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Objective:To explore the effect of spontaneous breathing during induction of general anesthesia on atelectasis in patients undergoing laparoscopic resection of gastrointestinal tumors.Methods:A total of 60 patients aged 18-60 years scheduled for laparoscopic resection of gastrointestinal tumors under general anesthesia in the First Hospital of Shanxi Medical University from October 2021 to August 2022 were selected. The body mass index was 18.5-28.0 kg/m 2 and the American Society of Anesthesiology grade wasⅠ-Ⅱ. All patients were divided into the spontaneous breathing group (group S, 30 cases) and the controlled breathing group (group C, 30 cases) according to the random number table method. Patients in group S received 0.2-0.3 mg/kg etomidate (pumping at the speed of 200 ml/h) and 2 μg/kg remifentanil (slowly injected more than 30 s) for anesthesia induction; patients in group C received 0.2-0.3 mg/kg etomidate and 2 μg/kg remifentanil (slowly injected more than 30 s) and 0.2 mg/kg cisatracurium. After bispectral index (BIS) decreased to 80, the patients had no response to the language stimulation; and then the mask was used to closely fit the face and maintain spontaneous breathing in group S; patients in group C received manual positive pressure ventilation. Atelectasis scores were collected immediately after endotracheal intubation (T 1) and 15 min after transferring to the recovery room (T 3), and oxygenation index (OI) was collected 5 min after endotracheal intubation (T 2) and at T 3. The postoperative pulmonary complication (PPC) on the 3rd day after the operation was recorded. Results:A total of 56 patients were finally enrolled, 27 cases in group S and 29 cases in groups C. Compared with group C, the atelectasis score of group S at T 1 and T 3 decreased [T 1: (2.4±0.8) scores vs. (4.2±0.7) scores, t = -9.12, P < 0.001; T 3: (8.2±1.8) scores vs. (10.5±1.6) scores, t = -4.96, P < 0.001]. The OI increased at T 2 and T 3 in group S [T 2: (334±11) mmHg (1 mmHg = 0.133 kPa) vs. (323±13) mmHg, t = 3.45, P = 0.001; T 3: (362±23) mmHg vs. (347±25) mmHg, t = 2.31, P = 0.025]. The incidence of PPC was 20.7% (6/29) and 18.5% (5/27), respectively in group C and group S on the 3rd day after the operation, and the difference was statistically significant ( χ2 = 0.04, P = 0.838). Conclusions:Maintaining spontaneous breathing during induction of general anesthesia can reduce atelectasis caused by general anesthesia and improve oxygenation for patients undergoing laparoscopic resection of gastrointestinal tumors.
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Objective:To evaluate the effect of continuous positive airway pressure(CPAP) ventilation strategy during induction of general anesthesia on atelectasis after induction in obese patients.Methods:A total of 86 patients, aged 30-60 yr, with body mass index of 28-35 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅱor Ⅲ, scheduled for elective cerebrovascular intervention under general anesthesia, were divided into 2 groups ( n=43 each) using a random number table method: CPAP group (group C) and routine group (group R). Group C received CPAP 5 cmH 2O-assisted ventilation after preoxygenation for spontaneous breathing and disappearance of spontaneous breathing. Chest CT scan and arterial blood gas analysis were performed after entering the operating room (T 1) and 5 min after endotracheal intubation (T 2) to calculate the percentage of atelectasis area and to record PaO 2. Dynamic lung compliance and plateau pressure were recorded at T 2. Mean minute ventilation under controlled breathing, P ETCO 2, and use of vasoactive drugs during induction were recorded. The occurrence of reflux and aspiration during mask ventilation was recorded. The development of pulmonary complications within 3 days after operation was recorded. Results:Compared with group R, the percentage of atelectasis area at T 2 was significantly decreased, PaO 2, dynamic lung compliance and plateau pressure were increased ( P<0.05), and no significant change was found in mean minute ventilation, P ETCO 2, requirement for vasoactive drugs and incidence of pulmonary complications in group C ( P>0.05). No reflux or aspiration was observed during mask ventilation. Conclusions:CPAP (5 cmH 2O) strategy during anesthesia induction can reduce the degree of atelectasis after induction in obese patients.
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Objective:To evaluate the effect of continuous positive airway pressure (CPAP) ventilation during induction of anesthesia on perioperative atelectasis and oxygenation in elderly patients.Methods:Forty-six elderly patients of either sex, aged 65-80 yr, of American Society of Anesthesiologists Physical Status classification Ⅱ or Ⅲ, undergoing elective cerebrovascular intervention surgery under general anesthesia, were divided into 2 groups ( n=23 each) according to the random number table method: control group (group C) and CPAP ventilation group (group CPAP). During induction of anesthesia, CPAP was set at 5 cmH 2O during spontaneous breathing, and PEEP was set at 5 cmH 2O when spontaneous breathing disappeared, and the ventilation mode was changed to pressure-controlled ventilation (PCV) mode in group CPAP. CPAP was not set, and PEEP was set at 0 cmH 2O for PCV when spontaneous breathing disappeared in group C. During anesthesia maintenance, PCV-volume guaranteed mode was used in both groups, and PEEP was set at 5 cmH 2O. Whole lung CT scanning was performed immediately after radial artery catheterization (T 0), at 1 min after endotracheal intubation (T 1), and before tracheal extubation (T 2) at the end of operation to calculate the percentage of atelectasis area at 1 cm above the right diaphragm. At T 0, T 1, T 2 and 30 min after entering postanesthesia care unit (T 3), blood samples from the radial artery were taken to record PaO 2 and PaCO 2 and calculate the oxygenation index (OI). Results:Compared with the baseline at T 0, the percentage of atelectasis area was significantly increased at T 1 and T 2 in two groups ( P<0.05); PaO 2 was significantly increased at T 1 and T 2 and decreased to T 0 level at T 3, OI was decreased at T 1 and T 2 and increased to T 0 level at T 3 in two groups ( P<0.05). Compared with group C, the percentage of atelectasis area was significantly decreased and PaO 2 and OI were increased at T 1 and T 2 in group CPAP ( P<0.05). There was no significant difference in PaCO 2 at each time point between the two groups ( P>0.05). Conclusions:CPAP ventilation during induction of anesthesia can reduce the development of perioperative atelectasis and improve the oxygenation in elderly patients.
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Objective:To investigate the clinical application of multimodal low-opioid combined with saphenous nerve block analgesia in elderly patients undergoing knee arthroplasty.Methods:This study is a randomized controlled study.A total of 60 elderly patients who underwent elective knee arthroplasty in the Department of Orthopedics, the First Hospital of Shanxi Medical University from January 2021 to December 2021 were selected and divided into 2 groups by numerical randomization: mode low opioid analgesia regimen group(observation group)and traditional analgesia regimen group(control group), 30 cases in each group.Observation group: (1)Preemptive analgesia: Oral celecoxib 200 mg, qd.from 3 days before surgery, the mini-mental state examination(MMSE)score was used to evaluate the cognitive function; (2)Intraoperative analgesia: After the prosthesis was installed, choose to inject analgesics around the knee joint(ropivacaine 200 mg, morphine 5 mg, epinephrine 0.25 mg, dexamethasone 5 mg/100 ml normal saline, also known as "cocktail" solution); (3)Postoperative analgesia: After the operation, continuous saphenous nerve block(0.2% ropivacaine, 2 ml/h)was performed under ultrasound guidance, and the dose of nerve block was adjusted according to the degree of rehabilitation training.Control group: no special treatment before and during the operation, traditional postoperative patient-controlled intravenous analgesia(PCIA)was used after the operation, the formula WAs as follows: sufentanil(2 μg/kg)+ flurbiprofen axetil(200-300 mg)+ Tropisetron(5-10 mg). The numerical rating scale(NRS)scores were observed and recorded 1 day before surgery, 6, 12, 24, and 48 hours after surgery; the time of the first active straight leg raising after surgery, the time of landing; the range of motion(ROM)of the knee joint 3, 7, and 14 days after surgery; the American Hospital for Special Surgery Knee Score(HSS)at 14 days, 1, 3, and 6 months after surgery; serum substance P(SP)and interleukin-6(IL-6)concentrations 1 day before surgery and 48 hours after surgery, and adverse events were recorded.Results:Compared with the control group, the patients in the observation group had lower NRS scores at 6, 12, 24, and 48 hours after the operation( t=27.705, 27.532, 21.739, 25.780, all P<0.05); the first active straight leg raising time and the time of landing earlier after the operation, and the knee joint at 3, 7, and 14 days after the operation, the range of motion(ROM)was better( t=35.496, 43.716, 3.766, 5.216, 6.009, all P<0.05). And the American hospital for special surgery knee score(HSS)was higher at 14 days, 1 month, and 3 months after surgery( t=19.247, 32.337, 22.651, all P<0.05), but there was no significant difference at 6 months after surgery.Simultaneously, the serum SP and IL-6 concentrations in the observation group 48 h after the operation were (431.0±11.3)ng/L and(11.9±2.7)ng/L, respectively.Compared with the control group(442.5±15.6)ng/L, (14.4±2.9)ng/L( t=5.362, 4.144, both P<0.05). Compared with the control group, which were lower than those in the incidence of postoperative nausea and vomiting was lower, the length of hospital stay was shorter in the observation group( χ2=4.630, t=3.311, P=0.031, 0.002), and the other indicators had no statistical differences(all P>0.05). Conclusions:Multimodal low-opioid combined with saphenous nerve block analgesia can significantly reduce perioperative pain in elderly patients undergoing knee arthroplasty, improve early postoperative mobility, and speed up postoperative functional recovery.
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Objective:To evaluate the effect of driving pressure (ΔP)-guided PEEP titration on lung injury in elderly patients undergoing robot-assisted radical prostatectomy (RARP).Methods:Forty-six American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-80 yr, with body mass index of 19-28 kg/m 2, with Assess Respiratory Risk in Surgical Patients in Catalonia score assessed as medium to high risk, scheduled for elective RARP, were divided into control group (group C, n=23) and ΔP titration group (group D, n=23) using a random number table method.Volume-controlled mechanical ventilation was used after anesthesia induction and tracheal intubation.In group C, 5 cmH 2O was used to fix PEEP.In group D, the optimal PEEP was titrated after computer-controlled breathing and after establishing Trendelenburg position and pneumoperitoneum, the first titration started from 4 cmH 2O and increased by 1 cmH 2O every 4 min until ΔP reached the minimum value or PEEP increased to 12 cmH 2O, and the second titration was increased in increments as the method described above based on the optimal PEEP of the first titration.At 4 min after completion of the first PEEP titration (T 1, 4 min after mechanical ventilation with fixed PEEP in group C), 2 h after establishment of Trendelenburg position (T 2), 1 min after extubation (T 3) and 2 h after operation (T 4), serum concentrations of Clara cell protein (CC16), surfactant protein D (SP-D), soluble receptor for advanced glycation end-products (sRAGE) and soluble intercellular adhesion molecule-1 (sICAM-1). Pulmonary complications were assessed within 7 days after operation. Results:The serum concentrations of CC16, SP-D, sRAGE and sICAM-1 were significantly higher at T 2-4 than at T 1 in two groups ( P<0.05). Compared with group C, the serum concentrations of CC16, SP-D, sRAGE and sICAM-1 were significantly decreased at T 2-4 ( P<0.05), and no significant change was found in the incidence of pulmonary complications within 7 days after operation in group D ( P>0.05). Conclusions:ΔP-guided PEEP titration can reduce lung injury in elderly patients undergoing RARP.
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Objective:To evaluate the role of adiponectin in sevoflurane pretreatment-induced improvement in cognitive function in mice with myocardial ischemia/reperfusion (I/R).Methods:Thirty SPF healthy adult male wild-type C57 mice, aged 8-10 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) using a random number table method: sham operation group (group Sham), myocardial I/R group (group MI/R) and sevoflurane pretreatment group (group SP). Another 10 SPF healthy male adiponectin knockout SPF mice, aged 8-10 weeks, weighing 20-25 g, were selected and served as APNKO group.Myocardial I/R was induced by 30 min occlusion of anterior descending branch of left coronary artery followed by reperfusion.In SP and APNKO groups, sevoflurane pretreatment included 3 cycles of 10-minute inhalation of 2% sevoflurane-93% O 2-5% CO 2 interspersed with 15-minute inhalation of 95% O 2-5% CO 2, and then the model was established.At 1, 2 and 4 days of reperfusion, cognitive function was assessed by Morris water maze test. Results:There was no significant difference in swimming velocity at each time point between the 4 groups ( P>0.05). Compared with group Sham, the escape latency was significantly prolonged, and the frequency of crossing the original platform was decreased at each time point in group MI/R ( P<0.05). Compared with group MI/R, the escape latency was significantly shortened, and the frequency of crossing the original platform was increased at each time point in group SP ( P<0.05). Compared with group SP, the escape latency was significantly prolonged, and the frequency of crossing the original platform was decreased at each time point in group APNKO ( P<0.05). Conclusion:Adiponectin is involved in the process of sevoflurane pretreatment-induced improvement in cognitive function in mice with myocardial I/R.
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Objective:To evaluate the effect of preoperative respiratory muscle exercise combined with intraoperative lung protective ventilation strategy on atelectasis in elderly patients undergoing robot-assisted radical prostatectomy.Methods:In the prospective study, a total of 45 patients aged 65-80 years undergoing scheduled robot-assisted radical prostatectomy in First Hospital of Shanxi Medical University from August 2020 to November 2020 were divided into three groups( N=15, each): respiratory muscle exercise combined with lung protective ventilation strategy group(combined group), lung protective ventilation strategy group(pulmonary protective group)and conventional ventilation strategy(control group). Heart rate, systolic blood pressure, diastolic pressure, and pulse oxygen saturation as well as blood gas analysis of arterial blood and the calculated oxygenation index were measured and recorded immediately after establishing invasive artery monitoring in operating room, 10 min after endotracheal intubation, 1 h after the flexitic position, 30 min after tracheal extubation, 24 h after operation in all three groups of patients.The lung compliance values, peak airway pressure, and end-tidal carbon dioxide were recorded at 10 minutes after tracheal intubation, 30 minutes after tracheal extubation, 1 hour after succession position.A single-slice chest CT scan was performed at 1 h after surgery while satisfying the anesthesia recovery steward score ≥ 5.And the percentage of atelectasis area was calculated. Results:The American Society of Anesthesiologisits(ASA)classification of patients was 11/4, 12/3, and 11/4 in the combination group, lung protection group and control group respectively, and the difference was not statistically significant( χ2=0.127, P>0.05). Oxygenation index(mmHg)(1 mmHg=0.133 kPa)at 24 h after surgery was significantly higher in the combined group(351.1±11.2)than in lung protection group(337.0±13.4)( t=3.287, P<0.05). Atelectasis area(Median, Interquartile range)assessed by CT imaging at 30 min after tracheal extubation was 1.92(0.77)% in the combination group, 2.09(1.13)% in lung protection group, and 3.01(1.01)% in control group, with statistically significant difference( χ2 values, 26.036, 12.313, both P<0.05). Atelectasis area at 30 minutes after tracheal extubation was statistically significant smaller in the combination group than in lung protection group( χ2=6.240, P<0.05). Conclusions:Preoperative respiratory muscle exercise combined with intraoperative lung protective ventilation strategy can achieve the better effect of lung protection, reduce the degree of perioperative atelectasis in elderly patients, and improve oxygenation function.
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Objective:To analyze the clinical characteristics and influencing factors on postoperative emotional and cognitive function for elderly versus non-elderly male patients with laryngeal carcinoma.Methods:The patients with laryngeal cancer hospitalized in the Department of Otorhinolaryngology-Head and Neck Surgery were selected for a questionnaire survey in two Grade III-A Hospital in Shanxi Province from January 2018 to December 2019.There were 105 patients with laryngeal cancer, including 60 in the elderly and 45 in the non-elderly group.Negative emotion and cognitive function were investigated by using Self-rating Anxiety Scales(SAS), Self-rating Depression Scale(SDS), and Montreal Cognitive Assessment(MOCA)before surgery, 10 days after surgery, and 1 year after surgery, respectively.The clinical characteristics of the elderly versus non-elderly groups were analyzed and compared.Results:One year after surgery, there were 52 cases(86.7%)and 27 cases(45.0%)of depression and cancer-related cognitive impairment(CRCI)in the elderly group, which were higher than 30 cases(66.7%)and 4 cases(8.9%)in the non-elderly group, with statistically significant difference( χ2 = 6.013, χ2 =16.115 and P<0.05, P<0.01). The elderly group showed much more anxiety and CRCI 10 days after surgery(60.50±4.31 vs.55.84±3.81, 27.47±1.08 vs.28.31±1.08, P<0.01)and showed much more depression and CRCI(57.20±5.66 vs.62.60±5.37, 27.36±1.37 vs.26.08±1.42, P<0.01)than did the non-elderly group 1 year after surgery.The results of multiple linear regression analysis in the elderly group showed that the mode of operation and the pronunciation one year after surgery significantly affected their anxiety; the marriage and the educated level significantly affected their depression; the marriage, the educated level and operation mode significantly affected their cognitive function.Clinical stage of tumor significantly affected anxiety and depression, the educated level significantly affected cognitive function in the non-elderly group. Conclusions:Postoperative negative emotion and cognitive function in patients with laryngeal cancer continues to deteriorate after surgery, which were affected by many factors, especially in elderly patients.It is necessary to conduct active and effective interventions as soon as possible.
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Objective:To evaluate the effect of driving pressure-guided individualized positive end-expiratory pressure (PEEP) titration on atelectasis in elderly patients undergoing robot-assisted radical prostatectomy.Methods:Fifty elderly patients, aged 65-80 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index of 19-28 kg/m 2, undergoing elective robot-assisted radical prostatectomy under general anesthesia, were divided into 2 groups ( n=25 each) according to the random number table method: traditional lung-protective ventilation group (group C) and driving pressure-guided individualized PEEP group (group D). The method for setting PEEP was as follows: PEEP 5 cmH 2O was used throughout operation in group C. In group D, the optimal PEEP was titrated after intubation and mechanical ventilation and Trendelenburg position-pneumoperitoneum construction, the initial value was the lowest PEEP allowed by the anesthesia machine, the PEEP was increased by 1 cmH 2O (PEEP≤12 cmH 2O) every 4 min, the plateau pressure and PEEP were simultaneously recorded to calculate the driving pressure, and the corresponding PEEP was considered as the optimal PEEP for the individual when the driving pressure reached the minimum.Ultrasound examination was performed after catheterization of radial artery (T 0), after anesthesia induction (T 1), 4 min after developing optimal PEEP ventilation (T 2, 4 min after developing ventilation in group C), after restoration of body position (T 3), before extubation (T 4), and at 2 h after admission to postanesthesia care unit (T 5). Atelectatic aeration loss scores were recorded at T 0, T 1, T 4 and T 5.Bilateral optic nerve sheath diameter was measured at T 0-4.Arterial blood gas analysis was performed at T 0, T 2, T 3 and T 5, PaO 2 and PaCO 2 were recorded, and oxygenation index was calculated.The postoperative pulmonary complications within 3 days after operation were recorded. Results:Compared with group C, atelectasis aeration loss scores at T 4, 5 and PaCO 2 at T 2, 3 were significantly decreased, and PaO 2 and oxygenation index were increased at T 2, 3, 5 in group D ( P<0.05). There were no significant differences in the bilateral optic nerve sheath diameter and incidence of postoperative pulmonary complications between the two groups ( P>0.05). Conclusion:Driving pressure-guided individualized PEEP can increase intraoperative oxygenation and decrease the development of atelectasis in elderly patients undergoing robot-assisted radical prostatectomy.
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Objective:To evaluate the effect of calcitonin gene-related peptide (CGRP) on action potential duration (APD) in rat ventricular myocytes and the role of ATP-sensitive potassium (K ATP) channels. Methods:Ventricular myocytes ( n=6)acutely isolated from clean-grade Sprague-Dawley rats by enzymatic hydrolysis were obtained.Using the method of self-control before and after administration, the cells were first perfused with Tyrode′s solution alone for 2 min, and then with Tyrode′s solution containing CGRP 10 -10 mol/L, CGRP8-37 10 -9 mol/L and glibenclamide 10 -5 mol/L sequentially for 2 min.The APD was recorded, and K ATP channel current density was determined by whole-cell patch-clamp technique, and APD at 90% of repolarization(APD 90) was calculated. Results:Compared with the results after giving Tyrode′s solution alone, APD 90 of ventricular myocytes was significantly shortened, and the K ATP channel current density of ventricular myocytes was increased after giving CGRP ( P<0.01). The APD 90 of ventricular myocytes was significantly prolonged, and K ATP channel current density of ventricular myocytes was decreased after giving CGRP 8-37 or glibenclamide as compared with that after giving CGRP ( P<0.05). Conclusion:CGRP can shorten APD of rat ventricular myocytes through its specific receptor, and activation of K ATP channels is involved in this process.
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Objective:To evaluate the effect of sevoflurane postconditioning on early inflammatory responses during intestinal ischemia-reperfusion (I/R) in rats.Methods:Sixty clean-grade Sprague-Dawley rats, aged 8-10 weeks, weighing 200-230 g, were divided into 3 groups ( n=20 each) using a random number table method: sham operation group (Sham group), intestinal I/R group (I/R group), and sevoflurane postconditioning group (Sevo group). Intestinal I/R was produced by occlusion of the superior mesenteric artery for 60 min followed by reperfusion for 2 h in anesthetized rats in I/R group and Sevo group.Laparotomy was performed, and the superior mesenteric artery was only isolated in Sham group.The rats inhaled 1.15% sevoflurane for 30 min for postconditioning in Sevo group.Blood samples were collected by cardiac puncture at 2 h of reperfusion, and then the rats were sacrificed.Samples of intestine were obtained for examination of the pathological changes of intestinal tissues (with a light microscope) which were scored according to Chiu and for determination of the neutrophil L-selectin levels in blood (by flow cytometry), tumor necrosis factor-alpha (TNF-a) expression (by Western blot), myeloperoxidase (MPO) activity (by spectrophotometry). Results:Compared with group Sham, the neutropil L-selectin level in blood was significantly increased in group I/R and decreased in group Sevo, and Chiu′s score, TNF-a expression and MPO activity were significantly increased in I/R and Sevo groups ( P<0.05). Compared with group I/R, the neutropil L-selectin level in blood, Chiu′s score, TNF-a expression, TNF-a expression and MPO activity were significantly decreased ( P<0.05), and the pathological changes were significantly attenuated in group Sevo. Conclusion:The mechanism by which sevoflurane postconditioning reduces intestinal I/R injury may be related to inhibiting early inflammatory responses in rats.
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Objective:To investigate the effect of ultrasound-guided erector spine plane block(ESPB)on postoperative analgesia in elderly patients undergoing abdominal operation.Methods:This was a prospective study.A total of 50 patients undergoing cholecystectomy and choledochotomy under laparotomy and general anesthesia were divided into two groups(n=25, each)according to the random number table method.The patient-controlled intravenous analgesia was named as the group P, and a single ESPB(the group E)was conducted with 0.33% ropivacaine 30 ml before induction of anesthesia as add-on to the management of group P. The block rang of ESPB, visual analogue scale(VAS)at 4, 12, 24 h postoperatively, number of analgesia pump pressure, number of patients receiving parecoxib sodium medication, complications related to the ESPB including dyspnea and local anesthetic systemic toxicity and anal exhaust time were recorded in the two groups.Results:The range of pain block in group E included the spinal innervation area(T5~T12)(13 cases)and(T6~L1)(12 cases). Compared with the group P, the group E showed that EVAS scores at 4, 12, 24 h postoperatively were decreased(4.2±1.1 vs.1.4±0.6, 4.0±0.8 vs.1.8±1.2, 3.5±0.9 vs.2.0±1.1, P<0.01), the number of analgesia pump pressure and the number of patients receiving supplemental parecoxib sodium were decreased(2.5±0.9 vs.9.9±1.5, 20.0% or 5 cases vs.64.0% or 16 cases, t=10.566, χ2=9.934, P<0.01), and the anal exhaust time was shortened[(20.1±1.9)h vs.(24.5±2.1)h, t=7.388, P<0.01]. No patients had dyspnea or local anesthetic toxicity. Conclusions:Ultrasound-guided ESPB has less complications, lower dose of postoperative opioid analgesics, faster recovery of postoperative intestinal function.
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Objective:To investigate the effects of driving pressure(DP)-guided individualized positive end-expiratory pressure(PEEP)on intraoperative pulmonary function in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.Methods:This was a retrospective case-control study.A total of 40 elderly patients undergone robot-assisted radical resection of prostate cancer were enrolled and divided into the control group and the DP-guided group(n=20, each group)based on the random number table method.Data on the peak inspiratory pressure(PIP)at time points including 4 min after the first PEEP set(T1), 4 min, 1 hour, 2 hours(T2-4)after the second PEEP set, and 1 min after closing abdomen(T5), lung compliance(Crs), PEEP and the partial pressure of carbon dioxide in end expiratory gas(PetCO 2)were recorded and compared between the two groups.Blood gas analysis was conducted, and the oxygenation index(OI), alveolar-arterial oxygen tension difference(A-aDO 2)and the dead space volume/tidal volume(Vd/Vt)were calculated. Results:Compared with the control group, Crs, OI and PaO 2 were increased and DP, Vd/Vt, A-aDO 2 and PaCO 2 were decreased in the DP-guided group at each time point( P<0.05). PIP showed no significant difference between the two groups at each time point( P>0.05). Compared with T1, PIP and DP were increased and Crs was decreased( P<0.05)in both groups at T2-T4( P<0.05). At T5, PIP was increased in both groups( P<0.05), Crs was decreased and DP was increased in the control group( P<0.05), while Crs and DP had no significant difference in the DP group at T1( P>0.05). OI and PaO 2 showed no significant difference between the two groups at T2-T5( P>0.05). Vd/Vt and PaCO 2 were increased in both groups at T3-T5( P<0.05). Compared with T1 levels, A-aDO 2 was increased in the control group at T3-T5( P<0.05)and in the DP group at T4( P<0.05). Conclusions:DP-guided individualized PEEP can reduce the occurrence of intraoperative atelectasis, improve intraoperative respiratory mechanical state and gas exchange, reduce the risk of potential ventilator-related lung injury and has good lung-protective effects of PEEP in elderly patients undergoing robot-assisted laparoscopic prostatectomy.
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Objective:To investigate whether ventricular non-excitatory electrical stimulation(NES)preconditioning can protect myocardial ischemia-reperfusion(IR)injury in aged mice by regulating cardiac calcitonin gene-related peptide(CGRP).Methods:Male C57BL/6J mice were randomly divided into 3 groups, (1)the Sham group, receiving sham operation group(n=6); (2)the IR group, receiving ligation of coronary artery to induce myocardial ischemia for 45 min and reperfusion for 120 min(n=13); (3)the NES group, IR model receiving NES from 15 min before IR to the end of reperfusion(n=13). Infarct size was detected by staining with 2, 3, 5-triphenyltetrazolium chloride.The level of serum cTnI and expression of myocardial CGRP were measured by enzyme linked immunosorbent assay and quantitative real time polymerase chain reaction.Results:Compared with the IR group, the infarct sizes were significantly lower in NES group[(38.17±4.36)% vs.(45.33±5.68)%, P<0.05]. Besides, the IR and NES groups were associated with significantly increased levels of serum cTnI[(10.89±2.14)μg/L, (7.03±1.79)μg/L vs.(3.92±0.47)μg/L, P<0.001], myocardial CGRP protein[(26.33±4.55)μg/kg, (19.67±5.79)μg/kg vs.(17.00±2.90)μg/kg, P<0.01], CGRP mRNA[(1.40±0.20), (2.20±0.75) vs.(1.05±0.10), P<0.01]compared with the Sham group.Furthermore, the NES group was associated with markedly decreased levels of serum cTnI and myocardial CGRP protein, and increased level of CGRP mRNA compared with the IR group(all P<0.05). Conclusion:NES may protect myocardium IR injury by regulating endogenous CGRP expression in aged mice.
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Objective To evaluate the effects of ketamine anesthesia on proteome in hippocampus in aged rats.Methods Thirty healthy male Wistar rats,aged 20 months,weighing 560-610 g,were di-vided into 2 groups(n＝15 each)using a random number table method: control group(group C)and ket-amine group(group K).In group K,ketamine 80 mg/kg was intraperitoneally injected,additional 1/2 ini-tial dose was given when the righting reflex was recovered,and anesthesia was maintained for 3 h.Morris water maze test was performed starting from 1st day after the end of anesthesia.Five rats were selected at days 1 and 7 after the end of anesthesia and sacrificed,and hippocampal tissues were obtained to extract proteins.Proteins extracted from rat hippocampi were identified by 2-dimensional electrophoresis(2-DE).The differentially expressed proteins were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF-MS)and biological information system.Results Compared with group C,the escape latency and total swimming distance to find the submerged platform in Morris water maze at the 1st day after anesthesia were significantly prolonged in group K(P＜0.05 or 0.01).The MAL-DI-TOF-MS analysis showed that there were 21 differentially expressed proteins at 1st day after ketamine an-esthesia,of which 6 proteins(involving maintenance of intracellular protein homeostasis,energy metabo-lism,etc.)presented with up-regulated expression and 15 proteins(involving synaptic vesicle transport ef-ficiency,synaptic structural and functional plasticity,maintenance of intracellular protein homeostasis,NMDA-mediated Ca2+signal transport,energy metabolism,etc.)presented with down-regulated expres-sion.There were 8 differentially expressed proteins at 7th day,including 3 proteins with up-regulated ex-pression and 5 proteins with down-regulated expression(P＜0.05).Conclusion Ketamine anesthesia can induce 21 differentially expressed proteins in hippocampi of aged rats,involving synaptic vesicle transport efficiency,synaptic structural and functional plasticity,intracellular protein homeostasis,NMDA-mediated Ca2+signal transport,energy metabolism,and etc.which may be involved in the mechanism of ketamine-induced temporary cognitive dysfunction.
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Objective@#To investigate the protective effects of pretreatment with a Shenfu(SF)injection on arrhythmias induced by myocardial ischemia-reperfusion(IR)injury in aged mice.@*Methods@#Thirty 18-month-old C57BL/6J mice were randomly divided into 3 groups(n=10, each group): the sham treatment group(receiving sham operation without thoracotomy), the IR group(undergoing the ligation of the left anterior descending coronary artery with ischemia for 30 min and reperfusion for 2 h)and the SF group(receiving SF intraperitoneal injection of 10 ml/kg 30 min before thoracotomy and the same treatment as the IR group). Arrhythmias were monitored, and serum levels of creatine kinase-isoenzyme(CK-MB), troponin(cTnI)and tumor necrosis factor α(TNFα), and the ratio of myocardial connexin 43(Cx43)phosphorylation(ser368)to total protein(p-Cx43/t-Cx43)were detected in the three groups.@*Results@#Ventricular arrhythmias occurred in the IR and SF groups.Compared with the IR group, ventricular arrhythmias in the SF group were alleviated, the frequency of ventricular premature systolic episodes was reduced(36.6±13.5 times vs. 48.4±22.1 times), the frequency of ventricular tachycardia/fibrillation decreased(3.4±1.8 times vs. 7.6±3.5 times), and the total duration of ventricular tachycardia/fibrillation episodes was shortened(8.9±4.5 times vs. 17.7±5.1 times)in the SF group(P<0.05), but there was no significant difference in arrhythmia scores(1.8±1.2 points vs. 1.9±1.7 points, P>0.05)between the two groups.Compared with the sham treatment group, serum levels of CK-MB, cTnI and myocardial TNF(increased in the IR and SF groups(P<0.05), and their levels were lower in the SF group than in the IR group(P<0.05). Compared with the sham treatment group, the ratio of Cx43 ser368/total protein was lower in the IR and SF groups, but was higher in the SF group than in the IR group(P<0.05).@*Conclusions@#SF pretreatment can significantly reduce IR-induced arrhythmias in aged mice possibly by reducing TNF(and up-regulating the phosphorylation activity of Cx43.
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Objective@#To evaluate the effects of ketamine anesthesia on proteome in hippocampus in aged rats.@*Methods@#Thirty healthy male Wistar rats, aged 20 months, weighing 560-610 g, were divided into 2 groups (n=15 each) using a random number table method: control group (group C) and ketamine group (group K). In group K, ketamine 80 mg/kg was intraperitoneally injected, additional 1/2 initial dose was given when the righting reflex was recovered, and anesthesia was maintained for 3 h. Morris water maze test was performed starting from 1st day after the end of anesthesia.Five rats were selected at days 1 and 7 after the end of anesthesia and sacrificed, and hippocampal tissues were obtained to extract proteins.Proteins extracted from rat hippocampi were identified by 2-dimensional electrophoresis (2-DE). The differentially expressed proteins were analyzed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and biological information system.@*Results@#Compared with group C, the escape latency and total swimming distance to find the submerged platform in Morris water maze at the 1st day after anesthesia were significantly prolonged in group K (P<0.05 or 0.01). The MALDI-TOF-MS analysis showed that there were 21 differentially expressed proteins at 1st day after ketamine anesthesia, of which 6 proteins (involving maintenance of intracellular protein homeostasis, energy metabolism, etc.) presented with up-regulated expression and 15 proteins (involving synaptic vesicle transport efficiency, synaptic structural and functional plasticity, maintenance of intracellular protein homeostasis, NMDA-mediated Ca2+ signal transport, energy metabolism, etc.) presented with down-regulated expression.There were 8 differentially expressed proteins at 7th day, including 3 proteins with up-regulated expression and 5 proteins with down-regulated expression (P<0.05).@*Conclusion@#Ketamine anesthesia can induce 21 differentially expressed proteins in hippocampi of aged rats, involving synaptic vesicle transport efficiency, synaptic structural and functional plasticity, intracellular protein homeostasis, NMDA-mediated Ca2+ signal transport, energy metabolism, and etc.which may be involved in the mechanism of ketamine-induced temporary cognitive dysfunction.
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Objective To investigate the protective effects of pretreatment with a Shenfu(SF) injection on arrhythmias induced by myocardial ischemia-reperfusion(IR)injury in aged mice.Methods Thirty 18-month-old C57BL/6J mice were randomly divided into 3 groups (n=10,each group):the sham treatment group(receiving sham operation without thoracotomy),the IR group (undergoing the ligation of the left anterior descending coronary artery with ischemia for 30 min and reperfusion for 2 h)and the SF group(receiving SF intraperitoneal injection of 10 ml/kg 30 min before thoracotomy and the same treatment as the IR group).Arrhythmias were monitored,and serum levels of creatine kinase-isoenzyme (CK-MB),troponin (cTnI) and tumor necrosis factor α (TNFα),and the ratio of myocardial connexin 43 (Cx43) phosphorylation (ser368) to total protein (p-Cx43/t-Cx43) were detected in the three groups.Results Ventricular arrhythmias occurred in the IR and SF groups.Compared with the IR group,ventricular arrhythmias in the SF group were alleviated,the frequency of ventricular premature systolic episodes was reduced(36.6 ± 13.5 times vs.48.4 ± 22.1 times),the frequency of ventricular tachycardia/fibrillation decreased(3.4 ± 1.8 times vs.7.6 ± 3.5 times),and the total duration of ventricular tachycardia/fibrillation episodes was shortened(8.9± 4.5 times vs.17.7± 5.1 times)in the SF group(P＜0.05),but there was no significant difference in arrhythmia scores(1.8± 1.2 points vs.1.9 ± 1.7 points,P ＞0.05) between the two groups.Compared with the sham treatment group,serum levels of CK-MB,cTnI and myocardial TNF(increased in the IR and SF groups (P ＜ 0.05),and their levels were lower in the SF group than in the IR group (P＜0.05).Compared with the sham treatment group,the ratio of Cx43 ser368/total protein was lower in the IR and SF groups,but was higher in the SF group than in the IR group(P＜0.05).Conclusions SF pretreatment can significantly reduce IR-induced arrhythmias in aged mice possibly by reducing TNF(and up-regulating the phosphorylation activity of Cx43.
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Objective To evaluate the effect of dynamic lung compliance ( Cdyn) -guided positive end-expiratory pressure (PEEP) titration on extravascular lung water in elderly patients undergoing robot-assisted radical prostatectomy. Methods Forty American Society of Anesthesiologists physical statusⅡ orⅢ patients, aged 65-80 yr, with body mass index of 19-28 kg∕m2 , scheduled for elective robot-assisted radical prostatectomy, were divided into 2 groups ( n=20 each) using a random number table method:control group (group C) and PEEP group (group P). In group P, immediately after endotracheal intuba-tion, immediately after establishing pneumoperitoneum-Trendelenburg position and after restoring the supine position, PEEP was set starting from the lowest PEEP allowed by the machine, increasing by 2 cmH2 O ev-ery 4 min until the maximum Cdyn was obtained. PEEP was not set in group C. Immediately after establis-hing the invasive blood pressure monitoring ( T1 ) , at 10 min after the first successful PEEP titration ( T2 ) , 10 min, 1 h and 2 h after the second successful PEEP titration ( T3-5 ) , 10 min after the third successful PEEP titration (T6), and 30 min after tracheal extubation (T7) in group P, or at T1, 10 min after intu-bation ( T2 ) , 10 min, 1 h and 2 h after establishing pneumoperitoneum-Trendelenburg position ( T3-5 ) , 10 min after restoring the supine position ( T6 ) and T7 in group C, blood samples were collected from the radial artery for blood gas analysis, and the oxygenation index was calculated. The B-line score was recor-ded at T1 and T7 . Results Compared with group C, the B-line score was significantly decreased at T7 , and the oxygenation index was increased at T5-7 in group P (P<0. 05). Conclusion Cdyn-guided PEEP titration can decrease the formation of extravascular lung water in elderly patients undergoing robot-assisted radical prostatectomy.
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Objective To evaluate the effect of dynamic lung compliance ( Cydn)-guided positive end-expiratory pressure (PEEP) titration on lung injury in the patients undergoing robot-assisted radical prostatectomy. Methods Forty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 65-80 yr, with body mass index of 19-28 kg∕m2 , scheduled for elective robot-assisted radical prosta-tectomy under general anesthesia, were divided into 2 groups ( n=20 each) using a random number table method: control group (group C) and PEEP group (group P). Mechanical ventilation was performed ac-cording to preset parameters after tracheal intubation in group C, and PEEP was set by a double titration method after tracheal intubation and after pneumoperitoneum in group P. At 4 min after intubation (T1), 4 min, 1 h and 2 h after establishing pneumoperitoneum-Trendelenburg position ( T2-4 ) , and 1 and 30 min after extubation ( T5,6 ) in group C or at 4 min after completing the first PEEP titration ( T1 ) , 4 min, 1 h and 2 h after completing the second PEEP titration (T2-4) and T5,6 in group P, blood samples were collect-ed from the radial artery for determination of club cell protein 16, surfactant protein-D, tumor necrosis fac-tor-alpha and interleukin-6 concentrations in serum ( by enzyme-linked immunosorbent assay) . Results Compared with group C, the serum concentrations of club cell protein 16 at T2-6 and surfactant protein-D, tumor necrosis factor-alpha and interleukin-6 at T3-6 were significantly decreased in group P (P<0. 05). Conclusion Cydn-guided PEEP titration can reduce the lung injury in patients undergoing robot-assisted radical prostatectomy.