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Objective:To evaluate the modified efficacy of serratus anterior plane block (SAPB) combined with general anesthesia for thoracoscopic radical resection of lung cancer.Methods:Eighty-two patients of both sexes, aged 40-64 yr, with body mass index of 18-24 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective thoracoscopic radical resection of lung cancer, were divided into 2 groups ( n=41 each) using a random number table method: general anesthesia group (group G) and SAPB combined with general anesthesia group (group SG). Ultrasound-guided SAPB was performed before induction of general anesthesia in group SG.General anesthesia was induced with midazolam, etomidate, sufentanil and cis atracurium, and anesthesia was maintained with sevoflurane and remifentanil.Sufentanil was used for patient-controlled intravenous anesthesia (PCIA) after the end of operation.When visual analog scale score≥4, sufentanil 2.5 μg was injected intravenously for rescue analgesia.The intraoperative consumption of sevoflurane and remifentanil, extubation time, requirement for rescue analgesia within 48 h after operation, consumption of sufentanil, requirement for nicardipine and esmolol and occurrence of adverse events were recorded. Results:Compared with group G, the intraoperative consumption of remifentanil and sevoflurane, postoperative consumption of sufentanil, postoperative requirement for rescue analgesia, postoperative requirement for nicardipine and esmolol, postoperative incidence of nausea and vomiting, skin pruritus and urinary retention were significantly decreased, the extubation time was shortened, and the time of the first postoperative requirement for rescue analgesia was prolonged in group SG ( P<0.05). Conclusion:Compared with general anesthesia alone, SAPB combined with general anesthesia can not only significantly reduce intraoperative general anesthetics and opioid consumption, but also improve postoperative stress management, which is helpful for early postoperative outcome when used for thoracoscopic radical resection of lung cancer.
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Objective:To evaluate the effects of different doses of ulinastatin on lung function in patients undergoing total aortic arch replacement.Methods:One hundred and thirty five patients with acute Stanford type A aortic dissection of both sexes, aged 20-70 yr, with body mass index of 16.2-33.3 kg/m 2, of American Society of Anesthesiologist physical status Ⅳ, were divided into 3 groups ( n=45 each) using a random number table method: high-dose ulinastatin group (group H with total dose of 30 000 U/kg), low-dose ulinastatin group (group L with total dose of 20 000 U/kg) and control group (group C). In group H and group L, half of the total dose of ulinastatin was given after induction of anesthesia, the rest of the total dose was primed after being added to cardiopulmonary bypass (CPB) circuit, while normal saline 100 ml was given at the same time point in group C. After induction of anesthesia (T 0), and at 3, 6, 12, 24 and 48 h after the beginning of CPB (T 1-5), blood samples from the central vein were collected for determination of plasma concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). The oxygenation index (OI) and alveolar-arterial partial pressure of oxygen difference (P A-aO 2) at T 0 and T 2-T 5, intraoperative blood loss and blood transfusion, postoperative mechanical ventilation time, length of intensive care unit (ICU) stay and the incidence of complications within 30 days after surgery were collected. Results:Compared with group C, the plasma concentrations of TNF-α and IL-6 were significantly at T 1-T 5, OI was increased, and P A-aO 2 was decreased at T 2, 3 in H and L groups ( P<0.05). There was no significant difference in the mechanical ventilation time, length of ICU stay and incidence of complications within 30 days after surgery among the 3 groups ( P>0.05). Conclusion:Ulinastatin can inhibit inflammatory responses and improve lung function in patients undergoing total aortic arch replacement, but it has no value for clinical outcomes.
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Objective:To evaluate the effects of sevoflurane on right ventricular myocardial fibrosis caused by pulmonary arterial hypertension (PAH) in rats.Methods:Eighteen SPF healthy adult male Wistar rats, weighing 260-300 g, were divided into 3 groups ( n=6 each) by a random number table method: control group (group C), group PAH and PAH plus sevoflurane group (group PS). The PAH model was established by single intraperitoneal injection of monocrotaline 60 mg/kg in group PAH and group PS, while the equal volume of normal saline was intraperitoneally injected in group C. Sevoflurane 1.5 MAC was inhaled for 1 h starting from the end of injection, twice a week for 6 weeks in total, in group PS.Echocardiography was performed at the end of 6th week to measure right ventricular end-diastolic diameter (RVEDD), right ventricular anterior wall end-diastolic thickness (RVWTd), interventricular septal end-diastolic thickness (IVSTd), pulmonary artery inner diameter (PAID) and pulmonary valve orifice maximum peak velocity (PV). At the end of 6th week, the hearts were taken to measure the weight of right ventricle, interventricular septum and left ventricle, and Fulton′s index was calculated, and the tissue of the lower lobe of the right lung was taken, the outer diameter and inner diameter of the vascular wall were measured to calculate the vascular wall thickness index (WT), and total vascular area and lumen area were measured to calculate the vascular wall area index (WA) after HE staining.The myocardial tissue of the right ventricle was obtained to observe the degree of myocardial fibrosis (with a light microscope after Masson staining) and to detect the expression of TGF-β1 (after immunofluorescence staining) and expression of TGF-β1, phosphorylated Smad3 (p-SMad3) and Smad7 (by Western blot). Results:Compared with group C, Fulton′s index, RVEDD, RVWTd, IVSTd, PAID, WT and WA were significantly increased, PV was decreased, the expression of TGF-β1 and pSmad3 in right ventricular myocardial tissues was up-regulated, the expression of Smad7 was down-regulated( P<0.01), and myocardial fibrosis occurred in group PAH.Compared with group PAH, Fulton′s index, RVEDD, RVWTd, IVSTd, PAID, WT and WA were significantly decreased, PV was increased, the expression of TGF-β1 and pSmad3 in right ventricular myocardial tissues was down-regulated, the expression of Smad7 was up-regulated ( P<0.05 or 0.01), and myocardial fibrosis was significantly improved in group PS. Conclusion:Sevoflurane can improve the myocardial fibrosis in right ventricle induced by PAH in rats, and the mechanism may be related to inhibiting activation of TGF-β1/Smad3 signaling pathway.
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Objective:To evaluate the effect of propofol on right ventricular hypertrophy induced by pulmonary arterial hypertension (PAH) in rats.Methods:Twenty-two clean-grade healthy adult male Wistar rats, weighing 250-280 g, were divided into 3 groups using a random number table method: control group (group C, n=8), PAH group (group PH, n=6) and propofol group (group P, n=8). In PH and P groups, monocrotaline 60 mg/kg was injected intraperitoneally to establish the model of PAH, while the equal volume of normal saline was administered in group C. Propofol 100 mg/kg was injected intraperitoneally twice a week for 6 consecutive weeks starting from 2 weeks after establishment of the model in group P. The weight of rats was measured before establishment of model and after administration, and the weight difference (△BW=weight after administration-weight before administration) was calculated.At the end of administration, the right ventricular end-diastolic dimension (RVEDD), right ventricular wall thickness in diastole (RVWTd), intraventricular septum in diastole (IVSd), left ventricular posterior wall in diastole (LVPWd) and maximal velocity of pulmonic valve (PV) were measured using cardiac ultrasound.The animals were then sacrificed, and the lungs and hearts were removed for examination of the pathological changes (after haematoxylin and eosin staining) and for determination of the degree of myocardial fibrosis in right ventricular (by Masson staining), expression of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in lung tissues and myocardial tissues of the right ventricle (by immunohistochemistry). Results:Compared with group C, △BW and PV were significantly decreased, RVWTd, IVTd and RVEDD were increased, the thickness of the wall of pulmonary arterioles and myocardial cell penetration area in right ventricular were increased, the expression of IL-6 and TNF-α in lung tissues and myocardial tissues of right ventricle was up-regulated ( P<0.05 or 0.01), inflammatory cell infiltration and structural disorders were found in lung tissues, and intercellular spaces were widened, and the myocardial tissue was extensively fibrotic in group PH.Compared with group PH, △BW and PV were significantly increased, RVWTd, IVTd and RVEDD were decreased, the thickness of the wall of pulmonary arterioles and myocardial cell penetration area (the area of cardiomyocytes in which the nucleus located in the middle) were decreased, the expression of IL-6 and TNF-α in lung tissues and myocardial tissues of right ventricle was down-regulated ( P<0.05 or 0.01), inflammatory cell infiltration, structural disorders, intercellular spaces and degree of fibrosis were improved in group P. Conclusion:Propofol can alleviate right ventricular hypertrophy induced by PAH, and the mechanism is probably related to reduction of inflammatory responses in rats.
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Objective:To evaluate the effect of jugular vein bulb pressure (JVBP) on postoperative cognitive function in elderly patients undergoing valve replacement-coronary artery bypass grafting under cardiopulmonary bypass (CPB).Methods:Ninety-two patients of both sexes, aged 65-75 yr, with body mass index of 18-25 kg/m 2, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with New York Heart Association class Ⅱ or Ⅲ, were selected.All the patients underwent right internal jugular vein catheterization to monitor central venous pressure (CVP) and retrograde catheterization to measure JVBP.JVBP was recorded immediately after anesthesia induction (T 11), 10 min after CPB (T 12) and at the end of operation (T 13). The patients were divided into 2 groups according to JVBP: JVBP<12 mmHg group (group L) and JVBP≥12 mmHg group (group H). At T 11-13 and on 1st and 2nd days after operation (T 14, 15), heart rate, mean arterial pressure (MAP) and central venous pressure (CVP) were recorded, and blood samples from the jugular vein bulb were collected to determine the concentrations of S100β protein and matrix metalloproteinase-9 (MMP-9) in plasma and nerve specific enolase (NSE) in serum.Cognitive function was evaluated by Mini-Mental State Examination (MMSE) at 1 day before operation (T 21), 3 and 7 days after operation (T 22, 23) and 3 months after operation (T 24). Results:A total of 80 patients were included in this study, including 46 patients in group L and 34 patients in group H. Compared with those at T 11, CVP, JVBP, and concentrations of S100β protein and MMP-9 in plasma and NSE in serum were significantly increased at T 12 in group H, and CVP at T 13-15 and JVBP at T 12, 13 and concentrations of S100β protein and MMP-9 in plasma and NSE in serum at T 12-15 were significantly increased in two groups ( P<0.05). MMSE scores were significantly lower at T 22, 23 than at T 21 in the two groups ( P<0.05). Compared with group L, JVBP at T 12, 13, CVP at T 12-14 and concentrations of S100β protein and MMP-9 in plasma and NSE in serum at T 13 were significantly increased, concentrations of S100β prote in plasma were increased at T 12, MMSE scores were decreased at T 22-24, and the incidence of POCD was increased in group H ( P<0.05). JVBP was positively correlated with CVP, plasma S100β protein, MMP-9 concentration and serum NSE concentration, and the r values were 0.95, 0.56, 0.70 and 0.58, respectively ( P<0.05). Conclusion:Increased JVBP can decrease the postoperative cognitive function of elderly patients undergoing valve replacement-coronary artery bypass grafting under CPB, and the mechanism is related to blood-brain barrier damage.
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Objective To evaluate the effect of autologous platelet-rich plasma(aPRP)on postop-erative outcomes in the patients undergoing Sun's procedure.Methods One hundred and sixteen patients with acute Stanford type A aortic dissection of both sexes,aged 18-64 yr,with body mass index of 19-34 kg/m2,of American Society of Anesthesiologist physical status Ⅳ,were divided into aPRP group(group A)and control group(group C)by a random number table method,with 58 cases in each group.After an-esthesia induction and intubation,aPRP preparation was completed before surgery in group A,and surgery began in group C.After heparin neutralization,group A received retransfusion of platelet-rich plasma,while group C received conventional fluid management.Thromboelastography was performed on all patients,and the results were recorded.The intraoperative amount of allogeneic blood products and blood loss were recorded in two groups.Plasma concentrations of tumor necrosis factor-alpha(TNF-α)and interleukin-6(IL-6)were recorded after anesthesia induction(T0),immediately after completion of aPRP preparation(T1),3 h after heparin neutralization(T2),and at 24 and 48 h after surgery(T3,4).The volume of post-operative chest drainage and amount of allogeneic blood products,mechanical ventilation time,lengths of intensive care unit and hospital stay,incidence of important complications and fatality rate within 30 days after surgery were also collected.Results Compared with group C,the intraoperative amount of allogeneic blood products and blood loss were significantly reduced,α angle and MA values of thromboelastograph were larger,plasma concentrations of TNF-α and IL-6 were reduced at T2,3,postoperative chest drainage volume and allogeneic blood transfusion were reduced,the postoperative mechanical ventilation time and length of hospital stay were shortened,and the incidence of pulmonary complications was reduced in group A(P＜0.05).There was no significant difference in the length of intensive care unit stay,incidence of other complications or fatality rate within 30 days after surgery between the two groups(P>0.05).Conclu-sion aPRP can improve postoperative outcomes in the patients undergoing Sun's procedure.
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Objective@#To evaluate the effect of autologous platelet-rich plasma (aPRP) on postoperative outcomes in the patients undergoing Sun′s procedure.@*Methods@#One hundred and sixteen patients with acute Stanford type A aortic dissection of both sexes, aged 18-64 yr, with body mass index of 19-34 kg/m2, of American Society of Anesthesiologist physical status Ⅳ, were divided into aPRP group (group A) and control group (group C) by a random number table method, with 58 cases in each group.After anesthesia induction and intubation, aPRP preparation was completed before surgery in group A, and surgery began in group C. After heparin neutralization, group A received retransfusion of platelet-rich plasma, while group C received conventional fluid management.Thromboelastography was performed on all patients, and the results were recorded.The intraoperative amount of allogeneic blood products and blood loss were recorded in two groups.Plasma concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) were recorded after anesthesia induction (T0), immediately after completion of aPRP preparation (T1), 3 h after heparin neutralization (T2), and at 24 and 48 h after surgery (T3, 4). The volume of postoperative chest drainage and amount of allogeneic blood products, mechanical ventilation time, lengths of intensive care unit and hospital stay, incidence of important complications and fatality rate within 30 days after surgery were also collected.@*Results@#Compared with group C, the intraoperative amount of allogeneic blood products and blood loss were significantly reduced, α angle and MA values of thromboelastograph were larger, plasma concentrations of TNF-α and IL-6 were reduced at T2, 3, postoperative chest drainage volume and allogeneic blood transfusion were reduced, the postoperative mechanical ventilation time and length of hospital stay were shortened, and the incidence of pulmonary complications was reduced in group A(P<0.05). There was no significant difference in the length of intensive care unit stay, incidence of other complications or fatality rate within 30 days after surgery between the two groups (P>0.05).@*Conclusion@#aPRP can improve postoperative outcomes in the patients undergoing Sun′s procedure.
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Objective To investigate the development of painless bronchoscope diagnosis and treatment under general anesthesia in five provinces and cities in China.Methods From December 2018 to February 2019,a self-designed electronic questionnaire was sent to related personnels in a department of anesthesiology in hospitals within the range of survey through the WeChat platform.The survey mainly included three aspects:basic information of hospital,development of bronchoscope diagnosis and treatment under general anesthesia and the specific management plan.Results Questionnaires were sent to 326 hospitals in total,and 261 hospitals responded with a response rate of 80.06％.Among the 261 hospitals involved in the survey,34 hospitals responded that no related diseases were found,and thus the number of valid questionnaires was 227,and the rate of valid questionnaires was 87.0％.Among the 261 hospitals,161 hospitals were tertiary hospitals,and 66 hospitals were secondary hospitals,with a constituent ratio of 70.9％ to 29.1％.The average development rate of painless bronchoscopy was 34.8％,the highest rate was 54.0％ in Beijing,and the lowest rate was 27.5％ in Hebei province.The average development rate of painless bronchoscopy was significantly higher in tertiary hospitals than in secondary hospitals (P＜0.05).The per capita GDP in each region in the past five years was positively correlated with the development of painless bronchoscopic surgery.In hospitals where painless bronchoscope diagnosis and treatment was not performed,the top three reasons for the greatest difficulties in carrying out painless bronchoscopy were insufficient personnel,inadequate technologies and restrictions on hospital management conditions.The number of hospitals using general anesthesia with laryngeal mask ventilation and monitoring anesthesia was larger than that of hospitals using local anesthesia (P＜0.05).In terms of the places where painless bronchoscope diagnosis and treatment was carried out,the number of hospitals selecting the operating room and endoscopic center was larger than that of hospitals choosing intensive care unit or ward,and the number of hospitals selecting the endoscopic center was larger than that of hospitals choosing the operating room (P＜0.05).In terms of anesthesia equipment application for painless bronchoscope diagnosis aud treatment,the number of hospitals applying bispectral index monitoring in operation was significantly less than that of hospitals applying anesthesia machines,micro-pumps and monitors (P＜0.05).In terms of medication for painless bronchoscope diagnosis and treatment,the number of hospitals applying muscle relaxants was significantly smaller and the number of hospitals using inhaled drugs and other types of drugs was less when compared with that of hospitals applying sedatives and analgesics (P＜0.05);for sedatives,the number of hospitals applying propofol was larger than that of hospitals applying other intravenous anesthetic drugs (P＜0.05);for analgesics,there was no significant difference in the number of hospitals applying fentanyl,sufentanil or fentanyl (P＞0.05);the number of hospitals applying sevoflurane was larger as compared with that of hospitals applying desflurane (P＜0.05);in terms of muscle relaxant drug use,there was no significant difference in the number of hospitals applying rocuronium,cisatracurium or vecuronium (P＞0.05).Conclusion At present,the development rate of painless bronchoscopy in China is lower,and the greatest difficulty in further developiment is the shortage of personnel.Bronchoscope diagnosis and treatment under laryngeal mask or under monitoring anesthesia is the most commonly used method in clinic,and general anesthesia under tracheal intubation is more suitable for highly difficult bronchoscope diagnosis and treatment.Opioids combined with propofol is the most commonly used anesthesia method.
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Objective To evaluate the protective effect of therapeutic hypercapnia on the lung during one-lung ventilation (OLV) in the patients undergoing pulmonary lobectomy.Methods Fifty patients of both sexes,aged 20-60 yr,with body mass index 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅱ,scheduled for elective pulmonary lobectomy,were randomly divided into 2 groups (n=25 each) using a random number table:control group (group C) and therapeutic hypercapnia group (group H).After induction of general anesthesia,the patients were endotracheally intubated and mechanically ventilated in volume-controlled mode.The ventilator settings were adjusted during two-lung ventilation to maintain the end-tidal pressure of carbon dioxide (PETCO2) at 25-35 mmHg.Group H inhaled the mixture of CO2 (3％-6％) and O2 (70％-82％) during OLV to maintain PETCO2 at 50-60 mmHg.Group C inhaled O2 (70％-88％) during OLV to maintain PETCO2 at 25-35 mmHg.Anesthesia was maintained with inhalation of sevoflurane and intravenous infusion of remifentanil.Immediately before OLV and at 30 min after restoration of two-lung ventilation,the airway peak pressure,airway plateau pressure and lung compliance were recorded,arterial blood samples were collected for blood gas analysis,and broncho-alveolar lavage fluid (BALF) from the collapsed lung and venous blood samples were collected for determination of tumor necrosis factor-alpha (TNF-α),interleukin-1beta (IL-1β),IL-6,IL-8 and IL-10 concentrations in BALF and serum by enzyme-linked immunosorbent assay.Oxygenation index was calculated.Results Compared with group C,the airway peak pressure and airway plateau pressure were significantly decreased,the lung compliance was significantly increased,the concentrations of TNF-α,IL-1β,IL-6 and IL-8 in BALF were significantly decreased,and the concentrations of IL-10 in BALF were significantly increased at 30 min after restoration of two-lung ventilation (P＜0.05),and no significant change was found in the oxygenation index and concentrations of inflammatory factors in serum in group H (P ＞ 0.05).Conclusion Therapeutic hypercapnia can improve pneumodynamics and attenuate inflammatory responses,and has no significant difference clinically in improving oxygenation during OLV in the patients undergoing pulmonary lobectomy.
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Objective To compare the effects of propofol-and sevoflurane-based anesthesia on postoperative cognitive dysfunction in elderly patients undergoing cardiac valve operation under cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 65-72 yr,weighing 60-80 kg,scheduled for elective cardiac valve operation under CPB,were randomly divided into 2 groups (n =40 each) using a random number table:propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S).In group P,propofo] was given by target-controlled infusion with the target plasma concentration of 0.5-2.0 μg/ml to maintain anesthesia.In group S,0.5％-2.5％ sevoflurane was inhaled for maintenance of anesthesia.Immediately after induction of anesthesia,at the end of operation,and at 6,12 and 24 h after operation,blood samples were taken from the superior vena cava for determination of plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations.Cognitive function was assessed at 1 day before operation,and at 3,7 and 30 days after operation.Results Compared with group P,the plasma matrix metalloproteinase-9,S100β protein and neuron-specific enolase concentrations at the end of operation and at 6 h after operation and incidence of postoperative cognitive dysfunction were significantly increased in group S (P ＜ 0.05).Conclusion Propofol-based anesthesia provides better cerebral protection than sevoflurane-based anesthesia,and the development of postoperative cognitive dysfunction is decreased in elderly patients undergoing cardiac valve operation under CPB.
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Objective To compare the cerebral protective effect of propofol and sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under cardiopulmonary bypass (CPB).Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients, aged 60-70 yr, scheduled for elective valvular surgery under CPB, were randomly divided into either propofol-based anesthesia group (group PA) or sevoflurane-based anesthesia group (group SA) , with 30 patients in each group.From induction of anesthesia to the end of surgery, group P received targetcontrolled infusion of propofol 0.5-2.0 μg/ml, and group S continuously inhaled 0.5％-2.5％ sevoflurane.Bispectral index value was maintained at 45-55.Immediately after induction (T0), at the end of surgery (T1) , and at 6, 12 and 24 h after surgery (T2-4) , the superior vena cava was retrogradely cannulated for blood sampling, and the concentrations of plasma S-100β protein and neuron-specific enzyme were determined using enzyme-linked immunosorbent assay.Results Compared with group SA, the plasma S-100β concentrations at T1,2 and neuron-specific enzyme concentrations at T1-3 were significantly decreased in group PA.Conclusion The cerebral protective effect of propofol combined with sufentanil anesthesia is superior to that of sevoflurane combined with sufentanil anesthesia in the patients undergoing valvular surgery under CPB.
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Objective To observe the effects of different anesthetic solutions on postoperative cognitive function and serum S100β protein levels.Methods A prospective randomized controlled trial was conducted. Ninety patients necessary to perform off-pump coronary artery bypass grafting (op-CABG) in Tianjin Chest Hospital from November 2013 to July 2014 were enrolled. They were divided into three groups by random number table: P1, P2 and P3 groups, 30 cases in each group. The anesthesia was maintained with propofol by target-controlled infusion (TCI) in all the patients in the three groups, and the respective dosages were 3.0 - 4.0μg/mL. The operation time, anesthesia time, dosages of propofol and the incidence of postoperative cognitive dysfunction (POCD) were compared among the three groups. At the following times: before induction of anesthesia (T0), completion of anesthesia induction (T1), after tracheal intubation (T2), skin incision (T3), 1 hour after operation (T4), 2 hours after operation (T5) and the end of operation (T6), the narcotrend index (NTI) and hemodynamic levels were observed; the serum S100β protein levels were measured at the following times: before induction of anesthesia (Ta), 2 hours after operation (Tb), the end of operation (Tc), postoperative 6 hours (Td) and postoperative 24 hours (Te).Results There were no significant differences in operation times and anesthesia times among three groups (allP > 0.05); dosages of propofol in P2 and P3 groups were obviously higher than those of P1 group (mg: 1 746.3±43.9, 2 332.7±42.8 vs. 968.5±35.6, bothP < 0.05), and the incidences of POCD in P2 and P3 groups were lower than that in P1 group (10.00%, 6.67% vs. 33.33%, bothP < 0.05). With the extension of anesthesia time, the level of NTI was gradually declined in each group, in P3 group, it was occasionally increased at T6, and beginning from time point T1 afterwards, the NTI levels were lower than those of P1 and P2 groups at all the time points (allP < 0.05); the mean arterial pressure (MAP) in the three groups had a tendency of firstly going down and then increasing, and the inflection point being at T2, in P1 group, the elevation of MAP level persisted to T4, and it began to decline at T5, while in P2 and P3 groups, the levels started to decline at T4; the heart rate (HR) in three groups showed a tendency of firstly going up and then declining, and the inflection point being at T3; until T6, in P3 group, MAP and HR were all lower than those of P1 and P2 groups, the differences being statistically significant [MAP (mmHg, 1 mmHg = 0.133 kPa): 74.9±8.3 vs. 85.3±11.2, 84.2±10.1;HR (bpm): 74.1±4.2 vs. 80.9±8.1, 78.7±7.9, allP < 0.05]. The serum S100β protein levels of three groups at Tb began to be obviously higher than those at Ta, and reached the peak points at Tc, then the levels started to decline until Td, and the levels at Te was approximately close to those of Ta, but the serum S100β protein levels in P2 and P3 groups were lower than that in P1 group, the differences being statistically significant (mg/L: 1.05±0.22, 1.04±0.21 vs. 1.33±0.22, bothP < 0.05).Conclusion Application of propofol by TCI 2.0 - 3.0μg/mL for maintenance of anesthesia can achieve the satisfactory depth of anesthesia, and it not only can reduce the effects on hemodynamics, but also can decrease the serum S100β protein level and the incidence of POCD.
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Objective To investigate the efficacy of prostaglandin E1 administered via the pulmonary artery for treatment of pulmonary hypertension in patients.Methods Thirty ASA Ⅱ or Ⅲ patients undergoing offpump coronary artery bypass grafting complicated with pulmonary hypertension,with pulmonary arterial systolic pressure (PASP) ＞ 40 mm Hg,were randomly divided into 2 groups (n =15 each):administration via the central vein group (group C) and administration via the pulmonary artery group (group P).Anesthesia was induced with midazolam,etomidate,cisatracurium and sufentanil.The patients were tracheal intubated and mechanically ventilated.Swan-Ganz catheter was placed via the right internal jugular vein for monitoring of hemodynamic parameters after induction of anesthesia.The central vein and pulmonary artery were cannulated for infusion of prostaglandin E1.Prostaglandin E1 was infused at a rate of 20-50 ng· kg-1 · min-1 starting from the end of skin incision until PASP was decreased to 20-30 mm Hg.Heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),PASP,pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) were recorded at 5 rain before administration (To) and 5 min after administration (T1).The pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) were calculated.The amount of prostaglandin E1 consumed was recorded.Results Compared with group C,the amount of prostaglandin E1 consumed was significantly reduced,PASP and PVR were decreased at T1,while MAP and SVR were increased at T1 in group P(P ＜ 0.05).Conclusion Administration via the pulmonary artery can increase the potency of prostaglandin E1 for treatment of pulmonary hypertension and exerts no influence on the systemic hemodynamics.
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Objective To compare the efficacy of patient-controlled intravenous analgesia (PCIA),patient-controlled paravertebral block (PCPB) and patient-controlled epidural analgesia (PCEA) in patients after lobectomy performed via video-assisted thoracoscope (VAT).Methods Forty-eight ASA Ⅰ or Ⅱ patients,aged 50-64 yr,with a body mass index of 20-25 kg/m2,undergoing elective lobectomy via VAT,were randomly divided into 3 groups ( n =16 each):PCIA group,PCPB group and PCEA group.PCIA solution contained sufentanil 2 μg/kg in 100 ml of normal saline,The PCA pump was set up with a 2 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 2 ml/h.PCPB solution contained 0.75％ ropivacaine 60 ml in 250 ml of normal saline and the pump was set up with a 5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 5 ml/h.The PCEA solution contained 0.75％ ropivacaine 50 ml and sufentanil 1 μg/kg in 250 ml of normal saline.The PCEA pump was set up to deliver a 5 ml bolus dose with a 15-min lockout interval and background infusion at 5 ml/h.VAS score was maintained ≤3.Peripberal venous blood samples were obtained before operation ( baseline),and at 24 and 48 h after operation for determination of the plasma cortisol concentration.The side effects were recorded.Results The plasma cortisol concentration and incidence of Somnolence were significantly lower in groups PCPB and PCEA than in group PCIA ( P ＜ 0.05 ).The plasma cortisol concentration was significantly lower in group PCEA than in group PCPB ( P ＜ 0.05).Compared with the baseline value,the plasma cortisol concentrstion was significantly higher after operation in groups PCIA and PCPB ( P ＜ 0.05),while no significant change was found in group PCEA ( P ＞ 0.05).Conclusion Compared with PCIA,PCEA can inhibit the stress response,while PCPB can reduce the stress response with good safety in patients after lobectomy performed via VAT if they can provide the equivalent postoperative analgesia.
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ObjectiveTo investigate the effects of dexmedetomidine on cerebral oxygen and glucose metabolism in patients undergoing mitral valve replacement under cardiopulmonary bypass (CPB).Methods Fiftyeight ASA Ⅱ or Ⅲ patients of both sexes aged 32-64 yr weighing 52-90 kg undergoing mitral valve replacement were randomly divided into 2 groups (n =29 each): control group (group C) and dexmedetomidine group (group D).Dexmedetomidine was infused iv at 0.5 μg· kg- 1 · h- 1 starting after tracheal intubation until the end of operation in group D,while in group C equal volume of normal saline was infused instead of dexmedetomidine.Blood samples were collected from radial artery and jugular venous bulb for blood gas analysis and determination of glucose and lactate concentrations before CPB (T1,nasopharyngeal temperature =36 ℃ ),during CPB (T2,nasopharyngeal temperature =30 ℃ ),immediately and 30 min after restoration of spontaneous heart beat ( T3,T4 ).Arterial O2 content ( CaO2 ),arteriovenous O2 content difference ( Da-jvO2 ),cerebral extraction of O2 ( CEO2 ),arteriovenous glucose and lactate content differences (Da-jvGlu and Da-jvLac) were calculated.ResultsThe Da-jvO2 and CEO2 were significantly decreased at T2 in group D as compared with group C.There was no significant difference in CaO2,Da-jvGlu and Da-jvLac between the 2 groups.ConclusionDexmedetomidine can reduce cerebral O2 metabolism and help maintain the balance between cerebral O2 supply and demand but has no effect on cerebral glucose metabolism in patients undergoing mitral valve replacement under CPB.
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Objective To evaluate the cardioprotective effect of dexmedetomidine in patients undergoing off-pump coronary artery bypass grafting. Methods Forty-six ASA Ⅱ or Ⅲ patients aged 37-64 yr weighing 54-81 kg undergoing off-pump coronary artery bypass grafting were randomized into 2 groups ( n = 23 each): control group (group C) and dexmedetomidine group (group D) . Dexmedetomidine was infused at 0.5 μg·kg-1·h-1 starting after induction of anesthesia until the end of operation in group D. Radial artery was cannulated and Swan-Ganz catheter placed via right internal jugular vein. HR, MAP, mean pulmonary arterial pressure, pulmonary capilary wedge pressure, central venous pressure, and cardiac output were recorded and stroke volume index, left and right ventricular stroke work index, systemic vascular resistance and pulmonary vascular resistance were calculated at the beginning of operation (T1 ), immediately (T2 ) and at 30 min after reestablishment of coronary blood flow (T3 ) and the end of operation (T4 ) . Venous blood samples were taken before induction of anesthesia (T0 , baseline) , at T4 and 4 h (T5 ) and 24 h (T6 ) after operation for determination of plasma concentration of cardiac troponin I by ELISA. Results Stroke volume index and left ventricular stroke work index were significantly higher at T4 while systemic vascular resistance was lower at T34 in group D than in group C. Plasma cardiac troponin Ⅰ concentration was significantly lower at T6 in group D than in group C. Conclusion Dexmedetomidine infusion at 0.5 μg ·kg-1·h-1 during operation can protect myocardium in patients undergoing off-pump coronary artery bypass grafting.