Airway and anesthesia management in tracheoesophageal fistula closure implantation: a single-centre retrospective study.

OBJECTIVE: To review and analyze the airway and anesthesia management methods for patients who underwent endoscopic closure of tracheoesophageal fistula (TEF) and to summarize the experience of intraoperative airway management. METHOD: We searched the anesthesia information system of the First Affiliated Hospital of Nanjing Medical University for anesthesia cases of TEF from July 2020 to July 2023 and obtained a total of 34 anesthesia records for endoscopic TEF occlusion. The intraoperative airway management methods and vital signs were recorded, and the patients' disease course and follow-up records were analyzed and summarized. RESULTS: The airway management strategies used for TEF occlusion patients included nasal catheter oxygen (NCO, n = 5), high-flow nasal cannula oxygen therapy (HFNC, n = 4) and tracheal intubation (TI, n = 25). The patients who underwent tracheal intubation with an inner diameter of 5.5 mm had stable hemodynamics and oxygenation status during surgery, while intravenous anesthesia without intubation could not effectively inhibit the stress response caused by occluder implantation, which could easily cause hemodynamic fluctuations, hypoxemia, and carbon dioxide accumulation. Compared with those in the TI group, the NCO group and the HFNC group had significantly longer surgical times, and the satisfaction score of the endoscopists was significantly lower. In addition, two patients in the NCO group experienced postoperative hypoxemia. CONCLUSION: During the anesthesia process for TEF occlusions, a tracheal catheter with an inner diameter of 5.5 mm can provide a safe and effective airway management method.

Vicarious traumatization in the general public, members, and non-members of medical teams aiding in COVID-19 control

Since December 2019, more than 79,000 people have been diagnosed with infection of the Corona Virus Disease 2019 (COVID-19). A large number of medical staff were dispersed for Wuhan city and Hubei province to aid COVID-19 control. Psychological stress, especially vicarious traumatization (VT) caused by the COVID-19 pandemic, should not be ignored. To address this concern, the study employed a total of 214 general public (GP) and 526 nurses to evaluate VT scores via a mobile app-based questionnaire. Results showed that the VT scores slightly increased across periods of aiding COVID-19 control, although no statistical difference was noted (P = 0.083). However, the study found lower scores for VT in nurses [median = 69; interquartile range (IQR) = 56-85] than those of the GP (median = 75.5; IQR = 62-88.3) (P = 0.017). In addition, the VT scores for front-line nurses (FLNs; median = 64; IQR = 52-75), including scores for physiological and psychological responses, were significantly lower than those of non-front-line nurses (nFLNs; median = 75.5; IQR = 63-92) (P < 0.001). Interestingly, the VT scores of the GP were significantly higher than those of the FLNs (P < 0.001). However, no statistical difference was observed compared with those of nFLNs (P > 0.05). Importantly, nFLNs are more likely to suffer from VT, which might be related to two factors, namely, gender [odds ratio (OR) = 3.1717; 95% confidence interval (CI) = 4.247-18.808; P = 0.002] and fertility [OR = 2.072; 95%CI = 0.626-24.533; P = 0.039]. Therefore, increased attention should be paid to the psychological problems of the medical staff, especially nFLNs, and GP under the situation of the spread and control of COVID-19. Early strategies that aim to prevent and treat VT in medical staff and GP are extremely necessary.

Role of ERK signaling pathway in dexmedetomidine against mouse neuroblastoma N2a cell injury induced by oxidative stress / 临床麻醉学杂志

Objective To investigate the role and underlying mechanism of dexmedetomidine in protecting mouse neuroblastoma N2a cells against oxidative stress injury,and to discuss the effect of ERK signaling pathway.Methods Na2 cell oxidative stress injury model was established by H2O2 treatment.Cells were divided into 5 groups:control group (group C),H2O2group (group H), dexmedetomidine group (group D),H2O2+dexmedetomidine group (group HD),H2O2+dexme-detomidine+ERK inhibitor group (group HDP).Group H,group HD and group HDP were given 200 μmol/L H2O2with or without 100 ng/ml dexmedetomidine and 20 μmol/L ERK inhibitor PD98059,group D was treated with dexmedetomidine at the corresponding point,group C was treated with equal normal saline,After 1,4 hours of H2O2stimulation,cell survival,morphology changes,SOD production and ERK intracellular signaling pathway were compared between groups. Results Compared to group C,N2a cells in the group H demonstrated significantly ruduced cell sur-vival,much worse cell morphology and less SOD production (P<0.05).Compared to group H,N2a cells in group HD demonstrated significantly increased cell survival,much better preserved cell mor-phology,higher levels of SOD and enhanced ERK activation (P<0.05);Compared to group HD, cells in the group HDP had markedly decreased cell survival,worse cell morphology and lower SOD level (P<0.05).No significant changes were found in cell survival,morphology changes,SOD pro-duction and ERK intracellular signaling pathway between the groups C and D.Conclusion Dexme-detomidine protected mouse neuroblastoma N2a cells against oxidative stress injury by regulating ERK activation and SOD production.

Effects of different doses of dexmedetomidine on cardiac conduction system / 临床麻醉学杂志

Objective To investigate the effect of dexmedetomidine on cardiac conduction system at different loading doses.Methods Eighty male patients with orthopedic surgery,aged 20-65 years,falling into ASA physical atatus Ⅰ or Ⅰ,were randomly divided into groups D1,D2,D3 and C with 20 in each.Groups D1,D2 and D3 were infused with dexmedetomidine 0.3,0.5 and 0.8μg/ kg using a micro-pump for 10 min,group C infused 0.9％ NaCl solution in the same manner.MAP,HR,SpO2 were recorded and ECG was traced before injection (T1),5 min (T2),10 min (T3) after injection and 10 min after the end of pumping (T4).P wave duration,P-R interval,QRS time,and QTc value were calculated.Results There was no significant difference in SpO2,P wave duration,P R interval and QRS time among the four groups.There was no significant difference in MAP,HR and QTc value in group C and group D1.Compared with that in group C,MAP was significantly decreased,HR was significantly slowed down and QTc value was significantly shortened in group D2 and D3 from T2 to T4 (P ＜ 0.05).Conclusion Dexmedetomidine does not affect the cardiac conduction system.0.5 μg/kg and 0.8μg/kg dexmedetomidine can effectively shorten the QT interval.To avoid severe bradycardia,patients with low heart rate should use no more than 0.5 μg/kg dexmedetomidine.

Impact of patient controlled epidural analgesia on postoperative recovery in patients undergoing laparotomy pancreatic surgeries / 临床麻醉学杂志

Objective To compare the impact of patient controlled epidural analgesia with patient controlled intravenous analgesia on postoperative recovery and complications in patients undergoing laparotomy pancreatic surgeries.Methods Forty patients undergoing pancreatic surgeries, 27 males and 13 females, aged 18-70 years, ASA physical status Ⅰ or Ⅱ, were randomly divided into two groups (n=20 each).Patients in group E received T8-9 or T9-10 epidural block, 2% lidocaine test dose was given to ensure the location of epidural catheter, after that, each patient in group E was given 0.375% ropivacaine 5 ml into epidural space before skin incising and incision closures.Meanwhile, patients in groups E and V received propofol-sevoflurane combined intravenous inhalation anesthesia.After surgery, patients in group E received patient controlled epidural analgesia while patients in group V received patient controlled vein analgesia.Length of hospital stay, time to ambulation and exhaust defecation were recorded.Other complications were compared.Results Compared to group V, patients in group E showed earlier ambulation [(50.4±4.2) h vs (64.2±5.0) h, P<0.01], shorter hospital stays [(18.5±8.5) d vs (21.5±6.8) d, P<0.05].There was no statistically significant difference in flatus time between the two groups [(39.7±4.1) h vs (39.5±8.4) h].There was no significant difference in complications between the two groups.Conclusion The present study shows that for patients undergoing pancreatic surgeries, patient controlled epidural analgesia could effectively release post-operative pain, shorten the ambulation time and length of hospital stay with no extra complications.

Risk of cardiovascular events in the use of nonsteroidal anti-inflammatory drugs during the perioperative period: a meta-analysis / 临床麻醉学杂志

Objective To evaluate the risk of cardiovascular adverse events using nonsteroidal anti-inflammatory drugs during the perioperative period.Methods A systematic review of formally published in English and Chinese literature was conducted by using computerized database on PubMed, Web of Science, Medline, Cochrane Library, CNKI and Wanfang database.The literature about controlled clinical study of nonsteroidal anti-inflammatory drugs in perioperative use, a prospective cohort study and a retrospective review were collected.The cardiovascular risk was evaluated by the number of adverse cardiovascular events cases (myocardial infarction, angina, myocardial ischemia, arrhythmia) occurred during the period of drug use.The relevant data was extracted and their heterogeneity was tested.Results A total of 8 articles including 15 623 patients met the inclusion criteria, including 5 articles (n=13 019) on non-selective nonsteroidal anti-inflammatory drugs, and 3 articles (n=2 604) about selective (cyclooxygenase 2) COX-2 inhibitors.Nonsteroidal anti-inflammatory drugs used in the perioperative or a short term would reduce the risk of adverse cardiovascular events (OR=0.59, 95%CI 0.45-0.77, P=0.000 1), non-selective nonsteroidal anti-inflammatory drugs using in the perioperative or a short term would reduce the risk of adverse cardiovascular events, the difference being statistically significant (OR=0.42, 95%CI 0.31-0.58, P＜0.001).A selective COX-2 inhibitor using in the perioperative or short-term might increase cardiovascular adverse events (OR=2.53, 95%CI 1.26-5.09, P=0.009).Conclusion Non-selective nonsteroidal anti-inflammatory drugs should be chosen for patients at high risk of adverse cardiovascular events during the perioperative period.

Target-controlled Intravenous Analgesia with Remifentanil on Hyoxemia in Obese Patients with Painless Gastroscopy / 医学研究杂志

Objective To explor the safty and the effect of controlled intravenous analgesia with remifentanil on hyoxemia in obese patients with painless gastroscopy.Methods One hundred patients undergoing painless gastroscopy were randomly and equally allocated into 2 groups(50 each).In group R,anesthesia was induced with TCI(target-controlled infusion) of remifentanil,and the target plasma concentration (Cp) of propofol was set at 2ng/ml.In group N,the same volume of saline was continues infusion.MAP,RR and HR were monitored and recorded before the examination(T0),the time point of examination start(T1),gastroscopy go through glottis(T2),at the end of the operation (T3) and 5 min after examination (T4).The effect of sedation was evaluated by Ramsay.Except that,gastroscopy time,the satisfaction of patient,anesthetist and endoscopist were recored.In addition,apnea,bradycardia,hypoxemia,myoclonus,body movement,hypotension and postoperative complications were also recorded.Results Compared with group N,in group R,HR,MAP and rate of body movement were significantly decreased (P ＜ 0.05).Except that,the satisfaction of patient and endoscopist were increased (P ＜ 0.05).Conclusion TCI of remifentanil can provide satisfaction sedation for obese patients with painless gastroscopy with few adverse effects.

Effects of dexmedetomidine on the perioperative stress response and immunologic function in hepatectomy patients with hepatitis cirrhosis / 临床麻醉学杂志

Objective To observe the effects of dexmedetomidine on the perioperative stress response and immunologic function in hepatectomy patients with hepatitis cirrhosis.Methods Forty patients(Child-Pugh A or B),ASA Ⅱ or Ⅲ with hepatitis cirrhosis undergoing hepatectomy were randomly divided into dexmedetomidine group(group D)and control group(group C)with 20 cases in each.Patients in group D were administered 0.5 μg/kg bolus dose of dexmedetomidine over 10 min, followed by 0.4 μg·kg-1 ·h-1 infusion until closing abdomen.And patients in group C were given normal saline by the same way as in group D.Flow cytometry was used to detect peripheral blood T lymphocytes (CD3 + ,CD4 + ,CD8 + ,CD4 +/CD8 + ),NK cells at 30 min before anesthesia(T0 ),imme-diately(T1 ),24 h(T2 )and 48 h(T3 )after surgery.Enzyme-linked immunosorbent assay was used to detect the levels of inflammatory cytokines concentration(IL-2,IL-10)at T0-T3 and stress hormones (Cor,ACTH,ALD)at T0 ,T2 and T3 .The levels of SBP,DBP and CVP at T0 ,immediately with intu-bation(Ta ),T1 and extubation(Tb ).Results Compared to those at T0 ,the levels of CD3 + ,CD4 + , CD8 + ,CD4 +/CD8 + at T1 and T2 were significantly lower in both groups(P <0.05),and the levels in group D were obviously higher than those in group C(P <0.05).The levels in group D were back to preoperative levels at T3 ,but the levels in group C were still lower than those at T0 (P <0.05).The levels of NK cells were higher at T1 in both groups,and the levels in group D was significantly higher than those in group C(P <0.05).Compared to those at group D,the concentration of IL-2 was lower at T1 and T2 ,the concentration of IL-10 was higher at T2 and T3 in group C (P <0.05).The levels of Cor,ALD,ACTH at T2 and T3 were significantly higher than those at T0 in both groups,but those in group D were markedly lower than those in group C (P < 0.05 ).The SBP,DBP and CVP of two groups was no statistically significant difference at T0 ,and SBP,DBP and CVP of the group D at Ta , T1 ,Tb was lower than that of T0 and group C (P <0.05).Conclusion Patients with hepatitis cirrho-sis underwent general anesthesia has certain immune suppression after liver cancer surgery,and con-tinuous intravenous infusion of dexmedetomidine during anesthesia may suppress the perioperative stress reaction effectively and alleviate the inhibition of immunologic function.

Effects of dexmedetomidine on short-latency somatosensory evoked potentials / 临床麻醉学杂志

Objective To investigate the effects of two different dosages of dexmedetomidine on short-latency somatosensory evoked potentials (SLSEP)in intracranial surgery.Methods Forty pa-tients,ASA Ⅰor Ⅱ,aged 20-65 years old,selected for intracranial surgery were randomly divided in-to two groups,20 patients in each group.Bolus dose of 0.5 μg/kg dexmedetomidine was infused within first 10 min and followed by continuous infusion of 0.5 μg·kg-1·h-1 for 10 min in group A;Bolus dose of 1.0 μg/kg dexmedetomidine was infused within first 10 mins and followed by continu-ous infusion of 1.0 μg·kg-1·h-1 for 10 min in group B.SLSEP indications include N20-P25 amplitute and N20 latent period were observed.MAP,HR,N20-P25 amplitute and N20 latent period were re-corded respectively before dexmedetomidine adminstraition (T0 )and 20 mins after dexmedetomidine adminstraition (T1 ).Results Compared with T0 ,MAP and HR at T1 significantly decreased in both groups(P <0.05).N20-P25 amplitude had no statistically significant difference in both groups,while N20 latent period significantly prolonged (P <0.05).Conclusion Both doses of 0.5 μg/kg and 1.0μg/kg dexmedetomidine can significantly prolong the latent period of N20.

Clinical application of prelocalization with ultrasound during internal jugular vein cannulation / 中国医师进修杂志

Objective To evaluate the clinical value and safety of prelocalization with ultrasound during internal jugular vein cannulation. Methods One hundred patients scheduled for internal jugular vein cannulation from February 2009 to April 2010 were divided into two groups by random digits table with 50 cases in each group. Group U patients were performed by ultrasound-prelocalization method and group T patients were performed by traditional technique. The first successful punctures and the first successful catheterization,puncture times,operation time and complications were recorded. Results Compared with group T, puncture times,operation time and complications were lower in group U [(1.0±0.5) times vs.(2.1±1.4) times;(4.5±1.2) min vs.(6.8±1.6) min;0 vs. 12.0%(6/50)](P＜ 0.01 ). The first successful punctures and the first successful catheterization [96.0% (48/50) and 95.8% (46/48)] in group U were obviously higher than those in group T [ 72.0%(36/50) and 77.8% (28/36)] (P ＜ 0.01 ). Two cases were failed in group T. Conclusion Ultrasound-prelocalization technique is simply and practically method for internal jugular vein cannulation under the stable body position.

Effects of limb ischemia-reperfusion injury on blood coagulation / 临床麻醉学杂志

Objective To investigate the effects of limb ischemia-reperfusion injury(I-RI) on blood coagulation.Methods Eighteen patients scheduled for unilateral knee arthroscopy surgery under epidural anesthesia were treated with an inflatable tourniquet to ptoduce ischemia for (42 ± 6) min.Venous blood was taken before tourniquet inflation,at 30 min during ischemia,3 min and 30 min during reperfusion for measuring blood coagulation by thrombelastography(TEG).Results TEG showed the decreases in reaction time(R value) and coagulation time(K value),and the increases in alpha angle(α) and maximal amplitude(MA),which were all within the normal limits and had no significant differences among four time points of testing.Conclusion I-RI of the limbs has no significant effects on blood coagulation.

Influence of preemptive analgesia with Iornoxicam on balance of Th1/Th2 during radical gastrectomy / 临床麻醉学杂志

Objective To observe the effect of preemptive analgesia with lornoxicam on balance of Th1/Th2 during radical gastrectomy. Methods Thirty patients undergoing selective radical gastrectomy were randomly divided into 2 groups with 15 cases each. Lornoxicam 8 mg was used.before surgery,and PCA with lornoxieam and morphine was used for postoperative analgesia in group Ⅰ.PCA with morphine was used for postoperative analgesia in group Ⅱ. Plasma cortisol, interferon-γ(IFN-γ) and interleukin-4 (IL-4) were measured before induction of anesthesia(T_0 ), at the end ofoperation(T_1 ),at 24 h(T_1 ) and 72 h(T_3 ) after operation. Results Compared to that at T_0 ,Cor washigher at T_1 and T_2 in group Ⅱ and at T_2in group I(P<0. 05). (Cor levels at T_1 and T_2were lower ingroup Ⅰ than those in group Ⅱ(P<0. 05). IL-4 of group Ⅰ was lower at T_2 than that at T_0 (P<0.05). IL_4 at T_3 was lower in group Ⅰ than that in group Ⅱ (P < 0.05). IFN-γ of group Ⅰ washigher at T_1 than that at T_0 (P<0. 05), which was higher at T_2 than that of group Ⅱ(P＜0. 05). Theratio of IFN-γ/IL-4 in both groups was significantly higher at T_1-T_3 than those at T_0, which at T_2 washigher in group Ⅰ than that in group Ⅱ (P<0. 05). Conclusion Preemptive analgesia with lornoxicamcan alleviate the excurtion degree of Th1/Th2 and improve inmmnological suppression after radicalgastrectomy.

Effects of midazolam on ventilatory response to carbon dioxide when used as sedative during epiduralblockade / 中华麻醉学杂志

Objective To investigate the effect of midazolam on ventilatory response to carbondioxide (CO2) when it is used as sedative supplement to epidural blockade(EB). Methods Fifteen ASAⅠ -Ⅱ patients [age (49±7) years , weight (56±13)kg] undergoing upper abdominal surgery were studied. Patients with respiratory disease were excluded. No patient was addicted to smoking, alcohol,received any sedatives or hypotics within one month before surgery. The patients were premedicated with intramuscular phenobarbital 0. 1g and atropine 0.5mg. Epidural catheter was inserted in a cephala direction for 4 cm into epidural space via the tuohy needle at T9.10. 1% lidocaine and 0.2% pontocaine solution was used for epidural block. The level of block was T3.5. When the level of block was fixed, midazolam 0.1mg/kg was given intravenously. Respiratory rate(RR), tidal volume (VT), end-tidal concentration of CO2 (PETCO2) and pulse oxygen saturation (SpO2) were measured before anesthesia (baseline values), before midazolam when the level of block was fixed and 5 min after midazolam. Measurement of ventilatory response to CO2: the patient was asked to breathe with a closed system without a CO2 absorber. PET CO2 increased to 55 mm Hg in 6-10 min. RR, VT and minute ventilation (MV) were measured at PETCO2 40, 45, 50, and 55 mm Hg. The patient then breathed fresh air and PETCO2 returned to normal. 5 min after midazolam the measurment was repeated. The CO2 ventilatory response curve was obtained by plotting MV against the corresponding PET CO2. Results PET CO2, RR and SpO2 did not change significantly after epidural block and midazolam. There was no significant change in VT after epidural block as compared with the baseline value but VT decreased significantly after midazolam (P<0.01).There was no significant change in the slope of CO2 ventilatory response curve before and after midazolam but MV at different PET CO2 decreased significantly 5 min after midazolam. Conclusions Midazolam 0. 1mg/kg given after epidural block decreases VT but depression of respiratory center is slight and lasts for only a short period of time.[Key Words] Midazolam; Anesthesia, epidural; Carbon dioxide

The effect of cholecystectomy under epidural block on glucose transport-4 mRNA expression in skeletal muscle / 中华麻醉学杂志

Objective Surgical stress induces a series of endocrine and metabolic changes including glucose metabolism and insulin-resistance. The purpose of the present study was to investigate the changes in glucose transporter-4 (Glut-4) mRNA expression in skeletal muscle after cholecystectomy under epidural block. Methods One gram of the rectus abdominis muscle was taken while abdomen was being opened and closed in patients undergoing cholecystectomy under epidural block. Total RNA of the muscle cells was extracted by trizol one-step template. RT-PCR was used to determine the Glut-4 mRNA amplification products with ?-actin mRNA as an internal control. The Glut-4 mRNA expression was expressed by (desired gene/ ?-actin?100% . The plasma glucose and insulin levels were determined at the same time. Results Glut-4 mRNA expression was significantly reduced (P 0.05 ) . Conclusions The results indicated that the synthesis of Glut-4 is suppressed by surgical stress of cholecystectomy under epidural block leading to insulin resistance.

Effects of desflurane, isoflurane and propofol on plasma levels of endothelin and atrial natriuretic polypeptide in patients undergoing upper abdominal surgery / 中华麻醉学杂志

Objective To investigate the effects of anesthesia on plasma level of endothelin(ET) and atrial natriuretic polypeptide (ANP) in patients undergoing upper abdominal surgery. Methods Thirty ASA Ⅰ -Ⅱ patients(14 male, 16 female), aged 31-68 years and weighing 41-82kg, undergoing elective upper abdominal surgery were divided into three groups with ten patients in each group: Ⅰ desflurane group,Ⅱ isoflurane group and Ⅲ propofol group. The patients were premedicated with intramuscular phenobarbital sodium O.1g and atropine 0.5mg. Anesthesia was induced with midazolam 0.lmg?kg-1, propofol 1 mg?kg-1, vecuronium .015mg?kg-1 and fentanyl 4?g?kg-1 . After intubation the patients were mechanically ventilated and PET CO2 was maintained with 1.0 MAC desflurane in group I or 1.0 MAC isoflurane in groupⅡ or propofol infusion at 60-70 ?g ?kg-1?min-1 in groupⅢ and vecuronium infusion at l-2?g?kg-1?min-1 . ECG, HR, BP, SpO2, PETCO2, end-tidal concentration of desflurane or isoflurane, tidal volume (VT), total compliance ( C?), Pplat, Ppeak were monitored during anesthesia. Blood samples were taken from peripheral vein before anesthesia(T1 ), after induction(T2), 10 min(T3), 50 min(T4) after skin incision and at the end of surgery(T5 ) for determination of plasma levels of ET and ANP by radioimmunoassay. Results (1) There was no significant difference in plasma levels of ET between group Ⅰ and Ⅱ , but ET level decreased significantly during isoflurane inhalation. (2) There was no significant change in plasma ANP level during anesthesia in group I but plasma ANP level decreased significantly at 50 min after skin incision in group Ⅱ and increased significantly at the end of operation in group Ⅲ . (3) MAP decreased significantly after induction in the three groups.Conclusions Anesthesia induced with propofol and maintained with isoflurane could be anesthesia of choice patients with airwayhyperreactivity in terms of plasma ET level which is a strong bronchial constrictor.

Perioperative changes of erythrocytes hexokinase, phosphofructokinase and glucose-6-phasphate dehydrogenase activities in patients undergoing upper abdominal surgery / 中华麻醉学杂志

Objective To investigate the role of pentose phosphate pathway (PPP) after upper abdominal operationMethods Twenty-six patients undergoing upper abdominal surgery, were divided randomly into three groups: epidural block(EB,n=10), intravenous propofol anesthesia(PRO, n=10) and intravenous procaine balanced anesthesia(IPBA,n=6) The venous blood samples were collected to measure of erythrocytes hexokinase (HK), phosphofructokinase (PFK) and glucose-6-phasphate dehydrogenase (G-6PD), and activities, and plasma glucose before anesthesia induction, 60 min after incision,60 min after surgery, on the 1st and 2nd postoperative daysResults Compared with the values before anesthesia, the activities of erythrocyte HK and PFK decreased significantly on the 1st postoperative day in three groups (P

Effects of midazolam on ventilatory response to carbon dioxide when used as sedative during epidural blockade / 中华麻醉学杂志

Objective To investigate the effect of midazolam on ventilatory response to carbon dioxide (CO 2) when it is used as sedative supplement to epidural blockade(EB) Methods Fifteen ASA Ⅰ Ⅱ patients [age (49?7) years , weight (56?13)kg] undergoing upper abdominal surgery were studied Patients with respiratory disease were excluded No patient was addicted to smoking,alcohol,received any sedatives or hypotics within one month before surgery The patients were premedicated with intramuscular phenobarbital 0 1g and atropine 0 5mg Epidural catheter was inserted in a cephala direction for 4 cm into epidural space via the tuohy needle at T 9 10 1% lidocaine and 0 2% pontocaine solution was used for epidural block The level of block was T 3 5 When the level of block was fixed, midazolam 0 1 mg/kg was given intravenously Respiratory rate(RR), tidal volume (V T), end tidal concentration of CO 2 (P ET CO 2) and pulse oxygen saturation (SpO 2) were measured before anesthesia (baseline values), before midazolam when the level of block was fixed and 5 min after midazolam Measurement of ventilatory response to CO 2: the patient was asked to breathe with a closed system without a CO 2 absorber P ET CO 2 increased to 55 mm Hg in 6 10 min RR,V T and minute ventilation (MV) were measured at P ET CO 2 40, 45, 50, and 55 mm Hg The patient then breathed fresh air and P ET CO 2 returned to normal 5 min after midazolam the measurment was repeated The CO 2 ventilatory response curve was obtained by plotting MV against the corresponding P ET CO 2 Results P ET CO 2, RR and SpO 2 did not change significantly after epidural block and midazolam There was no significant change in V T after epidural block as compared with the baseline value but V T decreased significantly after midazolam(P

Effects of narcotics on adenyl cyclase and phosphodiesterase activity in rabbit bronchial smooth muscle / 中华麻醉学杂志

The effects of morphine, pethidine and fentanyl on adenyl cyclase (AC) and phospho- diesterases (PDE) in rabbit bronchial smooth muscle were examined in vitro. The results were as follows: morphine could inhibit the activity of AC which was decreased from 15. 9911 ? 0. 8597u to 15.0463?0. 7989u, P