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1.
Medicine (Baltimore) ; 99(6): e19031, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028416

RESUMO

The study was designed to verify if mini-fluid challenge test is more reliable than dynamic fluid variables in predicting stroke volume (SV) and arterial pressure fluid responsiveness during spine surgery in prone position with low-tidal-volume ventilation.Fifty patients undergoing spine surgery in prone position were included. Fluid challenge with 500 mL of colloid over 15 minutes was given. Changes in SV and systolic blood pressure (SBP) after initial 100 mL were compared with SV, pulse pressure variation (PPV), SV variation (SVV), plethysmographic variability index (PVI), and dynamic arterial elastance (Eadyn) in predicting SV or arterial pressure fluid responsiveness (15% increase or greater).An increase in SV of 5% or more after 100 mL predicted SV fluid responsiveness with area under the receiver operating curve (AUROC) of 0.90 (95% confidence interval [CI], 0.82 to 0.99), which was significantly higher than that of PPV (0.71 [95% CI, 0.57 to 0.86]; P = .01), and SVV (0.72 [95% CI, 0.57 to 0.87]; P = .03). A more than 4% increase in SBP after 100 mL predicted arterial pressure fluid responsiveness with AUROC of 0.86 (95% CI, 0.71-1.00), which was significantly higher than that of Eadyn (0.52 [95% CI, 0.33 to 0.71]; P = .01).Changes in SV and SBP after 100 mL of colloid predicted SV and arterial pressure fluid responsiveness, respectively, during spine surgery in prone position with low-tidal-volume ventilation.


Assuntos
Pressão Sanguínea , Monitorização Intraoperatória/métodos , Posicionamento do Paciente , Medula Espinal/cirurgia , Volume Sistólico , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pletismografia/métodos , Decúbito Ventral , Estudos Prospectivos , Adulto Jovem
2.
Paediatr Anaesth ; 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900969

RESUMO

BACKGROUND: We have previously reported that dynamic preload variables predicted fluid responsiveness in adult patients with liver cirrhosis. However, pediatric patients with cirrhosis may present with unique hemodynamic characteristics, and therefore, the predictive accuracy of these variables in such patients must be clarified. AIMS: To investigate the accuracy of dynamic preload variables for predicting fluid responsiveness in pediatric patients with cirrhosis. METHODS: A total of 27 pediatric patients with cirrhosis undergoing orthotopic liver transplantation were enrolled in this study. Patients' pulse pressure variation, stroke volume variation, stroke volume index, and central venous pressure were measured using the calibrated pulse contour cardiac output system. The plethysmographic variability index was measured using a Masimo Radical 7 co-oximeter. During the hepatic dissection phase of the surgery, repeated intraoperative fluid challenges with 10 mL kg-1 of crystalloid within 15 minutes were administered. Fluid responsiveness was defined as an increase in stroke volume index of ≥15% after fluid challenge. RESULTS: A total of 61 fluid challenges were administered resulting in 15 fluid responders and 46 fluid nonresponders. Fluid challenge induced significant decreases in all three dynamic preload variables but not in the fluid nonresponders. However, the area under the receiver operating characteristic curves for pulse pressure variation, stroke volume variation, plethysmographic variability index, and central venous pressure for predicting fluid responsiveness were 0.67 (95% confidence interval: 0.52-0.82; P = .0255), 0.68 (95% confidence interval: 0.54-0.83; P = .0140), 0.56 (95% confidence interval: 0.40-0.71; P = .4724), and 0.57 (95% confidence interval: 0.40-0.74; P = .4192), respectively. CONCLUSIONS: Dynamic preload variables do not predict fluid responsiveness in pediatric patients with liver cirrhosis.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31789951

RESUMO

BACKGROUND: Glioma is associated with high recurrence and poor survival, despite the success of tumor resection surgery. This may be partly because the immune microenvironment within a glioma is susceptible to perioperative immunosuppression. Therefore, intraoperative anesthesia-related immunomodulators, such as scalp block, intravenous anesthesia, the opioid dosage administered, and transfusions, may influence oncological outcomes among patients with glioma. The aim of this retrospective study was to investigate the influence of anesthetic techniques on oncological outcomes after craniotomy for glioma resection, particularly the effects of scalp block, intravenous anesthesia, and inhalation anesthesia. METHODS: Consecutive patients who underwent primary glioma resection surgeries between January 2010 and December 2017 were analyzed to compare postcraniotomy oncological outcomes (progression-free survival [PFS] and overall survival) by using the Kaplan-Meier method and multivariate Cox regression analysis. A propensity score-matched regression analysis including prognostic covariates was also conducted to analyze the selected relevant anesthetic factors of the unmatched regression model. RESULTS: A total of 230 patients were included in the final analysis. No analyzed anesthetic factor was associated with overall survival. Patients who received scalp block had a more favorable median (95% confidence interval [CI]) PFS (55.37 [95% CI, 12.63-62.23] vs. 14.07 [95% CI, 11.27-17.67] mo; P=0.0053). Scalp block was associated with improved PFS before (hazard ratio, 0.465; 95% CI, 0.272-0.794; P=0.0050) and after (hazard ratio, 0.367; 95% CI, 0.173-0.779; P=0.0091) propensity score-matched Cox regression analysis. By contrast, intravenous anesthesia, amount of opioid consumed, and transfusion were not associated with PFS. CONCLUSIONS: The study results suggest that the scalp block improves the recurrence profiles of patients receiving primary glioma resection.

4.
Biomed Res Int ; 2019: 8958069, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31111072

RESUMO

Background: Acute respiratory distress syndrome (ARDS) after living-donor liver transplantation (LDLT) is not uncommon, but it lacks the biomarkers for early detection. Club cell protein 16 (CC16), high-motility group box 1 protein (HMGB1), interleukin-1ß (IL-1ß), and IL-10 have been reported as relevant to the development of ARDS. However, they have not been investigated during LDLT. Methods: Seventy-three consecutive recipients undergoing LDLT were enrolled and received the same perioperative care plan. Perioperative serum CC16, HMGB1, IL-1ß, and IL-10 levels were measured at the pretransplant state, 30 minutes after reperfusion, postoperative day 1 (POD1), and POD3. ARDS was diagnosed according to the 2012 Berlin definition. Results: Of the 73 recipients, 13 developed ARDS with significantly longer durations of mechanical ventilation and intensive care unit stay. Serum CC16 levels on POD1 increased significantly from the pretransplant state in the ARDS group but not in the non-ARDS group. Pretransplant serum CC16 levels were also higher in the ARDS group. The area under the receiver operating characteristic curves for POD1 serum CC16 levels used to discriminate ARDS was 0.803 (95% confidence interval: 0.679 to 0.895; p < 0.001). By comparison, HMGB1, IL-1ß, and IL-10 were not associated with ARDS after LDLT. Conclusion: The higher pretransplant serum CC16 level and its increased level on POD1 were associated with the development of early ARDS after LDLT. This trial is registered with NCT01936545, 27 August 2013.


Assuntos
Biomarcadores/sangue , Transplante de Fígado , Doadores Vivos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico , Uteroglobina/biossíntese , Adulto , Feminino , Proteína HMGB1/sangue , Proteína HMGB1/metabolismo , Humanos , Unidades de Terapia Intensiva , Interleucina-10/sangue , Interleucina-10/metabolismo , Interleucina-1beta/sangue , Interleucina-1beta/metabolismo , Masculino , Pessoa de Meia-Idade , Curva ROC , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/metabolismo , Taiwan , Uteroglobina/metabolismo
5.
J Formos Med Assoc ; 118(7): 1138-1143, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30522856

RESUMO

BACKGROUND: Nonintubation anaesthesia for laryngomicrosurgery (LMS) provides both excellent visualization of the surgical field and complete examination on vocal cord. However, adequate oxygenation remains challenging during nonintubated LMS. Recently, transnasal humidified rapid-insufflation ventilator exchange (THRIVE) has been reported effectively maintaining apneic oxygenation in patient with difficult airways. The feasibility and safety of nonintubated LMS with THRIVE was evaluated in this case series. METHODS: From September 2016 to February 2017, a total of 23 patients receiving nonintubated LMS were included. Anaesthesia was induced and maintained through target-controlled propofol infusion and muscle relaxation with THRIVE oxygen support. Perioperative data were collected from medical records and analysed. RESULTS: The mean (±SD) duration of the operation was 12.4 (±4.4) min. The mean (±SD) total anaesthesia time (from induction to emergence) was 24.1 (±6.4) min. 22 patients received nonintubated LMS with surgical satisfaction without intraoperative desaturation. One patient who underwent laryngeal tumour biopsy experienced a single episode of desaturation. A 5.5-mm tracheal tube was needed for short-term mechanical ventilation to regain SpO2 to 100%. No significant complication was noted in all patients. All patients discharged as per schedule on the next day after surgery as intubated LMS patients in our hospital. CONCLUSION: Nonintubated LMS with THRIVE is a feasible and safe alternative to intubated LMS with a small size tracheal tube to provide a better surgical field. However, for patients with easy-bleeding tumor, intubated LMS remains suggestive for better airway protection.


Assuntos
Anestesia por Inalação/métodos , Laringoscopia , Máscaras , Oxigenoterapia/métodos , Administração Intranasal , Adulto , Idoso , Manuseio das Vias Aéreas/métodos , Anestesia por Inalação/efeitos adversos , Apneia/etiologia , Gasometria , Feminino , Humanos , Insuflação/métodos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade
6.
Mediators Inflamm ; 2018: 2575910, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29853785

RESUMO

One-lung ventilation in thoracic surgery provokes profound systemic inflammatory responses and injury related to lung tidal volume changes. We hypothesized that the highly selective a2-adrenergic agonist dexmedetomidine attenuates these injurious responses. Sixty patients were randomly assigned to receive dexmedetomidine or saline during thoracoscopic surgery. There is a trend of less postoperative medical complication including that no patients in the dexmedetomidine group developed postoperative medical complications, whereas four patients in the saline group did (0% versus 13.3%, p = 0.1124). Plasma inflammatory and injurious biomarkers between the baseline and after resumption of two-lung ventilation were particularly notable. The plasma high-mobility group box 1 level decreased significantly from 51.7 (58.1) to 33.9 (45.0) ng.ml-1 (p < 0.05) in the dexmedetomidine group, which was not observed in the saline group. Plasma monocyte chemoattractant protein 1 [151.8 (115.1) to 235.2 (186.9) pg.ml-1, p < 0.05] and neutrophil elastase [350.8 (154.5) to 421.9 (106.1) ng.ml-1, p < 0.05] increased significantly only in the saline group. In addition, plasma interleukin-6 was higher in the saline group than in the dexmedetomidine group at postoperative day 1 [118.8 (68.8) versus 78.5 (58.8) pg.ml-1, p = 0.0271]. We conclude that dexmedetomidine attenuates one-lung ventilation-associated inflammatory and injurious responses by inhibiting alveolar neutrophil recruitment in thoracoscopic surgery.


Assuntos
Dexmedetomidina/uso terapêutico , Ventilação Monopulmonar/efeitos adversos , Pneumonia/tratamento farmacológico , Toracoscopia/efeitos adversos , Volume de Ventilação Pulmonar/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/imunologia , Volume de Ventilação Pulmonar/efeitos dos fármacos , Volume de Ventilação Pulmonar/imunologia
7.
Oncotarget ; 8(38): 63715-63723, 2017 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-28969023

RESUMO

INTRODUCTION: Malignant primary brain tumors are one of the most aggressive cancers. Pretreatment serum nonneuronal biomarkers closely associated with postoperative outcomes are of high clinical relevance. The present study aimed to identify potential pretreatment serum biomarkers that may influence oncological outcomes in patients with primary brain tumors. METHODS: A total of 74 patients undergoing supratentorial primary brain tumor resection were enrolled. Before tumor resection, serum neuronal biomarkers, namely neuron-specific enolase (NSE), S100ß, and glial fibrillary acidic protein (GFAP), and serum nonneuronal biomarkers, namely neutrophil gelatinase-associated lipocalin (NGAL), lactate dehydrogenase (LDH), and lactate, were measured and associated postoperative oncological outcomes, including brain tumor grading, progression-free survival (PFS), and overall survival (OS), were compared. RESULTS: Patients with high-grade brain tumors had significantly higher pretreatment serum lactate levels (p = 0.011). By contrast, other biomarkers were comparable between patients with high-grade and low-grade brain tumors. Receiver operating characteristic curve analysis of serum lactate levels yielded an area under the curve of 0.71 for differentiating between high-grade and low-grade brain tumors. Kaplan-Meier survival analysis revealed patients with high serum lactate levels (≧2.0 mmol/L) had shorter PFS and OS (p = 0.021 and p = 0.093, respectively). In a multiple regression model, only elevated serum lactate levels were associated with poor PFS and OS (p = 0.021 and p = 0.048, respectively). CONCLUSIONS: An elevated pretreatment serum lactate level is a prognostic biomarker of high-grade primary brain tumors and is significantly associated with poor PFS in patients with supratentorial brain tumors undergoing tumor resection. By contrast, other serum biomarkers are not significantly associated with oncological outcomes.

8.
J Surg Res ; 211: 242-250, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28501124

RESUMO

BACKGROUND: Endotoxins contribute to systemic inflammatory response and microcirculatory dysfunctions under conditions of sepsis. Polymyxin B hemoperfusion (PMX-HP) is used to remove circulating endotoxins and improve clinical outcomes. This study aims to investigate the effect of PMX-HP on microcirculation in septic pigs. MATERIALS AND METHODS: By using a septic pig model, we tested the hypothesis that PMX-HP can correct intestinal microcirculation, tissue oxygenation saturation, and histopathologic alterations. A total of 18 male pigs were divided into three groups: (1) sham; (2) sepsis (fecal peritonitis); and (3) sepsis + PMX-HP groups. A sidestream dark field video microscope was used to record microcirculation throughout the terminal ileal mucosa, colon mucosa, kidney surface, and sublingual area. A superficial tissue oxygenation monitor employing the light reflectance spectroscopy technique was used to measure the tissue oxygen saturation. Hematoxylin and eosin staining was used for histologic examination. RESULTS: The perfused small vessel density and tissue oxygen saturation of the ileal mucosa at 6 h were higher in the sepsis + PMX-HP group than those in the sepsis group. The fluid amount and norepinephrine infusion rate between the sepsis group and sepsis + PMX-HP groups did not differ significantly. The histologic score for the ileal mucosa was lower in the sepsis + PMX-HP group than that in the sepsis group. Finally, the urine output was higher in the sepsis + PMX-HP group than it was in the sepsis group. CONCLUSIONS: This study demonstrates that PMX-HP attenuates microcirculatory dysfunction, tissue desaturation, and histopathologic alterations in the ileal mucosa in septic pigs.


Assuntos
Antibacterianos/uso terapêutico , Hemoperfusão/métodos , Microcirculação , Polimixina B/uso terapêutico , Sepse/terapia , Animais , Biomarcadores/sangue , Endotoxinas/sangue , Íleo/patologia , Íleo/fisiopatologia , Mucosa Intestinal/patologia , Mucosa Intestinal/fisiopatologia , Masculino , Sepse/sangue , Sepse/patologia , Sepse/fisiopatologia , Suínos , Resultado do Tratamento
9.
BMC Anesthesiol ; 17(1): 3, 2017 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-28125979

RESUMO

BACKGROUND: The use of supraglottic airway devices (SADs) in surgeries with laparoscopic pneumoperitoneum and Trendelenburg (LPT) positioning is controversial due to concerns about insufficient pulmonary ventilation and aspiration. In this prospective, randomized-controlled trial, we evaluated whether the i-gel, a new second generation SAD, provides an effective alternative to an endotracheal tube (ETT) by comparing respiratory parameters and perioperative respiratory complications in non-obese patients. METHODS: In a randomized controlled trial, forty anesthetized patients with ASA I-II were divided into equally sized i-gel and ETT groups. We evaluated the respiratory parameters in the supine and LPT position in comparison between the two groups. The leak fraction was our primary outcome, which was defined as the leak volume divided by the inspired tidal volume. The leak volume was the difference between the inspired and expired tidal volumes. We also monitored pulmonary aspiration and respiratory complications during the perioperative period. RESULTS: In the LPT position, there were no differences in the leak fraction (median [IQR]) between the i-gel and ETT groups (6.20[3.49] vs 6.38[3.71] %, P = 0.883). In the i-gel group, notably less leakage was observed in the LPT position than in the supine position (median [IQR]: 7.01[3.73] %). This phenomenon was not observed in the ETT group. The rate of postoperative sore throat was also significantly lower in the i-gel group than in the ETT group (3/17 vs 9/11). No vomitus nor any signs associated with aspiration were noted in our patients after extubation in the follow-up prior to discharge. CONCLUSIONS: The i-gel provides a suitable alternative to an ETT for surgeries with LPT positioning in non-obese patients. TRIAL REGISTRATION: Registered at Clinicaltrials.gov NCT02462915 , registered on 1 June 2015.


Assuntos
Decúbito Inclinado com Rebaixamento da Cabeça , Complicações Intraoperatórias/fisiopatologia , Intubação Intratraqueal/instrumentação , Laparoscopia/métodos , Pneumoperitônio/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Adulto , Feminino , Humanos , Intubação Intratraqueal/efeitos adversos , Laparoscopia/efeitos adversos , Masculino , Faringite/prevenção & controle , Aspiração Respiratória/prevenção & controle , Fenômenos Fisiológicos Respiratórios , Adulto Jovem
10.
J Formos Med Assoc ; 116(6): 432-440, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27667769

RESUMO

BACKGROUND/PURPOSE: Postoperative acute lung injury (ALI) after liver transplantation is clinically relevant and common. The perioperative thoracic fluid indices changes as well as the association with ALI in liver transplantation have not been thoroughly investigated. METHODS: A total of 52 consecutive adult recipients for elective living donor liver transplantation were enrolled. Each recipient received the same perioperative care plan. Thoracic fluid indices, including the cardiac index, intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), and pulmonary vascular permeability index (PVPI), were obtained at seven time points (pretransplantation, anhepatic phase, 30 minutes after reperfusion, 2 hours after reperfusion, and postoperative days 1-3) using the pulse contour cardiac output system. The indices of those who developed ALI (PaO2/FiO2 < 300 mmHg with lung infiltrates on chest X-ray) were compared with the indices of those who did not. RESULTS: Recipients who developed postoperative ALI had longer mechanical ventilation duration and had a higher model for end-stage liver disease score, required more platelet transfusion, and were higher in pretransplant EVLWI and PVPI level. During the anhepatic phase, ITBVI, central venous pressure, cardiac index, and EVLWI decreased and PVPI increased. After transplantation, ITBVI increased above pretransplant status, while EVLWI and PVPI were comparable in both groups. CONCLUSION: Recipients who did or did not develop ALI after liver transplantation had a longer mechanical ventilation duration and showed different patterns of perioperative thoracic fluid indices, especially in the pretransplant status of PVPI level. Knowledge of these perioperative changes may provide clinicians with helpful information to make postoperative care choices.


Assuntos
Volume Sanguíneo , Permeabilidade Capilar , Pressão Venosa Central , Água Extravascular Pulmonar , Transplante de Fígado , Lesão Pulmonar Aguda/etiologia , Feminino , Humanos , Transplante de Fígado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Monitorização Fisiológica , Complicações Pós-Operatórias , Respiração Artificial/estatística & dados numéricos
11.
Zhongguo Zhong Xi Yi Jie He Za Zhi ; 37(1): 86-93, 2017 01.
Artigo em Chinês | MEDLINE | ID: mdl-30695431

RESUMO

Objective To observe the effect of Ruyiping (RYP, a recipe for fighting against re- currence and metastasis of breast cancer) on pre-metastatic microenvironment, and to study its possi- ble mechanism. Methods The experiment was divided into two parts. The 1st part lies in setting the pre- cancerous transfer, and the 2nd part lies in the effect of RYP on pre-metastatic microenvironment. There were 24 BALB/c mice in the 1st part. Logarithmic phase 4T1 cells were dispensed into cell suspension. Blood cells were counted by blood cell counter. Then they were injected into the 4th mammary fat pad of the 24 BALB/c mice under aseptic condition (1 x 106 cells/mL, 0.1 mL for each mouse). There were 60 BALB/c mice in the 2nd part. They were divided into the blank group, the model group, low, middle, high dose RYP groups by random digit table, 12 in each group. The modeling method was the same as men- tioned above. Medication was started from the 2nd day of inoculation. Mice in low, middle, high dose RYP groups were administered with 5. 13, 10. 26, 20. 52 g/kg RYP crude drugs per day by gastrogavage, once per day for 14 successive days. Equal volume of normal saline was administered by gastrogavage to mice in the blank group and the model group. Six mice were sacrificed at day 10, 14, 18, and 22, respectively in the 1 st part of the experiment. The pulmonary metastasis was observed. The histology and mi- cromorphology of lung tissues were observed under light microscope and electron microscope/transmission electron microscopy (TEM) in the 2nd part of the experiment. The relative pulmonary vascular per- meability was determined by Evans blue. The effect of RYP on the formation of pre-metastatic microenvironment was observed. The levels of angiogenin2 (Angpt2), vascular endothelial growth factor (VEGF) , IL6 and IL1 ß were detected by Western blot and Real time PCR. Results The period from day 0 to day 14 was considered to be the pre-metastatic phase. Compared with the model group, significant inhibition on the tumor weight and tumor volume were shown in middle and high dose RYP groups (P <0. 05,P <0. 01). RYP dose-dependently inhibited the tumor weight and tumor volume (P <0. 05,P <0. 01). Infiltration of lymphocytes occurred in the model group and the low dose RYP group. But there was no statistical difference in the morphology of lung tissue in light microscopic results between middle/high dose RYP groups and the blank group. The pulmonary blood vessel net was consisted of continuously densely capillaries. The structure of pulmonary capillaries was normal in the blank group. The blood vessel walls were not regular and even in the model group, with obviously distended capillaries. After treated by RYP, the injury was improved, with normal basic morphology of blood vessels. Compared with the blank group, the exudate in Evans blue was obviously increased, protein and mRNA expressions of Angpt2, VEGF, IL6, and IL1ß were increased in the model group (P <0. 05,P <0. 01). Compared with the model group, the exu- date in Evans blue was obviously decreased in each YRP group. The reduction of the exudate was dose- dependently with the dose of YRP (P <0. 01). Protein and mRNA expressions of VEGF in the middle dose RYP group, protein and mRNA expressions of Angpt2, VEGF, IL6, and ILI1ß were decreased in middle and high dose RYP groups (P <0. 05,P <0. 01). Protein expressions of IL6 were decreased in the middle dose RYP group (P <0. 01). Conclusions RYP had favorable regulation in the tumor growth and the formation of pre-metastatic microenvironment. It could protect the integrity of vascular system, inhibit the formation of pre-metastatic microenvironment possibly through inhibiting the expressions of Angpt2, VEGF, IL6, and IL11ß, and finally inhibiting the occurrence of pulmonary metastasis of breast cancer.


Assuntos
Neoplasias da Mama , Medicamentos de Ervas Chinesas , Neoplasias Pulmonares , Animais , Neoplasias da Mama/tratamento farmacológico , Medicamentos de Ervas Chinesas/farmacologia , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Distribuição Aleatória , Fator A de Crescimento do Endotélio Vascular
12.
Eur J Anaesthesiol ; 33(9): 645-52, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27167058

RESUMO

BACKGROUND: Predicting whether a fluid challenge will elicit 'fluid responsiveness' in stroke volume (SV) and arterial pressure is crucial for managing hypovolaemia and hypotension. Pulse pressure variation (PPV), SV variation (SVV) and the plethysmographic variability index (PVI) have been shown to predict SV fluid responsiveness, and the PPV/SVV ratio has been shown to predict arterial pressure fluid responsiveness under various conditions. However, these variables have not been investigated in liver cirrhosis patients. OBJECTIVE: The objective was to evaluate SV and arterial pressure fluid responsiveness in liver cirrhosis patients by using dynamic preload and vascular tone variables. DESIGN: A prospective study of diagnostic accuracy. SETTINGS: A single-centre trial conducted from November 2013 to April 2015. PATIENTS: Thirty-one adult patients, recipients of a living donor liver transplantat. INTERVENTION: An intraoperative fluid challenge with 10 ml kg of 0.9% normal saline. MAIN OUTCOME MEASURES: PPV, SVV, cardiac index and systemic vascular resistance index were measured using the Pulse index Continuous cardiac system. The PVI and perfusion index were measured using the Masimo Radical 7 co-oximeter. The PPV, SVV and PVI were measured to investigate SV fluid responsiveness, and the PPV/SVV ratio, perfusion index and systemic vascular resistance index were measured to investigate arterial pressure fluid responsiveness. RESULTS: The areas under the receiver operating characteristic curves for PPV, SVV and PVI were 0.794, 0.754 and 0.800, respectively (all P < 0.001). The cut-off values for PPV, SVV and PVI were 10% (sensitivity 78.3%, specificity 79.5%), 12% (sensitivity 69.6%, specificity 71.8%) and 11% (sensitivity 95.7%, specificity 59.0%), respectively. However, all investigated vascular tone variables failed to predict arterial pressure and fluid responsiveness. CONCLUSION: Dynamic preload variables predicted SV fluid responsiveness. Therefore, these variables can be used for fluid management in liver cirrhosis patients receiving mechanical ventilation. In contrast, vascular tone variables did not predict arterial pressure fluid responsiveness in liver cirrhosis patients. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT01971333.


Assuntos
Pressão Arterial/fisiologia , Cirrose Hepática/diagnóstico , Cirrose Hepática/fisiopatologia , Volume Sistólico/fisiologia , Adulto , Anestesia Geral/métodos , Feminino , Humanos , Cirrose Hepática/cirurgia , Transplante de Fígado/efeitos adversos , Transplante de Fígado/tendências , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos
13.
Anesthesiology ; 125(2): 355-67, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27111533

RESUMO

BACKGROUND: Dexmedetomidine reduces cytokine production in septic patients and reduces inflammation and mortality in experimental models of endotoxemia and sepsis. This study investigated whether dexmedetomidine attenuates endothelial dysfunction, intestinal microcirculatory dysfunction, and intestinal epithelial barrier disruption in endotoxemic rats. METHODS: Ninety-two male Wistar rats were randomly assigned to the following four groups: (1) Sham; (2) lipopolysaccharide, received IV lipopolysaccharide 15 and 10 mg/kg at 0 and 120 min; (3) dexmedetomidine, received IV dexmedetomidine for 240 min; and (4) lipopolysaccharide + dexmedetomidine, received both lipopolysaccharide and dexmedetomidine. Sidestream dark-field videomicroscope, tissue oxygen monitor, and full-field laser perfusion image were used to investigate the microcirculation of the terminal ileum. Serum endocan level was measured. The Ussing chamber permeability assay, lumen-to-blood gadodiamide passage by magnetic resonance imaging, and bacterial translocation were conducted to determine epithelial barrier function. Mucosal apoptotic levels and tight junctional integrity were also examined. RESULTS: The density of perfused small vessels in mucosa, serosal muscular layer, and Peyer patch in the lipopolysaccharide + dexmedetomidine group was higher than that of the lipopolysaccharide group. Serum endocan level was lower in the lipopolysaccharide + dexmedetomidine group than in the lipopolysaccharide group. Mucosal ratio of cleaved to full-length occludin and spleen bacterial counts were significantly lower in the lipopolysaccharide + dexmedetomidine group than in the lipopolysaccharide group. CONCLUSION: The study finding suggests that dexmedetomidine protects against intestinal epithelial barrier disruption in endotoxemic rats by attenuating intestinal microcirculatory dysfunction and reducing mucosal cell death and tight junctional damage. (Anesthesiology 2016; 125:355-67).


Assuntos
Dexmedetomidina/farmacologia , Endotoxemia/metabolismo , Hipnóticos e Sedativos/farmacologia , Mucosa Intestinal/efeitos dos fármacos , Intestinos/irrigação sanguínea , Microcirculação/efeitos dos fármacos , Animais , Translocação Bacteriana/efeitos dos fármacos , Células Endoteliais/efeitos dos fármacos , Mucosa Intestinal/irrigação sanguínea , Intestinos/efeitos dos fármacos , Lipopolissacarídeos/toxicidade , Imagem por Ressonância Magnética , Masculino , Consumo de Oxigênio/efeitos dos fármacos , Permeabilidade , Ratos , Ratos Wistar , Fluxo Sanguíneo Regional/efeitos dos fármacos , Junções Íntimas/efeitos dos fármacos
14.
Crit Care ; 19: 434, 2015 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-26651994

RESUMO

INTRODUCTION: Fluid resuscitation is an indispensable procedure in the acute management of hemorrhagic shock for restoring tissue perfusion, particularly microcirculation in splanchnic organs. Resuscitation fluids include crystalloids, hypertonic saline (HTS), and synthetic colloids, and their selection affects the recovery of microcirculatory blood flow and reactive oxygen species (ROS) formation, which is often evident in the kidney, following reperfusion. In this study, the effects of acute resuscitation with 0.9% saline (NS), 3% HTS, 4% succinylated gelatin (GEL), and 6% hydroxyethyl starch (HES) 130/0.4 were compared in a hemorrhagic shock rat model to analyze restoration of microcirculation among various splanchnic organs and the gracilis muscle and reperfusion-induced renal ROS formation. METHODS: A total of 96 male Wistar rats were subjected to sham operation (sham group), hemorrhagic shock (control group), and resuscitation with NS, HTS, GEL and HES. Two hours after resuscitation, changes in the mean arterial pressure (MAP), serum lactate level and the microcirculatory blood flow among various splanchnic organs, namely the liver, kidney, and intestine (mucosa, serosal muscular layer, and Peyer's patch), and the gracilis muscle, were compared using laser speckle contrast imaging. Renal ROS formation after reperfusion was investigated using an enhanced in vivo chemiluminescence (CL) method. RESULTS: Microcirculatory blood flow was less severely affected by hemorrhaging in the liver and gracilis muscle. Impairment of microcirculation in the kidney was restored in all resuscitation groups. Resuscitation in the NS group failed to restore intestinal microcirculation. Resuscitation in the HTS, GEL, and HES groups restored intestinal microcirculatory blood flow. By comparison, fluid resuscitation restored hemorrhagic shock-induced hypotension and decreased lactatemia in all resuscitation groups. Reperfusion-induced in vivo renal ROS formation was significantly higher in the GEL and HES groups than in the other groups. CONCLUSION: Although fluid resuscitation with NS restored the MAP and decreased lactatemia following hemorrhagic shock, intestinal microcirculation was restored only by other volume expanders, namely 3% HTS, GEL, and HES. However, reperfusion-induced renal ROS formation was significantly higher when synthetic colloids were used.


Assuntos
Microcirculação/efeitos dos fármacos , Ressuscitação/métodos , Choque Hemorrágico/tratamento farmacológico , Circulação Esplâncnica/efeitos dos fármacos , Animais , Soluções Cristaloides , Hidratação/instrumentação , Hidratação/métodos , Hidratação/mortalidade , Hemodinâmica/efeitos dos fármacos , Infusões Intravenosas/instrumentação , Infusões Intravenosas/métodos , Infusões Intravenosas/mortalidade , Soluções Isotônicas/administração & dosagem , Soluções Isotônicas/uso terapêutico , Rim/irrigação sanguínea , Rim/efeitos dos fármacos , Rim/metabolismo , Rim/fisiopatologia , Masculino , Microcirculação/fisiologia , Ratos , Ratos Wistar , Espécies Reativas de Oxigênio/análise , Espécies Reativas de Oxigênio/sangue , Espécies Reativas de Oxigênio/metabolismo , Solução Salina Hipertônica/administração & dosagem , Solução Salina Hipertônica/uso terapêutico , Choque Hemorrágico/mortalidade , Choque Hemorrágico/fisiopatologia , Cloreto de Sódio/administração & dosagem , Cloreto de Sódio/uso terapêutico
15.
Microvasc Res ; 101: 55-61, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26093177

RESUMO

OBJECTIVE: Hemorrhagic shock induces both macrocirculatory and microcirculatory impairment. Persistent microcirculatory dysfunction is associated with the dysfunction of multiple organs, especially in the splanchnic organs. However, few studies have simultaneously investigated microcirculation in multiple organs. In the present study, we used laser speckle contrast imaging to simultaneously investigate microcirculatory changes secondary to hemorrhagic shock and after fluid resuscitation among multiple splanchnic organs and the gracilis muscle. MATERIALS AND METHODS: 72 male Wistar rats were subjected to sham operation, hemorrhagic shock (total blood loss of 30mL/kg) and saline resuscitation. Macrocirculatory parameters, including the mean arterial pressure (MAP) and heart rate, and microcirculatory parameters, including microcirculatory blood flow intensity and tissue oxygen saturation in the liver, kidney, intestine (mucosa, serosal muscular layer, and Peyer's patch), and gracilis muscle were compared in a period of 3h. RESULTS: Hemorrhagic shock induced a significant reduction of microcirculatory blood flow intensity in the kidney and intestine (especially the mucosa). Tissue oxygen saturation reduction secondary to hemorrhagic shock was comparable among the various splanchnic organs but lower than the gracilis muscle. Fluid resuscitation restored the MAP but not the microcirculatory blood flow in the intestine and the tissue oxygen saturation in each splanchnic organ. CONCLUSION: Hemorrhagic shock induced the largest reduction in microcirculatory blood flow intensity in the intestinal mucosa. By comparison, the reduction of tissue oxygen saturation was not significantly different among the various splanchnic organs. Although fluid resuscitation restored the MAP, the intestinal microcirculation remained damaged.


Assuntos
Hidratação/métodos , Ressuscitação/métodos , Choque Hemorrágico/terapia , Animais , Diagnóstico por Imagem/métodos , Hemodinâmica , Lasers , Masculino , Microcirculação , Músculo Esquelético/patologia , Oxigênio/química , Ratos , Ratos Wistar , Circulação Esplâncnica/fisiologia
16.
Ann Surg Oncol ; 22(6): 1943-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25404473

RESUMO

BACKGROUND: The role of ultrasound examination in detection of postprocedure complications from totally implantable venous access devices (TIVAD) placement is still uncertain. In a cohort of 665 cancer outpatients, we assessed a quick ultrasound examination protocol in early detection of mechanical complications of catheterization. METHODS: Immediately after TIVAD placement, an ultrasound examination and chest radiography were performed to detect hemothorax, pneumothorax, and catheter malposition. The two methods were compared. RESULTS: Of the 668 catheters inserted, 628 were placed into axillary veins and 40 into internal jugular veins. The ultrasound examination took 2.5 ± 1.1 min. No hemothorax was detected, and neither pneumothorax nor catheter malposition was evident among the 40 internal jugular vein cannulations. Ultrasound and chest radiography examinations of the 628 axillary vein cannulations detected five and four instances of pneumothorax, respectively. Ultrasound detected all six catheter malpositions into the internal jugular vein. However, ultrasound failed to detect two out of three malpositions in the contralateral brachiocephalic vein and one kinking inside the superior vena cava. Without revision surgery, the operating time was 34.1 ± 15.6 min. With revision surgery, the operating time was shorter when ultrasound detected catheter malposition than when chest radiography was used (96.8 ± 12.9 vs. 188.8 ± 10.3 min, p < 0.001). CONCLUSIONS: Postprocedure ultrasound examination is a quick and sensitive method to detect TIVAD-related pneumothorax. It also precisely detects catheter malposition to internal jugular vein thus reduces time needed for revision surgery while chest radiography remains necessary to confirm catheter final position.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Neoplasias/complicações , Neoplasias/diagnóstico por imagem , Pneumotórax/diagnóstico por imagem , Complicações Pós-Operatórias , Ultrassom , Cateteres de Demora/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Pneumotórax/etiologia , Prognóstico , Estudos Prospectivos , Ultrassonografia
17.
BMC Anesthesiol ; 14: 75, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25210501

RESUMO

BACKGROUND: The abdominal insufflation and surgical positioning in the laparoscopic surgery have been reported to result in an increase of airway pressure. However, associated effects on changes of endotracheal tube cuff pressure are not well established. METHODS: 70 patients undergoing elective laparoscopic colorectal tumor resection (head-down position, n = 38) and laparoscopic cholecystecomy (head-up position, n = 32) were enrolled and were compared to 15 patients undergoing elective open abdominal surgery. Changes of cuff and airway pressures before and after abdominal insufflation in supine position and after head-down or head-up positioning were analysed and compared. RESULTS: There was no significant cuff and airway pressure changes during the first fifteen minutes in open abdominal surgery. After insufflation, the cuff pressure increased from 26 ± 3 to 32 ± 6 and 27 ± 3 to 33 ± 5 cmH2O in patients receiving laparoscopic cholecystecomy and laparoscopic colorectal tumor resection respectively (both p < 0.001). The head-down tilt further increased cuff pressure from 33 ± 5 to 35 ± 5 cmH2O (p < 0.001). There six patients undergoing colorectal tumor resection (18.8%) and eight patients undergoing cholecystecomy (21.1%) had a total increase of cuff pressure more than 10 cm H2O (18.8%). There was no significant correlation between increase of cuff pressure and either the patient's body mass index or the common range of intra-abdominal pressure (10-15 mmHg) used in laparoscopic surgery. CONCLUSIONS: An increase of endotracheal tube cuff pressure may occur during laparoscopic surgery especially in the head-down position.


Assuntos
Anestesia por Inalação/métodos , Intubação Intratraqueal/métodos , Laparoscopia/métodos , Posicionamento do Paciente , Adulto , Idoso , Resistência das Vias Respiratórias , Índice de Massa Corporal , Feminino , Cabeça , Decúbito Inclinado com Rebaixamento da Cabeça , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Estudos Prospectivos
18.
BMC Anesthesiol ; 14: 34, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24914401

RESUMO

BACKGROUND: Precise control of anesthetic depth during electroconvulsive therapy (ECT) is crucial because most intravenous anesthetics have anticonvulsant effects. In this study, we investigated the association between anesthetic depth measured by the Alaris auditory evoked potential index (AAI) and seizure inducibility and seizure duration during ECT. METHODS: Sixty-four ECTs were evaluated in 12 consecutive patients. General anesthesia was performed with a thiopental-based method. The relationship between the pre-ictal AAI, seizure activity and seizure duration was analyzed, and a possible threshold pre-ictal AAI to induce a seizure duration of at least 25 seconds was calculated. RESULTS: Forty-one of the 64 ECT stimuli successfully induced seizure activity that lasted longer than 25 seconds. Pre-ictal AAI was significantly correlated to seizure duration (r = 0.54, p < 0.001) and the threshold pre-ictal AAi value was calculated to be 26 (area under curve: 0.76, sensitivity: 70.3% and specificity: 73.9%, p < 0.001). ECT with a pre-ictal AAI ≧ 26 had a higher incidence of successful seizure activity ( p < 0.001) and a longer seizure duration (55 ± 35 v.s. 21 ± 27 seconds, p < 0.001). CONCLUSION: Maintenance of a pre-ictal AAI value ≧ 26 was associated with an increased incidence of successful seizure activities and a longer seizure duration. This is the first report to investigate Alaris AEP monitoring during ECT.


Assuntos
Anestésicos Intravenosos/administração & dosagem , Eletroconvulsoterapia/métodos , Potenciais Evocados Auditivos , Convulsões/metabolismo , Adulto , Anestesia Geral/métodos , Anestésicos Intravenosos/farmacologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tiopental/administração & dosagem , Tiopental/farmacologia , Fatores de Tempo
19.
World J Gastroenterol ; 20(4): 1030-7, 2014 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-24574775

RESUMO

AIM: To establish a Chinese esophageal squamous cell carcinoma (ESCC) cell line with high bone metastasis potency using (99m)Tc-methylene diphosphonate ((99m)Tc-MDP) micro-pinhole scintigraphy, X ray and micro-positron emission tomography/computed tomography (PET/CT) for exploring the mechanism of occurrence and development in esophageal cancer. METHODS: The cells came from a BALB/c nu/nu immunodeficient mouse, and oncogenic tumor tissue was from a surgical specimen from a 61-year-old male patient with ESCC. The cell growth curve was mapped and analysis of chromosome karyotype was performed. Approximately 1 × 106 oncogenic cells were injected into the left cardiac ventricle of immunodeficient mice. The bone metastatic lesions of tumor-bearing mice were detected by (99m)Tc-MDP scintigraphy, micro-PET/CT and X-ray, and were resected from the mice under deep anesthesia. The bone metastatic cells in the lesions were used for culture and for repeated intracardiac inoculation. This in vivo/in vitro experimental metastasis study was repeated for four cycles. All of the suspicious bone sites were confirmed by pathology. Real-time polymerase chain reaction was used to compare the gene expression in the parental cells and in the bone metastatic clone. RESULTS: The surgical specimen was implanted subcutaneously in immunodeficient mice and the tumorigenesis rate was 100%. First-passage oncogenic cells were named CEK-Sq-1. The chromosome karyotype analysis of the cell line was hypotriploid. The bone metastasis rate went from 20% with the first-passage oncogenic cells via intracardiac inoculation to 90% after four cycles. The established bone metastasis clone named CEK-Sq-1BM had a high potential to metastasize in bone, including mandible, humerus, thoracic and lumbar vertebrae, scapula and femur. The bone metastasis lesions were successfully detected by micro-pinhole bone scintigraphy, micro-PET/CT, and X-ray. The sensitivity, specificity and accuracy of the micro-pinhole scintigraphy, X-ray, and micro-PET/CT imaging examinations were: 89.66%/32%/80%, 88.2%/100%/89.2%, and 88.75%/77.5%/87.5%, respectively. Some gene expression difference was found between parental and bone metastasis cells. CONCLUSION: This newly established Chinese ESCC cell line and animal model may provide a useful tool for the study of the pathogenesis and development of esophageal carcinoma.


Assuntos
Neoplasias Ósseas/secundário , Carcinoma de Células Escamosas/secundário , Neoplasias Esofágicas/patologia , Imagem Multimodal/métodos , Tomografia por Emissão de Pósitrons , Microtomografia por Raio-X , Animais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/genética , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/cirurgia , Linhagem Celular Tumoral , Cromossomos Humanos , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago , Regulação Neoplásica da Expressão Gênica , Xenoenxertos , Humanos , Cariotipagem , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Nus , Pessoa de Meia-Idade , Transplante de Neoplasias , Valor Preditivo dos Testes , Compostos Radiofarmacêuticos , Medronato de Tecnécio Tc 99m
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