0.05) . PaO2/FiO2 at T2 and IL-10 content in the lung were significantly lower in group H2 than in group H, ( P < 0.05) . The lung damage was significantly ameliorated in group H1 and H2 especially in group H, as compared with group RS. Conclusion Volume therapy with 6% HES 130/0.4 33 or 50 ml/kg can attenuate lung injury in a rat model of hemorrhagic shock and the efficacy of 33 ml/kg is better.
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Objective To investigate the effect of malignant tumor on neuromuscular block of cisatracurium. Methods Sixty ASA Ⅰ or Ⅱ patients with head and neck neoplasms (15 cases with benign tumor, 45 with malignant tumor), aged 18-64 yr, were randomly divided into 4 groups ( n = 15 each): Ⅰ benign tumor group (group B,3 × ED95 ); Ⅱ -Ⅳ different dose cisatracurium group (group C1 (2 × ED95 ), C2 (3 × ED95 ) and C3 (4 ×ED95)). Neuromuscular block was assessed with accelerograph F (TOF-watch SX). Single stimulation of ulnar nerve was used. Anesthesia was induced with TCI of propofol (target plasma concentration 3 μg/ml) and remifentanil (target effect-site concentration 3 ng/ml). Tracheal intubation was facilitated with cisatracurium 0.15 mg/kg in group B, and with cisatracurium 0.10, 0.15 and 0.20 mg/kg in group C1, C2 and C3 respectively. The onset time, clinical duration, time for recovery of T/Tc to 75 % and recovery index were recorded. Results The clinical duration, time for recovery of T/Tc to 75 % and recovery index were significantly longer in group C2 than in group B (P ＜ 0.05). The onset time was significantly shorter, while the clinical duration and time for recovery of T/Tc to 75% were significantly longer in group C2 and C3 than in group C1 , and in group C3 than in group C2 ( P ＜0.05) .Conclusion The duration of action and recovery times of cisatracurium were prolonged in patients with malignant tumor.
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Objective To evaluate the effects of gender and age on median-effective target plasma concentration(EC50)of propofol administered by target controlled infusion(TCI)causing respiratory depression.Methods Eighty ASA Ⅰ or Ⅱ patients aged 40-79 yr,with body mass index 18-25 kg/m2.undergoing general anesthesia were divided into 4 groups(n=20 each):1 middle-aged male group(MA);Ⅱ middle-aged female group(FA);Ⅲold male group(MO) and Ⅳo ld female group(FO).No premedication was administered.Propofol Was administered by TCI for 15 min,using TCI system incorporating Marsh pharmacokinetic model.EC50 Was determined by up-end-down sequential trial.The target plasma concentration(Cr)was set at 3.1μg/ml in the first Patient in each group.Each time Cr increased/decreased by 10%in the next patient depending on whether or not the respiratory depression occurred.Respiratory depression was defined as RR<8 bpm,Vr≤5 ml/kg,end-tidal PCO2≥50 mm Hg,SaO2≤94%and/or apnea≥15s.Results The EC50 and 95%confidence interval of propofol TCI causing respiratory depression were 6.40(6.09-6.72)μg/ml in group MA,5.93(5.54-6.34)μg/ml group FA,4.58(4.32-4.91)μg/ml in group MO and 4.37(4.14-4.61)μg/ml in group FO.EC50 was significantly lower in group FO than in group FA and in group MO than in group MA,but there Was no significant difference in EC50 between group MA and group FA or between group MO and FO. Conclusion The potency of propofol given by TCI causing respiratory depression is increased in the old patients as compared with the middle-aged patients and is not related to sex.
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Objective To investigate the effects of sufentanil,remifentanil and fentanyl oH cellular immune function in patients undergoing radical resection of esophageal cancer.Methods Forty-five ASA Ⅰ or Ⅱpatients aged 45-64 yr undergoing radical resection of esophageal cancer were randomly divided into 3 groups(n=15 each):sufentanil group(SF);remifentanil group(RF)and fentanyl group(F).The patients were premedicated with iv atropine 0.5 mg.Anesthesia was induced with midazolam 0.04 mg/kg,propofol TCI(CT=3μg/ml)and TCI of sufentanil,remifentanil or fentanyl(CT=0.5,5 and 5 ng,ml respectively in the 3 groups).Endobronchial intubation was facilitated with vecuronium 0.1 mg/kg.The patients were mechanically ventilated.PETCO2 was maintained at 30-40 mm Hg.Anesthesia was maintained with inhalation of sevoflurane(0.7-1.5 MAC)and TCI of sufentanil,remifentanil or fentanyl(CT=0.5,5 and 5 ng/ml respectively).Venous blood samples were taken from peripheral vein before anesthesia(T0,baseline),60 min after skin incision(T1),immediately(T2),24 h(T3)and 72 h(T4)after the end of operation for determination of the expression of CD3+,CIM+,CD8+on T cells and CD3-CD16+CD56+on natural killer cells by flow cytometry,CD4+/CD8+ratio,serum concentrations of IL-2 and IL-10 by ELISA.Results Compared with the baseline values,the CD4+T-lymphocytes and CIM+/CD8+ratio were significantly decreased at T2,while the CD3-CD16+CD56+NK cells were significantly increased in all 3 groups.The CD3+T-lymphocytes were significantly decreased at T2 as compared to the baseline value at T0 in SF and RF groups.The CIM+and CD3+T-lymphocytes were significantly decreased at T3 as compared with the baseline value in all 3 groups.Serum IL-2 concentration was significantly higher at T3 in SF group than in RF group.Serum IL-10 concentration was sismficantly higher at T4 in RF group than in SF group.Conclusion Sufentanil,remifentanil and fentanyl can depress cenular immune function to some extent in patients undergoing radical resection of esophageal cancer.
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Objective To determine the difference between target and measured concentration of remifentanil given by target-controlled infusion (TCI) and evaluate the performance of a new type Ⅰ TCI system for Chinese. Methods Thirty-six ASA Ⅰ or Ⅱ patients aged 40-60 yr weighing 50-70 kg undergoing elective lung resection were randomly divided into 2 groups according to target remifentanil concentration: group Ⅰ 6 ng ? ml-1 and group Ⅱ 8 ng?ml-1. The patients were premedicated with intramuscular midazolam 0.05 mg?kg-1 and atropine 0.5 mg. Anesthesia was induced with remifentanil and propofol both given by TCI. The target concentration of propofol (effect-site concentration) was set at 3 ?g?ml-1 and remifentanil (plasma concentration) at 6 or 8 ng? ml-1. When the patients lost consciousness, vecuronium 0.1 mg?kg-1 was given i. v. to facilitate intubation. The patients were mechanically ventilated and PETCO2 was maintained at 30-40 mm Hg. Anesthesia was maintained with TCI of propofol and remifentanil and intermittent i. v. boluses of vecuronium. Target plasma concentration of remifentanil remained unchanged during anesthesia. BIS value was maintained at 45-55 by modifying target propofol concentration. Arterial blood samples were taken before and 5, 10, 20, 40, 60, 90 and 120 min after TCI remifentanil was started for determination of blood remifentanil concentration by high performance liquid chromatography.The performance error (PE) was determined for each measured blood remifentanil concentration. The performance in the population was determined by median absolute performance error (MDAPE), median performance error (MDPE) and the wobble (the median absolute deviation of each PE from the MDPE). Results The measured concentrations (Cm) of remifentanil were significantly lower than the target plasma concentration (Cp) at5, 10, 20 min of TCI in both groups ( P
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0 05), only T 8 level decreased significantly in group Ⅲ (P
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Objective To investigate the effect and safety of combined spinal-epidural analgesia (CSEA) with different doses of ropivacaine during labor. Methods One hundred ASA Ⅰ -Ⅱ full term primigravidae were randomly divided into 5 groups: group Rl (n =20), R2 (n =21), R3 (n = 21), group Y ( n = 19) and group C ( n = 20) . When the external cervical os was dilated to 3-4cm lumbar puncture was performed at L2-3 or L3-4 with a special CSE needle. 0.75% ropivacaine 0.33ml (2.5mg), 0.5ml (3.75mg) or 0.67ml (5mg) was added to 5% glucose with a total volume of 2.5ml and injected into subarachnoid space in group R1, R2 and R3 respectively. When subarachnoid block was wearing off, patient controlled-epidural analgesia (PCEA) with 0.175% ropivacaine was started (background infusion 6ml/h, bolus 2ml, lock-out time 15min) . In group Y patients received only PCEA with 0.175% ropivacaine and in group C patients received neither CSEA nor PCEA and served as control. Level of pain (VAS scores), degree of motor block (modified Bromage scores), Apgar scores and neurological and adaptive capacity scores (NACS), the progress of labor, the amount of ropivacaine used and side effects were recorded and compared. Blood samples were taken from umbilical vein for blood gas analysis immediately after delivery. Results Demographic data were comparable between groups and there were no significant differences in the progress of labor, Apgar score, NACS and blood gases of umbilical venous blood between groups. The onset of analgesia was significantly faster in group R1, R2 and R3 than that ingroup Y(P
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OBJECTIVE:To develop a RP-HPLC method for determining serum concentration of propofol METHODS:Using ODS C18 column as fixed phase,a mixture of methanol and water(75∶25) as mobile phase,excitation wavelength 270nm,emission wavelength 295nm RESULTS:The linear range was 0 0 375～8 0?g/ml,r=0 9 996 The within-day and between-day RSDs were less than 5%,the average recovery was 83 98% CONCLUSION:This is a good method to monitor propofol serum concentration