Activation of GABAergic neurons in the zona incerta accelerates anesthesia induction with sevoflurane and propofol without affecting anesthesia maintenance or awakening in mice / 南方医科大学学报

OBJECTIVE@#To explore the regulatory effects of GABAergic neurons in the zona incerta (ZI) on sevoflurane and propofol anesthesia.@*METHODS@#Forty-eight male C57BL/6J mice divided into 8 groups (n=6) were used in this study. In the study of sevoflurane anesthesia, chemogenetic experiment was performed in 2 groups of mice with injection of either adeno-associated virus carrying hM3Dq (hM3Dq group) or a virus carrying only mCherry (mCherry group). The optogenetic experiment was performed in another two groups of mice injected with an adeno-associated virus carrying ChR2 (ChR2 group) or GFP only (GFP group). The same experiments were also performed in mice for studying propofol anesthesia. Chemogenetics or optogenetics were used to induce the activation of GABAergic neurons in the ZI, and their regulatory effects on anesthesia induction and arousal with sevoflurane and propofol were observed; EEG monitoring was used to observe the changes in sevoflurane anesthesia maintenance after activation of the GABAergic neurons.@*RESULTS@#In sevoflurane anesthesia, the induction time of anesthesia was significantly shorter in hM3Dq group than in mCherry group (P < 0.05), and also shorter in ChR2 group than in GFP group (P < 0.01), but no significant difference was found in the awakening time between the two groups in either chemogenetic or optogenetic tests. Similar results were observed in chemogenetic and optogenetic experiments with propofol (P < 0.05 or 0.01). Photogenetic activation of the GABAergic neurons in the ZI did not cause significant changes in EEG spectrum during sevoflurane anesthesia maintenance.@*CONCLUSION@#Activation of the GABAergic neurons in the ZI promotes anesthesia induction of sevoflurane and propofol but does not affect anesthesia maintenance or awakening.

Changes in activity of layer 2/3 cortical neurons in isoflurane-anesthetized mice: Real-time Ultra-large-Scale High-resolution imaging platform / 中华麻醉学杂志

Objective:To observe and analyze the changes in activity of layer 2/3 cortical neurons in isoflurane-anesthetized mice by Real-time Ultra-large-Scale High-resolution (RUSH) imaging platform.Methods:Clean-grade healthy male Rasgrf2-Cre/Ai148d mice, aged 8-12 weeks, weighing 18-25 g, were studied.The mice recovered ten days after the skull replacement surgery and proceeded to the next experiment.Imaging data of calcium fluorescence signals from layer 2/3 cortical neurons were acquired by RUSH imaging platform after fixing the head of mice.The time of imaging data acquisition in the awake state, during anesthesia with 1.2% isoflurane, and after the end of anesthesia was 100, 600 and 600 s, respectively.Imaging data were analyzed using Image J and MATLAB softwares.Results:The overall trend of activity of layer 2/3 cortical neurons decreased first and then stabilized with the inhalation of 1.2% isoflurane.The cortical neural activity were gradually increased when isoflurane inhalation was stopped.The recovery rate of neural activity was different in different brain regions after isoflurane inhalation was stopped.The recovery of neural activity in the primary motor cortex was delayed obviously.During the maintenance of anesthesia, the activities of most layer 2/3 cortical neurons in the retrosplenial cortex were weakened, however, some of the neurons became more active.Conclusions:The neural activity in the 2/3 layer of cortex in isoflurane anesthetized mice is inconsistent in observation region, brain region and single cell, suggesting that different neural pathways are involved in the process of anesthesia induction and recovery from anesthesia.

Dopaminergic Neurons in the Ventral Tegmental-Prelimbic Pathway Promote the Emergence of Rats from Sevoflurane Anesthesia / 神经科学通报·英文版

Dopaminergic neurons in the ventral tegmental area (VTA) play an important role in cognition, emergence from anesthesia, reward, and aversion, and their projection to the cortex is a crucial part of the "bottom-up" ascending activating system. The prelimbic cortex (PrL) is one of the important projection regions of the VTA. However, the roles of dopaminergic neurons in the VTA and the VTADA-PrL pathway under sevoflurane anesthesia in rats remain unclear. In this study, we found that intraperitoneal injection and local microinjection of a dopamine D1 receptor agonist (Chloro-APB) into the PrL had an emergence-promoting effect on sevoflurane anesthesia in rats, while injection of a dopamine D1 receptor antagonist (SCH23390) deepened anesthesia. The results of chemogenetics combined with microinjection and optogenetics showed that activating the VTADA-PrL pathway prolonged the induction time and shortened the emergence time of anesthesia. These results demonstrate that the dopaminergic system in the VTA has an emergence-promoting effect and that the bottom-up VTADA-PrL pathway facilitates emergence from sevoflurane anesthesia.

Design and Application of Perioperative Multi-center Data Center / 中国医疗器械杂志

Based on 18 hospitals including the Chinese People's Liberation Army General Hospital and Peking University People's Hospital, and based on the "Specifications for Perioperative Data", explore the construction and application of perioperative multi-center data centers in the era of medical big data. The use of data ferry technology avoids hidden safety hazards in hospitals, realizes the integration and sharing of perioperative medical data of various medical institutions, and forms a complete data chain combining patient medical data and follow-up data.

Establishment and evaluation of anesthesia nurses training system for postoperative delirium assessment / 中华麻醉学杂志

Objective:To establish training system for postoperative delirium (POD) assessment and evaluate the efficacy of training for anesthesia nurses.Methods:Sixteen nurse anesthetists of both sexes in our hospital were selected and received the systemic training for POD assessment.The training system included questionnaire survey, theoretical teaching, simulated visit, clinical observation, independent evaluation, centralized question-answering, evaluation of efficacy and random inspection.The level of POD knowledge tests were performed before the training and at the end of the fourth week of independent evaluation, respectively.At week 1 and 4 of independent evaluation, the diagnostic rate of POD and sensitivity and specificity of the assessment were calculated, and Kappa consistency analysis was used to assess the consistency between anesthesia nurses and training group in diagnosis of POD.In the first week of the third month after the end of training, the evaluation results were randomly inspected, the POD diagnosis rate was calculated between the anesthesia nurses and the training group, and the consistency analysis was conducted.Results:Compared with the scores of POD knowledge questionnaire and sensitivity of the assessment of the anesthesia nurses in the first week of training, the scores were significantly increased ( P<0.05), and no significant change was found in the POD diagnosis rate in the fourth week of training ( P>0.05). Compared with the training group, the diagnosis rate of POD of anesthesia nurses was significantly decreased in the first week of training ( P<0.05), and no significant change was found at the fourth week of training ( P>0.05). In the first and fourth weeks of training, the Kappa value of anesthesia nurses and the training group was 0.676 and 0.954 ( P<0.001), respectively.In the first week of the third month after the end of training, the Kappa value between anesthesia nurses and the training group in diagnosis of POD was 0.862 ( P<0.05). Conclusion:The training system of POD assessment has been successfully established, and the standardized anesthesia nurses training of POD has been achieved with good results.

Effect of dexmedetomidine on antioxidant ability in rats brain with focal cerebral ischemia/reperfusion / 临床麻醉学杂志

Objective To explore the effect of dexmedetomidine preconditioning on antioxidant ability in Rats Brain with focal cerebral ischemia/reperfusion.Methods Forty-two healthy male SD rats,weighted 250-280 g,were randomly divided into three groups (n = 14):sham-operation group (group Sham):in which carotid artery was exposed but MCAO was not performed;ischemia/reper-fusion group(group IR):NS were injected intraperitoneally at 30 minutes before the MCAO;dexme-detomidine group (group Dex):dexmedetomidine 100 μg/kg were injected intraperitioneally injected at 30 minutes before the MCAO.Focal cerebral ischemia-reperfusion (IR)model in rats was made by transient occlusion of the middle cerebral artery occlusion (MCAO)using a nylon thread with rounded tip inserted into internal carotid artery and advanced cranially until resistance was met.MCAO was maintained for 2 hours followed by 24 hours reperfusion.Neurologic deficit scores(NDS),the infarc-tion volume as well as the activities of endogenous antioxidants (such as superoxide dismutase(SOD), glutathione peroxidase(GSH-PX),glutathione reductase (GR),catalase (CAT))in ischemic brain were evaluated 24 h after reperfusion.Results Compared to group Sham,the neurologic deficit scores and the infarction volume in group Dex and IR were significantly higher,but the concentration of SOD,GSH-PX,GR,CAT were significantly lower(P <0.05).Compared to group IR,however,the neurologic deficit scores and the infarction volume in group Dex were significantly lower,but the concentra-tion of SOD,GSH-PX,GR,CAT were significantly higher (P <0.05).Conclusion Dexmedetomidine can protect the brain from focal cerebral ischemia-reperfusion injury,and its mechanism maybe relate to preserving the activities of endogenous antioxidants.

Effects of goal-directed fluid therapy on postoperative cognitive function in elderly patients / 临床麻醉学杂志

Objective To investigate the influence of stroke volume variation (SVV)-guided fluid therapy on postoperative cognitive function in elderly patients undergoing the unilateral total knee arthroplasty(UTKA).Methods One hundred patients undergoing the UTKA were randomly di-vided into two groups,group A(SVV 4%-9%)and group B(SVV 10%-14%).The liquid manage-ment,serum markers (CRP,IL-6)and the incidences of deflating-tourniquet-related hypotension and preoperative, 5 d after surgery of the occurrence of POCD in two groups were recorded. Results There was no significant difference in general information between the two groups. Compared with group B,group A needed more fluid transfusion and had a higher 24 h urine volume. The CRP and IL-6 was significantly higher in group B than that in group A;The incidence of defla-ting-tourniquet-related hypotension in group A [22(44%)]was also lower than that in group B [43 (86%)].However,there was no significant difference in the incidence of POCD between the two groups.Conclusion Sufficient blood volume can help to reduce the incidence of deflating-tourniquet-related hypotension,and reduce the inflammatory reaction in elderly patients.

Efficacy of laryngeal mask airway Supreme and Streamlined Liner of the Pharynx Airway in patients undergoing general anesthesia / 中华麻醉学杂志

Objective To compare the efficacy of laryngeal mask airway Supreme (LMAS) and Streamlined Liner of the pharynx Airway (SLIPA) in patients undergoing general anesthesia. Methods Eighty ASA Ⅰ or Ⅱ patients aged 18-70 yr weighing 45-80 kg undergoing general anesthesia were randomly divided into 2 groups ( n = 40 each): group LMAS and group SLIPA. Pharyngeal airway was inserted after induction of anesthesia with fentanyl 3μg/kg and propofol 2.0-2.5 mg/kg. MAP, HR, number of insertion, rate of successful placement at first attempt, placement time, airway sealing pressure, peak and mean airway pressure and side effects were recorded. Results There were no significant differences in MAP, HR and rate of successful placement at first attempt between the two groups. The placement time was significantly longer, the airway sealing pressure lower and the incidence of side effects higher in SLIPA group than in LMAS group. There was no significant difference in the peak and mean airway pressure between the 2 groups. Conclusion Both LMAS and SLIPA can assure good airway sealing and adequate ventilation. The complication is rare. The efficacy of LMAS is better.

Efficacy of laryngeal mask airway ProSeal and Supreme under low cuff pressure in patients undergoing laparoscopic surgery / 中华麻醉学杂志

Objective To assess the efficacy of laryngeal mask airway Proseal (LMA Proseal) and Supreme (LMA Supreme) used in patients undergoing laparoscopic surgery when the cuff-pressure was 35 cm H2O.Methods Sixty ASA Ⅰ or Ⅱ patients, aged 20-70 yr, weighing 50-80 kg, undergoing elective laparoscopic surgery, were randomized into2 groups (n = 30 each): LMA ProSeal group (group P) and LMA Supreme group (group S). After the LMA Proseal and LMA Supreme were inserted in group P and S respectively, the cuff pressure was monitored and maintained at 35 cm H2O by manipulate manometer. The airway sealing pressure, peak and mean airway pressure before and after pneumoperitoneum during mechanical ventilation and the complications were also recorded. Results The peak airway pressure was significantly higher after pneumoperitoneum than before pneumoperitoneum during mechanical ventilation (P ＜ 0.05), but there was no significant difference in the peak airway pressure before and after pneumoperitoneum between the two groups ( P ＞ 0.05). The air leakage had never happened before or after pneumoperitoneum during mechanical ventilation. There was no significant difference in the airway sealing pressure between the two groups ( P ＞ 0.05). There was no significant difference in the incidence of throat pain between the two groups(P＞0.05).Conclusion When the cuff pressure is 35 cm H2O, the LMA ProSeal and Supreme can provide adequate ventilation during operation with fewer complications and can be used safely for laparoscopic surgery.

Compound A concentrations in breathing circuit with different carbon dioxide absorbents during low-flow sevoflurane anesthesia / 中华麻醉学杂志

Objective To investigate the influence of different carbon dioxide (CO2) absorbents (Dr(a)gersorb 800 plus , Sodasorb,Sodasorb LF) on the production of compound A during low-flow sevoflurane anesthesia.Methods Twenty-seven ASA Ⅰ or Ⅱ patients aged 20-64 years were randomly assigned to three groups according to different CO2 absorbents: Dr(a)gersorb 800 plus' group (group D, n = 10), Sodasorb group (group S, n = 10) and Sodasorb LF group (group LF, n = 7). Anesthesia was maintained with low-flow (500 ml/min) sevoflurane inhalation (with the end-tidal sevoflurane concentration of approximately 2% ). At 2 h after low-flow sevoflurane anesthesia, gas samples were taken from the expiratory limb of the circuit. Compound A was detected by gas chromatography. Serum alanine transaminase (ALT), aspartate aminotransferase (AST), bilirubin (BR), urea nitrogen (BUN) and creatinine (Cr) levels were measured before (T0 ) and 24 h after operation (T1).Results The three groups were comparable with respect to age, body weight and height. After 2 h of low-flow sevoflurane anesthesia, compound A concentrations in the expiratory limb of the circuit were 11.6 ± 5.8 (group D), 2.1 ± 1.9 (group S)and ＜ 0.1 ppm (group LF), respectively. There were no significant changes in the serum ALT, AST, BR, BUN and Cr levels at 24 h after operation as compared with the preoperative baseline values in the three groups.Conclusion After 2 h of low-flow (500 ml/min) sevoflurane anesthesia, compound A concentrations within the circuit with different CO2 absorbents ( Dr(a)gersorb 800 plus' , Sodasorb, Sodasorb LF) are less than 50 ppm, with the lowest in Sodasorb LF.However, they have no significant effects on hepatic or renal function.

Protective effect of midazolam against injury to PC12 cells induced by N-methyl-D-aspartate / 中华麻醉学杂志

Objective To evaluate the protective effect of midazolam (MID) on PC 12 cells against injury induced by N-methyl-D-aspartate (NMDA) -Methods The differentiated PC12 cell strain was isolated and cultured in DMEM full nutrient liquid medium and incubated in CO2 incubator at 37℃ and 5 % CO2 for 3-4 days. The experiment consisted of 3 groups : (1) control group; (2) NMDA group and (3) MID treatment group. In NMDA group NMDA 300 ?mol?L-1 was added to DMEM liquid medium. MID group was further divided into five subgroups according to different concentrations of midazolam (MID) added to DMEM liquid medium in addition to NMDA 300 ?mol?L-1 :MID Ⅰ -Ⅴ subgroups (midazolam 0.33, 1, 3, 10, 30?mol?L-1 ). The PC 12 cells were then cultured for another few hours. Cellular viability was assessed by lactic dehydrogenase (LDH) assay and MTT assay. Meanwhile the [Ca2+ ] was measured by Fura-2/AM fluorescence and nitric oxide synthase (NOS) activity was measured with ultraviolet spectrophotometer. Results Exposure to NMDA 300 ?mol?L-1 for 4 h resulted in increase in release of LDH from PC 12 cells and decrease in optical density (OD570nm) absorbed by living cells, indicating that NMDA induced injury to PC12 cells. The presence of midazolam 0.33, 1, 3, 10 ?mol?L-1 ( MID subgroup I -IV ) decreased LDH release and increased OD570nm value. Exposure to NMDA 300 ?mol?L-1 for 4h also resulted in increase in intracellular Ca2+ concentration ([Ca2+ ];) and NOS activity in PC 12 cells. Midazolam 3 and 30?mol?L-1 significantly decreased [Ca2+ ]; and NOS activity as compared with NMDA group.Conclusion Midazolam can attenuate the NMDA-induced injury to PC12 cells, decrease the Ca2+ overloading and NOS activity in PC 12 cells. The inhibitory effects of midazolam on [Ca2+ ]; overloading and NOS activity may be involved in the mechanism of its protective action.

Effect of propofol on amino acid levels in cultured pc12 cells impaired by n-methyl-d-aspartate / 解放军医学杂志

Objective To observe the influence of propofol on amino acid levels in cultured PC12 cells impaired by N-methyl-D-aspartate, and explore the possible protective action mechanism of anesthetic propofol. Methods The levels of amino acid were measured by high performance liquid chromatography (HPLC). Results After exposing to NMDA 300?mol/L for 4h, the release of glutamate levels from PC12 cells was increased significantly, whereas the release of glutamine, aspartate, and glysine levels remained unchanged. In the presence of propofol 12.5, 125?mol/L for 4h, the levels of glutamate decreased significantly (P