[Effect of intravenous lornoxicam at different doses on the immune function in patients undergoing total abdominal hysterectomy].

OBJECTIVE: To investigate the effect of intravenous lornoxicam (LOR) at different doses given preoperatively on the immune function of patients undergoing total abdominal hysterectomy (TAH). METHODS: Forty-five patients undergoing TAH were randomly divided into 3 groups, namely NS group, L8 group and L16 group with intravenous injection of 4 ml saline, 8 mg LOR, and 16 mg LOR before the induction of anesthesia respectively. Venous blood samples were taken before anesthesia (T0), at 30 min during the operation (T1), at the end of the operation (T2), and at 24 h and 48 h after the operation (T3 and T4, respectively) to determine the serum levels of regulated upon activation normal T cell expressed and secreted (RANTES), monocyte chemotactic protein-1 (MCP-1), and stromal cell-derived factor 1 alpha (SDF-1alpha) by enzyme-linked immunosorbent assay (ELISA). RESULTS: The serum RANTES levels in NS group and L8 group at T1-T3 were significantly lower than those at T0 (P<0.05), but the levels in L8 group at each time point were all higher than those in NS group NS (P<0.05). The serum RANTES levels in L16 group L16 only decreased at T1-T2 as compared to those at T0, and were significantly higher than those in NS group and L8 group (P<0.05). The expressions of MCP-1 and SDF-1alpha in the 3 groups all increased at T1 and reached the peak levels after the operation. In L8 group and L16 group, MCP-1 expression at T2-T3 and SDF-1alpha at T1-T2 were both significantly lower than those in NS group (P<0.05). SDF-1alpha expression at T1-T2 was significantly lower in L16 group than in L8 group (P<0.05). The decrements of MCP-1 and SDF-1alpha were more obvious in L16 group than L8 group. CONCLUSIONS: Preoperative intravenous LOR injection may increase serum RANTES level and decrease MCP-1 and SDF-1alpha expressions to effectively relieve the perioperative immune disorders caused by TAH, and the effect is more potent at the dose of 16 mg.

[Effects of etomidate infusion on serum cortisol in patients undergoing radical resection of lung cancer].

OBJECTIVE: To evaluate the effect of etodimate infusion on serum cortisol in patients undergoing radical resection of lung cancer operations during the perioperative period. METHODS: Forty ASA I-II patients undergoing radical resection of lung cancer were randomly divided into etomidate group (Group E) and propofol group (Group P) (n=20). The serum cortisol was measured at 8:00 am (T(0)) before anesthesia, 4:00 pm (T(1)) on the day of operation and 24 h after the operation (T(2)) by radioimmunoassay. RESULTS: Compared with that at T0, the serum level of cortisol significantly increased at 24 h after the operation in both groups (P<0.01); serum cortisol decreased lightly at T1, which was not statistically significant (P>0.05), and remained higher than the normal level. At each of the time points, serum cortisol levels were comparable between the two groups (P>0.05). CONCLUSION: Etomidate infusion can not inhibit the synthesis of cortisol in patients undergoing radical resection of lung cancer.

[Effect of controlled hypotension with different drugs combined with acute hypervolemic hemodilution on bleeding volume and gastrointestinal perfusion in nasal endoscopic surgery].

OBJECTIVE: To investigate the effect of controlled hypotension using different drugs on gastrointestinal perfusion and bleeding volume in nasal endoscopic surgery. METHODS: Thirty ASA class I or II patients scheduled for nasal endoscopic surgery were randomized into three groups, including a routine general anesthesia group (group A) and two controlled hypotension groups (groups B and C). After anesthesia induction, anesthesia was maintained with 1%-2% isoflurane and vecuronium. ECG, mean arterial blood pressure (MAP), heart rate (HR), SpO(2) and PETCO(2) were continuously monitored. TRIP tonometry catheter 14 F was inserted into the stomach and connected to Tonocap (Datex-Ohmeda, Finland ). In groups B and C, hypotension was induced with isoflurane (1%-2%) and sodium nitroprusside (0.3-3 microg.kg(-1).min(-1)), and with isoflurane (1%-2%) and glonoine (0.5-5 microg.kg(-1).min(-1)), respectively, and the MAP was reduced to 50-55 mmHg in 10-15 min. In groups B and C, blood samples were taken for blood gas analysis after anesthesia (T(0)), after acute hypervolemic hemodilution (T(1)), at 30 and 60 min after controlled hypotension (T(2) and T(3)), and 30 min after recovery from hypotension (T(4)). In group A, blood samples were taken at different time points in the perioperative period. RESULTS: The patients in groups B and C had smaller bleeding volume than those in group A. HR was decreased after moderate acute hypervolemic hemodilution, and increased after controlled hypotension (T(2) and T(3)) in comparison with that at T(1) to a level similar to that at T(0). No significant changes were found in pHi at T(2) and T(3) in comparison with that at T(1) in the three groups. CONCLUSION: When appropriate measures are taken, induced hypotension at 50-55 mmHg does not necessarily produce disturbance in gastrointestinal perfusion. Induced hypotension with glonoin can decrease the bleeding volume better than sodium nitroprusside in nasal endoscopic surgery.

[Effect of mechanical ventilation with different tidal volumes on the respiratory function during general anesthesia].

OBJECTIVE: To determine the effect of mechanical ventilation with different tidal volumes on the respiratory function during general anesthesia and to seek optimum way and parameters of mechanical ventilation during general anesthesia. METHODS: Forty ASA I-II patients scheduled for elective craniotomies in the supine position were included in this study. According to latin square design, the patients were randomly divided into 4 groups. Every group has its own tidal volume sequence. Each patient used 4 tidal volumes in turn. Every tidal volume maintained 30 minutes. The rate of mechanical ventilation was 15. But ECG, blood pressure, heart rate, SPO2, ETCO2, airway pressure, lung compliance, and blood gas analysis were continuously monitored. RESULTS: A-aDO2, P(a-ET)CO2, P(PEAK), P(MEAN), P(PLAT), C(DYN), and C(STAT) significantly increased as the tidal volume increased (P<0.05). But ETCO2 and PaCO2 decreased as the tidal volume increased (P<0.05). PaO2, SPO2, MAP and HR had no significant difference between the 4 tidal volume groups(P>0.05). CONCLUSION: The optimum tidal volume of mechanical ventilation is not 4 mL/kg at the rate of 15 respiratory rate during general anesthesia in the supine position because of a high arterial carbon dioxide tension. Yet 6-8 mL/kg is better for neurosurgical anesthesia. Increasing the tidal volume alone may not improve the respiratory function impairment during general anesthesia.

[Effects of different mechanical ventilation methods on oxygenation and shunt fraction in patients undergoing valve replacement].

OBJECTIVE: To determine the effects of different mechanical ventilation on oxygenation and shunt fraction in patient undergoing valve replacement. METHODS: Thirty ASA II-III patients (12 males, 18 females), aged 25-56 years, undergoing valve replacement were randomly divided into 3 groups according to the mechanical ventilation method. Anesthesia was induced with midazolam 0.1 mg/kg, fentanl 10 microg/kg,vecuronium 0.1 mg/kg,and etomidate 0.3 mg/kg. Valve replacement was performed with moderate hypothermic cardiopulmonary bypass( CPB). The patients were mechanically ventilated with pure oxygen and I:E ratio 1:2. Group A (TV = 7 ml/kg, f=12 bpm) ,Group B (TV=5 ml/kg, f=15 bpm), and Group C (TV=7 ml/kg, f=15 bpm). ECG, BP, SPO2, and CVP were routinely monitored. Blood samples were taken from the radial artery and pulmonary artery at 30 min after the induction of anesthesia, 10 min before CPB, and the end of operation for blood gas analysis. Respiratory index (P(A-a) DO2/PaO2), and Qs/Qt were calculated. RESULTS: There was no significant difference in age, weight, duration of operation of CPB time and aortic cross-clamping time among the 3 groups. At the end of operation, PaO2 decreased significantly, P (A-a)DO2, RI, and Qs/Qt increased significantly in group A, while there was no significant change in group B and group C. At the end of the operation, PaCO2 was lower than the baseline value (< 35 mmHg) in Group A, but it was normal in Group B and group C. CONCLUSION: The mechanical ventilation method of lower tidal volume and higher respiratory rate might increase the oxygenation and decrease shunt fraction and might be more suitable in patients undergoing valve replacement.