Conservative management of a rare case of post thyroidectomy tracheal injury with coagulation abnormalities.

Background: Tracheal injury is a rare but potentially serious acute complication of endotracheal intubation. Very few cases of tracheal injury associated with coagulation abnormalities have been reported in the literature. We present a rare case of a patient presenting with tracheal injury in combination with coagulation abnormalities following thyroidectomy. Case presentation: A 58-year-old woman with a history of postoperative chemotherapy for breast cancer, gastric polyps, multiple colonic polyps, esophageal papillary adenomas, and thyroid adenomas presented with dyspnea following 10 ml hemoptysis on the third day after thyroidectomy; she was admitted to the intensive care unit and underwent tracheal intubation for maintaining the airway. Subsequent bronchoscopy revealed a nodular red neoplasm 5-cm from the carina in the trachea obstructing part of the lumen, with a small amount of fresh hemorrhage on the surface. Tracheal injury was considered the preliminary diagnosis. Fiberoptic bronchoscope guided tracheal intubation helped prevent rupture of the tumor, and the cannula was properly inflated to arrest the bleeding while blocking the lower part of the trachea. An emergency surgical evacuation of the cervical hematoma was performed for managing postoperative bleeding. The patient demonstrated persistent pancytopenia despite frequent transfusions. Laboratory examination results revealed abnormal coagulation parameters, anemia, and hepatic dysfunction. Following a multidisciplinary team discussion, pituitrin for hemostasis, tranexamic acid for strengthening hemostasis treatment, and nutritional support and anti-infection treatment were initiated. Endotracheal tube cuff inflation was performed to compress the bleeding site. Complete resolution of the subcutaneous hematoma was observed nine days after the tracheal injury; bronchoscopy revealed residual ecchymosis in the airway hematoma with no evidence of obstruction. Conclusion: Conservative management of tracheal injury limited to the mucosa or submucosa without significant amount of active bleeding using endotracheal intubation is considered a practical and effective approach. Successful management was ensured by appropriate clinical suspicion, early multidisciplinary team discussion, and prompt diagnosis and interventions.

Placement of bronchial occluder outside the tracheal tube in a patient combined with airway compression undergoing mediastinal tumors resection: a case report.

BACKGROUND: Mediastinal tumors pose a challenging respiratory and circulatory management during anesthesia procedures, there is a risk of circulatory collapse or complete airway obstruction, which in severe cases can lead to cardiac arrest. We reported a case of anesthetic management using a bronchial blocker placed outside the tracheal tube. In this case report, the patient's trachea was so severely compressed that the airway was extremely narrow, only 4 mm at its narrowest point. By reporting the anesthetic management of this patient, we intend to provide an unusual approach for airway management. CASE PRESENTATION: A 52-year-old male patient was admitted to the hospital due to cough and expectoration for one year. Additionally, the patient experienced chest tightness and asthma after physical activity. The enhanced computed tomography revealed there existed an irregular soft tissue mass in the right upper mediastinum, which significantly compressed the trachea and esophagus. The results of the mediastinal puncture pathology showed the presence of mesenchymal tumors. According to the results above, the patient was diagnosed with a mediastinal tumor and scheduled to undergo tumor resection under general anesthesia. We used a bronchial occluder outside the tracheal tube for general anesthesia. After surgery, the patient received thorough treatment and was subsequently discharged from the hospital. CONCLUSION: In patients with severe airway compression from a mediastinal tumor airway compression, positioning a bronchial occluder externally to the tracheal tube is an effective method of airway management. However, we still need more clinical practice to help the process become more standardized.

Anesthetic management of thyroid carcinoma invading the upper tracheal segment: A case report.

INTRODUCTION AND IMPORTANCE: Intratracheal tumors account for approximately 0.2 % of respiratory tumors, including primary and secondary tumors. Secondary tumors of the upper trachea are most commonly derived from advanced thyroid cancer. Surgical resection is currently the general curative modality for thyroid cancer with tracheal invasion. Patients with tracheal tumors invading and protruding into the lumen may have reduced oxygen reserve capacity, leading to a shorter safe window for general anesthesia induction. Establishing an appropriate artificial airway is essential to ensure intraoperative safety for these patients. Here, we report a case of tracheal tumor caused by differentiated papillary thyroid carcinoma invading the upper segment of the trachea and the non-conventional approach used for intraoperative airway management without traditional endotracheal intubation. PRESENTATION OF CASE: A 59-year-old female presented with bilateral neck masses and hemoptysis. The CT scan revealed suspicious malignant thyroid nodules, and tracheoscopy showed an approximately 50 % obstruction of the tracheal lumen. The patient's physical examination and biochemical examination showed no significant abnormalities. Based on imaging studies and pre-anesthetic assessment, a multidisciplinary team decided against performing endotracheal intubation in the patient due to the risk of tumor bleeding during the procedure. Instead, they opted for a modified endotracheal tube and the insertion of a laryngeal mask airway (LMA). The anesthesia induction and maintenance proceeded smoothly, with stable intraoperative hemodynamics. The tumor was successfully resected and tracheal anastomosis was performed without any complications. CLINICAL DISCUSSION: The strategy adroitly evades the risk of bleeding and dislodgement due to tumor contact during the intubation process. In this case report, the anesthetic highlight is the employment of a reverse insertion technique for endotracheal intubation, facilitated by a sterile suction catheter and complemented by an innovative modification to the tracheal tube. CONCLUSION: For patients with thyroid cancer invading the upper segment of the trachea, and in whom rapid induction anesthesia is anticipated not to cause tumor collapse, the use of laryngeal mask airway combined with modified tracheal tube mechanical ventilation is both safe and feasible.

Effects of Press Needling combined with general anesthesia on postoperative analgesia in thoracoscopic pulmonary resection for lung cancer: A randomized, single-blind, controlled trial.

OBJECTIVES: To investigate the effects of press needle therapy on postoperative analgesia and other relevant complications in patients undergoing thoracoscopic pulmonary resection. DESIGN: randomized, single-blind, controlled trial SETTING: Teaching hospitals affiliated with universities. INTERVENTIONS: Eighty-six patients were randomized into: the Acu group (press-needle group) and the control group MAIN OUTCOME MEASURES: Pain levels 24, 48, and three months after surgery were measured using the numeric rating scale (NRS). Perioperative hemodynamics, total and effective pressing numbers of patient-controlled intravenous analgesia (PCIA), and incidence of postoperative pulmonary complications were recorded. Peripheral blood samples were collected to measure the levels of inflammatory mediators RESULTS: Acu group had significantly lower NRS scores at 24 and 48 h after operation (NRS scores on movement at 24 h after surgery: Acu vs. Control, 3 (2,3) vs. 3 (3,5), Z = -3.393, P < 0.01 and NRS scores on movement at 48 h after surgery: 2 (1,3) vs. 3 (2,5), Z = -3.641, P < 0.01), lower number of PCIA attempts and effective rates (mean total pressing numbers: 4(2,8) vs. 6(3,19), Z = -1.994, P = 0.046 and mean effective pressing numbers: 3(2,8) vs. 6(3,16), Z = -2.116, P = 0.034). The Acu group had significantly reduced IL-1 (14.52 ± 3.84 vs. 16.36 ± 3.30, mean difference (MD): - 1.85, 95% confidence interval (CI): - 3.46, - 0.23, P = 0.026), HIF-1α (10.15 ± 1.71 vs. 10.96 ± 1.73, MD: -0.81, 95% CI: -1.59, -0.04, P = 0.040) and the incidence of pulmonary complications after surgery. CONCLUSION: Press needles are a non-invasive and feasible adjunctive intervention for postoperative analgesic management in patients undergoing thoracoscopic pulmonary resection.

A randomized controlled trial of positive end-expiratory pressure on pulmonary oxygenation and biventricular function in esophageal cancer patients receiving one-lung ventilation under a lower FiO2.

Background: Arterial oxygenation is often impaired during one-lung ventilation (OLV), due to both pulmonary shunt and atelectasis. Lower fraction of inspiration O2 (FiO2) may reduce inflammation and complications, but may increase the risk of hypoxemia. The aim of this randomized controlled parallel trial was to analyze whether higher positive end-expiratory pressure (PEEP) could improve oxygenation and maintain lower levels of inflammation during OLV under a lower FiO2. Methods: One hundred and twenty patients with selective thoracotomy for esophageal cancer (EC) were classified randomly into four groups on a ratio of 1:1:1:1 using a computer-generated list, including Group A (FiO2 =0.6, PEEP =0), Group B (FiO2 =0.6, PEEP =5 cmH2O), Group C (FiO2 =1.0, PEEP =8 cmH2O), and Group D (FiO2 =1.0, PEEP =10 cmH2O). The oxygenation and pulmonary shunt were primary outcomes. Haemodynamics, respiratory mechanics, serum IL-6 and IL-10 levels, and complications were taken as secondary outcomes. Follow-up was terminated until discharge. Results: Two patients in Group A and two in Group D were excluded due to hypoxemia and hypotension, respectively. Then the data of 116 patients (Group A =28, Group B =30 Group C =30, and Group D =28) were assessed for final analysis. Compared with Group B, the partial pressure of oxygen (PaO2) and dynamic compliance during OLV in Group D were significantly increased from 15 minutes to 60 minutes, while pulmonary shunt was significantly decreased (P>0.05). Patients in Group D had higher levels of central venous pressure (CVP) and airway pressure (Paw) during OLV and higher levels of IL-6 and IL-10 after OLV compared with Group B (P>0.05). No statistical differences were found in oxygen saturation (SaO2), PvO2 (partial pressure of oxygen in venous blood), partial pressure of end-tidal carbon dioxide (ETCO2), partial pressure of carbon dioxide in artery (PaCO2), heart rate (HR), mean arterial pressure (MAP), and complications among the four groups (P>0.05). Conclusions: Higher PEEP increased the oxygenation under 60% O2 during OLV. However, the haemodynamics and respiratory mechanics changed, and the levels of inflammation increased. A higher PEEP under 60% O2 during OLV is not recommended. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024726.

A randomised controlled trial on roles of prostaglandin E1 nebulization among patients undergoing one lung ventilation.

BACKGROUND: Prostaglandin E1 (PGE1) has been reported to maintain adequate oxygenation among patients under 60% FiO2 one-lung ventilation (OLV). This research aimed to explore whether PGE1 is safe in pulmonary shunt and oxygenation under 40% FiO2 OLV and provide a reference concentration of PGE1. METHODS: Totally 90 esophageal cancer patients treated with thoracotomy were enrolled in this study, randomly divided into three groups (n = 30/group): Group A (60% FiO2 and 0.1 µg/kg PGE1), Group B (40% FiO2 and 0.1 µg/kg PGE1), and Group C (40% FiO2, 0.2 µg/kg PGE1). Primary outcomes were oxygenation and pulmonary shunt during OLV. Secondary outcomes included oxidative stress after OLV. RESULTS: During OLV, patients in Group C and B had lower levels of PaO2, SaO2, SpO2, MAP, and Qs/Qt than those in Group A (P < 0.05). At T2 (OLV 10 min), patients in Group C and B exhibited a lower level of PaO2/FiO2 than those in Group A, without any statistical difference at other time points. The IL-6 levels of patients in different groups were different at T8 (F = 3.431, P = 0.038), with IL-6 in Group C being lower than that in Group B and A. MDA levels among the three groups differed at T5 (F = 4.692, P = 0.012) and T7 (F = 5.906, P = 0.004), with the MDA level of Group C being lower than that of Group B and A at T5, and the MDA level of Group C and B being lower than that of Group A at T7. In terms of TNF-α level, patients in Group C had a lower level than those in Group B and A at T8 (F = 3.598, P = 0.033). Compared with patients who did not use PGE1, patients in Group C had comparable complications and lung infection scores. CONCLUSION: The concentration of FiO2 could be reduced from 60 to 40% to maintain oxygenation. 40% FiO2 + 0.2 µg/kg PGE1 is recommended as a better combination on account of its effects on the inflammatory factors. TRIAL REGISTRATION: Chictr.org.cn identifier: ChiCTR1800018288, 09/09/2018.

Intraoperative airway management for patients with tracheal tumors: A case series of 37 patients.

BACKGROUND: Tracheal tumors are rare. The aim of this case series was to investigate airway selection during radical surgery for patients with tracheal tumors. METHODS: Here, we performed a retrospective case review of patients with tracheal tumors who underwent tracheal surgery in our center. A total of 37 cases, including 26 patients with primary tracheal tumors and 11 cases with advanced thyroid cancer, were enrolled into the study. Baseline characteristics and differential prognosis of included patients were estimated. We summarize the strategies for intraoperative airway selection and analyze the risk factors associated with delayed extubation. RESULTS: There is a trend for primary tracheal tumors to appear toward the upper (9 of 26) and middle third (9 of 26) of the trachea, followed by the lower third airway (8 of 26). Advanced thyroid cancers occur most frequently in the upper trachea (7 of 11) and then the middle trachea (4 of 11). All primary and secondary patients underwent R0 resection. Minor histological subtypes were found to correlate with a poor prognosis. Extracorporeal support and tracheotomy intubation were applied in high-risk cases, and a total of 32 patients achieved intrathoracic intubation during the surgical process. Intensive care unit (ICU) delay (>1 day) was observed among 25 patients, which were not enriched in cases who underwent cross-field endotracheal intubation. Additionally, temporal suboptimal oxygenation (SpO2 < 95%) was an independent risk factor of ICU delay. CONCLUSIONS: Airway selection plays an important role in successful tracheal surgery, and an appropriate ventilation routine depends on the patient and a surgical process which is safe and effective.

Long non-coding RNA MALAT1 enhances the protective effect of dexmedetomidine on acute lung injury by sponging miR-135a-5p to downregulate the ratio of X-box binding proteins XBP-1S/XBP-1U.

Acute lung injury (ALI) is the common and clinically severe complication. Dexmedetomidine (DEX) can protect against lipopolysaccharide (LPS)-induced ALI through anti-apoptosis, anti-inflammatory and immune regulatory actions. It is well documented that major causes of LPS-induced ALI are endoplasmic reticulum stress (ERS) and abnormally elevated CHOP. Moreover, XBP-1 can enhance CHOP expression. XBP-1S can aggravate ERS and XBP-1 U can repress ERS. By querying Starbase, miR-135a-5p interacts with XBP-1 and lncRNA MALAT1 sponges miR-135a-5p. It has been reported that MALAT1 interference markedly promoted the apoptosis of pulmonary microvascular endothelial cells in ALI rats by activating TLR4/NF-κB pathway. miR-135a-5p inhibitor remarkably alleviated LPS-induced A549 cell injury through suppressing cell apoptosis. In the present work, LPS was dripped into the nasal cavity of SD rats to establish the rat model of ALI and LPS was also applied to stimulate BEAS-2B cells to imitate ALI in vitro. Then, the pathology, lung function indexes, levels of inflammatory factors, apoptosis of lung tissues in SD rats and apoptotic level of BEAS-2B cells were measured, so as to confirm whether upregulation of lncRNA MALAT1 was able to suppress ERS, thus enhancing the protective effect of DEX against ALI. Herein, overexpression of lncRNA MALAT1 strengthened the remission effects of DEX on LPS-triggered ALI, severe pulmonary edema, inflammatory response and cell apoptosis of lung tissues in SD rats and reinforced the anti-apoptosis effect of DEX on LPS-stimulated BEAS-2B cells. Mechanically, lncRNA MALAT1 enhanced the protective effect of DEX against ALI by downregulating the ratio of XBP-1S/XBP-1U to repress ERS.

Sugammadex enhances recovery after abdominal surgery in cancer patients: a real-world, observational study.

BACKGROUND: Sugammadex, a modified γ-cyclodextrin that selectively binds to muscle relaxants, is increasingly being used to reverse neuromuscular blockade after surgery, but the potential benefits for cancer patients in the real-world setting are obscure. METHODS: This was a real-world, retrospective study. Adult cancer patients (≥18 years) undergoing abdominal surgery at Jiangsu Cancer Hospital, a tertiary care cancer hospital in China, between 2 March 2018 and 25 November 2019, were included in the analysis. Patients received 2 mg/kg (maximally 200 mg) sugammadex based on the discretion of the attending anesthetists. Patients were extubated as soon as they were awake and able to follow commands. The endpoint measures included extubation time, bowel function recovery and length of hospital stay. RESULTS: A total of 1,615 patients were included in the analysis: 795 participants received sugammadex at a dosage of 2 mg/kg (maximum 200 mg) upon completion of surgery; the remaining 820 participants did not receive sugammadex or neostigmine (another antidote for neuromuscular blockade). Despite several biases that clearly favored patients not receiving sugammadex [younger, better American Society of Anesthesiologists (ASA) status, and fewer comorbidities], the extubation time was significantly shorter in patients receiving sugammadex [median: 14 (range, 0-121) vs. 30.5 (range, 0-183) min; P<0.001]. In multivariate linear regression analysis, sugammadex use was associated with a significantly shorter extubation time (P<0.05). Patients who received sugammadex also had accelerated bowel function recovery and shorter postoperative hospital stay. CONCLUSIONS: Sugammadex shortens extubation time and accelerates postoperative recovery in cancer patients undergoing abdominal surgery.

Effects of prostaglandin E1 nebulization of ventilated lung under 60%O2 one lung ventilation on patients' oxygenation and oxidative stress: a randomised controlled trial.

BACKGROUND: High FiO2 during one-lung ventilation (OLV) can improve oxygenation, but increase the risk of atelectasis and oxidative stress. The aim of this study was to analyze whether Prostaglandin E1 (PGE1) can improve oxygenation and attenuate oxidative stress during OLV under a lower FiO2. METHOD: Ninety patients selectively undergoing thoracotomy for esophageal cancer were randomly divided into three groups (n = 30/group): Group P (FiO2 = 0.6, inhaling PGE1 0.1 µg/kg), Group L (FiO2 = 0.6) and Group C (FiO2 = 1.0). The primary outcomes were oxygenation and pulmonary shunt during OLV. Secondary outcomes included haemodynamics, respiratory mechanics and oxidative stress in serum. RESULTS: Patients in Group P had significantly higher PaO2 and lower shunt fraction in 30 min of OLV compared with Group L. Compared with Group C, patients in Group P had similar levels of PaO2/FiO2 in 60 min and higher levels of PaO2/FiO2 at 2 h during OLV. The levels of PvO2 and SvO2 in Group P and Group L were significantly lower than Group C. Patients in Group P and Group L had significantly higher levels of superoxide dismutase and lower levels of malondialdehyde than Group C. No significant differences were found in SPO2, ETCO2, PaCO2, Paw, HR and MAP among the three groups. The complications in Group C were significantly higher than another two groups. CONCLUSION: PGE1 can maintain adequate oxygenation in patients with low FiO2 (0.6) during OLV. Reducing FiO2 to 0.6 during OLV can decrease the levels of oxidative stress and complications after OLV. TRIAL REGISTRATION: chictr.org.cn identifier: ChiCTR1800017100.

Inhibition Of Monocarboxylate Transporter 1 In Spinal Cord Horn Significantly Reverses Chronic Inflammatory Pain.

PURPOSE: Chronic inflammatory pain is a common condition in the clinic, and the underlying mechanism is not being completely understood. Various studies have demonstrated that central and peripheral sensitization and synaptic plasticity could play crucial functions in chronic inflammatory pain. Moreover, families of monocarboxylate transporters (MCTs) are closely related to cellular metabolism and synaptic plasticity, and it is also reported that MCTs participate in chronic inflammatory pain. Nevertheless, there is a probability of the engaging role of MCT 1 is in chronic inflammatory pain, but its specific cellular level mechanism is yet to be investigated. In our study, we hypothesized that MCT 1 in the spinal dorsal horn plays an important part in chronic inflammatory pain. METHODS: In experiment A, rats were gone through nociceptive behavioral testing at 1 d day before and 1 d, 3 d, and 7 d after completing complete Freund's adjuvant (CFA) injection. The specimens collected for detecting MCT 1 by Western blotting. In experiment B, rats were randomly divided into four groups. Intrathecal injection of MCT 1 inhibitor and nociceptive behavioral tests were performed 1 d day before and 1 d, 3 d, 7 d, 14 d, and 21 d after CFA injection. MCT 1 and p-ERK levels in spinal dorsal horn were measured by Western blotting, and GFAP in spinal dorsal horn was detected by immunofluorescence. RESULTS: The expression of MCT 1 in the spinal dorsal horn was increased during chronic inflammatory pain in rats. The intrathecal injection of an MCT 1 inhibitor evidently diminished the expression of MCT 1 and GFAP in the spinal dorsal horn, and the behavioral nociceptive responses were also attenuated. Meanwhile, the expression of p-ERK was also decreased by the intrathecal injection of an MCT 1 inhibitor. CONCLUSION: Our results indicate that MCT 1 very likely play a critical role in regulating chronic inflammatory pain and may influence the regulation of synaptic plasticity via ERK in the spinal dorsal horn of rats.

Comparison of laryngeal mask airway and endotracheal intubation in gynecological cancer operation.

Endotracheal intubation (ETI) and laryngeal mask airway (LMA) in terms of hemodynamics and reaction were compared. A total of 54 general anesthesia patients were randomized into two groups with 27 cases in each group. Acceleration index (ACI), cardiac index (CI), cardiac output (CO), left cardiac work (LCW), systemic circulation resistance (SVR), mean arterial pressure (MAP), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded at 12 time-points: before surgery (T0), start effect (T1), lost consciousness (T2), before ETI or LMA (T3), 1 min (T4), 3 min (T5), 5 min (T6) after ETI or LMA, the beginning of surgery (T7), 30 min (T8), 1 hour (T9) after surgery, the end of surgery (T10) and extubation (T11). In each group these indexes went down and rose up gently during surgery except for T4 (intubation) and T11 (extubation) in ETI. These indexes reached the highest at T11 (extubation). This is due to the stimulus on mucosa and muscle of root of tongue, throat and epiglottis from the windpipe. The stimulus excites sympathetic nerve and increases the release of catecholamine. As a result, the heart beats faster and blood pressure rises. However, the range in the LMA group is smaller especially at T4 and T11. This is most likely due to LMA not stimulating the trachea. SVR, MAP, HR, SBP and DBP were lower in LMA with statistical significance in some time-points. The other indexes such as ACI, CI, CO and LCW were significantly higher in LMA (P<0.05). These results indicated that LMA can be suitable for use in general anesthesia for less stimulation. The airway with LMA in patients undergoing gynecological cancer operation is better than ETI in keeping stable hemodynamics and producing less anesthetic complications with smooth recovery from general anesthesia.

Effects of volume-controlled ventilation vs. pressure-controlled ventilation on respiratory function and inflammatory factors in patients undergoing video-assisted thoracoscopic radical resection of pulmonary carcinoma.

BACKGROUND: The best ventilation approach for patients undergoing video-assisted thoracic surgery (ATS) for pulmonary carcinoma remains undefined. This study aimed to assess hemodynamics, airway pressure, arterial blood gas, and inflammatory factors in patients undergoing VATS for pulmonary carcinoma under volume-controlled ventilation (VCV) or pressure-controlled ventilation (PCV). METHODS: This was a prospective study of 60 patients with pulmonary carcinoma treated at a tertiary center in 2015-2016. The subjects were randomized to the VCV or PCV group after anesthesia and total lung ventilation (TLV). Hemodynamics and blood gas parameters were compared between the two groups pre-OLV (one-lung ventilation) (T1) and after 30 (T2), 60 (T3), and 120 (T4) minutes of OLV. Radial artery blood was collected to measure interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-α levels. RESULTS: Hemodynamic and blood gas parameters were similar between the two groups (all P>0.05). During OLV, airway resistance (RAW) was significantly lower in the PCV group compared with the VCV group at T2 (26.0±3.8 vs. 29.9±7.3 cmH2O/L/s), T3 (26.0±3.7 vs. 30.2±7.7 cmH2O/L/s), and T4 (25.8±4.1 vs. 29.6±6.7 cmH2O/L/s). Similar trends were found for peak pressure (Ppeak) and plateau pressure (Pplat). Mean pressure (Pmean) was similar between the two groups. Compared with the PCV group, TNF-α and IL-6 levels in the VCV group were significantly increased (all P<0.05). The levels of the anti-inflammatory mediator IL-10 were higher in the PCV group compared with the VCV group. CONCLUSIONS: PCV for OLV during radical resection of pulmonary carcinoma by VATS could reduce Ppeak and downregulate pro-inflammatory factors, likely decreasing airway injury.

The change of HCN1/HCN2 mRNA expression in peripheral nerve after chronic constriction injury induced neuropathy followed by pulsed electromagnetic field therapy.

Neuropathic pain is usually defined as a chronic pain state caused by peripheral or central nerve injury as a result of acute damage or systemic diseases. It remains a difficult disease to treat. Recent studies showed that the frequency of action potentials in nociceptive afferents is affected by the activity of hyperpolarization-activated cyclic nucleotide-gated cation channels (HCN) family. In the current study, we used a neuropathy rat model induced by chronic constriction injury (CCI) of sciatic nerve to evaluate the change of expression of HCN1/HCN2 mRNA in peripheral nerve and spinal cord. Rats were subjected to CCI with or without pulsed electromagnetic field (PEMF) therapy. It was found that CCI induced neural cell degeneration while PEMF promoted nerve regeneration as documented by Nissl staining. CCI shortened the hind paw withdrawal latency (PWL) and hind paw withdrawal threshold (PWT) and PEMF prolonged the PWL and PWT. In addition, CCI lowers the expression of HCN1 and HCN2 mRNA and PEMF cannot restore the expression of HCN1 and HCN2 mRNA. Our results indicated that PEMF can promote nerve regeneration and could be used for the treatment of neuropathic pain.

[Dexmedetomidine suppresses the expressions of TLR4, NF-κB and ICAM-1 mRNA in the lung of rabbits during one lung ventilation].

Objective To investigate the effect of dexmedetomidine on lung injury and the expressions of Toll-like receptor 4 (TLR4), nuclear factor κB p65 (NF-κB p65) and intercellular adhesion molecular 1 (ICAM-1) mRNA during one-lung ventilation (OLV) in rabbits. Methods Thirty healthy New Zealand white rabbits were randomly divided into three groups ( n=10 in each group): two-lung ventilation (TLV) group (group T), OLV group (group O), dexmedetomidine used during OLV group (group D-O). The rabbits in group T were treated with TLV for 3.5 hours, while in group O and group D-O, the rabbits were ventilated through right lung for 3 hours following 30-minute TLV. In group D-O, dexmedetomidine (1 µg/kg) were given intravenously for 10 minutes before tracheostomy, followed by intravenous infusion at the rate of 1 µg/(kg.h). Equal volume of normal saline was given in group O and group T as controls. At the end of the experiment, rabbits were sacrificed and lung tissues were collected. The pulmonary wet/dry mass (W/D) ratio was calculated and the pathological changes of the lungs were observed using HE staining under a light microscope. The expressions of TLR4, NF-κB p65, ICAM-1 mRNA were analyzed by real-time quantitative PCR. Results W/D ratio of left lung tissues in group O and group D-O were significantly higher as compared with group T. However, W/D ratio in group D-O was obviously lower than that in group O. Compared with group T, both group O and group D-O showed much more serious morphological damage in the lung, and such lung injury was less obvious in group D-O than in group O. The expressions of TLR4, NF-κB p65, ICAM-1 mRNA increased significantly in group O as compared with group T, and such enhancement was ameliorated by dexmedetomidine as observed in group D-O. Conclusion Dexmedetomidine might inhibit inflammatory responses and attenuate OLV-induced lung injury in rabbits, possibly by suppressing the expressions of TLR4 and NF-κB p65 mRNA.

A novel method for right one-lung ventilation modeling in rabbits.

There is no standard method by which to establish a right one-lung ventilation (OLV) model in rabbits. In the present study, a novel method is proposed to compare with two other methods. After 0.5 h of baseline two-lung ventilation (TLV), 40 rabbits were randomly divided into sham group (TLV for 3 h as a contrast) and three right-OLV groups (right OLV for 3 h with different methods): Deep intubation group, clamp group and blocker group (deeply intubate the self-made bronchial blocker into the left main bronchus, the novel method). These three methods were compared using a number of variables: Circulation by heart rate (HR), mean arterial pressure (MAP); oxygenation by arterial blood gas analysis; airway pressure; lung injury by histopathology; and time, blood loss, success rate of modeling. Following OLV, compared with the sham group, arterial partial pressure of oxygen and arterial hemoglobin oxygen saturation decreased, peak pressure increased and lung injury scores were higher in three OLV groups at 3 h of OLV. All these indexes showed no differences between the three OLV groups. During right-OLV modeling, less time was spent in the blocker group (6±2 min), compared with the other two OLV groups (13±4 min in deep intubation group, P<0.05; 33±9 min in clamp group, P<0.001); more blood loss was observed in clamp group (11.7±2.8 ml), compared with the other two OLV groups (2.3±0.5 ml in deep intubation group, P<0.001; 2.1±0.6 ml in blocker group, P<0.001). The first-time and final success rate of modeling showed no differences among the three OLV groups. Deep intubation of the self-made bronchial blocker into the left main bronchus is an easy, effective and reliable method to establish a right-OLV model in rabbits.

Oxygenation, inflammatory response and lung injury during one lung ventilation in rabbits using inspired oxygen fraction of 0.6 vs. 1.0.

Maintaining adequate oxygenation during one-lung ventilation (OLV) requires high inspired oxygen fraction (FiO2). However, high FiO2 also causes inflammatory response and lung injury. Therefore, it remains a great interest to clinicians and scientists to optimize the care of patients undergoing OLV. The aim of this study was to determine and compare oxygenation, inflammatory response and lung injury during OLV in rabbits using FiO2 of 0.6 vs. 1.0. After 30 minutes of two-lung ventilation (TLV) as baseline, 30 rabbits were randomly assigned to three groups receiving mechanical ventilation for 3 hours: the sham group, receiving TLV with 0.6 FiO2; the 1.0 FiO2 group, receiving OLV with 1.0 FiO2; the 0.6 FiO2 group, receiving OLV with 0.6 FiO2. Pulse oximetry was continuously monitored and arterial blood gas analysis was intermittently conducted. Histopathologic study of lung tissues was performed and inflammatory cytokines and the mRNA and protein of nuclear factor kappa B (NF-κB) p65 were determined. Three of the 10 rabbits in the 0.6 FiO2 group suffered hypoxemia, defined by pulse oximetric saturation (SpO2) less than 90%. Partial pressure of oxygen (PaO2), acute lung injury (ALI) score, myeloperoxidase (MPO), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), mRNA and protein of NF-κB p65 were lower in the 0.6 FiO2 group than in the 1.0 FiO2 group. In conclusion, during OLV, if FiO2 of 0.6 can be tolerated, lung injury associated with high FiO2 can be minimized. Further study is needed to validate this finding in human subjects.

[Ketamine inhalation before one-lung ventilation for perioperative lung protection in thoracic surgery patients].

OBJECTIVE: To explore the effects of ketamine inhalation before one-lung ventilation (OLV) in patients undergoing transthoracic esophagectomy for esophageal cancer. METHODS: Upon the approval of hospital ethic committee, 90 American Society of Anesthesiologists grade I-II patients scheduled for elective trans-left-thoracic esophagectomy for esophageal cancer were randomly and single-blindly divided into 3 groups. After intravenous anesthesia with double-lumen endobronchial intubation, the patients in each group received different therapies before OLV, i.e. inhaling ketamine 1 mg/kg in Group Ki, intravenous infusion of ketamine 1 mg/kg in Group Kv and inhaling normal saline 10 ml in Group C. Arterial blood gas analysis was performed. And (oxygen saturation) SpO2, (partial pressure of end-tidal carbon dioxide) PETCO2, (airway pressure) Paw and hemodynamic indicators were recorded at these points:before OLV (T1), OLV for 30 min (T2), OLV for 1 h (T3), OLV for 2 h (T4), OLV ended 5 min (T5) and end of surgery (T6). Central venous blood was sampled at T1, T2 and 2 h after surgery (T7) for the determination of interleukin-6 (IL-6), interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations by enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum levels of IL-6, IL-8 and sICAM-1 in all groups increased significantly than those at previous timepoints. Serum levels of IL-6, IL-8 and sICAM-1 in Groups Ki and Kv were significantly lower than those in Group C at T7. PaO2 in Groups Ki and Kv was significantly higher than that in Group C at T4. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in Group Kv were significantly higher than that in Groups Ki and C at T2-T4; HR in Group Kv was significantly higher than that in Group C at T2-T3. Paw in Group Kv was significantly higher than that in Group C at T2-T6. CONCLUSION: Inhalation and intravenous infusion of ketamine before OLV are equally effective in lowering the serum levels of IL-6, IL-8 and sICAM-1. And ultrasonic atomizing inhalation of ketamine can avoid adverse effects on airway pressure and circulatory system caused by an intravenous infusion of ketamine.

[Ridge regression analysis of pulmonary infection rate after transthoracic esophagectomy for esophageal cancer].

OBJECTIVE: To identify the influencing factors of pulmonary infections after transthoracic esophagectomy for esophageal cancer. METHODS: A retrospective review of 349 patients undergoing transthoracic esophagectomy at our hospital for esophageal cancer was performed between January and December 2009. The postoperative pneumonia rate was examined and 26 perioperative factors possibly affecting the postoperative respiratory complications were collected. Ridge regression modeling was performed to determine if a significant association existed between perioperative factors and postoperative pneumonia. RESULTS: The postoperative pneumonia rate of all patients was 27.8%. Eight perioperative factors were found to have affected significantly the postoperative respiratory complications. The influencing factors included (according to contribution): patient control epidural analgesia (PCEA), diabetes, general anesthesia plus epidural analgesia, other postoperative complications, one lung ventilation (OLV), transfusion volume of red blood cells (RBC), body mass index (BMI) and age. CONCLUSION: The major influencing factors of pulmonary infection after transthoracic esophagectomy for esophageal cancer are PCEA, diabetes, general anesthesia plus epidural analgesia, other postoperative complications, OLV, transfusion volume of RBC, BMI and age.

[Airway stenting with inhalation anesthesia in malignant airway stenosis or fistula under radiological guidance].

OBJECTIVE: To assess the efficacy and safety of airway stenting with inhalation anesthesia under radiological guidance in the palliation of malignant tracheobronchial stenosis. METHODS: Between June 2001 and August 2010, 74 consecutive patients with malignant tracheobronchial stenosis were treated by the insertion of an ultraflex self-expandable metal stent with inhalation anesthesia under fluoroscopic guidance. RESULTS: All patients achieved obvious symptomatic relief. The outcomes were as follows: dyspnea (n = 2), long-term angina (n = 1), strong irritation cough (n = 2), hard phlegm (n = 3), clotting expectoration (n = 3), blood-tinged expectoration (n = 64), airway stent displacement (n = 1) and tracheoesophageal fistulas (n = 1). CONCLUSION: Performed with inhalation anesthesia under radiological guidance, tracheobronchial recanalization with a self-expandable metal stent is a safe and effective palliative treatment for malignant stenosis.