Effect of postoperative application of esketamine on postoperative depression and postoperative analgesia in patients undergoing pancreatoduodenectomy: a randomized controlled trial protocol.

BACKGROUND: Pancreatoduodenectomy (PD) is traumatic, difficult to perform, and has a high incidence of postoperative complications and perioperative mortality. Postoperative complications and pain occur frequently and seriously affect the psychological status of patients. Esketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has analgesic and antidepressant effects. In this study, we aim to investigate the effect of esketamine on postoperative depression and pain in patients undergoing PD. METHODS/DESIGN: This prospective, single-center, randomized control trial will include 80 patients who will undergo elective PD. The patients will be randomly assigned to two groups: the experimental group that will receive esketamine (n = 40) and the control group (n = 40). In the esketamine group, the analgesic pump will be connected immediately after surgery. A solution of esketamine 1.5 mg/kg + sufentanil 2 µg/kg, diluted to 150 mL, will be administered continuously for 72 h at the background infusion and impact doses of 1 mL/h and 2 mL/time, respectively; the locking time will be 10 min. The control group will receive sufentanil 2 µg/kg that will be administered as per the esketamine group. The primary outcome will be the Hamilton Depression Scale (HAMD-17) score on the third day post-surgery (POD3). Secondary study indicators will include (1) visual analog scale (VAS) score and HAMD-17 score prior to surgery, immediately after entering the postanesthesia care unit (PACU) and 1, 2, 3, 4, and 5 days after surgery; (2) Richmond Agitation-Sedation Scale (RASS) score at 1, 2, 3, 4, and 5 days after surgery; (3) consumed doses of sufentanil and esketamine after surgery; (4) postoperative analgesia pump effective press times, rescue analgesia times, and rescue drug dosage, recording the number of rescue analgesia and rescue drug dosage at 6, 24, 48, and 72 h after the patient enters the PACU; (5) postoperative complications and adverse events; (6) postoperative hospital stay; (7) concentrations of brain-derived neurotrophic factor (BDNP), 5-hydroxytryptamine (5-HT), tumor necrosis factor (TNF-α) and interleukin-6, at 1, 3, and, 5 days post-surgery; and (8) the patient survival rate at 6 and 12 months post-surgery. DISCUSSION: The study hypothesis is that the postoperative HAMD-17 and VAS scores, incidence of postoperative adverse reactions, and concentration of serum markers BDNP, 5-HT, TNF-α, and IL-6 in the experimental group will be lower than those in the control group. TRIAL REGISTRATION: ClinicalTrials.gov ChiCTR2200066303. Registered on November 30, 2022. PROTOCOL VERSION: 1.0.

Intracranial electroencephalography features of young and old mice under midazolam administration.

Understanding the electroencephalography features of young and old patients treated with anesthetic drugs is important to allow accurate drug use in elderly patients. This study aimed to monitor the intracranial electroencephalography (in the cortex and hippocampus) in free-moving young and old mice under midazolam administration. Behavioral assessment revealed that compared with young mice, old mice had a longer immobility time with a similar midazolam dose. In both young and old mice, midazolam significantly suppressed the total, δ (0.5-4 Hz), θ (4-8 Hz), and α (8-12 Hz) power, and thus induced an increase in the relative ß (12-30 Hz) and γ (30-140 Hz) power. Age had a main effect on the γ frequency; specifically, under normal conditions, old mice had a lower γ power than young mice. After midazolam administration, the relative power of high γ frequency (50-140 Hz) remained lower in old mice than in young mice. Our findings suggest that a lower γ power is indicative of an aging brain.

Preoperative oral thyroid hormones to prevent euthyroid sick syndrome and attenuate myocardial ischemia-reperfusion injury after cardiac surgery with cardiopulmonary bypass in children: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Both euthyroid sick syndrome and myocardial ischemia-reperfusion injury are common and have been significantly associated with morbidity and mortality after pediatric cardiac surgery with cardiopulmonary bypass. This single-center, prospective, double-blind, randomized placebo-controlled clinical pilot trial was designed to assess if preoperative oral thyroid hormone therapy could prevent the occurrence of euthyroid sick syndrome (ESS) and attenuate myocardial ischemia-reperfusion injury (IRI) after cardiac surgery with cardiopulmonary bypass (CPB) in children. METHODS: Forty children aged 3 to 12 year, scheduled for elective congenital heart disease repair surgery with CPB, were randomized into 2 groups of equal size to receive the following treatments in a double-blind manner: placebo (control group) and thyroid tablet 0.4 mg/kg (trial group) taken orally once a day for 4 days before surgery. The perioperative serum thyroid hormone levels and hemodynamic variables were determined. The extubation time, duration of intensive care unit (ICU) stay, and use of inotropic drugs in the ICU were recorded. The myocardial expressions of heat shock protein 70 (HSP70), myosin heavy chain (MHC) mRNA, and thyroid hormone receptor (TR) mRNA were detected. The serum creatine kinase-MB (CK-MB) activity and troponin I (TnI) positive ratio at 24 hour after surgery were assessed. RESULTS: There were no significant differences in hemodynamic variables at all observed points, extubation time, and duration of ICU stay between groups. As compared with baselines on administration, serum triiodothyronine (T3) and free T3 (FT3) levels on the first, second, and fourth postoperative day, and serum thyrotropic-stimulating hormone (TSH), tetraiodothyronine (T4), and free T4 (FT4) levels on the first postoperative day were significantly decreased in the 2 groups. Serum T3, FT3, and T4 levels on the first and second postoperative day, and serum FT4 level on the first postoperative day were significantly higher in the trial group than in control group. As compared with the control group, the number of patients requiring inotropic drugs in the ICU, serum CK-MB activity, serum positive TnI ratio, and myocardial expression of MHCß mRNA were significantly decreased, and myocardial expressions of both HSP70 and MHCα mRNA were significantly increased in the trial group. CONCLUSIONS: In children undergoing cardiac surgery with CPB, preoperative oral small-dose thyroid hormone therapy reduces severity of postoperative ESS and provides a protection against myocardial IRI by increasing HSP70 and MHCα expression.

Effects of ulinastatin on early postoperative cognitive function after one-lung ventilation surgery in elderly patients receiving neoadjuvant chemotherapy.

We investigated the effects of ulinastatin on early postoperative cognitive dysfunction (POCD) after one-lung ventilation (OLV) surgery in elderly patients receiving neoadjuvant chemotherapy. Eighty elderly patients with preoperative neoadjuvant chemotherapy scheduling for radical esophagectomy under OLV were recruited. They were randomly divided into an ulinastatin pretreatment group (U group, n = 40) and a control group (C group, n = 40). The U group received 10,000 U/kg ulinastatin before anesthesia and 5000 U/kg daily on postoperative days 1 to 3, while C group received saline. Levels of interleukin (IL)-6, IL-10, C-reactive protein (CRP), and S-100ß protein were assayed before surgery, at the end of surgery, and on postoperative days 1 and 3. Patients underwent cognitive assessment 1 day before and 7 days after surgery. 38 patients in U group and 37 patients in C group completed the neuropsychological tests. The U group had a lower incidence of POCD than C group (23.7 % versus 45.9 %, P = 0.043). The levels of S-100ß protein, IL-6, IL-10, and CRP in both groups increased after surgery. The postoperative concentrations of S-100ß protein, IL-6, and CRP in U group were lower than those in C group. On postoperative day 3, compared with C group, the level of CRP in U group was lower, while that of IL-10 was higher. These findings demonstrate that ulinastatin can attenuate the elevation of S100ß protein levels and the incidence of POCD, most likely by the mechanism of reducing serum IL-6 and CRP levels and increasing IL-10 levels.

[Effects of NO3- stress on cucumber seedling growth and magnesium absorbing under suboptimal temperature].

The effects of NO3- stress on the growth and the magnesium absorption of cucumber seedlings were investigated after 1 and 14 d of suboptimal temperature [18 °C/12 °C (day/night)] treatment. The results indicated that the growth, net photosynthetic rate, transpiration rate, Fv/Fm and ΦPSII of cucumber seedlings were significantly inhibited by NO3- stress under suboptimal temperature. The magnesium content of cucumber seedlings was also significantly decreased compared with control treatment, especially in the IV treatment (suboptimal temperature +140 mmol · L(-1) NO3- + 1 mmol · L(-1) Mg2+), and the antagonistic impact of magnesium ion absorption on the absorption of potassium and calcium ion was observed. The magnesium deficiency symptom of cucumber seedlings could be partly alleviated by increasing the concentration of magnesium ion in the nutrient solution.

[Effect of remifentanil preconditioning on myocardial ischemia-reperfusion injury].

OBJECTIVE: To investigate the delayed cardioprotection induced by remifentanil in intact rat ischemia-reperfusion (I/R) models. METHODS: Totally 42 adult male Wistar rats weighing 200-300 g were randomly divided into 7 groups (n = 6 in each group): In Group I, rats were injected with normal saline via tail vein, performed with the regimen of 3 x 5-min intravenous (i.v.) infusion at a rate of 0.1 ml x kg(-1) min(-1) 24 h before I/R; In Group II, rats were treated according to the same experimental protocols as in Group I except receiving additional naloxone (0.1 mg/kg) 10 minutes before normal saline pretreatment; In Groups III, IV, V, and VI, rats were treated with remifentanil via tail vein, performed with the regime of 3 x 5-min i.v. infusion at a rate of 2 microg x kg(-1) x min(-1) 12 h, 24 h, 48 h, and 72 h before I/R; In Group VII, the rats were treated according to the same experimental protocols as in Group IV except that they received additional naloxone (0.1 mg/kg) 10 minutes before remifentanil pretreatment. Heart rate (HR), mean arterial pressure (MAP), and a lead II electrocardiogram were continuously monitored during IR process. To determine plasma concentration of creatine kinase myocardial isoenzyme-MB (CK-MB), arterial blood samples were obtained immediately before ischemia, and at the end of ischemia and reperfusion. After a 120-min reperfusion, heart was removed for the measurement of myocardial infarct size. Infarct size (IS) was expressed as percentage of the area at risk. RESULTS: HR, MAP, and rate-pressure product were not significantly different at each time points among all groups (P > 0.05). Compared with Group I, plasma concentrations of CK-MB at the end of ischemia and reperfusion and myocardial infarct size were significantly lower in Groups IV and V (P < 0.05). Compared with Group IV, plasma concentrations of CK-MB at the end of ischemia and reperfusion were significantly higher and myocardial infarct size was significantly larger in Group VII (P < 0.05). CONCLUSION: Remifentanil preconditioning induces delayed cardioprotection in intact rat ischemia-reperfusion model, which may be triggered via opioid receptors.

Median effective dose of remifentanil for awake laryngoscopy and intubation.

BACKGROUND: Awake intubation requires an anesthetic management that provides sufficient patient safety and comfort, adequate intubating conditions, and stable hemodynamics. In this prospective clinical study, our aim was to determine the median effective dose (ED(50)) of remifentanil in combination with midazolam and airway topical anesthesia for awake laryngoscopy and intubation. METHODS: Thirty-six female adult patients, scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were included in this study. Ten minutes after intravenous administration of midazolam 0.1 mg/kg, patients were assigned to receive remifentanil in bolus, followed by a continuous infusion. The bolus dose and infusion rate of remifentanil were adjusted by a modified Dixon's up-and-down method. Patient's reaction score at laryngoscopy and an Observer's Assessment of Alertness/Sedation Scale (OAA/S) were used to determine whether the remifentanil dosage regimen was accepted. During laryngoscopy, 2% lidocaine was sprayed into the airway to provide the topical anesthesia. ED(50) of remifentanil was calculated by the modified Dixon up-and-down method, and the probit analysis was then used to confirm the results obtained from the modified Dixon's up-and-down method. In the patients who were scored as "accept", patient's OAA/S and reaction scores at different observed points, intubating condition score and patient's tolerance to the endotracheal tube after intubation were evaluated and recorded. Blood pressure and heart rate at different measuring points were also noted. RESULTS: ED(50) of remifentanil for awake laryngoscopy and intubation obtained by the modified Dixon's up-and-down method was (0.62 +/- 0.02) microg/kg. Using probit analysis, ED(50) and ED(95) of remifentanil were 0.63 microg/kg (95% CI, 0.54 - 0.70) and 0.83 microg/kg (95% CI, 0.73 - 2.59), respectively. Nineteen patients who were scored as "accept" had an OAA/S of > 15 and tolerated well laryngoscopy without significant discomfort or gagging. The mean intubating condition score was 1.8 +/- 0.8. The endotracheal tube was well tolerated. During awake laryngoscopy and intubation, blood pressure and heart rate were also kept stable. The postoperative follow up showed that no patient recalled discomfort and pain for airway manipulation. CONCLUSIONS: When combined with midazolam 0.1 mg/kg and airway topical anesthesia, ED(50) of remifentanil for successful awake laryngoscopy and intubation is 0.62 microg/kg in bolus followed by continuous infusion of 0.062 microg*kg(-1)*min(-1). This sedation and analgesia regimen can provide patient safety and comfort, ensure adequate intubating conditions, maintain hemodynamic stability, and prevent negative recall of the airway procedure.

Clinical assessment of awake endotracheal intubation using the lightwand technique alone in patients with difficult airways.

BACKGROUND: There is few study to determine whether the use of the lightwand technique alone could achieve effective, safe and successful awake endotracheal intubation (ETI), therefore we designed a prospective clinical study to systematically evaluate the feasibility, safety and efficacy of awake ETI using the lightwand alone in patients with difficult airways. METHODS: Seventy adult patients with difficult airways were enrolled in this study. After the desired sedation with fentanyl and midazolam, airway topical anesthesia was performed with 9 ml of 2% lidocaine, which were in order sprayed in three aliquots at 5 minutes intervals into the supraglottic (two doses) and laryngotracheal areas (one dose) using a combined unit of the lightwand and MADgic atomizer. After airway topical anesthesia, awake ETI was performed using a Lightwand. Subjective assessments by patients and operators using the visual analogue scores (VAS), and objective assessments by an independent investigator using patients' tolerance and reaction scores, coughing severity, intubating conditions and cardiovascular variables were taken as the observed parameters. RESULTS: Of 210 airway sprays, 197 (93.8%) were successfully completed on the first attempt. The total time for airway spray was (14.6 +/- 1.5) minutes. During airway topical anesthesia, the average patients' tolerance scores were 1.7 - 2.3. After airway topical anesthesia, the mean VAS for discomfort levels that the patients reported was 6.5. Also airway topical anesthesia procedure was rated as acceptable and no discomfort by 94.3% of patients. The lightwand-guided awake ETI was successfully completed on first attempt within 29 seconds in all patients. During awake ETI, patients' reaction and coughing scores were 1.9 and 1.6, respectively. All patients exhibited excellent or acceptable intubating conditions. Cardiovascular monitoring revealed that changes of systolic blood pressure and heart rate at each stage of airway manipulations were less than 20% of baseline values. The postoperative follow-up showed that 95.7% of patients had no recall or slight memories of all airway instrumentation. The incidence of postoperative mild airway complications was 38.6%. CONCLUSION: Alone use of the lightwand technique can achieve effective, safe and successful awake ETI in patients with difficult airways.

Comparison of bolus remifentanil versus bolus fentanyl for blunting cardiovascular intubation responses in children: a randomized, double-blind study.

BACKGROUND: The authors found no study to compare the efficacy of bolus dose fentanyl and remifentanil blunting the cardiovascular intubation response in children, so they designed this randomized, double-blind clinical study to assess the effects of remifentanil 2 microg/kg and fentanyl 2 microg/kg by bolus injection on the cardiovascular intubation response in healthy children. METHODS: One hundred and two children, the American Society of Anesthesiologists (ASA) physical status 1-2 and scheduled for elective plastic surgery under general anesthesia, were randomly divided into one of two groups to receive the following treatments in a double blind manner: remifentanil 2 microg/kg (Group R) and fentanyl 2 microg/kg (Group F) when anesthesia was induced with propofol and vecuronium. The orotracheal intubation was performed using a direct laryngoscope. Blood pressure (BP) and heart rate (HR) were recorded before anesthesia induction (baseline values), immediately before intubation, at intubation and every minute for 5 minutes after intubation. The percent changes of systolic blood pressure (SBP) and HR relative to baseline values and the rate pressure product (RPP) at every observing point were calculated. The incidences of SBP and HR percent changes >30% of baseline values and RPP >22,000 during the observation were recorded. RESULTS: There were no significant differences between groups in the demographic data, baseline values of BP and HR and the intubation time. As compared to baseline values, BP, HR and RPP at intubation and their maximum values during observation increased significantly in Group F, but they all decreased significantly in Group R. BP, HR and RPP at all observed points, and their maximum values during the observation, were significantly different between groups. There were also significant differences between groups in the percent change of SBP and HR relative to baseline values at all observed points and their maximum percent changes during the observation. The incidences of SBP and HR percent increased >30% of the baseline values and RPP >22,000 during the observation, were significantly higher in Group F than in Group R, but the incidences of SBP and HR percent decreased >30% of baseline values were significantly lower in Group F compared with Group R. CONCLUSIONS: When used as part of routine anesthesia induction with propofol and vecuronium in children, fentanyl 2 microg/kg by bolus injection fails to effectively depress the cardiovascular intubation response. Remifentanil 2 microg/kg by bolus injection can completely abolish the cardiovascular intubation response, but also cause more adverse complications of temporary significant cardiovascular depression.

Bolus dose remifentanil and sufentanil blunting cardiovascular intubation responses in children: a randomized, double-blind comparison.

BACKGROUND AND OBJECTIVE: The present randomized controlled study was designed to compare the efficacy of remifentanil 2 microg kg(-1) and sufentanil 0.2 microg kg(-1) by bolus injection on the cardiovascular response to intubation in healthy children. METHODS: One hundred and five children, ASA 1-2 and scheduled for elective plastic surgery under general anaesthesia, were randomly divided into one of two study groups to receive the following treatments in a double-blind manner: remifentanil 2 microg kg(-1) (group R) and sufentanil 0.2 microg kg(-1) (group S). Blood pressure and heart rate (HR) were recorded before anaesthesia induction (baseline values), immediately before intubation (postinduction values), at intubation and every minute for 5 min after intubation. The percentage changes in systolic blood pressure (SBP) and HR relative to baseline values were calculated. The incidences of SBP and HR percentage changes of more than 30% of baseline values during the observation were recorded. RESULTS: As compared with baseline values, blood pressure and HR at intubation and their maximum values during the observation increased significantly in group S, but decreased significantly in group R. Blood pressure and HR at intubation and their maximum values during the observation were significantly different between the groups. There were significant differences between the groups in the percentage changes of SBP and HR relative to baseline values and their maximum percentage changes during the observation. The incidences of SBP and HR percentage increases of more than 30% of baseline values were not significantly different between the groups, but the incidences of SBP and HR percentage decreases of more than 30% of baseline values were significantly higher in group R than in group S. CONCLUSION: In combination with propofol for anaesthesia induction in children, sufentanil 0.2 microg kg(-1) by bolus injection fails to depress the cardiovascular intubation response. Remifentanil 2 microg kg(-1) by bolus injection can completely abolish the cardiovascular intubation response, but causes more adverse cardiovascular depression.

Clinical experience of airway management and tracheal intubation under general anesthesia in patients with scar contracture of the neck.

BACKGROUND: Because patients with scar contracture of the neck are at a high risk of loss of the airway control after anesthesia induction, awake intubation is usually recommended. This retrospective clinical study was designed to evaluate the possibility, safety and efficacy of airway management and tracheal intubation under general anesthesia in such patients. METHODS: This retrospective study included 1683 patients from January 1994 to December 2006 with scar contracture of the neck, aged 1.5 - 67.0 years, who were scheduled for elective plastic surgery under general anesthesia in Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. Based on the results of the preoperative airway assessment, the patients were classified into group 1 (including 1375 patients with the atlanto-occipital extension of > 20 degrees and the Mallampatti's grade I or II) and group 2 (containing 308 patients with the atlanto-occipital extension of < 20 degrees and the Mallampatti's grade III or IV. In group 1, the intravenous induction and maintenance of anesthesia and succinylcholine for muscle relaxation were used. The intubation was done using a modified Macintosh technique. In group 2, the total intravenous anesthesia (TIVA) or the sevoflurane inhalation anesthesia was chosen and the spontaneous breathing was reserved during anesthesia. The intubation was performed by a fiberoptic stylet laryngoscope (FOSL). The number of intubation attempts, intubation time and relative complications were observed and recorded in all patients. RESULTS: In group 1, the intubation was accomplished during the first attempt in 1279 cases (93%) and the intubation time was < 3 minutes in 1304 cases (95%). In group 2, the intubation was completed by the first attempt in 114 patients (37%) and 123 patients had an intubation time of < 3 minutes (40%). Tracheal intubation was successful by the second or third attempt in 96 patients in group 1 and 156 patients in group 2. Thirty-eight patients required four or more attempts which only occurred in group 2. The incidence of traumatic complication was 2.6% and 9.7% with one intubation attempt in groups 1 and 2, respectively, 12.5% and 17.0% with multiple intubation attempts (one vs multiple attempts in both groups, P < 0.001). All non-traumatic complications occurred in group 2 and laryngospasm and hypoxemia were more common in patients using the TIVA compared to those using the sevoflurane inhalational anesthesia (P < 0.001). CONCLUSIONS: This study demonstrated that with a precise airway evaluation, an adequate preoperative preparation and a pre-planned failed intubation strategy, the anesthetist who was experienced in the difficult airway management could safely perform airway control and tracheal intubation under general anesthesia in patients with scar contracture of the neck. We believe that this technique may be very valuable for the management of a known difficult airway because it is comfortable for the patient and saves time for the anesthetist.

Circulatory responses to nasotracheal intubation: comparison of GlideScope videolaryngoscope and Macintosh direct laryngoscope.

BACKGROUND: The GlideScope videolaryngoscope (GSVL) has been shown to have no special advantage over the Macintosh direct laryngoscope (MDL) in attenuating the circulatory responses to orotracheal intubation, but no study has compared the circulatory responses to nasotracheal intubation (NTI) using the two devices. This prospective randomized clinical study was designed to determine whether there was a clinically relevant difference between the circulatory responses to NTI with the GSVL and the MDL. METHODS: Seventy-six adult patients were randomly allocated equally to the GSVL group and the MDL group. After induction of anesthesia, NTI was performed. Non-invasive blood pressure (BP) and heart rate (HR) were recorded before induction (baseline values) and immediately before intubation (post-induction values), at intubation and every minute for a further five minutes. During the observation, times required to reach the maximum values of systolic BP (SBP) and HR, times required for recovery of SBP and HR to postinduction values and incidence of SBP and HR percent changes > 30% of baseline values were also noted. The product of HR and systolic BP, i.e. rate pressure product (RPP), and the areas under SBP and HR vs. time curves (AUC(SBP) and AUC(HR)) were calculated. RESULTS: The NTI with the GSVL resulted in significant increases in BP, HR and RPP compared to postinduction values, but these circulatory changes did not exceed baseline values. BPs at all measuring points, AUC(SBP), maximum values of BP and incidence of SBP percent increase > 30% of baseline value during the observation did not differ significantly between groups. However, HR and RPP at intubation and their maximum values, AUC(HR) and incidence of HR percent increase > 30% of baseline value were significantly higher in the MDL group than in the GSVL group. Times required for recovery of SBP and HR to postinduction values were significantly longer in the MDL group than in the GSVL group. CONCLUSIONS: The pressor response to NTI with the GSVL and the MDL was similar, but the tachycardiac response to NTI was lesser and of a shorter duration when using a GSVL than when using an MDL.

[Comparison of cardiovascular responses between orotracheal and nasotracheal intubation with the aid of GlideScope video laryngoscope].

OBJECTIVE: To compare the cardiovascular responses to orotracheal or nasotracheal intubation with the aid of GlideScope video laryngoscope (GSVL). METHODS: Sixty patients, American Society of Anesthesiologists (ASA) physical status I, aged 16-50 years, scheduled for elective plastic surgery under general anesthesia,were randomly allocated equally to the orotracheal intubation group (OTI group) and the nasotracheal intubation group (NTI group). After the routine anesthesia induction, orotracheal and nasotracheal intubation was respectively performed with the aid of GSVL. Non-invasive blood pressure and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), during intubation and every minute for 5 minutes after intubation. Maximum values of blood pressure and HR during the observation periods were recorded. The product of HR and systolic blood pressure [rate pressure product (RPP)] at every time point was calculated. Duration for glottis exposure and duration for successful intubation were also noted. RESULTS: There were no significant differences between two groups in the demographic data (P>0.05). Glottis exposure time and intubation time in NTI group were significantly longer than those in OTI group [(52.2+/-13.5) seconds vs. (40.5+/-15.2) seconds, P<0.05]. After anesthesia induction, blood pressure and RPP in both groups decreased significantly compared with baseline values, but no significant change in HR was noted. Compared with their postinduction values, the blood pressure and RPP in both groups and HR in OTI group increased significantly at intubation. In OTI group,the maximum values of HR, diastolic blood pressure (DBP), mean arterial pressure (MAP), RPP exceeded their baseline values. But in NTI group,only maximal HR during the observation period was significantly higher than the baseline values. The blood pressure at every time point was not significantly different between two groups. But intubation in OTI group caused significant increases in HR and RPP compared with those in NTI group (both P<0.05). CONCLUSION: In anesthetized adult patients, orotracheal and nasotracheal intubations with the GSVL can result in a similar pressor response, however orotracheal intubation with GSVL causes more marked cardiovascular responses than nasotracheal intubation with the aid of GSVL.

Hemodynamic responses to tracheal intubation with the Glidescope videolaryngoscope: a comparison of oral and nasal routes.

BACKGROUND: Although there have been numerous favorable reports on the uses of the GlideScope videolaryngoscope (GSVL) in oral and nasal intubations, no study has compared the hemodynamic responses to oral and nasal intubations with the GSVL in a single clinical trial. The purpose of this randomized clinical study was to determine whether there was a clinically relevant difference between the hemodynamic responses to oral and nasal intubations with the GSVL. METHODS: A total of 71 patients, ASA physical status I, aged 18-50 years, scheduled for elective plastic surgery under general anesthesia, were randomly allocated to the oral intubation group (OI group) and the nasal intubation group (NI group). Noninvasive blood pressure (BP) and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation and every minute for a further 5 minutes. Maximum values of BP and HR during the observation were noted. The product of HR and systolic blood pressure (rate pressure product, RPP), the percent changes of systolic blood pressure (SBP) and HR relative to the baseline values at every measuring point, and the areas under the SBP and HR versus time curves were calculated. RESULTS: The intubation time was significantly longer in the NI group than in the OI group. The total incidence of difficulties encountered during laryngoscopy and intubation were higher in the OI group than in the NI group (29% vs. 6%, p < 0.05). BP at all measuring points, the maximum values of BP, the area under the SBP versus time curve, and the incidence of SBP percent increase more than 30% of baseline value did not differ significantly between the two groups. However, HR and RPP at intubation and their maximum values during the observation, the area under the HR versus time curve, and the incidence of HR percent increase more than 30% of baseline value were significantly higher in the OI group than in the NI group (p < 0.05). As compared with the NI group, the times required to reach the maximum values of SBP and HR were significantly shorter and the times required for recovery of SBP and HR to postinduction values were significantly longer in the OI group (p < 0.05). CONCLUSION: In anesthetized adult patients, oral and nasal intubations with the GSVL can result in a similar pressor response. However, the tachycardic response to nasal intubation using a GSVL is smaller and of shorter duration than that to oral intubation using a GSVL.

[Influence of pressure on cricoid on insertion ProSeal laryngeal mask airway and ventilation function].

OBJECTIVE: To assess the influence of cricoid pressure (CP) on insertion and ventilation function of ProSeal laryngeal mask airway (PLMA). METHODS: Fifty adult patients with American Society of Anesthesiologists (ASA) physical status category I, scheduled for elective plastic surgery were studied. After induction of intravenous anesthesia, the PLMA was inserted using an introducer under CP and the intracuff pressure was set to 60 cm H(2)O (1 cm H(2)O=0.098 kPa) with the introducer in place. The content degree of lung ventilation, airway seal pressure and anatomic position of the cuff were assessed. Then CP was temporary terminated, the PLMA was further advanced to the ideal position and the intracuff pressure was readjusted to 60 cm H(2)O. The above-mentioned assessments were re-performed, and the expiratory tidal volume and peak inspiratory pressure during positive-pressure ventilation (PPV) with and without CP were recorded. The gastric tube placement through the PLMA was observed, anatomical position of the drain tube was also scored by fiberoptic examination. RESULTS: After the PLMA was further advanced to the ideal position under temporary termination of CP, lung ventilation content degree (good: acceptable=50:14 cases), airway seal pressure [(27+/-7) cm H(2)O vs. (21+/-7) cm H(2)O] and fiberoptic score of anatomical position of cuff were significantly improved compared with those after PLMA insertion under CP (P<0.05). The expiratory tidal volume during PPV was not significantly different between with and without CP, but the peak inspiratory pressure increased from (14+/-2) cm H(2)O without CP to (28+/-5) cm H(2)O with CP, and there was statistically significant difference (P<0.05). In all patients, gastric tube placement through the PLMA was successful with single attempt and correct anatomical position of the drain tube was confirmed by fiberoptic examination. CONCLUSION: The CP can impede the insertion of PLMA into the ideal position. The PLMA is still able to be advanced to the ideal position with a special introducer under temporary termination of CP. After the PLMA is advanced to the ideal position, the CP produces a significant increase in the peak inspiratory pressure during PPV.

Effect of intrathecal NG-nitro-L-arginine methyl ester administration on Fos expression in the spinal dorsal horn in rats following sciatic nerve ligation.

BACKGROUND: In the available literature, the pro- or antinociceptive role of nitric oxide (NO) is warmly disputed. As a marker of neuronal activation of the central nervous system, Fos expression has been widely used to assess the change in central neuronal activity evoked by peripheral input. In this study, we examined the effect of intrathecal L-NAME, a non-selective nitric oxide synthase (NOS) inhibitor, on nociceptive behavior and spinal Fos expression in rats following chronic constriction injury (CCI) of sciatic nerve, a model of neuropathic pain similar to that observed in clinical setting. METHODS: Eighty adult male SD rats showing no neurological deficiency a week after intrathecal catheterization were used in this study. L-NAME 250 microg of 10 microl (an equivalent or 0.9% saline) was injected intrathecally 15 min prior to CCI or sham operation. In addition to examination of thermal hyperalgesia by paw withdrawal latency (PWL), measurement of Fos protein staining neurons in the lumbar spinal cord using an immunohistochemistry technique were made at 1, 3, 7 and 14 days after operation. RESULTS: As compared with untreated animals, both CCI and sham operations evoked an early and long-term Fos expression, whereas a significant decrease in PWL was demonstrated only in rats receiving CCI. On days 3, 7 and 14 after CCI, the number of FLI neurons in the spinal dorsal horn ipsilateral to the injury decreased by 54%, 57% and 43%, respectively, in CCI-L-NAME group when compared with CCI-saline group, corresponding to the significant attenuation of thermal hyperalgesia. However, intrathecal L-NAME preadministration had no effect on the spinal Fos expression evoked by sham operation. CONCLUSIONS: Spinal Fos expression could be induced by different mechanisms, and it should not regarded as a reliable marker of pain sensation disorders. NO plays an important role in the development of nociception and spinal Fos expression through central sensitization mediated by peripheral nerve injury.