Effects of remazolam vs propofol on hemodynamics during induction of anaesthesia in elderly patients: area under curve method / 中华麻醉学杂志

Objective:To evaluate the effects of remazolam and propofol on the hemodynamics during induction of anaesthesia in elderly patients using the area under curve (AUC) method.Methods:Eighty elderly patients of either sex, aged 65-75 yr, with body mass index of 20-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective non-cardiac surgery, were divided into 2 groups ( n=40 each) by using a random number table method: remazolam group (R group) and propofol group (P group). Remazolam 1 mg/ml or propofol 10 mg/ml was slowly and intravenously injected through titration to achieve loss of responsiveness to verbal command. The accumulative areas under the curve below (AUC MAP-) or above (AUC MAP+ ) baseline mean arterial pressure and under the curve below or above 10% of baseline heart rate at the same time (AUC HR-, AUC HR+ ) were calculated within the first 10 min after administration of propofol or remazolam. The use of vasoactive drugs and injection pain were recorded during this period. The intraoperative awareness during the 24-h follow-up after surgery and development of cardiovascular complications, cerebral infarction and oliguria or anuria within 30 days after surgery were recorded. Results:Compared with R group, AUC MAP- was significantly enlarged (the mean difference 59.375 mmHg·min, 95% confidence interval 26.763-91.987 mmHg·min), AUC HR- was enlarged ( P<0.05), and no significant change was found in AUC MAP+, AUC HR+, requirement for vasoactive drugs, frequency of vasoactive drugs, and postoperative complications in P group ( P>0.05). No injection pain or intraoperative awareness was found in two groups. Conclusions:Remazolam is superior to propofol in maintaining hemodynamic stability during anesthesia induction in elderly patients.

Effect of anesthetic factors on inflammatory responses in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass: sevoflurane-dexmedetomidine combined anesthesia / 中华麻醉学杂志

Objective:To evaluate the effect of sevoflurane-dexmedetomidine combined anesthesia on inflammatory responses in patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB).Methods:A total of 96 American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes, aged 45-60 yr, weighing 60-75 kg, with New York Heart Association Ⅱ or Ⅲ, scheduled for elective CABG with CPB, were divided into 4 groups ( n=24 each) using a random number table method: routine general anesthesia (group C), sevoflurane-based general anesthesia group (group S), dexmedetomidine-based general anesthesia group (group D) and sevoflurane combined with dexmedetomidine-based general anesthesia group (group SD). In D and SD groups, dexmedetomidine was intravenously infused in a loading dose of 1μg/kg over 10 min at the beginning of induction anesthesia, followed by an infusion at 0.4 μg·kg -1·h -1 until the end of the surgery.After tracheal intubation, 1%-2% sevofluran was inhaled in S and SD group.Before anesthesia induction, before the CPB, immediately at the end of CPB, at 6 h after the end of CPB and 24 h after surgery, central venous blood samples were collected for determination of plasma interleukin-6 (IL-6), IL-10 and tumor necrosis factor-alpha (TNF-α) concentrations by enzyme linked immunosorbent assay.The restoration of spontaneous heart beat, the occurrence of serious adverse events during surgery and within 24 h after surgery, the retention time of intubation and duration of intensive care unit (ICU) stay after surgery were recorded. Results:Compared with group C, the plasma concentrations of IL-6, IL-10 and TNF-α were significantly decreased in the other 3 groups, and the postoperative retention time of tracheal intubation was shortened in group SD ( P<0.05). Compared with group S or group D, the plasma concentrations of IL-6, IL-10 and TNF-α were significantly decreased ( P<0.05), and no significant change was found in the postoperative retention time of tracheal intubation in group SD ( P>0.05). There was no significant difference in the duration of ICU and restoration of spontaneous heart beat ( P>0.05), and no serious adverse events occurred during surgery and within 24 h after surgery among the groups. Conclusion:Sevoflurane combined with dexmedetomidine anesthesia is helpful in reducing the inflammatory responses in patients undergoing CABG with CPB, but provides no value in clinical outcomes.

Accuracy of ultrasonography in determining laryngeal mask airway position: evaluation using 3D-CTR / 中华麻醉学杂志

Objective:To evaluate the accuracy of ultrasonography in determining the laryngeal mask airway position using three-dimensional CT reconstruction (3D-CTR) images as the standard.Methods:One hundred and thirty-four patients, aged 18-64 yr, weighing 30-100 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective cerebral vascular interventional stent surgery in our hospital, were selected.Cervical ultrasonography was performed before and after laryngeal mask airway placement, and digital subtraction angiography was performed during operation to obtain 3D-CTR images.Neck ultrasound and 3D-CTR images were analyzed and graded.Results:A total of 125 patients completed the study.At the vertical position of the laryngeal mask airway, ultrasonic grading was positively correlated to 3D-CTR grading ( r=0.742, P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound in determining the rotation of the laryngeal mask airway was 73.0% (95% CI: 62.0%-84.4%), 92.8% (95% CI: 86.9%-98.7%), 89.1% (95% CI: 80.5%-97.7%), 81.0% (95% CI: 72.6%-89.4%), and 74.2% (95% CI 65.2%-81.1%), respectively.In terms of laryngeal mask airway depth grading, the correlation between ultrasonic grading was positively correlated to 3D-CT grading ( r=0.332, P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound in determining the depth of the laryngeal mask airway was 58.5% (95% CI: 46.9%-70.1%), 93.3% (95% CI: 87.2%-99.4%), and 90.5% (95% CI: 82.0%-99.0%), 67.5% (95% CI: 57.7%-77.3%), and 33.2% (95% CI: 16.8%-47.8%), respectively.The positive predictive value of ultrasound in determining the optimal placement of the laryngeal mask airway was 61.1% (95% CI: 48.6%-73.6%). Conclusion:Although ultrasound cannot measure the depth of the tip of the laryngeal mask airway into the esophagus, it has higher accuracy in determining the rotation and can be used as a reliable tool for clinical detection of the position of the laryngeal mask airway, especially the rotation.

Relationship between effect of PPARγ in pulmonary vascular remodeling and NOX-4 in rats with pulmonary hypertension / 中华麻醉学杂志

Objective To evaluate the relationship between the effect of peroxisome proliferator-activated receptor-γ (PPARγ) in pulmonary vascular remodeling and NADPH oxidase 4 (NOX-4) in rats with pulmonary hypertension.Methods Thirty-two healthy adult male Sprague-Dawley rats,aged 2 months,weighing 200-250 g,were divided into 4 groups (n =8 each) using a random number table method:control group (group C),pulmonary arterial hypertension group (group PH),PPARγ agonist rosiglitazone treatment group (group R),and PPARγ antagonist GW9662 treatment group (group G).In group PH,monocrotaline 60 mg/kg was injected subcutaneously in the neck and back to induce pulmonary hypertension.The suspension of rosiglitazone and normal saline 5 mg · kg-1 · d-1 and GW9662 solution 2 mg · kg-1 · d-1 were administered by intragastric gavage after injecting monocrotaline,in group R and group G,respectively,for 4 consecutive weeks.The mean pulmonary arterial pressure (mPAP) was measured at 4 weeks after establishing the model.The animals were then sacrificed,and the lungs were removed for microscopic examination of the pathological changes (with a light microscope) and for determination of the expression of PPARγ and NOX-4 protein and mRNA in lung tissues (by real-time polymerase chain reaction or Western blot).The percentage of media thickness of pulmonary arterioles was calculated.Results Compared with group C,the mPAP and percentage of media thickness of pulmonary arterioles were significantly increased,the expression of PPARγ protein and mRNA was down-regulated,and the expression of NOX-4 protein and mRNA was up-regulated in PH,R and G groups (P＜0.05).Compared with group PH,the mPAP and percentage of media thickness of pulmonary arterioles were significantly decreased,the expression of PPARγ protein and mRNA was up-regulated,and the expression of NOX-4 protein and mRNA was down-regulated in group R,and the mPAP and percentage of media thickness of pulmonary arterioles were significantly increased,the expression of PPARγ protein and mRNA was down-regulated,and the expression of NOX-4 protein and mRNA was up-regulated in group G (P＜0.05).Conclusion The mechanism of endogenous protective effect of PPARγ in the development of pulmonary hypertension and pulmonary vascular remodeling may be related to down-regulating the expression of NOX-4 in rats.

Anesthetic management of pediatric patients with Kasabach-Merritt phenomenon undergoing radical resection for huge hemangioma of head and neck / 中华麻醉学杂志

Nine pediatric patients (4 females,5 males) with huge hemangioma of head and neck complicated with Kasabach-Merritt phenomenon,aged 15-135 days,undergoing elective radical resection for huge hemangioma of head and neck,were selected from June 2012 to June 2016 in our hospital.Two pediatric patients were sensitive to preoperative hormone treatment,the platelet count almost increased to the normal value,7 pediatric patients were not sensitive to preoperative hormone treatment,and the increase in platelet count was not obvious.When the platelet count ＜ 40× 109/L,platelet was infused at 12 h before operation until the platelet count ＞ 100× 109/L.Two pediatric patients with larger haemangioma in maxillofacial region kept spontaneous breathing,and anesthesia was induced by inhaling high-concentration of sevoflurane.Anesthesia was induced with intravenous midazolam,sufentanil and cisatracurium in the other seven pediatric patients.Pediatric patients were mechanically ventilated in pressure-controlled mode after endotracheal intubation with airway pressure of 9-12 cmH2O.All pediatric patients inhaled sevoflurane,and anesthesia was maintained by infusing remifentanil.Heart rate and systolic blood pressure were maintained within the normal range during operation.Fluid and blood products were infused according to the blood loss,urine volume,physiological requirement and central venous pressure,etc.Pediatric patients were transferred to pediatric intensive care unit (PICU) at the end of operation,and the endotracheal tube was removed after the patients were completely awake.One pediatric patient developed pulmonary infection after operation,was discharged from PICU on day 7 after operation,then cured and discharged from hospital after healing on day 20 after operation.The other eight pediatric patients were discharged from PICU on day 2 after operation,then cured and discharged from hospital on days 5-10 after operation.After a followup period of 1 yr,the pediatric patients recovered well,the platelet count was normal,and the tumor recurrence was not found.

Effect of dexmedetomidine on cell apoptosis during acute lung injury induced by blunt chest trauma in rats / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine on the cell apoptosis during the acute lung injury induced by blunt chest trauma in rats.Methods Thirty pathogen-free male SpragueDawley rats,weighing 240-270 g,aged 8 weeks,were divided into 3 groups (n=10 each) using a random number table:shan operation group (group Sham),blunt chest trauma group (group T) and blunt chest trauma plus dexmedetomidine group (group TD).The model of acute lung injury was induced by dropping a 300 g weight onto a precordium in anesthetized rats.After the model was established,dexmedetomidine was intravenously infused at a rate of 5 μg · kg 1 · h-1 for 6 h in group TD.At 6 h after the model was established,blood samples were collected from the femoral artery for determination of concentrations of serum tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6).The rats were sacrificed after blood sampling,and lungs were removed for examination of the pathological changes (with light microscope) and for determination of Bax and Bcl-2 expression in lung tissues (by immuno-histochemistry) and cell apoptosis (by TUNEL).Bcl-2/Bax ratio and apoptosis index (AI) were calculated.Results Compared with group C,the serum TNF-α and IL-6 concentrations and AI were significantly increased,the expression of Bax and Bcl-2 was up-regulated,and Bcl-2/Bax ratio was decreased in T and TD groups (P＜ 0.01).Compared with group T,the serum TNF-α and IL-6 concentrations and AI were significantly decreased,the expression of Bax in lung tissues was down-regulated,the expression of Bcl-2 in lung tissues was up-regulated,Bcl-2/Bax ratio was increased (P＜0.05),and the pathological changes of lung tissues were significantly attenuated in group TD.Conclusion The mechanism by which dexmedetomidine mitigates the acute lung injury induced by blunt chest trauma is related to inhibition of cell apoptosis in rats.

Role of NKCC1 in neurons in sevoflurane-induced epileptiform electroencephalogram activity in cortex of neonatal rats / 中华麻醉学杂志

Objective To evaluate the role of Na+-K+-2Cl-cotransporter isoform 1 (NKCC1) in neurons in sevoflurane-induced epileptiform electroencephalogram (EEG) activity in the cortex of neonatal rats.Methods Twenty-four neonatal Sprague-Dawley rats,aged 4-6 days,weighing 8-15 g,were randomly divided into 3 groups (n =8 each) using a random number table:control group (group C),sevoflurane group (group S),and NKCC1 inhibitor bumetanide + sevoflurane group (group B).After electrodes were placed correctly,EEG was monitored continuously.At 30 min of monitoring,normal saline 3 μl/g was injected intraperitoneally in D and S groups,and bumetanide 10 μg/g was injected intraperitoneally in group B.At 60 min after the end of intraperitoneal administration,anesthesia was induced with inhalation of 6％ sevoflurane for 3 min and maintained with inhalation of 2.1％ sevoflurane for 1 h in group S and group B.The total duration of seizures,the duration of a single episode,the number of episodes of electroencephalographic seizures,and the amplitude and frequency of spike-and-wave were recorded.Results Seizures were not detected in group C,and no spike-and-wave was found in group B.Compared with group C,the incidence of seizures in S and B groups (75％ and 25％,respectively) and incidence of spike-and-wave in group S (100％) were significantly increased (P＜0.05).Compared with group S,the incidence of seizures and spike-and-wave was significantly decreased,the total duration of seizures,and duration of a single episode were significantly shortened,and the number of episodes of electroencephalographic seizures was significantly decreased in group B (P＜0.05).Conclusion NKCC1 in neurons may be involved in the formation of sevoflurane-induced epileptiform EEG activity in the cortex of neonatal rats.