Effect of Positive End-Expiratory Pressure (PEEP) Titration in Elderly Patients Undergoing Lobectomy.

BACKGROUND Currently, one-lung ventilation in thoracoscopic lobectomy adopts mostly a protective ventilation mode, which includes low tidal volume (a tidal volume of 6 mL/kg predicted body weight), positive end-expiratory pressure (PEEP), and intermittent lung inflation. However, there is no clear conclusion regarding the value of PEEP in elderly patients undergoing lobectomy. MATERIAL AND METHODS Fifty patients who underwent video-assisted thoracoscopic unilateral lobectomy, aged 65 to 78 years, with a body mass index of 18 to 29 kg/m² and ASA grades I to III, were randomly divided into 2 groups (n=25 each): optimal oxygenation titration group (group O) and optimal compliance titration group (group C). Mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) were recorded in both groups at different time points. The radial artery blood samples were collected at 3 time points for blood gas analysis, and the void volume/tidal volume ratio was calculated. The peak airway pressure and PEEP values were recorded at 4 min after the completion of one-lung ventilation titration (T2), and the driving pressure was calculated. RESULTS The best PEEP value of titration in the best compliance group was lower than that of the best oxygenation method, the peak was lower, and the dynamic lung compliance was higher; however, this had no effect on MAP and HR. The CVP was lower than optimal oxygenation at T2. CONCLUSIONS Dynamic lung compliance-guided PEEP titration improved lung function in elderly patients undergoing lobectomy.

Effects of bronchial blockers on one-lung ventilation in general anesthesia: A randomized controlled trail.

BACKGROUND: Double-lumen bronchial tubes (DLBT) and bronchial blockers (BB) are commonly used in the anesthesia for clinical thoracic surgery. But there are few systematic clinical comparisons between them. In this study, the effects of BB and DLBT on one-lung ventilation (OLV) are studied. METHODS: The 200 patients with thoracic tuberculosis undergoing thoracic surgery, were randomly assigned to group A (DLBT) and group B (BB). Intubation time, hemodynamic changes (mean arterial pressure [MAP], heart rate [HR]), and arterial blood gas indicators (arterial partial pressure of carbon dioxide [PaCO2], arterial partial pressure of oxygen [PaO2], airway plateau pressure [Pplat], and airway peak pressure [Ppeak]) at 4 time points were recorded. Complications such as hoarseness, pulmonary infection, pharyngalgia, and surgical success rate were also evaluated postoperatively. RESULTS: Intubation times were shorter in group B. Both MAP and HR in group A were significantly higher 1 minute after intubation than before, but also higher than those in group B. PaO2 levels were lower in both groups during (OLV) than immediately after anesthesia and after two-lung ventilation (TLV), with PaO2 being lower after 60 minutes of OLV than after 20 minutes of OLV. Furthermore, at both points during OLV, PaO2 was lower in group A than in group B. No significant differences in PaCO2 were found between the 2 groups. Ppeak and Pplat were increased in both groups during OLV, with both being higher in group A than in group B. The incidence of postoperative hoarseness, pulmonary infection, and pharyngalgia were lower in group B. There was no significant difference in the success rate of operation between the 2 groups. CONCLUSIONS: Compare with using DLBT, implementation of BB in general anesthesia has less impact on hemodynamics, PaO2 and airway pressures, and achieves lower incidence of postoperative complication.

MicroRNA-188-3p is involved in sevoflurane anesthesia-induced neuroapoptosis by targeting MDM2.

Sevoflurane is a commonly used inhalation anesthetic. Sevoflurane-induced neuroapoptosis and cognitive impairments in animals are widely reported, however, the underlying molecular mechanisms remain largely unknown. The results of the present study demonstrated that sevoflurane anesthesia induced spatial memory impairments in rats, as determined by the Morris water maze test. Mechanistically, the current study demonstrated that sevoflurane administration significantly enhanced the expression of microRNA (miR)­188­3p. Furthermore, inhibition of miR­188­3p using lentiviral miR­188­3p inhibitors attenuated sevoflurane­induced cognitive impairments in rats. The present study also demonstrated that miR­188­3p targeted MDM2 proto­oncogene (MDM2) and negatively regulated the expression of MDM2, as determined by luciferase assays, reverse transcription­quantitative polymerase chain reaction and western blot analysis. Furthermore, decreased abundance of MDM2 following transfection with miR­188­3p mimics was associated with increased stability of p53 protein. Suppression of p53 activity using the specific p53 inhibitor pifithrin­α alleviated sevoflurane­induced neuroapoptosis. These results indicate that the miR­188­3p­MDM2­p53 axis may have a critical role in sevoflurane­induced cognitive dysfunction. Therefore, miR­188­3p may be a potential target for the treatment of sevoflurane­induced cognitive impairment.

Dezocine for anesthesia and stress reduction in induced abortion.

BACKGROUND: The purpose of this study was to evaluate the efficacy of dezocine with regard to analgesic and stress reduction outcomes in women undergoing induced abortion. METHODS: A total of 126 women in early pregnancy (up to 14 weeks' gestation) who underwent induced abortion at Cangzhou Central Hospital from May 2012 to May 2013 were randomly assigned to a control (propofol) group (n=63) or an intervention (propofol + dezocine) group (n=63). Wake-up time, orientation force recovery time, incidence of adverse reactions, postoperative visual analog scale (VAS) score, analgesic effect, and respiratory and circulatory monitoring before the operation, 5 minutes into the operation, and 5 minutes after the operation were compared between the two groups. RESULTS: The surgical procedure and anesthesia were performed successfully in all patients. Systolic and diastolic blood pressure and oxyhemoglobin saturation in the intervention group were significantly higher than in the control group; however, heart rate was significantly lower in the intervention group than in the control group 5 minutes into the operation (all P<0.05). There were no statistically significant differences in these parameters before surgery and after recovery. The postoperative VAS score (2.82±0.72), Ramsay score (2.65±0.65), and anesthetic effect in the intervention group were better than in the control group (3.90±0.84 and 2.21±0.49, respectively), and all differences were statistically significant (P<0.05). The wake-up time (3.41±0.79 minutes) and orientation force recovery time (4.28±0.92 minutes) were all significantly shorter (P<0.05) in the intervention group than in the control group, as was the incidence of adverse reactions (7.94% versus 26.98%, respectively). CONCLUSION: Adverse reactions of propofol combined with dezocine in painless induced abortion are less while the analgesic effect is better.