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Objective To investigate continuous infusion and inermittent injection of cisatra-curium for deep neuromuscular blockade during laparoscopic surgery and to compare the effectiveness and safety.Methods Sixty ASA Ⅰ or Ⅱ patients,aged from 18 to 65,undergoing selective laparo-scopic gastrointestinal surgery with general anesthesia were randomly divided into 2 groups:group A (n =30)received cisatracurium 0.1 5 mg/kg for intubation,and then continuous infusion of cisatra-curium with micropump at an original rate of 0.2 mg·kg-1 ·h-1 when post tetanic count (PTC)≥3;group B(n =30)was given cisatracurium 0.1 5 mg/kg for intubation,and then intermittent infusion of cisatracurium of 0.05 mg/kg when PTC≥ 3.The cisatracurium consumption,duration of neuro-muscular blocking agent used in group A from induction to the end of infusion and in group B from in-duction to the last infusion,satisfaction of neuromuscular blockade (grade 0-10)of the surgeons,the time of T1 recovered to 25%,75%,TOFr recovered to 0.7,0.9,fulfillment of tongue depressor test,the incidence of hyoxemia after extubation,pneumonia,atelectasis were recorded.Results In comparison with group B,the cisatracurium consumption in group A was significantly more (P <0.05),and the satisfaction of the surgeons was significantly higher at the beginning,1 h,2 h of the operation (P <0.05).The satisfaction of the surgeons respectively showing no significant differences between the two groups at the end of the operation.Recovery index (T1 from 25% to 75%),time of TOFr recovery to 0.7,0.9 in group A was increased,but not statistically.Two patients (7.1%)in group A had hyoxemia after extubation while 1 (4.2%)in group B,the incidence rate was not signifi-cant;3 patients (10.7%)in group A was unable to perform sustained tongue depressor test while 4 (1 6.7%)in group B,the incidence was not significant;all of the patients did not suffer pneumonia and atelectasis.Conclusion Continuous infusion cisatracurium during laparoscopic procedures for deep neuromuscular blockade is effective and safe.The dose of cisatracurium is bigger,and muscular relax-ation would be deeper compared to intermittent infusion.Continuous infusion may prolong the working time of muscle relaxant,but have on influence on the residual effect of muscle relaxant.
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Objective To compare the pharmacodynamics of rocuronium intermittently administered according to body surface area and real body weight and individual differences. Method Forty-two patients undergoing elective surgery under general anesthesia were enrolled into the body surface area group (BSA group) and the real body weight group (RBW group), with 21 patients in each group. The patients in the two groups were induced with 2ED95 of rocuronium according to body surface area and real body weight (16.64 mg/m2 in BSA group; 0.6 mg/kg in RBW group). Whenever T1 recovered to 10%, a dosage of 0.5ED95 was administred repeatedly for 30 min before the end of the operation. The time of neuromuscular blockade and recovery of muscle relaxation were recorded, and the dosage of rocuronium was also recorded. Results No significant difference in each index of neuromuscular block time-effect was found between the two groups (P > 0.05). The single dosage and maintainance amount of muscle relaxation were less in the BSA group than that in RBW group (P < 0.05). Compared with the RBW group, the single dosage, dosing intervals, pharmacological duration and the time TOFr recovered to 0.7 between the different individuals were less in the BSA group (P < 0.05). Conclusion The intermittent administration of rocuronium can maintain the same clinical efficacy according to body surface area as that according to real body weight , with significantly less dosageand reducing the differences of individuals in blockade time-effect of muscle relaxation.
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Ojective To compara the individual differences and clinical efficacy of cis-atracurium intermittent bolus injected according to fat-free mass and real body weight. Methods Forty patients (ASAI-II) who had no neuromuscular disease and underwent selective abdominal surgery under general anesthesia were randomly divided into group FFM (n=20) and group RBW(n=20) according to the different administration method. The responses of adductor pollicis to train-of-four (TOF) stimulation were monitored. Anesthesia was induced with propofol 2 mg/kg, fentanyl 3 ug/kg, cis-atracurium 129.6μg/kg (group FFM) or 100μg /kg (group RBW),and maintained with propofol and fentanyl given by target-controlled infusion. Intubation was attempted when T1 reached maximal inhibition. When the TOF stimulus T1 recovery to 5%, both group additional cis-atracurium 64.8 μg/kg (group FFM) or 50μg /kg (group RBW). The onset time, nonresponsive time, clinical duration, recovery index, pharmacological duration, cis-atracurium consumption, interval and frequency were recorded. Results No significant differences were found in general, interval, frequency,onset time, clinical duration, nonresponsive time,recovery index, pharmacological duration between the two groups (P > 0.05); There were significant differences in the cisatracurium consumption between two groups (P < 0.05); Compare with the group RBW, the differences of pharmacological duration and nonresponsive time between different individuals in group FFM were smaller (P < 0.05). Conclusion It can reduce the individual differences of muscle relaxant effect to apply cis-atracurium and cis-atracurium consumption according to fat-free mass.
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Objective To explore whether lipoxin A4 (LXA4)could prevent lipopolysaccharide (LPS)-induced human umbilical vein endothelial cells (HUVEC) monolayer hyperpermeability and its possible mechanism. Methods Human umbilical cords were obtained from women with normal pregnancy immediately after delivery from Tongji Hospital Affiliated of Tongji Medical College. Primary HUVEC were isolated from umbilical veins and subcultured, then, HUVEC were divided into four groups:control group;LPS group (10 mg/L of LPS); LPS + LXA4 group(10 mg/L of LPS and 100 nmol/L of LXA4); LPS +LXA4 + BOC-2 group [10 μmol/L of BOC-2, an effective antagonist of formyl peptide receptor like 1 (FPRL-1)]. All expriments were performed after cells were treated for 24 hours. Endothelial permeability was measured by fluorescein isothiocyan-ate labelled bovine serum albumin (FITC-BSA) clearance across the monolayer; tumor necrosis factor α(TNF-o) mRNA and secretion were detected by reverse transcriplase (RT) -PCR and ELISA assay respectively, and nuclear factor κB(NF-κB) protein change was determined by western blot. Results (1) LPS induced a significant increase in the permeability [Pa value of LPS group was (183.1 ±1.7)%], while co-administrating with LXA4 obviously attenuated this LPS-induced hyperpermeability, Pa value of LPS + LXA4 group was (103.1 ±2.2)%, LPS + LXA4 + BOC-2 group was (162.2 ± 2.8)%, control group was 100%, the permeability of HUVEC monolayer was significantly increased by LPS which was (83.1 ± 1.7)% of control (P <0.01), however, it was notably inhibited by LXA4 (P<0.05); the blockade of FPRL-1 could attenuate the effect of LXA4, that is, there was no difference between the LPS + LXA4 + BOC-2 group and the LPS group. (2) After treatment with different concentration of LPS(0,0.1, 1,10 mg/L), the mRNA expressions of TNF-α were increased (1.11 ±0.11,1.27 ± 0.03, 1.60 ± 0.06, 1.82 ± 0. 04, respectively), compared with the control group, at the concentration of 1,10 mg/L LPS, the difference was statistically significant (P<0. 05). (3) The increased levels of NF-κB and inflammatory mediator TNF-α in the LPS group were both inhibited by LXA4. Levels of NF-κB protein and TNF-o mRNA secretion in LPS treated group (0.53 ±0.06 and 0.81 ±0.09 ,respectively)were both inhibited by LXA4 (0.19 ± 0.05 and 0.41 ± 0.07, respectively, and both had significant difference, P<0.05). (4) Levels of TNF-α in HUVEC culture medium of LPS group [(31.94 ±0.01)ng/L] was significantly higher than the control group [(18.17 ± 0.03) ng/L, P<0.05], LPS + LXA4 group [(15.72 ± 0.07) ng/L] was significantly lower than the LPS group (P<0.05). Conclusion Our findings demonstrated that LXA4 could prevent the endothelial cell hyperpermeability induced by LPS in HUVEC under which the possible mechanism was through inhibiting the expression of NF-κB and its related cytokines through receptor-dependent.
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Objective To explore the effects of lipoxin A4 ( LXA4 ) on lipopolysaccharide ( LPS)-induced oxidative stress in human umbilical veins endothelial cells(HUVEC) and the possible mechanism.Methods Neonatal umbilical cords were obtained from normal term pregnant women with cesarean section within 4 hours and then were used to isolate HUVEC for subculture.HUVEC were divided into four groups:control group; LPS group ( 10 μg/ml of LPS); LPS + LXA4 group ( 10 μg/ml of LPS and 100 nmol/L of LXA4); LXA4 group (100 nmol/L of LXA4) All expriments were performed after cells treated for 12 and 24 hours respectively.Immunofluorescence was used to detect the expression of Ⅷ foctor and nuclear translocation of nuclear factor-erythroid-2-related factor 2 ( Nrf2 ); the mRNA expression of Nrf2, heme oxygenase 1 (HO-1) and reduced form of nicotinamide-adenine dinucleotide quinone oxidoreductase-1(NQO1) were evaluated by reverse transcription-PCR .Results (1)The flavovirens fluorescence was observed in the cytoplasm under fluorescence microscope, which confirmed the existence of Ⅷ factor which specifically expressed in endothelial cells, especially in HUVEC.(2)Immunofluorescent results showed that in control group, Nrf2 protein expressed in the cytosol rather than in the nucleus.In LPS group, the expression of Nrf2 protein obviously increased in the nucleus while decreased in the cytosol after 12 hours.However, after LPS treatment for 24 hours, Nrf2 expression reduced in the cytosol and nucleus.In cotreatment with LPS and LXA4 group,the expression of Nrf2 protein was much higher than that in LPS group after 12 hours or 24 hours.Furthermore, Nrf2 protein also mostly expressed in the cytosol in LXA4 group.(3) After stimulation for 12 hours, compared with control group, the gene expression of Nrf2 and HO-1 were significantly enhanced in LPS group (0.581 ± 0.019 and 0.081 ±0.009, P ＜ 0.05 ) and in LPS + LXA4group(0.692 ±0.048 and 0.136 ± 0.018, P ＜ 0.05 ), the level of NQO1 mRNA in LPS group and LPS +LXA4 group were 0.381 ± 0.009 ( P ＞ 0.05 ) and 0.574 ± 0.034 ( P ＜ 0.05 ).After treatment for 24 hours,compared with control goup, the gene expressions of Nrf2 and NQO1 were down-regulated in LPS group (0.180±0.017 and 0.472 ±0.064, P＜0.05).But in LPS + LXA4 group the expression of Nrf2 and NQOI were upregulated (0.532 ± 0.051 and 0.830 ± 0.068, P ＜ 0.05, compared with treatment for LPS group).The mRNA expressions of Nrf2, HO-1 and NQO1 were increased in LPS + LXA4 group compared with LPS group ( P ＜ 0.05 ).In addition, there was no markedly difference in the expressions of Nrf2, HO1 and NQO1 between control and LXA4 group after 12 hours and 24 hours ( P ＞ 0.05 ) .Conclusion Through activating nuclear translocation of Nrf2 protein from cytoplasm, LXA4 upregulates the Nrf2downstream enzymes, such as NQO1 and HO-1 to protect HUVEC against the oxidative stress induced by LPS.