[Effect of methylprednisolone pretreatment on pulmonary permeability and dipalmitoylphosphatidylcholine content in rabbits with reexpansion pulmonary edema].

OBJECTIVE: To investigate the effects of methylprednisolone pretreatment on pulmonary lung permeability index and the content of the pulmonary surfactant dipalmitoylphosphatidylcholine (DPPC) in a rabbit model of reexpansion pulmonary edema. METHODS: Twenty-one male New Zealand white rabbits were randomly divided into control group, reexpansion, and reexpansion+methylprednisolone pretreatment groups. The rabbit model of reexpansion pulmonary edema was established using Sakaos method. A bolus dosage of methylprednisolone (3 mg/kg) in reexpansion+methylprednisolone group group or 2.0 ml/kg normal saline in the other two groups was administered intravenously 20 min before reexpansion pulmonary edema. Bronchoalveolar lavage fluid (BALF) and arterial blood samples were collected for measurement of the total protein (TP) and DPPC contents 4 h after reexpansion, and the pulmonary permeability index was calculated. RESULTS: The pulmonary permeability index in methylprednisolone pretreatment group was significantly lower than that in the reexpansion group (0.007∓0.002 vs 0.177∓0.004, P<0.05). Methylprednisolone pretreatment significantly increased DPPC concentration in the BALF as compared with saline treatment in the reexpansion group (61.815∓28.307 vs 101.955∓24.544 µg/ml, P<0.05). CONCLUSION: Methylprednisolone pretreatment can increase pulmonary surfactant content and improve pulmonary permeability in the rabbit model of reexpansion pulmonary edema.

[Narcotrend index monitoring can predict the recovery of consciousness in patients undergoing abdominal surgery].

OBJECTIVE: To investigate the value of Narcotrend (NT) index monitoring versus standard hemodynamic parameters in predicting the recovery of consciousness in patients undergoing abdominal surgery. METHODS: Forty ASA I or II patients undergoing elective abdominal surgery were randomized into two groups to receive sevoflurane-sufentanil anesthesia monitored by NT index or solely by clinical parameters. Anesthesia was induced with the inhalation of 8% sevoflurane and sufentanil target-controlled infusion at 0.2-0.5 ng/ml. The values of NT stage (NTS), NT index (NTI), and hemodynamic parameters (MAP and HR) were recorded during the period of recovery. The prediction probability (Pk) of each parameter was calculated and compared. RESULTS: NTS and NTl were closely correlated to the changes of consciousness during the recovery from general anesthesia. The Pk values of NTS and NTI in predicting eye opening and orientation recovery were 0.95, 0.92, and 0.92, 0.89, respectively, obviously higher than the Pk values of MAP and HR (P<0.05). CONCLUSION: NT monitoring can be used to effectively predict the recovery of consciousness in patients undergoing abdominal surgery and facilitates a significant reduction of the recovery time and sufentanil dosage during a sevoflurane-sufentanil anesthesia.

[The retrospective study of sudden cardiac death in 118 cases].

The sudden cardiac death (SCD) is the primary cause of death in adults. 118 cases of sudden cardiac death from 1998 to 2005 in Shanxi area were studied. The results showed that there as 5.9 times of males as females. There were 55.1% coronary artery diseases, 17.8% myocarditis, 9.3% cardiomyopathy, 2.5% each of congenital heart diseases, valvular heart diseases, and rupture of dissecting aneurysm of aorta, and 4.55 of other diseases. The data indicate that SCD happened in males more often than in females and coronary artery disease was the most common disease. Myocardititis was more common in adolescents and cardiomyopathy was more prevalent in young adults resulting in SCD. The cardiac disease without abnormal structure changes might also be a serious threat to human health.

[Time window for intubation after rocuronium administration during target-controlled infusion of propofol and sulfentanil].

OBJECTIVE: To define the ideal time window for intubation after rocuronium administration during target-controlled infusion (TCI) ofpropofol and sulfentanil. METHODS: One hundred and twenty elective surgical patients (age range 18-55 years) were randomized into 4 groups (n=30) according to the intubation time after administration of the muscle relaxant. Patients with predicted difficult airway were excluded. General anesthesia was induced by TCI of propofol and sulfentanil. A senior anesthesiologist blinded for the randomization performed the intubations at 1, 2, 3, or 4 min after injection of rocuronium, and the vocal card visibility was evaluated upon full exposure of the vocal cord and the intubation conditions assessed according to Cooper's score. RESULTS: The intubation conditions were excellent or good in all patients, but the vocal cord visibility at 2-4 min differed significantly from that at 1 min after rocuronium administration (P<0.01). Suppression of the neuromuscular function 1 min after rocuronium administration differed significantly from that at other time points (P<0.01). CONCLUSION: The condition of vocal cord can be more suitable for intubation at 2-4 min than at 1 min after rocuronium administration as the ideal time window for intubation during TCI of propofol and sulfentanil.

[Effect of etomidate on hemodynamics in elderly and shock patients during general anesthesia induction].

OBJECTIVE: To investigate the effect of etomidate on the hemodynamics in elderly and shock patients during general anesthesia induction. METHODS: Totally 100 elderly patients or patients with hemorrhagic shock (ASA II -III ) undergoing surgery were studied. Anesthesia was induced with 4 microg/kg of fentanyl, 0.1 mg/kg of vecuronium and 0.2-0.3 mg/kg of etomidate, and the mean arterial blood pressure (MAP), heart rate (HR), stroke volume (SV), stroke index (SI), cardiac output (CO), cardiac index (CI), cardiac acceleration index (ACI), left cardiac work (LCW), and left cardiac work index (LCWI) were recorded using thoracic electrical bioimpedance (TEB) hemodynamic monitoring system before induction and at 1, 2 and 3 min after etomidate injection as well as at 3 min after intubation. RESULTS: After etomidate injection, MAP, HR, SV, SI, CO, CI, ACI, LCW and LCWI were decreased significantly as compared with those before induction (P<0.05). MAP, HR, CO, CI and ACI at 3 min after intubation were higher than those before induction (P<0.05), and the other indices resumed the baseline level. The amplitudes of such changes in the recorded indices was below 20% of the baseline level in the course of anesthesia induction. CONCLUSION: Cardiovascular hemodynamics may vary slightly during the course of induction with etomidate, which is an ideal drug for anesthesia induction for elderly or shock patients with unstable hemodynamics.

[Intravenous propofol combined with fentanyl for anesthesia during ultrasound-guided transvaginal oocyte retrieval].

OBJECTIVE: To compare the clinical efficacy and safety of anesthesia with intravenous propofol combined with fentanyl for ultrasound-guided transvaginal oocyte retrieval. METHODS: Totally 100 unpremedicated infertile women (ASA I-II) scheduled for oocyte retrieval with ultrasound guidance were randomly divided into two groups to receive anesthesia with either intravenous propofol (group A, n=50) or the combination of propofol and fentanyl (group B, n=50). The time when consciousness loss and recovery occurred, dosage of propofol for anesthesia maintenance, mean arterial blood pressure (MAP), heart rate (HR) and oxygen saturation (SpO2) were recorded. RESULTS: There was no significant difference in the time of consciousness loss between groups A and B (58.8+/-3.8 s vs 57.7+/-5.2 s, P=0.283), but consciousness recovery occurred earlier in group B (6.0+/-0.6 min vs 5.7+/-0.4 min, P<0.01). The maintenance dosage of propofol in group B (0.20+/-0.03 mg/kg) was significantly lower than that in group A (0.52+/-0.05 mg/kg, P<0.01). At 2 min after anesthesia induction, the MAP decreased from 11.1+/-0.8 kPa to 8.0+/-0.6 kPa in group A (P<0.05), and from (10.9+/-0.9) kPa to (8.3+/-0.7) kPa in group B(P<0.05), and returned to normal within 2-3 min in both groups. The incidence of low SpO2 (<90%) was lower in group A than in group B ((52% vs 88%, P<0.001). CONCLUSION: Anesthesia with propofol combined with fentanyl may reduce the maintenance dosage of propofol, shorten the time of consciousness recovery during oocyte retrieval with ultrasound guidance, and can be helpful for the patients' early recovery and discharge from hospital.

[Effects of fentanyl on EC50 of ropivacaine for postoperative epidural analgesia after gynecological surgery].

OBJECTIVE: To determine the effect of fentanyl on 50% effective concentration (EC50) of ropivacaine for postoperative epidural analgesia following gynecological surgery. METHODS: Sixty-five patients (ASA class I to II) scheduled for elective gynecological surgery were randomly divided into two groups to receive 20 ml ropivacaine (group R, n=33) or ropivacaine combined fentanyl (group RF, n=32) for postoperative epidural analgesia. The concentration of ropivacaine was adjusted according to double-blinded up-down sequential allocation. The efficacy was assessed using visual analog scores (VAS) and EC50 calculated using method of Dixon. RESULTS: The EC50 of ropivacaine was 0.098% in group R and 0.069% in group RF, showing significant difference (P<0.01). CONCLUSION: EC50 of ropivacaine for postoperative epidural analgesia determined by up-down sequential allocation is 0.098%, which can be decreased by the use of fentanyl.

[Management of hyperkalemia-induced cardiac arrest in anhepatic stage of orthotopic liver transplantation without venovenous bypass: report of 3 cases].

The causes of high serum potassium-induced cardiac arrest in anhepatic stage of orthotopic liver transplantation were analyzed in 3 cases without venovenous bypass, and the effectiveness of insulin was evaluated in correcting hyperkalemia during the anhepatic stage. To improve the survival rate of patients with such cardiac arrest, early cardiopulmonary resuscitation and timely defibrillation should be performed.

Clinical efficacy of brachial plexus block with patient-controlled analgesia for postoperative analgesia and recovery in the antebrachium.

OBJECTIVE: To evaluate the analgesic effect of brachial plexus block using patient-controlled analgesia device after micro-surgery in the antebrachium and its impact on postoperative recovery. METHOD: Twenty-four patients (ASA class I or II ) scheduled for micro-surgery in the antebrachium under brachial plexus block were randomly divided into PCBPA group (n=12) with patient-controlled analgesia and control group (n=12) without postoperative analgesia. In PCBPA group, postoperative patient-controlled analgesia was implemented using the mixture of 1% lidocaine and 0.25% bupivacaine and a computer- based system (Graseby 9300) with basal infusion of 2 ml/h, bolus dose of 3 ml and lockout time of 45 min. Visual analogue scale (VAS) was adopted for the evaluation of the pain intensity in both groups within 72 h after surgery, and changes in the mean arterial pressure (MAP) and heart rate (HR) observed during the peri-operation period. RESULTS AND CONCLUSION: VAS, MAP and HR in PCBPA group were significantly lower than those in the control group ( P<0.05) within 24 h after surgery, suggesting the effectiveness of the analgesic modality using patient-controlled analgesia, which also inhibits postoperative stress reaction and promotes recovery following micro-surgery of the antebrachium.

[Determination of EC50 of ropivacaine and bupivacaine for postoperative epidural analgesia by up-down sequential allocation].

OBJECTIVE: To determine the median effective concentration (EC50) of ropivacaine and bupivacaine for postoperative epidural analgesia, and compare the efficacy of the 2 analgesics. METHODS: Sixty-five patients (ASA I to II) scheduled for elective gynaecological surgeries were randomly assigned into ropivacaine and bupivacaine groups to receive postoperative epidural analgesia with the indicated analgesics (20 ml). The concentration was determined by the response of a previous patient to a higher or lower concentration using double-blinded, up-down sequential allocation. The analgesic efficacy was assessed with 100 mm visual analog pain scores (VAS), and effectiveness was defined as having a VAS

[Effects of dexamethasone on epidural morphine-related nausea and vomiting].

OBJECTIVE: To observe the effect of intravenous dexamethasone injections in preventing nausea and vomiting resulted from epidural morphine for post-operation pain relief. METHODS: Eighty-four adult patients (ASA class I to II ) requiring epidural anesthesia for low abdominal surgical procedures were randomly divided into 2 groups, of which Group 1 (n=42) received intravenous dexamethasone injections at 10 mg and Group 2 (n=42) intravenous injection of 2 ml normal saline before administration of 2 mg epidural morphine for post-operation pain relief. The incidence of nausea and vomiting were recorded within 24 h after surgery. RESULTS: The incidence of nausea and vomiting were 12% and 7% in Group 1, while 31% and 21% in Group 2 respectively, showing significant difference between the 2 groups (P<0.05). The total incidence of nausea and vomiting were also significantly different (19% vs 52%, P<0.01). CONCLUSION: Intravenous dexamethasone injections at 10 mg can significantly decrease the incidence of epidural morphine-related nausea and vomiting.