[Evaluation of gastric emptying after drinking carbohydrates before cesarean section by gastric ultrasonography].

OBJECTIVE: To investigate the effect of gastric antrum ultrasonography in evaluating gastric emptying after oral administration of 300 mL carbohydrates two hours before cesarean section, and to analyze the risk factors of gastric emptying in pregnant women. METHODS: From August 2020 to February 2021, a total of 80 patients, aged 22-43 years, body mass index (BMI) < 35 kg/m2, gestational age≥36 weeks, falling into American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, scheduled for cesarean sections in Peking University International Hospital were recruited and divided into two groups: the intervention group (n=40)and the control group (n=40). In the intervention group, solid food was restricted after 22:00, the patients were required to take 300 mL carbohydrates two hours before cesarean section. In the control group, solid food and liquid intake were restricted after 22:00 the night before surgery. All the patients received assessment of preoperative feeling of thirst and starvation with visual analogue scale (VAS). The cross-sectional area (CSA)of gastric antrum was measured in supine position and right supine position before anesthesia, the gastric volume (GV)and the gastric volume/weight(GV/W)of the two groups was further calculated. Perlas A semi-quantitative grading assessments were performed in each patient. The blood pressure and heart rate were recorded at admission(T0), 5 minutes after anesthesia (T1), immediately after fetal delivery (T2) and at the end of the surgery (T3). The occurrence of nausea and vomiting during the operation and 24 hours after the operation were recorded. RESULTS: One case in each group was excluded because the antrum was not clearly identified during the ultrasound assessments. In the semi-sitting position, the CSA was (5.07±1.73) cm2 in the intervention group vs. (5.24±1.96) cm2 in the control group, respectively; in the right lateral decubitus position, CSA was (7.32±2.17) cm2 in the intervention group vs. (7.25±2.24) cm2 in the control group, GV was (91.74±32.34) mL vs. (90.07±31.68) mL, GV/W was (1.27±0.40) mL/kg vs. (1.22±0.41) mL/kg, respectively; all the above showed no significant difference between the two groups (P > 0.05). Perlas A semi-quantitative grading showed 0 in 20 patients (51.3%), 1 in 16 (41%), 2 in 3 (7.7%)in the intervention group and 0 in 22 (56.4%), 1 in 15 (38.5%), 2 in 2 (5.1%)in the control group, the proportion of Perlas A semi-quantitative grading showed no significant difference between the two groups (P > 0.05). For the patients with Perlas A semi-quantitative grade 2 (3 cases in the intervention group and 2 cases in the control group), metoclopramide 0.2 mg/kg was intravenously injected before anesthesia. No aspiration case was observed in this study. The intervention group was endured less thirst and hunger (P < 0.05). There was no significant difference in blood pressure and heart rate between the two groups at each time point (P > 0.05). There was no significant difference in the incidence of intraoperative hypotension between the two groups (P > 0.05). There was no significant difference in the incidence of nausea intraoperatively and postoperatively between the two groups (P > 0.05). CONCLUSION: Ultrasonography of gastric antrum can provide objective basis for evaluating gastric emptying of pregnant women perioperatively. 300 mL carbohydrates intake two hours before surgery, which does not increase GV and the risk of reflux aspiration, and is helpful in minimizing disturbance to the patient's physiological status, therefore leading to better clinical outcome.

[Effect of preoperative carbohydrates intake on the gastric volume and the risk of reflux aspiration in patients positioning in trendelenburg undergoing gynecological laparoscopic procedures].

OBJECTIVE: To investigate the effect of 300 mL carbohydrates intake two hours before sur-gery on the gastric volume (GV) in patients positioning in trendelenburg undergoing gynecological laparoscopic procedures by using gastric antrum sonography, and further assess the risk of reflux aspiration. METHODS: From June 2020 to February 2021, a total of 80 patients, aged 18-65 years, body mass index (BMI) 18-35 kg/m2, falling into American Society of Anesthesiologists (ASA) physical status Ⅰ or Ⅱ, scheduled for gynecological laparoscopic procedures positioning in trendelenburg were recruited and divided into two groups: the observation group (n =40) and the control group (n=40). In the observation group, solid food was restricted after 24:00, the patients were required to take 300 mL carbohydrates two hours before surgery. In the control group, solid food and liquid intake were restricted after 24:00 the night before surgery. The cross-sectional area (CSA) of gastric antrum was measured in supine position and right lateral decubitus position before anesthesia. Primary outcome was gastric volume (GV) in each group. Secondary outcome included Perlas A semi-quantitative grading and gastric volume/weight (GV/W). All the patients received assessment of preoperative feeling of thirsty and hunger with visual analogue scale (VAS). RESULTS: Complete data were available in eighty patients. GV was (58.8±23.6) mL in the intervention group vs. (56.3±22.1) mL in the control group, GV/W was (0.97±0.39) mL/kg vs. (0.95±0.35) mL/kg, respectively; all the above showed no significant difference between the two groups (P > 0.05). Perlas A semi-quantitative grading showed 0 in 24 patients (60%), 1 in 15 patients (37.5%), 2 in 1 patient (2.5%) in the intervention group and 0 in 25 (62.5%), 1 in 13 (32.5%), 2 in 2 (5%) in the control group, the proportion of Perlas A semi-quantitative grading showed no significant difference between the two groups (P > 0.05). A total of 3 patients (1 in the intervention group and 2 in the control group) with Perlas A semi-quantitative grading 2 were treated with special intervention, no aspiration case was observed in this study. The observation group endured less thirst and hunger (P＜0.05). CONCLUSION: Three hundred mL carbohydrates intake two hours before surgery along with ultrasound guided gastric content monitoring does not increase gastric volume and the risk of reflux aspiration in patients positioning in trendelenburg undergoing gynecological laparoscopic surgery, and is helpful in minimizing disturbance to the patient's physiological needs, therefore leading to better clinical outcome.

Silencing circ_0000644 inhibits papillary thyroid cancer cell malignancy by combining with miR-671-5p to release the inhibition on ANXA2.

BACKGROUND: Papillary thyroid cancer (PTC) is life-threatening due to its malignant progression. Considerable evidence demonstrates that circular RNA (circRNA) regulates PTC development. This study aims to explore the mechanism of circ_0000644 modulating PTC malignant progression. METHODS: The RNA levels of circ_0000644, microRNA-671-5p (miR-671-5p) and annexin A2 (ANXA2) were detected by quantitative real-time polymerase chain reaction. Western blot was performed to check protein expression. Cell proliferation and cell apoptosis were investigated by 5-ethynyl-29-deoxyuridine and flow cytometry. Angiogenic capacity, migration and invasion were analyzed by tube formation assay and transwell assay. The interaction between miR-671-5p and circ_0000644 or ANXA2 was identified by dual-luciferase reporter assay. Xenograft mouse model assay was performed to analyze the effect of circ_0000644 on tumor formation in vivo. RESULTS: Circ_0000644 and ANXA2 expression was significantly upregulated, while miR-671-5p was downregulated in PTC tissues and cells when compared with control groups. Circ_0000644 knockdown inhibited PTC cell proliferation, tube formation, migration, and invasion, but induced apoptosis in vitro. Moreover, circ_0000644 knockdown led to delayed tumorigenesis in vivo. In addition, circ_0000644 acted as a miR-671-5p sponge and mediated PTC cell tumor properties through miR-671-5p. ANXA2 was identified as a target gene of miR-671-5p, and its overexpression relieved miR-671-5p-induced effects in PTC cells. Furthermore, circ_0000644 depletion inhibited ANXA2 production by combining with miR-671-5p. CONCLUSION: Circ_0000644 depletion repressed PTC cell tumor properties through the miR-671-5p/ANXA2 axis.

Ginsenoside Rg1 regulates innate immune responses in macrophages through differentially modulating the NF-κB and PI3K/Akt/mTOR pathways.

Ginsenoside Rg1 is one of the major active components of ginseng, which has been shown to regulate the immune response of hosts. However, the mechanism underlying the immunomodulatory effect of Rg1 is incompletely understood. In this study, we aimed to explore whether and how Rg1 regulates the innate immune response in macrophages. The results showed that Rg1 treatment significantly increased tumor necrosis factor (TNF)-α but decreased interleukin-6 (IL-6) protein expression in both lipopolysaccharide (LPS)-activated RAW 264.7 cells and mouse peritoneal macrophages. However, Rg1 reduced the mRNA levels of both cytokines in LPS-activated macrophages, which might be a consequence of decreased activation of IκB and nuclear factor-κB (NF-κB). Importantly, Rg1 treatment further promoted LPS-induced activation of the Akt/mechanistic target of rapamycin (mTOR) pathway, which is critical for controlling protein translation. The elevated Akt/mTOR signaling was likely responsible for increased production of TNF-α protein at the translational level, as suppression of this pathway by LY294002, an inhibitor of the upstream phosphatidylinositol 3-kinase (PI3K), abrogated such an enhancement of TNF-α protein expression even though its mRNA levels were conversely increased. These findings highlight a novel mechanism for Rg1 to regulate the innate immune response in macrophages through differentially modulating the NF-κB and PI3K/Akt/mTOR pathways.

Unclassified renal cell carcinoma: a clinicopathological, comparative genomic hybridization, and whole-genome exon sequencing study.

Unclassified renal cell carcinoma (URCC) is a rare variant of RCC, accounting for only 3-5% of all cases. Studies on the molecular genetics of URCC are limited, and hence, we report on 2 cases of URCC analyzed using comparative genome hybridization (CGH) and the genome-wide human exon GeneChip technique to identify the genomic alterations of URCC. Both URCC patients (mean age, 72 years) presented at an advanced stage and died within 30 months post-surgery. Histologically, the URCCs were composed of undifferentiated, multinucleated, giant cells with eosinophilic cytoplasm. Immunostaining revealed that both URCC cases had strong p53 protein expression and partial expression of cluster of differentiation-10 and cytokeratin. The CGH profiles showed chromosomal imbalances in both URCC cases: gains were observed in chromosomes 1p11-12, 1q12-13, 2q20-23, 3q22-23, 8p12, and 16q11-15, whereas losses were detected on chromosomes 1q22-23, 3p12-22, 5p30-ter, 6p, 11q, 16q18-22, 17p12-14, and 20p. Compared with 18 normal renal tissues, 40 mutated genes were detected in the URCC tissues, including 32 missense and 8 silent mutations. Functional enrichment analysis revealed that the missense mutation genes were involved in 11 different biological processes and pathways, including cell cycle regulation, lipid localization and transport, neuropeptide signaling, organic ether metabolism, and ATP-binding cassette transporter signaling. Our findings indicate that URCC may be a highly aggressive cancer, and the genetic alterations identified herein may provide clues regarding the tumorigenesis of URCC and serve as a basis for the development of targeted therapies against URCC in the future.

VASP activation via the Gα13/RhoA/PKA pathway mediates cucurbitacin-B-induced actin aggregation and cofilin-actin rod formation.

Cucurbitacin B (CuB), a potent antineoplastic agent of cucurbitacin triterpenoids, induces rapid disruption of actin cytoskeleton and aberrant cell cycle inhibiting carcinogenesis. However, the underlying molecular mechanism of such anticancer effects remains incompletely understood. In this study, we showed that CuB treatment rapidly induced vasodilator-stimulated phosphoprotein (VASP) phosphorylation (i.e. activation) at the Ser157 residue and generated VASP clumps which were co-localized with amorphous actin aggregates prior to the formation of highly-ordered cofilin-actin rods in melanoma cells. Knockdown of VASP or inhibition of VASP activation using PKA-specific inhibitor H89 suppressed CuB-induced VASP activation, actin aggregation and cofilin-actin rod formation. The VASP activation was mediated by cAMP-independent PKA activation as CuB decreased the levels of cAMP while MDL12330A, an inhibitor of adenylyl cyclase, had weak effect on VASP activation. Knockdown of either Gα13 or RhoA not only suppressed VASP activation, but also ameliorated CuB-induced actin aggregation and abrogated cofilin-actin rod formation. Collectively, our studies highlighted that the CuB-induced actin aggregation and cofilin-actin rod formation was mediated via the Gα13/RhoA/PKA/VASP pathway.

Efficacy of multimodal cocktail periarticular injection with or without steroid in total knee arthroplasty.

BACKGROUND: Multimodal cocktail periarticular injection (MCPI) with a large volume of low concentration local anesthetics, adrenaline, and anti-inflammatory agents such as non-steroidal anti-inflammatory drug or steroids have shown good pain control and improvement in range of motion after surgery. This study compares the efficacy of pain control after total knee arthroplasty, using multimodal cocktail periarticular injection with steroid or without steroid. METHODS: This is a prospective, double-blinded, randomized and control study. Seventy-two patients with osteoarthritis that met clinical criteria for total knee arthroplasty were recruited into the study, and were randomized to receive either multimodal cocktail periarticular injection with steroid or without steroid. Pain was assessed by visual analogue scale (VAS) at preoperative and postoperative at rest, and during activity. The range of motion was recorded preoperatively and postoperatively. The amount of daily and cumulative morphine consumption were measured by patient-controlled analgesia in the first 72 hours postoperatively. The duration of celecoxib usage was also recorded at the last follow-up. RESULTS: There were no differences between the non-steroid and steroid groups with regard to VAS at rest and during activity, or range of motion, at any postoperative observation time. The postoperative Knee Society Knee Score in the steroid group improved significantly as compared with that in non-steroid group at the one-month (84.1±13.1 and 65.9±12.1; P < 0.0045), three-month follow-up (90.2±16.3 and 72.5±16.6; P < 0.0027), but after postoperative six-month the Knee Society Knee Score showed no significant difference between the groups. There was no significant difference in consumption of the morphine about daily or total consumption within 72 hours between the two groups. The duration of celecoxib usage in patients in the steroid group was significantly shorter than that in the non-steroid group ((7.2±0.7) compared with (10.5±1.9) weeks; P = 0.012). CONCLUSION: The patients who received the steroid injection had faster rehabilitation and less non-steroidal antiinflammatory drugs consumption.

Piperine inhibits the proliferation of human prostate cancer cells via induction of cell cycle arrest and autophagy.

Piperine, an alkaloid from black and long peppers (Piper nigrum Linn & Piper longum Linn), has been reported to exhibit antitumor activities in vitro and in vivo. To further understand the antitumor mechanism of piperine, we investigated the growth inhibitory effects of piperine on human prostate cancer DU145, PC-3 and LNCaP cells. Piperine treatment resulted in a dose-dependent inhibition of the proliferation of these cell lines. Cell cycle arrest at G0/G1 was induced and cyclin D1 and cyclin A were downregulated upon piperine treatment. Notably, the level of p21(Cip1) and p27(Kip1) was increased dose-dependently by piperine treatment in both LNCaP and DU145 but not in PC-3 cells, in line with more robust cell cycle arrest in the former two cell lines than the latter one. Although piperine induced low levels of apoptosis, it promoted autophagy as evidenced by the increased level of LC3B-II and the formation of LC3B puncta in LNCaP and PC-3 cells. The piperine-induced autophagic flux was further confirmed by assaying LC3-II accumulation and LC3B puncta formation in the presence of chloroquine, a well-known autophagy inhibitor. Taken together, these results indicated that piperine exhibited anti-proliferative effect in human prostate cancer cells by inducing cell cycle arrest and autophagy.

[Effects of tuina on the mechanical properties of skeletal muscles of four limbs in patients with chronic fatigue syndrome].

OBJECTIVE: To study the effects of tuina on the mechanical properties of skeletal muscles of four limbs in patients with chronic fatigue syndrome (CFS). METHODS: Thirty CFS patients were recruited as the test group, while another 30 healthy volunteers were recruited as the healthy control group. Patients in the test group received tuina therapy, 30 min each time, once every other day, for totally 10 times. Isokinetic testing technology was used to compare peak torque (PT), total watt (TW), average power (AP), and flexor/extensor (F/E) ratio in the elbow and knee muscles of CFS patients before and after treatment. The Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale was used to evaluate the fatigue degree before and after treatment, and compared with the healthy control group. RESULTS: After treatment the FACIT fatigue scale score decreased significantly in the test group when compared with before treatment (27.5 +/- 9.1 vs 42.5 +/- 11.2), showing statistical difference (P < 0.05). The pre-treatment PT, TW, AP, and F/E ratio in the skeletal muscle were all lower in the test group than in the healthy control group. Compared with before treatment in the test group, patients' elbow 60 degrees/s angular velocity values during exercise extensor PT and TW, knee 60 degrees/s and 180 degrees/s angular velocity values during exercise flexor PT and TW increased significantly; elbow extensor and knee extensor, flexor AP was significantly elevated; knee in 180 degrees/s angular velocity of movement F/E ratio significantly increased, and all the differences were statistically significant (P < 0.05). The improvement of the fatigue degree in CFS patients and elbow in 60 degrees/s angular velocity values under the flexor and extensor TW, and flexor AP value of the degree of improvement were negatively correlated (r = -0.282, -0.482, -0.285, P < 0.05, P < 0.01). Meanwhile, the muscles with the knee in 180 degrees/s angular velocity was negatively correlated with the F/E ratio of the degree of improvement (r = -0. 330, P < 0.05). CONCLUSIONS: CFS patients have lowered mechanical properties of four limbs. Tuina therapy can improve the biomechanical properties of limb skeletal muscle and reduce the overall degree of fatigue in patients. The changes of limb skeletal muscle and mechanical properties can provide objective reference for the clinical diagnosis and assessment of CFS.

[A study of median frequencies of skeletal muscle undergoing Tuina intervention in patients with chronic fatigue syndrome].

OBJECTIVE: To study the changes in median frequency (MF) from a surface electromyogram of skeletal muscles and functional assessment of chronic illness therapy (FACIT) figure scale scores for patients with chronic fatigue syndrome (CFS) before and after Tuina treatment. METHODS: A controlled clinical trial was adopted. Thirty-two patients suffering from CFS were enrolled according to the inclusion criteria from outpatient department of Shanghai Yueyang Hospital of Integrated Chinese and Western Medicine in China; thirty normal people whose gender, age, height and body mass were concordant with the CFS patients were selected as the normal group. Surface electromyography was used to detect the median frequency (MF) of biceps, quadriceps, and waist and back muscle before and after a 20-day course of treatment. CFS patients also were asked to fill out the figure scale of FACIT to evaluate the degree of fatigue. RESULTS: There was no significant difference in surface electromyography MF of myoelectric signal of biceps and quadriceps between CFS and normal person; however, the waist and back muscle MF of the normal person was significantly lower than that of the CFS patients. Before and after treatment, there were no obvious changes in the MF of myoelectric signals of all muscles. Tuina significantly decreased the scale score of FACIT. CONCLUSION: Tuina can improve the symptom of patients with CFS.

[Comparison of hemodynamic responses to orotracheal intubation with shikani laryngoscope or macintosh direct laryngoscope].

OBJECTIVE: To compare the hemodynamic responses to orotracheal intubation using a Shikani Optical Stylet (SOS) laryngoscope or a Macintosh direct laryngoscope (MDLS). METHODS: Totally 41 patients with American Society of Anesthesiologists ASA physical status -aged 20-60 years and scheduled for elective surgery under general anesthesia requiring orotracheal intubation, were randomly allocated to either the SOS group (n=21) or MDLS group (n=20). After an intravenous anesthetic induction the orotracheal intubation was performed using a SOS laryngoscope or a MDLS. Blood pressure and heart rate (HR) were recorded before and after anesthetic induction immediately after intubation, and 5 minutes after intubation. Rate pressure product RPP were calculated. RESULTS: Blood pressures and RPP in both two groups significantly decreased after anesthetic induction (P<0.05) while blood pressures HR, and RPP significantly increased after orotracheal intubation (P<0.05). HR in both groups after intubation were significantly higher than the pre-induction level (P<0.05)and such an increase lasted for 3 min. HR immediately after intubation was also significantly higher in MDLS group than in SOS group (P<0.05); however, such difference was not observed in other time points (P>0.05). In the MDLS group when compared with the occurrence time required for the maximum values of systolic blood pressure (SBP)the occurrence time required for the maximum values of HR after the start of intubation and success of intubation during the observation were significantly delayed (P<0.05). Compared with the MDLS group, the occurrence time required for the maximum values of SBP after the start of intubation and the success of intubation were significantly delayed in the SOS group (P<0.05). The incidences of SBP more than 130% of baseline value and RPP more than 22 000 were not significantly differently(P>0.05). Also, the intubation time was not significantly different (P>0.05). CONCLUSION: The hemodynamic responses to orotracheal intubation is milder in SOS laryngoscope than in MDLS.

[Influence of pressure on cricoid on insertion ProSeal laryngeal mask airway and ventilation function].

OBJECTIVE: To assess the influence of cricoid pressure (CP) on insertion and ventilation function of ProSeal laryngeal mask airway (PLMA). METHODS: Fifty adult patients with American Society of Anesthesiologists (ASA) physical status category I, scheduled for elective plastic surgery were studied. After induction of intravenous anesthesia, the PLMA was inserted using an introducer under CP and the intracuff pressure was set to 60 cm H(2)O (1 cm H(2)O=0.098 kPa) with the introducer in place. The content degree of lung ventilation, airway seal pressure and anatomic position of the cuff were assessed. Then CP was temporary terminated, the PLMA was further advanced to the ideal position and the intracuff pressure was readjusted to 60 cm H(2)O. The above-mentioned assessments were re-performed, and the expiratory tidal volume and peak inspiratory pressure during positive-pressure ventilation (PPV) with and without CP were recorded. The gastric tube placement through the PLMA was observed, anatomical position of the drain tube was also scored by fiberoptic examination. RESULTS: After the PLMA was further advanced to the ideal position under temporary termination of CP, lung ventilation content degree (good: acceptable=50:14 cases), airway seal pressure [(27+/-7) cm H(2)O vs. (21+/-7) cm H(2)O] and fiberoptic score of anatomical position of cuff were significantly improved compared with those after PLMA insertion under CP (P<0.05). The expiratory tidal volume during PPV was not significantly different between with and without CP, but the peak inspiratory pressure increased from (14+/-2) cm H(2)O without CP to (28+/-5) cm H(2)O with CP, and there was statistically significant difference (P<0.05). In all patients, gastric tube placement through the PLMA was successful with single attempt and correct anatomical position of the drain tube was confirmed by fiberoptic examination. CONCLUSION: The CP can impede the insertion of PLMA into the ideal position. The PLMA is still able to be advanced to the ideal position with a special introducer under temporary termination of CP. After the PLMA is advanced to the ideal position, the CP produces a significant increase in the peak inspiratory pressure during PPV.

Effect of intrathecal NG-nitro-L-arginine methyl ester administration on Fos expression in the spinal dorsal horn in rats following sciatic nerve ligation.

BACKGROUND: In the available literature, the pro- or antinociceptive role of nitric oxide (NO) is warmly disputed. As a marker of neuronal activation of the central nervous system, Fos expression has been widely used to assess the change in central neuronal activity evoked by peripheral input. In this study, we examined the effect of intrathecal L-NAME, a non-selective nitric oxide synthase (NOS) inhibitor, on nociceptive behavior and spinal Fos expression in rats following chronic constriction injury (CCI) of sciatic nerve, a model of neuropathic pain similar to that observed in clinical setting. METHODS: Eighty adult male SD rats showing no neurological deficiency a week after intrathecal catheterization were used in this study. L-NAME 250 microg of 10 microl (an equivalent or 0.9% saline) was injected intrathecally 15 min prior to CCI or sham operation. In addition to examination of thermal hyperalgesia by paw withdrawal latency (PWL), measurement of Fos protein staining neurons in the lumbar spinal cord using an immunohistochemistry technique were made at 1, 3, 7 and 14 days after operation. RESULTS: As compared with untreated animals, both CCI and sham operations evoked an early and long-term Fos expression, whereas a significant decrease in PWL was demonstrated only in rats receiving CCI. On days 3, 7 and 14 after CCI, the number of FLI neurons in the spinal dorsal horn ipsilateral to the injury decreased by 54%, 57% and 43%, respectively, in CCI-L-NAME group when compared with CCI-saline group, corresponding to the significant attenuation of thermal hyperalgesia. However, intrathecal L-NAME preadministration had no effect on the spinal Fos expression evoked by sham operation. CONCLUSIONS: Spinal Fos expression could be induced by different mechanisms, and it should not regarded as a reliable marker of pain sensation disorders. NO plays an important role in the development of nociception and spinal Fos expression through central sensitization mediated by peripheral nerve injury.

Assessment of small-dose fentanyl and sufentanil blunting the cardiovascular responses to laryngoscopy and intubation in children.

BACKGROUND: The authors found no study assessing the efficacy of small-dose narcotics on the cardiovascular response from intubation in children, so they observed the effects of fentanyl 2 microg x kg(-1) and sufentanil 0.2 microg x kg(-1) on the cardiovascular changes during laryngoscopy and intubation in children. METHODS: Ninety-three children aged 3-9 years were randomized to one of three groups to receive the following treatments in a double-blind manner: normal saline (group C), fentanyl 2 microg x kg(-1) (group F) and sufentanil 0.2 microg x kg(-1) (group S) 2 min before induction. Noninvasive blood pressure (BP) and heart rate (HR) were recorded before anesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and 5 min after intubation at 1-min interval. RESULTS: Tracheal intubation caused significant increases in BP and HR in the three groups compared with baseline values. BP and HR at intubation and after intubation and their maximum values during observation were significantly lower in groups F and S than in group C (P < 0.05). The mean percent increases of systolic blood pressure (SBP) and HR at intubation were significantly lower in group S, 7% and 10%, than in group F, 17% and 25% (P < 0.05). The increases in SBP and HR of more than 30% of baseline values during the observation period were significantly higher in group F, 27% and 43%, than in group S, 0% and 3% (P < 0.05). CONCLUSIONS: When used as part of anesthesia induction with propofol in children, sufentanil 0.2 microg x kg(-1) 2 min before induction is more effective in attenuating the cardiovascular intubation response than fentanyl 2 microg x kg(-1).

Comparisons of the dose-response and recovery time course of vecuronium and atracurium in anesthetized chinese adult patients.

BACKGROUND: The authors found no study comparing potency and duration of action of vecuronium and atracurium in healthy Chinese, so they compared the dose-response relations of vecuronium and atracurium in anesthetized Chinese adult patients and evaluated the time-course of action of two drugs following administration of equipotent doses. METHODS: Sixty patients, ASA grade 1, aged from 17 to 50 yr, scheduled for elective plastic surgery were randomly distributed to either the vecuronium or the atracurium group. General anesthesia was maintained with 60% nitrous oxide in oxygen (N2O-O2), thiopental and fentanyl. Neuromuscular function was assessed using a accelerometer with train-of-four (TOF) stimulation at the wrist every 12 sec, and the percentage of depression of first twitch (T1) was used as the study parameter. The dose-response relations of vecuronium and atracurium were determined using the cumulative dose-response technique. RESULTS: The cumulative dose-response curve of vecuronium was shifted to the left in a parallel fashion compared with that of atracurium. As assessed by linear regression, the potency ratio of vecuronium:atracurium was 6:1. There were significant differences in the ED50, ED90, and ED95 between the two drugs. After the intravenous administration of equipotent doses of both drugs (1.5 x ED95), the duration of peak effect, clinical duration, recovery index, and total duration were not significantly different between the two drugs. CONCLUSIONS: The neuromuscular blocking potency of atracurium is approximately 17% that of vecuronium in anesthetized Chinese adult patients. Following equipotent doses, the time course of action of atracurium is similar to that of vecuronium.

[An auto control comparison of the use of ProSeal laryngeal mask airway and standard laryngeal mask airway for positive pressure ventilation].

OBJECTIVE: To compare the ProSeal laryngeal mask airway (PLMA) and the standard laryngeal mask airway (SLMA) for intermittent positive pressure ventilation (IPPV) in a randomized auto control design. METHODS: Fifty adult patients with American Society of Anesthesiologists (ASA) physical status 1-2, scheduled for elective plastic surgery under general anesthesia were recruited. After the routine intravenous anesthesia induction, the PLMA and the SLMA were inserted randomly in sequence into each patient and inflated to an intracuff pressure of 60 cm H(2)O (1 cm H(2)O=0.098 kPa), airway seal pressure and lung ventilation satisfaction were evaluated, and fiberoptic (FOB) scores of the cuff anatomic position were measured. The mean expired volume and the mean peak inspiratory pressure of five continuous breaths were calculated after IPPV with 10 ml/kg tidal volume was performed. RESULTS: Without cuff inflation, airway seal pressure was higher with the PLMA than with the SLMA (P<0.05), and adequate or acceptable lung ventilation was obtained in 46 (92%) patients with the PLMA, but only 22 (44%) patients with the SLMA. When the air volume required to obtain an intracuff pressure of 60 cm H(2)O, adequate lung ventilation was obtained in 50 patients with the PLMA, but only 28 patients with the SLMA, and the inflation volume and sequential airway seal pressure were higher with the PLMA than with the SLMA (both P<0.05), and the airway seal pressure with the PLMA was not less than with the SLMA in each patient. The ventilation volume was higher with the PLMA than with the SLMA, except in 2 patients. The FOB score of the cuff position was lower with the PLMA than with the SLMA (P<0.05). The mean expired tidal volume and the mean peak inspiratory pressure were not significantly different between 29 patients with the PLMA and 21 patients with the SLMA for airway maintenance during operation (both P>0.05). CONCLUSION: Compared with SLMA, PLMA can achieve a higher airway seal pressure and potentially isolate the glottis and the upper esophagus, and is safer and more effective for positive pressure ventilation.