Role of nNOS-NOS1AP coupling in remifentanil-induced hyperalgesia in rats / 中华麻醉学杂志

Objective:To evaluate the role of neuronal nitric oxide synthase (nNOS)-nitric oxide synthase 1 adaptor protein (NOS1AP) coupling in remifentanil-induced hyperalgesia in rats.Methods:Forty clean-grade healthy adult male Sprague-Dawley rats, weighing 240-260 g, aged 2-3 months, were divided into 4 groups ( n=10 each) using a random number table method: control group (group C), remifentanil group (group R), nNOS-NOS1AP inhibitor ZLc002 group (group C+ Z) and remifentanil + ZLc002 group (group R+ Z). Normal saline was intravenously infused at a rate of 0.1 ml·kg -1·min -1 for 60 min in C group. Remifentanil was intravenously infused at a rate of 1.0 μg·kg -1·min -1 for 60 min in R group. ZLc002 10 mg/kg was intraperitoneally injected for 3 consecutive days, and then normal saline 0.1 ml·kg -1·min -1 and remifentanil 1.0 μg·kg -1·min -1 were intravenously infused for 60 min in C+ Z group and R+ Z group. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 24 h before intravenous infusion and 6, 24 and 48 h after intravenous infusion (T 0-3). All the rats were sacrificed after the last measurement of pain thresholds, and the L 4-6 segments of the spinal cord were removed for determination of the expression of nNOS, NOS1AP and Dexamethasone-induced Ras-related protein 1 (Dexras1) protein and mRNA using the real-time polymerase chain reaction. Nitrosylated proteins were extracted by biotin conversion for determination of the expression of nNOS, NOS1AP and total and nitrosylated Dexras1 (by Western blot) and co-expression of nNOS-NOS1AP (by co-immunoprecipitation). The content of NO in the spinal cord was measured. Results:Compared with group C, the MWT was significantly decreased, and the TWL was shortened at T 1-3, the expression of nNOS and NOS1AP protein and mRNA was up-regulated, the co-expression of nNOS-NOS1AP and NO production were increased, and the expression of nitrosylated Dexras1 was up-regulated in group R ( P<0.05), and no significant change was found in each aforementioned parameter in group C+ Z ( P>0.05). Compared with group R, the MWT was significantly increased, and the TWL was prolonged at T 1-3, the co-expression of nNOS-NOS1AP and NO production were decreased, the expression of nitrosylated Dexras1 was down-regulated ( P<0.05), and no significant change was found in the expression of nNOS and NOS1AP protein and mRNA in group R+ Z ( P>0.05). There were no significant differences in total Dexras1 protein and mRNA expression among the four groups ( P>0.05). Conclusions:The mechanism by which remifentanil induces hyperalgesia may be related to up-regulating the expression of nNOS and NOS1AP in the spinal cord, promoting interaction between nNOS and NOS1AP and mediating NO generation and Dexras1 nitrosylation modification in rats.

Effect of ultrasound-guided internal branch of superior laryngeal nerve block on quality of anesthesia recovery in patients undergoing intracranial tumor surgery: a retrospective study / 中华麻醉学杂志

Objective:To evaluate the effect of ultrasound-guided internal branch of superior laryngeal nerve(ibSLN) block on the quality of anesthesia recovery in the patients undergoing intracranial tumor surgery.Methods:The data from patients of either gender, aged 18-65 yr, with a body mass index of 18-28 kg/m 2, who underwent intracranial tumor surgery from December 2022 to October 2023, were retrospectively collected. Patients were divided into control group (group C) and ultrasound-guided ibSLN block group (group U). Bilateral ibSLN block was performed with 0.375% ropivacaine hydrochloride 2 ml.The tracheal extubation time, emergence time, development of cardiovascular events within 15 min after extubation, emergence agitation, Ramsay sedation score, Steward recovery score, visual analogue scale scores at 10 min after extubation and development of postoperative sore throat and hoarseness in postanesthesia care unit were recorded. Results:Compared with group C, the incidence of emergence agitation, Ramsay sedation score, visual analogue scale scores and sore throat were significantly decreased, the incidence of hoarseness was increased ( P<0.05), and no significant change was found in the extubation time, emergence time and Steward recovery score in group U( P>0.05). No hypertension, hypotension, tachachycardia and bradycardia were found in two groups. Conclusions:Ultrasound-guided ibSLN block can improve the quality of anesthesia recovery in the patients undergoing intracranial tumor surgery.

Role of RhoA in hydrogen-induced alleviation of lipopolysaccharide-caused damage to pulmonary microvascular endothelial cell barrier function in mice / 中华麻醉学杂志

Objective:To evaluate the role of Ras homolog gene family member A (RhoA) in hydrogen-induced alleviation of lipopolysaccharide (LPS)-caused damage to pulmonary microvascular endothelial cell(PMVEC) barrier function in mice.Methods:PMVECs were cultured in DMEM/F12 medium containing 10% fetal bovine serum and 1% penicillin/streptomycin until 4-6 passage. These cells were divided into 6 groups ( n=36 each) using a random number table method: control group (group A), hydrogen-rich medium group (group B), LPS group (group C), LPS + hydrogen-rich medium group (group D), LPS + RhoA inhibitor C3 enzyme group (group E) and LPS + hydrogen-rich medium + RhoA agonist U-46619 group (group F). Cells were cultured within normal medium in group A, group C and group E and within hydrogen-rich medium in group B, group D and group F. LPS at a final concentration of 1 μg/ml was simultaneously added in group C, group D, group E and group F. C3 enzyme at a final concentration of 3 μg/ml was added at 2 h before addition of LPS in group E. U-46619 at a final concentration of 10 mg/ml was added at 3 h before addition of LPS in group F. The expression of vascular endothelial (VE)-cadherin and occludin was determined by Western blot at 6, 12 and 24 h after incubation with LPS. At 24 h after incubation with LPS, the release rate of LDH was measured by LDH method, cell viability was measured by MTT method, and the activity of RhoA was determined by GST pull-down method. Results:Compared with group A, the expression of VE-cadherin and occludin was significantly down-regulated at 6, 12 and 24 h of incubation, the cell viability was decreased at 24 h of incubation, and the release rate of LDH and activity of RhoA were increased in group C ( P<0.05). Compared with group C, the expression of VE-cadherin and occludin was significantly up-regulated at 6, 12 and 24 h of incubation, the cell viability was increased at 24 h of incubation, and the release rate of LDH and activity of RhoA were decreased in group D ( P<0.05). Compared with group C, the expression of VE-cadherin and occludin was significantly up-regulated at 6, 12 and 24 h of incubation, the cell viability was increased at 24 h of incubation, and the release rate of LDH and activity of RhoA were decreased in group E ( P<0.05). Compared with group D, the expression of VE-cadherin and occludin was significantly down-regulated at 6, 12 and 24 h of incubation, the cell viability was decreased at 24 h of incubation, and the release rate of LDH and activity of RhoA were increased in group F ( P<0.05). Conclusions:RhoA is involved in hydrogen-induced alleviation of LPS-caused damage to PMVEC barrier function in mice.

Effect of ultrasound-guided serratus anterior plane block on postoperative analgesia in patients undergoing laparoscopic radical gastrectomy / 中国肿瘤临床

Objective:To evaluate the effect of ultrasound-guided subserratus anterior plane block on postoperative analgesia in patients un-dergoing laparoscopic radical gastrectomy.Methods:Sixty patients who underwent elective laparoscopic radical gastrectomy were enrolled between May 2022 and October 2023 at Tianjin Medical University Cancer Institute&Hospital.Patients were assigned into two groups us-ing a random number table method:the control(group C)and the ultrasound-guided serratus anterior plane block(SAPB)(group S).Patient-controlled intravenous analgesia(PCIA)was administered at the end of the surgery.After surgery,visual analogue scale(VAS)of static pain scores was evaluated at 1,6,12,24,and 48 hours.PCIA pump was started at the VAS pain score≥4 after surgery,and sufentanil 0.1μg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA use,time to first postoperative anal exhaust,first postoperative out-of-bed activity,first oral intake,and the duration of hospitalization stay were recorded for the two groups.Results:VAS scores were significantly lower at postoperative 1,6,and 12 h in group S than in group C(P<0.05).Additionally,the number of effective uses of PCIA,and rescue analgesia were significantly lower in group S[(6.1±0.4)(2)]than in group C[(18.6±1.4)(17)](P<0.001).The time to first postoperative anal exhaust,first postoperative out-of-bed activity,first oral intake,and duration of hospital stay were shortened in group S than in group C(P<0.05).There were no significant differences in other parameters between these two groups.Conclusion:Ultrasound-guided SAPB can reduce postoperative pain and facilitate fast recovery in laparoscopic radical gastrectomy patients.

Relationship between S-nitrosylation of spinal divalent metal transporter 1 modification and mechanism of remifentanil-induced hyperalgesia in rats / 中华麻醉学杂志

Objective:To investigate the relationship between S-nitrosylation of spinal divalent metal transporter 1 (DMT1) modification and mechanism of remifentanil-induced hyperalgesia in rats.Methods:Forty pathogen-free healthy male Sprague-Dawley rats, aged 2-3 months, weighing 240-260 g, were divided into 4 groups ( n=10 each) using a random number table method: control group (group C), remifentanil group (group R), L-NAME group (group C+ L) and remifentanil+ L-NAME group (group R+ L). Normal saline was infused at a rate of 0.1 ml·kg -1·min -1 for 60 min via the caudal vein in C group. Remifentanil was infused at a rate of 1.0 μg·kg -1·min -1 for 60 min via the caudal vein in R group. L-NAME 30 mg/kg was intraperitoneally injected, and 10 min later normal saline was infused at a rate of 0.1 ml·kg -1·min -1 for 60 min in C+ L group. L-NAME 30 mg/kg was intraperitoneally injected, and 10 min later remifentanil was infused at a rate of 1.0 μg·kg -1·min -1 for 60 min in R+ L group. The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured at 24 h before iv infusion and 6, 24 and 48 h after the end of infusion (T 0-3). All the rats were sacrificed under anesthesia after the last measurement of pain thresholds, and the L 4-6 segments of the spinal cord were removed for determination of the expression of neuronal nitric oxide sythases (nNOS) and DMT1 mRNA (using quantitative real-time polymerase chain reaction), extraction of nitrosylated proteins (by biotin switch assay), expression of nNOS, total DMT1 and S-nitrosylation of DMT1 (by Western blot), nitric oxide (NO) content (by spectrophotometry) and iron content (using atomic absorption spectrophotometer). Results:Compared with group C, the MWT was significantly decreased, and the TWL was shortened at T 1-3 in group R ( P<0.05), and the expression of nNOS protein and mRNA and S-nitrosylation of DMT1 was significantly up-regulated, and contents of NO and iron were increased in R and R+ L groups ( P<0.05), and no significant change was found in each index in group C+ L ( P>0.05). Compared with group R, the MWT was significantly increased, and the TWL was prolonged at T 1-3, and the expression of nNOS protein and mRNA and S-nitrosylation of DMT1 was down-regulated, and contents of NO and iron were decreased in group R+ L ( P<0.05). Compared with group C+ L, the MWT was significantly decreased, and the TWL was shortened at T 1-3, and the expression of nNOS protein and mRNA and S-nitrosylation of DMT1 was up-regulated, and the contents of NO and iron were increased in group R+ L ( P<0.05). There were no significant differences in the expression of DMT1 mRNA and total DMT1 in spinal cord among all the groups ( P>0.05). Conclusions:Activation of nNOS induces an increase in NO generation in the spinal cord and mediates the S-nitrosylation of DMT1, which may be related to the mechanism of remifentanil-induced hyperalgesia in rats.

Effect of stroke volume variation-guided fluid therapy on perioperative haemodynamics and tissue perfusion in patients with end-stage renal disease undergoing parathyroidectomy / 中华麻醉学杂志

Objective:To evaluate the effect of stroke volume variation (SVV)-guided fluid therapy on perioperative haemodynamics and tissue perfusion in the patients with end-stage renal disease (ESRD) undergoing parathyroidectomy.Methods:One hundred and twenty-one patients of either sex, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅲ, with body mass index of 18-28 kg/m 2, with ESRD undergoing elective parathyroidectomy, who received haemodialysis treatment within 24 h before surgery, were enrolled in this study. The patients were divided into standard restrictive fluid therapy group (group SRT, n=61) and goal-directed fluid therapy group (group GDT, n=60) using a random number table method. Group SRT received restrictive fluid therapy, with a continuous infusion of 0.9% normal saline at a rate of 4 ml·kg -1·h -1. Group GDT received goal-directed fluid therapy guided by SVV, and when the SVV≥10% lasted for 5 min, the 0.9% normal saline 3 ml/kg was infused within 5 min until SVV<10%. Systolic blood pressure (SBP) was maintained at ≥90 mmHg or mean arterial pressure(MAP) at ≥65 mmHg throughout the perioperative period in both groups. The intraoperative volume of fluid infused, usage rate and consumption of intraoperative vasoactive drugs were recorded, and arterial blood lactate (Lac) level, MAP, heart rate, cardiac output, and inferior vena cava collapse index (IVC-CI) after removal of endotracheal tube at the end of surgery were measured. MAP was continuously recorded within 12 h after surgery, and MAP variability (CV MAP) was calculated. The occurrence of cardiovascular and cerebrovascular events within 30 days after operation was also recorded. Results:Compared with group SRT, the intraoperative volume of fluid infused was significantly increased, the usage rate of ephedrine and norepinephrine was decreased, the consumption of ephedrine was reduced, and the percentage of postoperative IVC-CI<50% and cardiac output were increased, the percentage of Lac≥2.0 mmol/L and CV MAP were decreased ( P<0.05), and no significant change was found in the incidence of cardiovascular and cerebrovascular events within 30 days after surgery in group GDT ( P>0.05). Conclusions:Compared with restrictive fluid therapy, SVV-guided fluid therapy can optimize the perioperative hemodynamics and tissue perfusion in the patients with ESRD undergoing parathyroidectomy.

Crosstalk Between Peripheral Innervation and Pancreatic Ductal Adenocarcinoma / 神经科学通报·英文版

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive lethal malignancy, characterized by late diagnosis, aggressive growth, and therapy resistance, leading to a poor overall prognosis. Emerging evidence shows that the peripheral nerve is an important non-tumor component in the tumor microenvironment that regulates tumor growth and immune escape. The crosstalk between the neuronal system and PDAC has become a hot research topic that may provide novel mechanisms underlying tumor progression and further uncover promising therapeutic targets. In this review, we highlight the mechanisms of perineural invasion and the role of various types of tumor innervation in the progression of PDAC, summarize the potential signaling pathways modulating the neuronal-cancer interaction, and discuss the current and future therapeutic possibilities for this condition.

Efficacy of different delivery routes of oxytocin in preventing hemorrhage after cesarean section: a meta-analysis / 中华麻醉学杂志

Objective To systematically review the effects of different delivery routes of oxytocin in preventing hemorrhage after cesarean section.Methods Databases including PubMed,Medline,Embase,Cochrane library,Wanfang Medical Database,China National Knowledge Internet (CNKI),VIP Database for Chinese Technical Periodicals were searched by computers and Conference papers were manually searched.The randomized,controlled clinical trials of oxytocin given by intramuscular injection,intravenous injection or intravenous infusion were included in elective cesarean section under spinal anesthesia.The quality of included literatures was evaluated by Cochrane systematic evaluation.The primary outcome measure was intraoperative amount of blood loss or change in Hb before and after operation.The secondary outcome measures were changes in blood pressure and heart rate,electrocardiogram,uterine contraction and other adverse reactions after using oxytocin.Results Seven studies involving 2 325 patients were included in this meta-analysis.Among the 2 325 patients,oxytocin was given through intramuscular injection in 79 cases,by intravenous injection in 1 147 cases and in the way of intravenous infusion in 1 099 cases.Compared with intramuscular injection group or intravenous infusion group,no significant change was found in the amount of blood loss during operation in intravenous injection group (P＞0.05).There was no statistically significant difference in the amount of blood loss during operation between intravenous injection group and intravenous infusion group (P＞0.05).Intravenously infusing oxytocin produced less effect on the mean arterial pressure and heart rate than intravenously injecting oxytocin (P＜0.01).Conclusion Intravenous infusion is a suitable route for oxytocin delivery in cesarean section with spinal anesthesia.

Risk factors for postoperative residual paralysis in patients undergoing general anesthesia / 中华麻醉学杂志

Objective To determine the risk factors for postoperative residual paralysis in patients undergoing general anesthesia and establish the warning score system initially.Methods A total of 369 patients who underwent general anesthesia and developed residual paralysis after returning to the recovery room and 740 patients who did not developed residual paralysis were enrolled in the study.Logistic regression was used to analyze the factors of which P values were less than 0.05 to identify the independent risk factors for postoperative residual paralysis.The warning score system was established initially according to the odds ratios of each risk factor,and the area under receiver operating characteristic curve was used to evaluate the predicting ability of the system.Results Logistic regression analysis showed that the consumption of cisatracurium more than 0.4 mg · kg-1 · h-1,time from the last administration of muscle relaxants to the end of operation less than 60 min and volume of intraoperative fluid infused more than 20 ml/kg were independent risk factors for postoperative residual paralysis in patients undergoing general anesthesia.The warning score system of residual paralysis was established initially,and the area under receiver operating characteristic curve was 0.82.The best cut-off value of predicting residual paralysis was 1.5 (sensitivity 63.5％,specificity 82.7％,Youden index 0.462),and thus the risk stratification criteria were determined initially with score less than or equal to 1 predicting low risk,and score more than or equal to 2 predicting high risk.Conclusion The consumption of cisatracurium more than 0.4 mg · kg-1 · h-1,time from the last administration of muscle relaxants to the end of operation less than 60 min and volume of intraoperative fluid infused more than 20 ml/kg are independent risk factors for postoperative residual paralysis in patients undergoing general anesthesia;the initially established warning score system produces higher accuracy in predicting postoperative residual paralysis.

Risk Factors and Prognosis of Reintubation Following Surgeries under General Anesthesia / 中国医学科学院学报

Objective To investigate the independent risk factors and the prognosis of reintubation following surgeries under general anesthesia in post-anesthesia care unit (PACU). Methods 　We retrospectively analyzed the clinical data of 14 407 patients undergoing elective surgeries from October 2013 to October 2014 in the China-Japanese Friendship Hospital. Patients were divided into reintubation group and control group according to the application of reintubation (or not) in PACU. Multivariate Logistic analysis was performed for factors showing significant difference between these two groups to screen for risk factors and analyze the prognosis. Results 　Sixteen patients (0.11%) were reintubated in PACU.The Logistic regression analysis showed that the independent risk factors for reintubation were as following:preoperative chronic obstructive pulmonary disease (COPD)(OR=17.55,95%CI :3.08-59.84,P=0.001) or preoperative coronary artery disease (OR=5.98,95%CI :1.67-21.42,P=0.006),intraoperative blood loss greater than 12 ml·kg-1 (OR=27.83,95%CI :10.75-54.62,P <0.001),and thoracic surgery (OR=22.96,95%CI :12.66-48.19,P=0.004). Conclusion s　Preoperative COPD or coronary artery disease,intraoperative blood loss greater than 12 ml·kg-1,and thoracic surgery are the independent risk factors for postoperative PACU reintubation of patients undergoing surgeries with general anesthesia.Although the mortality rate is relative high,most patients have a good prognosis.

Propofol enhances the field excitatory postsynaptic potentials in CA1 hippocampal slices of young and aged mice / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Increasing age was shown to decrease the requirements for propfol. However, the mechanisms of ageing-induced potentiation of anesthetic actions have not been clearly explored. The aim of this study is to compare the effects of propofol on the field excitatory postsynaptic potentials (fEPSPs) in hippocampal slices of young and aging mice.</p><p><b>METHODS</b>Brain slices were prepared from C57BL6 male young (2 months) and aging (>12 months) mice. The dendritic field excitatory postsynaptic potential was recorded from the CA1 stratum radiatum using patch clamp electrophysiological methods. A bipolar concentric stimulating electrode was placed along the Schaffer collateral for othodromic stimulation. The effects of clinically-relevant concentrations of propofol were studied in the young and ageing mouse tissues.</p><p><b>RESULTS</b>Propofol application increased the orthodromically evoked fEPSP produced in slices taken from young and older animals. A striking feature in the I/O relationship was the decreased enhancement of the fEPSPs by propofol in slices from older mice. A clinically relevant concentration of propofol, 10 µmol/L, showed more significant enhancement in amplitude and area under the curve (AUC) of fEPSP in young compared to tissues from older mice (amplitude: young (24.9 ± 3.4)%, old (4.6 ± 1.6)%; AUC young (30.6 ± 5.4)%, old (2.1 ± 1.7)%). There was no statistically significant difference between the paired-pulse facilitation (PPF) ratios calculated for the responses obtained in tissues from young mice. In slices from older mice, in the presence of 10 µmol/L propofol, PPF was decreased and returned to baseline after washout (baseline 1.21 ± 0.01, propofol: 1.16 ± 0.01). Bicuculline (15 µmol/L) blocked the enhancement of propofol on fEPSP in tissues from young and old mice.</p><p><b>CONCLUSION</b>The fEPSP of slices from aging mice demonstrates diminished sensitivity to the enhancing actions of propofol.</p>

Risks of hypoxemia after uvulopalatopharyngoplasty in patients with obstructive sleep apnea syndrome / 中华麻醉学杂志

Objective To observe the risks of hypoxemia after uvulopalatopharyngoplasty (UPPP) in patients with obstructive sleep apnea syndrome (OSAS).Methods Forty-six ASA Ⅱ or Ⅲ male patients with OSAS,aged 30-50 yr,with body mass index 27-33 kg/m2,Mallampati Ⅰ-Ⅳ,underwent UPPP under general anesthesia with propofol and remifentanil.O2 was inhaled for 24 h via a nasal catheter starting from the end of surgery.SpO2 was monitored within 24 h after surgery.Oxygen desaturation index (ODI,hourly average number of desaturation episodes in which the decrease in SpO2 ≥4% and duration ≥ 10 s) and the cumulative time percentage with SpO2 ＜ 90% (CT90) from oximetry were recorded.Results Compared with the baseline value before surgery,ODI and CT90 were significantly decreased at 2 and 2-4 h after extubation and on 1 st night after surgery (11:00 pm-6:00 am) (P ＜ 0.05).ODI and CT90 were significantly lower on 1st night after surgery than at 2 and 2-4 h after extubation (P ＜ 0.05).The rate of ODI abnormalities was 100%,48% and 50% before surgery and at 2 and 2-4 h after extubation,respectively.Compared with the baseline value before surgery,the rate of ODI abnormalities was significantly decreased at 2 and 2-4 h after extubation,while increased on 1 st night after surgery (P ＜ 0.05).There was no significant difference in the rate of ODI abnormalities between that on 1 st night after surgery and that before surgery (P ＞ 0.05).Conclusion Although UPPP can significantly improve airway obstruction in patients with OSAS,hypoxemic episodes still occur after surgery,suggesting that UPPP should not be treated as an ambulatory surgery.

Relationship between clinicopathologic factors and prognosis of patients with early gastric cancer / 中华消化外科杂志

Objective To investigate the relationship between various clinicopatholngic factors and prognosis of early gastric cancer. Methods The clinical data of 459 patients with early gastric cancer who had undergone gastrectomy combined with extended (D2) lymphadenectomy at Zhongshan Hospital from January 2002 to October 2007 were retrospectively analyzed. Survival was calculated using the Kaplan-Meier method, and clinicopathologic factors such as age, sex, tumor size, gross morphology, tumor differentiation, depth of invasion, lymphatic vessels involvement and lymph node metastasis were analyzed using the Cox regression model. Univariate analysis was done by Log-rank test. Results Univariate analysis demonstrated that tumor size and differentiation, depth of invasion, lymphatic vessels involvement and lymph node metastasis significantly affected survival in patients with early gastric cancer (χ~2 = 8.476, 6.210, 4.014, 14. 197, 55.027, P < 0.05). The status of lymph node metastasis was an independent predictor of survival in patients with early gastric cancer, and the more metastatic lymph nodes detected, the greater the influence on the prognosis. Conclusions Lymph node metastasis is the most important factor influencing the prognosis of early gastric cancer. Appropriate lymph node dissection is necessary, especially for patients with risk factors associated with lymph node metastasis.

Orcadian rhythm of perioperative melatonin secretion and neuropsychological status in patients undergoing coronary artery bypass grafting / 中华麻醉学杂志

Objective To investigate the relationship between circadian rhythm of perioperative melatonin secretion and neuropsychological status in patients undergoing coronary artery bypass grafting (CABG) .Methods Forty male ASA Ⅱ-Ⅲ patients aged 45-60yr scheduled for elective CABG under hypothermic cardiopulmonary bypass (CPB) or off-pump were enrolled in this study. They were allocated to CPB group ( n = 20) or off-pump group (n - 20). Blood samples were taken before induction of anesthesia (T1 ), 10 min after tracheal intubation (T2), 10 min after heparinization (T3) , 2h after skin incision (T4), immediately before neutralization of heparin with protamine (T5 ), at the end of surgery after skin suture (T6 ) and every 3h after operation for 24h for determination of plasma melatonin concentration using enzyme-linked immunosorbent. Degree of depression was assessed by Self-Rating Depression Scale; anxiety by the State-Trait Anxiety Inventory and cognitive function by neuropsychological tests respectively, the day before operation, 7-10 days after surgery and 3 months postoperatively. Results In the 24 hours after operation the circadian secretion pattern of melatonin was kept in 2 patients in CPB group and 6 patients in off-pump group, but disturbed in the remaining patients in both groups. Postoperative depression scores were significantly higher than the preoperative baseline values in both groups. Anxiety scores at 7-10 days after operation were significantly higher in CPB group than those in off-pump group (P

Changes in perioperative plasma melatonin, cortisol and neuron-specific enolase and neuropsychological function in patients who develop CNS complication after coronary artery bypass / 中华麻醉学杂志

Objective To determine the changes in perioperative plasma melatonin, cortisol and neuron-specific enolase (NSE) and neuropsychological function in patients who developed CNS complications after coronary artery bypass grafting (CABG) .Methods Three patients developed CNS complications (cerebral infarction, motor aphasia, motor and sensory aphasia) after CABG performed under hypothermic cardiopulmonary bypass (CPB) were studied. Blood samples were taken before induction of anesthesia (T1) , 10 min after tracheal intubation (T2), 10 min after heparinization (T3), at 30 min of CPB (T4) , immediately after discontinuation of CPB (T5), at closure of chest (T6), immediately after returning to ICU (T7) and every 3 h in ICU for 24 h (T8-15) for determination of plasma concentrations of NSE, cortisol and melatonin using enzyme-linked immunosorbent assay and radioimmunoassay. Cognitive function was measured before and 10 to 20 days after operation using a battery of tests, while depression and anxiety were assessed by self-rating depression scale and state-trait anxiety inventory respectively. Results The plasma NSE concentration was increased after operation in all 3 patients. The circadian rhythms of melatonin and cortisol were disturbed in patient 1 and 2 during the 24h after operation but were retained in patient 3. In patient 1 and 3 the performance of the trailing making test, the digit symbol subtest of WAIS-R and the stroop color word interference test were poor, meanwhile they became more depressed and less anxious. Conclusion In patients who develop CNS complication after CABG, there are cognitive decline, sentimental disorders and disrupted circadian rhythm of melatonin and cortisol secretion.