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1.
Paediatr Anaesth ; 2020 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-32338441

RESUMO

BACKGROUND: Lung protective ventilation (LPV) has been applied to surgical adults with normal pulmonary function for optimizing mechanic ventilation and reducing postoperative pulmonary complications. Few studies have reported the use of LPV in infants undergoing cardiac surgery with cardiopulmonary bypass (CPB). AIMS: To explore safety and effectiveness of LPV in infants undergoing CPB surgery for congenital heart disease (CHD). METHODS: Included in this study were 77 infants who underwent CPB surgery for CHD from November 2017 to September 2018. They were randomized into the LPV group and conventional ventilation (CV) group. In LPV group, small-tidal-volume (6-8ml/kg) ventilation, lung recruitment by PEEP increment to the maximum level of 15cmH2 O after CPB, and individualized optimal PEEP titration were applied. In CV group, traditional tidal volume (10-12ml/kg with zero PEEP) was applied. The primary outcome was the ratio of arterial partial pressure of oxygen to inspiratory oxygen fraction (PaO2 /FiO2 ). The secondary outcomes were respiratory dynamics parameters, hypoxemia, prognostic indexes and postoperative pulmonary complications. RESULTS: PaO2 /FiO2 in LPV group(416.86, 95%CI:381.60-452.12) was significantly higher than that in CV group(263.37, 95%CI:227.65-299.09) after intervention (P<0.001). There was significant difference in the trend of change in dynamic compliance, alveolar-arterial oxygen difference, arterial-end expired carbon dioxide difference, driving pressure and Respiratory Index between the two groups at different time points from weaning from CPB to 2 hours after operation. There was no significant difference in PaO2 /FiO2, alveolar-arterial oxygen difference, Respiratory Index and dynamic compliance 2 hours postoperative and in the incidence of postoperative pulmonary complications, prognostic indexes between the two groups. CONCLUSIONS: LPV could be used safely in infants undergoing CPB in that it can improve oxygenation, alveolar aeration and dynamic compliance; reduce driving pressure, pulmonary shunting, dead-space. Its effect on oxygenation, pulmonary gas exchange and pulmonary compliance was relatively short, and had less impact on postoperative pulmonary complications and prognosis.

2.
J Infect Dis ; 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32347939

RESUMO

BACKGROUND: Lymphocyte activation gene-3 (LAG-3) is one of the immune checkpoint molecules, negatively regulating the T cell reactions. The present study investigated the role of LAG-3 in sepsis-induced T lymphocytes disability. METHODS: Mice sepsis was induced by cecal ligation and puncture (CLP). LAG-3 expression on some immune cells were detected 24h after CLP. LAG-3-knockout mice and anti-LAG-3 antibody were applied to investigate the effects on the survival, bacterial clearance. Cytokines level, T cell counts and apoptosis (blood/spleen/thymus) were also determined. In vitro T cells apoptosis, IFN-γ secretion, proliferation were detected. IL-2 receptor (IL-2R) on T cells was also determined after CLP. RESULTS: LAG-3 upregulated on CD4+/CD8+ T, CD19+ B, NK, CD4+ CD25+ Treg cells and DCs. Both LAG-3-knockout and anti-LAG-3 antibody had a positive effect on the survival, blood/peritoneal bacterial clearance in CLP mice. Cytokines level and T cells apoptosis decreased in anti-LAG-3 antibody-treated mice. Induced T cells apoptosis decreased while the IFN-γ secretion and proliferation were improved by anti-LAG-3 antibody in vitro. IL-2R on T cells upregulated both in wild-type and LAG-3 deficiency CLP mice. CONCLUSIONS: LAG-3 diminish or anti-LAG-3 antibody blockade protected CLP mice from sepsis-associated immunodysfunction and maybe a new target for the treatment.

3.
Mediators Inflamm ; 2020: 2720369, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32189992

RESUMO

Xuebijing injection is a Chinese herb compound to treat sepsis in China, but it contains many different kinds of components, and each component may have different effects in treating sepsis. The present study was performed to investigate the effect of three ingredients of Xuebijing, safflor yellow A (SYA), hydroxysafflor yellow A (HSYA), and anhydrosafflor yellow B (AHSYB), in lipopolysaccharide- (LPS-) induced acute lung injury (ALI). LPS (10 mg/kg) was injected intratracheally to induce acute lung injury in mice, which were then treated with SYA, HSYA, and AHSYB. The blood, bronchoalveolar lavage fluid (BALF), and lung tissues were collected to detect degree of lung injury, level of inflammation, and neutrophil extracellular traps (NETs). In vitro experiments were performed using HL-60 cells stimulated with phorbol myristate acetate (PMA). Lung injury induced by LPS was alleviated by SYA, HSYA, and AHSYB as demonstrated by the histopathologic test. The three components inhibit LPS-induced elevation of the levels of inflammatory factors and wet-to-dry weight ratio as well as the amount of protein and cells in the BALF. They also induced a remarkably less overlay of myeloperoxidase (MPO) and histone in the immunofluorescence assay and reduced level of MPO-DNA complex in plasma. The in vitro assay showed a similar trend that the three components inhibited PMA-induced NET release in neutrophil-like HL-60 cells. Western blot demonstrated that phosphorylation of c-rapidly accelerated fibrosarcoma (c-Raf), mitogen-activated protein kinase ERK kinase (MEK), and extracellular signal-regulated kinase (ERK) in the lungs of LPS-challenged mice, and PMA-treated HL-60 cells were all significantly reduced by SYA, HSYA, and AHSYB. Therefore, our data demonstrated that three components of XBJ, including SYA, HSYA, and AHSYB, showed a protective effect against LPS-induced lung injury and NET release.

4.
J Clin Monit Comput ; 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31808060

RESUMO

Surgical pleth index (SPI) has been widely investigated in assessing the nociceptive level. The aim of this study was to investigate the relationship between SPI level and patient responses to trachea intubation and skin incision. A total of 40 patients undergoing open abdominal general surgery were recruited for analyses. The patients were monitored with electrocardiogram, non-invasive blood pressure, SpO2, invasive blood pressure and SPI before anesthesia induction. Anesthesia was induced with midazolam, propofol, sufentanil and rocuronium and maintained with sufentanil and sevoflurane. Blood pressure, heart rate and SPI were recorded for analyses during the peri-intubation and peri-incision periods. A receiver operating characteristic (ROC) curve analysis was performed to analyze the predictive value of blood pressure, heart rate (HR) and SPI for hemodynamic responses for trachea intubation and skin incision. SPI had a similar changing trend to systolic blood pressure (SBP) and diastolic blood pressure (DBP). The SPI level was linearly correlated with SBP, DBP and HR. SPI increased significantly after intubation and incision in patients with positive but not negative responses to intubation and incision. The ROC analysis showed that only SBP level is predictive of intubation responses. These data suggested that SPI elevated under the noxious stimulation by intubation and incision, but it was not predictive of the hemodynamic responses to intubation and incision.

5.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 41(3): 379-382, 2019 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-31282333

RESUMO

Objective To compare the impacts of different nostril on nasotracheal intubation with video laryngoscopy.Methods Totally 120 ASA grade I maxillofacial surgery patients were equally randomized into two groups:group A(left nostril)and group B(right nostril).After rapid induction of anesthesia,the nasal intubation was completed by Tosight video laryngoscope,and the success rate of the first attempt of the tube passing through the nasal cavity was recorded and compared between these two groups.In addition,time of tube through nasal cavity,time of glottis exposure,total intubation time,intubation success rate,and nasal bleeding were recorded.Results The success rate of the first attempt of tube passing through the nasal cavity was not significantly different between groups A and B(84.7% vs. 81.7%;χ 2=0.202,P=0.653).The time of tube passing through nasal cavity [(7.3±4.6)s vs.(7.5±4.1)s;t=-0.223,P=0.824] and the time of glottic exposure [(6.6±1.4)s vs.(6.7±1.4)s;t=-0.348,P=0.728] had no significant differences between two groups.The success rates of first intubation attempt were 100% in both groups.The total intubation time was(35.1±9.2)s in group A and(34.0±7.8)s in group B(t=0.663,P=0.509).Intubation-related epistaxis was found in 16 cases(27.1%)in group A and in 17 cases(28.3%)in group B(χ 2 =0.022,P=0.882).Conclusion Different nasal approaches have no effect on nasal intubation.


Assuntos
Intubação Intratraqueal/métodos , Laringoscopia , Cavidade Nasal , Glote , Humanos , Laringoscópios , Procedimentos Cirúrgicos Bucais
6.
Cell Physiol Biochem ; 45(6): 2497-2505, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29554659

RESUMO

BACKGROUND/AIMS: Retinoic acid receptor beta (RAR beta) is a retinoic acid receptor gene that has been shown to play key roles during multiple cancer processes, including cell proliferation, apoptosis, migration and invasion. Numerous studies have found that methylation of the RAR beta promoter contributed to the occurrence and development of malignant tumors. However, the connection between RAR beta promoter methylation and prostate cancer (PCa) remains unknown. This meta-analysis evaluated the clinical significance of RAR beta promoter methylation in PCa. MATERIALS AND METHODS: We searched all published records relevant to RAR beta and PCa in a series of databases, including PubMed, Embase, Cochrane Library, ISI Web of Science and CNKI. The rates of RAR beta promoter methylation in the PCa and control groups (including benign prostatic hyperplasia and normal prostate tissues) were summarized. In addition, we evaluated the source region of available samples and the methods used to detect methylation. To compare the incidence and variation in RAR beta promoter methylation in PCa and non-PCa tissues, the odds ratio (OR) and 95% confidence interval (CI) were calculated accordingly. All the data were analyzed with the statistical software STATA 12.0. RESULTS: Based on the inclusion and exclusion criteria, 15 articles assessing 1,339 samples were further analyzed. These data showed that the RAR beta promoter methylation rates in PCa tissues were significantly higher than the rates in the non-PCa group (OR=21.65, 95% CI: 9.27-50.57). Subgroup analysis according to the source region of samples showed that heterogeneity in Asia was small (I2=0.0%, P=0.430). Additional subgroup analysis based on the method used to detect RAR beta promoter methylation showed that the heterogeneity detected by MSP (methylation-specific PCR) was relatively small (I2=11.3%, P=0.343). CONCLUSION: Although studies reported different rates for RAR beta promoter methylation in PCa tissues, the total analysis demonstrated that RAR beta promoter methylation may be correlated with PCa carcinogenesis and that the RAR beta gene is particularly susceptible. Additional studies with sufficient data are essential to further evaluate the clinical features and prognostic utility of RAR beta promoter methylation in PCa.


Assuntos
Metilação de DNA , Regiões Promotoras Genéticas , Neoplasias da Próstata/genética , Receptores do Ácido Retinoico/genética , Carcinogênese/genética , Carcinogênese/patologia , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Próstata/patologia , Neoplasias da Próstata/patologia
7.
Sci Rep ; 8(1): 51, 2018 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-29311654

RESUMO

Increasing evidence suggests that T cells and glia participate in the process of neuropathic pain. However, little is known about the involvement of T cells or the interaction between glia and T cells at the molecular level. Here we investigated the phenotype of T cell infiltration into the spinal cord in inflammatory pain and explored potential crosstalk between glia and T cells. The establishment of monoarthritis produced T cell infiltration and astrocyte activation, exhibiting similar kinetics in the spinal cord. T-cell-deficient (Rag1-/-) mice significantly attenuated MA-induced mechanical allodynia and GFAP upregulation. Double immunofluorescence staining showed that CD3 mainly colocalized with interferon-gamma (IFN-γ). Western blot and flow cytometry showed that multiple intrathecal administrations of astrocytic inhibitor fluorocitrate decreased IFN-γ-production without decreasing T cell number in the spinal cord. Spinal IFN-γ blockade reduced MA-induced mechanical allodynia and astroglial activation. In contrast, treatment with rIFN-γ directly elicited persistent mechanical allodynia and upregulation of GFAP and pJNK1/2 in naïve rats. Furthermore, rIFN-γ upregulated the phosphorylation of NF-κB p65 in cultured astrocytes vitro and spinal dorsal horn vivo. The results suggest that Th1 cells and astrocytes maintain inflammatory pain and imply that there may be a positive feedback loop between these cells via IFN-γ.


Assuntos
Artrite/complicações , Astrócitos/metabolismo , Hiperalgesia/etiologia , Hiperalgesia/metabolismo , Medula Espinal/metabolismo , Linfócitos T/patologia , Animais , Modelos Animais de Doenças , Proteína Glial Fibrilar Ácida/metabolismo , Proteínas de Homeodomínio/genética , Proteínas de Homeodomínio/metabolismo , Interferon gama/metabolismo , Ativação Linfocitária/imunologia , NF-kappa B/metabolismo , Neuroglia/metabolismo , Fosforilação , Ratos , Medula Espinal/imunologia , Corno Dorsal da Medula Espinal/metabolismo , Linfócitos T/imunologia , Linfócitos T/metabolismo
8.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 39(4): 465-470, 2017 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-28877822

RESUMO

Objective To investigate the effect of intravenous dexmedetomidine injection(1 µg/kg)on the intubating conditions after inhalation induction with sevoflurane 8% and nitrous oxide(N2O)50% in children. Methods Totally 122 patients aged 4-10 years with an American Society of Anesthesiologists physical statusⅠ undergoing elective plastic surgery under general anesthesia were randomly divided to dexmedetomidine group(intraveneously injected with dexmedetomidine 1µg/kg)and control group(injected with normal saline)by using the random sampling table.On arrival of the operating room,anesthesia was induced with sevoflurane 8% and N2O 50% in oxygen 50%.When the patient became unconscious,the intravenous cannula 24# was inserted on the dorsum of hand.One minute later,laryngoscopy and tracheal intubation were performed.The intubating conditions were assessed by the scoring system in the previous study. Results The rates of acceptable conditions were 97% and 90% in dexmedetomidine group and in control group(P=0.143),and the rates of excellent conditions were 82% and 67%(P=0.04),respectively.In dexmedetomidine group,there were no signifi-cant differences of mean arterial presser and heart rate between the time-point of before intubation and the time-point of immediately after intubation.Conclusion Intravenous bolus of dexmedetomidine(1 µg/kg)can effectively improve the intubating conditions after inhalation induction of sevoflurane 8% and N2O 50% in children and make the hemodynamics more stable during tracheal intubation.


Assuntos
Anestésicos Inalatórios/uso terapêutico , Dexmedetomidina/uso terapêutico , Intubação Intratraqueal , Sevoflurano/uso terapêutico , Anestésicos Inalatórios/administração & dosagem , Criança , Pré-Escolar , Dexmedetomidina/administração & dosagem , Procedimentos Cirúrgicos Eletivos , Hemodinâmica , Humanos , Sevoflurano/administração & dosagem
10.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 38(5): 563-567, 2016 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-27825415

RESUMO

Objective To compare two spray administration of intranasal dexmedetomidine (DEX) doses for premedication in children. Methods In this prospective,randomized,double-blind study,41 children aged 3-6 years were enrolled. Children were assigned to receive either spray administration of intranasal DEX 1 µg/kg (Group D1) or 2 µg/kg (Group D2). The Ramsay Sedation Scale scores were evaluated at 5 min intervals. Sedation status at separation from patient was also evaluated. Heart rate (HR) and saturation of peripheral oxygen (SpO2) were recorded before and every 15 min after drug administration. Results The median sedation onset time was 30 min and 20 min in group D1 and group D2,respectively. Compared with the children in group D1,those in group D2 were significantly more sedated when they were separated from their parents (61.9% vs. 95.0%,respectively)(χ2=5.549,P=0.010). In Group D2,the HR decreased by 15.8% (t=2.415,P=0.021) 30 min after the spray administration of intranasal DEX. Compared with the baseline values,there was no significant difference in both groups in terms of SpO2(t=-1.426,P=0.162;t=-1.096,P=0.280)and HR in group D1 (t=-0.299,P=0.767) 30 min after the spray administration of intranasal DEX. Conclusion Spray administration of intranasal DEX 2 µg/kg provides superior sedation in children.


Assuntos
Administração Intranasal , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Anestesia/métodos , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Frequência Cardíaca , Humanos , Masculino , Oxigênio/análise , Estudos Prospectivos
11.
Mediators Inflamm ; 2016: 1045657, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26924896

RESUMO

Sepsis-associated encephalopathy (SAE) is characterized as brain dysfunction associated with sepsis. In this study we sought to investigate the effects of resveratrol in mice with SAE, as well as its effects in NLRP3 inflammasome and IL-1ß, which were critical in the pathogenesis of SAE. SAE was induced in mice via cecal ligation and puncture (CLP), and resveratrol was administered at two doses after surgery. Spatial learning memory functions were evaluated by Morris water maze testing. Apoptosis in the hippocampus was quantified using TUNEL assay. Inflammation in the hippocampus was quantified by measuring the levels of microglial activation, NLRP3, and IL-1ß. CLP mice treated with resveratrol demonstrated a better spatial memory during water maze training. The TUNEL assay demonstrated significantly attenuated rates of apoptosis, in resveratrol treated mice, while decreasing the number of iba-1 positive microglia in the hippocampus region. NLRP3 expression and IL-1ß cleavage were well inhibited by resveratrol dose-dependently. The in vitro results showed that in the BV2 cell lines resveratrol prevents ATP induced NLRP3 activation and IL-1ß cleavage, which were reversed by the sirtuin 1 inhibitor, nicotinamide. In conclusion, resveratrol improves the spatial memory in mice with SAE and inhibits the NLRP3/IL-1ß axis in the microglia.


Assuntos
Interleucina-1beta/metabolismo , Microglia/efeitos dos fármacos , Microglia/metabolismo , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Encefalopatia Associada a Sepse/tratamento farmacológico , Encefalopatia Associada a Sepse/metabolismo , Estilbenos/uso terapêutico , Animais , Linhagem Celular , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Resveratrol
13.
Med Sci Monit ; 22: 206-10, 2016 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-26787637

RESUMO

BACKGROUND: Propofol is widely used in sedation for colonoscopy, but its adverse effects on cardiovascular and respiratory systems are still concerning. The present study investigated whether target controlled infusion (TCI) of propofol could provide a better sedation quality than manually controlled infusion (MCI) in training inexperienced anesthesiology residents. MATERIAL/METHODS: Eighteen training residents were allocated into 2 groups receiving TCI and MCI training in their first month in the endoscopy center, while receiving MCI and TCI training instead in their second month. The last 2 patients at the end of each month were included to analyze the sedation quality of TCI and MCI techniques by comparing satisfaction of endoscopist and patients based on the visual analogue scale (VAS). Heart rate (HR), mean blood pressure (MAP), SpO2, and recovery time were also compared as the secondary outcomes. RESULTS: The demographic data were similarly distributed among the TCI and MCI patients. Endoscopist's satisfaction score in the TCI group was significantly higher than in the MCI group, 81.3±7.2 versus 74.2±9.5 (P=0.003), but the patients' satisfaction score was similar between the 2 groups. More stable hemodynamic status was obtained in the TCI group, manifested as higher lowest MAP and lower highest MAP than in the MCI group. Lowest SpO2 in the TCI group was significantly higher than in the MCI group. Patients in the TCI group recovered earlier than in the MCI group. CONCLUSIONS: TCI is a more effective and safer technique for anesthesiology residents in sedation for colonoscopy.


Assuntos
Anestesiologia/educação , Colonoscopia/educação , Internato e Residência , Propofol/administração & dosagem , Propofol/farmacologia , Adulto , Estudos Cross-Over , Demografia , Feminino , Humanos , Infusões Intravenosas , Masculino , Estudos Prospectivos
14.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 38(6): 627-631, 2016 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-28065226

RESUMO

Objective To observe the effects of two different intranasal dexmedetomidine doses as premedication on the EC50 of sevoflurane for successful laryngeal mask airway placement in children. Methods Children aged 3-6 years, of American Society of Anesthesiologists physical status 1, and scheduled for plastic surgery were enrolled in this study. Children were assigned to receive either spray administration of intranasal dexmedetomidine 1 µg/kg (group D1, n=21) or 2 µg/kg (group D2, n=20) approximately 30 minutes before anesthesia. Anesthesia was induced with sevoflurane up to 8% in 100% O2, with fresh gas flow set to 6 L/min. After the pupil fixed to the middle position, sevoflurane dial setting was reduced to 5% and fresh gas flow reduced to 3 L/min. The endtidal sevofluran (ETsevo) concentration for laryngeal mask airway insertion sustained for 10 minutes after vein intubation, which was determined according to the Dixon's up and down method. The initial endtidal sevoflurane concentration in each group was set at 2%. ETsevo was increased/decreased (1:1.2) in the next patient according to the response to laryngeal mask airway insertion. Bispectral index, mask acceptance, all response to laryngeal mask airway insertion, and ETsevo of laryngeal mask airway insertion of children were recorded. Results The bispectral index value was 77.4±3.6 in group D2, which was significantly lower than that (87.4±1.9) in group D1 when children entered operation room (P<0.05). Mask acceptance was 76.2% in group D1 and 90.0% in group D2. The EC50 of sevoflurane for laryngeal mask airway insertion was 1.09% (95% CI=0.89%-1.28%) in group D2, which was lower than 1.59% (95% CI=1.41%-1.78%) in group D1 (P<0.05). Conclusion Compared with the dose of 1 µg/kg, spray administration of intranasal dexmedetomidine 2 µg/kg as premedication can reduce the sevoflurane EC50 for successful laryngeal mask airway placement in children.


Assuntos
Anestésicos Inalatórios/administração & dosagem , Dexmedetomidina/administração & dosagem , Máscaras Laríngeas , Éteres Metílicos/administração & dosagem , Administração Intranasal , Anestesia , Criança , Pré-Escolar , Humanos , Sevoflurano
15.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 38(6): 637-642, 2016 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-28065228

RESUMO

Objective To compare the Ambu Aura-i with the Air-Q intubating laryngeal airway for fiberoptic-guided tracheal intubation in ear deformity children.Methods Totally 120 children who were scheduled for elective auricular reconstruction surgery requiring general anaesthesia with tracheal intubation were enrolled in this prospective study. They were randomized to receive either the Ambu Aura-i (Aura-i group) or Air-Q (Air-Q group). The time for successful tracheal intubation was assessed. The attempts for successful device insertion, leak pressures, cuff pressures, fiberoptic grade of laryngeal view, time for removal of the device after endotracheal intubation, and complications were recorded. Results Device placement, endotracheal intubation, and removal after endotracheal intubation were successful in all patients. The Air-Q group required longer time than the Aura-i group in device placement[(14.1±7.2) s vs. (10.8±5.2) s, P<0.05], successful endotracheal intubation [(39.8±9.5) s vs. (24.1±8.2) s, P<0.05], and device removal [(18.2±5.1) s vs. (14.7±3.7) s, P<0.05]. There were no differences in fiberoptic grade of view between these devices, and the percentage of glottis seen was 80.0% (Air-Q group) vs. 86.7% (Aura-i group). The leak pressure was (20.5±4.8) cmH2O in the Air-Q group and (22.2±5.0) cmH2O in the Aura-i group (P<0.05), and the cuff pressure was (22.9±11.5)cmH2O in the Air-Q group and (33.9±15.9) cmH2O in the Aura-i group (P<0.05). Hemodynamic changes were not significantly different between two group. The incidence rate of sore throat two hours after operation was 6.5% (n=4) in the Air-Q group and 5% (n=3) in the Aura-i group. Conclusion Both Ambu Aura-i and Air-Q intubating laryngeal airway are effective conduits for beroptic-guided tracheal intubation, with advantages including simple operation, high success rate, and fewer complications, especially the Ambu Aura-i.


Assuntos
Remoção de Dispositivo , Tecnologia de Fibra Óptica , Intubação Intratraqueal/métodos , Máscaras Laríngeas , Anestesia Geral , Criança , Procedimentos Cirúrgicos Eletivos , Humanos , Pressão , Estudos Prospectivos
16.
J Neurosurg Anesthesiol ; 28(4): 303-8, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26368663

RESUMO

BACKGROUND: Parkinson's disease (PD) is a common neurodegenerative disease affecting the quality of life in the elderly. We speculated that PD patients might have abnormal pharmacodynamics due to the degenerative neural system, and the present study was performed to investigate the pharmacodynamics of remifentanil in PD patients. MATERIALS AND METHODS: Two arms of patients were recruited, including 31 PD patients undergoing pulse generator placement after deep brain stimulator implantation and 31 pair-controlled patients undergoing intracranial surgery without PD (NPD). Patients were anesthetized with target-controlled infusion of propofol and remifentanil. The effective concentration of remifentanil to inhibit responses to intubation and skin incision in 50% and 95% patients (EC50 and EC95) was determined by the up and down method. RESULTS: Demographic data, bispectral index, and hemodynamic values were similar between the PD and the NPD groups. The average remifentanil concentration used in the PD group for tracheal intubation is significantly lower than in the NPD group (P<0.001). The EC50 for inhibiting the response to tracheal intubation were 1.86 ng/mL (95% confidential interval [CI], 1.77-1.96 ng/mL) in the PD group and 3.20 ng/mL (95% CI, 3.13-3.27 ng/mL) in the NPD group. The average remifentanil concentration used in the PD group for skin incision is significantly lower than in the NPD group (P<0.001). EC50 for inhibiting the response to skin incision were 2.17 ng/mL (95% CI, 2.09-2.25 ng/mL) in the PD group and 3.09 ng/mL (95% CI, 3.02-3.17 ng/mL) in the NPD group. CONCLUSIONS: The remifentanil concentrations required for inhibiting responses to tracheal intubation and skin incision are reduced markedly in PD patients undergoing pulse generator placement (NCT01992692).


Assuntos
Anestésicos Intravenosos/farmacologia , Estimulação Encefálica Profunda/instrumentação , Intubação Intratraqueal , Doença de Parkinson/cirurgia , Piperidinas/farmacologia , Ferida Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Remifentanil , Pele
17.
J Anesth ; 30(2): 284-9, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26671260

RESUMO

Within the airway management field, simulation has been used as a tool of training for over 40 years. Simulation training offers a chance of active involvement for the trainees. It can effectively enhance and upgrade the knowledge and skills of the trainees in airway management, and subsequently decrease medical errors and improve patients' outcomes and safety through a variety of airway management training modalities, such as common airway skills, difficult airway management strategies, and crisis management skills. To perform simulation-based airway management training effectively, not only are task trainers and high-fidelity simulators required but also instructors with rich experience in airway management simulation training and optimal curriculum design are essential.


Assuntos
Manuseio das Vias Aéreas/métodos , Competência Clínica , Treinamento por Simulação/métodos , Simulação por Computador , Currículo , Humanos , Sistema Respiratório
18.
BMC Anesthesiol ; 15: 161, 2015 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-26547293

RESUMO

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is an effective therapeutic method used to treat patients with pancreatic stones. However, the anesthesia for this procedure has been underappreciated, with minimal reports of these procedures in certain case series with general or epidural anesthesia. METHODS: A cohort of 60 patients who elected to undergo ESWL in order to treat pancreatic stones for the first time were randomly selected and divided into two groups. One group of patients received target controlled infusion (TCI) of remifentanil, while the other group of patients received TCI of remifentanil plus a bolus of flurbiprofen axetil (a cyclooxygenase inhibitor) (Rem group and Rem + Flu group, n = 30 for each group). The Dixon's up-and-down method was used to calculate the half maximum effective concentration (EC50) of remifentanil. Visual analogue scales of pain, Ramsay sedation scale, hemodynamic changes, and adverse events were also recorded. RESULTS: The EC50 of remifentanil was calculated to be 4.0 ng/ml (95 % confidential interval: 3.84 ng/ml, 4.16 ng/ml) and 2.76 ng/ml (95 % confidential interval: 2.63 ng/ml, 2.89 ng/ml) in the Rem group and Rem + Flu group respectively (p < 0.001). Pain score was comparable between the two groups, while the Ramsay sedation scale was higher in the Rem group. Hemodynamic data showed that patients in the Rem group experienced higher mean arterial pressures and higher heart rates across the procedures. Patients in Rem group demonstrated a lower respiratory rate (p < 0.001) and a lower SpO2 (p = 0.001). Less adverse events occurred in Rem + Flu group, including a reduced respiratory depression requiring wake-up as well as reduced postoperative nausea and vomiting. CONCLUSION: Remifentanil plus flurbiprofen axetil provided satisfactory analgesia and sedation for ESWL of pancreatic stones with less adverse events. (Clinicaltrial.gov: NCT01998217 ; registered on November 19, 2013).


Assuntos
Cálculos/terapia , Flurbiprofeno/análogos & derivados , Litotripsia/métodos , Piperidinas/administração & dosagem , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Pressão Arterial/efeitos dos fármacos , Cálculos/patologia , Quimioterapia Combinada , Feminino , Flurbiprofeno/administração & dosagem , Flurbiprofeno/efeitos adversos , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Pancreatopatias/patologia , Pancreatopatias/terapia , Piperidinas/efeitos adversos , Náusea e Vômito Pós-Operatórios/epidemiologia , Estudos Prospectivos , Remifentanil , Taxa Respiratória/efeitos dos fármacos
19.
Biomed Res Int ; 2015: 953729, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26495319

RESUMO

Parkinson's disease (PD) is the second most prevalent neurodegenerative disease, but whether the neurodegenerative process influences the pharmacodynamics of propofol remains unclear. We aimed to evaluate the effect of PD on pharmacodynamics of propofol. A total of 31 PD patients undergoing surgical treatment (PD group) and 31 pair-controlled non-PD patients undergoing intracranial surgery (NPD group) were recruited to investigate the propofol requirement for unconsciousness induction. Unconsciousness was induced in all patients with target-controlled infusion of propofol. The propofol concentration at which unconsciousness was induced was compared between the two groups. EC50 and EC95 were calculated as well. Demographic data, bispectral index, and hemodynamic values were comparable between PD and NPD groups. The mean target concentration of propofol when unconsciousness was achieved was 2.32 ± 0.38 µg/mL in PD group, which was significantly lower than that in NPD group (2.90 ± 0.35 µg/mL). The EC50 was 2.05 µg/mL (95% CI: 1.85-2.19 µg/mL) in PD group, much lower than the 2.72 µg/mL (95% CI: 2.53-2.88 µg/mL) in NPD group. In conclusion, the effective propofol concentration needed for induction of unconsciousness in 50% of patients is reduced in PD patients. (This trial is registered with NCT01998204.).


Assuntos
Estado de Consciência/efeitos dos fármacos , Esquema de Medicação , Propofol/administração & dosagem , Anestésicos Gerais/administração & dosagem , Estudos de Casos e Controles , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Resultado do Tratamento
20.
Int J Clin Exp Med ; 8(11): 20323-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26884947

RESUMO

Activation of hepatic stellate cells (HSC) plays a pivotal role in the development of hepatic fibrosis. Transforming growth factor-ß1 (TGF-ß1) is considered to be the main stimuli factor responsible for the activation of HSC. Diosgenin is a steroidal saponin found in several plants including Solanum and Dioscorea species, and it inhibited high glucose-induced renal tubular fibrosis. However, the effects of diosgenin against hepatic fibrosis remain elusive. Therefore, in this study, we investigated the effects of diosgenin on TGF-ß1-induced HSCs and elucidate the possible mechanism of its anti-fibrotic effect. Our results demonstrated that diosgenin inhibited TGF-ß1-induced HSC proliferation, reduced the expression of collagen I and α-smooth muscle actin (α-SMA), as well as the expression of TGF-ß receptor I (TGF-ß RI) and II. Moreover, diosgenin suppressed TGF-ß1-induced phosphorylation of Smad3 in HSCs. In conclusion, our data demonstrate that diosgenin inhibited HSC-T6 cell proliferation and activation, at least in part, via the TGF-ß1/Smad signaling pathway. These results provide that diosgenin may have potential to treat liver fibrosis.

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