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Objective:To evaluate the anesthetic efficacy of remiazolam combined with alfentanil in the patients undergoing painless gastroscopy.Methods:A total of 400 patients of both sexes, aged 20-64 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, scheduled for elective painless gastroscopy, were divided into 2 groups ( n=200 each) using the computer-generated random numbers: remimazolam combined with alfentanil group (group RA) and propofol combined with alfentanil group (group PA).All subjects inhaled oxygen and were denitrogenated by deep inhalation.Alfentanil 7 μg/kg and remimazolam 0.2 mg/kg were intravenously injected in group RA, and alfentanil 7 μg/kg and propofol 1.5 mg/kg were intravenously injected in group PA.When body movement occurred during operation, remimazolam 2.5 mg was intravenously injected in group RA, propofol 0.5 mg/kg was intravenously injected in group PA, and anesthesia was defined as failure when there was still body movement after 3 times of additional injection within 15 min.The success of anesthesia, effective time of sedatives, time of gastroscopy, emergence time, perioperative adverse reactions, and satisfaction score of endoscopic surgeons-anesthesiologists-patients were assessed using visual analog scale score. Results:Compared with group PA, the incidence of hypotension (6.2%/14.0%), bradycardia (6.2%/19.0%), respiratory depression (3.1%/8.0%), injection pain (2.1%/30.0%), postoperative nausea (6.3%/25.0%), fatigue (7.8%/14.0%) was significantly decreased, and the incidence of hiccup (8.3%/1.0%) and patient′ s satisfaction score were increased in group RA ( P<0.05).There was no significant difference between the two groups in the success rate of sedation, effective time of sedatives, time of gastroscopic examination, emergence time, satisfaction scores of anesthesiologists-endoscopic surgeons, and incidence of postoperative vomiting, dizziness, and lethargy ( P>0.05). Conclusions:Compared with conventional anesthesia for painless gastroscopy, remiazolam (0.2 mg/kg) combined with alfentanil (7 μg/kg) has a certain optimization effect in anesthesia for gastroscopy.
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Objective To compare the cardiac function in patients with type 2 diabetes (T2DM) and insulin resistance(IR),and analyze the correlation between IR and cardiac function.Methods A total of 282 patients with T2DM were enrolled randomly in this study from our clinic and ward from Aug.2015 to Aug.2016.All the subjects were divided into two groups according to the level of HOMA-IR:HOMA-IR ＜2.69 group(n=153) and HOMA-IR≥2.69 group(n=129).Healthy subjects were selected as the normal control group (NC group,n=150).The clinical data and biochemical index were collected in all the subjects.The cardiac function index included LVPWTd,WsTd,LVSV,LVFS and LVEF were tested and compared among the three groups.Pearson's correlation analysis was used to evaluate the correlation between HOMA-IR and cardiac function index.Multiple stepwise linear regression was adopted to analyze the influencing factors for cardiac systolic function(LVEF) and diastolic function(E/A).Results (1) FPG,2 hPG and FIns decreased,while HOMA-β increased from HOMA-IR≥ 2.69 group,HOMA-IR＜ 2.69group to NC group (P＜0.05 or P＜0.01);(2) LVPWTd [(15.43±1.92) vs (11.38±1.78) vs (10.16±1.50) mm,P＜0.05 or P＜0.01)and WSTd [(14.35±2.00) vs (10.46±1.67) vs (9.00±1.08) mm,P＜0.05 or P＜0.01)were higher in HOMA-IR≥2.69 group and HOMA-IR＜2.69 group than in NC group.LVSV[(55.15±8.26)％ vs (60.27±8.12)％ vs (65.33±7.78)％,P＜0.05 or P＜0.01],LVEF [(62.41±8.89)％ vs (71.57±5.16)％ vs (76.35±7.80)％,P＜0.05 or P＜0.01],and E/A[(0.65±0.11) vs (0.76±0.18) vs (1.03±0.23),P＜0.05 or P＜0.01] were lower in HOMA-IR≥2.69 group and HOMA-IR＜2.69 group than in NC group.(3)Pearson correlation analysis showed that HOMA-IR was negatively correlated with LVEF and E/A(r=-0.746,-0.729,P=0.001).(4) Multiple stepwise linear regression analysis showed that HOMA-IR was an influencing factor for LVEF and E/A(P＜0.05 or P＜0.01).Conclusion With the aggravating of IR,LVEF and E/A are declined in diabetic patients.IR is a common risk factor for LVEF and E/A.
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Objective To evaluate the effects of multiple exposures to sevoflurane anesthesia on the expression of apolipoprotein E (ApoE) in the hippocampus of neonatal rats.Methods Twenty-four pathogen-free Sprague-Dawley rats (12 males,12 females),aged 7 days,weighing 15-20 g,were randomly divided into 2 groups (n=12 each) using a random number table:control group (group Con) and multiple exposures to sevoflurane anesthesia group (group Sev).On postnatal day 7,14 and 21,2.6％ sevoflurane was inhaled for 2 h in group Sev,while the mixed gas of oxygen and air was inhaled instead of sevoflurane in group Con.Morris water maze test was carried out on postnatal day 31-37 to assess cognitive function.The rats were then sacrificed,and the hippocampus was removed to determine the expression of ApoE protein in hippocampal CA1,CA3 and DG regions (by immunohistochemistry) and the expression of ApoE mRNA (by fluorescent quantitative real-time reverse transcriptase polymerase chain reaction).Results There was no significant difference between the two groups in cognitive function (P＞0.05).Compared with group Con,the expression of ApoE protein in hippocampal CA1 and CA3 regions and ApoE mRNA was significantly up-regulated in group Sev (P＜0.05),and no statistically significant change was found in the expression of ApoE protein in hippocampal DG region in group Sev (P＞0.05).Conclusion Multipie exposures to sevoflurane anesthesia can up-regulate the expression of hippocampal ApoE and produce mild neurotoxicity without causing changes in cognitive function in neonatal rats.
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Objective To evaluate the neurotoxicity induced by multiple exposures to sevoflurane anesthesia in the neonatal rats.Methods Thirty-two healthy SPF Sprague-Dawley rats of both sexes,aged 7 days,weighing 15-20 g,were randomly divided into 2 groups (n=16 each) using a random number table:control group (group C) and multiple exposures to sevoflurane anesthesia group (group Sev).On postnatal day 7,14 and 21,2.6％ sevoflurane was inhaled for 2 h in group Sev,while the mixed gas of oxygen and air was inhaled instead of sevoflurane in group C.Morris water maze test was carried out on postnatal day 32-36 to assess the cognitive function.On postnatal day 21 and 36,8 rats in each group were selected and anesthetized,and the cerebrospinal fluid was collected for determination of the concentrations of amyloid β-protein by enzyme-linked immunosorbent assay.Results Compared with group C,no significant change was found in the escape latency,movement time spent in the effective region of the platform,movement distance,the number of entries into the effective region,percentage of residence time,percentage of movement distance,and percentage of the number of entries (P＞0.05),and the concentrations of amyloid β-protein in the cerebrospinal fluid were significantly increased on postnatal day 36 in group Sev (P＜0.05).Conclusion Multiple exposures to sevoflurane anesthesia can induce central neurotoxicity,but do not induce changes in the cognitive function in the neonatal rats.
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Obj cetive A large number of recent studies show that sevoflurane anesthesia may cause learning and memory dysfunction.The aim of this study was to explore changes of learning and memory ability and hippocampal volume in infantile rats after neonatal interrupted and repeated inhalation of 2.6% sevoflurane through detecting the learning and memory ability by Morris water maze and the hippocampus volume by MRI.Method s Thirty two neonatal SD rats were randomly devided into two groups (n=16):experimental group and control group.Rats inhalated 2.6%sevoflurane in the experimental group and 1 L/min O2 +1 L/min Air in the control group at the postnatal days of 7, 14 and 21 (P7, P14, P21). The learning and memory ability was determined by the Morris water maze test from P31 to P37;The brains of rats were scanned by mag-netic resonance imaging ( MRI) machine under anesthesia with 1%sodium pentobarbital at P37, and the brain and bilateral hippocampal volumes were measured. Results ①In the place navigation test, the escape latency had no significant difference between the two groups (P>0.05).In the spatial probe test, the dwelling time, movement distance and number of entering times in platform quadrant decreased slightly in experimental group compared with those in the control group, while there was no significant difference (P>0.05).②The brain volume [(1.53 ±0.18) cm3 vs (1.60 ±0.13) cm3] and right hippocampal volume [(16.15 ±1.76)mm3 vs(16.46 ±1.71)mm3] had no significant difference between the two groups (P>0.05).The left hippocampal volume [(16.46 ±1.71)mm3] was decreased in the experimental group compared with the control group [(18.10 ±2.53)mm3](P<0.05). Conclusion The learning and memory ability has no significant changes in in-fantile rats after neonatal interrupted and repeated sevoflurane inhalation and MRI examination of hippocampal volume is not sufficient for the diagnosis of cognitive dysfunction.
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Objective To evaluate the feasibility and security of general anesthesia for elective surgery in infants with mild upper respiratory tract infections (URI). Methods A total of 169 cases of infants underwent general anesthesia for elective surgery, ASAⅠorⅡ, both sexes, aged 20 days to 36 months, were divided into URI group (n=41) and non-URI group (n=128), according to the preoperative symptoms of URI. The general data, the perioperative and postoperative respiratory-related complications were observed and recorded. Results (1) There was a higher incidence rate of breath holding during the operation in URI group than that of URI group. There were no significant differences in cough, sputum, blood oxygen saturation (SpO 2)<0.95, fever, glossoptosis between two groups. No fever was found in both groups. There was a higher incidence rate of sputum after operation in URI group. There were no significant differences in other complications including cough, SpO2<0.95, fever, glos?soptosis and incidence rate of breath holding between two groups. No laryngospasm and bronchospasm were found during operation and after operation in two groups. (2)The incidence of postoperative cough and fever increased, while the inci?dence rates of SpO2<0.95 and glossoptosis were lower after operation compared with those during operation in non-URI group. In URI group, the incidence rate of postoperative fever was higher,and SpO2<0.95 and breath holding was lower. There were no significant differences in other complications in URI group. Conclusion It is feasible and relatively safe to implement tracheal intubation general anesthesia for the infants with mild URI under thorough preoperative assessment and careful opera?tive management.
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Objective:To analyze the clinical characteristics and treatment effect between bilateral(bi-)and unilateral(uni-) sudden sensorineural hearing loss(SSNHL).Method:Four hundred and eighty cases of SSNHL were retrospective study,which were divided into two groups of bi-SSNHL(n=40) and uni-SSNHL(n=440).Clinical characteristics and treatment effects were compared of the two groups.Result:The incidence rate of bi-SSNHL was 8.3 percent and uni-SSNHL was 91.7 percent of all patients with SSNHL. Bi-SSNHL occurs more commonly in patients of old age, diabetes mellitus, and lipid panes abnormalities compared to uni-SSNHL. Twenty-eight ears in the bi-SSNHL group showed hearing recovery (35%),compared with 56.4 percent of patients with uni-SSNHL.Conclusion:Bi-SSNHL and uni-SSNHL may have a completely different clinical characteristics and treatment effect,that implies a different pathophysiology and prognosis. Recognition their different clinical characteristics and treatment effect between bilateral and unilateral SSNHL can help in counseling and managing the patients and correctly evaluate the prognosis.
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OBJECTIVE@#To analyze the clinical characteristics and treatment effect between bilateral (bi-) and unilateral (uni-) sudden sensorineural hearing loss (SSNHL).@*METHOD@#Four hundred and eighty cases of SSNHL were retrospective study, which were divided into two groups of bi-SSNHL (n = 40) and uni-SSNHL (n = 440). Clinical characteristics and treatment effects were compared of the two groups.@*RESULT@#The incidence rate of bi-SSNHL was 8.3 percent and uni-SSNHL was 91.7 percent of all patients with SSNHL. Bi-SSNHL occurs more commonly in patients of old age, diabetes mellitus, and lipid panes abnormalities compared to uni-SSNHL. Twenty-eight ears in the bi-SSNHL group showed hearing recovery (35%), compared with 56.4 percent of patients with uni-SSNHL.@*CONCLUSION@#Bi-SSNHL and uni-SSNHL may have a completely different clinical characteristics and treatment effect, that implies a different pathophysiology and prognosis. Recognition their different clinical characteristics and treatment effect between bilateral and unilateral SSNHL can help in counseling and managing the patients and correctly evaluate the prognosis.