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Objective To evaluate the feasibility of using auditory evoked potential index(AAI) to monitor the depth of nitrous oxide anesthesia. Methods Sixteen ASAⅠ-Ⅱpatients aged 23-64 years, weighing 51-86 kg scheduled for elective surgery under general anesthesia were studied. Patients with psychoneural diseases and hearing disturbances were excluded. The patients were premedicated with phenobarbital sodium 0.1g and atropine 0.5mg. AAI, BIS, 95% SEF, BP, HR, SpO2 monitoring were started before induction of anesthesia. The patients were preoxygenated for 5 min using a close-fitting face mask and 100% O2 at l0L?min-1 . Inhalation of nitrous oxide was then started. Nitrous oxide concentration was gradually increased in increments of 10% from 0% to 70% . AAI, BIS and 95%SEF were recorded and observer's assessment of alertness/sedation (OAA/S) scores were measured at each 10% increment of end-tidal nitrous oxide concentration which was maintained for 5 min. The correlation between AAI, BIS, 95% SEF and OAA/S scores was analyzed. Results OAA/S scores and AAI decreased as the nitrous oxide concentration increased. AAI correlated closely with OAA/S scores and end-tidal nitrous oxide concentration (the coefficients of Spearman' s rank correlation ? = - 0.739, 0.837, P
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Objective To examine the effects of propofol, midazolam and pyrrolidine dithiocarbamate (PDTC) on acute lung injury (ALI) induced by normothermic cardiopulmonary bypass (CPB) .Methods Twenty-six adult SD rats of both sexes weighing 350-450 g were randomly divided into 4 groups: group I midazolam (MZ, n = 7); group 11 MZ + PDTC ( n = 7); group III propofol (PROP, n = 7) and group IV sham operation ( n = 5). The animals were premedicated with intraperitoneal (i.p.) atropine 1 mg?kg-1 and anesthetized with i.p. midazolam 4 mg?kg-1 and fentanyl 150?g?kg-1 in group I , II and IV or with i.p. propofol 30mg?kg-1 and fentanyl 150 ?g?kg-1 in group III . CPB was performed at a flow rate of 100 ml?kg-1? min-1 for 60 min. In group II PDTC 100 mg?kg-1 was given i.p. 30 min before CPB. In sham operation group the animals were anesthetized, intubated and mechanically ventilated but underwent no CPB. Arterial blood samples were taken before initiation of CPB (T1 ) , at the end of CPB (T2) and 60 min after CPB (T3) for blood gas analysis and determination of the expression of CD11b on neutrophils by flow cytometry. Respiratory index (RI) was calculated at T1 and T3 . The animals were killed at 60 min after CPB and the lungs were removed for broncho-alveolar lavage. PMN count, protein and IL-8 concentration of broncho-alveolar lavage fluid (BALF) and lung MDA content were determined. The lung histology was also examined. Results RI was significantly increased at T3 as compared to T1 in group MZ ( P
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Objective To compare the effects of three different crystalloid solutions on arterial blood lactate concentration and acid-base balance during orthotopic liver transplantation (OLT) without veno-venous bypass. Methods Ninety ASA Ⅱ-Ⅳ patients with end-stage liver disease of both sexes (78 males, 12 females) aged 16-67 yrs weighing 45-87 kg undergoing OLT were randomly allocated to one of 3 groups ( n = 30 each): group Ⅰ received normal saline (NS); group Ⅱ received lactated Ringer's solution (LR) and group Ⅲ acetated Ringer's solution (Plasma A, Baxter) (PA). The crystalloid was infused at a rate of 6-8 ml?kg-1?h-1. Colloid, albumin, RBC and whole blood were infused based on BP, CVP and Hb concentration. The arterial pH, BE and lactate concentration were measured before anesthesia (T0 baseline) , before cross-clamping of the portal vein (T1) at 30 min and the end of anhepatic phase (T2,T3) , 5 and 30 min after unclamping of the portal vein (T4,T5) and at the end of surgery (T6). Results There was no significant difference in the amount of crystalloid, colloid and blood products infused during operation among the 3 groups. Arterial pH decreased significantly at T1 (immediately before anhepatic phase) as compared to the baseline value at T0 and the low pH was maintained until the end of operation. BE was significantly decreased during anhepatic phase (at T2 and T3 ) . The blood lactate was increasing during operation and was 3 times that of baseline value at the end of operation. However there was no significant difference in arterial pH, BE and lactate concentration among the 3 groups.Conclusion In OLT without venovenous bypass, blood lactate increases progressively but the lactated Ringer's solution does not have any effect on the blood lactate concentration.
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Objective Orthotopic liver transplantation (OLT) without bypass is technically simpler butimposes additional stress and strain on already compromised ciroulatory function and milieu interieur. The purposeof this study was to investigate the changes in arterial blood concentrations of glucose and lactate during OLTwithout bypass. Methods Eighty patients (66 male, 14 female) aged 12-67 yr weighing 40-130 kg undergoingOLT without veno-venous bypass for terminal liver cirrhosis (40 patients), liver cancer (28 patients), hepato-lenticular degeneration (5 patients), polycystic liver (3 patients) and severe hepatitis (4 patients). Nine patientswere classified as ASA physical status Ⅱ, thirty-nine patients as ASA Ⅲ, thirty patients ASA Ⅳ and two patientsASAV. Anesthesia was induced with midazolam 2 mg, fentanyl 10-15?g?kg~(-1), propofol 1 .0 - 1 .5 mg?kg~(-1) andpancuronium 0. 15 mg?kg~(-1) and maintained with isoflurane inhalation and intermittent i. v. boluses of fentanyl,midazolam and pipecuronium. The patients were mechanically ventilated after intubation, P_(ET) CO_2 was maintained at32-35 mm Hg. No fluid containing glucose was infused during operation. Radial artery and internal jugular veinwere cannulated for BP and CVP monitoring. ECG, MAP, CVP, SpO_2, P_(ET)CO_2, temperature and urine outputwere continuously monitored during operation. Blood samples were taken from artery before anesthesia (T_0 ), beforecross-clamping of portal vein (T_1), 30 and 60 min during anhepatic phase (T_2, T_3), 5 and 30 min afterunclamping of vena cava before the unclamping of portal vein (T_4, T_5 ) and at the end of surgery (T_6 ) fordetermination of blood glucose and lactate concentrations. Blood lactate was determined only in 50 patients whoreceived no lactated but acetated Ringer's solution during operation. In 70 patients blood samples were obtainedfrom hepatic vein after unclamping of portal vein and before the end of exsanguination from the hepatic vein fordetermination of blood glucose and lactate. Results No patient developed hypoglycemia during operation. Bloodglucose increased slightly before cross-clamping of portal vein (T_1) and during anhepatic phase (T_2, T_3) comparedwith the baseline value before anesthesia (T_0 ) (P