ABSTRACT
To investigate the changes of anesthetic drug concentration in plasma during isolation of autologous blood with acute normovolemic hemodiluti-on and its influence on the depth of anesthesia, muscle relaxant effect and blood drug concentration after reinfusion. METHODS: Forty patients of both sexes, aged 20-60 yr, American Society of Anesthesiologists physical status or Ⅱ, hemoglobin (Hb) >120 g / L, hematocrit (Hct) >35%, undergoing eletive multilevel spinal surgery were included, were divided into 2 groups (n=20 each) using a random number table. ANH group (group A): ANH was performed after stable induction of anesthesia, the target Hct value was 28%-30%, and autologous blood was reinfused after the main operation steps. Control group (group C): routine transfusion and infusion treatment. The bispectral index (BIS) and Train-of-Four stimulation (TOF) were observed and recorded at the stable induction of anesthesia (T1), 30 minutes of stable induction (T2), the end of operation (T3), 30 minutes after the end of the operation (T4), 1 hour after the end of the operation (T5) and 2 hours after the end of the operation (T6). The concentrations of propofol and cisatracurium besylate in plasma at T1-T6, stored blood at 1 h (TS1), 2 h (TS2), and before reinfusion (TS3) were detected by Liquid Chromatography-tandem Mass Spectrometry. The extubation time and recovery score at T4-6 hours were recorded. RESULTS: There was no significant difference in propofol between the two groups at each time point (P > 0.05). The plasma concentration of cisatracurium besylate in group A was higher than that in group C at T3 (P0.05). The BIS value at T4 and TOF value at T3 in group A were significantly lower than those in group C. The recovery score of group A was lower than that of group C at T4 (P0.05). CONCLUSION: The plasma concentrations of propofol and cisatracurium besylate were basically unchanged during the in vitro isolation of ANH autologous blood. The plasma concentrations of cisatracurium besylate were only temporarily affected after the main operation steps, but the postoperative muscle relaxation recovery and recovery quality were not significantly affected.
ABSTRACT
Carbon dioxide (CO<sub>2</sub>)-enriched water, one of the Japanese pharmacopeias, has been used as an alternative thermotherapy to treat the intractable diabetic skin diseases. However, few scientific researches on the physiological effects of CO<sub>2</sub>-enriched footbath have been reported. Fifteen males (aged 22-52, 31±10) took part in this study after providing their written informed consents. They took three kinds of footbath (plain water, CO<sub>2</sub>-enriched water and control without water) at 38°C for 30min in random sequence. Their core temperature from oral and tympanic membrane, cutaneous blood flow, tissue hemoglobin concentration at the cerebral frontal cortex and trapezoid muscle, systemic blood pressure, heart rate variability, salivary IgA, comfortable feeling with face scale were measured before, during and after footbath. CO<sub>2</sub>-enriched footbath showed significant physiological effects on the systemic and peripheral circulation. Local (under water) cutaneous blood flow, and tissue blood flow of the frontal cortex were significantly higher than in the plain water footbath. The systolic and diastolic blood pressure and heart rate in CO<sub>2</sub>-enriched footbath were also lower than those in the plain water footbath. Heart rate variability of CO<sub>2</sub>-enriched footbath showed an decrease of LF/HF ratio and more HF/(LF+HF) ratio than that of plain water footbath. These parameters indicated lesser stress for the heart in CO<sub>2</sub>-enriced footbath than in the plain water footbath. The relaxing effect of CO<sub>2</sub>-enriched footbath was also indicated from the results of face scale and salivary IgA concentration. All of these results supported that the CO<sub>2</sub>-enriched footbath was less stressful and more relaxing, and had more physiological effects on the local systemic and cerebral circulatory system and autonomic nervous system than plain water footbath.