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Objective To observe the skin temperature changes on blocked area of ultrasoundguided thoracic paravertebral block and to explore the accuracy of the temperature changes in predic ting the effect of nerve block in breast cancer patients.Methods One hundred and twenty breast cancer patients undergoing modified radical mastectomy,aged 29-67 years,ASA physical status Ⅰ-Ⅲ,were selected for the study.Before general anesthesia induction,ultrasound-guided thoracic paravertebral block was performed.After the block site T34 was determined,25 ml 0.25％ ropivacaine was injected around the thoracic paravertebral space.The skins of palm and axillary regions both in blocked and unblocked sites were randomly selected.The skin temperature before nerve block and 15 min after were recorded,and the skin temperature changes were calculated.The sensitivity and specificity of the temperature changes in determining the effect of thoracic paravertebral block was assessed by using the receiver operating characteristic curve (ROC).Pearson correlation was used to analyze the correlation.Results The value of area under curve (AUC) of the ROC of the skin temperature changes in palm regions responding to the effects of block was 0.892 (95％CI 0.803-0.947).The cut-off value was 0.9C which sensitivity and specificity was 87.3％ and 75.9％,respectively.The AUC in axillary regions was 0.813 (95％CI 0.756 0.884),the cut-off value was 0.4 C which sensitivity and specificity was 80.7％ and 71.6％,respectively.The value of AUC in palm regions was larger than in axillary regions (P＜0.05).Conclusion The present study demonstrated that the changes of the skin temperature in palm and axillary regions have a high accuracy in predicting the effect of T3-4 thoracic paravertebral block,which can be used in determining the success of T3-4 thoracic paravertebral block.The assessment of temperature changes in palm regions is more accuracy than in axillary.
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Objective To evaluate the effect of isoflurane on the expression of hippocampal ubiq-uitin C-terminal hydrolase-L1(UCH-L1)mRNA in aged rats. Methods Thirty-six pathogen-free healthy male Sprague-Dawley rats, aged 20 months, weighing 500-700 g, were divided into 2 groups using a ran-dom number table: control group(group C, n=12)and isoflurane group(group I, n=24). In group I, 2% isoflurane was continuously inhaled for 2 h. Twelve rats were selected at 24 and 72 h after stopping isoflurane inhalation(T1,2), and Y-maze test was performed to evaluate cognitive function. The animals were sacrificed after the end of Y-maze test and their hippocampi were removed for determination of UCH-L1 expression(by immuno-histochemistry)and UCH-L1 mRNA expression(by real-time polymerase chain reaction). Results Compared with group C, the total number of training achieving the standard was sig-nificantly increased at T1(P<001 or 005), and the expression of UCH-L1 mRNA was down-regulated, and no significant change was found at T2in group I(P>005). Conclusion The mechanism by which isoflurane induces cognitive decline may be related to down-regulating the expression of UCH-L1 mRNA in hippocampal tissues of aged rats.
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Objective To determine the optimum dose of bupivacaine for spinal anesthesia with epidural volume extension (EVE) in patients undergoing cesarean delivery.Methods A total of 100 parturients,weighing 55-100 kg,with body height of 155-170 cm,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective cesarean delivery,were included and randomized to receive bupivacaine at 5 different doses (A,B,C,D,and E groups) using a random number table,with 20 patients in each group.In A,B,C,D,and E groups,bupivacaine 6.75,7.50,8.25,9.00 and 9.75 mg were injected into the subarachnoid space,respectively,and the volume was all 1.5 ml.After successful spinal anesthesia,an epidural catheter was placed,and normal saline 10 ml was given through the catheter to perform EVE.A successful spinal block was defined as attainment of sensory block of at least T5 within 15 min after EVE along without requirement for additional local anesthetics within 60 min after EVE.The rate of successful spinal anesthesia,time to reach sensory block of T5,the maximum level of sensory block,and the first requirement for local anesthetics were recorded.The occurrence of hypotension,tachycardia,bradycardia,nausea,vomiting,chest distress,dyspnea,shivering,and referred pain and consumption of metaraminol were recorded during spinal anesthesia.Apgar scores at 1 and 5 min after birth were recorded.Results With the increasing doses of bupivacaine,the efficacy of spinal anesthesia was enhanced,and the occurrence of adverse reactions was increased.Compared with group C,the rate of successful spinal anesthesia,and the maximum level of sensory block were significantly increased,the time to reach sensory block of T5 was shortened,and the incidence of hypotension and nausea and consumption of metaraminol were increased in group E;the time to reach sensory block of T5 was significantly shortened,Apgar scores at 1 min after birth were increased (P＜0.05),and no significant change was found in the rate of successful spinal anesthesia,the first requirement for local anesthetics,the rate of time to reach sensory block ofT5≤ 15 min,and the maximum level of sensory block in group D (P＞0.05).Compared with group D,the time to reach sensory block of T5 was significantly shortened,the incidence of nausea and consumption of metaraminol were increased (P＜0.05),and no significant change was detected in the rate of successful spinal anesthesia,the first requirement for local anesthetics,the rate of time to reach sensory block of T5 ≤ 15 min,and the maximum level of sensory block in group E (P＞0.05).Conclusion The optimum dose of bupivacaine for spinal anesthesia with EVE is 9.00 mg in patients undergoing caesarean delivery.
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Objective To compare the analgesia effect of lidocaine carbonate combined with intravenous flurbiprofen axetil with intravenous flurbiprofen axetil on intrapelvic irrigation and incision infiltration after gynecological laparoscopy.Methods Seventy-five patients scheduled for gynecological laparoscopy under general anesthesia were divided into 3 groups by random number table method with 25 cases each.Patients in control group 1 receivcd intravenous flurbiprofen axetil 100 mg after surgery;patients in control group 2 received intrapelvic irrigation with 0.35％ lidocaine carbonate 100 ml,and incision infiltration with 0.87％ lidocaine carbonate 10 ml respectively after surgery;patients in observation group received the combination of control group 1 and control group 2.The visual analogue scores (VAS) at 1,4,8,12 and 24 h after surgery,time of passage of gas by anus and untoward reaction were recorded.Results One case in control group 1 and 1 case in observation group withdrew from the study.The VAS at 1,4,8,12 and 24 h in observation group were (9.5 ± 7.9),(14.9 ± 8.7),(17.2 ± 10.3),(12.2 ± 7.7),(5.3 ± 3.8) mm,in control group 1 were (39.2 ± 15.0),(33.4 ± 13.0),(36.2 ± 12.8),(35.8 ± 12.7),(10.6 ± 4.2) mm,and in control group 2 were (26.6 ± 13.0),(30.2 ± 12.0),(33.3 ± 13.1),(30.4 ±9.8),(9.8 ±4.7) mm.And there were statistical differences between observation group and control group 1,2 (P ＜ 0.05).There were no statistical differences in time of passage of gas by anus and untoward reaction incidence in the 3 groups (P ＞ 0.05).Conclusion Intrapelvic irrigation and incision infiltration with lidocaine carbonate and intravenous flurbiprofen axetil compared with intravenous flurbiprofen axetil alone after gynecological laparoscopy can significantly reduce the pain intensity and analgesia requirement,without increasing the untoward reaction incidence.
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Objective To determine the dose-response relationship of sufentanil inhibiting responses to tracheal intubation when combined with sevoflurane in pediatric patients.Methods Seventy-five pediatric patients of both sexes,aged 2-8 yr,weighing 11-28 kg,of ASA physical status Ⅰ,scheduled for elective operation on perineum or four extremity under general anesthesia,were randomly assigned into 5 groups (n =15 each) using a random number table:sevoflurane group (group S) and sevoflurane combined with sufentanil 0.15,0.30,0.45 and 0.60 μg/kg groups (SS14 groups).6％ sevoflurane was inhaled via a face mask.Mechanical ventilation was performed after spontaneous breathing weakened.The end-tidal sevoflurane concentration was maintained at 3％ after loss of consciousness.The corresponding doses of sufentanil were injected intravenously in SS14 groups,while the equal volume of normal saline was given in group S.The median effective dose (ED50),ED95 and 95 ％ confidence interval of sufentanil inhibiting responses to tracheal intubadon were calculated using Probit method.Results When combined with sevoflurane,the ED50 and ED95 (95 ％ confidence interval) of sufentanil inhibiting responses to tracheal intubation were 0.365 μg/kg (0.317-0.414μg/kg) and 0.513 μg/kg (0.454-0.647 μg/kg),respectively,in pediatric patients.Conclusion The ED50 of sufentanil required for inhibiting responses to tracheal intubation is 0.365 μg/kg and ED95 is 0.513 μg/kg when combined with sevoflurane in pediatric patients.
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Objective To study the feasibility and long-term effects in 173 infants with congenital ventricular septal defect who underwent transcatheter therapy by double-disk ventricular septal defect occluder. Methods We analyzed the clinical data of 173 infants with ventricular septal defect who were performed interventional therapy followed by a follow up study from December 2002 to October 2013. Results The procedure was performed in 173 infants (male = 81 cases and female = 92 cases) aged 11 month-3 years[(2.1±0.7)years]. The weight were 6-15 kg[(10.2±3.6)kg]. The diameter of the defects ranged from 2.5-9.0 mm[(5.1±1.7) mm]. The characteristics of septal were classiifed into four types:the simply perimembranous ventricular septal defects (88 patient,50.8%), the perimembranous ventricular septal defects with pseudoaneurysm (52 patients, 30.0%), the perimembranous ventricular septal defects complicated with aortic valve prolapse (13 patients, 7.5%), and the intracristal ventricular septal defect (20 patients, 11.7%). The diameter of the occluders were between 4-12 mm[(6.3±2.2)mm]. The period of follow-up ranged from 1 month-10 years[(6.2±1.3)years]. The 168 defects were completely occluded in 173 patients(97.1%closure rate) except 5 infants, which 3 patients because the occluder hinder the function of aortic valves and the other occurred complete atrioventricular block(CAVB) when the catheter through defect. One patient occurred CAVB on the third day after the procedure, was reversed by dexamethasone after 4 days. 3 patients with complete left bundle branch block(CLBBB) after the procedure and one went to sustained, but did not observed heart failure in this case during 5 years follow-up. One patient observed sustained CLBBB on the fourth year after the procedure, also did not observed heart failure in this case during 3 years follow-up. 8 patients with trivial residual shun and 4 patients with newly appearance of trivial aortic regurgitation after the procedure, the shun all disappear at one year and the regurgitation did not progress during longest follow-up period at 8.5 years. No other complications, including late-onset CAVB, hematolysis, the occluder displacement and detachment, occurred during 1 month-10 years of follow-up. Conclusions Transcatheter closure of congenital ventricular septal defects is an efifcient method that can be safely used in the majority of infants with ventricular septal defects and have signiifcant long-term effects.
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Objective To evaluate the upper thoracic block on the consumed oxygen and ischemia dergoing lobectomy were randomized to receive either combined general-epidural anesthesia(GEA group,n=25)or general anesthesia(GA group,n=25).To observe systolic pressure(SBP),heart rate(HR),ST section and T wave before anesthesia(T1),after epidural infusion 20 minutes(T2),intubated the trachea(T3),at the end of operation(T4),drew the trachea(T5),after drew the trachea 30minutes(T6).Results SBP,HR,RPP were significantly increased in GA groupas compared with those in GEA group at L3,L5,T6(P＜0.05),The change of ST section and T wave were significantly improved in GEA group as compared with those in GA group at T2,B3,T4,T5,T6(P＜0.05).Conclusion The influence of the upper thoracic block can decrease the consumed oxygen and ischemia, improve the myocardial ischemia in the coronary disease patient undergoing lobectomy, to reduce the complication of the coronary disease patient in the perioperative.
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Objective To determine the influence of stellate ganglion block on myocardial ischemial reperfusion arrhythmia.Methods Sixteen rabbits were divided randomly into two groups : group A(control group), group B (experimental group) was left lateral stellate ganglion blocks. Myocardial ischemia reperfusion model in vivo was carried out routinely. Blood samplies were taken from coronary sinus for the determination of neuropeptide(NPY) and noradrenaline(NE) at the following time point before LAD crossclamping , 5min, 30min after reperfusion.The occurrence of RA was measured in 1～5min during reperfusion.Results The level of plasma NPY and NE were significantly reduced at 5min, 30min after reperfusion (P