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 controlled hypotension on predicting transfusion response and threshold of stroke variability in hypertensive patients undergoing robotic hepatobiliary surgery / 中南大学学报(医学版)

To investigate the effect of controlled hypotension by urapidil on the predictive accuracy and diagnostic threshold of stroke volume variation (SVV) in hypertensive and non-hypertensive patients undergoing robotic hepatobiliary surgery.
 Methods: Eighty patients undergoing robotic hepatobiliary surgery under general anesthesia were divided into a hypertension group (n=25) and a non-hypertension group (n=38) according to whether or not essential hypertension was present (excluding some cases that didn't meet requirements). The pump speed was at 6.0-7.0 µg/(kg﹒min), and the range of hypotension was between 10%≤Δ systolic blood pressure (SAP)≤20%. Volume loading test was performed after artificial pneumoperitoneum was established in reverse-Trendelenburg position. Hemodynamic indexes including heart rate (HR), SAP, cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke volume index (SVI) and SVV were recorded before and after infusion. Then the receiver operating characteristic (ROC) curves of SVV was drawn to determine the accuracy and diagnosis of SVV in predicting volume status in hypertensive and non-hypertensive patients after anti-Trendelenburg posture and pneumoperitoneum.
 Results: In the patients with controlled hypotension by urapidil, the area under the ROC curve of SVV in the hypertension group was 0.974, the diagnostic threshold was 13.5%, the ROC curve of SVV in the non-hypertension group was 0.832, and the diagnostic threshold was 15.5%.
 Conclusion: SVV can accurately predict the volume status in the hypertension group and the non-hypertension group after controlled hypotension in the anti-Trendelenburg position and fixed pneumoperitoneal pressure, and the SVV diagnostic threshold in the non-hypertensive group is higher than that in the hypertensive group.

Efficacy of sevoflurane in preventing depression-like behavior in mice: the relationship with BDNF/TrkB signaling pathway / 中华麻醉学杂志

Objective To evaluate the efficacy of sevoflurane in preventing depression-like behavior in mice and the relationship with brain-derived neurotrophic factor (BDNF)/tyrosine kinase B (TrkB) signaling pathway.Methods Forty-four clean-grade male C57BL/6 mice,weighing 18-22 g,aged 8-10 weeks,were divided into 2 groups (n =22 each) using a random number table method:control group (group C) and sevoflurane group (group S).Mice in group C inhaled oxygen for 30 min,and mice in group S inhaled 2.5％ sevoflurane for 30 min.The forced swimming test and novelty-suppressed feeding test were performed after the mice were fully awake.The brains were immediately removed under anesthesia at the end of inhalation of oxygen or sevoflurane,and the prefrontal cortex and hippocampus were isolated for detection of the expression of BDNF,TrkB and phosphorylated TrkB (p-TrkB) by Western blot.Results Compared to group C,the immobility time and feeding latency were significantly shortened,the expression of p-TrkB in the prefrontal cortex and hippocampus was up-regulated (P＜0.05),and no significant change was found in the feeding consumption or expression of BDNF and TrkB in the prefrontal cortex and hippocampus in group S (P＞0.05).Conclusion Sevoflurane produces a preventive effect on depression-like behavior in mice,and the mechanism is related to increased phosphorylation of TrkB in BDNF/TrkB signaling pathway.

Study on operation service quality and safety management standard / 中华医院管理杂志

This study aimed at the quality and safety improvements of surgical services in terms of preoperative, intraoperative and postoperative sections, and at establishing corresponding restraint standards. To this end, such methods as literature analysis, dispute case analysis, surgical adverse event analysis, and system standard interpretation as well as clinical experts survey were called into play, to identify key elements in terms of the universality, high-prevalence rate, criticality and impact degree. A standard framework is established focusing on surgical service and such nodes as key components of the event; a standard text on surgical service quality and safety management is developed, comprising three sections, 8 nodes, 27 key elements and 82 standards.

Effects of different levels of stroke volume variation directed fluid therapy on short terms of prognosis in elderly patients / 临床麻醉学杂志

Objective To observe the effects of different levels of stroke volume variation (SVV)directed fluid therapy on prognosis in elderly patients.Methods One hundred and ten patients (male 67 cases,female 43 cases,aged 65-80 years,ASA grade Ⅰ or Ⅱ)undergoing abdominal sur-geries were randomized into three groups on the basis of SVV level:1 1%≤SVV≤14% (group H,n=37),7%≤SVV≤10% (group M,n = 37),3% ≤ SVV≤ 6% (group L,n = 36).Each group ac-cepted different fluid therapy strategy.Perioperative intake and outtake volume were recorded.Progno-sis indicators included gastrointestinal function recovery,post and total length of hospital stay and so on were collected.Postoperative complications were also recorded.Results Along with the level of SVV dropped,The volume of colloid and crystalloid among groups were significantly increased (P <0.05).There were no remarkable difference in the time interval of activity off bed,liquid diet,gastrointestinal decompres-sion and catheterization.Group L had a delayed exhaust time compared with group H (P <0.05).Patients in the group M had a shorter time to have semi-liquid diet.The transition of diet was also shortest in the group M.But these differences were not statistically significant.The group M also had a shorter time in first-degree or above nursing time and post and total length of hospital stay compared with group L (P <0.05).The incidence of postoperative infection in group L was higher than other two groups.Incidence of anastomosis leakage in group H was higher than that in other two groups (P <0.05).Conditions of compli-cations in group L were more severe and complicated compared with other two groups.Conclusion 3%≤SVV≤6% may increase the risk of postoperative infection and prolong the time of hospitalization.Patients in the level of 7%≤SVV≤10% may have a better postoperative recovery.This level could be a better goal of perioperative fluid therapy in elderly patients.

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.

Effects of carbon dioxide pneumoperitoneum and steep Trendelenburg positioning on cerebral blood backflow during robotic radical prostatectomy / 南方医科大学学报

<p><b>OBJECTIVE</b>To observe the effect of carbon dioxide pneumoperitoneum and Trendelenburg position on cerebral blood backflow during robot-assisted radical prostatectomy in elderly patients.</p><p><b>METHODS</b>Fifty elderly patients (65-80 years) and 50 middle-aged patients (45-64 years) undergoing elective robot-assisted prostatectomy were enrolled in this study. For all the patients, jugular bulb and arterial blood gas was monitored and recorded before pneumoperitoneum (0), 10 min after pneumoperitoneum was achieved (T₁), 10 min (T₂) and 60 min (3) after Trendelenberg position, and 10 min in supine position after termination of pneumoperitoneum (4).</p><p><b>RESULTS</b>Compared with those at 0, the mean arterial pressure, heart rate, and BIS value at 1, 2, 3 and 4 all showed no significant variations (P>0.05), but rSO2, SjvO2, and JBP increased significantly in both groups (P<0.01). Compared with those in the middle-aged group, rSO₂, SjvO₂, and JBP increased significantly and Da-jO₂decreased at 2, 3 in the elderly group (P<0.01), but jugular vein blood glucose or lactic acid content showed no significant difference between the two groups (P>0.05).</p><p><b>CONCLUSION</b>Pneumoperitoneum and Trendelenburg position cause more obvious cerebral blood backflow in elderly patients than in middle-aged patients but do not affect cerebral metabolism of oxygen.</p>

Effects of dexmedetomidine on recovery period of anesthesia and postoperative cognitive function after robot-assisted laparoscopicradical prostatectomy in the elderly people / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the neuroprotective effect of dexmedetomidine on recovery period of anesthesia and postoperative cognitive function after robot assisted laparoscopicradical prostatectomy in the elderly people.@*METHODS@#A total of 100 elderly patients who underwent robotic laparoscopic radical prostatectomy were divided into 2 groups: A dexmedetomidine group (n=50) and a control group (n=50). Patients in the dexmedetomidine group were given a loading dosage of dexmedetomidine [0.8 μg/(kg.h)] intravenously 10 min before the induction of general anesthesia followed by continuous infusion [0.3 μg/(kg.h)]. Patients in the control group were given 0.9% saline solution instead of dexmedetomidine. After pneumoperitoneum establishment, all patients adopted 40°trendelenberg position. MAP, HR, and BIS from each patient at the end of surgery immediately (T0), wake up (T1), extubation (T2), 10 min after extubation (T3) were monitored. Ramsay score, surgery comfort score, postoperative delirium score, and VAS scores were measured. At the time of preoperative 1 d, postoperative 1 d or 5 d, cognitive function was assessed and the concentration of neuron-specific enolase (NSE), tumor necrosis factor-α (TNF-α), superoxide dismutase (SOD) and interleukin-6 (IL-6) were detected.@*RESULTS@#In the dexmedetomidine group, delirium rating scale was significantly smaller than that of the control group (P<0.05) while Ramsay sedation score was significantly greater than that of the control group (P<0.05). The levels of TNF-α, NSE, and IL-6 in the dexmedetomidine group were significantly reduced compared with those in the control group (P<0.05). The level of SOD in the dexmedetomidine group significantly elevated compared with that in the control group (P<0.05). Seventeen patients in the control group and 11 in the dexmedetomidine group displayed postoperative cognitive dysfunction (POCD) at the 1st day after surgery. Meanwhile, 12 patients in the control group and 9 in the dexmedetomidine group showed POCD at the 5th day after surgery (P<0.05).@*CONCLUSION@#Dexmedetomidine could exert a neuroprotective effect on elderly patients in robotic-assisted laparoscopic radical prostatectomy in recovery period of anesthesia and postoperative recovery period, which might be related to the reduction of inflammatory reaction by dexmedetomidine.

Thoracic paravertebral block versus general anaesthesia for breast surgery:a meta-analysis / 临床麻醉学杂志

Objective To explore the effect of thoracic paravertebral block (TPVB)versus general anaesthesia (GA)on breast surgery.Methods Public databases were searched including Med-line and Springer,in order to collect randomized controlled trial (RCT)of the effects of TPVB and GA on breast surgery.The data of the meta-analysis was analyzed by Stata 11.0 and RevMan 5.1. Results There were five RCTs consisting of 295 patients with breast surgery,group TPVB (n=148) and group GA (n=147).The overall results of meta-analysis showed that pain scores of group TPVB were higher than those of group GA for breast surgery patients (SMD 2.59,95%CI 1.10-4.08),but the postoperative analgesic consumption and postoperative nausea or vomiting of group TPVB were lower than those of group G (RR 0.23,95%CI 0.15-0.37 and RR 0.27,95%CI 0.12-0.61,respec-tively).Conclusion Compared with GA,TPVB has higher pain scores,lower postoperative anal-gesic consumption and postoperative nausea or vomiting.

The clinical value of stroke volume variation and pleth variability index in predicting fluid responsiveness during increased intra-abdominal pressure / 中国基层医药

Objective To evaluate the abilities and thresholds of stroke volume variation (SVV) and pleth variability index (PVI) in predicting fluid responsiveness during increased intra-abdominal pressure.Methods 28 patients undergoing laparoscopy-assisted radical gastrectomy were selected.PV1 was continuously displayed by the Masimo.Radical 7.All patients were also monitored with Vigileo/FloTrac system.Haemodynamic data such as MAP,HR,SVI,SVV,PI,PVI and C VP were recorded before and after volume expansion(HES 6％,7ml/kg).Fluid responsiveness was defined as an increase in SVI≥ 15％ (△ SVI ≥ 15).Results The SVV threshold of 9.5％ before volume expansion was able to diserimihate the responders from the non-responders with a sensitivity of 100％,and a specificity of 63.6％.The threshold for PVI was 14.0％,the sensitivity of 100％ and specificity of 81.8％ were obtained.There was no significant difference between the area under the receiver operating characteristics (ROC) curves of SVV and PVI(0.981,0.939,respectively),and there was significant correlation between the baseline SVV and the baseline PVI(r =0.740,P ＜ 0.01).Conclusion SVV and PVI can predict fluid responsiveness accurately during increased intra-abdominal pressure,the baseline SVV is correlated well with baseline PVI,and the ability of SVV and PVI in predicting fluid responsiveness is similar.

Efficacy of anesthesia with BIS-guided etomidate TCI in combination with iv remifentanil infusion for noncardiac surgery: a prospective randomized single-blinded multicenter controlled clinical study / 中华麻醉学杂志

Objective To evaluate the efficacy of anesthesia with etomidate administered by TCI in combination with continuous iv remifentanil infusion titrated to maintain BIS values at 40-60 for non-cardiac surgery in a prospective randomized single-blinded multicenter controlled clinical study.Methods Two hundred and forty-four ASA Ⅰ or Ⅱ patients of both sexes aged 20-60 yr undergoing non-cardiac surgery lasting less than 3 h were randomly allocated into 2 groups:etomidate group (group E,n =123) and propofol group (group P,n =121 ).The patients were unpremedicated.A bolus of midazolam 0.03 mg/kg was injected iv immediately before induction of anesthesia.Anesthesia was induced with sufentanil 0.3-0.4 μg/kg and TCI of etomidate (effect-site concentration (Ce) =0.5-1.0 μg/ml) or propofol (Ce =3-4 μg/ml).Tracheal intubation was facilitated with rocuronium 0.9 mg/kg.The patients were mechanically ventilated (VT 8-10 ml/kg,RR 10-12 bpm,FiO2 =1 ).PETCO2 was maintained at 35-40 mm Hg.Anesthesia was maintained with TCI of etomidate ( Ce =0.3-0.8 μg/ml ) or propofol ( Ce =3-4 μg/ml) in combination with continuous iv infusion of remifentanil at 0.1-1.0 μg· kg-1 ·min-1 and intermittent iv boluses of rocuronium.BIS values were maintained at 40-60 during operation.Sufentanil 0.1 μg/kg was administered iv before skin closure.Ce at loss of consciousness,during maintenance of anesthesia and at emergence,the consumption of remifentanil and vasoactive agents,the emergence time and extubation time were recorded.The incidences of injecton pain,post-operative nausea and vomiting (PONV) and emergence agitation were measured.Results Ce of etomidate at loss of consciousness,at emergence and during maintenance of anesthesia was (0.50 ± 0.22),(0.16 ± 0.09) and 0.22-0.39 μg/ml respectively.The incidence of injection pain and the consumption of vasoactive agents were significantly lower but more remifentanil was needed in group E than in group P (P ＜0.05 or 0.01).There was no significant difference in emergence time and extubation time between the 2 groups (P ＞ 0.05).The incidence of PONV and emergence agitation were significantly higher during recovery in group E than in group P ( P ＜ 0.05 ).Conclusion The hemodynamics is stabler during operation,but the incidence of PONV and emergence agitation are significantly higher during recovery in group E than in group P.Etomidate induces little injection pain.

Changes in expression of acid-sensing ion channel 3 in dorsal root ganglion in a rat model of bone cancer / 中华麻醉学杂志

Objective To investigate the changes in the expression of acid-sensing ion channel 3(ASIC3)in the dorsal root ganglion(DRG)in a rat model of bone cancer pain.Methods Twenty-four female SD rats,aged 3-4 yr,weighing 180-220 g,were randomly divided into 2 groups:sham operation group(group S,n =8)and bone cancer pain group(group P,n =16).Bone cancer pain was induced by intra-tibial inoculation of 10 μl Walker 256 cancer cell suspension in group P,while group S received intra-tibial inoculation of 5 μl normal saline.Body weight and paw withdrawal threshold to mechanical stimulation with yon Frey filaments(MWT)were measured at 0,1,3,5,7,9,1 1 and 14 d after cancer cell inoculation.The tibia was removed at 14 d after cancer cell inoculation in group S and at 7 and 14 d after cancer cell inoculation in group P for pathological and imaging examinations.The tumor cell growth and bony destruction were observed.The expression of ASIC3 in the DRG was determined by immunolluorescence.Results Pathological damage occurred at 14 d after cancer cell inoculation,bony destruction was observed obviously,ant cortical bone was missing in many places.Compared with group S,body weight at T3-7 and MWT al T2-7:were significantly decreaed,and the expression of ASIC3 was up-regulated at 14 d after cancer cell inoculation in group P(P ＜ 0.05).Conclusion Up-regulation of the expression of ASIC3 in the DRG is involved in the developntent and maiutenence ot bone cancer pain in rars.

Perioperative anesthetic management for patients who received percutaneous nephroscopic peripancreatic necrectomy for acute necrotizing pancreatitis / 中华肝胆外科杂志

Objective To review our experiences on perioperative anesthetic management for patients who received percutaneous nephroscopic peripancreatic necrectomy for acute necrotizing pancreatitis.Method The clinical data on 18 patients with acute necrotizing pancreatitis who received percutaneous nephroscopic peripancreatic necrectomy in our hospital from August 2008 to January 2011 were retrospectively analyzed.Results There was a marked fluctuation in hemodynamic status of the patients which required the use of vasoactive drugs during perioperative period.PETCO2 significantly increased after pneumoperitoneum.Tracheal extubation was possible in 11 patients immediately after surgery in the operation room,while 7 patients required tracheal intuhation to be transported back to the surgical intensive care unit (SICU).Conclusion Most patients who underwent percutaneous nephroscopic peripancreatic necrectomy had a varying degree of shock and multi-organ injury before operation.Proper anesthetic induction and maintenance,correct use of vasoactive drugs and lung protective ventilation strategy,and active fluid resuscitation are the keys to good perioperative anesthetic management and to improve treatment results.

Changes in expression of acid-sensing ion channel 3 in dorsal root ganglion in a rat model of bone cancer pain / 中华麻醉学杂志

Objective To investigate the changes in the expression of acid-sensing ion channel 3 (ASIC3)in the dorsal root ganglion (DRG) in a rat model of bone cancer pain.Methods Twenty-four female Sprague-Dawley rats,aged 3-4 weeks,weighing 180-220 g,were randomized into 2 groups:sham operation group (group S,n =8) and bone cancer pain group (group P,n =16).Bone cancer pain was induced by inoculating Walker 256 carcinoma cells into the medullary cavity of the left tibia,while group S received normal saline instead.The pain threshold was measured after determination of body weight on the day of inoculation (T0) and on 1,3,5,7,9,11 and 14 days after inoculation (T1-7).The tibia was removed for microscopic examination of the inoculated tibia and X-ray examination.The growth of tumor cells and damage to the tibia were observed.The expression of ASIC3 in the DRG was detected using immunofluorescence.Results The tumor cell infiltration occurred in the medullary cavity and bone destruction was observed in P group.Compared with S group,the body weight was decreased at T3-T7,and the pain threshold was decreased at T4-T7,and the expression of ASIC3 in the DRG was upregulated at T7 in P group (P ＜ 0.05).Conclusion ASIC3 protein expression in DRG is significantly up-regulated in the rats with bone cancer pain,suggesting that the pathway may be involved in the mechanism of bone cancer pain.

Effect of different doses of propofol on cognitive function after chronic cerebral ischemia-induced injury in aged rats / 中华麻醉学杂志

Objective To investigate the effects of different doses of propofol on cognitive function after chronic cerebral ischemia-induced injury in aged rats. Methods Eighty male SD rats, aged 18 months, weighing 400-500 g, were randomly divided into 4 groups ( n = 20 each): shame operation group (group S), chronic cerebral ischemia group (group I), two propofol groups (groups P1 and P2 ). The chronic cerebral ischemia was induced by permanent occlusion of bilateral common carotid arteries. On 1 day after operation, intraperitoneal normal saline 2.5 ml was injected twice a day for7 consecutive days in groups S and I, and intraperitoneal propofol 10 and 50 mg/kg in 2.5 ml of normal saline were injected twice a day for 7 consecutive days in groups P1 and P2 respectively. On 3rd and 33rd days after the last injection (T1.2), 10 rats in each group underwent Morris water maze test to assess the cognitive function. After the test was completed, the rats were sacrificed and the hippocampi were removed and sliced (450-500 μm thick). Schaffer lateral branch in CA1 region was stimulated to induce long-term potentiation (LTP). Results Compared with group S, the escape latency was significantly prolonged, the number of animals' swimming across the platform, the ratio of the swimming time spent in the forth quadrant to the total swimming time, and the success rate of LTP induction were significantly decreased at T1 and T2 in groups I, P1 and P2 (P ＜ 0.05). Compared with group I, the escape latency was significantly prolonged, the number of animals' swimming across the platform, the ratio of the swimming time spent in the forth quadrant to the total swimming time, and the success rate of LTP induction were significantly decreased at T1 in groups P1 and P2, and at T2 in group P2 ( P ＜ 0.05). Conclusion Propofol aggravates the damage to cognitive function while it attenuates the chronic cerebral ischemia-induced injury in aged rats, especially the high dose.

Effects of different target effect-site concentrations of remifentanil on the sedative effect of propofol / 中华麻醉学杂志

Objective To investigate the effects of different target effect-site concentrations (Ces) of remifentanil on the sedative effect of propofol. Methods Fifty ASA Ⅰ or Ⅱ patients aged 20-55 yr weighing 48-86 kg with body mass index ＜ 30 kg/m2 were randomly divided into 5 groups ( n = 10 each) . Anesthesia was induced with TCI of remifentanil (Ce = 0, 2, 4, 6 and 8 ng/ml in groups R0-R4 respectively) and propofol. The initial Ce of propofol was 2.0 μg/ml in the 5 groups, and then the Ce of propofol increased by 0.5 μg/ml every 1 min until BIS value decreased to 50. BIS value and Ce of propofol were recorded as the patient lost consciousness. The effect-site concentration and consumption of propofol and the time required were recorded when BIS value decreased to 50.Results BIS value was significantly increased, while the effect-site concentration of propofol was significantly decreased as the patient lost consciousness, and the effect-site concentration and consumption of propofol were significantly decreased and the time required was shortened when BIS value decreased to 50 in R2-R4 groups compared with group R0 (P ＜ 0.05 or 0.01) . Conclusion The sedative effect of propofol can be enhanced when the Ce of remifentanil reaches 4 ng/ml, and the effects are comparable when the Ce of remifentanil reaches 4, 6 and 8 ng/ml.