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Enhanced recovery after surgery (ERAS) emphasizes applicating a series of sophisticated measures with the synergy effect of optimized combination to minimize various physical and mental stress reaction.The aim of ERAS is to accelerate postoperative recovery,shorten duration of hospital stay and hospital expenses,improve postoperative life quality of patients.ERAS includes minimally invasive surgery,anesthetic management,reasonable postoperative management,among which anesthetic management is very important.
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Resident standardization training is an important part of postgraduate medical educa-tion and anesthesiology rotation is an important part in resident standardization training. Anesthesiology rotation is an effective way to improve the efficiency of hospital operation and is an important starting point to promote 'comfortable medical' and hospital upgrades. To improving the quality of training , anes-thesiology department should establish training and supervision system clearly , organize teacher training regularly. Continuous improvements in institutional mechanism can be achieved by detailed theoretical studies, technical operations and departmental rotation examination requirements as well as by exchanging ideas between teachers and students.
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Objective To investigate the protective effect of a COX inhibitor,flurbiprofen (Flurb) on hepatic ischemia/reperfusion (IR) injury in rats and the action mechanism.Method C57BL/6 mice were randomized into sham,IR and Flurb (4 different doses) groups.The model of segmental (70％) warm hepatic ischemia was established in IR and Flurb groups.Flurbiprofen of different doses (5,7.5,10 and 15 mg/kg) was injected via the tail vein 20 min before ischemia.At different time points after reperfusion,liver cell necrosis and apoptosis were evaluated by HE and TUNEL staining.The COX and inflammatory cytokine gene expression was detected by using realtime PCR.Liver mitochondria were separated and mitochondrial permeability transition (MPT) pore sensitivity was examined by using swelling assay and fluorescence spectrophotometry assay.Result In flurbiprofen groups of different doses,the serum AST and ALT levels were significantly decreased at 6 h after reperfusion as compared with IR group.Moreover,10 mg/kg Flurb pretreatment significantly inhibited the mitochondrial permeability transition (MPT) pore opening,and thus alleviated liver cell damage and prevented mitochondria-related cell death and apoptosis by inhibiting COX-2 and inflammatory factor genes expression such as IL-1β,IL-6 and TNF-α.Conclusion Flurbiprofen protects mice from hepatic I/R injury possibly by inhibiting mitochondrial permeability transition and IL-1β,IL-6 and TNF-α expression,which may provide experimental evidence for clinical use of flurbiprofen to protect liver function in surgical settings other than its conventional use for pain relief.
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Objective To compare the efficacy of supraclavicular approach and infraclavicular approach in ultrasound-guided brachial plexus block(BPB).Methods One hundred and twenty patients,ASA Ⅰ-Ⅲ,aged 18-80 yr,scheduled for upper extremity surgeries of both gender,were randomized into two groups(n =60):supraclavicular group(group SCB)and infraclavicular group(group ICB).The anesthetic mixture consisted of ropivacaine 0.375％ and lidocaine 1％ in equal volumes with epinephrine 1∶200 000,the total dose was 0.5 ml/kg.The block performance time,duration of anesthesia and success of anesthesia(surgery was accomplished without supplementary block)were recorded.A blinded observer assessed pinprick sensory block in the seven distal nerve territories(axillary,radial,musculocutaneous,median,ulnar,medial antebrachial and medial brachial cutaneous nerves)every 5 min up to 30 min after injection.Success of nerve block,side effects and complications were recorded during and after operalion.Results Group ICB was superior in success rate of anesthesia and nerve block of ulnar,medial antebrachial and medial brachial cutaneous nerves,the rate of parasthesia was lower and the block performance time was longer compared with group SCB(P ＜ 0.05).No major complications occurred in both groups.Conclusion Under ultrasound guidance,infraclavicular BPB is superior to supraclavicular approach.
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Objective To investigate the effect of propofol pretreatment on hypoxia-induced apoptosis of alveolar epithelial type Ⅱ (AE Ⅱ) cells in fetal rats. Methods Primary cultured AE Ⅱ cells isolated from fetal rats were seeded in 96-well plates (1 × 106/L, 180 μl/well) and randomly assigned to one of 3 groups (n = 72each):normal control group (group C), hypoxia group (group H) and propofol-hypoxia group (group P-H).Group H and P-H were exposed to hypoxia (5% O2). In group P-H, propofol (final concentration 5 μ mol/L) was added 1 h prior to hypoxia (5% O2). The apoptotic rate and expression of hypoxia-inducible factor (HIF)-1αmRNA, Bnip3L mRNA, HIF-1α protein and Bnip3L protein were determined at 3, 12, 24 and 48 h of hypoxia.Results The apoptotic rate and expression of HIF-1α mRNA, Bnip3L mRNA, HIF-lα protein and Bnip3L protein were significantly up-regulated in group H compared with group C (P ＜ 0.05). Propofol pretreatment could significantly inhibit the hypoxia-induced changes mentioned above (P ＜ 0.05). Conclusion Propofol pretreatment can inhibit hypoxia-induced apoptosis of AE Ⅱ cells, and the mechanism is related to inhibition of HIF-1αactivation and down-regulation of Bnip3L expression in fetal rats.
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Objective To investigate the effect of autologous transplantation of circulating endothelial progenitor cells (EPCs) on oleic acid-induced acute lung injury (ALI) in rabbits. Methods Thirty New Zealand long ear rabbits weighing 1.8-2.0 kg were randomly divided into 2 groups ( n = 15 each): normal saline group (group NS) and EPC group. ALI was induced by iv oleic acid 80 mg/kg. EPC (106/200 μl) or equal volume of normal saline (NS) was administered iv at 4 h after iv oleic acid injection. Arterial blood samples were obtained before (T0) and at 4, 8, 12, 24 and 48 h (T1-5) after oleic acid injection for blood gas analysis and determination of serum vascular endothelial growth factor (VEGF) concentration. The animals were then scrificed (at T5 ) and the lungs were removed for microscopic examination and determination of W/D lung weight ratio, Pulmonary infiltration of PMN and non-PMN was counted and hyaline membrane formation and hemorrhage were examined. Results PaO2/FaO2 ratio and serum VEGF concentration were significantly higher in group EPC than in group NS. Infiltration of leukocytes in the lung was significantly reduced by EPC transplantation. EPC also decreased lung water content, hyaline membrane formation and hemorrhage in the lungs. Conclusion Autologous transplantation of circulating EPC can ameliorate oleic acid-induced acute lung injury in rabbits.
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Objective To investigate the cerebral protective effect of anti-intercellular adhesion molecule-1 (anti-ICAM-1) antibody (1A29) in rats with global cerebral ischemia/reperfusion (I/R) injury. Methods Forty healthy SD rats weighing 180-200 g were randomly divided into 4 groups ( n = 10 each) : group Ⅰ received isotype-matched control antibody 1 mg/kg iv (control group); group Ⅰ ,Ⅲ ,Ⅳ received 1A29 1 mg/kg iv before cerebral ischemia (group Ⅱ), at the onset of reperfusion (group Ⅲ) and at 4 h of reperfusion (group Ⅳ) respectively. The global cerebral I/R was produced by 30 min four-vessel occlusion followed by 24 h reperfusion. All animals were killed at 24 h of reperfusion. Their brains were removed for microscopic examination and measurement of W/D weight ratio, infarct size and neurological deficits (0 = no deficit,4 = unable to crawl with mental depression) .Results The PMN leukocyte and monocyte infiltration, water content of the brain and infarct size were significantly decreased in group Ⅱ ,Ⅲ and Ⅳ as compared with control group. The neurological deficit scores were significantly lower in group Ⅱ ,Ⅲ, Ⅳ(1.6-1.8) than in control group (2.5).Conclusion 1A29 antibody administered either before ischemia or during the 4 h of reperfusion can protect the brain against global cerebral I/R injury.
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Preoperative anesthetic interview is not only an important part of clinical teaching,but also a vital tache of improvement for medical treatment quality.Unlike internal medicine and surgery,interview for anesthesiology department has its own characteristics.Anesthesiology department of Changzheng hospital has put great emphasis on preoperative anesthetic interview.Some experiences about preoperative anesthetic interview were introduced in our article.
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[Objective]To investigate the relationship between neurogenic pulmonary edema(NPE)and the changes of substance P in serum and bronchoatveolar lavage fluid(BALF)in acute spinal cord injured rats during isoflurane inhalation.[Method]Thirty male SD rats with body weight of 300-330g were randomly divided into 3 groups:1.5% isoflurane group,chloral hydrate group and sham operation group,ten in each group.Epidural balloon compression of the T8 spinal cord was performed.Alt animals were sacrificed 10 min after being compressed.The content of substance P and protein concentration in serum and BALF were measured.Then the lung permeability index(LPI)was calculated.[Result]The content of substance P in serum and BALF in 1.5% isofiurane group was higher than that in chloral hydrate group(P0.05).[Conclusion]1.5% isofturane can stimulate the release of substance P to take part in the development of neurogenic pulmonary edema in rats.
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We made our specific teaching program for these students with evidence-based medicine theory,according to their teaching characteristics. They studied the research methods of evidencebased medicine,and learned to search informations,write reviews,discuss clinical cases, design subjects under the guidance of teachers. Their scientific research ability was improved after these practices and training program.
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Artery cannulation is one of the clinical skills that should be mastered by the internships of anesthesiology. In consideration of its invasiveness,teachers should carry out the clinical teaching strictly and patiently,and assist the internships to establish a correct opinion on clinical practice. We should train the internships step by step,improve their success rates on artery cannulation and avoid complications as far as possible.
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Evidence-based medicine(EBM)is an inevitable development tendency of clinical medicine education in 21 century.Its core thinking is to combine evidence,personal experiences and patients'actual situation.The thinking of EBM will magnificently promote the conversion of conception and model of clinical education and will make significant influence on clinical teaching,scientific research and clinical practice.
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It is an important way for interns to evaluate and test quality of teaching and results of practice by means of clinical check.Applying dynamic simulation of anesthesia in our university,we statistically analyzed check results for interns of anesthesia specialty from 1996 to 2003 to invest present problems,aiming at perfecting clinical practice and teaching work of anesthesia specialty and favoring to cultivating talents with high diathesis.
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Objective To analysis the causes of cardic arrest during liver transplantation, and investigate the preventive measures. Methods Clinical records about 5 patients with cardiac arrest in liver transplant were studied retrospectively. Results Occurrence of cardiac arrest was 2.1 % (5/240). All the events happened at 3-6 min after graft reperfusion, and arrest lasted 3-8 min. Two patients died of resuscitation failure. After graft reperfusion, CVP and MPAP were much high in 5 patients. All of them had hypothermia and hypocalcemia. Three of them also had acidosis and two complicated with hyperkalemia. In one case, the difference between PaCO_2 and P_ETCO_2 was 47 mm Hg. Conclusion Many factors, such as disturbances of electrolyte and acid-base equilibrium or hypothermia, seemed to have some contribution to cardiac arrest occurrence after reperfusion. Various methods should be used to counter it.
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Objective: To investigate jugular bulb venous oxyg en partial pressure(PjO2)， hemoglobin saturation (SjO2) and the arterial t o jugular bulb venous oxygen content difference(AjDO2) during anesthesia with desflurane and isoflurane in patients with brain tumor. Methods: Fifty-six patients with brain tumor were randomized into desflur ane or isoflurane for maintaining anesthesia. PjO2, SjO2 and AjDO2 in pati ents were measured during normoventilation, hyperventilation and hypoventilation . Results: During normoventilation， SjO2 and PjO2 in desflu rane group was significantly higer than those in isoflurane group（P<0.05 or P<0.01）, and AjDO2 in desflurane group was significantly lower than that in isoflurane group（P<0.05）.Except that PjO2 in desflurane group was si gnificantly higer than that in isoflurane group during hyperventilation （P< 0.01）, there were no differences in SjO2, PjO2 or AjDO2 between the 2 g roups during hyperventilation or hypoventilation. While anesthesia with desflura ne and isoflurane, there was a positive correlation between PaCO2 and SjO2. Conclusion: At the same anesthetic effect concentration, desflur ane can significantly increase SjO2 and PjO2 in comparison to isoflurane un der normoventilation, suggesting that desflurane may have stronger effect of rel axing cerebral vessel than isoflurane.
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Objective: To observe the inhibitory effect of scopolamine(Spm) and chlopromazine (Clo) on withdrawal syndromes in morphine dependent rats. Methods: The intensity of withdrawal syndromes on the model of morphine dependent rats was recorded after single or muiltiple subcutaneous administration(sc) of Spm and Clo at different doses. Results: Withdrawal syndromes were markedly decreased when single Spm 1 mg/kg and Clo 0.5 mg/kg combined with morphine were injected (P<0.05). Spm+Clo(sc) had much stronger effects on inhibiting withdrawal syndromes after intraperitoneal (ip) naloxone in morphine dependent rats (P<0.01). Conclusion: Spm can act on Ach-receptor and relieve morphine withdrawal syndromes. Clo may have a synergistic action with Spm via α2-receptor in the locus coeruleus of the rat brain stem.
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Objective: To observe the controlled hypotension effects of nicardipine in 2 different ways for spinal tumor operalion. Methods: Twenty-four adult patients, scheduled for selective spinal tumor operation, were randomly divided into 2 groups. In groupⅠ(n=12), the nicardipine was infused at a rate of 10 μg*kg-1*min-1 and the infusion continued until MAP was at the level of 7.33-8.66 kPa, and then the rate was decreased to 1 μg*kg-1*min-1. In Group Ⅱ(n=12), nicardipine was given 0.01-0.02 mg/kg as the load dose, then infused at 1-2 μg*kg-1*min-1. Results: During the period of controlled hypotension, cardiac index(CI) increased significantly, other hemodynamic variables were stable and no hypertension rebound occurred in both groups. Reaching time of target blood pressure in groupⅡ was shorter than that in groupⅠ（P＜0.05）. The dose required to obtain target blood pressure in group Ⅱwas less than that in group Ⅰ（P＜0.05）. BP recovery time from discontinuing nicardipine infusion to pre-hypotension level,bleeding volume and transfusion volume were similar between 2 groups（P＞0.05）.During mass bleeding, serious arrhythmia and oliguria did not occur in any case. Conclusion: Controlled hypotension with nicardipine is rapid, stable and easily controlled without hypertension rebound. Nicardipine has considerable protective effects on heart and kidney during mass bleeding. The method of bolus injection followed with intravenous infusion is more suitable to clinical application.
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Objective To explore the protective effect of uridine 5'-triphosphate (UTP) on cerebral ischemia reperfusion injury in rats.Methods One hundred adult male SD rats were randomly divided into five groups (20 each):sham operation group,saline control group,G_ 10 group,G_ 30 group and G_ 90 group.Ischemia was induced by intraluminal suture embolism of mesocephalic artery (MAO) of the rats in all the groups except sham operation group.UTP solution was delivered through an indwelling tail venous catheter via microinfusion pump 30min after the occlusion of mesocephalic artery at a rate of 5ml/(kg?min),and rats in G_ 10,G_ 30 and G_ 90 group received 10,30 and 90?g/kg UTP,respectively.Rats in sham group and saline control group received normal saline.The total fluid volume was the same,1ml/kg,in all groups.Neurological deficit score (NDS) was determined 24h after reperfusion.Eight SD rats were then randomly selected from each group,and water content of cerebral hemispheres was measured.Two rats from each of sham operation group,saline control group and G_ 90 group were selected for studying the ultrastructure of brain tissue by electron microscopy.Infarct volume was determined by 2,3,5-triphenyl-tetrazolium chloride (TTC) staining with another 10 rats in each group.Results The protective effect of UTP was determined on cerebral ischemia-reperfusion injury in rats,and in G_ 90 group showed the most significant protective effect.For the rats in saline group and G_ 90 group,NDS score was 0.7 and 1.8 (P
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Objective To observe the reactivity of spinal cord transection (SCT) rat abdominal aorta to ?-AR agonists and the infuence of propofol on vascular reactivity, so as to explore the mechanism of autunomic dysreflxia. Methods The rats were divided into sham-operated group and SCT group. 4 weeks after transection of the fourth thoracic spinal cord, the rats were killed, then abdominal aorta rings were adopted to assay their sensitivity to noradrenaline, phenylephrine, clonidine and propofol in isolated organ perfusion system. Results Compared with the rats in sham-operated group, the abdominal aorta reactivity of SCT rats to noradrenaline and clonidine was significantly higher (P
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Objective To evaluate the pharmacokinetics and pharmacodynamics of bupivacaine polylactic acid microspheres in rabbits. Methods Sixteen New Zealand rabbits weighing (2.58?0.17) kg were randomly divided into two groups:in group A a bolus of bupivacaine solution 5 mg?kg-1 was injected subcutaneously, in group B a bolus of bupivacaine polylactic acid microspheres 5 mg ? kg-1 was implanted in subcutaneous tissue. Blood samples were obtained for determination of plasma bupivacaine concentration at 5,10,20,30,45 min and 1,2,3,4, 6,8,12,24h after subcutaneous injection in group A and at 0.5,1,2,3,4,5,6,8,12,24,36,48 and 60 h after subcutaneous implantation in group B. Pharmacodynamics study was conducted using a model evaluating the efficacy of regional anesthesia by skin incision and needle pricking. Results In group A plasma bupivacaine concentration peaked quickly at about 0. 34h after subcutaneous injection, then quickly declined and became indetectable in plasma within 12 h. In group B plasma bupivacaine concentration reached a peak much slowly at about 13h after subcutaneous implantation. Cmax was 0.7781 ? 0.3573 ?g?ml-1 significantly lower than that in group A [Cmax = (2.4664 ? 0.7822) ?g?ml-1 ] . The mean retention time (MRT) was 25.2667 ? 2.4857 h, significantly longer than that in group A [MRT= (5.5580 ? 1.3843)h] . Pharmacodynamic study showed that the duration of regional sensory block was significantly longer in group B than that in group A( P