Effects of autologous blood withdrawal-reinfusion on inflammatory responses of patients undergoing cardiac surgery with different time courses of cardiopulmonary bypass / 中华麻醉学杂志

Objective To evaluate the effects of autologous blood withdrawal-reinfusion on inflam-matory responses of patients undergoing cardiac surgery with different time courses of cardiopulmonary by-pass(CPB). Methods A total of 120 patients, aged 18-70 yr, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, were divided into 2 groups(n=60 each)using a random number table: autologous blood withdrawal-reinfusion group(ABWR group)and non-autologous blood withdrawal-reinfusion group (NABWR group). Each group was further divided into 3 subgroups(n=20 each)according to the expected time of CPB: long time course(>120 min)subgroup(L subgroup), medium time course(>60 min-≤120 min)subgroup(M subgroup)and short time course(≤60 min)subgroup(S subgroup). In group ABWR, after the end of CPB and after heparin was reversed with protamine, blood shed from the surgical field and left in the autologous blood recycling machine pipeline after the end of CPB was collected, filtra-ted, washed, concentrated and reinfused. After the end of CPB, blood left in the autologous blood recy-cling machine pipeline was directly kept in the storage bag and partially or totally reinfused in group NAB-WR. Before operation and at 1, 6, 24 and 48 h after the end of CPB, blood samples were collected for de-termination of serum tumor necrosis factor-alpha(TNF-α), interleukin-6(IL-6)and IL-10 concentrations by enzyme-linked immunosorbent assay. Results Compared with ABWR-S subgroup, the serum TNF-α and IL-6 concentrations were significantly increased at each time point after the end of CPB(P<005), and no significant change was found in serum IL-10 concentrations in ABWR-L and ABWR-M subgroups (P>005). There were no significant differences in serum TNF-α, IL-6 and IL-10 concentrations between ABWR-L subgroup and ABWR-M subgroup(P>005). Compared with NABWR subgroup of the same time course, the serum TNF-α concentration was significantly decreased at each time point after the end of CPB, the serum IL-6 concentration was decreased at 6-48 h after the end of CPB(P<005), and no significant change was found in serum IL-10 concentrations in ABWR-L subgroup(P>005); the serum TNF-α con-centration was significantly decreased at 1 h after the end of CPB, and the serum IL-6 concentration was de-creased at 6 and 24 h after the end of CPB in ABWR-M subgroup(P<005); no significant difference was found in the serum concentrations of TNF-α, IL-6 or IL-10 at each time point after the end of CDB in AB-WR-S subgroup(P<005). Conclusion With prolongation of the time courses of CPB, the efficacy of autologous blood withdrawal-reinfusion in inhibiting inflammatory responses of patients undergoing cardiac surgery is more significant.

Effects of dexmedetomidine on hemodynamics during induction of anesthesia in patients with atrial fibrillation with rapid ventricular rate undergoing noncardiac surgery / 中华麻醉学杂志

Objective To evaluate the effects of dexmedetomidine on hemodynamics during induction of anesthesia in the patients with atrial fibrillation with rapid ventricular rate undergoing noncardiac surgery.Methods Fifty patients with rheumatic valvular heart disease complicated with atrial fibrillation,aged 45-64 yr,weighing 50-75 kg,with ventricular rate ≥ 90 bpm,of ASA physical status Ⅱ or Ⅲll (NYHA Ⅱ or Ⅲ),scheduled for elective surgery,were randomly divided into 2 groups (n =25 each) using a random number table:control group (group C) and dexmedetomidine group (group D).Dexmedetomidine 0.6 μg/kg was infused intravenously at 10 min prior to induction of anesthesia in group D.Anesthesia was induced with iv midazolam 0.06 mg/kg,sufentanil 0.6 μg/kg,and vecuronium 0.12 mg/kg.Tracheal intubation was performed when the BIS value≤≤ 55After admission to operating room (T0,baseline),immediately after the end of dexmedetomidine infusion (T1),immediately before intubation (T2),and at 1,3 and 5 min after intubation (T3-5),SP,DP,MAP and HR were recorded.The adverse cardiovascular events were recorded starting from induction of anesthesia to 5 min after intubation.Results Compared with the baseline value at T0,HR was significantly decreased at T2,5,while increased at T3,4 in group C,and HR was decreased at T1-5 in group D; SP,DP and MAP were decreased at T2,5,while increased at T3 in group C,and no significant changes were found in the indices mentioned above in group D.Compared with group C,the incidence of hypotension,hypertension and tachycardia was significantly decreased,and no significant changes were found in theincidence of bradycardia in group D.Conclusion Dexmedetomidine 0.6 μg/kg infused intravously is helpful in maintaining the hemadynamics stable during induction of anesthesia in the patients with atrial fibrillation with rapid ventricular rate underging noncardiac surgery.

Altered morphology in erythrocytes of autologous blood stored at different temperatures / 中国组织工程研究

BACKGROUND:Transfusion guidelines pointed out:whole blood should be stored at (4±2)℃. The bacterial growth or loss of function should occur if the blood leaves the suitable storage conditions. Recipients wil suffer from different degrees of blood transfusion reaction or invalid infusion. OBJECTIVE:To observe morphology of erythrocytes of autologous blood stored at different temperatures using microscope. METHODS:Blood was obtained from 40 cases of acute normovolemic hemodilution and stored in ACD citrate bags. Whole blood was respectively stored at 4 ℃ and 23 ℃. Blood smear was taken respectively in the blood storage immediately, 1, 2, 3, 4, 5 and 6 hours after col ecting autologous blood. Changes in morphology of erythrocytes were observed with a microscope. Deformity rate of erythrocytes was calculated. Six blood samples were randomly selected to test pH, K+, and free hemoglobin respectively in 6-hour common temperature group and ACD banked blood within the valid period. Six blood samples were randomly selected for the bacterial culture in each group of two groups at 6 hours. RESULTS AND CONCLUSION:There were no significant differences in abnormality rates of erythrocytes between 4 ℃ and common temperature groups at each time point. The pH, K+, free hemoglobin at six hours in the common temperature group were better than those of ACD banked blood within the valid period and there was no bacterial growth in culture between the two groups. Therefore, it is feasible to transfuse autologous blood back to the patient within 6 hours of storage at room temperature.

Comparison of effects of dexmedetomidine and fentanyl on median effective concentration of propofol required for inducing respiratory depression / 中华麻醉学杂志

Objective To compare the effects of dexmedetomidine and fentanyl on the median effective concentration (EC50) of propofol required for inducing respiratory depression.Methods ASA physical status Ⅰ or Ⅱ patients,aged 30-50 yr,weighing 50-75 kg,with body mass index of 22-28 kg/m2,scheduled for elective gynecological surgery under general anesthesia,were randomly divided into 3 groups:control group (group C),dexmedetomidine group (group D) and fentanyl group (group F).Dexmedetomidine 0.5 μg/kg and fentanyl 1.5 μg/kg in 10ml of normal saline were infused over 10 min in D and F groups,respectively,while the equal volume of normal saline was given in group C.Lidocaine was injected intravenously followed by target-controlled infusion of propofol.In C,D and F groups,the initial target concentration of propofol was 2.5,2.1 and 1.1 μg/ml,respectively,and the ratio between the two successive concentration gradients was 1.1.It was defined as positive when patients developed respiration depression.EC50 and 95％ confidence interval of propofol inducing respiratory depression were calculated.BIS values and OAA/S scores were recorded after admission to operating room (T0),after infusion of dexmedetomidine,fentanyl or normal saline,at 5 and 10 min after the start of propofol target-controlled infusion and after the target effect-site and plasma concentrations were balanced.Results EC50 (95％ confidence interval) of propofol required for inducing respiratory depression was 2.72 (2.55-2.91),2.15 (2.05-2.27)and 1.17(1.08-1.25) μg/ml in C,D and F groups,respectively.Compared with group C,the EC50 was significantly decreased in D and F groups and the BIS values and OAA/S scores were increased in group F (P ＜ 0.05),and no significant changes were found in the BIS values and OAA/S scores in group D (P ＞ 0.05).The EC50 was significantly decreased and the BIS values and OAA/S scores was increased in group F as compared with group D (P ＜ 0.05).When the BIS values reached 65 or OAA/S scores was 3,the effect-site concentration was significantly lower in D and F groups than in group C (P ＜ 0.05).In C,D and F groups,the percentage of patients who developed upper airway obstruction caused by glossocoma was 100％,60％ and 20％,respectively,and who developed decreased respiratory rate or apnea (RR≤ 8 bpm or respiratory arrest time≥ 15 s) was 0,40％ and 80％,respectively.Conclusion Although dexmedetomidine induces no respiratory depression,dexmedetomidine can enhance the potency of propofol required for inducing respiratory depression and the prtency is lower than that of small-dose fentanyl.

Characteristics of erythrocytes washing with the autologous transfusion system / 中国组织工程研究

BACKGROUND:Autologous shed blood washing with the autologous transfusion system involving recovery, anticoagulation, centrifugation, concentrating and washing has been widely used in clinical practice. OBJECTIVE:To clarify the characteristics of erythrocytes washing with autologous transfusion system, including recovery rate and hematocrit, the changes of shape, deformability, flow properties and in vivo half-life, oxygen carrying and delivering capacity and erythrocyte immunity and immunereceptor expression. METHODS:The literatures published from January 1987 to January 2013 were retrieved by the first author in Wanfang and PubMed databases. Key words were“blood transfusion, autologus, blood preservation, erythrocytes”in English and Chinese. A total of 200 literatures relating to the erythrocyte characteristics in autologous blood transfusion were found by the computer, 60 of which were retained for further analysis after eliminating repetitive researches. RESULTS AND CONCLUSION:Because of the mechanical force, such as negative pressure suction, centrifugal separation, and inflammatory mediators, enzymes, activated complements released by various damaged tissues and cells, the col ected erythrocytes were damaged to some extent. As a result, the total recovery rate of erythrocytes depended on the recovery rate, storage breakage rate and cleaning loss rate. The oxygen carrying capacity of erythrocytes was not influenced significantly by this procedure, so the recycled erythrocytes had the same oxygen carrying capacity with normal erythrocytes. To some extent, the number of surface receptors and immune function of recycled erythrocytes descended, but they were better than the erythrocytes preserved for 2 weeks. Studies suggested that blood recovery technology should be improved to reduce the functional decline in immune adherence of the recycled erythrocytes.

Effect of different doses of dexmedetomidine on median effective concentration of propofol required to prevent response to Supreme laryngeal mask airway insertion in aged patients / 中华麻醉学杂志

Objective To investigate the effect of different doses of dexmedetomidine on the median effective concentration (EC50) of propofol required to prevent the response to Supreme laryngeal mask airway (LMA) insertion in aged patients.Methods ASA Ⅰ or Ⅱ patients of both sexes,aged ≥ 65 yr,with a body mass index of 20-28 kg/m2,undergoing knee operation under general anesthesia,were randomly divided into 3 groups:control group (group C),small dose dexmedetomidine group (group D1 ) and large dose dexmedetomidine group (group D2 ).Dexmedetomidine 0.4 and 0.8 μg/kg were infused intravenously over 10 min in groups D1 and D2 respectively,while group C received the equal volume of normal saline instead.Anesthesia was induced with target-controlled infusion of propofol.The initial target plasma concentration of propofol was set at 3.5,3.0 and 2.6 μg/ml in groups C,D1 and D2 respectively.Following equilibration between the plasma and effect-site concentration of propofol,LMA was inserted when BIS value was 50-60.EC50 was determined by up-and-down sequential trial.The target plasma concentration of propofol increased/decreased by 10％ in the next patient depending on whether or not the LMA insertion response occurred.Positive LMA insertion response was defined as body movement,comer of the mouth movement,biting LMA,bucking and/or wallowing during insertion.The EC50 and 95％ confidence interval (CI) of propofol required to prevent LMA insertion response were calculated with sequential method.Results EC50(95％ CI) of propofol was 3.57 μg/ml (2.91-3.87 μg/ml),3.09 μg/ml (2.66-3.53 μg/ml) and 2.62 μg/ml (2.30-3.15 μg/ml) in groups C,D1 and D2 respectively.EC50 was significantly lower in groups D1 and D2 than in group C,and in group D2 than in group D1 ( P ＜ 0.05 ).Conclusion Dexmedetomidine 0.4 and 0.8 μg/kg infused intravenously can reduce the EC50 of propofol required to prevent the response to Supreme LMA insertion in aged patients,and the effect of 0.8 μg/kg is more obvious.

Effect of shenfu injection on airway resistance and oxygenation during one-lung ventilation in patients undergoing lobectomy / 中华麻醉学杂志

ObjectiveTo evaluate the effect of shenfu injection on airway resistance and oxygenation during one-lung ventilation (OLV) in patients undergoing lobectomy.MethodsSixty ASA Ⅱ patients of both sexes,aged 50-80,BMI 20-29 kg/m2,scheduled for lobectomy under thoracic epidural block combined with general anesthesia,were randomly divided into 2 groups( n =30 each):normal saline control group (group C) and shenfu injection group (group S).In group S,shenfu injection was infused intravenously at 4.5 ml·kg-1 ·h-1 for 20 min before anesthesia induction.In group C,equal volume of normal saline was infused instead of shenfu injection.Airway peak pressure was recorded and arterial blood samples were taken for determination of PaO2 before OLV,at 30,60 min of OLV and the end of surgery.Oxygenation index was calculated.ResultsCompared with group C,airway peak pressure was significantly decreased and oxygenation index increased at 30,60 min of OLV in group S ( P ＜ 0.05).ConclusionShenfu injection can decrease airway resistance and increase oxygenation during OLV in patients undergoing lobectomy,indicating that shenfu injection has a lung-protective effect.

Effects of dexmedetomidine conmbined with small-dose of sulfentanil on hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting / 中华麻醉学杂志

Objective To investgate the effects of dexmedetomidine combined with small-dose of sufentanil on the hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting.Methods Seventy-five ASA Ⅱ or Ⅲ and NYHA Ⅱ or Ⅲ patients aged 46-72 yr,weighing 59-86 kg,ejection fraction ≥45％,undergoing off-pump coronary artery bypass grafting,were randomly divided into 3 groups ( n =25):dexmedetomidine combined with small-dose of sufentanil group (group DS),small-dose of sufentanil group (group S1 ) and large-dose of sufentanil group (group S2 ).In group DS,dexmedetomidine 0.8 μg/kg (diluted with normal saline to 15 ml) was injected for 15 min at a rate of60 ml/h,while the same volume of normal saline were given in groups S1 and S2.Anesthesia was induced with midasolam 0.08 mg/kg and pipecuronium 0.12 mg/kg.After administration of the total dose of 1/3 midazolam and 1/8 pipecuronium,sufentanil 0.5,0.5 and 0.8μg/kg (diluted with narmalsaline to 10 ml) were injected in groups DS,S1 and S2 respectively.Then the rest of midazolam was injected.When BIS value ≤ 75,the rest of pipecuronium was injected.When BIS value ≤ 55,the patients were tracheal intubated and mechanically ventilated.PETCO2 was maintained at 30-35 mm Hg.The adverse ardiovascular events (hypertension,hypotension,tachycardia and bradycardia) and drugs intervention were recorded during anesthesia induction.Results Compared with group S2,the incidence of hypertension and tachycardia was significantly increased in group S1,the incidence of hypotension decreased in groups S1 and DS,the incidence of drug intervention decreased in group DS (P ＜ 0.05).Compared with group S1,the incidence of hypertension,hypotension and tachycardia was significantly decreased,the incidence of bradycardia increased,theincidence of drug intervention decreased in group DS (P ＜ 0.05).Conclusion Dexmedetomidine (0.8 μg/kg) combined with small-dose of sufentanil (0.5 μg/kg) is beneficial for keep the stable of hemodynamics during anesthesia induction in patients undergoing off-pump coronary artery bypass grafting.

Effect of dexmedetomidine on median effective target effect-site concentration of sufentanil inhibiting body movement evoked by skin incision in patients undergoing bilateral subtotal thyroidectomy / 中华麻醉学杂志

Objective To investigate the effect of dexmedetomidine on median effective target effect-site concentration ( EC50) of sufentanil inhibiting body movement evoked by skin incision in patients undergoing bilateral subtotal thyroidectomy. Methods Thirty-nine ASA I or II patients of both sexes aged 20-64 yr with a body mass index of 20-25 kg/m2 undergoing bilateral subtotal thyroidectomy were randomly divided into 2 groups: control group (group C) and dexmedetomidine group (group D). The patients were premedicated with intramuscular phenobarbital 0.1 g and scopolamine 0.3 mg. In group D dexmedetomidine 0.6 μg/kg was injected iv over 10 min at S min before induction of anesthesia. Anesthesia was induced with target-controlled infusion (TCI) of propofol and sufentanil. The target plasma concentration of propofol was set at 3.0 μg/ml which was maintained until the end of operation. TCI of sufentanil was started at 10 min after initiation of propofol TCI. The initial target effect-site concentration was set at 0.20 ng/ml and decreased/increased by 20% in the next patient according to whether the patient's body moved or not within 1 min after skin incision. Laryngeal mask airway was inserted at 3 min after initiation of sufentanil TCI. Spontaneous breathing was maintained. Skin incision was made at 10 min after initiation of sufentanil TCI. The EC50 and 95% confidence interval (CI) of sufentanil inhibiting skin incision-evoked body movement were calculated with sequential method. Results EC50, of sufentanil was 0.1148 ng/ml (95% CI 0.1055-0.1249 ng/ml) in group D and 0.1454 ng/ml (95% CI 0.1339-0.1580 ng/ml) in group C, and was significantly lower in group D than in group C. Conclusion Dexmedetomidine 0.6 μg/kg infused iv before operation can reduce the EC50 of sufentanil inhibiting body movement evoked by skin incision in patients undergoing bilateral subtotal thyroidectomy.

Preoperative autologous blood donation using the leap-frog technique for cardiopulmonary bypass surgery in a swine model / 中国组织工程研究

BACKGROUND: Allogeneic blood transfusion in humans of the same blood type has been implemented, but studies regarding swine blood type and how to perform allogeneic blood transfusion have been rarely reported. OBJECTIVE: To investigate the feasibility of preoperative autologous blood donation using the leap-frog technique for cardiopulmonary bypass surgery in a swine model.METHODS: Sixteen domestic swine were randomly divided into two groups: autologous blood donation and allogeneic blood transfusion. Another four swine were used as blood donors. Two groups of swine underwent cardiopulmonary bypass surgery. The autologous blood donation group received self-transfusion reserved before surgery while the allogeneic blood transfusion group received the same amount of allogeneic blood. Hemoglobin (Hb) concentration and hematocrit (Hct) level prior to and after donation in the autologous blood donation group was recorded. Hb concentration in the two groups was recorded prior to, during, immediately after, and 1 day after the surgery. RESULTS AND CONCLUSION: The total blood volume of each experimental swine was (2500±428) mL. For the autologous blood donation group, the predicted blood volume of the first donation was (501±86) mL and the actual blood volume was (493±93) mL; in the second donation, the predicted blood volume was (750±128) mL and the actual blood volume was (719±98) mL. There was a significant difference in Hb concentration and Hct level between prior to and after donation in the autologous blood donation group (P < 0.01). Hb concentration at 1 day after the surgery was significantly higher in the autologous blood donation group than in the allogeneic blood transfusion group (P < 0.01), while no significant difference in Hb concentration existed between these two groups prior to, during, and immediately after the surgery (P > 0.05). Compared with prior to surgery, Hb concentration in each group was significantly lower at 1 day after the surgery (P < 0.01). The autologous blood donation group exhibited significantly higher survival rate of swine than the allogeneic blood transfusion group (P < 0.01). These findings indicate that compared with allogeneic blood transfusion, preoperative autologous blood donation using the leap-frog technique appears to be a safe, effective method with a high survival rate for cardiopulmonary bypass surgery.

Effect of dexmedetomidine on minimum alveolar concentration of isoflurane required to inhibit the body movement during skin incision / 中华麻醉学杂志

Objective To investigate the effect of dexmedetomidine on minimum alveolar concentration (MAC) of isoflurane required to inhibit the body movement during skin incision. Methods Forty-eight ASA Ⅰ or Ⅱ patients aged 40-60 yr with body mass index of 22-27 kg/m2 undergoing elective upper abdominal surgery under general anesthesia were randomly divided into 3 groups: control group (group C, n = 15);low dose dexmedetomidine group (group D1, n = 17) and high dose dexmedetomidine group (group D2, n = 16). The patients were unpremedicated. Dexmedetomidine 0.4 and 0.8 μg/kg in normal saline (NS) 15 ml was infused over 15 min before induction of anesthesia in D1 and D2 groups respectively. Anesthesia was induced with fentanyl-propofol-succinylcholine. The patients were mechanically ventilated after tracheal intubation. Anesthesia was maintained with isoflurane. MAC of isoflurane was determined by up-and-down technique. The initial end-tidal isofiurane concentration was set at 1.0%, 0.8% and 0.6% in C, D1 and D2 groups respectively. Each time the end-tidal isoflurane concentration was increased/decreased by 0.2%. Skin incision was made after 15 min of equilibration, when the twitch height returned to more than 90% of its control value. Movement of body and limbs including swallowing and coughing were carefully looked for when skin incision was made. MAC of isoflurane was the mean of end-tidal concentration of isoflurane of each crossover pair, and 95 % CI was calculated. Results MAC of isoflurane was significantly decreased in D1 and D2 groups as compared with group C and in group D2 as compared with group D1( P ＜ 0.05 or 0.01 ). Conclusion Dexmedetomidine can significantly decrease MAC of isoflurane required to inhibit the body movement during skin incision in a dose-dependent manner.

Effect of nicorandil pretreatment on myocardial mitochondria in a rabbit model of myocardial ischemia-reperfusion / 中华麻醉学杂志

Objective To investigate the effect of nicorandil pretreatment on myocardial mitochondria in a rabbit model of myocardial ischemia-reperfusion (I/R). Methods Tirty-two healthy male New Zealand white rabbits weighing 2.0-2.5 kg aged 4 months were randomly allocated into 4 groups ( n = 8 each): Ⅰ group sham operation (group S); Ⅱ group I/R; Ⅲ group nicorandil pretreatment (group N) and Ⅳ group nicorandil + 5 hydroxydecanoic acid (group N + 5-HD). Myocardial I/R was induced by 30 min occlusion of left circumflex coronary artery followed by 120 min reperfusion. In group N and N + 5-HD a bolus of nicorandil 100 μg/kg was given iv at 10 min before myocardial ischemia followed by continuous infusion at 10 μg· kg-1 · min-1 until the beginning of myocardial ischemia. In group Ⅳ a bolus of 5-HD 5 mg/kg was injected iv at 20 min before myocardial ischemia.The animals were sacrificed at the end of 120 min reperfusion. The mitochondrial membrane potential was measured by flow cytometry using JC-1 fluorescence probe as indicator. Bcl-2, Bax and cytochrome c protein expression was determined by immuno-histochemistry. Myocardial ultrastructure was examined with transmission electron microscope. Results Red fluovescence intensity indicating normal live cells was significantly higher, the green fluorescence intensity indicating apoptotic cells was lower and red/green fluorescence intensity ratio was higher; the Bcl-2/Bax ratio was significantly higher and cytochrome c protein expression lower in group N than in group I/R.5-HD administration negated the protective effect of nicorandil pretreatment against myocardial I/R injury. Conclusion Nicorandil stabilizes mitochondrial membrane potential, decreases cytochrome c protein releasing, and suppresses mitochondrial apoptotic signal transduction by opening the mito-KATP channels.

Half-effective target effect-site concentration of sufentanil required to inhibit body movement during insertion of ureteroscopes when combined with propofol / 中华麻醉学杂志

Objective To determine the half-effective target effect-site concentration (Ce) (EC50) of sufentanil required to inhibit the body movement during insertion of ureteroscopes when combined with propofol in patients undergoing transureteroscopic holmium laser lithotripsy. Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes, aged 20-60 yr, BMI ＜ 30 kg/m2 , undergoing transureteroscopic holmium laser lithotripsy were randomly divided into 5 groups according to the different C es of sufentanil ( n = 10 each): group S1 (Ce 0.21 ng/ml), group S2(Ce 0.14 ng/ml), group S3(Ce 0.09 ng/ml), group S4(Ce 0.06 ng/ml), group S5(Ce 0.04 ng/ml). TCI of propofol with target plasma concentration set at 2.5-3.0 μg/ml was given. Sufentanil with the corresponding Ce was infused in each group. The ureteroscopes were inserted as soon as the patients lost consciousness and the effect-site concentration of sunfentanil was achieved. The response was defined as positive when body movement occurred within 1 min after insertion of ureteroscopes. The EC50 of sufentanil required to inhibit the body movement during insertion of ureteroscopes when combined with propofol and 95% confidence interval (CI) were calculated. Results The EC50 of sufentanil required to inhibit the body movement during insertion of ureteroscopes when combined with propofol was 0.084 ng/ml and 95% CI was 0.066-0.107 ng/ml. Conclusion The EC50 of sufentanil required to inhibit the body movement during insertion of ureteroscopes was 0.084 ng/ml when combined with propofol.

Changes in lung ultrastructure after 7-hour pure oxygen ventilation through endotracheal intubation in dogs / 中国组织工程研究

BACKGROUND:It has been clinically confirmed that inhalation of hyperoxic oxygen for 36-48 hours can causes irreversible hyperoxic lung injury.Whether inhaling oxygen less than 50％ can reduce the potential oxygen toxicity in lung injury? OBJECTIVE:To observe the changes of lung ultrastructures after pure xygen inhalation for 7 hours through endotracheal intubation in dogs. DESIGN:A randomized and controlled animal experiment. SETTING:Department of Anesthesiology,Affiliated Hospital of Medical College,Qingdao University.MATERIALS:Totally 20 healthy hybrid dogs (6 females and 14 males),weighing 15-16 kg,were provided by the Animal Experimental Center in the Affiliated Hospital of Medical College,Qingdao University.BIRD 8400STi respiratory machine (Bird,USA) and HP-M102A multi-functional monitor (HP,USA) were used.METHODS:The experiment was completed in the Experimental Animal Center in the Affiliated Hospital of Medical College,Qingdao University from July 1999 to January 2000.① Interventions:The dogs were randomly ventilated with either fraction of inspired oxygen (FiO2) of 1 (group 1,n =10) or FiO2 of 0.34 (group 2,n =10),there were 3 females and 7 males in each group.All the dogs were ventilated for 7 hours.② Evaluation:The mean arterial pressure and heart rate were monitored at 1,3,5 and 7 hours after endotracheal intubation.Anesthetic gas monitor (Ohmeda 5250 RGM) was used to observe the fractional inspired oxygen concentration,end-tidal partial pressure of carbon dioxide (PetCO2), respiratory frequency and peaks of respiratory organs.Changes of lung ultrastructures of right lower lung lobe were observed with electron microscopy after 7-hour mechanical ventilation.MAIN OUTCOME MEASURES:① Hemodynamic parameters; ② Changes of lung ultrastructures. RESULTS:All the 20 dogs were involved in the anlaysis of analysis.① Results of hemodynamic parameters:There was no significant difference between the two groups at each time point mean arterial pressure,PetCO2,peaks of respiratory organs and heart rate (P ＞ 0.05).② Changes of lung ultrastructures:The results of electron microscope showed that in group 1,there were swelling mitochondria was arranged in disorder,less matrix,and hyalomere appeared,thin double-deck membrane in 50％ samples; Interalveolar septum stroma was with edema in 60％ samples;Polymorphonuclear leukocyte gathered in vessel or emigrated out of vessel in 50％ samples; In group 2,double-deck membranes of mitochondria were integral,densely matrix showed micro-granule shape in 90％ samples; Pinocytosis in epithelial cells of type Ⅰ lung strengthened,being destroyed,and pinocytosis in endothelial cells strengthened in 10％ samples; Interalveolar septum stroma was with edema,no polymorphonuclear leukocyte gathered in vessel or emigrated out of vessel or corpuscule was empty in type Ⅱ alveolar epithelium in 20％ samples.CONCLUSION:More pathological ultramicroscopic changes are observed after 7-hour mechanical ventilation with pure oxygen,which reduces after mechanical ventilation with 34％ oxygen.Oxygen concentration should be decreased while long-time mechanical ventilation is executed so as to reduce potential lung injury with oxygen toxicity.

Comparative effects of homologous versus autologous blood transfusion on T-lymphocyte subsets and natural killer cell during perioperative period in cancer patients / 中华麻醉学杂志

0 35 The patients had no endocrine or immune disease and received neither radio , chemo nor hormone therapy Anesthesia was induced with propofol, midazolam, fentanyl and succinylcholine After tracheal intubation the patients were mechanically ventilated Anesthesia was maintained with enflurane inhalation and intermittent intravenous boluses of midazolam, fentanyl and vecuronium After operation the patients were transferred to recovery room and PCA was started when the patients were wide awake VAS was maintained at 2 4 Venous blood samples were taken before surgery, before blood transfusion and on the 1st and 5th postoperative day for determination of T lymphocyte subsets and natural kill cell counts by flow cytometry (EPICS Elite USA) Results The two groups were comparable regard to sex, types of operation, intraoperative blood loss and volume of fluid infused The mean duration of operation of the two groups was (196?42) min The NK cell and CD + 3 and CD + 4 counts and CD + 4/CD + 8 ratio before transfusion were not significantly different from those before operation in both groups The NK cell, CD + 3 and CD + 4 counts and CD + 4/CD + 8 ratio decreased significantly on the 1st postoperative day in both groups but the decrease was more pronounced in group H On the 5th postoperative day the NK cell, CD + 3, CD + 4 counts and CD + 4/CD + 8 ratio returned to preoperative level in group A but remained low in group H Couclusions Perioperative homologous blood transfusion has serious and prolonged inhibitory effects on patient′s immune function In autologous blood transfusion group the changes are milder and the recovery is more rapid as compared with those in group H

Patient-controlled sedation during epidural anesthesia / 中华麻醉学杂志

Objective: To evaluate the feasibility and advantages or disadvantages of patient-controlled sedation (PCS) compared with doctor-controlled sedation (DCS) during epidural anesthesia. Method: Forty patients were divided at random into two groups with 20 patients in each group. Patients in group I were administered by themselves a mixture of propofol (20mg) and fentanyl (10?g) in increments using a Graseby PCA infuser (lockout period 1 min) to achieve sedation; patients in group Ⅱ received propofol 3.6mg?kg~(-1)?h~(-1) and fentanyl 1.8?g~(-1)?kg~(-1)?h~(-1)contin uously intravenously by the anesthesiologist to achieve intra-operative sedation. Sedation scale, satisfaction and cooperation degrees were measured. Cognition was also evaluated using abbreviated Mini Mental Status Examination. Result: The drug total dose used in DCS group was higher than that in group PCS (P

Establishment of neuropathic pain model by transection of L_4 spinal nerve in rats / 中华麻醉学杂志

Objective To establish a neuropathic pain model by transection of L4 spinal nerve in rats.Methods Twenty-eight male SD rats weighing 270-310 g were randomly divided into 3 groups: A experimental group (n = 12) received transection of right L4 spinal nerve; B sham operation group ( n = 8) in which right L4 spinal nerve was exposed but not transected and C control group ( n = 8) received no surgery. The paw withdrawal threshold (PWT) to mechanical stimulation was measured by using modified von Frey test. The response to cold stimulation evoked by applying acetone to the plantar region of hindpaw was measured and scored. The threshold to both noxious mechanical and thermal stimuli was measured once a week for 8 weeks. Results In experimental group the pain threshold to mechanical stimuli (von Frey hair stimulation) and cold stimuli (acetone test) on the operated side were significantly decreased after L4 spinal nerve transection as compared to the baseline values before operation and significantly lower than in sham operation and control groups. There was no significant change in the withdrawal response of the hindpaw to mechanical and cold stimuli after surgery on the unoperated side. Conclusion Hyperalgesia to mechanical and cold stimuli develops after L4 spinal nerve transection on the operated side and lasts more than 8 weeks