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Objective To compare the different doses of dexmedetomidine combined with remifen-tanil and propofol for anesthesia in the burn patients with non-intubation. Methods Sixty burn patients of both sexes, aged 18-64 yr, with body mass index of 19-24 kg∕m2 , of American Society of Anesthesiologists physical statusⅠorⅡ, scheduled for elective skin grafting with burn covering less than 10％ of the total body surface, tangential excision, or dressing change with burn covering 10％-50％ of the total body surface, were selected and divided into A, B and C groups using a random number table method, with 20 patients in each group. In A, B and C groups, dexmedetomidine 1. 0 μg∕kg was intravenously infused for 10 min at a constant rate, followed by an infusion of 0. 6, 0. 8 and 1. 0 μg·kg-1 ·h-1 , respectively, until 10 min be-fore the end of surgery. Remifentanil and propofol were given by target-controlled infusion via the dual chan-nel, the target plasma concentration of propofol was adjusted to maintain the index of consciousness at 40-60, and administration was stopped at the end of surgery in three groups. The development of respiratory depres-sion, body movement and hypotension was observed during operation. The consumption of remifentanil and propofol, emergence time and Ramsay sedation score at 1 h after operation were recorded. Results Com-pared with group A, the incidence of respiratory depression and consumption of propofol were significantly de-creased, and the rate of satisfaction with sedation was increased in B and C groups (P<0. 05), and the inci-dence of hypotension was significantly increased in group C ( P<0. 05) . The incidence of hypotension was sig-nificantly higher in group C than in group B ( P<0. 05) . There were no significant differences in the consump-tion of remifentanil or emergence time among three groups ( P>0. 05) , and no body movement was found in three groups. Conclusion Intravenously infused dexmedetomidine 0. 8 μg·kg-1 ·h-1 combined with remifentanil and propofol provides better efficacy when used for the burn patients with non-intubation.
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Objective To evaluate the effects of different doses of dexmedetomidine on stress responses of the hypertensive patients undergoing thoracic surgery and find the uptimal infusion rate of dexmedetomidine in decreasing stress responses.Methods Sixty hypertensive patients of both sexes,aged 45-64 yr,weighing 65-80 kg,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,were divided into 4 groups (n =15 each) using a random number table:control group (group C) and 3 different doses of dexmedetomidine groups (D1-3 groups).In D1,D2 and D3 groups,dexmedetomidine 0.2,0.3 and 0.4 μg · kg 1 · h 1 were intravenously infused until 30 min before the end of surgery,respectively,starting from 15 min before induction of anesthesia.The equal volume of normal saline was given instead of dexmedetomidine in group C.Before administration of dexmedetomidine (T0),at 1 min after endotracheal intubation (T1),at skin incision (T2) and immediately after extubation (T3),venous blood samples were collected for determination of epinephrine and norepinephrine concentrations in plasma (using high-performance liquid chronatography) and blood glucose concentrations.The development of adverse effects such as bradycardia,hypotension and respiratory depression was recorded.Results Compared with group C,epinephrine and norepinephrine concentrations in plasma and blood glucose concentrations were significantly decreased at T1-3 in D1,D2 and D3 groups,the incidence of bradycardia and hypotension was significantly increased in group D3 (P＜0.05),and no significant change was found in the incidence of bradycardia or hypotension in D1 and D2 groups (P＞0.05).There were no significant differences in epinephrine and norepinephrine and concentrations in plasma and blood glucose concentrations at each time point between group D1,group D2 and group D3 (P ＞ 0.05).Conclusion The optimal infusion rates of dexmedetoinidine are 0.2 and 0.3μg · kg-1 · h-1 in decreasing stress responses of the hypertensive patients undergoing thoracic surgery.
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Objective To evaluate the effects of personality on the development of postoperative cognitive dysfunction (POCD) in elderly patients undergoing gastrointestinal surgery.Methods Fifty-eight elderly patients,aged 65-70 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with Eysenck Personality Questionnaire (EPQ) P rating scale score ＜50,scheduled for elective gastrointestinal surgery under general anesthesia,were enrolled in the study.Personality was assessed by using EPQ at 1 day before surgery.By using a 2 × 2 factorial design,2 empirical factors introversion or extroversion (factor A) and neuroticism (factor B) were used.A1 and A2 were introversion (EPQ E rating scale score＜50) and extroversion (EPQ E rating scale score ≥ 50),respectively.B1 and B2 were emotional stability (EPQ N rating scale score＜50) and emotional instability (EPQ N rating scale score ≥ 50),respectively.The patients were divided into 4 groups:A1B1 group (n=8),A1B2 group (n=10),A2B1 group (n=26),and A2B2 group (n =14).Cognitive function was assessed at 7 days after surgery,and the development of POCD was recorded.Results The incidence of POCD was 0,0,15％ and 57％ in A1B1,A1B2,A2B1and A2 B2 groups,respectively,the incidence of POCD was significantly higher in group A2B1 than in A1B1and A1 B2 groups,and the incidence of POCD was significantly higher in group A2B2 than in the other three groups (P＜0.05).Factor A and factor B produced effects on the development of POCD (P＜0.01),and an interaction between them was found (P＜0.01).Conclusion The incidence of POCD is higher for the non-mentation patients who are extroverted and emotionally unstable.
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Objective To compare the postoperative analgesic effect of the single dose of oxycodone and dezocine in patients who underwent gynecological laparoscopic operation. Methods Sixty patients who underwent elective gynecological laparoscopic operation were randomly divided into two groups (n=30): oxycodone group (group O) and dezocine group (group D). Fifteen minutes before the end of surgery, oxycodone 0.1 mg/kg was given in O group, and dezocine 5 mg was given to D group. Twenty minutes before the end of surgery, tropisetron 5 mg was given to both groups. Analgesia was maintained by propofol-remifentanil with TCI. The mean arterial pressure (MAP) and heart rate (HR) of T1, T2, T3 and T4 were recorded respectively in both two groups. After the operation, pain of visual analogue scale (VAS) was assessed in 2 h ,4 h , 6 h and 24 h, respectively. Results There were no significant differences in MAP and HR between two groups at T1, T2, T3 and T4 (P＞0.05). The VAS score was significantly lower in group O than that of group D (P＜0.05). There was significant difference in the incidence of nausea between the two groups (P＜0.05). Conclusion Single dose of oxycodone 0.1 mg/kg can be used for postoperative analgesia after gynecological laparoscopic operation, and which has better analgesia than that of dezocine, except for the adverse reaction of nausea.
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Objective To evaluate the effect of obesity on the potency of propofol for sedation.Methods Sixty patients of both sexes, aged 35-55 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , scheduled for elective operation under general anesthesia, were enrolled in the study.The patients were divided into 2 groups (n=30 each) according to the body mass index (BMI) : normal body weight (BMI ＜ 25 kg/m2) group (group C) and obesity (BMI 30-40 kg/m2) group (group O).No patients received premedication.Propofol was given by target-controlled infusion.The initial target plasma concentration of propofol was set at 1.2 μg/ml.After the target concentration was steadily maintained for 30 s, it was increased in 0.3 μg/ml increment until the patients lost consciousness (OAA/S score =1).The target plasma concentration of propofol was recorded during each period.The median effective concentration (EC50) and 95％ confidence interval of propofol for loss of consciousness was calculated using probit analysis.Results The EC50 and 95％ confidence interval of propofol for loss of consciousness were 3.82 (3.73-3.90) and 3.29 (3.20-3.37) μg/ml in group C and group O, respectively.Compared with group C, the EC50 was significantly decreased in group O (P＜0.05).Conclusion Obesity can enhance the potency of propofol for sedation.
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Objective To evaluate the accuracy of stroke volume variation (SVV) in monitoring the changes in blood volume during laparoscopic surgery.Methods Forty ASA physical status Ⅰ or Ⅱ patients of both sexes,aged 40-64 yr,with body mass index ranged from 20 to 25 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were studied.After induction of general anesthesia,baseline registrations of variables were obtained.After establishing pneumoperitoneum,6％ hydroxyethyl starch (HES 130/0.4) 500 ml was infused over 30 min.Before pneumoperitoneum (T1),at 5 min after pneumoperitoneum (T2),immediately before volume expansion (T3) and at 3 min after volume expansion (T4),cardiac output (CO),cardiac index (CI),SV,stroke volume index (SVI) and SVV were monitored and recorded.The changing rate of CI (△CI) was calculated.The criterion for effective volume expansion was △CI ≥ 15％.The ROC curve for SVV in determining the volume expansion responsiveness was plotted,and the diagnostic threshold was determined.The area under the curve and 95％ confidence interval were calculated.Results SVV was significantly lower at T2 than at T1.CO,CI,SV and SVI were significantly higher,and SVV was lower at T4 than at T3.The results of ROC curve analysis showed that a 9.2％ SVV threshold discriminated between responders and non-responders with a sensitivity of 61％ and a specificity of 50％,and the area under the curve (95％ confidence interval) was 0.567 (0.378-0.757).Conclusion SVV is not a suitable index in monitoring the changes in blood volume during laparoscopic surgery.
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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 investigate the effect of carbon dioxide ( CO2 ) pneumoperitoneum on the neuromuscular block of cisatracurium in patients undergoing laparoscopic operation.Methods Sixty ASA Ⅰ or Ⅱ patients,aged 35-60 yr,with body mass index of 18-24 kg/m2,scheduled for elective hysterectomy,were randomly divided into 2 groups ( n =30 each ):pneumoperitoneum group ( group P) and control group ( group C ).Each group was further divided into 2 subgroups according to the use of the antagonist of neuromuscular block ( n =15 each):no neostigmine group ( group P0 or C0 ) and neostigmine group (group P1 or C1 ).Anesthesia was induced with fentanyl,propofol and cisatracurium and maintained with target-controlled infusion of propofol and remifentanil.Tracheal intubation was performed and the patients were mechanically ventilated.Neuromuscular function was monitored by TOF-Watch SX accelerography (Organon Co.,Organon).A train of four (TOF) stimulation of the ulnar nerve was used.When T,returned to 5％ of control height after CO2 pneumoperitoneum was established,cisatracurium 0.05 mg/kg was injected intravenously in group P.When T1 returned to 25％ of control height after the end of operation,neostigmine was injected intravenously in groups P1 andC1.The clinical duration and recovery index were recorded after CO2 pneumoperitoneum was established.Arterial blood samples were obtained immediately before induction,at 30 and 60 min of pneumoperitoneum,and at the end of operation for blood gas analysis.Results The clinical duration and recovery index were significantly longer in group P0 than in group C0,and in group P1 than in group C1 ( P ＜ 0.05).Compared with group C0,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P0 ( P ＜ 0.05).Compared with group C1,the pH value was significantly decreased and PaCO2 was significantly increased at 30 and 60 min of pneumoperitoneum,and at the end of operation in group P1 ( P ＜ 0.05).Conclusion CO2 pneumoperitoneum can strengthen the neuromuscular block induced by cisatracurium and prolong the recovery time following antangonism by neostigmine administration in patients undergoing laparoscopic operation.
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Objective To investigate the effects of edaravone pretreatment on the lung injury during onelung ventilation (OLV) in patients.Methods Forty ASA Ⅰ or Ⅱ male patients, aged 48-64 yr, with body mass index 18-26 kg/m2, undergoing elective resection of esophageal carcinoma, were randomly divided into 2 groups (n = 20 each): control group (group C) and edaravone group (group E). Anesthesia was induced with fentanyl,propofol and rocuronium and maintained with sevoflourane, remifentanil and atracurium. The patients were mechanically ventilated (during OLV VT 8 ml/kg, RR 15 bpm, I:E 1:1.5). In group E edaravone 0.5 mg/kg (in normal saline 100 ml) was infused over 30 min after skin incision. PETCO2 and peak airway pressure (Ppeak) were recorded during operation. Venous blood samples were obtained before opening the thoracic cavity and at the end of operation for determination of serum SOD activity and the levels of serum surfactant protein A (SP-A), MDA and TNF-α. Results There was no significant difference in PETCO2 and Ppeak during operation between the two groups (P ＞ 0.05). Serum SOD activity was significantly decreased, while the levels of serum SP-A, MDA and TNF-α were significantly increased after OLV in both groups (P ＜ 0.05). Serum SOD activity was significantly higher,while the levels of serum SP-A, MDA and TNF-α were significantly lower at the end of operation in group E than in group C (P ＜ 0.05). Conclusion Edaravone pretreatment can reduce the lung injury during OLV through inhibiting oxidative response and inflammatory response in patients.
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Objective To investigate the effect of CHRNA1 genetic polymorphism on neuromuscular blockade induced with rocuronium. Methods Ninety-five ASA Ⅰ or Ⅱ patients of both sexes (age 18-64 yr,BMI 18-25 kg/m2 ) undergoing elective intra-abdominal surgery under general anesthesia were divided into 3 groups according to their genotypes: group Ⅰ AA ( n = 71 ); group Ⅱ AG ( n = 19) and group Ⅲ GG ( n = 5). ECG,BP, HR and SpO2 were continuously monitored during anesthesia. Neuromuscular function was assessed by response of adductor pollicis muscle to stimulation of the ulnar nerve using TOF-Watch SX monitor. Genomic DNA was extracted by using proteinase K digestion followed by a salting out prosedure. rs16862847 polymorphisms were analyzed by PCR-restriction fragment length polymorphism analysis and direct sequence analysis. Anesthesia was induced with fentanyl 4 μg/kg and propofol 2 mg/kg. Rocuronium 0.2 mg/kg was injected iv as soon as the patients lost consciousness. Results The twitch height of adductor pollicis muscle was significantly decreased in group AG and GG as compared with group AA ( P ＜ 0.05). There was no significant difference between group AG and GG.Conclusion CHRNA1 genetic polymorphism can influence the neuromuscular blockade induced with rocuronium,indicating that the genetic factor is one of the reasons contributing to the individual variation in neuromuscular blockade induced with muscle relaxants in patients.
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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 evaluate the feasibility of application of preoperative acute hypervolemic hemodilution (AHH) to the patient with carcinoma during major surgery Methods Forty ASA Ⅰ Ⅱ patients scheduled for resection of esophagus or cardia cardinoma were randomized to two groups: in AHH group with the routine infusion of lactated Ringer's solution, Gelofusine solution 15ml/kg was infused intravenously at a rate of 80 ml/min immediately before incision under isoflurane inhalation anesthesia, and in control group only lactated Ringer's solution was administered routinly under isoflurane inhalation anesthesia In both groups, MAP, HR, CVP,SpO 2 and P ET CO 2 were monitored during the whole anesthetic procedures; Hb, Hct, Pt and Aptt were measured before and after the hemodilution, at the end of operation, 24h and 1 week after operation; The volume of infusion, blood loss and blood transfusion were recorded during the operation Results Following hemodilution in AHH group , CVP increased markedly (P0 05); the required volume of lactated Ringer's solution and blood loss remained unchanged significantly,but transfusion volume reduced significantly in AHH groups (P