Anesthesia management in cesarean section for a patient with coronavirus disease 2019 / 浙江大学学报·医学版

Since the corona virus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management in the cesarean section for the patients, as well as the protection for medical staff is significantly different from that in ordinary surgical operation. This paper reports a pregnant woman with COVID-19, for whom a cesarean section was successfully performed in our hospital on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the patients during the operation are discussed. Importance should be attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For ordinary COVID-19 patients intraspinal anesthesia is preferred in cesarean section, and the influence on respiration and circulation in both maternal and infant should be reduced; while for severe or critically ill patients general anesthesia with endotracheal intubation should be adopted. The safety of medical environment should be ensured, and level-Ⅲ standard protection should be taken for anesthetists. Special attention and support should be given to maternal psychology. It is important to give full explanation before operation to reduce anxiety; to relieve the discomfort during operation to reduce tension; to avoid the bad mood of patients due to pain after operation.

Anesthesia management in cesarean section for patient with COVID-19: a case report / 浙江大学学报·医学版

Since the coronavirus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management and protection of medical staff in the cesarean section is significantly different from that in ordinary surgical operation. This paper reports a case of cesarean section for a woman with COVID-19, which was successfully performed in the First Affiliated Hospital of Zhejiang University School of Medicine on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the pregnant woman during the operation were discussed. Importance has been attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For moderate patients, intraspinal anesthesia is preferred in cesarean section, and try to reduce its influence in respiration and circulation in both maternal and infant; general anesthesia with endotracheal intubation should be adopted for severe or critically ill patients. Ensure the safety of medical environment, and anesthetists should carry out level-Ⅲ standard protection. Special attention and support should be paid to maternal psychology: fully explanation before operation to reduce anxiety; relieve the discomfort during operation, so as to reduce tension; avoid the bad mood due to pain after operation.

Effect of dexmedetomidine postconditioning on cardiac function after cardiac arrest-cardiopulmonary resuscitation in swine / 中华麻醉学杂志

Objective To evaluate the effect of dexmedetomidine postconditioning on cardiac function after cardiac arrest-cardiopulmonary resuscitation in swine.Methods Twenty-eight healthy male white swine,weighing 33-41 kg,were divided into 4 groups (n=7 each) using a random number table:sham operation group (group S),cardiac arrest-cardiopulmonary resuscitation group (group CA-CPR),lowdose dexmedetomidine postconditioning group (group LDP) and high-dose dexmedetomidine postconditioning group (group HDP).Ventricular fibrillation was electrically induced and left untreated for 8 min,and then cardiopulmonary resuscitation was initiated and continued for 5 min.At 5 min after successful resuscitation,dexmedetomidine was infused via the femoral vein at a loading dose of 0.25 μg/kg followed by an infusion of 0.25 μg · kg-1 · h-1 for 6 h in group LDP,and dexmedetomidine was infused via the femoral vein at a loading dose of 0.50 μg/kg followed by an infusion of 0.50 μg · kg-1 · h-1for 6 h in group HDP.The equal volume of normal saline was given in S and CA-CPR groups.At 1,3,6 and 24 h after resuscitation,stroke volume (SV) and global ejection fraction (GEF) were measured using PiCCO,and the concentration of cardiac troponin Ⅰ (cTnⅠ) in serum was also measured by enzyme-linked immunosorbent assay.At 24 h after resuscitation,the animals were sacrificed,hearts were removed and myocardial tissues were obtained for determination of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) contents (by enzyme-linked immunosorbent assay),malondialdehyde (MDA) content (by thiobarbituric acid method),and superoxide dismutase (SOD) activity (using xanthine oxidase method).Results Compared with group S,the SV and GEF were significantly decreased,the cTnⅠ concentration in serum and contents of TNF-α,IL-6 and MDA in myocardial tissues were increased,and the activity of SOD in myocardial tissues was decreased in CA-CPR,LDP and HDP groups (P＜0.05).Compared with group CA-CPR,the SV and GEF were significantly increased,the cTnⅠ concentration in serum and contents of TNF-α,IL-6 and MDA in myocardial tissues were decreased,and the activity of SOD in myocardial tissues was increased in LDP and HDP groups (P＜0.05).Compared with group LDP,the SV and GEF were significantly increased,the cTnⅠ concentration in serum and contents of TNF-α,IL-6 and MDA in myocardial tissues were decreased,and the activity of SOD in myocardial tissues was increased in group HDP (P＜0.05).Conclusion Dexmedetomidine postconditioning can improve cardiac function after cardiac arrest-cardiopulmonary resuscitation in swine,and the mechanism may be related to inhibiting inflammatory responses and oxidative stress responses.

Expression of phosphorylated cyclic AMP response element binding protein (pCREB) in the dorsal root ganglia and superficial dorsal horn neurons following chronic constriction injury in rats / 中华麻醉学杂志

Objective To determine whether chronic constriction injury (CCI) to sciatic nerve is associated with changes in the phosphorylation of CREB in dorsal root ganglia ( DRG) and superficial dorsal horn neurons of the spinal cord.Methods Thirty-two adult female SD rats weighing 230-270 g were randomly divided into 4 groups (n = 8 each): Ⅰ blank control;Ⅱ sham operation; Ⅲ CCI 2w and Ⅳ CCI 4w. The animals were anesthetized with intraperitoneal pentobarbital 40 mg?kg-1. Right sciatic nerve was exposed and 4 ligatures were placed on the right sciatic nerve at 1 mm interspace with 3-0 silk suture. Paw withdrawal threshold to mechanical stimulation (von Frey filament) applied to plantar surface ( MWT) and paw withdrawal latency to thermal stimulation (radiant heat) (TWL) were measured before operation (baseline) and 14 days (group Ⅰ,Ⅱ and Ⅲ) or 28 days (group Ⅳ) after nerve ligation. The animals were killed the next day and the L4,5 segment of the spinal cord and L5 dorsal root ganglion were removed for determination of expression of phosphorylated-CREB-immuno-reaction(pCREB-IR) using immuno-histochemistry. The pCREB-IR cells both in DRG and superficial dorsal horn neurons were quantified and analyzed. Results The animals developed mechanical and thermal hyperalgesia on the 14th day after CCI (in group CCI 2w) . The hyperalgesia was greatly attenuated on the 28th day after CCI. Interestingly enough the animals in sham operation group (Ⅱ) also developed mechanical hyperalgesia to some extent on the 14th day after operation. The number of pCREB-IR cells was significantly increased in the ipsilateral L5 DRG and superficial dorsal horn in group Ⅲ(CCI 2w) as compared to sham operation group ( P

Effects of intrathecal H89 on phosphorylation of cAMP element binding protein in the spinal dorsal horn neurons hiduced by chronic constriction injury to sciatic nerve in rats / 中华麻醉学杂志

Objective To investigate the effects of a highly selective protein kinase A (PKA) inhibitor, H89, injected intrathecally (IT) on hyperalgesia and phosphorylation of cAMP element binding protein(pCREB) in the dorsal horn neurons of the spinal cord induced by chronic constriction injury (CCI) to the sciatic nerve.Methods Fifty-eight adult female SD rats weighing 230-270 g were used in this study. CCI was produced by 4 loose ligatures place on the sciatic nerve of right hind leg at 1 mm interspace with 3-0 silk suture. The experiment was carried out in two parts. In part Ⅰ 28 animals were randomized to receive H89 1 (group H1), 2 (group H2 ) or 4 nmol (group H4) or 10 ?l of DMSO (the solvent) 10mmol?L-1 (control group) intrathecally (IT) (n = 7 each) 7 days after surgery. The paw-withdrawal latency following mechanical (MWL) and thermal stimulation (TWL) were recorded before (baseline) and 15, 30 and 60 min after drug administration. In part Ⅱ 24 rats were randomized to receive H89 1, 2 or 4 nmol or 10 ?l of DMSO 10 mmol?L-1 IT as in part Ⅰ (group H1, H2, H4 and control group, n = 6 each) . Another 6 animals received 10 ?l of DMSO 10 mmol?L IT 7 days after sham operation. The animals were killed 30 min after drug administration and lumbar (L4.5) segment of spinal cord was removed for determination of pCREB expression in the dorsal horn neurons of spinal cord using immuno-histochemical technique. Results MWL and TWL were significantly increased after drug administration in group H2(at 15min) and group H4(at 15 and 30 min) as compared to the baseline values(P