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1.
Chinese Medical Sciences Journal ; (4): 135-142, 2015.
Artigo em Inglês | WPRIM | ID: wpr-242832

RESUMO

<p><b>OBJECTIVE</b>To investigate the effect of propofol on brain regions at different sedation levels and the association between changes in brain region activity and loss of consciousness using blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) and bispectral index (BIS) monitoring.</p><p><b>METHODS</b>Forty-eight participants were enrolled at Peking Union Medical College Hospital from October 2011 to March 2012 and randomly assigned to a mild or a deep sedation group using computer- generated random numbers. Preliminary tests were performed a week prior to scanning to determine target effect site concentrations based on BIS and concomitant Observer's Assessment of Alertness/Sedation scores while under propofol. Within one week of the preliminary tests where propofol dose-response was established, BOLD-fMRI was conducted to examine brain activation with the subject awake, and with propofol infusion at the sedation level.</p><p><b>RESULTS</b>Mild propofol sedation inhibited left inferior parietal lobe activation. Deep sedation inhibited activation of the left insula, left superior temporal gyrus, and right middle temporal gyrus. Compared with mild sedation, deep propofol sedation inhibited activation of the left thalamus, precentral gyrus, anterior cingulate, and right basal nuclei.</p><p><b>CONCLUSION</b>Mild and deep propofol sedation are associated with inhibition of different brain regions, possibly explaining differences in the respective loss of consciousness processes.</p>


Assuntos
Adulto , Humanos , Masculino , Encéfalo , Monitores de Consciência , Sedação Profunda , Relação Dose-Resposta a Droga , Hipnóticos e Sedativos , Farmacologia , Propofol , Farmacologia
2.
Chinese Medical Sciences Journal ; (4): 55-57, 2013.
Artigo em Inglês | WPRIM | ID: wpr-243218

RESUMO

Severe tracheal stenosis can not only cause critical medical problems such as severe shortness of breath, hypoxia, and even orthopnea, but also impose overwhelming challenges on the physicians, particularly the anesthesiologist. Life-threatening airway obstruction can make the patient's gas exchange extremely difficult.Though several options could be offered regarding the treatment of tracheal stenosis, normally, tracheal resection and following reconstruction is the first choice for severe airway stenosis. Successful surgical intervention relies on the close communication and cooperation between surgeons and anesthesiologists. In these cases, airway management is the top issue for the anesthesiologist, and the level of difficulty varies with stenosis location, severity of stenosis, and surgical technique. Extracorporeal membrane oxygenation (ECMO), or cardiopulmonary bypass (CPB), is rarely utilized for the surgery, but for those impossible airways due to nearly complete tracheal obstruction, ECMO or CPB could be the final choice for anesthesiologists. Here we report a case of successful urgent airway management for tracheal resection and reconstruction assisted by temporary CPB.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Ponte Cardiopulmonar , Emergências , Procedimentos de Cirurgia Plástica , Métodos , Traqueia , Cirurgia Geral
3.
Acta Academiae Medicinae Sinicae ; (6): 451-456, 2013.
Artigo em Chinês | WPRIM | ID: wpr-285977

RESUMO

<p><b>OBJECTIVE</b>To investigate the effect of subanaesthetic dose of ketamine on mechanical stimulus on brain regions.</p><p><b>METHODS</b>Totally 13 healthy male volunteers were enrolled in this study, in whom 0 and 100 ng/ml ketamine were administrated by target controlled infusion system in pilot study. After von Frey filaments (vFFs) 300 g were used as mechanical stimuli, Visual Analogue Scale scores were evaluated. Functional magnetic resonance imaging (fMRI)was taken 1 week after pilot study at the following sequences: structure imaging + functional imaging (stimulus sequence with 300 g vFFs, ketamine sequence); stimulus sequence = 6×(20s on + 20s off), with target concentration of ketamine at 0,100 ng/ml.fMRI result was processed by SPM2 and Metlab 7.01 software package.</p><p><b>RESULTS</b>Posterior cerebellum lobe and corpus callosum were inhibited at 100 ng/ml under vFFs stimulus, whereas cingulate gyrus, middle frontal gyrus, inferior parietal lobule, occipital lobe, and posterior cerebellum lobe were activated at 100 ng/ml under vFFs stimulus.</p><p><b>CONCLUSIONS</b>Ketamine 100 ng/ml exerts its effect on pain related brain regions. It can both activate and inhibit these brain regions, with the activating effect being the primary effect.</p>


Assuntos
Adulto , Humanos , Masculino , Analgésicos , Farmacologia , Encéfalo , Ketamina , Farmacologia , Imageamento por Ressonância Magnética , Dor , Projetos Piloto
4.
Acta Academiae Medicinae Sinicae ; (6): 222-227, 2012.
Artigo em Inglês | WPRIM | ID: wpr-352924

RESUMO

<p><b>OBJECTIVE</b>To observe the effects of different concentrations of propofol on brain regions activated by mechanical stimuli, and then to investigate the analgesic effect of propofol.</p><p><b>METHODS</b>Twenty healthy male volunteers were randomly divided into two groups: light anesthesia group (group L) (BIS 60-80) and deep anesthesia group (group D)(BIS 40-60). Propofol was administrated by target controlled infusion system in pilot study. The target effect site concentration (ESC) of propofol was defined as the average of the ESC from BIS 80 to 60 or BIS 60 to 40 in group L or group D respectively. Mechanical stimuli were applied using von Frey filaments at the center of the left foot, and the pain threshold and VAS scores were evaluated. fMRI examinations were taken 1 week after pilot study with the following sequences: structure imaging+ functional imaging: functional imaging=stimulus sequence+propofol sequence, in which the stimulus sequence was 6 × (20 s on + 20 s off). This sequence was repeated after propofol sequence.</p><p><b>RESULTS</b>As shown by fMRI, in group L, active brain regions of (the second stimulation-the first stimulation, P2-P1) were seen in cingulate gyrus, thalamus, and cerebellum, while active brain regions of (P1-P2) were seen in temporal lobe, frontal gyrus, and occipital lobe. In group D, the active brain region of (P2-P1) was only seen in cerebellum, while active brain regions of (P1-P2) were seen in cingulate gyrus and thalamus. Active brain regions of (deep-low) with propofol infusion in response to vFFs stimulation were observed in cerebellum.</p><p><b>CONCLUSIONS</b>Propofol at different concentrations has different effect on the activation of brain regions. It may exert its analgesic effect via different mechanisms.</p>


Assuntos
Adulto , Humanos , Masculino , Adulto Jovem , Encéfalo , Fisiologia , Imageamento por Ressonância Magnética , Propofol , Farmacologia , Estresse Mecânico
5.
Acta Academiae Medicinae Sinicae ; (6): 489-494, 2011.
Artigo em Chinês | WPRIM | ID: wpr-353000

RESUMO

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of domestic sevoflurane by comparing the pharmacokinetic and pharmacodynamic characteristics of domestic sevoflurane and an imported product.</p><p><b>METHODS</b>Eighty patients undergoing general anesthesia for transabdominal hysterectomy were equally randomized into domestic sevoflurane group and imported sevoflurane group. The following data were recorded and compared: vital signs; change of sevoflurane concentrations in the induction period and recovery period; the time when inhaled sevoflurane concentration reached half of the pre-set concentration of the vaporizer; the time when the end-tidal sevoflurane concentration reached half of the pre-set concentration of the vaporizer; the time when the end-tidal sevoflurane concentration reached half of inhaled sevoflurane concentration; the time of the end-tidal sevoflurane concentration reached 0. 8 MAC in the induction period; the recovery time; the extubation time; and time to recovery of consciousness.</p><p><b>RESULTS</b>The general conditions of the two groups were not significantly different. The pharmacokinetic and pharmacodynamic parameters at the intra-operative time points as well as the minimal alveolar concentration, the inspired and end-tidal sevoflurane concentrations, and the time to recovery of consciousness also showed no significant differences between the two groups.</p><p><b>CONCLUSION</b>The domestic sevoflurane has similar pharmacokinetic and pharmacodynamic characteristics as the imported products. It can serve as a cost-effective product for transabdominal hysterectomy.</p>


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Anestesia por Inalação , Anestésicos Inalatórios , Farmacocinética , Método Duplo-Cego , Histerectomia , Éteres Metílicos , Farmacocinética
6.
Acta Academiae Medicinae Sinicae ; (6): 445-448, 2011.
Artigo em Chinês | WPRIM | ID: wpr-341386

RESUMO

<p><b>OBJECTIVE</b>To compare the efficacy of ondansetron and granisetron in the prevention of postoperative nausea and vomiting (PONV) in high-risk patients.</p><p><b>METHODS</b>Totally 200 patients with three key risk factors for PONV (female, non-smoking and postoperative opioid use) were equally randomized into ondansetron group and granisetron group. Ondansetron (4 mg) or granisetron (3 mg) was intravenously administered upon the completion of surgery. The episodes of nausea and vomiting were observed for 24 hours after surgery.</p><p><b>RESULTS</b>A significantly greater proportion of patients in granisetron group achieved a complete response (i.e., no PONV or rescue medication) during the first 24 hours postoperatively versus those in ondansetron group (62.6% vs. 46.9%, respectively; P=0.048). There were no significant differences in terms of postoperative nausea incidences (42.9% vs. 34.3%, respectively), postoperative vomiting incidences (25.5% vs. 20.2%, respectively) and postoperative rescue anti-emetics incidences (19.4% vs. 15.2%, respectively) (P>0.05).</p><p><b>CONCLUSION</b>Granisetron is more effective than ondansetron in preventing PONV in high-risk patients during the first 24 hours postoperatively.</p>


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Antieméticos , Usos Terapêuticos , Método Duplo-Cego , Granisetron , Usos Terapêuticos , Ondansetron , Usos Terapêuticos , Náusea e Vômito Pós-Operatórios , Resultado do Tratamento
7.
Chinese Medical Journal ; (24): 997-1000, 2011.
Artigo em Inglês | WPRIM | ID: wpr-239906

RESUMO

<p><b>BACKGROUND</b>Perioperative disorder of magnesium, an important cation in the human body, may affect clinical anesthesia. The pharmacological data of propofol use, which is popularly used in the anesthesiology department and intensive care unit, is incomplete in Chinese patients. This study aimed to assess the effect of magnesium sulfate on the calculated plasma medial effective concentration (Cp50cal) of propofol at loss of response to command in Chinese females.</p><p><b>METHODS</b>Fifty patients undergoing gynecological laparoscopic surgery were randomly divided into the control group and the magnesium group. Before induction, magnesium sulfate (30 mg/kg) or placebo (equal volume of 0.9% saline) was given to patients in the magnesium group or the control group, respectively. Propofol was infused using a target-controlled infusion system, with a target concentration for each patient decided by up-and-down sequential allocation. After the equilibration between target plasma concentration and effective-site concentration, the state of consciousness was assessed. For determination of serum magnesium and calcium concentration, blood samples were taken before induction, after induction and at the end of surgery.</p><p><b>RESULTS</b>The Cp50cal was 2.52 µg/ml (2.47 - 2.57 µg/ml) for patients in the control group, and 2.46 µg/ml (2.41 - 2.51 µg/ml) for those in the magnesium group. A significant reduction of Cp50cal was observed (P = 0.021). There was a significant difference between the serum magnesium concentrations after induction and at the end of the surgery (P < 0.05). In the magnesium group, there was a trend toward decreasing after surgery, while in the control group, Cp50cal decreased significantly (P < 0.01).</p><p><b>CONCLUSIONS</b>Cp50cal of propofol at loss of response to command was 2.52 µg/ml (2.47 - 2.57 µg/ml) for Chinese female adults in this study. Infusion of 30 mg/kg magnesium sulfate may reduce the Cp50cal of propofol at loss of consciousness, which implies that magnesium may enhance the pharmacological effects of propofol.</p>


Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Anestésicos , Usos Terapêuticos , Sulfato de Magnésio , Usos Terapêuticos , Propofol , Sangue , Farmacocinética , Usos Terapêuticos , Inconsciência
8.
Chinese Medical Journal ; (24): 702-706, 2010.
Artigo em Inglês | WPRIM | ID: wpr-242586

RESUMO

<p><b>BACKGROUND</b>Previous studies demonstrated general anesthetics affect potassium ion channels, which may be one of the mechanisms of general anesthesia. Because the effect of etomidate on potassium channels in rat hippocampus which is involved in memory function has not been studied, we investigated the effects of etomidate on both delayed rectifier potassium current (I(K(DR))) and transient outward potassium current (I(K(A))) in acutely dissociated rat hippocampal pyramidal neurons.</p><p><b>METHODS</b>Single rat hippocampal pyramidal neurons from male Wistar rats of - 10 days were acutely dissociated by enzymatic digestion and mechanical dispersion according to the methods of Kay and Wong with slight modification. Voltage-clamp recordings were performed in the whole-cell patch clamp configuration. Currents were recorded with a List EPC-10 amplifier and data were stored in a computer using Pulse 8.5. Student's paired two-tail t test was used for data analysis.</p><p><b>RESULTS</b>At the concentration of 100 micromol/L, etomidate significantly inhibited I(K(DR)) by 49.2% at +40 mV when depolarized from -110 mV (P < 0.01, n = 8), while did not affect I(K(A)) (n = 8, P > 0.05). The IC(50) value of etomidate for blocking I(K(DR)) was calculated as 5.4 micromol/L, with a Hill slope of 2.45. At the presence of 10 micromol/L etomidate, the V1/2 of activation curve was shifted from (17.3 +/- 1.5) mV to (10.7 +/- 2.9) mV (n = 8, P < 0.05), the V1/2 of inactivation curve was shifted from (-18.3 +/- 2.2) mV to (-45.3 +/- 9.4) mV (n = 8, P < 0.05). Etomidate 10 micromol/L shifted both the activation curve and inactivation curve of I(K(DR)) to negative potential, but mainly affected the inactivation kinetics.</p><p><b>CONCLUSIONS</b>Etomidate potently inhibited I(K(DR)) but not I(K(A)) in rat hippocampal pyramidal neurons. I(K(DR)) was inhibited by etomidate in a concentration-dependent manner, while I(K(A)) remained unaffected.</p>


Assuntos
Animais , Masculino , Ratos , Anestésicos Intravenosos , Farmacologia , Canais de Potássio de Retificação Tardia , Fisiologia , Etomidato , Farmacologia , Canais de Potássio , Fisiologia , Células Piramidais , Fisiologia , Ratos Wistar
9.
Acta Academiae Medicinae Sinicae ; (6): 215-221, 2010.
Artigo em Chinês | WPRIM | ID: wpr-322797

RESUMO

<p><b>OBJECTIVE</b>To explore the effects of naloxone on the expression of c-kit receptor (c-kit R) and its ligand stem cell factor (SCF) in human embryo neuronal hypoxic injury.</p><p><b>METHODS</b>Serum-free cerebral cortical cultures prepared from embryonic human brains were deprived of both oxygen and glucose which would set up an environment more likely with that of in vivo ischemic injury. Neurons in 24-well culture plates were randomly divided into four groups: control group, hypoxia group, naloxone 0.5 microg/ml group and naloxone 10 microg/ml group. MTT assay and biological analysis were performed to study the cell death and the changes of extracellular concentrations of lactate dehydrogenase (LDH) after combined oxygen-glucose deprivation. Neurons in 25 ml culture flasks were also randomly allocated into four groups as previously described. Intracellular total RNA were extracted at different time points: pre-hypoxia, immediately after hypoxia, and 3, 6, 12, and 24 hours after reoxygenation. The changes of SCF/c-kit R mRNA expression in hypoxic neurons treated with different concentrations of naloxone pre and post oxygen-glucose deprivation were determined with RT-PCR.</p><p><b>RESULTS</b>The cell vitality detected by MTT assay decreased significantly in hypoxia group and naloxone 0.5 microg/ml group when compared with control group (P<0.01), while no significant difference was found between naloxone 0.5 microg/ml group and hypoxia group or between naloxone 10 microg/ml group and control group. Extracellular concentration of LDH significantly increased in hypoxia group (P<0.05), while no difference was found between naloxone 0.5 microg/ml group and control group, between naloxone 0.5 microg/ml and hypoxia group, or between naloxone 10 microg/ml and control group (all P>0.05). Immediately after oxygen-glucose deprivation, the expression of SCF/c-kit R mRNA increased significantly (P<0.01). Among those the expression of SCF presented a distribution of double-peak value within 24 hours. After treated with different concentrations of naloxone, the peak value of each group were delayed to appear and went down with the increasing of naloxone concentration. The peak values in all treated groups were significantly different from that in control group (P<0.01).</p><p><b>CONCLUSIONS</b>The expression of SCF/c-kit R mRNA increases at the early stage after combined oxygen-glucose deprivation. Naloxone 0.5 microg/ml can attenuate cell injuries and regulate the expression of SCF/c-kit R. Naloxone may protect neurons by modulating the expressions of some cytokines.</p>


Assuntos
Humanos , Hipóxia Celular , Fisiologia , Células Cultivadas , Córtex Cerebral , Biologia Celular , Naloxona , Farmacologia , Neurônios , Metabolismo , Patologia , Proteínas Proto-Oncogênicas c-kit , Genética , Metabolismo , RNA Mensageiro , Genética , Fator de Células-Tronco , Genética , Metabolismo
10.
Acta Academiae Medicinae Sinicae ; (6): 441-444, 2010.
Artigo em Chinês | WPRIM | ID: wpr-322754

RESUMO

<p><b>OBJECTIVE</b>To investigate the effect of ketamine on the high-voltage-activated calcium currents (ICa(HVA)) in rat hippocampal neurons.</p><p><b>METHODS</b>Neurons were cultured from Wistar rat hippocampus. ICa(HVA) was recorded using whole-cell patch clamp technique. After application with ketamine at different concentrations (10, 30, 100, 300, and 1000 μmol/L), the effect of ketamine on ICa(HVA) was evaluated.</p><p><b>RESULTS</b>ICa(HVA) was inhibited by ketamine in a concentration-dependent manner. Ketamine at 10 μmol/L showed no effect on ICa(HVA). Four concentrations of ketamine (30, 100, 300,and 1000 μmol/L) reduced the peak ICa(HVA) currents by (17.5 ∓ 4.5)%, (25.5 ∓ 6.9)%, (38.5 ∓ 4.1)%, and (42.3 ∓ 4.6)% respectively,with a mean half maximal inhibitory concentration of 68.2 μmol/L and Hill coefficient of 0.47. The maximal activation membrane potential was shifted to (5.3 ∓ 0.8) from (5.4 ∓ 0.9). The half maximal activation membrane potential of inactivation curve was shifted from(-26.7 ∓ 3.9) mV to(-32.8 ∓ 4.2) mV.</p><p><b>CONCLUSION</b>Ketamine can remarkably inhibit calcium currents in the central neurons,which may explain at least partly the action of ketamine on central nervous system.</p>


Assuntos
Animais , Ratos , Canais de Cálcio , Fisiologia , Células Cultivadas , Hipocampo , Fisiologia , Ketamina , Farmacologia , Potenciais da Membrana , Neurônios , Fisiologia , Ratos Wistar
11.
Acta Academiae Medicinae Sinicae ; (6): 569-573, 2010.
Artigo em Chinês | WPRIM | ID: wpr-322730

RESUMO

<p><b>OBJECTIVE</b>To evaluate the value of propofol target-controlled infusion combined with dribbled and nebulized lidocaine in tracheal intubation under spontaneous breathing.</p><p><b>METHODS</b>Totally 40 elective surgery patients to accept tracheal intubation under unconsciousness and spontaneous breathing were randomly divided into 2 groups: 6-8 cm of endotracheal tube was inserted subglottic ally in the complete intubation group (n=20) while 3-4 cm was inserted temporarily in the partial intubation group (n=20).</p><p><b>RESULTS</b>The tracheal intubation was successfully completed under spontaneous breathing in all patients; meanwhile,the hemodynamic status was stable without any severe respiratory complications. Eleven patients suffered from moderate coughing response in the complete intubation group while no such response was noted in the partial intubation group (P<0.01).</p><p><b>CONCLUSIONS</b>Application of propofol target-controlled infusion combined with dribbled and nebulized lidocaine provides a good condition for tracheal intubation under unconsciousness and spontaneous breathing. The partial intubation can effectively prevent the occurrence of coughing response.</p>


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Tosse , Intubação Intratraqueal , Métodos , Lidocaína , Propofol
12.
Acta Academiae Medicinae Sinicae ; (6): 102-107, 2010.
Artigo em Chinês | WPRIM | ID: wpr-301585

RESUMO

<p><b>OBJECTIVE</b>To evaluate the residual paralysis after a single intubating dose of rocuronium and its effect of residual paralysis after a single dose of rocuronium on the postoperative pulmonary function of patients undergoing laparoscopic gynecological surgeries.</p><p><b>METHODS</b>Sixty American Society of Anesthesiologists (ASA) I - II patients undergoing laparoscopic gynecological surgeries were randomly divided into rocuronium (R) group (n = 30) and rocuronium + neostigmine (R + N) group (n = 30).All patients received midazolam (0.02 mg/kg), fentanyl (1 microg/kg), propofol(1.5-2 mg/kg), and rocuronium (0.6 mg/kg) to facilitate tracheal intubation and no more relaxant thereafter. Anesthesia was maintained with isoflurane and nitrous oxide in oxygen (N(2)O:O(2) = 1:1). At the end of the procedure, neuromuscular blockade was not reversed in R group, while antagonism was accomplished with neostigmine (0.04 mg/kg) and atropine (0.02 mg/kg) in R + N group. Immediately after tracheal extubation and on arrival in the PACU, the train-of-four (TOF) ratio at the adductor pollicis of all patients were measured using acceleromyography. Forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), and peak expiratory flow rate (PEFR) of all patients were measured using spirometry before surgery, after administration of midazolam and fentanyl, immediately after tracheal extubation, on arrival in the PACU, and after the TOF ratio recovered to 1.0. The TOF ratio and pulmonary function between two groups were compared.</p><p><b>RESULTS</b>Immediately after tracheal extubation and on arrival in the PACU, the mean TOF ratio in R group was significantly lower than that in R + N group (P < 0.05). The mean time to achieve TOF ratio of 0.9 and 1.0 in R group was significantly longer than in R + N group (P < 0.05). Immediately after tracheal extubation and on arrival in the PACU, FVC, FEV(1), and PEFR were significantly lower in R group than in R + N group (P < 0.05). FVC, FEV(1), and PEFR after administration of midazolam and fentanyl and after TOF ratio recovered to 1.0 were significantly lower than the baseline values in all patients (P < 0.01).</p><p><b>CONCLUSIONS</b>After a single intubating dose of rocuronium, residual paralysis exists in the majority of patients undergoing laparoscopic gynecological surgeries. The pulmonary function is impaired after the surgery, even after recovery of TOF ratio to 1.0.</p>


Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Extubação , Androstanóis , Procedimentos Cirúrgicos em Ginecologia , Intubação Intratraqueal , Laparoscopia , Fármacos Neuromusculares não Despolarizantes , Paralisia , Período Pós-Operatório , Testes de Função Respiratória
13.
Acta Academiae Medicinae Sinicae ; (6): 68-72, 2009.
Artigo em Chinês | WPRIM | ID: wpr-259071

RESUMO

<p><b>OBJECTIVE</b>To study the psychedelic effects in healthy volunteers when given subanesthetic dose of ketamine.</p><p><b>METHODS</b>Thirteen male healthy volunteers aged 24-39 years were enrolled. All subjects received subanesthetic doses of ketamine using target control infusion. A stepwise series of target plasma concentrations (0, 100, 200, and 300 ng/ml) were maintained for 20 minutes each. Visual analogue scale (VAS) of mechanical pain by von Frey hair was evaluated, and then the volunteers completed a VAS rating of 13 symptom scales. Pictures were shown to them at the same time. Heart rate, mean blood pressure, and SpO2 were monitored throughout the infusion.</p><p><b>RESULTS</b>During the process of analgesia, ketamine produced dose-related analgesic effects. With the increase of ketamine dose, some psychedelic effects became more obvious and the memory impairment became worse stepwisely.</p><p><b>CONCLUSION</b>Target control infusion of subanesthetic doses of ketamine produce obvious psychedelic effects in healthy volunteers.</p>


Assuntos
Adulto , Humanos , Masculino , Anestésicos Dissociativos , Farmacologia , Relação Dose-Resposta a Droga , Alucinações , Ketamina , Farmacologia
14.
Acta Academiae Medicinae Sinicae ; (6): 73-76, 2009.
Artigo em Chinês | WPRIM | ID: wpr-259070

RESUMO

<p><b>OBJECTIVE</b>To determine the effects of atracurium pretreatment with magnesium on speed of onset, duration, and recovery of neuromuscular block.</p><p><b>METHODS</b>Thirty patients who were undergoing elective gynecologic laparoscopic examination and treatments under general anesthesia were randomized into magnesium group (n = 15) and control group (n = 15). Before induction of general anesthesia, patients in magnesium group intravenously received MgSO4 30 mg/kg in saline within 5 minutes, and patients in control group received the same volume of saline without MgSO4. In both groups, the train-of-four (TOF) responses to stimuli of the ulnar nerve were measured at intervals of 12 seconds. Anesthesia was induced with Fentanyl and Propofol through target controlled infusion (TCI), and tracheal intubation was performed with 0.5 mg/kg atracurium after stabilization of the electromyography recording. The onset time of muscle relaxation, clinical duration of action, recovery index, and recovery time were recorded. To determine serum magnesium and calcium levels, blood samples were collected before MgSO4/saline infusion and at the end of operation. Haemodynamic changes and other responses during induction were also recorded.</p><p><b>RESULTS</b>The onset time from the end of injection to maximum neuromuscular blockade was significantly shorter in magnesium group than in control group (P < 0.01). Duration of relaxant action, recovery index, and recovery time in magnesium group were significantly prolonged than in control group (P < 0.01). Serum magnesium level significantly decreased after management (P < 0.01), and there was also a decrease trend in magnesium group. No change of serum calcium levels in both groups was observed. No adverse event was reported.</p><p><b>CONCLUSION</b>Prior administration of magnesium sulphate can increase the onset speed of atracurium and prolong the duration of atracurium-induced neuromuscular blockade.</p>


Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Período de Recuperação da Anestesia , Anestesia Geral , Atracúrio , Farmacologia , Sinergismo Farmacológico , Sulfato de Magnésio , Farmacologia , Bloqueio Neuromuscular , Junção Neuromuscular , Fármacos Neuromusculares não Despolarizantes , Farmacologia , Fatores de Tempo
15.
Acta Academiae Medicinae Sinicae ; (6): 330-333, 2008.
Artigo em Chinês | WPRIM | ID: wpr-270695

RESUMO

<p><b>OBJECTIVE</b>To compare the accuracies of cerebral state index (CSI) and bispectral index (BIS) in sedation monitoring during target control infusion of midazolam.</p><p><b>METHODS</b>Twenty informed adult male volunteers were intravenously administered with midazolam through plasma target control infusion from 30ng/ml (in increments of 10ng/ml every time) until they became unresponsive to tactile stimulation (i. e., mild prodding or shaking). The BIS and CSI were continuously recorded simultaneously. Sedation was assessed using the Observers' Assessment of Alertness/Sedation (OAA/S) scale at each time when Ct equaled to Ce. The electroencephalogram (EEG) parameters were correlated with the OAA/S scores using nonparametric Spearman's correlation analysis. The prediction probabilities were calculated at the points of lost of verbal contact (LVC) and lost of responses to stimulus (LOR). BIS05, BIS50, BIS95, and CSI05, CSI50, CSI95 were also calculated for LVC and LOR.</p><p><b>RESULTS</b>BIS and CSI were well correlation with OAA/S scales during both the onset and recovery phases. When the sedation level increased, BIS and CSI progressively decreased. The prediction probabilities of BIS and CSI were 84%, 74% for LVC and 79%, 68% for LOR, while the BIS05, BIS50, and BIS95 as well as CSI05, CSI50, and CSI95 were 85.5, 60.6, and 35.7 (for BISs) and 82.2, 65.2, and 30.3 (for CSIs) at the point of LVC and 79.7, 47.6, and 15.6 (for BISs) and 75.9, 43.4, and 11 (for CSIs) at the point of LOR.</p><p><b>CONCLUSIONS</b>Both CSI and BIS seem to be useful parameters for assessing midazolam-induced sedation. BIS is superior in the prediction of LVC and LOR.</p>


Assuntos
Adulto , Humanos , Masculino , Adulto Jovem , Anestésicos Intravenosos , Usos Terapêuticos , Encéfalo , Fisiologia , Sedação Consciente , Métodos , Estado de Consciência , Eletroencefalografia , Infusões Intravenosas , Midazolam , Usos Terapêuticos
16.
Acta Academiae Medicinae Sinicae ; (6): 107-110, 2007.
Artigo em Chinês | WPRIM | ID: wpr-230022

RESUMO

<p><b>OBJECTIVE</b>To compare the efficacy of different 5-hydroxytryptamine 3 receptor antagonists in the prevention of postoperative nausea and vomiting (PONV) in patients undergoing general anesthesia.</p><p><b>METHODS</b>Totally 360 patients, American Society of Anesthesiologists (ASA) grade I - II, aged 18-75 years, and having received elective operation with endotracheal intubation general anesthesia, were randomly divided into three double-blind groups: ondansetron group, tropisetron group, and granisetron group, with 120 patients in each group. Before anesthesia induction, patients were intravenously given ondansetron (4 mg), tropisetron (5 mg), or granisetron (3 mg), respectively. The episodes of nausea and vomiting were recorded for 24 hours after operation.</p><p><b>RESULTS</b>No significant differences were observed in the terms of complete inhibition rate of PONV among ondansetron group (70.0%), tropisetron group (68.6%), and granisetron group (72.9%) within 24 hours postoperatively (P >0.05), and so did postoperative nausea incidences (22.5%, 25.4%, and 20.3%, respectively), and postoperative vomiting incidences (10.0%, 13.6%, and 8.5%, respectively) (P > 0.05). No remarked antiemetic-related adverse effects were observed within 24 hours postoperatively.</p><p><b>CONCLUSION</b>Intravenous ondansetron (4 mg), tropisetron (5 mg), or granisetron (3 mg) before anesthesia induction can prevent PONV with similar efficacy and safety.</p>


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Anestesia Geral , Antieméticos , Usos Terapêuticos , Método Duplo-Cego , Granisetron , Usos Terapêuticos , Indóis , Usos Terapêuticos , Ondansetron , Usos Terapêuticos , Náusea e Vômito Pós-Operatórios
17.
Acta Academiae Medicinae Sinicae ; (6): 510-513, 2007.
Artigo em Chinês | WPRIM | ID: wpr-229944

RESUMO

<p><b>OBJECTIVE</b>To initially observe the effect of classical endotracheal intubation on endotracheal bacterial contamination and evaluate the validity of protective endotracheal intubation on reducing endotracheal bacterial contamination.</p><p><b>METHODS</b>Ninety elective patients undergoing general anesthesia for hysterectomy were randomly assigned to two equal groups. Group II received endotracheal intubation protected by sterilized transparent sleeve while group I correspondingly adopted unprotective classical endotracheal intubation. Endotracheal swab sampling and bacterial counting were performed on the principle of aseptic processing before endotracheal intubation and extubation, respectively.</p><p><b>RESULTS</b>Bacteria were found in 62 of 180 samples. The difference of bacterial counting between before extubation and before intubation was (-0.3 +/- 35.6) 100 CFU/ ml in group II, lower than that in group I, which was (21.4 +/- 56.7) 100 CFU/ml (P<0.05).</p><p><b>CONCLUSION</b>Endotracheal bacterial contamination may be caused by unprotective classical endotracheal intubation and could be reduced by protective endotracheal intubation.</p>


Assuntos
Feminino , Humanos , Anestesia Geral , Bactérias , Histerectomia , Intubação Intratraqueal , Métodos , Traqueia , Microbiologia
18.
Acta Academiae Medicinae Sinicae ; (6): 858-861, 2006.
Artigo em Chinês | WPRIM | ID: wpr-313668

RESUMO

In recent years increased studies on the relationship between addictive drugs abuse and infectious diseases such as acquired immunodeficiency syndrome (AIDS) have shown that these drugs, including heroin, marijuana and cocaine, not only alter the abusers' neuropsychological and pathophysiological responses, but also impair their immune functions. The possible mechanisms may include the direct effect on immune cells or an indirect method ( e. g., stimulation of the hypothalamus-pituitary-adrenal axis). The correlation between intravenous drug users (IVDUs) and human immunodeficiency virus infections has led to the proposal that the immunomodulation mediated by additive drugs is a major factor contributing to the progression of AIDS in IVDUs. Immunosuppression caused by drug abuse may increase the susceptibility to opportunistic infections, while drug abusers' lifestyles also increase exposure risk to infectious pathogens. In summary, increased infection risks and drug-mediated immunomodulation increase drug abusers' susceptibility to infectious pathogens.


Assuntos
Humanos , Suscetibilidade a Doenças , Sistema Imunitário , Fisiologia , Infecções , Entorpecentes , Abuso de Substâncias por Via Intravenosa
19.
Chinese Medical Sciences Journal ; (4): 57-61, 2006.
Artigo em Inglês | WPRIM | ID: wpr-243619

RESUMO

<p><b>OBJECTIVE</b>To investigate the changes of perioperative serum levels of interleukin-6 (IL-6), C-reactive protein (CRP), and cortisol, as well as gastric intramucosal pH (pHi) and plasma lactate, aiming to compare systemic changes and tissue perfusion during colorectal and orthopaedic surgical procedures.</p><p><b>METHODS</b>Twenty patients were randomly assigned to two groups, 10 cases of operation on vertebral canal, 10 cases of colorectal radical operation. Venous blood was drawn at 1 day before operation, 2, 4, and 6 hours following skin incision, and 1 day after operation, in order to measure serum IL-6, CRP, and cortisol. pHi and plasma lactate were also measured at the same time points.</p><p><b>RESULTS</b>Serum concentrations of IL-6 and cortisol increased gradually following operation, reaching the peak value at 6 hours from the beginning of operation. CRP was not detectable until the first day after operation. Peak concentration of IL-6 had positive relationship with CRP. These variables changed more significantly in colorectal group than that in orthopaedic group (P < 0.05). pHi decreased gradually, reaching the lowest level at 4 hours from the beginning of operation, and to more extent in colorectal group than that in orthopaedic group (P < 0.05).</p><p><b>CONCLUSION</b>IL-6 may reflect tissue damage more sensitively than CRP. Colorectal surgery might induce systemic disorder to more extent, in terms of immuno-endocrinal aspect as well as tissue perfusion, reflected with pHi.</p>


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteína C-Reativa , Metabolismo , Neoplasias Colorretais , Sangue , Cirurgia Geral , Determinação da Acidez Gástrica , Mucosa Gástrica , Metabolismo , Hidrocortisona , Sangue , Concentração de Íons de Hidrogênio , Interleucina-6 , Sangue , Deslocamento do Disco Intervertebral , Sangue , Cirurgia Geral , Ácido Láctico , Sangue , Assistência Perioperatória , Métodos , Estenose Espinal , Sangue , Cirurgia Geral
20.
Acta Academiae Medicinae Sinicae ; (6): 111-114, 2005.
Artigo em Chinês | WPRIM | ID: wpr-343756

RESUMO

<p><b>OBJECTIVE</b>To determine the effect of neostigmine on antagonizing atracurium-induced neuromuscular blockage with sulfate magnesium pretreatment.</p><p><b>METHODS</b>Forty patients who undertook elective gynecologic laparoscopic examinations and treatments under general anesthesia were randomized into four groups (group A, B, C, and D, group A paired with group C, and group B paired with group D). Before induction of general anesthesia, patients in group A and group C received MgSO4 30 mg/kg in saline intravenously within 5 min, while patients in group B and group D received the same volume of saline. Anesthesia was induced with fentanyl and propofol; subsequently tracheal intubation was performed with 0.5 mg/kg atracurium after stabilization of the electromyography recording, and neostigmine (0.02 mg/kg) and atropine (0.01 mg/kg) were infused in group C and group D when neuromuscular recovery (T1/T(C)) reached 10%. T1/T(C) changes after neostigmine infusion as well as haemodynamic changes and other responses during induction and neostigmine and atropine infusion were recorded.</p><p><b>RESULTS</b>The neuromuscular recovery speed had no significant difference between group A and group B after the neuromuscular recovery reached 10%, but it was lower in group C than in group D (P < 0.05). Significant difference existed between group AC and group BD (P < 0.05). No haemodynamic changes and other responses were found during induction and neostigmine and atropine infusion.</p><p><b>CONCLUSION</b>Neostigmine-induced neuromuscular recovery can be attenuated in patients pretreated with magnesium sulfate.</p>


Assuntos
Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Anestesia Geral , Atracúrio , Inibidores da Colinesterase , Farmacologia , Laparoscopia , Sulfato de Magnésio , Farmacologia , Neostigmina , Farmacologia , Bloqueio Neuromuscular , Fármacos Neuromusculares não Despolarizantes
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