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Objective To evaluate the optimum compatibility of nabufine mixed with flurbiprofen for patient-controlled intravenous analgesia (PCIA) after gynecological laparoscopic surgery.Methods A total of 210 patients,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologist physical status Ⅰ or Ⅱ,scheduled for gynecological laparoscopic surgery under general anesthesia,were divided into 4 groups using a random number table method:sufentanil 2.0 μg/kg+flurbiprofen axetil 2.0 mg/kg group (SF group,n =55),nalbuphine 1.5 mg/kg+flurbiprofen axetil 2.0 mg/kg group (N1 F group,n=49),nalbuphine 2.0 mg/kg+flurbiprofen axetil 2.0 mg/kg group (N2F group,n =55) and nalbuphine 3.0 mg/kg +flurbiprofen axetil 2.0 mg/kg group (N3F group,n=51).PCIA solution was prepared correspondingly after surgery in each group.The PCA pump was set up to deliver a 1 ml bolus dose with a 15-min lockout interval and background infusion at 2.0 ml/h.Nalbuphine 5 mg or sufentanil 5 μg was intravenously injected as a rescue analgesic to maintain visual analogue scale score at rest ＜4 at 48 h after surgery in SF and N1 F-N3F groups.Ramsay sedation scores were recorded on admission to post-anesthesia care unit (T1),at the time of post-anesthesia care unit discharge (T2) and at 6,24 and 48 h after surgery (T3-5).The total pressing times of PCIA in 0-6 h,6-24 h and 24-48 h periods after surgery and requirement for rescue analgesics were recorded.The incidence of adverse reactions such as nausea and vomiting,drowsiness and shivering within 48 h after surgery was also recorded.Results Compared with group SF,the incidence of nausea and vomiting was significantly decreased in N1 F and N2F groups,the requirement for rescue analgesics was significantly decreased,and the total pressing times of PCIA was reduced in N2F and N3 F groups,and Ramsay sedation scores at T3,4 were significantly increased in group N3F (P＜0.05).Compared with group N1 F,the requirement for rescue analgesics was significantly decreased,and the total pressing times of PCIA was reduced in N2F and N3F groups,and the incidence of nausea and vomiting and Ramsay sedation scores at T3,4 were significantly increased in group N3F (P＜0.05).Compared with group N2F,the incidence of nausea and vomiting was significantly increased (P＜ 0.05),and no significant change was found in the requirement for rescue analgesics,total pressing times of PCIA or Ramsay sedation scores in group N3F (P＞0.05).Conclusion Nabufine 2.0 mg/kg mixed with flurbiprofen 2.0 mg/kg is the optimum compatibility when used for PCIA after gynecological laparoscopic surgery.
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Objective To evaluate the effects of goal-directed fluid therapy on the tissue perfusion of elderly patients undergoing Laparoscopic Radical Cystectomy.Methods Thirty patients aged 60-82 years with ASA physical status Ⅰ or Ⅱ who were presenting for elective laparoscopic radical cystectomy were randomly divided into routine fluid replacement group (group C,n=15) and GDFT group (group G,n=15).Patients in group C received routine fluid replacement.Patients in group G were treated under goal-directed fluid infusion strategy with a target of SVV≤13%,CI≥2.5 L·min-1·m-2 and ScvO2≥73% under the monitoring of PiCCO.The indexes of hemodynamics and tissue perfusion were collected and recorded at 7 time points: before induction of anesthesia (T1),5 minutes after intubation (T2),5 minutes after pneumoperitoneum and change positions (T3),1 hour after pneumoperitoneum (T4),5 minutes after the abdomen was opened (T5),1 hour after the abdomen was opened (T6) and the end of surgery (T7).Results Compared with group C,group G received less fluid.MAP and SVV between two groups were no statistical significance.The CI in group G in time point T4,T6 and T7 was significantly higher than that in group C (P<0.05).The HR in group G in time point T5 and T6 was significantly higher than that in group C (P<0.05).The aLac in group G in time point T4 and T5 was significantly lower than that in group C (P<0.05).Pcv-aCO2,DO2I and O2ERe between the two groups were not statistically different.Postoperative rehabilitation indexes between the two groups were not statistically significant.Conclusion The GDFT guided under SVV,CI and ScvO2 can keep the effective circulatory volume and pressure to ensure the whole body perfusion,reduce aLac and improve microcirculation without affecting the balance of oxygen supply and demand and the postoperative complication.
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Objective To prepare the rat model of type 2 diabetes mellitus (T2DM), and to ob-serve the characteristics of peripheral neuropathy. Methods High fat and high sugar diets were fed for 8 weeks to induce insulin resistance and then low dose streptozotocin ( STZ) was injected intraperitoneally to induce type 2 diabetes mellitus models in Sprague Dawley rats. Blood glucose and serum insulin levels con-tinuous were monitored. Tactile allodynia in response to von Frey ( VF) filament stimulation of the plantar hind paws and paw withdrawal thermal latency ( PWTL) to plantar test were used as the criterion for diabetic neuropathy. Instruments AD was used to detect nerve conduction velocity ( NCV) of sciatic nerve in rat and the morphological and pathological changes of sciatic nerve were detected by electron microscope. Results The characteristics of T2DM rats by peripheral neuropathy in this method were that 50％ force withdrawal threshold and PWTL were measured. Both values of diabetic rats were decreased from the day of STZ injec-tion until 4 weeks after STZ injection, and then increased 8 weeks after STZ injection (50％ force withdraw-al threshold values, (11.8 ±0.8)g, (8.4 ±0.7)g and (16.2 ±1.4)g; PWTL (10.2 ±0.9)s, (8.3 ± 1. 2)s and (13. 2 ± 1. 0)s. These results indicated that tactile sensation changed from hypersensitive to hy-posensitive. Compared to the NC group, the sciatic nerve motor and sensory conduction velocity were signifi-cantly decreased at 4 and 8 weeks in DM group, respectively. Compared to DM group at 4 weeks, the sciat-ic nerve motor and sensory conduction velocities were further decreased in the DM group at 8 weeks. Con-clusively, sciatic nerve showed obvious demyelination and axonal collapse. Conclusions T2DM rat model was successfully induced by high fat and sugar diet combined with small dose of STZ injection. The rat mod-el has typical pathological change of peripheral nerve. It might provide a particularly advantageous tool for investigations of diabetes and its chronic complications.
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Objective To evaluate the effect of preoperative anxiety on the dosage of opioid drugs in perioperative period.Methods Fourty female patients who aged 18-65 years,ASA Ⅰ or Ⅱ, undergoing laparoscopic hysterectomy were enrolled during November 2014 to August 2015.Demo-graphic characteristics of the patients were recorded.The patients were separated into two groups ac-cording to their state anxiety inventory (SAI).The patients with SAI>37 score were included in the high-anxious patients group (group H,n=22)while the other patients with SAI≤37 were enrolled in the low-anxious patients group (group L,n=18).All patients received the SAI test at the day be-fore surgery.The anesthesia time,intraoperative remifentanil consumption,duration of the first time giving analgesia after surgery,consumption of sufentanil at 1(T1 ),2(T2 ),4(T3 ),6(T4 ),24(T5 ) and 48 hours(T6 )after operation were recorded.Visual analogue scale (VAS)scores,the times of pressing PCIA and the side effects of opioid 48 h after the surgery were recorded.Results In group H, the time for first dose of opioid after surgery was significantly shorter than group L (P <0.05).The con-sumption of sufentanil in group H was significantly more than group L at T1-T6 (P <0.05).The times of pressing PCIA at the T5 time point after operation in group H was more than group L (P<0.05).No sta-tistically difference was found in the incidence of nausea or vomit between the two groups.There were no re-spiratory depression, pruritus or urinary retention in all patients.Conclusion Patients with high preoperative anxiety level perceive needed more opioids in postoperative pain control.
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Objective To evaluate the effect of ropivacaine-induced convulsion on hippocampal synaptic development in neonatal rats.Methods Sixty 21-day-old Sprague-Dawley neonatal rats,weighing 40-41 g,were randomly divided into 3 groups (n=20 each) using a random number table:control group (group C),single convulsion group (group SC),and recurrent convulsion group (group RC).Normal saline 0.1 ml was intraperitoneally injected in group C.Group SC received single intraperitoneal injection of 0.5％ ropivacaine 33.8 mg/kg.In group RC,0.5％ ropivacaine 33.8 mg/kg was intraperitoneally injected once a day for 5 consecutive days.The rats developed convulsion were included in the study.Five rats were selected at 24 h,3 days and 7 days after convulsion and at the age of 60 days in C and SC groups,and at 24 h,3 days and 7 days after the last convulsion and at the age of 60 days in group RC,the rats were sacrificed,and the hippocampus was removed for examination of the ultrastructure of neurons (with a electron microscope) and for determination of the number of synapses,synaptic space and thickness of synaptic density.Results Compared with group C,the number of synapses was significantly decreased,and the synaptic space was widened at 24 h and 3 days after convulsion,and the thickness of synaptic density was thinned at 24 h after convulsion in group SC,and the number of synapses was significantly decreased,and the synaptic space was widened,and the thickness of synaptic density was thinned at 24 h,3 days and 7 days after convulsion in group RC (P＜0.05).Compared with group SC,the number of synapses was significantly decreased,the synaptic space was widened,and the thickness of synaptic density was thinned at 24 h,3 days and 7 days after convulsion in group RC (P＜0.05).There was no significant difference in the parameters mentioned above at the age of 60 days between the three groups (P＞0.05).Neurons exhibited nuclear swelling,mitochondria showed edema,and disrupted mitochondrial cristae and vacuoles were observed at 24 h and 3 days after convulsion,and these changes mentioned above were significantly attenuated at 24 h,3 days and 7 days after convulsion.Conclusion Ropivacaine-induced convulsion exerts no effects on hippocampal synaptic development in neonatal rats.
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Objective To investigate continuous infusion and inermittent injection of cisatra-curium for deep neuromuscular blockade during laparoscopic surgery and to compare the effectiveness and safety.Methods Sixty ASA Ⅰ or Ⅱ patients,aged from 18 to 65,undergoing selective laparo-scopic gastrointestinal surgery with general anesthesia were randomly divided into 2 groups:group A (n =30)received cisatracurium 0.1 5 mg/kg for intubation,and then continuous infusion of cisatra-curium with micropump at an original rate of 0.2 mg·kg-1 ·h-1 when post tetanic count (PTC)≥3;group B(n =30)was given cisatracurium 0.1 5 mg/kg for intubation,and then intermittent infusion of cisatracurium of 0.05 mg/kg when PTC≥ 3.The cisatracurium consumption,duration of neuro-muscular blocking agent used in group A from induction to the end of infusion and in group B from in-duction to the last infusion,satisfaction of neuromuscular blockade (grade 0-10)of the surgeons,the time of T1 recovered to 25%,75%,TOFr recovered to 0.7,0.9,fulfillment of tongue depressor test,the incidence of hyoxemia after extubation,pneumonia,atelectasis were recorded.Results In comparison with group B,the cisatracurium consumption in group A was significantly more (P <0.05),and the satisfaction of the surgeons was significantly higher at the beginning,1 h,2 h of the operation (P <0.05).The satisfaction of the surgeons respectively showing no significant differences between the two groups at the end of the operation.Recovery index (T1 from 25% to 75%),time of TOFr recovery to 0.7,0.9 in group A was increased,but not statistically.Two patients (7.1%)in group A had hyoxemia after extubation while 1 (4.2%)in group B,the incidence rate was not signifi-cant;3 patients (10.7%)in group A was unable to perform sustained tongue depressor test while 4 (1 6.7%)in group B,the incidence was not significant;all of the patients did not suffer pneumonia and atelectasis.Conclusion Continuous infusion cisatracurium during laparoscopic procedures for deep neuromuscular blockade is effective and safe.The dose of cisatracurium is bigger,and muscular relax-ation would be deeper compared to intermittent infusion.Continuous infusion may prolong the working time of muscle relaxant,but have on influence on the residual effect of muscle relaxant.
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Objective To compare pharmacodynamics of vecuronium administered according to body surface area and body weight during general anesthesia.Methods Forty ASA Ⅰ or Ⅱ patients,aged 18-64 yr,weighing 40-85 kg,undergoing general anesthesia,were randomly divided into 2 group ( n =20 each ).The patients received vecuronium 2× ED95 based on body weight (group W) or based on body surface area (group S).Anesthesia was induced with propofol 2 mg/kg,fentanyl 3 μg/kg and vecuronium 0.1 mg/kg ( group W) or 2.824 mg/m2 (group S).The patients was tracheal intubated and mechanically ventilated when the maximal depression of T1 was achieved.PET CO2 was maintained at 35-45 mm Hg and BIS value was maintained at 40-50.The intubation condition was evaluated using Cooper's score.The onset time,maximal depression of T1,duration of clinical action,recovery index,duration of pharmacological action and amount of vecuronium consumed were recorded.The coefficient of variation for all the indexes mentioned above was calculated.Results There was no significant difference in the coefficient of variation for intubation condition,onset time,duration of clinical action,recovery index,and duration of pharmacological action between the two groups ( P ＞ 0.05).Compared with group W,the coefficient of variation for the maximal depression of T1 and amount of vecuronium consumed were significantly decreased in group S ( P ＜ 0.05).Conclusion Vecuronium 2 × ED95 administered according to body surface area can reduce the individual variation in pharmacodynamics during general anesthesia.
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ObjectiveTo establish a rat model of nerve damage induced by intrathecal(IT) lidocaine.MethodsFifty-five adult male SD rats weighing 200-220 g were randomly divided into 5 groups (n =11 each):group normal control (group C); group dimethyl sulfoxide (DMSO)-the solvent(group D) and groups IT 5％,10％,15％ lidocaine (groups L5.10.15 ).IT catheter was successfully implanted without complication in groups D,L5,L1o,L15.DMSO,5％,10％ and 15％ lidocaine 20 μl were injected IT in groups D,L5,L10,L15 respectively.Motor dysfunction of hindlimb was assessed and scored (0 =normal,2 =complete block) and paw withdrawal threshold to mechanical stimulation (von Frey filaments) (MWT) and paw withdrawal latency to thermal nociceptive stimulus (TWL) were measured before (baseline) and at 1,2,3,4,5,7 d after IT administration in 8 animals in each group.Three animals in each group were sacrificed at 1 d after IT administration.The lumbar segment (L4-5) was removed for microscopic examination.ResultsThere was no significant difference in motor dysfunction score,MWT and TWL among groups C,D and L5.MWT was significantly increased and TWL prolonged at 1 and 2 d after IT administration in group L10,while in group L15 motor dysfunction score was significantly increased at 1,2 d after IT administration and MWT was significantly increased and TWL prolonged at 1,2,3 d after IT administration.There was significant histologic damage to spinal cord in groups L10 and L15.Conclusion Nerve damage can be induced by IT 10％ lidocaine.
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Objective To investigate the effect of pregnancy on the potency of bupivacaine for spinal anesthesia in rats. Methods Female non-pregnant SD rats weighing 180-220 g and 17 day pregnant SD rats weighing 350-400 g were used in this study. The rats ( 18 non-pregnant, 18 pregnant) in which PE-10 catheter were successfully placed without complications were selected. The 18 non-pregnant rats were randomly divided into 3 groups (n =6 each): control group (group C), 2% bupivacaine group (group B2 ) and 4% bupivacaine group (group B4). The 18 pregnant rats were also randomly divided into 3 groups (n = 6 each): control group (group PC),2% bupivacaine group (group PB2 ) and 4% bupivacaine group (group PB4 ). Group C and PC received intrathecal (IT) normal saline 30 μl, and the other 4 groups received 2% or 4% bupivacaine 30 μl intrathecally. Analgesia was determined using the taifllick latency (TFL) before IT administration (baseline), and at 10 min, 20 min,30 min, 1 h, 2 h, 4 h, 1 d, 2 d, 3 d and 4 d after IT administtation. The percentage of the maximal possible effect (MPE) was calculated. Hind-limb motor function (MF) was also assessed. Results Compared with the baseline value, MPE at 10 min-2 h after administration and MF scores at 10 min-1 h after administration were significantly increased in group B2, MPE at 10 min-4 h after administration and MF scores at 10 min-1 h after administration were significantly increased in group B4;MPE at 10 min-1 d after administration and MF scores at 10 min2 h were significantly increased in group PB2 and MPE at 10 min-1 d after administration and MF scores at 10 min4 h were significantly increased in group PB4 ( P ＜ 0.05 ). Conclusion Pregnancy can enhance the potency of bupivacaine for spinal anesthesia in rats.