Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels in patients with open midline incisions undergoing transabdominal gynecological surgery: a randomized-controlled trial.

BACKGROUND: Nerve block is usually performed before surgery because it inhibits reflection of the skin incision and reduces the amount of intraoperative anesthetic used. We hypothesized that performing rectus sheath block (RSB) after surgery would result in a longer duration of the analgesic effects and have a subtle influence on sleep time after surgery but that it would not decrease the perioperative cytokine levels of patients undergoing gynecological surgery. METHODS: A randomized, double-blinded, controlled trial was conducted from October 2015 to June 2016. Seventy-seven patients undergoing elective transabdominal gynecological surgery were randomly assigned to the following two groups: a general anesthesia group who received 0.5% ropivacaine hydrochloride RSB preoperatively and saline RSB postoperatively, and another group who received the opposite sequence. The objective of the trial was to evaluate the postoperative pain, sleep and changes in cytokine levels of patients during the postoperative 48 h. RESULTS: A total of 61 female patients (mean age: 50 years; range: 24-65 years) were included in the final study sample. There was no significant difference in the pain, consumption of oxycodone, or time to first administration of patient-controlled intravenous analgesia between the two groups. The postoperative sleep stages N2 and N3 were increased by 52.9 and 29.1 min per patient, respectively, in the preoperative RSB group compared with those in the postoperative group. The preoperative IL-6 concentration in the preoperative RSB group was lower than that in the same group at the end of surgery and 24 h postoperatively. CONCLUSIONS: We concluded that preoperative RSB might preserve postoperative sleep by inhibiting the increase of IL-6 without shortening the analgesia time compared with postoperative RSB in female patients undergoing elective midline incision transabdominal gynecological surgery. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02477098 , registered on 15 June 2015.

Changes in the first postoperative night bispectral index of patients after thyroidectomy with different types of primary anesthetic management: a randomized controlled trial.

Despite major advances in anesthesia management and developments in anesthetic agents, postoperative sleep disturbances remain dissatisfactory for many patients. We hypothesized that propofol might have a subtle influence on sleep after thyroidectomy compared to sevoflurane. A randomized, single-blinded, controlled trial was conducted at the First Hospital of China Medical University from October 2014 to October 2015. One hundred and twenty-four patients undergoing thyroidectomy were enrolled and received sevoflurane (sevoflurane group) or propofol (propofol group) as anesthesia maintenance. Major assessments were made during the operation (different types of anesthetic management) and on the first postoperative night (sleep status). The primary outcome was postoperative sleep status, measured by the BIS-Vista monitor on the first night after surgery between propofol and sevoflurane groups. A total of 105 patients (79 women, 26 men; mean age 49 years; range 18-65 years) were included in the final study sample. All patients in both groups showed one of the five sleep patterns classified by this trial. The BIS-area under the curve was decreased, the sleep efficiency index was significantly increased, and the durations of postoperative sleep and sleep stage N3 were increased by 110.5 and 36.5 min per patient, respectively, in the propofol compared to the sevoflurane group. Propofol might preserve sleep time immediately after thyroidectomy. Clinical Trials.gov identifier: NCT 02146976.

Effects of ultrasound-guided stellate-ganglion block on sleep and regional cerebral oxygen saturation in patients undergoing breast cancer surgery: a randomized, controlled, double-blinded trial.

Numerous factors could contribute to sleep disturbances in women with breast cancer. We hypothesized that stellate ganglion block (SGB) during surgery would preserve sleep after surgery and increase intraoperative regional cerebral oxygen saturation (rSO2) on the blocked side in patients undergoing breast cancer surgery. A randomized, double-blinded, controlled trial was conducted at the First Hospital of China Medical University from January 2016 to September 2016. Ninety-six patients who underwent radical breast cancer surgery requiring general anaesthesia were randomly assigned to one of two study groups: a control group that received a saline SGB and a block group that received a 0.25% ropivacaine hydrochloride SGB. The primary outcome measure was the postoperative sleep profile, which was assessed using the bispectral index on the first postoperative night. The secondary outcome measure was the intraoperative rSO2, monitored was throughout surgery using near-infrared spectroscopy. A total of 91 female patients (mean age: 45 years; range 24-51 years) were included in the study. The duration of sleep was significantly increased by 66.3 min in the ropivacaine-SGB group compared with the saline-SGB group. No differences in rSO2 were observed on either the left or right side of the patients in either group 50 min after anaesthesia induction. We conclude that ropivacaine-SGB combined with general anaesthesia might increase the first postoperative sleep duration without influencing the intraoperative rSO2 in female patients undergoing elective breast cancer surgery. Clinical trials.gov identifier NCT02651519.

Effects of CO2 Pneumoperitoneum on the Cognitive Function of Patients Undergoing Gynecologic Laparoscopy.

AIM: To evaluate the effects of CO2 pneumoperitoneum during gynecologic laparoscopy on patients' postoperative cognitive function. METHODS: This prospective clinical study included 225 adult female patients with American Society of Anesthesiologists physical status I or II. Patients underwent conventional open surgery (group I, n = 115) or gynecologic laparoscopy using abdominal insufflation with CO2 to an intra-abdominal pressure of 15 mm Hg (group II, n = 110). Serum S100ß and neuron-specific enolase (NSE) concentrations were measured, both immediately before surgery and before the patient awoke after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery as well as 1, 6, 12, 24 and 72 h after surgery and before discharge. RESULTS: MMSE scores were significantly lower relative to baseline at 1, 6 and 12 h post surgery, but returned to baseline by 48 h (group I) or 72 h (group II) post surgery. One hour after surgery, S100ß serum levels were higher in group II than in group I (p < 0.05). NSE levels did not differ between the groups. In group II, the MMSE score significantly correlated with serum S100ß or NSE concentrations. CONCLUSION: CO2 pneumoperitoneum influences postoperative cognitive function in patients undergoing gynecologic laparoscopy.

[Effect of electroacupuncture on the cognitive function and plasma antibodies against beta-amyloid protein in aged rats with ketamine anesthesia].

OBJECTIVE: To study the effects of electroacupuncture (EA) on the changes of behavior after ketamine anesthesia, and changes of serum antibodies against beta-amyloid (Abeta) and Abeta protein in the hippocampus of aged rats, thus exploring the effects of EA on the cognitive dysfunction. METHODS: Thirty 14-month old SD rats were randomly divided into 3 groups, i. e. , the control group (Group A), the ketamine anesthesia group (Group B), and the EA+ketamine anesthesia group (Group C), 10 in each group. 50 mg/kg katemine was intraperitoneally injected to rats in Group B and Group C, once daily for 7 successive days. EA was performed to rats in Group C from the 1st day of the experiment after rats awoke completely from anesthesia, twice daily for 7 successive days. Changes of the ratio of the swim time in the original platform quadrant to the total swim time and the escape latency phase were observed by Morris water maze. The peripheral blood was withdrawn by the end of the experiment. Serum anti-Abeta antibody contents were detected using enzyme-linked immunosorbent assay (ELISA). The expressions of Abeta in the hippocampus were detected using Westen blot. RESULTS: Long-term application of ketamine could lower aged rats' cognitive function. In the navigation test, the escape latency phase of rats in Group B was significantly prolonged ( P < 0.01) . On the 7th day of the experiment, the serum level of anti-Abeta antibodies was lower in Group B than in Group A (P < 0.05), while the serum level of anti-Abeta antibodies was significantly higher in Group C than in Group B (P < 0.01). On the 7th day of the experiment, the expression of Abeta in the hippocampus was higher in Group B than in Group A (P < 0.05). CONCLUSION: EA could increase the contents of anti-Abeta antibodies in aged rats with ketamine anesthesia, decrease the expression of Abeta in the hippocampus, alleviate the deposition of Abeta, thus improving rats' cognitive dysfunction.

Ketamine reduces inducible superoxide generation in human neutrophils in vitro by modulating the p38 mitogen-activated protein kinase (MAPK)-mediated pathway.

Many cellular stresses and inflammatory stimuli can activate p38 mitogen-activated protein kinase (MAPK), a serine/threonine kinase in the MAPK family. The different stimuli act via different receptors or signalling pathways to induce phosphorylation of the cytosolic protein p47(phox), one subunit of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase. Formyl-methionyl-leucyl-phenylalanine (fMLP) has been shown to induce the p38 MAPK phosphorylation during the respiratory burst in human neutrophils. Here, we show that treatment with S(+)-ketamine or R(-)-ketamine at different concentrations (50, 100, 200, 400 microM) reduced fMLP-induced superoxide anion generation and p47(phox) phosphorylation in neutrophils in a concentration-dependent manner (y = -0.093x + 93.35 for S(+)-ketamine and y = -0.0982x + 95.603 for R(-)-ketamine, respectively). While treatment with 50 microM ketamine inhibited fMLP-induced superoxide generation by 10%, treatment with 400 microM S(+)-ketamine and R(-)-ketamine reduced fMLP-induced superoxide generation to 60.5 +/- 8.3% and 60.0 +/- 8.5%, respectively, compared with that in neutrophils treated with fMLP alone. Furthermore, treatment with ketamine down-regulated both fMLP-induced p47(phox) and isoproterenol-induced p38 MAPK phosphorylation and superoxide production. Interestingly, treatment with SB203580, the p38 MAPK inhibitor, also mitigated fMLP-induced superoxide anion generation and p38 MAPK and p47(phox) phosphorylation as well as apoptosis in a concentration-dependent fashion in neutrophils. Therefore, ketamine racemes inhibited fMLP-induced superoxide anion generation and p47(phox) phosphorylation by modulating fMLP-mediated p38 MAPK activation in neutrophils.

Changes in First Postoperative Night Bispectral Index After Daytime Sedation Induced by Dexmedetomidine or Midazolam Under Regional Anesthesia: A Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Supplementation of spinal anesthesia with various sedatives is a standard protocol to alleviate patient anxiety associated with the surgical procedure. We hypothesized that, compared with dexmedetomidine, midazolam might have a subtle influence on sleep quality after surgery following elective transurethral prostatic resection (TURP) in elderly male patients. METHODS: A randomized, double-blind, controlled trial was conducted at the First Hospital of China Medical University from July 2014 to January 2015. One hundred eleven patients undergoing TURP were enrolled and received intravenous saline infusion (control group), dexmedetomidine (dexmedetomidine group), or midazolam (midazolam group) for sedation during the spinal anesthesia procedure. The intraoperative sedative state and postoperative sleep quality were evaluated using a Bispectral Index (BIS)-Vista monitor. The primary outcome was postoperative sleep quality, as measured by the BIS-Vista monitor on the first night after surgery. RESULTS: The intraoperative BIS area under the curve value was significantly lower in the dexmedetomidine group (54.1%) compared with those in the other 2 groups (control group, 94.1%; midazolam group, 77.2%).The postoperative BIS area under the curve value was highest in the dexmedetomidine group at 88.7%. The BIS sleep efficiency index showed a significant 33.1% increase in the midazolam group compared with the dexmedetomidine group. The duration of sleep in the midazolam group was 237.8 minutes longer than that in the dexmedetomidine group. CONCLUSIONS: We conclude that midazolam combined with spinal anesthesia might preserve the sleep quality of elderly male patients immediately after TURP.

Preoperative versus postoperative ultrasound-guided rectus sheath block for improving pain, sleep quality and cytokine levels of patients with open midline incisions undergoing transabdominal gynaecological operation: study protocol for a randomised controlled trial.

BACKGROUND: Rectus sheath block (RSB) is used for postoperative pain relief in patients undergoing abdominal surgery with midline incision. Preoperative RSB has been shown to be effective, but it has not been compared with postoperative RSB. The aim of the present study is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively versus postoperatively. METHODS/DESIGN: This study is a prospective, randomised, controlled (randomised, parallel group, concealed allocation), single-blinded trial. All patients undergoing transabdominal gynaecological surgery will be randomised 1:1 to the treatment intervention with general anaesthesia as an adjunct to preoperative or postoperative RSB. The objective of the trial is to evaluate postoperative pain, sleep quality and changes in the cytokine levels of patients undergoing gynaecological surgery with RSB performed preoperatively (n = 32) versus postoperatively (n = 32). All of the patients, irrespective of group allocation, will receive patient-controlled intravenous analgesia (PCIA) with oxycodone. The primary objective is to compare the interval between leaving the post-anaesthesia care unit and receiving the first PCIA bolus injection on the first postoperative night between patients who receive preoperative versus postoperative RSB. The secondary objectives will be to compare (1) cumulative oxycodone consumption at 24 hours after surgery; (2) postoperative sleep quality, as measured using a BIS-Vista monitor during the first night after surgery; and (3) cytokine levels (interleukin-1, interleukin-6, tumour necrosis factor-α and interferon-γ) during surgery and at 24 and 48 hours postoperatively. DISCUSSION: Clinical experience has suggested that RSB is a very effective postoperative analgesic technique, and we will answer the following questions with this trial. Do preoperative block and postoperative block have the same duration of analgesic effects? Can postoperative block extend the analgesic time? The results of this study could have actual clinical applications that could help to reduce postoperative pain and shorten hospital stays. TRIAL REGISTRATION: Current Controlled Trials NCT02477098 15 June 2015.

Effect of five triterpenoid compounds isolated from leaves of Diospyros kaki on stimulus-induced superoxide generation and tyrosyl phosphorylation in human polymorphonuclear leukocytes.

BACKGROUND: The crude drug "kaki-yô" is a traditional medicine used in Japan as a hypotensive drug. METHODS: The effect of five triterpenoid compounds, isolated from leaves of Diospyros kaki on stimulus-induced superoxide generation and phosphorylation of tyrosine residues of protein in human neutrophils was investigated. The five compounds examined were alpha-amyrin (A), uvaol (UV), ursolic acid (UA), 19 alpha-hydroxy ursolic acid (HU) and 19 alpha,24-dihydroxy ursolic acid (DHU). RESULTS: When the cells were preincubated with these compounds, the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was significantly suppressed in a concentration-dependent manner. These compounds also suppressed the superoxide generation induced by arachidonic acid (AA) in high concentrations. In the case of the superoxide generation induced by phorbol 12-myristate 13-acetate (PMA), UA, HU and DHU suppressed the superoxide generation but A and UV gave no effect. When the cells were incubated with fMLP in UA, HU and DHU, fMLP-induced tyrosyl phosphorylation of 45 kDa proteins of the cells was dose-dependently suppressed in parallel to the suppression of fMLP-induced superoxide generation. CONCLUSIONS: Triterpenoid compounds suppress stimulus-induced superoxide generation and tyrosyl phosphorylation and may have pharmaceutical applications.

Effect of five flavonoid compounds isolated from leaves of Diospyros kaki on stimulus-induced superoxide generation and tyrosyl phosphorylation of proteins in human neutrophils.

BACKGROUND: The crude drug "kaki-yô" is a traditional medicine used in Japan as a hypotensive drug. METHODS: The effect of five flavonoid compounds isolated from the leaves of Diospyros kaki was investigated on the stimulus-induced superoxide generation and phosphorylation of tyrosine residues of protein in human neutrophils. The five compounds examined were kaempferol 3-O-beta-D-galactopyranoside (TR), kaempferol 3-O-beta-D-glucopyranoside (AS), isorhamnetin 3-O-beta-D-glucopyranoside (IS), quercetin 3-O-beta-D-galactopyranoside (HY), quercetin 3-O-beta-D-glucopyranosyl-(6-->1)-alpha-L-rhamnopyranoside (RU). RESULTS: When the cells were preincubated with these five compounds, the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was significantly suppressed in a concentration-dependent manner. The arachidonic acid (AA)-induced superoxide generation was suppressed by TR, AS, HY and RU. On the other hand, the superoxide generation was weakly enhanced by IS in low concentration (5-20 micromol/l), but was suppressed in high concentration (50 micromol/l). The superoxide generation induced by phorbol 12-myristate 13-acetate (PMA) suppressed the TR, IS, HY and RU, but AS gave no effect. When the cells were incubated with fMLP in the presence of TR, IS and RU, fMLP-induced tyrosyl phosphorylation of 45-kDa proteins of the cells was dose-dependently suppressed in parallel to the suppression of fMLP-induced superoxide generation. These five flavonoids showed almost no hemolytic effect even at a concentration of 500 micromol/l. CONCLUSION: Flavonoid compounds suppressed stimulus-induced superoxide generation and tyrosyl phosphorylation and may have pharmaceutical application.

Effect of three triterpenoids, lupeol, betulin, and betulinic acid on the stimulus-induced superoxide generation and tyrosyl phosphorylation of proteins in human neutrophils.

BACKGROUND: The roots of Anemone raddeana are used in Chinese folk medicine for curing rheumatism and neuralgia. METHODS: The three triterpenoids lupeol, betulin and betulinic acid were isolated from ethanol extracts of the roots of A. raddeana. The effect of these triterpenoids on superoxide generation and tyrosyl phosphorylation of proteins in human neutrophils was investigated. RESULTS: The superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was significantly suppressed by betulin and lupeol depending on the concentration of the triterpenoids. The suppressive effect of betulinic acid was low. The phorbol 12-myristate 13-acetate (PMA)-induced superoxide generation was suppressed by betulin in a concentration-dependent manner, but not by lupeol and betulinic acid. In contrast, the superoxide generation induced by arachidonic acid (AA) was suppressed by lupeol, while betulin and betulinic acid weakly enhanced the AA-induced superoxide generation. Lupeol and betulin suppressed tyrosyl phosphorylation of a 45.0-kDa protein in fMLP-treated human neutrophils in parallel to the suppression of fMLP-induced superoxide generation, but betulinic acid did not. Lupeol, betulin and betulinic acid showed no hemolytic effect even at a concentration of 500 micromol/l. CONCLUSIONS: Lupeol and betulin suppress superoxide generation by preventing tyrosyl phosphorylation of a 45.0-kDa protein in human neutrophils, and may have pharmaceutical applications.

Effect of three triterpenoid compounds isolated from root bark of Aralia elata on stimulus-induced superoxide generation and tyrosyl phosphorylation and translocation of p47(phox) and p67(phox) to cell membrane in human neutrophil.

BACKGROUND: Root bark of Aralia elata is used as a folk medicine for neurasthenia, rheumatism, diabetes, hepatitis virus and spasm of the stomach in China, Japan and Russia. METHODS: The effect of three triterpenoid compounds isolated from root bark of A. elata on stimulus-induced superoxide generation and tyrosyl phosphorylation and translocation of p47(phox) and p67(phox) to cell membrane was investigated. The three compounds examined were Elatoside A, Elatoside C, and Tarasaponin V. RESULTS: When the cells were preincubated with these compounds, the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was suppressed in a low concentration range. However, the superoxide generation was significantly enhanced by 40 micromol/l triterpenoid, and was again suppressed in the higher concentration range. In the case of superoxide generation induced by phorbol 12-myristate 13-acetate (PMA), the compounds had no obvious effect on the superoxide generation in low concentration but suppressed that at 40 micromol/l. These compounds also efficiently suppressed the superoxide generation induced by arachidonic acid (AA) at 10 micromol/l. In parallel to the effect on the fMLP-induced superoxide generation, these compounds suppressed fMLP-induced tyrosyl phosphorylation and the translocation to membrane of cytosolic compounds, p47(phox) and p67(phox) at 10 and 80 micromol/l but not at 40 micromol/l. CONCLUSIONS: Triterpenoid saponins examined in this study effect stimulus-induced superoxide generation and tyrosyl phosphorylation and translocation to membrane of p47(phox) and p67(phox) in a concentration-dependent manner, and may have some pharmaceutical applications.

Effect of six flavonoid compounds from Ixeris sonchifolia on stimulus-induced superoxide generation and tyrosyl phosphorylation in human neutrophils.

BACKGROUND: Ixeris sonchifolia (Bge.) Hance is an herbal medication used in China as an analgesic. METHODS: The effect of six flavonoid compounds isolated from Ixeris sonchifolia (Bge.) Hance on stimulus-induced superoxide generation and phosphorylation of tyrosine residues of protein in human neutrophils was investigated. The six compounds examined were luteolin 7-glucuronide methylester (LGME), luteolin 7-glucuronide ethylester (LGEE), luteolin 7-glucoside (LG), luteolin 7-glucopyranosyl-(1-->6)-glucoside (LGG6), luteolin 7-glucopyranosyl-(1-->2)-glucoside (LGG2) and apigenin 7-glucoside (AG). RESULTS: When the cells were preincubated with these six flavonoids, the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was significantly suppressed in a concentration-dependent manner. These flavonoids also suppressed the superoxide generation induced by arachidonic acid (AA). The rate of suppression by these flavonoids was AG>LG, LGG6, LGEE, LGG2>LGME. In case of the superoxide generation induced by phorbol 12-myristate 13-acetate (PMA), LG, LGG6 and AG suppressed the superoxide generation but LGME, LGEE and LGG2 gave no effect. When the cells were incubated with fMLP in the presence of LGME, LGEE and AG, fMLP-induced tyrosyl phosphorylation of 45-kDa proteins of the cells was dose-dependently suppressed in parallel to the suppression of fMLP-induced superoxide generation. CONCLUSION: Flavonoids suppress tyrosine phosphorylase in a dose-dependent manner, and may have pharmacoceutical applications.

Effect of S-(1,2-dicarboxyethyl) glutathione and S-(1,2-dicarboxyethyl) cysteine on the stimulus-induced superoxide generation and tyrosyl phosphorylation of proteins in human neutrophils.

We investigated the effects of S-(1,2-dicarboxyethyl) glutathione (DCEG) and S-(1,2-dicarboxyethyl) cysteine (DCEC) on the stimulus-induced superoxide generation and tyrosyl phosphorylation of proteins in human neutrophils. When the cells were preincubated with DCEG, the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) was enhanced in concentration-dependent manner but DCEC showed no effect. The influence of DCEG and DCEC on phorbol 12-myristate 13-acetate-induced superoxide generation showed no effect. On the other hand, the superoxide generation induced by arachidonic acid was markedly suppressed by DCEG and DCEC in concentration-dependent manner. The suppression of DCEG was more effective than that of DCEC. The superoxide generation induced by fMLP in the DCEG-treated cells was suppressed by genistein. DCEG enhanced tyrosyl phosphorylation of 80.0 kDa, 60.0 kDa, and 45.0 kDa proteins in human neutrophils. The tyrosyl phosphorylation of 80.0 kDa, 60.0 kDa, and 45.0 kDa proteins was suppressed by genistein. The enhancement of tyrosyl phosphorylation of these proteins in the DCEG-treated cells was parallel to the enhancement of the fMLP-induced superoxide generation.