The impacts of corrected left ventricular ejection time combined with dobutamine on hepatocellular carcinoma patients.

To evaluate the clinical effect of corrected left ventricular ejection time (LVETc) combined with dobutamine on the intraoperative management of patients undergoing hepatectomy for hepatocellular carcinoma. Sixty-eight patients with elective proposed pancreaticoduodenectomy, aged 61-78 years, body mass index 19-26 kg/m2, and ASA classification II or III, were divided into two groups (n = 34) using the random number table method: the esophageal ultrasound group (S group) and the esophageal ultrasound combined with dobutamine group (D group). In both groups, an esophageal ultrasound probe was placed after induction of anesthesia, and the left ventricular ejection time (LVET) and stroke volume (SV) were measured via a long-axis section of gastric fundus to guide fluid infusion. Nitroglycerin or a combination of dobutamine and nitroglycerine were pumped intravenously from the beginning of surgery to the completion of hemostasis after partial hepatectomy, in groups S or D, respectively. Central Venous Pressure (CVP), heart rate HR, and mean arterial pressure MAP were recorded at entry (T0), immediately after induction (T1), at the beginning of the operation (T2), during hilar occlusion (T3), after partial hepatectomy (T4), and after the operation (T5). SV and LVETc were recorded between T1 and T5. At T0 and T5, blood samples from radial artery and central vein were taken to determine the concentration of blood lactic acid, and the oxygen supply index (DO2I) and oxygen uptake rate (O2ERe) were calculated by blood gas analysis. The operation time, hilar occlusion time, intraoperative urine volume, intraoperative crystalloid and colloid infusion, intraoperative blood loss and blood transfusion, and the occurrence of cardiac gas emboli during the operation were also recorded. Adverse events of cardiovascular, pulmonary, and renal function during and after operation were registered. Sixty-four patients were included in the final analysis. Compared with group S, group D had lower CVP values at T2-T3 and higher SV values at T2-T5, reduced intraoperative blood loss, significantly increased intraoperative urine output, a smaller total dose of nitroglycerin use, and lower incidences of intraoperative hypotension and cardiac gas emboli (P < 0.05). Esophageal ultrasound detection of LVETc combined with dobutamine ensures hemodynamic stability in patients undergoing partial hepatectomy while reducing the incidence of intraoperative hypotension and air embolism.

Efficacy of using combination of phloroglucinol and dyclonine hydrochloride mucilage in preventing cath-eter-related bladder discomfort during recovery from anesthesia in the patients undergoing general anes-thesia / 临床麻醉学杂志

Objective To evaluate the efficacy of phloroglucinol combined with dyclonine hydrochloride mucilage in preventing catheter-related bladder discomfort (CRBD)during recovery from anesthesia in patients under general anesthesia.Methods A total of 120 male patients scheduled for laparoscopic cholecystectomy under general anesthesia,aged 18-60 years,weighing 46-80 kg, ASA physical status I or II,were randomly divided into 3 groups (n=40 in each group):group of combination of phloroglucinol and dyclonine hydrochloride mucilage (group P),sufentanil group (group S)and control group (group C).After induction of general anesthesia,the patients in group P were tracheally incubated and then inj ected with 5 ml dyclonine hydrochloride mucilage per urethra.In the meantime,for patients of groups S and C,equal volume of normal saline was inj ected and paraffin oil was used to lubricate for urethral catheterization.The catheter was clamped and then reopened 30 min later.At 15 min before the end of surgery,80 mg Phloroglucinol,0.10 μg/kg sufentanil and an equal volume of normal saline were injected intravenously in group P,group S and group C,respec-tively.The catheter was removed when the patients were fully awake.The awakening time and extu-bation time were recorded.In addition,Riker sedation-agiation scale (SAS)score was documented at 5 min (T1),15 min (T2),30 min (T3),1 h (T4)and 2 h (T5)after extubation.The occurrence and severity of CRBD within 2 h after surgery,as well as occurrence of nausea and vomiting and respira- tory depression were recorded.Results Compared with group C,the SAS score at T1-T4and inci-dence and severity CRBD were decreased,whereas the emergence time and extubation time were pro-longed in group S.The SAS score at T1-T5,incidence and severity of CRBD were decreased (P<0.05),and no significant change was found in emergence time and extubation time in group P.Com-pared with group S,the SAS score at T1-T4was increased,whereas the SAS score at T5,incidence and severity of CRBD were decreased,and the emergence time and extubation time were shortened in group P (P<0.05).There was no significant difference in the incidence of nausea and vomiting,re-spiratory depression and extubation time among the three groups. Conclusion Dyclonine hydrochloride mucilage injected per urethra combined with phloroglucinolol injected intravenously at 1 5 min before the end of surgery can reduce the incidence and severity of CRBD during the recovery from anesthesia in the patients under general anesthesia.

Effects of curcumin pretreatment on expression of Nrf2 protein during ventilator-induced lung injury in rabbits / 中华麻醉学杂志

Objective To evaluate the effects of curcumin pretreatment on the expression of Nrf2 protein during ventilator-induced lung injury in rabbits.Methods Twenty-four healthy male New Zealand white rabbits,aged 3-6 months,weighing 2.5-3.0 kg,were randomized into 3 groups (n =8 each) using a random number table:two-lung ventilation (TLV) group; one-lung ventilation (OLV) group; and curcumin pretreatment group (group Cur).In group Cur,curcumin 40 mg/kg (dissolved in 2 ml of 1％ sodium carboxymethylcellulose) was given via a gastric tube into the stomach twice a day for 7 consecutive days starting from 7 days before ventilation,while the equal volume of sodium carboxymethylcellulose was given via a gastric tube instead of curcumin in TLV and OLV groups.All the rabbits were tracheostomized,and a tracheal tube was inserted to perform TLV in TLV group,and a tracheal tube was inserted into the right bronchus to establish OLV in OLV and Cur groups.Volumecontrolled ventilation was used in the three groups and the ventilatory parameters were regulated to maintain SpO2 ＞ 90 ％.Immediately before beginning of ventilation (T0) and at 1,2 and 3 h of ventilation (T1-3),arterial blood samples were obtained for blood gas analysis and determination of PaO2.The oxygenation index was calculated.At the end of ventilation,the rabbits were sacrificed and right lungs were removed for determination of wet/dry lung weight ratio (W/D ratio).The right lower lobe was isolated and puhmonary specimens were obtained for determination of malondialdehyde (MDA) content and superoxide dismutase (SOD) activity (using colorimetric method) and the expression of Nrf2 and HO-1 protein (by Western blot) in lung tissues and for microscopic examination of pathological changes of the lung which were scored.Results Compared with group TLV,the W/D ratio,pathological scores,MDA content,and expression of Nrf2 and HO-1 were significantly increased,and the SOD activity and oxygenation index at T2,3 were decreased in OLV and Cur groups (P ＜ 0.05).Compared with group OLV,the W/D ratio,pathological scores,and MDA content were significantly decreased,and the SOD activity,oxygenation index at T3,and expression of Nrf2 and HO-1 were increased in group Cur (P ＜ 0.05).Conclusion Curcumin pretreatment reduces ventilator-induced lung injury through promoting the expression of Nrf2 protein in lung tissues in rabbits.

Changes in expression of mitochondrial transcription factor A in lung tissues during one-lung ventilation-induced lung injury in rabbits / 中华麻醉学杂志

Objective To investigate the changes in the expression of mitochondrial transcription factor A (mtTFA) during one-lung ventilation (OLV)-induced lung injury in rabbits.Methods Sixty healthy male New Zealand white rabbits,weighing 2.5-3.0 kg,were randomized into 2 groups (n =8 each):two-lung ventilation (TLV) group and OLV group.The animals were anesthetized with iv 3％ pentobarbital sodium 30 mg/kg and tracheostomized.A self-made double lumen catheter was then intubated.Bilateral lungs were ventilated for 3 h in group TLN.In group OLV the left lung was ventilated for 2 h followed by 1 h TLV.Arterial blood samples were taken for blood gas analysis immediately after the beginning of ventilation,at 1 and 2 h of ventilation,and immediately after the end of ventilation.The oxygenation index was calculated.The animals were sacrificed after the end of ventilation and the apex of the left lung was removed and then cut and stained with HE for microscopic examination.The pathological changes of the lung were scored.The expression of mtTFA in lung tissues was measured by Western blot.Results Oxygenation index was significantly decreased,lung injury score was increased,the expression of mtTFA was down-regulated in group OLV compared with group TLV (P ＜ 0.05).The pathological changes of the lung were aggravated in group OLV.Conclusion OLV induces lung injury by down-regulation of mtTFA expression in rabbit lung tissues.