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Objective:To evaluate the effects of remazolam and propofol on the hemodynamics during induction of anaesthesia in elderly patients using the area under curve (AUC) method.Methods:Eighty elderly patients of either sex, aged 65-75 yr, with body mass index of 20-28 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, scheduled for elective non-cardiac surgery, were divided into 2 groups ( n=40 each) by using a random number table method: remazolam group (R group) and propofol group (P group). Remazolam 1 mg/ml or propofol 10 mg/ml was slowly and intravenously injected through titration to achieve loss of responsiveness to verbal command. The accumulative areas under the curve below (AUC MAP-) or above (AUC MAP+ ) baseline mean arterial pressure and under the curve below or above 10% of baseline heart rate at the same time (AUC HR-, AUC HR+ ) were calculated within the first 10 min after administration of propofol or remazolam. The use of vasoactive drugs and injection pain were recorded during this period. The intraoperative awareness during the 24-h follow-up after surgery and development of cardiovascular complications, cerebral infarction and oliguria or anuria within 30 days after surgery were recorded. Results:Compared with R group, AUC MAP- was significantly enlarged (the mean difference 59.375 mmHg·min, 95% confidence interval 26.763-91.987 mmHg·min), AUC HR- was enlarged ( P<0.05), and no significant change was found in AUC MAP+, AUC HR+, requirement for vasoactive drugs, frequency of vasoactive drugs, and postoperative complications in P group ( P>0.05). No injection pain or intraoperative awareness was found in two groups. Conclusions:Remazolam is superior to propofol in maintaining hemodynamic stability during anesthesia induction in elderly patients.
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Objective:To compare the efficacy of volume therapy guided by inferior vena cava ultrasound and lung ultrasound at different sites in patients undergoing grade four hysteroscopic surgery.Methods:A total of 90 patients, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ, undergoing elective grade four hysteroscopic surgery under general anesthesia, were divided into 3 groups ( n=30 each) using a random number table method: conventional group (C group), ultrasound at the subcostal area group (S group) and ultrasound at right mid-axillary line group (R group). When the inferior vena cava distensibility index<15% or pulmonary ultrasound B-line score>8.5 or arterial blood gas Na + concentrations <125 mmol/L, surgeons were advised to speed up the process of surgery and decrease the pressure of uterine distention, furosemide 10-20 mg was intravenously injected, and the speed of infusion was adjusted at the same time.On admission to the operating room (T 0), at 20 min after induction (T 1), 40 min after induction (T 2), and at the end of operation (T 3), the B-line score of lung ultrasound, concentrations of Lac and Na + and PaO 2/FiO 2 were recorded, and the postoperative complications, amount of uterine distention fluid, volume of fluid infused and time of laryngeal mask airway removal were recorded. Results:Compared with group C, the pulmonary ultrasound B-line score was significantly decreased, the concentrations of Na + and PaO 2/FiO 2 were increased, the time of laryngeal mask airway removal was shortened, and the amount of uterine distention fluid was decreased in S and R groups, and the total incidence of complications was significantly decreased in group R ( P<0.05). Compared with group S, the lung ultrasound B-line score was significantly decreased, PaO 2/FiO 2 was increased, and the amount of uterine distention fluid was decreased in group R ( P<0.05). Conclusions:Compared with subxiphoid process, the volume therapy guided by inferior vena cava ultrasound on the right mid-axillary line and lung ultrasound has more advantages in the patients undergoing grade four hysteroscopic surgery.
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Objective:To evaluate the accuracy of ultrasonography in determining the laryngeal mask airway position using three-dimensional CT reconstruction (3D-CTR) images as the standard.Methods:One hundred and thirty-four patients, aged 18-64 yr, weighing 30-100 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective cerebral vascular interventional stent surgery in our hospital, were selected.Cervical ultrasonography was performed before and after laryngeal mask airway placement, and digital subtraction angiography was performed during operation to obtain 3D-CTR images.Neck ultrasound and 3D-CTR images were analyzed and graded.Results:A total of 125 patients completed the study.At the vertical position of the laryngeal mask airway, ultrasonic grading was positively correlated to 3D-CTR grading ( r=0.742, P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ultrasound in determining the rotation of the laryngeal mask airway was 73.0% (95% CI: 62.0%-84.4%), 92.8% (95% CI: 86.9%-98.7%), 89.1% (95% CI: 80.5%-97.7%), 81.0% (95% CI: 72.6%-89.4%), and 74.2% (95% CI 65.2%-81.1%), respectively.In terms of laryngeal mask airway depth grading, the correlation between ultrasonic grading was positively correlated to 3D-CT grading ( r=0.332, P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ultrasound in determining the depth of the laryngeal mask airway was 58.5% (95% CI: 46.9%-70.1%), 93.3% (95% CI: 87.2%-99.4%), and 90.5% (95% CI: 82.0%-99.0%), 67.5% (95% CI: 57.7%-77.3%), and 33.2% (95% CI: 16.8%-47.8%), respectively.The positive predictive value of ultrasound in determining the optimal placement of the laryngeal mask airway was 61.1% (95% CI: 48.6%-73.6%). Conclusion:Although ultrasound cannot measure the depth of the tip of the laryngeal mask airway into the esophagus, it has higher accuracy in determining the rotation and can be used as a reliable tool for clinical detection of the position of the laryngeal mask airway, especially the rotation.
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Objective To evaluate the effect of dexmedetomidine combined with erector spinae plane block on inflammatory responses and cellular immune function after thoracic interbody fusion in patients.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients of both sexes,aged 18-60 yr,with body mass index of 19-25 kg/m2,scheduled for elective thoracic interbody fusion with the vertebral segments involved in the operation ＜6,were divided into 3 groups (n =30 each) using a random number table method:general anesthesia group (group G),dexmedetomidine group (group D) and dexmedetomidine plus erector spinae plane block group (group DE).In group D and group DE,dexmedetomidine was intravenously infused over 10 min at a loading dose of 0.5 μg/kg starting from 30 min before anesthesia induction,followed by continuous infusion of 0.5 μg · kg-1 · h-1 until 15 min before the end of operation.In group DE,bilateral erector spinae blocks were performed under ultrasound guidance at 20 min before anesthesia induction,and 0.25％ ropivacaine 30 ml was injected into each side.Patients received patient-controlled analgesia (PCA) after operation.The consumption of propofol was recorded.The patients were followed up for 48 h after operation,and the pressing times of PCA and consumption of sufentanil were recorded.The emergence time,extubation time and volume of blood loss were also recorded.Blood samples were collected from the radial artery immediately before induction (T1),at 30 min of operation (T2),and at 1 h and 1,3 and 5 days after operation (T3-6) for determination of plasma CD42+,HLA-DR+ and CD14+ concentrations,white blood cell (WBC) count (by electrical impedance method) and plasma C-reactive protein (CRP) concentrations (by latex-enhanced scattering turbidimetry assay).CD42+/CD14+ and HLA-DR+/CD14+ ratios were calculated.Results Compared with group G,the pressing times of PCA and consumption of sufentanil were significantly decreased,CD42+/CD14+ ratio was decreased,and HLA-DR+/CD14+ ratio was increased at T3-6 in group D,and the emergence time,extubation time,pressing times of PCA and consumption of sufentanil and propofol were significantly decreased,CD42+/CD14+ ratio was decreased,HLA-DR+/CD14+ratio was increased at T3-6,and the plasma CRP concentrations and WBC count were decreased at T2-6 in group DE (P ＜0.05).Compared with group D,the emergence time,extubation time,pressing times of PCA and consumption of sufentanil and propofol were significantly decreased,CD42+/CD14+ ratio was decreased at T5,HLA-DR+/CD14+ratio was increased at T3.4,and the plasma CRP concentrations and WBC count were decreased at T3-6 in group DE (P ＜0.05).Conclusion Dexmedetomidine combined with erector spinae plane block can reduce inflammatory responses and improve cellular immune function after thoracic interbody fusion in patients.
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Nine pediatric patients (4 females,5 males) with huge hemangioma of head and neck complicated with Kasabach-Merritt phenomenon,aged 15-135 days,undergoing elective radical resection for huge hemangioma of head and neck,were selected from June 2012 to June 2016 in our hospital.Two pediatric patients were sensitive to preoperative hormone treatment,the platelet count almost increased to the normal value,7 pediatric patients were not sensitive to preoperative hormone treatment,and the increase in platelet count was not obvious.When the platelet count ＜ 40× 109/L,platelet was infused at 12 h before operation until the platelet count ＞ 100× 109/L.Two pediatric patients with larger haemangioma in maxillofacial region kept spontaneous breathing,and anesthesia was induced by inhaling high-concentration of sevoflurane.Anesthesia was induced with intravenous midazolam,sufentanil and cisatracurium in the other seven pediatric patients.Pediatric patients were mechanically ventilated in pressure-controlled mode after endotracheal intubation with airway pressure of 9-12 cmH2O.All pediatric patients inhaled sevoflurane,and anesthesia was maintained by infusing remifentanil.Heart rate and systolic blood pressure were maintained within the normal range during operation.Fluid and blood products were infused according to the blood loss,urine volume,physiological requirement and central venous pressure,etc.Pediatric patients were transferred to pediatric intensive care unit (PICU) at the end of operation,and the endotracheal tube was removed after the patients were completely awake.One pediatric patient developed pulmonary infection after operation,was discharged from PICU on day 7 after operation,then cured and discharged from hospital after healing on day 20 after operation.The other eight pediatric patients were discharged from PICU on day 2 after operation,then cured and discharged from hospital on days 5-10 after operation.After a followup period of 1 yr,the pediatric patients recovered well,the platelet count was normal,and the tumor recurrence was not found.
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Objective To evaluate the effect of dexmedetomidine on the cell apoptosis during the acute lung injury induced by blunt chest trauma in rats.Methods Thirty pathogen-free male SpragueDawley rats,weighing 240-270 g,aged 8 weeks,were divided into 3 groups (n=10 each) using a random number table:shan operation group (group Sham),blunt chest trauma group (group T) and blunt chest trauma plus dexmedetomidine group (group TD).The model of acute lung injury was induced by dropping a 300 g weight onto a precordium in anesthetized rats.After the model was established,dexmedetomidine was intravenously infused at a rate of 5 μg · kg 1 · h-1 for 6 h in group TD.At 6 h after the model was established,blood samples were collected from the femoral artery for determination of concentrations of serum tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6).The rats were sacrificed after blood sampling,and lungs were removed for examination of the pathological changes (with light microscope) and for determination of Bax and Bcl-2 expression in lung tissues (by immuno-histochemistry) and cell apoptosis (by TUNEL).Bcl-2/Bax ratio and apoptosis index (AI) were calculated.Results Compared with group C,the serum TNF-α and IL-6 concentrations and AI were significantly increased,the expression of Bax and Bcl-2 was up-regulated,and Bcl-2/Bax ratio was decreased in T and TD groups (P＜ 0.01).Compared with group T,the serum TNF-α and IL-6 concentrations and AI were significantly decreased,the expression of Bax in lung tissues was down-regulated,the expression of Bcl-2 in lung tissues was up-regulated,Bcl-2/Bax ratio was increased (P＜0.05),and the pathological changes of lung tissues were significantly attenuated in group TD.Conclusion The mechanism by which dexmedetomidine mitigates the acute lung injury induced by blunt chest trauma is related to inhibition of cell apoptosis in rats.
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Objective To investigate the effects of dexmedetomdine on hemodynamics and myocardial injury in patients with pulmonary hypertension undergoing mitral valve replacement.Methods Forty ASA Ⅱ or Ⅲ patients with pulmonary hypertension,aged 18-64 yr,undergoing mitral valve replacement,were randomized into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).Anesthesia was induced with iv midazolam 0.05 mg/kg,sufentanil 1 μg/kg,etomidate 0.3 mg/kg and rocuronium 0.6 mg/kg and maintained with combined intravenous-inhalational anesthesia.Narcotrend index values were maintained at 40-50.The patients were tracheal intubated and mechanically ventilated.A loading dose of dexmedetomidine 1 μg/kg was injected intravenously over 10 min after intubation followed by infusion at 0.5 μg· kg-1· h-1 until the end of operation in group D.While the equal volume of normal saline was given in group C.Venous blood samples were taken immediately before dexmedetomidine administration,at 10 min after termination of cardiopulmonary bypass (CPB),at the end of operation,and at 6 and 24 h after operation for determination of plasma levels of creatine kinase MB (CK-MB) and cardiac troponin Ⅰ (cTnI) by ELISA.Before and after administration of dexmedetomidine,at skin incision,at sternum splitting,before and after CPB,and at the end of operation,HR,MAP,mean pulmonary arterial pressure (MPAP),cardiac output (CO),systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) were detected by using Swan-Ganz catheter and Vigilance Ⅱ monitor.The requirement for vasoactive drugs and condition of spontaneous heart beats were recorded.Results In group D,each hemodynamic parameter was maintained stable at skin incision and sternum splitting,and MPAP was decreased after CPB and maintained at a lower level.The plasma levels of CK-MB and cTnI,consumption of phenylephrine and dopamine,and requirement for epinephrine were significantly lower in group D than in group C (P ＜ 0.05).There was no significant difference in the consumption of milrinone and rate of spontaneous heart beat between the two groups (P ＞ 0.05).Conclusion During mitral valve replacement for patients with pulmonary hypertension,dexmedetomidine infused at 0.05 μg·kg-1· h-1 after a loading dose of 1 μg/kg is helpful in maintaining systemic circulation and pulmonary circulation stable and provides myocardial protection to some extent.