Postoperative Sleep Quality of Insomnia Patients After TIVA Anesthesia: A Prospective Study.

PURPOSE: The purpose of this study is to observe the postoperative sleep quality of insomnia patients undergoing laparoscopic gynecologic oncology surgery after total intravenous anesthesia. DESIGN: Prospective study. METHODS: We conducted a prospective, observational study in our hospital. All patients underwent propofol-remifentanil anesthesia without other sedative medications before or during the operation. Pittsburgh Sleep Quality Index (PSQI) scores of the baseline value, night-1 (the first night after surgery), night-3, night-5, and night-30 were observed. FINDINGS: Sixty-nine female insomnia patients were allocated based on the results of the PSQI and the diagnostic criteria of insomnia. The PSQI global scores were respectively 6 (5-8), 5 (4-6), 5 (3-6), and 6 (5-7) on night-1, night-3, night-5, and night-30, significantly lower than the baseline 7 (6-8) (P < 0.05). The 5 components (subjective sleep quality, sleep latency, sleep duration, sleep efficiency and daytime dysfunction) had significant changes at different postoperative time points (P < 0.05). The daytime dysfunction could also be improved 1 month after the surgery (P < 0.05). In contrast, the variations of sleep disturbance and use of sleep medication had no statistical differences. CONCLUSIONS: The sleep quality of female patients with insomnia was improved on the first night after surgery in the sides of sleep latency and daytime dysfunction, and the improvement could also be obtained 1 month after propofol-remifentanil general anesthesia.

GlideScope® versus C-MAC®(D) videolaryngoscope versus Macintosh laryngoscope for double lumen endotracheal intubation in patients with predicted normal airways: a randomized, controlled, prospective trial.

BACKGROUND: The double lumen endotracheal tube (DLT) is the most widely-used device for single lung ventilation in current thoracic anesthesia practice. In recent years, the routine application of the videolaryngoscope for single lumen endotracheal intubation has increased; nevertheless there are few studies of the use of the videolaryngoscope for DLT. We wondered whether there were benefits to using the videolaryngoscope for DLT placement in patients with predicted normal airways. Therefore, this study was designed to compare the performances of the GlideScope®, the C-MAC®(D) videolaryngoscope and the Macintosh laryngoscope in DLT intubation. METHODS: This was a randomized, controlled, prospective study. We randomly allocated 90 adult patients with predicted normal airways into three groups. All patients underwent routine anesthesia using different laryngoscopes according to group allocation. We compared DLT insertion times, first-pass success rates, numerical rating scales (NRS) of DLT delivery and DLT insertion, Cormack-Lehane degrees (C/L), hemodynamic changes and incidences of intubation complications. All outcomes were analyzed using SPSS13.0. RESULTS: Compared with the GlideScope, the Macintosh gave shorter times for DLT insertion (median: 96 (IQR: 51 [min-max: 62-376] s vs 73 (26 [48-419] s, p = 0.003); however, there was no difference between the Macintosh and C-MAC(D) (p = 0.610). The Macintosh had a significantly higher successful first attempt rate than did the GlideScope or C-MAC(D) (p = 0.001, p = 0.028, respectively). NRS of DLT delivery and insertion were significantly lower in the Macintosh than in the others (p < 0.001). However, the C/L degree in the Macintosh was significantly higher than in the others (p < 0.001). The incidences of oral bleeding, hoarseness, sore throat and dental trauma were low in all groups (p > 0.05). There were no significant differences in DLT misplacement, fiberoptic time or hemodynamic changes among the groups. CONCLUSIONS: Compared with the Macintosh laryngoscope, the GlideScope® and C-MAC®(D) videolaryngoscopes may not be recommended as the first choice for routine DLT intubation in patients with predicted normal airways. TRIAL REGISTRATION: The study was prospectively registered at the Chinese Clinical Trial Registry (no. ChiCTR1900025718); principal investigator: Z.L.H.; date of registration: September 6, 2019.

Divergent Effect of Dezocine, Morphine and Sufentanil on Intestinal Motor Function in Rats.

BACKGROUND: Opioid induced bowel dysfunction is the most common side effect of preoperatively administrated morphine, fentanyl and its derivative. However, the influence of dezocine on intestinal mobility is rarely reported. This study was designed to investigate the effects of dezocine, morphine and sufentanil on both intestinal smooth muscle contraction and propulsion in rats. METHODS: Contractile tension and frequency of isolated rat small intestine smooth muscle were measured using tension transducer after incubation with different concentrations of dezocine, morphine and sufentanil. The propulsive rate of methylene blue in rat intestinal tract was measured 30 minutes after intraperitoneal injection of morphine, sufentanil and dezocine. Percent of change in contractile tension and contraction frequency compared to baseline level were calculated to evaluate muscle contraction. Propulsive rate of methylene blue was calculated as the percentage of methylene blue moving distance in intestinal tract compared to the length of the small intestine. RESULTS: Morphine and sufentanil significantly increased the contractile tension of isolated small intestine smooth muscle at high doses. The contraction frequency did not change significantly among the 3 tested doses. Increasing the dose of dezocine from 1.7 mg.L(-1) to 10.2 mg.L(-1) did not change either the contractile tension or the contraction frequency. The propulsive rate of methylene blue in intestinal tract was significantly decreased after the treatment with morphine, sufentanil and dezocine (45.6%, 43.7%, and 42.1% respectively) compared to control group(57.1%), while the difference among the 3 drug groups were not significant. CONCLUSION: Morphine and sufentanil may dose dependently increase the contractile tension and contraction ability of isolated rat small intestine smooth muscle, while dezocine has no significant effect on intestine smooth muscle contraction. However, all these opioids might impair small intestinal propulsion.

Increase of beta-amyloid and C-reactive protein in liver transplant recipients with postoperative cognitive dysfunction.

BACKGROUND: Postoperative cognitive dysfunction (POCD) is an adverse condition characterized by declined cognitive functions following surgeries and anesthesia. POCD has been associated with increased hospital stay and mortality. There are histological similarities to Alzheimer's disease. Most early studies were conducted in patients receiving cardiac surgery. Since there is no information about POCD in liver transplant recipients, we measured the incidence of POCD in patients after liver transplantation and examined the correlation between neurological dysfunction and biological markers of dementia-based diseases. METHODS: We studied 25 patients who had a liver transplan-tation between July 2008 and February 2009. Patients with prior encephalopathy or risk factors associated with the development of POCD were excluded from the study. Five validated neuropsychiatric tests were used for diagnosis. The diagnosis was based on one standard deviation decline in two of the five neuropsychiatric tests. The correlation between patient variables and the development of POCD was examined. Serum levels of beta-amyloid and C-reactive protein were measured by standard ELISA and compared between patients with and without POCD. RESULTS: POCD was present in 11 (44%) of the 25 patients. Patients with POCD had significantly higher MELD scores, were more often Child-Pugh class C and received more blood transfusion during surgery. The serum beta-amyloid protein and C-reactive protein concentrations were significantly increased at 24 hours after surgery in the POCD group. CONCLUSIONS: The incidence of POCD in our group of liver transplant patients was greater than that reported in other surgical patients. The increase in the serum biomarkers of dementia in the POCD patients supports the hypothesis that chronic cognitive defects are due to a process similar to that seen in Alzheimer's disease.

Correlations between controlled endotracheal tube cuff pressure and postprocedural complications: a multicenter study.

BACKGROUND: Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness, and blood-streaked expectorant. In this study, we investigated the short-term (hours) impact of measuring and controlling endotracheal tube cuff (ETTc) pressure on postprocedural complications. METHODS: Five hundred nine patients from 4 tertiary care university hospitals in Shanghai, China scheduled for elective surgery under general anesthesia were assigned to a control group without measuring ETTc pressure, and a study group with ETTc pressure measured and adjusted. The duration of the procedure and duration of endotracheal intubation were recorded. Twenty patients whose duration of endotracheal intubation was between 120 and 180 minutes were selected from each group and examined by fiberoptic bronchoscopy immediately after removing the endotracheal tube. Endotracheal intubation-related complications including cough, sore throat, hoarseness, and blood-streaked expectorant were recorded at 24 hours postextubation. RESULTS: There was no significant difference in sex, age, height, weight, procedure duration, and duration of endotracheal intubation between the 2 groups. The mean ETTc pressure measured after estimation by palpation of the pilot balloon of the study group was 43 ± 23.3 mm Hg before adjustment (the highest was 210 mm Hg), and 20 ± 3.1 mm Hg after adjustment (P < 0.001). The incidence of postprocedural sore throat, hoarseness, and blood-streaked expectoration in the control group was significantly higher than in the study group. As the duration of endotracheal intubation increased, the incidence of sore throat and blood-streaked expectoration in the control group increased. The incidence of sore throat in the study group also increased with increasing duration of endotracheal intubation. Fiberoptic bronchoscopy in the 20 patients showed that the tracheal mucosa was injured in varying degrees in both groups, but the injury was more severe in the control group than in the study group. CONCLUSIONS: ETTc pressure estimated by palpation with personal experience is often much higher than measured or what may be optimal. Proper control of ETTc pressure by a manometer helped reduce ETT-related postprocedural respiratory complications such as cough, sore throat, hoarseness, and blood-streaked expectoration even in procedures of short duration (1-3 hours).

[Clinical evaluation of execution of early goal directed therapy in septic shock].

OBJECTIVE: To evaluate the efficacy of early goal directed therapy (EGDT) in septic shock. METHODS: Two hundred and three patients with septic shock were assigned into treatment group (n=98) and control group (n=105). According to the state of organ function at the beginning of treatment and multiple organ dysfunction syndrome (MODS) evaluation scores, each group was categorized into three strata: stratum A (mild organ dysfunction), stratum B (medium organ dysfunction) and stratum C (severe organ dysfunction). Mortality and incidence of organ dysfunction in each group were analyzed. RESULTS: At stratum A, the mortality and incidence of organ dysfunction in treatment group were significantly lower than those of control group [27.78% (15/54 cases) vs. 37.50% (18/48 cases), 31.48% (17/54 cases) vs. 43.75% (21/48 cases), both P<0.05]. There was no significant difference between treatment group and control group in patients of stratum B [75.86% (22/29 cases) vs. 76.92% (20/26 cases), 55.17% (16/29 cases) vs. 57.69% (15/26 cases)] and stratum C [93.33% (14/15 cases) vs. 96.77% (30/31 cases), 40.00 % (6/15 cases) vs. 41.93% (13/31 cases), all P>0.05]. CONCLUSION: In the earlier period of septic shock, EGDT can remarkably decrease the patients'mortality and incidence of organ dysfunction, but can not improve survival rate and prognosis in patients in advanced stage of septic shock.

Hippocampus bcl-2 and bax expression and neuronal apoptosis after moderate hypothermic cardiopulmonary bypass in rats.

Using a rat model of moderate hypothermic (26 degrees C-28 degrees C) cardiopulmonary bypass (CPB) with hemodilution, we investigated hippocampal apoptotic gene expression and neuronal apoptosis up to 6 h after CPB. The CPB was performed on male rats (380-400 g) under general anesthesia with isoflurane and fentanyl. The right atrium and tail artery were cannulated, and a peristaltic pump and membrane oxygenator were used for CPB. Two groups were studied: Group 1 consisted of fasted rats (n = 15) subjected to 60 min of moderate hypothermic nonpulsatile CPB; Group 2 consisted of sham-operated rats (n = 15). At 1 h after CPB, in 6 rats per group, hippocampus was processed for the apoptotic gene (bcl-2 and bax) messenger RNAs detection by reverse transcriptase polymerase chain reaction, and messenger RNA expression was determined by the ratio of the polymerase chain reaction product of bcl-2 or bax to the beta-actin gene. At 6 h after CPB, in 6 rats per group, hippocampus expression of Bcl-2 and bax protein was determined by immunohistochemistry, and neuronal apoptosis was detected by TUNEL. At 6 h after CPB, in three rats per group, changes in hippocampal CA1 neuronal ultra structure were determined with electron microscopy. Group 1 had increased ratios of bcl-2/beta-actin, bax/beta-actin, and bax/bcl-2 mRNA at 1 h after CPB (bcl-2/beta-actin, 0.82 +/- 0.14 versus 0.63 +/- 0.07; P = 0.03; bax/beta-actin, 1.04 +/- 0.14 versus 0.56 +/- 0.03; P = 0.00; bax/bcl-2, 1.31 +/- 0.12 versus 0.84 +/- 0.09; P = 0.02; Group 1 versus Group 2, respectively). Group 1 had increased bcl-2 and bax protein expression in hippocampal CA1 region at 6 h after CPB (bcl-2, 0.18 +/- 0.05 versus 0.09 +/- 0.01; P = 0.02; bax, 0.20 +/- 0.06 versus 0.04 +/- 0.02; P = 0.01; Group 1 versus Group 2, respectively). Group 1 had increased TUNEL staining in hippocampus CA1 at 6 h after CPB (0.14 +/- 0.02 versus 0.03 +/- 0.01; P = 0.00; Group 1 versus Group 2, respectively). In Group 1 CA1 hippocampus neurons, ultra-structural changes consistent with apoptosis occurred. In rats, moderate hypothermic CPB with hemodilution is associated with CA1 hippocampus bax and bcl-2 gene expression and neuronal apoptosis during the early post-CPB recovery period.

[Effects of moderate hypothermia on expression of nuclear factor-KappaB in rats with acute pancreatitis].

OBJECTIVE: To observe the dynamic changes in the DNA binding activity of nuclear factor-KappaB (NF-KappaB) in rat pancreatic and lung tissues in acute hemorrhagic necrotizing pancreatitis (AHNP), and investigate the effects of moderate hypothermia on AHNP-induced NF-KappaB binding activity in a time-dependent fashion. METHODS: A group of 24 rats was randomly divided into control group, 2, 5 or 12 hours groups after reproduction of AHNP. NF-KappaB binding activity in pancreas and lung tissues was determined using electrophoretic mobility shift assay (EMSA). In another group of 36 rats were randomized into three groups with equal number: sham-operated rats which were kept under 37-37.5 degrees C after laparotomy; AHNP rats with normothermia (37-37.5 degrees C); AHNP rats with moderate hypothermia (32-33 degrees C). Activity of NF-KappaB was assessed at 2 or 5 hours after reproduction of pancreatitis. RESULTS: DNA binding activity of NF-KappaB in pancreas and lung tissue of AHNP rats gradually increased after the development of pancreatitis, and NF-KappaB binding activity was more prominent in pancreas than that in lung tissue at each time point (all P<0.01). NF-KappaB binding activity was inhibited at 2 and 5 hours of moderate hypothermia in lung tissue (P<0.01), but there was no difference in pancreatic tissue between normothermic and hypothermic rats at each time point. CONCLUSION: These data suggest that the expression of NF-KappaB is significantly increased after the development of AHNP. Moderate hypothermia could inhibit the expression of NF-KappaB in lung tissue in acute pancreatitis.

Effects of dexmedetomidine on cellular immunity of perioperative period in children with brain neoplasms.

OBJECTIVE: To study the effects of dexmedetomidine (Dex) on cellular immunity during the perioperative period in children with brain neoplasms. METHODS: Forty children with brain neoplasms scheduled for selective operation were recruited and divided randomly into two groups. The Dex group was given a loading dose of 1 µg*kg(-1) Dex 15 minutes before anesthesia induction followed by a continuous infusion of 0.5 µg × kg(-1) × h(-1) Dex. Patients in control group received a same volume of normal saline for a same time period. Venous blood was collected before anesthesia (T0), 1 h after operation started (T1), immediately after operation ended (T2), 1 day after operation (T3) and 3 days after operation (T4), respectively. RESULTS: CD3 (+), CD4 (+), CD4 (+)/CD8 (+), NK and B cells at T1-T3 decreased significantly (P < 0.05) in both groups compared with those at T0, while the decrease of CD3 (+), CD4 (+), CD4 (+)/CD8 (+) and NK cells at T1-T3 and B cells at T1-T2 in Dex group was significantly less than the control group (P < 0.05). All values at T4 recovered to the level before anesthesia in both groups. CONCLUSION: Dex given by a continuous intravenous infusion during general anesthesia may effectively inhibit the stress responses and reduce the inhibition of cellular immunity in children with brain neoplasms during the perioperative period.

[Effect of acupuncture-drug compound anesthesia on alteration of immune function in patients undergoing open-heart surgery].

OBJECTIVE: To observe the effect of electro-acupuncture (EA) on alteration of immune function of patients undergoing open-heart surgery with cardiopulmonary bypass (CPB), and to appraise the value of acupuncture-drug compound anesthesia in the operation. METHODS: Thirty patients undergoing atrial septal defect repairing operation were selected and divided into three groups, Group A was the general anesthesia group; Group B, the acupuncture anesthesia group and Group C, the general anesthesia plus EA group. Peripheral venous blood of patients was collected at different time points, i.e. before anesthesia, before CPB, 30 min and 24 hrs after CPB, to determine natural killer cells activity (NKCA), and the levels of interferon-gamma (IFN-gamma) and interleukin-2 (IL-2) in supernatant of cell culture were also tested. RESULTS: NKCA was significantly lowered in Group A before CPB but increased in Group B, while no evident change was found in Group C, so the level of NKCA in Group B was significantly higher than in the other two groups. It lowered in all the three groups after CPB, especially evidently in Group B, so as to cause the NKCA level in Group B lower than that in Group A. The lowering further progressed, 24 hrs after CPB, NKCA in Group B was more reduced than that in Group C. Levels of IFN-gamma and IL-2 lowered in all the three groups after CPB, and further lowered at time point of 24 hrs after CPB, but the parameters in Group C were significantly higher than those in Group B. CONCLUSION: EA could enhance NKCA, but acupuncture anesthesia couldn't inhibit the suppressive effect of CPB on NKCA, IL-2 and IFN-gamma, suggesting that the immunosuppression induced by stress has a prior effect. General anesthesia plus EA yielded better effect than general anesthesia and acupuncture anesthesia, but it could't improve the immunosuppression completely, indicating that the compound anesthesia could partially improve the immunosuppression induced by CPB.

[Effects of moderate hypothermia on pancreatic injury and survival in rats with acute hemorrhagic necrotizing pancreatitis].

OBJECTIVE: To investigate the effect of moderate hypothermia on pancreatic injury and survival of rats with acute hemorrhagic necrotizing pancreatitis (AHNP). METHODS: A set of 112 rats were randomly divided into three equal groups: (1)sham-operated rats (n=24) which were kept at 37.0-37.5 centigrade after laparotomy; (2)AHNP rats (n=44) treated with normothermia (37.0-37.5 centigrade); (3)AHNP rats (n=44) treated with moderate hypothermia (32.0-33.0 centigrade). AHNP was induced by the infusion of 5% sodium taurocholate. Hypothermia was induced immediately after induction of pancreatitis by surface cooling until their rectal temperature reached 32.0-33.0 centigrade. Samples were obtained at 2 or 5 hours after pancreatitis induction in 24 rats of each group. Changes in serum amylase, lipase, wet/dry weight ratio and vascular permeability index, as well as pathology were observed. Another 40 rats of normothermic or hypothermic groups with AHNP were kept at scheduled temperature for 12 hours after pancreatitis induction. Survival was monitored for 72 hours. RESULTS: Serum amylase and lipase levels, vascular permeability index were significantly reduced at 2 or 5 hours, and pancreatic edema significantly reduced at 5 hours after pancreatitis induction in hypothermic group compared with normothermic group (all P<0.05). Mean survival time, which was 7.5 hours (3.0-18.0 hours) in normothermic group, was prolonged with hypothermia to 25.5 hour (13.0-72.0 hours). The survival of hypothermic animals was higher than normothermic ones after pancreatitis induction ( P=0.000 1). CONCLUSION: Moderate hypothermia applied after pancreatitis induction can provide protection against pancreatic injury, and increase survival in rats with AHNP. While the mechanism underlying this protection remains to be clarified, the findings of present study have implications for the possibility that hypothermia may be helpful as an adjunctive clinical therapy in acute pancreatitis.

[Changes of IFN-gamma, IL-2, IL-6 and IL-10 in the patient with cardiac surgery under combined acupuncture anesthesia].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on cytokines in the cardiac surgical patient and to evaluate the application of combined acupuncture anesthesia to cardiac surgery. METHODS: Thirty patients with atrial septal defect were divided into 3 groups, general anesthesia group (A), acupuncture anesthesia group (B) and combined general anesthesia and EA group (C). Peripheral blood samples were collected before anesthesia, before cardiopulmonary bypass (CPB), 30 min after CPB and 24 h after operation to determine the levels of interferon-gamma (IFN-gamma), interleukin-2 (IL-2), IL-6 and IL-10. RESULTS: The levels of IFN-gamma and IL-2 decreased in the 3 groups after CPB and further decreased 24 h after operation, and in the group C were higher than those in the group B. The levels of IL-6 and IL-10 significantly increased 24 h after operation in the 3 groups with no significant difference among the 3 groups. CONCLUSION: The general anesthesia combined with EA can not completely improve the decrease of IFN-gamma and IL-2 induced by CPB, indicating that the good response of the general anesthesia combined with EA to stress can partially improve the immunosupression induced by CPB. Acupuncture does not have significant effect on inflammatory cytokine reaction induced by cardiac surgery.

Mild hypothermia protects against sodium taurocholate (NaTc)-induced acute pancreatitis in rats with adverse effects on serum cytokines.

OBJECTIVES: To test the effect of mild hypothermia in reducing pancreatic damage and improving the survival of acute hemorrhagic and necrotic pancreatitis (AHNP) in rats. METHODS: Thirty-six male Sprague-Dawley rats were studied. Sham animals (n = 12) received laparotomy and normothermia; for AHNP with normothermia (n = 12), the core temperature was maintained at 37 degrees C to 37.5 degrees C after AHNP for 2 to 5 hours; for AHNP with hypothermia (n = 12), the core temperature was maintained at 32 degrees C to 33 degrees C afterward. Serum amylase and lipase, interleukin (IL)-1beta, and tumor necrosis factor (TNF-alpha) were measured. The pancreas was examined histologically. In a separate experiment, the core temperature was kept either in normothermia (n = 20) or mild hypothermia (n = 20) for 12 hours after the induction of AHNP; the animals were then returned to their cage. The survival rate was monitored up to 72 hours. RESULTS: Mild hypothermia significantly decreased the release of serum amylase and lipase compared with AHNP normothermia at 2 and 5 hours. Histology examination revealed significantly less tissue damage in AHNP hypothermia. There was a further increase in TNF-alpha and IL-1beta in AHNP in animals with hypothermia compared with normothermia animals. The application of mild hypothermia significantly improved the survival in animals induced with AHNP. CONCLUSIONS: Mild hypothermia decreases amylase and lipase release and improves a survival of AHNP in rats.