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Objective To evaluate the effect of dexmedetomidine on Toll-like receptor 4 ( TLR4)/myeloid differentiation factor 88 ( MyD88)/nuclear factor Kappa B ( NF-κB) signaling pathway in the pe-ripheral blood mononuclear cells of elderly patients with diabetes mellitus undergoing lower extremity surger-y. Methods Forty elderly patients of both sexes with type 2 diabetes mellitus, aged 65-80 yr, with body mass index of 18. 5-27. 9 kg/m2 , of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with New York Heart Association Ⅰ or Ⅱ, undergoing lower extremity surgery with tourniquets under general anesthesia, were divided into 2 groups ( n=20 each) by using a random number table method: control group ( group C) and dexmedetomidine group ( group D) . Combined intravenous-inhalational anesthesia was applied. Dexmedetomidine was infused over 15 min in a dose of 1μg/kg after induction of anesthesia, fol-lowed by a continuous infusion of 0. 5 μg·kg-1 ·h-1 until the end of surgery in group D, while the equal volume of normal saline was given instead of dexmedetomidine in group C. Before using the the tourniquet and at 15 min, 1 h and 24 h after loosing the tourniquet, arterial blood samples were collected for determi-nation of the expression of TLR4, NF-κB and MyD88 in peripheral blood mononuclear cells and concentra-tions of tumor necrosis factor-alpha ( TNF-α) , interleukin-1β ( IL-1β) , cardiac troponin I ( cTnI ) and creatine kinase-MB ( CK-MB) in plasma. Results Compared with group C, the expression of TLR4, NF-κB and MyD88 in peripheral blood mononuclear cells was significantly down-regulated, and the concentra-tions of TNF-α, IL-1β, cTnI and CK-MB in plasma were decreased at each time point after loosing the tourniquet in group D ( P＜0. 05) . Conclusion The mechanism by which dexmedetomidine reduces myo-cardial damage may be related to inhibiting TLR4/MyD88/NF-κB signaling pathway and reducing systemic inflammatory responses in elderly patients with diabetes mellitus undergoing lower extremity surgery.
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Objective To evaluate the Effect of dexmedetomidine on the stress reaction for awake nasotra-cheal intubation in patients with maxillofacial tumor. Methods Forty patients,which are ASA physical status Ⅰor Ⅱ,aged 20 ~ 62 yr ,BMI < 25 and scheduled for radical operation for maxillofacial tuomr ,were randomly divided into 2 groups (n = 20 each)using a random number table:dexmedetomidine groups(group D)and mid-azolam group(group M). MAP ,HR ,SpO2 were recorded ,and the rate of respiratory depression ,the degree of tolerance and matching and the memory to intubation were recorded. Results Compared with the baseline value at T0,MAP and HR at T1-2 and HR at T3 were increased in group M. HR were increased at T1 in group D(P<0.05). Compared with group M,MAP and HR at T1-2 and HR at T3 were decresed in group D(P<0.05). The rate of respi-ratory depression in group D was decreased compared with group M ,and the degree of tolerance and matching to intubation was better in group D. Conclusion dexmedetomidine can inhibit the stress reaction caused by nasotra-cheal intubation in patients with maxillofacial tuomr ,and improve the degree of comfort and security in the process of intubation.
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Objective To evaluate the Effect of dexmedetomidine on the stress reaction for awake nasotra-cheal intubation in patients with maxillofacial tumor. Methods Forty patients,which are ASA physical status Ⅰor Ⅱ,aged 20 ~ 62 yr ,BMI < 25 and scheduled for radical operation for maxillofacial tuomr ,were randomly divided into 2 groups (n = 20 each)using a random number table:dexmedetomidine groups(group D)and mid-azolam group(group M). MAP ,HR ,SpO2 were recorded ,and the rate of respiratory depression ,the degree of tolerance and matching and the memory to intubation were recorded. Results Compared with the baseline value at T0,MAP and HR at T1-2 and HR at T3 were increased in group M. HR were increased at T1 in group D(P<0.05). Compared with group M,MAP and HR at T1-2 and HR at T3 were decresed in group D(P<0.05). The rate of respi-ratory depression in group D was decreased compared with group M ,and the degree of tolerance and matching to intubation was better in group D. Conclusion dexmedetomidine can inhibit the stress reaction caused by nasotra-cheal intubation in patients with maxillofacial tuomr ,and improve the degree of comfort and security in the process of intubation.
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Objective To evaluate the efficacy of dexmedetomidine for improvement of postoperative analgesia with sufentanil in pediatric patients with a large area of burn after tangential excision and skin grafting.Methods Forty-two pediatric patients of both sexes with a large area of burn,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 2-10 yr,weighing 13-36 kg,scheduled for elective tangential excision and skin grafting under combined propofol-remifentanil-sevoflurane anesthesia,were randomly divided into 2 groups (n=21 each) using a random number table:sufentanil group (group Suf) and dexmedetomidine plus sufentanil group (group Dex-Suf).The patient-controlled intravenous analgesia (PCIA) was used for postoperative analgesia.PCIA solution contained sufentanil 2 μg/kg and granisetron 100 μg/kg in 100 ml of normal saline in group Suf,and contained dexmedetomidine 2.5 μg/kg,sufentanil 1.5 μg/kg,and granisetron 100 μg/kg in 100 ml of normal saline in group Dex-Suf.The PCA pump was set up with a 0.5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h after a loading dose of sufentanil 0.1 μg/kg.When Faces Pain Scale score＞2,sufentanil 0.1 μg/kg was injected intravenously as rescue analgesic.The consumption of sufentanil was recorded within 48 h after operation.Ramsay sedation scores at static and dynamic (during dressing changes) conditions were assessed after operation.The parents' satisfaction,requirement for rescue analgesics and incidence of adverse reactions such as agitation,nausea and vomiting were recorded after operation.Results Compared with group Suf,Ramsay sedation scores at static and dynamic conditions and patients' satisfaction scores were significantly increased,and the consumption of sufentanil,requirement for rescue analgesics and incidence of agitation,nausea and vomiting were significantly decreased after operation in group Dex-Suf (P＜0.05).Conclusion Dexmedetomidine significantly improves postoperative intravenous analgesia with sufentanil in the pediatric patients with a large area of burn after tangential excision and skin grafting,and combination of dexmedetomidine and sufentanil is recommended for this type of pediatric patients.
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Objective To investigate the effects of dexmedetomidine on plasma IL-8,IL-10 level and lung AQP1 expression in patients undergoing one lung ventilation(OLV).Methods Forty patients,ASA Ⅰ or Ⅱ,scheduled for lung cancer radical surgery were randomly divided into two groups:control group (group C)and dexmedetomidine group (group D).In group D,dexmedetomi-dine 1 μg/kg (initial dose)was given over more than 10 min before anaesthesia induction,followed by continuous infusion at 0.5 μg·kg-1 ·h-1 until 30 min before the end of operation.In group C,the e-qual volume of normal saline was infused.Blood samples were collected at immediately before OLV (T1 ),30 (T2 ),60 (T3 ),120 (T4 )min of OLV,30 min after lung inflate (T5 )and 2 h after opera-tion (T6 )for determination of plasma IL-8 and IL-10 levels.Lung tissues were obtained at T1 for de-termination of AQP1 expression.Results Compared with the value at T1 ,plasma IL-8 levels in group C at T3-T6 and in group D at T3-T5 were increased,plasma IL-10 levels were increased in both groups at T2-T5 (P <0.05).Compared with group C,plasma IL-8 levels at T3-T6 were decreased and plasma IL-10 levels at T2-T5 were increased in group D (P <0.05).Compared with the value at immediately before OLV,the expression of AQP1 was decreased at the time of lobectomy of lungs in group C (P<0.05).Compared with group C,the expression of AQP1 at the time of lobectomy of lungs in group D was increased (P <0.05).Conclusion Dexmedetomidine 1 μg/kg followed by continuous infusion at 0.5 μg·kg-1 ·h-1 can reduce inflammatory response,up-regulate the expression of AQP1 in pa-tients undergoing OLV.
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Objective To evaluate the role of endoplasmic reticulum stress in ketamine-induced apoptosis in rat neurons.Methods Rat adrenal pheochromocytoma cell line (PC12 cells) was seeded in the culture dishes 100 mm in diameter (10 ml/dish) or in 6-well plates (2 ml/well) at a density of 5 × 105 cells/ml.PC12 cells were divided into 4 groups (n =6 each) using a random number table:control group (group C);ketamine group (group K);endoplasmic reticulum stress inhibitor salubrinal group (group S);ketamine + salubrinal group (group K+S).In group C,the cells were cultured in the plain culture medium.In group K,1.5 mmol/L ketamine was added.In group S,30 mmol/L salubrinal was added.In group K + S,1.5 mmol/L ketamine and 30 mmol/L salubrinal were added.At 24 h of incubation,the cell morphology was observed under light microscope,the expression of Bip and caspase-12 in PC12 cells was detected by Western blot,and the cell apoptosis was measured by flow cytometry.The apoptosis rate was calculated.Results Compared with group C,the expression of Bip and caspase-12 was significantly upregulated,and the apoptosis rate was increased in K and K + S groups (P ＜ 0.05),and no significant change was found in the parameters mentioned above in group S (P＞ 0.05).Compared with group K,the expression of Bip and caspase-12 was significantly down-regulated,and the apoptosis rate was decreased in group K+S (P＜0.05).The degree of damage to PC12 cells was more serious in group K than in group C..The degree of damage to PC12 cells in group K+S was significantly mnilder than that in group K and more serious than that in group C.Conclusion The mechanism by which ketamine induces neuronal apoptosis is related to the enhancement of endoplasmic reticulum stress in rats.
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Objective To explore and analysis feasibility of the prevention of edaravone on myocardial ischemia after beating cor-onary artery bypass grafting .Methods From June 2011 to December 2012 ,78 patients which accepted beating heart coronary artery bypass grafting were randomly divided into treatment group (39 cases) and control group(39 cases) .After induction of anesthesia , the treatment group were continued to intravenous edaravone 60 mg ,while the control group were continued infusion of equivalent saline .The serum superoxide dismutase(SOD) ,malondialdehyde(MDA) levels were compared between the two groups at different times which were before surgery (T1) ,after incision 1 h(T2) ,surgery (T3) ,and after 24 h(T4) ,plasma brain natriuretic peptide (BNP) ,troponin I(cTnI) levels were compared at T1 and T4 .Left ventricular ejection fraction(LVEF) were also be compared .Re-sults The two groups of patients before treatment ,there were not statistically significant difference between the two groups on SOD ,MDA ,CK-MB ,BNP and cTnI(P> 0 .05) .At T2 ,T3 ,T4 point ,the SOD activity of the treatment group was significantly higher than that of control group(P<0 .05) .The MDA ,CK-MB value were significantly lower than that of control group (P<0 . 05) .At T4 ,the BNP and cTnI in the treatment group were less than that of control group (P<0 .05) .The postoperative LVEF% in treatment group were significantly higher than that of control group (P<0 .05) .Postoperative ventilator treatment time and ICU stay time and total hospitalization time of the treatment group were all significantly less than that of control group (P<0 .05) .Con-clusion For the beating heart coronary artery bypass surgery patients ,edaravone can effectively scavenge oxygen free radicals and reduce the release of enzymes ,reduce injury caused by myocardial ischemia-reperfusion and protect myocardial cells .
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Objective To evaluate the role of the expression of heat shock protein 70 (HSP70) and heme oxygenase-1 (HO-1) in the reduction of renal ischemia-reperfusion (I/R) injury by ischemic postconditioning in tats.Methods One hundred and forty healthy male SD rats weighing 250-280 g were randomized into 4 groups ( n = 35 each) : sham operation group (S group) ; I/R group; ischemic postconditioning group (IPo group); quercetin (an inhibitor of HSP) + ischemic postconditioning group (Q + IPo group). Renal I/R was produced by clamping bilateral renal pedicels for 45 min followed by reperfusion. In group S, bilateral kidneys were only exposed through a midline incision but their- pedicels were not clamped. In IPo and Q + IPo groups, 45 min ischemia was followed by three 10 s episodes of ischemia at 10 s intervals for reperfusion and in addition intraperitoneal quercetin 100 mg/kg was injected at 1 h before ischemia in group Q + IPo. Blood samples from hearts were obtained at 0, 1, 3, 6, 12, 24 and 48 h of reperfusion (T0-6) and the rats were then sacrificed and kidneys removed to detect the expression of HSP70 and HO-1 mRNA and protein in renal tissues. The blood samples obtained at T3 were used to determine serum creatinine (Cr) and urea nitrogen (BUN) concentrations and the expression of caspase-3 mRNA . The apoptosis in the renal tissues was detected using TUNEL and apoptotic index ( AI) was calculated. Microscopic examination was performed with light microscope. Results Compared with group S, the serum Cr and BUN concentrations and AI were significantly increased at T3,the expression of caspase-3 mRNA was up-regulated at T3, and the expression of HSP70 and HO-1 mRNA and protein was up-regulated at T0-6 in the other groups (P ＜ 0.05) . Compared with group I/R, the serum Cr and BUN concentrations and AI were significantly decreased at T3, the expression of caspase-3 mRNA was down-regulated at T3, and the expression of HSP70 and HO-1 mRNA and protein was up-regulated at T1-5 in group IPo ( P ＜ 0.05) . Compared with group IPo, the serum Cr and BUN concentrations and AI were significantly increased at T3, the expression of caspase-3 mRNA was up-regulated at T3, and the expression of HSP70 and HO-1 mRNA and protein was down-regulated at T1-5, in group Q + IPo ( P ＜ 0.05) . The microscopic examination showed that the renal I/R injury was significantly attenuated by ischemic postconditioning and the degree of injury in group IPo was similar to that in group I/R. Conclusion The expression of HSP70 and HO-1 is involved in the reduction of renal I/R injury by ischemic postconditioning in rats.