Effects of a Preoperative Carbohydrate-Rich Drink Before Ambulatory Surgery: A Randomized Controlled, Double-Blinded Study.

BACKGROUND The guidelines recommend oral carbohydrates up to 2 hr before elective surgery. The objective of this study was to explore the safety and feasibility of preoperative carbohydrate drink in patients undergoing ambulatory surgery. MATERIAL AND METHODS Patients undergoing ambulatory surgery under general anesthesia were enrolled. They were fasted from midnight and randomly assigned to a study group (200 mL of a carbohydrate beverage) or the control group (pure water) and received the assigned drink 2 hr before surgery. Bedside ultrasonography was performed to monitor gastric emptying at T0 (before liquid intake), T1 (5 min after intake), T2 (1 hr after intake), and T3 (2 hr after intake). Subjective feelings of thirst, hunger, anxiety, and fatigue were assessed 1 hr after liquid intake using the visual analogue scale (VAS). RESULTS In both groups, gastric antrum cross-sectional area, gastric content volume, and weight-corrected gastric content volume increased at T1 and returned to baseline at T3. These parameters were significantly higher in the study group at T2 (6.28±1.38 vs. 4.98±0.78, 67.22±29.49 vs. 49.04±15.4, 1.10±0.51 vs. 0.85±0.37, P<0.05). Thirst and hunger VAS scores were reduced in both groups. The study group suffered significantly less hunger (28.44±10.41 vs. 36.03±14.42, P<0.05). Blood electrolytes (sodium, potassium, calcium) and glucose concentration levels were similar in both groups at T2. No gastric regurgitation or pulmonary aspiration was recorded. CONCLUSIONS Administration of 200 mL of oral carbohydrate beverage 2 hr before ambulatory surgery is safe, effective, and can be used for preoperative management of fasting patients.

[Prophylactic effect of ambroxol on acute hydrochloric acid aspiration - induced lung injury].

OBJECTIVE: To evaluate the protective effect of ambroxol, a muco-active drug, on acute hydrochloric acid-induced lung injury in rats. METHODS: Thirty pathogen-free SD rats were randomly divided into three groups: group A (n=10) and group B (n=10) were injected normal saline (NS) intraperitoneally (6.7 ml/kg), and group C with ambroxol (50 mg/kg), once a day for 3 consecutive days. Then animals received in tracheal instillation of NS (group A, pH 5.3, 1.2 ml/kg) or hydrochloric acid/NS (group B and C, pH 1.25, 1.2 ml/kg). Five hours after instillation of the injury vehicle, the arterial gas was determined, and the extent of lung injury was assessed by measuring the ratio of wet to dry weight (W/D) and evaluation of pathological change in lung tissue. RESULTS: (1)Partial pressure of oxygen in arterial blood (PaO(2)) was significantly lower in group B than in groups A and C, although pH and partial pressure of carbon dioxide in arterial blood (PaCO(2)) in three groups showed little difference (all P<0.01). (2)The W/D was the highest in group B and the lowest in group A. (3)Severe acute lung injuries were detected in group B by pathological examination, the extent of injury was less in group C than in group B, but more severe than in group A (group A vs. B and B vs. C in mean pathologic score, P<0.01 and P<0.05, respectively). CONCLUSION: Hydrochloric-acid aspiration may induce an acute and diffuse lung injury, with manifestations of hyperpnea, lower PaO(2) and severe pathological changes in lung tissues. Ambroxol may have a protective effect against lung injury induced by hydrochloric acid.

[Oxidative and anti-oxidative effects of ambroxol on acute hydrochloric acid-induced lung injury in rats].

OBJECTIVE: To evaluate the protective effect of ambroxol on acute hydrochloric acid-induced lung injury in rats. METHODS: Thirty pathogen-free SD rats were randomly divided into 3 groups: Group A (n=10) served as control group, and received intracheal instillation of normal saline (NS, pH5.3, 1.2 ml/kg) with pre-treatment of intraperitoneal NS; Group B (n=10) received intracheal instillation of hydrochloric acid /NS (pH1.25, 1.2 ml/kg) with pre-treatment of intraperitoneal NS; and Group C received intracheal instillation of hydrochloric acid /NS (pH1.25, 1.2 ml/kg) with pre-treatment of intraperitoneal ambroxol (50 mg/kg/d, 3 days). Five hours after the instillation of the injury vehicle, the arterial gas was examined, the levels of superoxide dismutase (SOD), malondialdehyde (MDA) in the blood and homogenate of harvested lung were assayed respectively. RESULTS: PaO2 in Group B was significantly lower than that in Group A and C (P < 0.01), and pH and PaCO2 in the 3 groups had little difference (P > 0.05). MDA in the lungs of Group B increased obviously, and levels of SOD in the lung and blood decreased significantly in Group B (Group B vs Group A, P < 0.01). Levels of SOD of Group C in the lung and blood were markedly higher than those of Group B (P < 0.01), MDA of Group C was obviously lower than that of Group B (P < 0.01), and MDA of blood in the 3 groups had no significant difference (P > 0.05). CONCLUSION: Ambroxol can inhibit lipid peroxidation and increase antioxidant activity, which may be one of the mechanisms in protecting lung tissue from hydrochloric acid-induced injury.

[Effect of ulinastatin on lung injury after dilute hydrochloric acid aspiration].

OBJECTIVE: To determine the effect of ulinastatin (UTI) on blocking the development of acute lung injury (ALI) induced by acid aspiration in the early period. METHODS: The SD rats were randomly divided into 3 groups: control group (n = 10), injury group (n = 10), and UTI-treated group (n = 10). The rats in the control group were injected intrabronchialy saline while the other 2 groups were injected HCl. The UTI-treated group was injected UTI at 4 x 10(4) U/kg after acid instillation. Blood gas as well as wet/dry weight ratio (W/D) of the left lung was measured. The changes of IL-8 and TNF-alpha levels in the pulmonary tissues were determined by enzyme-linked immunosorbent assay. RESULTS: The result of blood gas analysis in the UTI-treated group was much better than that in the injury group (P < 0.01). W/ D and IL-8, TNF-alpha levels were lower in the UTI-treated group than those in the injury group significantly (P < 0. 01), and there was no difference between the UTI-treated group and the control group in IL-8 and TNF-alpha levels (P > 0. 05). CONCLUSION: UTI administration can lessen the development of ALI induced by acid aspiration in the early period.

Etanercept decreases HMGB1 expression in dorsal root ganglion neuron cells in a rat chronic constriction injury model.

In the present study, we examined the effect of etanercept on high mobility group box 1 (HMGB1) expression in dorsal root ganglion (DRG) neuron cells in a rat model of chronic constriction injury (CCI) of the sciatic nerve, with the aim of exploring the molecular mechanism underlying the therapeutic effect of etanercept on sciatica-related nociception and the potential interaction between tumor necrosis factor-α (TNF-α) and HMGB1 in DRG neuron cells. A rat CCI model was employed and the animals were randomly assigned to seven groups (n=20/group): untreated, sham only, sham/saline, sham/etanercept, CCI only, CCI/saline and CCI/etanercept. Our results revealed that compared with the sham/saline and sham/etanercept groups, thermal hyperalgesia and mechanical hyperalgesia, as well as HMGB1 expression at both the mRNA and protein levels in the DRG neuron cells, were induced by CCI, and were significantly inhibited by etanercept. Although etanercept showed no significant effect on the sham group, it significantly reduced the phosphorylated p38 mitogen-activated protein kinase (MAPK) levels induced by CCI in the DRG neuron cells. In conclusion, we demonstrated that etanercept significantly decreased the HMGB1 expression induced by CCI in the DRG neuron cells. This study not only explored the molecular mechanisms underlying the therapeutic effect of etanercept on sciatica-related nociception, but also provided indirect evidence for an interaction between TNF-α and HMGB1 in DRG neuron cells.