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Objective To explore the application effects of three-dimensional teaching mode for clinical anesthesiology. Methods 43 students were selected into control group, who were from class one, grade 2010 in the Department of Anesthesiology, Ningxia Medical University. 42 students were selected into observation group, who were from class two, grade 2010 in the Department of Anesthesiology, Ningxia Medical University. The traditional teaching mode were used for the students in control group during the teaching of clinical anesthesiology, while three-dimensional teaching mode were used for the students in observation group during the teaching. At the end of teaching, the teaching results were compared between the control group and the observation group, mainly including the usual scores evaluated from an anaesthesia plan plus an anaesthesia case discussion, and the final scores. The teaching satisfaction questionnaire were used to assess the effects of two teaching methods on the students' interest in learning, the capacity of clin-ical practice, the abilities of exploring, analyzing and solving problems, etc. SPSS 17.0 software was used in statistical analysis. The students' teaching results were tested by using two independent samples t-test. The satisfactions of these teaching effects were tested by using the Chi-square test. Results The usual and final scores in the observation group were significantly higher than those in the control group [(88.1±5.1) vs. (75.3±4.2), (82.1±3.3) vs. (75.7±3.9); P<0.05]. Compared with the control group, the satisfactions of teaching effects in the observation group were higher such as to stimulate interest in learning (60.5% vs. 90.5%), to improve the abilities of self-study (30.2% vs. 83.3%) and clinical practice (51.2% vs. 85.7%), to widen the scope of knowledge (46.5% vs. 88.1%) and to cultivate the spirits of innovation (55.8% vs. 83.3%), etc (P<0.05). Conclusion During the teaching of clinical anesthesiology, the three-dimensional teaching mode has more advantages than the traditional one, which is good for improving the students' innovation and practice abilities.
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Objective To investigate the role of orexin-A in doxapram-induced promotion of emergence from general anesthesia in patients.Methods Forty-four patients of both sexes,aged 18-60 yr,with body mass index of 21-25 kg/m2,of American Society of Anesthesiology physical status Ⅰ or Ⅱ,scheduled for elective lumbar surgery under general anesthesia,were divided into 2 groups (n =22 each) using a random number table:control group and doxapram group.Anesthesia was induced by intravenously injecting propofol,sufentanil and cisatracurium.The patients were mechanically ventilated after tracheal intubation.Anesthesia was maintained by inhaling sevoflurane and target-controlled infusion of remifentanil.Sevoflurane inhalation and remifentanil infusion were stopped at the end of operation,oxygen flow rate was adjusted to 6 L/min,doxapram 0.5 mg/kg were intravenously injected at the same time in doxapram group,and the equal volume of normal saline was given in control group.The emergence time and extubation time were recorded.On admission to operating room (T0),at 1 h after anesthesia induction (T1) and 5 and 30 min after tracheal extubation (T2,3),arterial blood samples were collected for determination of blood glucose concentrations and plasma orexin-A concentrations (by radioimmunoassay).Results Compared with the baseline at T0,blood glucose concentrations were significantly decreased at T1 and increased at T3,and plasma orexin-A concentrations were increased at T2 in two groups (P < 0.05).Compared with control group,the time to eye opening and extubation time were significantly shortened,plasma orexin-A concentrations were increased at T2 (P<0.05),and no significant change was found in blood glucose concentrations at each time point in doxapram group (P>0.05).Conclusion The mechanism by which doxapram promotes emergence from general anesthesia may be related to increasing plasma orexin-A concentrations in patients.
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Objective To investigate the current status of job burnout among anesthetists in Ningxia and to analyze its related risk factors.Methods A total of 310 anesthetists from 30 public hospitals in Ningxia were conducted to collect data on the job burnout by Maslach Burnout InventoryHuman Services Survey (MBI-HSS).The factors associated with severe job burnout and its three domains (high emotional exhaustion,high depersonalization and low personal accomplishment) were included in the multinomial logistic regression analysis.Results The incidence of job burnout and its three domains (high emotional exhaustion,depersonalization and low personal accomplishment) were 18 (5.81%) cases,134 (43.22%) cases,35 (11.29%) cases and 128 (41.29%) cases,respectively.Multinomial logistic regression analysis results indicated that the risk degree associated with job burnout was master and higher degree (OR=4.695,95%CI 1.556-4.172).The risk facts associated with three components of job burnout were work time per week [40-60 h (OR=4.420,CI 2.504-7.802);≥60 h (OR =7.469,95%CI 1.758-31.733)] and tertiary hospital (OR =1.847,95%oCI 1.112-3.069);master and higher degree (OR=2.306,95%CI 1.032-5.155),working years [6-15 years (OR=0.358,95%CI 0.135-0.949)] and cases of anesthesia per year [≥390 cases (OR =3.352,95%CI 1.301-8.639)];secondary hospital (OR =1.717,95%CI 1.045-2.823).Conclusion This survey indicates that job burnout exists among anesthetists in Ningxia and is mainly displayed in emotional exhaustion and low personal accomplishment domains.Master and higher degree tend to occur serve job burnout.
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<p><b>OBJECTIVE</b>To observe the effects of electroacupuncture (EA) pretreatment on the intestinal function, inflammatory reaction and blood lactic acid in the patients of colorectal cancer surgery.</p><p><b>METHODS</b>Sixty patients of colorectal cancer laparotomy at selective period, aged from 18 to 59 years old were selected. According toⅠ-Ⅲ grade of American Society of Anesthesiologists (ASA), the patients were randomized into group A (total intravenous anesthesia), group B[total intravenous anesthesia combined with EA pretreatment at Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) on the right side] and group C[total intravenous anesthesia combined with EA pretreatment at Zhongwan (CV 12), Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37) and Xiajuxu (ST 39) on the right side], 20 cases in each one. The total intravenous anesthesia was applied to all of the three groups. EA pretreatment was used one day before surgery and 30 min before surgery at corresponding acupoints in the group B and group C separately, 30 min each time. After surgery, the recovery time of bowel sound, the recovery time of flatus, the recovery time of defecation, the duration of diet fasting, the time of peritoneal drainage tube withdrawal and the total peritoneal drainage volume were observed in the three groups. The venous blood was collected to determine white blood cell count (WBC) and neutrophil count (NEUT) before surgery (T), 24 h after surgery (T) and on the 5th day after surgery (T) separately. The arterial blood was collected to determine the level of lactic acid before surgery (T), after peritoneal douching (T) and 24 h after surgery (T)separately.</p><p><b>RESULTS</b>The recovery time of bowel sound, the recovery time of flatus, the duration of diet fasting and the time of peritoneal drainage tube withdrawal in the group C were apparently earlier than those in the group A (all<0.05). WBC and NEUT at Tin the group C were apparently less than those in the group A (both<0.05). The differences in lactic acid at T, Tand Twere not significant statistically in comparison of the three groups (all>0.05).</p><p><b>CONCLUSIONS</b>The total intravenous anesthesia combined with EA pretreatment at Zusanli (ST 36), Shangjuxu (ST 37), Xiajuxu (ST 39), Tianshu (ST 25) and Zhongwan (CV 12) reduce the recovery time of bowel sound, the recovery time of flatus, the duration of diet fasting and the time of peritoneal drainage tube withdrawal so as to improve the recovery of intestinal function, reduce WBC in 24 h after surgery and alleviate inflammatory reaction. This therapy has no influence on blood lactic acid.</p>
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Objective To evaluate the effects of different doses of propofol on traumatic brain injury in rats .Methods Forty-eight healthy male Sprague-Dawley rats , aged 7-8 weeks , weighing 270-320 g , were randomly divided into 6 groups ( n=8 each ) using a random number table :sham operation group (group S ) , traumatic brain injury group (group I) ,fat emulsion group (group F) and low-dose propofol group (group L) , medium-dose propofol group (group M ) ,and high-dose propofol group (group H ) .Traumatic brain injury model was established according to the method described by Feeney .In group S ,0.9% normal saline was infused into the left femoral vein at 3.49 ml·kg-1 ·h-1 .In I ,F ,L ,M and H groups ,0.9% normal saline ,20% fat emulsion 3.49 ml·kg-1 ·h-1 ,and propofol 17.46 ,34.92 and 69.84 mg·kg-1 ·h-1 were infused into the left femoral vein ,respectively .Blood samples were collected from the right common carotid artery at 15 and 60 min of infusion (T1-2 ) for determination of serum S100β protein concentrations . The rats were then sacrificed after collecting blood samples at T2 and brains were removed for microscopic examination of the pathological changes of the cerebral cortex (light microscope ) and ultrastructure of neurons in the cerebral cortex (transmission electron microscope) .Results The serum S100β protein concentrations were significantly higher at T1 ,2 in the other five groups than in group S ( P<0.05 ) .Compared with I and F groups ,the serum S100βprotein concentrations were significantly decreased at T1 ,2 in L ,M and H groups ( P<0.05) .Compared with group L ,the serum S100βprotein concentrations were significantly decreased at T2 in M and H groups , and the serum S100β protein concentrations were increased at T1 in H group ( P< 0.05 ) . The serum S100β protein concentrations were significantly higher at T1 ,2 in H group than in group M ( P<0.05 ) .Light microscopic examination showed that nucleus condensation , cell necrosis , and cell edema were significantly attenuated in L ,M , and H groups as compared with group I;normal neurons could be found in group M .Transmission electron microscopic examination showed that the severity of neuronal damage was significantly attenuated in L ,M ,and H groups as compared with group I .Conclusion Different doses of propofol can reduce traumatic brain injury in rats .
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Objective To determine the risk factors contributing to deep vein thrombosis (DVT) in the lower extremity after orthopedic surgery.Methods Five thousand one hundred and thirty-three patients of both sexes,aged 18-89 yr,undergoing orthopedic surgery,were included in the study.Visits to patients were performed 1 day before surgery,and age,gender,body weight,diagnosis of diseases,smoking history,complications,medical history,and results of laboratory tests were recorded.General anesthesia,epidural anesthesia or combined spinal-epidural anesthesia,or field block (brachial plexus block or femoral nerve block) was performed during surgery.Ultrasound was performed on 7th day after surgery for detection of DVT.The patients were divided into DVTfree group and DVT group.The method of anesthesia,type and duration of surgery,postoperative use of low molecular heparin for anticoagulation,time for patients resumed ambulation were recorded.Multivariate logistic regression analysis was used to examine the relationship between these factors and to pick out the risk factors for DVT.Results Two hundred and twelve patients developed DVT after surgery.The incidence of DVT was 4.13 %.Logistic regression analysis showed that age > 64 yr,body mass index≥25 kg/m2,complications such as diabetes and hypertension,history of phlebeurysma,triglyceride ≥ 1.7 mmol/L,D-Dimer≥ 500 μg/L,duration of surgery > 4 h,general anesthesia,time for patients resumed ambulation ≥ 5 days were independent risk factors for DVT after orthopedic surgery.Conclusion Old age,obesity,history of phlebeurysma,complications such as diabetes and hypertension,high triglyceride and D-Dimer levels,long surgery,general anesthesia,prolonged duration of bed rest after operation are independent risk factors contributing to DVT in the lower extremity after orthopedic surgery.
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Objective To investigate the effects of pretreatment with remifentanil on hemorrhagic shock (HS)-induced acute liver injury in rabbits.Methods Thirty-two New Zealand white rabbits,weighing 2.0-2.5 kg,were randomly divided into 4 groups (n=8 each): sham operation group (group S) ; group HS,low-dose remifentanil group (group RL) ; high-dose remifentanil group (group RH).Remifentanil was infused at 0.66 and 1.32 μg· kg-1 · min-1 for 145 min in groups RL and RH respectively,while the equal volume of normal saline was infused in group C.HS was induced by withdrawing blood from the left femoral artery at 15 min after continuous infusion of normal saline or remifentanil and mean arterial pressure (MAP) was reduced to 40 mm Hg.MAP was reduced to 35-45 mm Hg and maintained at this level for 120 min in groups HS,RL and RH.Blood samples were taken for determination of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities before administration (T0),immediately before blood letting (T1),and at 10,30,60 and 90 min after blood letting (T3-6).The animals were then sacrificed and the livers were immediately removed for microscopic examination.Results Compared with group S,the serum ALT activity at T5 and T6 and serum AST activity at T4-T6 were significantly increased in the other three groups (P < 0.05).Compared with group HS,the serum ALT activity at T5 and T6,and serum AST activity at T4-T6 were significantly decreased in group RH,and no significant change was found in group RL (P > 0.05).Compared with group RL,the serum ALT activity at T5 and T6,and serum AST activity at T4-T6 were significantly decreased in group RH (P < 0.05).The serum ALT activity at T5 and T6 and serum AST activity at T4-T6 were significantly increased in groups HS,R and RH than those at T0 (P < 0.05 or 0.01).The patho1ogical injury was attenuated in group RH compared with groups HS and RL.Conclusion Remifentanil pretreatment can attenuate HS-induced acute liver injury in rabbits,and the effect is related to the dose.
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Objective To investigate the role of central and peripheral sensitization in remifentanil-induced hyperalgesia in a rat model of inflammatory pain. Methods Twenty-one male SD rats weighing 200-300 g were used in this study. Inflammatory pain was induced by intraplantar injection of 1 % carrageenan 100 fd in the left hindpaw in all animals. The animals were then randomly divided into 3 groups ( n = 7 each): control group (group C) and two remifentanil groups (group R1 , R2) . In R1 and R2 groups remifentanil was infused iv at a rate of 10 and 30 μg-kg-1·min-2 respectively starting from 5 min before till 25 min after carrageenan injection, while in group C normal saline was infused iv instead of remifentanil. Bilateral paw withdrawal threshold to mechanical stimulation with von Frey filament (PWT) was measured before (baseline) and at 1 h, 3 h and 1-7 d after carrageenan injection. Bilateral paw withdrawal latency to noxious thermal stimuli (PWL) was measured before and at 2 h, 4 h and 1-7 d after carrageenan injection. The thickness of the plantar surface of left hindpaw was measured before and at 1 h, 4 h and 1-7 d after carrageenan injection. Results Bilateral PWT was significantly lower at day 1 after carrageenan injection in R, and R2 groups than in group C. The right PWT was significantly lower at 2 d and 4-7 d after carrageenan injection in group R2 than in group R, . There was no significant difference in PWL and thickness of the plantar surface of left hindpaw among the 3 groups. Conclusion Central sensitization is involved in developing and maintaining the remifentanil-induced hyperalgesia in a rat model of inflammatory pain, while peripheral sensitization is not.
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Objective To investigate the effect of remifentanil pretreatment on lipid peroxidation following acute myocardial ischemia/reperfusion (1/R) in rabbits. MethodsForty healthy adult rabbits of both sexes weighing 1.5-2.5 kg were randomly divided into 5 groups (n = 8 each): group control (group Ⅰ ); group I/R(group Ⅱ ); group morphine pretreatment + I/R (group Ⅲ ); group remifentanil (group Ⅳ ) and group remifentanil pretreatment + I/R (group Ⅴ ). The animals were anesthetized with intraperitoneal 2% pentobarbital 45 mg/kg and were mechanically ventilated after tracheal intubation. PET CO2 was maintained between 35-45 mm Hg. Myocardial I/R was induced by iv pituitrin 2.5 U/kg in group Ⅱ , Ⅲ and Ⅴ. In group Ⅰ and Ⅳ normal saline 0.3 ml/kg was injected iv instead of pituitrin. In group Ⅲ morphine 3.3 mg/kg was injected iv at 30 min before iv pituitrin. In group Ⅳ and V remifentanil was infused at 3.3 μg· kg-1 ·min-1 for 30 min before iv normal saline and pituitrin.Venous blood samples were taken before (baseline) and at 24 h and 48 h after iv pituitrin for determination of serum cTnI concentration. The myocardial specimens were taken at T3 after blood sampling for microscopic examination and determination of SOD activity and MDA content. ResultsIntravenous pituitrin 2.5 U/kg significantly increased serum cTnI concentration and myocardial MDA content and decreased myocardial SOD activity in group Ⅱas compared with group Ⅰ . Morphine or remifentanil preatment significantly attenuated the myocardial I/R-induced changes mentioned above. Microscopic examination showed that myocardial tissue damages were ameliorated in group V as compared with group Ⅱ . ConclusionRemifentanil pretreament can attenuate acute myocardial ischemic injury by inhibiting lipid peroxidation.
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Objective To investigate the effects of remifentanil on lipid peroxidation druing hemorrhagic shock-induced acute lung injury (ALI) in rabbits. Methods Thirty-two healthy adult rabbits weighing 2.0-2.5 kg were randomly divided into 4 groups (n = 8 each): sham operation group (group S); ALI group; low-dose remifentanil group (group LR); high-dose remifentanil group (group HR). The left femoral artery was cannulated for blood-letting and blood sampling. The right femoral artery was cannulated for remifentanil administration. The model of hemorrhagic shock was established by modified Wigger' s methods. In group S, only cannulation was performed. In group LR and HR, remifentanil was infused intraperitoneally at 0.66 and 1.32 μg·kg-1 ·min-1 15 min before blood-letting respectively, while group ALI received equal volume of normal saline instead. Arterial blood samples were taken at 0, 20,70 and 100 min after blood-letting (T1-4) for blood gas analysis. The animals were then sacrificed and the lungs were immediately removed for histological examination with light microscope and determination of W/D lung weight ratio, MDA content and SOD activity. Results W/D ratio and MDA content were significantly increased, while SOD activity was significantly decreased in group ALI compared with group S (P <0.05). The pH value at T2 and PaO2 at T2-4 in group LR and the pH value and PaCO2 at T2-4 in group HR were significantly higher than those in group ALI (P < 0.05). W/D ratio and MDA content were significantly lower,while SOD activity was significantly higher in group LR and HR than in group ALI, and in group HR than in group LR (P < 0.05). Remifentanil infusion significantly attenuated the pathologic changes in a dose-dependent manner. Conclusion Remifentanil pretreatment can attenuate hemorrhagic shock-induced ALI through inhibiting lipid peroxidation in rabbits.
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Objective To investigate the effect of liver cirrhosis on the potency of propofol for sedation in rats. Methods Fifty-eight male SD rats, aged 10-12 weeks, weighing 180-220 g, were randomly divided into 3 groups: control group (group C, n = 18), mild liver cirrhosis group (group M1, n =20) and severe liver cirrhosis group (group M2, n = 20). The model of liver cirrhosis was established using four factors described by Chen et al. After successful establishment of the model, propofol was injected intravenously. The dose of propofol was determined by up-and-down sequential method for loss of righting reflex. The dose of propofol was 5.912 mg/kg in the first rat and the ratio of the doses between the two consecutive rats was 0.85. ED50 of propofol was calculated using up-and-down sequential method. Results ED50 of propofol was significantly lower in group M1 and M2 than in group C and in group M2 than in group M1 ( P < 0.05 or 0.01 ). Conclusion The liver cirrhosis can enhance the potency of propofol for sedation in rats.
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Objective To investigate the effects of remffentanil pretreatment on myocardial ischemiareperfusion (I/R) injury in rabbits. Methods Thirty healthy rabbits, aged 12-18 months, weighing 2.5-3.5 kg,were randomly divided into 3 groups (n = 10 each): I/R group, low-dose remifentanil pretreatment group (group R1 ) and high-dose remifentanil pretreatment group (group R2 ). Myocardial I/R was induced by ligation of anterior descending branch of left coronary artery for 30 min followed by 6 h of reperfusion in the 3 groups. Remifentanil was infused intavenously at 1.65 and 3.30 μg· kg - 1 · min- 1 for 30 min before ischemia in group R1 and R2 respectively, while equal volume of normal saline was infused instead in group I/R. Blood samples were taken for determination of serum cardiac troponin-Ⅰ (cTnI) and creatine kinase-MB isoenzyme (CK-MB) concentrations before administration (baseline), after administration, at 30 min of ischemia and at 6 h of reperfusion. The rabbits were then sacrificed and hearts removed. Myocardial tissues were obtained for microscopic examination. Results Serum cTnI and CK-MB concentrations were significantly lower in group R1 and R2 than in group I/R and serum cTnI concentration lower in group R2 than in group R1 ( P < 0.01). Remifentanil infusion significantly attenuated the pathologic changes in a dose-dependent manner. Conclusion Remifentanil pretreatment provides protective effect against myocardial I/R injury in rabbits and it is related to the dose.
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Objective To investigate the effects of endaravane on hypoxia-ischemia (HI)-induced brain injury in neonatal piglets. Methods Male piglets 3-7 days old weighing 2.0-3.0 kg were used in this study. Group Ⅰ 10 piglets were randomly collected as sham operation without HI. Twenty piglets with HI were randomly divided into 2 groups (n = 10 each) : group Ⅱ HI and group Ⅲ HI + endaravone. The animals were anesthetized with intraperitoneal pentobarbital sodium 50 mg/kg, tracheostomized and mechanically ventilated with 30% O_2. Right femoral artery and vein were cannulated. MAP, HR, PET CO_2, blood gases and glucose and rectal temperature were monitored. After 15 min stabilization cardiac arrest was induced by inhalation of hypoxic air (O_2 10%) for 40 min followed by inhalation of 21% O_2 for 5 min. The tracheal tube was then occluded for 7 min. Cardio-pulmonary resuscitation (CPR) was then started until recovery of spontaneous circulation (ROSC). CPR > 3 min was considered a failure. A bolus of endaravone 3 mg/kg was given iv over an hour at 30 min after CPR,followed by continuous infusion at 1.5 mg·kg~(-1)·h~(-1) for 5.5 h in group Ⅲ , while in group Ⅱ vehicle was given instead of endaravone. The neurological function of the animals was evaluated at 48, 72 and 96 h after ROSC and scored (0-154, 0 = normal, 154 = severest dysfunction). The animals were killed at 96 h after ROSC. The brains were removed for microscopic examination of striatum and cortex and determination of 8-hydroxy-2'-deoxyguanine (8-OHdG/OHG) expression in putamen by immuno-histochemistry. Results The neurological function scores were significantly higher at 48 h after ROSC and the number of viable neurons in striatum and sensory cortex were significantly lower and the expression of 8-OHdG/OHG in putamen was significantly higher in group Ⅱ than in group Ⅲ . Conclusion The antioxidant endaravone given after CPR can attenuate Hl-induced brain injury by inhibiting oxidative damage to DNA and RNA.
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Objective To investigate the effects of midazolam on hypoxic-ischemic (HI) brain injury in neonatal piglets.Methods Twenty-four newborn male piglets 3-7 days old weighing 1.8-3,0 kg were randomly divided into 3 groups ( n = 8 each): sham group (group S), HI + normal saline group (group HI-S) and HI + midasolam group (group HI-M). The animals of group HI-S and HI-M were subjected to 7 min of hypoxia, producing asphyxic cardiac arrest, followed by cardiopulmonary resuscitation. At 3 h after restoration of spontaneous circulation (ROSC), animals received i.v. infusion of fentanyl at a rate of 10-30 μg·kg-1·h-1 and pancuroniumat a rate of 0.1-0.2 mg·kg-1·h-1 from 3 h after ROSC to 24 h after ROSC to maintain the anesthesia. In addition, midazolam at a rate of 0.05 mg·kg-1·h-1 wee infused simultaneously until 24 h after ROSC in HI-M group, while the equal volume of normal saline was infused instead in group HI-S and S. Arterial blood samples were taken before hypoxia (baseline), and at 37 min of hypoxia, 5 min of air inspiration, 5 min of asphyxia and 6, 12, and 24 h after ROSC for blood gas analysis, and MAP was monitored at the each time point. Neurological behavior was assessed and scored (NBS) at 48, 72, 96 and 240 h after ROSC. Brains were removed at 10 h after ROSC, the remaining viable neurons in putamen and candate nucleus were counted and the density of viable neurons was determined using light microscopic examination. Results PaO2 was significantly decreased during hypoxia-eephyxia, and PaCO2 was significantly increased, while pH value and MAP were significantly decreased at 5 min of asphyxia in group HI-S and HI-M compared with group S and the baseline (P < 0.05).There were no significant differences in MAP and arterial blood gas analysis at the each time point between group HI-S and HI-M ( P > 0.05). The density of viable neurons in putamen and caudate nucleus was significantly lower, and NBS at 48-96 h after BOSC significantly higher in group HI-S and HI-M than in group S ( P < 0.05). The density of viable neurons in putamen and caudate nucleus was significantly higher and NBS at 72 and 96 h after ROSC significantly lower in group HI-M than in group HI-S ( P < 0.05). Conclusion Midazolam used at the early stage of cardiopulmonary resuscitation can attenuate HI brain injury in neonatal piglets.