Risk of Developing Hypertension in Atopic Dermatitis Patients Receiving Long-term and Low-dose Cyclosporine: A Nationwide Population-based Cohort Study.

BACKGROUND: Cyclosporine (CS) is a first-line immunosuppressive agent used to manage moderate to severe atopic dermatitis (AD). To date, the risk of developing hypertension associated with the long-term use of low-dose CS in AD patients is understudied. OBJECTIVE: To determine the cumulative dose-dependent effect of CS on the risk of developing hypertension in patients with AD. METHODS: A nationwide population-based retrospective cohort with 1,844,009 AD patients was built from the Korean National Health Insurance System database from 2005 to 2009. A Cox proportional-hazard regression analysis was performed according to patients' CS treatment history adjusted for potential confounders. RESULTS: Current use of CS was associated with an increased risk of developing hypertension (adjusted hazard ratio, 4.442; 95% confidence interval, 3.761-5.247). Among the current CS users, a higher cumulative dose of CS (≥39,725 mg) or longer cumulative use of CS (≥182 days), was significantly associated with an increased risk of developing hypertension. CONCLUSION: The incidence of CS-associated hypertension is very low when using low-dose treatment regimens for AD. However, the current use or a high cumulative dose of CS for treating patients with AD increases the risk of developing hypertension. Precaution is needed when prescribing CS for long-term treatment of AD.

Pharmacodynamics of remimazolam tosilate inducing loss of consciousness when combined with sufentanil in children / 中华麻醉学杂志

Objective:To evaluate the pharmacodynamics of remimazolam tosilate inducing loss of consciousness (LOC) when combined with sufentanil in children.Methods:American Society of Anesthesiologists Physical Status classificationⅠ or Ⅱ pediatric patients of either sex, aged 3-6 yr, undergoing electronic bronchoscopy, were included in this study. ECG monitoring was carried out in all children after admission, sufentanil 0.1 μg/kg was intravenously injected slowly, and 3 min later remidazolam tosilate was intravenously injected. The dose of remimazolam tosilate was determined by the modified Dixon′s up-and-down sequential experiment, and the initial dose of remimazolam tosilate was 0.30 mg/kg. The dose of remimazolam tosilate in the next child was determined according to the the loss of consciousness, and the successive dose gradient was 0.05 mg/kg. Loss of eyelash reflex and Modified Observer′s Assessment of Alertness/Sedation Scale score reaching 0 and the occurrence of 8 crossover points where consciousness transitioned from non-disappearance to disappearance after 1 min of remimazolam tosilate injection were considered to be signs of LOC. The median effective dose (ED 50), 95% effective dose (ED 95), and their 95% confidence interval ( CI) of remimazolam tosilate inducing LOC were calculated using probit method. Results:When combined with sufentanil, the ED 50 and 95% CI of remimazolam tosilate inducing loss of consciousness were 0.461 (0.429-0.493) mg/kg, and the ED 95 and 95% CI were 0.515 (0.487-0.689) mg/kg. Conclusions:When combined with sufentanil, the ED 50 of remimazolam tosilate inducing LOC is 0.461 mg/kg and the ED 95 is 0.515 mg/kg in children.

Effectiveness of a vitamin D regimen in deficient multiple myeloma patients and its effect on peripheral neuropathy.

PURPOSE: Peripheral neuropathy (PN) is common in multiple myeloma (MM) patients. More insight has been gained concerning the role of vitamin D in preventing PN. However, studies evaluating the effects of vitamin D3 supplementation on PN are lacking. The aims of this study are to (1) evaluate the effectiveness of a vitamin D3 regimen on achieving adequate vitamin D levels in deficient MM patients and to (2) exploratively evaluate the effect of vitamin D3 supplementation on PN. METHODS: Thirty-nine MM patients with inadequate (< 75 nmol/L [= 30 ng/mL]) 25-hydroxyvitamin D (25(OH)D) levels were included in this multicenter, prospective, single-arm study, of whom 35 patients completed the study. They received oral vitamin D3 for 6 months according to a dose escalation regimen that consisted of one or two loading doses of 200,000 international units (IU), and maintenance doses of 800, 1600, or 3200 IU/day depending on the 25(OH)D level. A validated questionnaire was used to measure PN. RESULTS: Median 25(OH)D increased from 38 (IQR 32-52) nmol/L at baseline to 77 (IQR 72-87) nmol/L after 6 months (P < 0.001). Adequate 25(OH)D levels were achieved by 66% of the subjects, and 34% were within the range of 50-75 nmol/L. Furthermore, in 37% of the participants, PN severity decreased (P = 0.007). CONCLUSION: The use of substantially higher vitamin D3 doses than recommended in current guidelines resulted in a significant increase in vitamin D levels in MM patients. Furthermore, evaluation of PN showed a significant decrease in PN grading. However, this exploratory evaluation needs further confirmatory research.

Effects of different doses of simvastatin and atorvastatin combined with trimetazidine on blood lipids and cardiac function in patients with chronic heart failure / 中国基层医药

Objective:To investigate the effects of different doses of simvastatin and atorvastatin combined with trimetazidine on blood lipids and cardiac function in patients with chronic heart failure.Methods:A total of 100 patients with chronic heart failure who received treatment in Jinan Second People's Hospital from September 2019 to August 2021 were included in this study. These patients were divided into three groups according to different treatment methods: group A ( n = 33), group B ( n = 33), and group C ( n = 34). Group A was treated with a conventional dose of simvastatin combined with trimetazidine. Group B was treated with a high dose of simvastatin combined with trimetazidine. Group C was treated with atorvastatin combined with trimetazidine. All patients were treated for 6 months. Cardiac function, blood lipids, inflammatory factors, and excellent and good rates of therapeutic effects post-treatment were compared between the three groups. The adverse events during the treatment were recorded. Results:There were no significant differences in blood lipids, cardiac function, inflammatory factors, and excellent and good rates of therapeutic effects between the two groups (all P > 0.05). After 6 months of treatment, high-density lipoprotein cholesterol [(1.99 ± 0.25) mmol/L, (2.01 ± 0.16) mmol/L] and left ventricular ejection fraction [(51.29 ± 4.15)%, (51.37 ± 4.44)%] in groups B and C were significantly higher than those in group A [(1.52 ± 0.16) mmol/L, (42.28 ± 4.86)%, t = 9.10, 6.24; 8.10, 11.38, all P < 0.05). Caspase-1 [(42.33 ± 3.19) ng/L, (41.87 ± 3.55) ng/L], interleukin-18 [(54.55 ± 4.39) ng/L, (53.98 ± 4.45) ng/L], left ventricular end-systolic diameter [(35.13 ± 2.13) mm, (35.68 ± 2.46) mm], left ventricular end-diastolic diameter [(44.39 ± 3.65) mm, (44.42 ± 3.32) mm], low-density lipoprotein cholesterol [(2.69 ± 0.39) mmol/L, (2.57 ± 0.13) mmol/L], total cholesterol [(3.79 ± 0.13 ) mmol/L, (3.56 ± 0.69) mmol/L], triacylglycerol [(1.12 ± 0.05) mmol/L, (1.10 ± 0.07) mmol/L] levels in groups B and C were significantly lower than those in group A [(68.41 ±10.23) ng/L, (88.37 ± 6.65) ng/L, (42.63 ± 3.13) mm, (51.68 ± 5.42) mm, (3.13 ± 0.11) mmol/L, (4.21 ± 0.11) mmol/L, (1.51 ± 0.11) mmol/L, t = -13.98, -24.38, -14.27, -24.95, -6.41, -5.64, -8.00, -10.12, -14.17, -18.54, -12.53, -19.01, -5.35, -18.26, all P < 0.05]. 6-minute walking distances [(352.19 ± 25.4) m, (351.74 ± 24.29) m] in groups B and C were significantly longer than that in group A [(319.71 ± 21.11) m, t = 6.63, 5.75, both P < 0.05). The excellent and good rates at 3 and 6 months after surgery in group B was significantly higher than that in group A ( χ2 = 4.00, 4.16, both P < 0.05), but the incidence of adverse reactions in group B [18.18% (6/33)] was significantly higher than 3.03% (1/33) in group A and 2.94% (1/34) in group C (both P < 0.05). There was no significant difference in the incidence of adverse reactions between group A and group C ( P > 0.05). Conclusion:Atorvastatin and high-dose simvastatin alone combined with trimetazidine can achieve good therapeutic effects on chronic heart failure. Both combined therapies are beneficial to improve heart function and reduce myocardial damage. However, atorvastatin combined with trimetazidine is safer than high-dose simvastatin combined with trimetazidine.

Effect of age factors on pharmacodynamics of intranasal dexmedetomidine for sedation in pediatric patients undergoing transthoracic echocardiography / 中华麻醉学杂志

Objective:To evaluate the effect of age factors on the pharmacodynamics of intranasal dexmedetomidine for sedation in the pediatric patients undergoing transthoracic echocardiography(TTE).Methods:American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ pediatric patients, aged 1-24 months, undergoing TTE from August 2019 to May 2022, were selected. This trial was performed in two parts. Part Ⅰ Pediatric patients were divided into 4 age groups: 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The initial dose of dexmedetomidine was 2.0 μg/kg in 0.1 μg/kg increment/decrement. The dose of dexmedetomidine was determined by using modified Dixon′s up-and-down method. The ED 50 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated by the Dexon-Massey method. Part Ⅱ One hundred patients were divided into 4 age groups ( n= 25 each): 1-6 month group, 7-12 month group, 13-18 month group and 19-24 month group. The 4 groups were further divided into 5 subgroups ( n=5 each) according to the dose of dexmedetomidine: 2.1 μg/kg subgroup, 2.2 μg/kg subgroup, 2.3 μg/kg subgroup, 2.4 μg/kg subgroup, and 2.5 μg/kg subgroup. Part Ⅰ and part Ⅱ trials were combined, and the ED 95 and 95% confidence interval of intranasally administered dexmedetomidine for sedation were calculated using the probit method. Results:A total of 220 pediatric patients were enrolled. There was no significant difference in ED 50 and ED 95 of dexmedetomidine intranasally administered for sedation among groups ( P>0.05). Conclusions:The pharmacodynamics of intranasal dexmedetomidine for sedation shows no significant difference in age in the pediatric patients aged 1-24 months undergoing TTE.

Median effective dose of alfentanil combined with propofol inhibiting responses to laryngeal mask airway insertion in children / 中华麻醉学杂志

Objective:To determine the median effective dose(ED 50) of alfentanil combined with propofol inhibiting responses to the laryngeal mask airway(LMA) insertion in children. Methods:American Society of Anesthesiologists Physical Status classification Ⅰ children, aged 6-10 yr, with body mass index of 18-24 kg/m 2, undergoing facial skin pigmented nevus resection, were selected. Propofol(target plasma concentration 3 μg/ml) was given by the target-controlled infusion, alfentanil was intravenously injected, 2 min later LMA was inserted, and anesthesia was maintained with 2%-3% sevoflurane until the end of surgery. The dose of alfentanil was determined by the up-and-down sequential method, the initial dose of alfentanil was 15 μg/kg, when the response to LMA insertion was positive/negative, the dose of alfentanil increased/decreased by 1 μg/kg in the next case. The LMA insertion response was defined as swallowing, bucking, body movement occurred during insertion of the LMA, and this process was repeated until 7th turning points appeared. The ED 50 and 95% confidence interval of alfentanil combined with propofol inhibiting responses to LMA insertion in children were calculated using probit method. Results:The ED 50 of alfentanil combined with propofol inhibiting responses to LMA insertion was 13.18(95% confidence interval 12.43-13.79) μg/kg in children. Conclusions:The ED 50 of alfentanil combined with propofol inhibiting responses to LMA insertion is 13.18 μg/kg in children.

Dose-response relationship of remimazolam for loss of consciousness during anesthesia induction in patients undergoing coronary artery bypass grafting / 中华麻醉学杂志

Objective:To evaluate the dose-response relationship of remimazolam for loss of consciousness during anesthesia induction in the patients undergoing coronary artery bypass grafting (CABG).Methods:American Society of Anesthesiologists Physical Status classification Ⅲ or Ⅳpatients, aged 55-64 yr, with body mass index of 21-26 kg/m 2, scheduled for elective CABG under general anesthesia, were included in this study.The trial was conducted using the modified Dixon′s up-and-down method. The initial dose of remimazolam was 0.225 mg/kg, each time the concentration increased/decreased by 0.025 mg/kg in the next patient depending on whether or not the patients lost consciousness. Criteria for loss of consciousness was considered as the modified vigilance sedation score≤1 within 3 min after remimazolam administration. The 50% effective dose (ED 50), 95% effective dose (ED 95) and their 95% confidence interval ( CI) was analyzed by probit probability analysis method. Results:The ED 50 of remimazolam for loss of consciousness during anesthesia induction was 0.175 mg/kg, 95% CI was 0.163-0.185 mg/kg, ED 95 was 0.211 mg/kg, and 95% CI was 0.197-0.255 mg/kg. Conclusions:The ED 50 and ED 95 of remimazolam were 0.175 and 0.211 mg/kg respectively when used for loss of consciousness during anesthesia induction in the patients undergoing CABG.

Potency of epidural ropivacaine in inhibiting breakthrough pain in primiparae undergoing epidural labor analgesia / 中华麻醉学杂志

Objective:To determine the potency of epidural ropivacaine in inhibiting breakthrough pain in primiparae undergoing labor analgesia with programmed intermittent epidural bolus (PIEB).Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ primiparae of full-termpregnancy, with a singleton fetus in vertex presentation, aged ≥18 yr, with body mass index < 30 kg/m 2, presenting with breakthrough pain during labor analgesia with PIEB, were enrolled in this study. Ropivacaine 10 ml was epidurally administered, and the concentration was determined by up-and-down sequential allocation. The initial concentration was set at 0.15% in the first patient in each group. Each time the concentration increased/decreased in the next patient depending on whether the patients showed breakthrough pain relief, and the ratio between the two successive doses was 0.9. The criterion of breakthrough pain relief was defined as numerical rating scale score < 4 points within 30 min after epidural injection of ropivacaine. The median effective concentration (EC 50) and 95% confidence interval of ropivacaine in inhibiting breakthrough pain were calculated by Dixon-Massey′s method. Results:Twenty-six patients were finally included in this study.The EC 50 (95% confidence interval)of ropivacaine in inhibiting breakthrough pain was 0.102% (0.088%-0.117%). Conclusions:The EC 50(95% confidence interval) of epidurally administered ropivacaine 10 ml is 0.102%(0.088%-0.117%) when used for inhibiting breakthrough pain during labor analgesia with PIEB in primiparae.

Pharmacodynamics of ropivacaine for ultrasound-guided pericapsular nerve group block in hip surgery / 中华麻醉学杂志

Objective:To evaluate the pharmacodynamics of ropivacaine for ultrasound-guided pericapsular nerve group (PENG) block in hip surgery.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex with hip trauma (femoral neck or trochanteric fracture), aged 18-64 yr, with body mass index of 18-30 kg/m 2, scheduled for elective hip surgery under general anesthesia, with VAS score>4 points at 15 degrees of hip flexion, were selected. PENG block was performed at 30 min before anesthesia, and 0.375% ropivacaine was injected with an initial dose of 15 ml and the successive volume gradient of 1.2 ml after successful localization. VAS score was assessed at 30 min after injection. When the VAS score was 3, the block was considered effective, a lower volume gradient was given in the next patient, otherwise a higher volume gradient was given in the next patient, which was repeated until 7 up-and-down cross waveforms were obtained. Probit analysis was used to calculate the median effective volume (EV 50) and 95% effective volume (EV 95) and 95% confidence interval ( CI) of 0.375% ropivacaine for PENG block. Results:The EV 50 (95% CI) of 0.375% ropivacaine for PENG block was 11.36 ml (9.41-12.64 ml), and the EV 95 (95% CI) of 0.375% ropivacaine for PENG block was 14.19 ml (95% CI 12.80-25.07 ml). Conclusions:The EV 50 of 0.375% ropivacaine is 11.36 ml when used for ultrasound-guided PENG block in hip surgery.

Effect of wrist-ankle acupuncture on pharmacodynamics of remimazolam for loss of consciousness in patients of different genders and ages undergoing painless gastroscopy / 中华麻醉学杂志

Objective:To evaluate the effect of wrist-ankle acupuncture on the pharmacodynamics of remimazolam for loss of consciousness in the patients of different genders and ages undergoing painless gastroscopy.Methods:American Society of Anesthesiologists Physical Status classificationⅠor Ⅱ patients, undergoing elective painless gastroscopy, were divided into 4 groups according to gender and age: agedmale (age≥65 yr) group (group AM), agedfemale (age≥65 yr) group (group AF), young male (18 yr≤age <65 yr) group (group YM), and young female (18 yr≤age <65 yr) group (group YF). After 10 min of wrist-ankle acupuncture on 1st and 2nd areas of the bilateralupper limbs of the patient, modified Dixon′s up-and-down sequential experiment was used for the test.The initial dose of intravenous remimazolam was 0.20 mg/kg. Each time the dose increased/decreased by 0.05 mg/kg. If the patient lost consciousness, the next patient received a lower dose of remimazolam, otherwise a higher dose was given in the next patient. Loss of consciousness was defined as MOAA/S score was 0 or 1, and the process was repeated until 7 turning points appeared.The median effective dose (ED 50)and 95% confidence interval of remimazolam were calculated by probit method. Results:The ED 50 and 95% confidence interval of remimazolam were 0.296(0.233-0.376), 0.319(0.262-0.388), 0.323(0.278-0.375) and 0.344(0.285-0.415)mg/kg in AM, AF, YM and YF groups, respectively. There was no significant difference in ED 50 among the four groups ( P>0.05). Conclusions:Under the action of wrist-ankle acupuncture, the pharmacodynamics of remazolam is comparable when used for the patients of different genders and ages undergoing painless gastroscopy.

Impact of Recent Acute Kidney Injury on Creatinine Clearance Estimation in Critically Ill Patients Undergoing Cardiac Surgery.

Acute kidney injury (AKI), often present in critically ill patients and patients with cardiac dysfunction, may alter estimates of renal function. The impact of recent AKI on the accuracy of the Cockcroft-Gault creatinine clearance equation (CG-CrCl) before cardiac surgery is unknown. This single-center, retrospective study included patients who underwent cardiac surgery from 1 January 2006 through 30 June 2012 and whose 24-hour urine creatinine clearance (24hr-CrCl) was measured in the intensive care unit before surgery. We evaluated CG-CrCl accuracy by calculating absolute differences between 24hr-CrCl and CG-CrCl estimates. Clinical impact was signified by discrepancies in United States Food and Drug Administration (FDA) renal impairment stage indicated by 24hr-CrCl versus CG-CrCl estimates. Acute kidney injury was evaluated by using Kidney Disease: Improving Global Outcomes criteria. Of 161 patients, 93 (58%) had recent AKI: stage 1, 31 (33%); stage 2, 39 (42%); and stage 3, 23 (25%). In mL/min, the CG-CrCl overestimated 24hr-CrCl (absolute difference: total, -10 ± 25; no AKI, -7 ± 26; stage 1, -8 ± 17; stage 2, -16 ± 28; and stage 3, -10 ± 26; P=0.29). Renal impairment stages assigned by CG-CrCl did not match 24hr-CrCl in 70 (43%) of the 161 patients, especially those with recent AKI: no AKI, 24/68 (35%); stage 1, 13/31 (42%); stage 2, 23/39 (59%); and stage 3, 10/23 (43%). The CG-CrCl consistently overestimated 24hr-CrCl in critically ill patients before cardiac surgery. Clinicians should use the CG-CrCl cautiously when estimating renal function and medication dosages in this population.

Effects of early intervention with low-dose dobutamine on pneumonia complicated by sepsis / 中国基层医药

Objective:To investigate the effects of early intervention with low-dose dobutamine on pneumonia complicated with sepsis.Methods:We retrospectively analyzed the clinical data of 200 patients with pneumonia complicated by sepsis who received treatment in the First People's Hospital of Taizhou from January 2015 to January 2018. We divided these patients into control and observation groups with 100 patients/group according to different treatment methods. The control group was treated with immunoglobulin and methylprednisolone and given ventilator-assisted ventilation. The observation group was given low-dose dobutamine based on the treatments given in the control group. Clinical efficacy, pulmonary function, the incidence of adverse reactions, length of hospital stay, time to dyspnea disappearance, organ failure rate, and mortality were compared between the two groups.Results:Total response rate was significantly higher in the observation group than in the control group [96.0% (96/100) vs. 77.0% (77/100), χ2 = 15.45, P < 0.05]. After treatment, improvements in the pulmonary function indexes [forced vital capacity, forced expiratory volume in one second, and forced expiratory volume in one second/forced vital capacity] in the observation group were superior compared with those in the control group ( t = -15.25, -34.56, -3.77, all P < 0.001). Length of hospital stay and time to dyspnea disappearance in the observation group were (4.23 ± 0.89) days and (3.21 ± 0.58) days, respectively, which were significantly shorter than those in the control group [(8.96 ± 1.58) days, (7.26 ± 0.24) days, t = -26.08, -64.52, both P < 0.001]. The incidence of adverse reactions, incidence of organ failure, and mortality in the observation group were 2.0% (2/100), 1.0% (1/100) and 2.0% (2/100) respectively, which were significantly lower than those in the control group [18.0% (18/100), 20.0% (20/100), 10.0% (10/100), χ2 = 16.80, 19.20, 5.67, all P < 0.05). Conclusion:Early intervention with low-dose dobutamine for the treatment of pneumonia complicated by sepsis can greatly improve clinical efficacy, reduce adverse reactions, decrease the incidence of organ failure and mortality, improve pulmonary function, and shorten the length of hospital stay and time to dyspnea disappearance.

Effects of different inhalation time on minimum alveolar concentration of sevoflurane in adult rats / 中华麻醉学杂志

Objective:To evaluate the effects of different inhalation time on the minimum alveolar concentration (MAC) of sevoflurane in adult rats.Methods:Two hundred SPF healthy adult Sprague-Dawley rats (half male, half female), aged 8-10 weeks, weighing 200-260 g, were divided into 2 groups using a random number table method: inhalation of sevoflurane for 1 h group and inhalation of sevoflurane for 20 min group, with 100 rats in each group.Each group was subdivided into 10 subgroups with 10 rats in each subgroup, the initial concentration was preset at 1.50%, and the ratio between two successive concentrations r was 1.08.The tail clamping stimulus was applied to evaluate the efficacy of anesthesia in each subgroup, a positive response was defined as a body movement occurred within 1 min after tail clamping stimulus, and the response was defined as negative when no body movement occurred within 1 min after tail clamping.The Bliss method was used to calculate the MAC, EC 95 and 95% confidence interval (CI) of sevoflurane. Results:The MAC and EC 95 (95% CI) of sevoflurane were 2.09% (1.98%-2.20%) and 2.75% (2.56%-3.04%), respectively, in inhalation of sevoflurane for 1 h group, and 2.35% (2.22%-2.49%) and 3.10% (2.87%-3.45%), respectively, in inhalation of sevoflurane for 20 min group ( P<0.05). Conclusions:The MAC of sevoflurane in adult rats inhaled sevoflurane for 1 h is decreased than that inhaled for 20 min.

Median effective dose of esketamine for preoperative sedation in pediatric patients of different ages / 中华麻醉学杂志

Objective:To determine the median effective dose (ED 50) of esketamine for preoperative sedation in different aged pediatric patients. Methods:Pediatric patients, aged 1-6 yr, of American Society of Anaesthesiologists physical status Ⅰ, with the preoperative parental Separation Anxiety Scale (PSAS) score ≥3, undergoing elective surgery under general anesthesia, were selected.According to the age, the children were divided into 1 yr≤age<4 yr low-age group (group L) and 4 yr≤age< 6 yr high-age group (group H). Esketamine 0.5 mg/kg was intravenously injected in the first child in each group.The dose in the next child was determined according to PSAS scores, and the two consecutive dose gradient was 0.1 mg/kg; when the PSAS score in the previous child was ≥3, the dose in the next child was increased; when the PSAS score in the previous child was< 3, the dose in the next child was decreased until appearance of 7 turning points, and then the experiment was terminated.The ED 50 and 95% confidence interval of esketamine for preoperative sedation were calculated by probit analysis. Results:A total of 54 children were enrolled in this study, including 26 cases in group L and 28 cases in group H. The ED 50 and 95% confidence interval of esketamine were 0.413 (0.314-0.530) mg/kg and 0.282 (0.252-0.318) mg/kg in group L and group H, respectively.Compared with group L, ED 50 of esketamine was significantly decreased in group H ( P<0.05). Conclusions:The ED 50 of esketamine for preoperative sedation is 0.413 mg/kg in pediatric patients of 1 yr≤age<4 yr old and 0.282 mg/kg in those of 4 yr≤age<6 yr old, and the efficacy of esketamine for preoperative sedation increases with age.

Effects of ultrasound-guided erector spinae plane block on analgesic dosage, lumbar function and pain in patients undergoing percutaneous kyphoplasty / 中国基层医药

Objective:To investigate the effects of ultrasound-guided erector spinae plane block on analgesic dosage, lumbar function and pain in patients undergoing percutaneous kyphoplasty.Methods:A total of 100 patients who underwent percutaneous kyphoplasty in Hangzhou Cancer Hospital from November 2018 to October 2021 were included in this study. They were randomly assigned to undergo either local infiltration anesthesia (control group, n = 50) or ultrasound-guided erector spinae plane block (observation group, n = 50). Analgesic dosages, pain status at different phases (Visual Analogue Scale score) and lumbar function (Oswestry Disability Index score), intraoperative and postoperative conditions (operative time, time to get out of bed, time to first exhaust), and the incidence of adverse reactions were compared between the two groups. Results:At 24 and 48 hours after surgery, the amount of analgesics infused in the observation group was (24.54 ± 2.52) mL and (55.68 ± 5.61) mL, respectively, and the number of analgesic pump pressings was (1.01 ± 0.26) times and (3.15 ± 1.02) times, which were significantly lower than those in the control group [amount of analgesics infused at 24 and 48 hours after surgery: (32.78 ± 3.31) mL, (62.57 ± 6.42) mL; the number of analgesic pump pressings at 24 and 48 hours after surgery: (6.42 ± 1.53) times, (10.78 ± 2.45) times, t = 14.00, 5.71, 24.65, 20.33, all P < 0.001]. Visual Analogue Scale score at the time at which the balloon was pressurized and expanded in the observation group was significantly lower than that in the control group [(4.10 ± 0.87) points vs. (4.65 ± 1.01) points, t = 2.92, P < 0.05]. At 1 day and 1 month after surgery, Oswestry Disability Index score in the observation group was (18.37 ± 2.78) points and (12.15 ± 2.02) points, respectively, which were lower than (23.56 ± 3.42) points and (17.53 ± 2.34) points in the control group ( t = 8.33, 12.31, both P < 0.05). The time to get out of bed and the time to first exhaust in the observation group were (9.12 ± 2.54) days and (23.56 ± 4.56) hours, respectively, which were significantly shorter than those in the control group [(11.64 ± 3.12) days, (28.14 ± 5.12) hours, t = 4.43, 4.72, both P < 0.001). There was no significant difference in the incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:Ultrasound-guided erector spinae plane block for percutaneous kyphoplasty can effectively ameliorate lumbar spine function, reduce postoperative pain, and facilitate postoperative recovery, without affecting the dosage of narcotics and analgesics. The method is safe and effective.

Clinical efficacy of different doses of alteplase in the treatment of acute cerebral infarction in older adult patients / 中国基层医药

Objective:To investigate the clinical efficacy and safety of intravenous thrombolysis with different doses of alteplase in the treatment of acute cerebral infarction in older adult patients.Methods:A total of 65 older adult patients with acute cerebral infarction (onset within 4.5 hours, age ≥ 75 years) who underwent intravenous thrombolysis in Wenzhou Central Hospital from February 2021 to February 2022 were included in this study. They were randomly assigned to undergo intravenous thrombolysis with either low dose alteplase (0.6 mg/kg, low dose group, n = 32) or standard dose alteplase (0.9 mg/kg, standard dose group, n = 33). The National Institutes of Health Neurological Stroke Scale score before and 24 and 48 hours after treatment, modified Rankin scale score before and 7, 14 and 90 days after treatment, serum C-reactive protein (CRP), neuron-specific enolase (NSE) and tumor necrosis factor-α (TNF-α) levels before and 24 hours after treatment, 24-hour incidence of intracranial hemorrhage, 24-hour incidence of symptomatic intracranial hemorrhage, and 90-day mortality were compared between the two groups. Results:Compared with before treatment, the National Institutes of Health Neurological Stroke Scale scores in each group were significantly decreased at 24 and 48 hours after treatment (low dose group, t24 h = 6.78, t48 h = 7.86; standard dose group: t24 h = 8.09, t48 h = 10.13, all P < 0.001). Compared with before treatment, the modified Rankin scale score in each group was significantly decreased at 7, 14 and 90 days after treatment (low-dose group: t7 d = 5.19, t14 d = 8.47, t90 d = 9.85; standard dose group: t7 d = 6.83, t14 d = 7.74, t90 d = 13.66, all P < 0.001). At 24 hours after treatment, serum levels of CRP, NSE, TNF-α in each group were significantly decreased (low-dose group: tCRP = 5.13 , tNSE = 4.22, tTNF-α = 34.29; standard dose group: tCRP = 4.87, tNSE = 5.53, tTNF-α = 31.98, all P < 0.001). At each time point after treatment, there were no significant differences in these indices between the two groups (all P > 0.05). The 24-hour incidence of intracranial hemorrhage in the low dose group was significantly lower than that in the standard dose group ( χ2 = 4.58, P = 0.032). There were no significant differences in incidence of symptomatic intracranial hemorrhage and 90-day mortality between the two groups (all P > 0.05). Conclusion:Intravenous thrombolysis with low dose alteplase (0.6 mg/kg) for the treatment of acute cerebral infarction in older adult patients exhibits equivalent clinical efficacy to that with standard dose alteplase (0.9 mg/kg), and the former is much safer than the latter.

Effect of obesity on dose-effect relationship of remimazolam when combined with alfentanil in painless gastroscopy / 中华麻醉学杂志

Objective:To evaluate the effect of obesity on the dose-effect relationship of remimazolam when combined with alfentanil in painless gastroscopy.Methods:American Society of Anesthesiologists physical status Ⅰor Ⅱ patients of both sexes, scheduled for elective painless gastroscopy, aged 18-64 yr, were divided into 2 groups according to the body mass index (BMI): normal (BMI 19-24 kg/m 2) group and obese (BMI≥28 kg/m 2) group.Alfentanil 5 μg/kg combined with remimazolam was given intravenously in all the patients, and the dose of remimazolam was determined by the modified Dixon′s up-and-down method.The initial dose of remimazolam was 0.25 mg/kg, and each time the dose was increased or decreased by 0.05 mg/kg based on the sedative effect.The response was defined as positive when the responses that affected the operation of examination developed during insertion of the gastroscope and within the first 2 min of examination such as swallowing, bucking or body movement.This process was repeated until the seventh intersection occurred.The 50% effective dose (ED 50), 95% effective dose (ED 95), and 95% confidence interval ( CI) of remimazolam were calculated by probit method. Results:There were 26 patients in normal group and 18 patients in obese group.The ED 50 (95% CI) of remimazolam was 0.196 (0.087-0.274) mg/kg, and the ED 95 (95% CI) was 0.322 (0.256-1.397) mg/kg in normal group.The ED 50 (95% CI) of remimazolam was 0.125 (0.102-0.148) mg/kg, and the ED 95 (95% CI) was 0.161 (0.141-0.242) mg/kg in obese group.The ED 50 and ED 95 were significantly lower in obese group than in normal group ( P<0.001). Conclusions:Obesity increases the potency of remimazolam when combined with alfentanil 5 μg/kg in the patients undergoing painless gastroscopy.

Effect of Parkinson′s disease factor on sedative efficacy of dexmedetomidine / 中华麻醉学杂志

Objective:To evaluate the effect of Parkinson′s disease factor on the sedative efficacy of dexmedetomidine.Methods:The patients of either sex, aged 45-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅱor Ⅲ, with body mass index of 18.5-30.0 kg/m 2, undergoing non-intracranial space-occupying lesions in neurosurgery, were selected.Patients were divided into control group (group C) and Parkinson′s disease group (group P) according to whether they had Parkinson′s disease or not.The ED 50 of dexmedetomidine was determined by using the Dixon′s up-and-down method.The initial dose of dexmedetomidine was 0.5 μg/kg in both groups, and each time the concentration increased/decreased by 0.05 μg/kg in the next patient, which was repeated until 7th independent crossover pair (loss of consciousness) appeared, and then the test was ended.The ED 50 and 95% confidence interval of dexmedetomidine inducing loss of consciousness were calculated using the probit test in a Logistic regression model.Hypertension, hypotension, bradycardia and nausea and vomiting were recorded. Results:Compared with group C, the ED 50 of dexmedetomidine inducing loss of consciousness was significantly increased in group P ( P<0.05), and no significant change was found in the incidence of adverse reactions in group P ( P>0.05). Conclusions:Parkinson′s disease factor can decrease the sedative efficacy of dexmedetomidine.

Dose-response relationship of alfentanil in combination with midazolam-etomidate inhibiting cardiovascular responses to laryngeal mask airway implantation in elderly patients / 中华麻醉学杂志

Objective:To evaluate the dose-response relationship of alfentanil in combination with midazolam-etomidate inhibiting cardiovascular responses to laryngeal mask airway implantation in elderly patients.Methods:American Society of Anesthesiologists Physical Status Ⅰ or Ⅱ patients of either sex, aged 65-85 yr, with body mass index of 20-30 kg/m 2, undergoing elective operation under general anesthesia, were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation, 5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at 3-min interval, the mean value was collected and considered as the baseline value.Etomidate 0.2 mg/kg was intravenously injected, and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value < 60.A laryngeal mask airway was inserted at 1.4 min after intravenous injection of alfentanil, and mechanical ventilation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 6.83 μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular response to laryngeal mask airway placement.If the cardiovascular response to laryngeal mask airway placement occurred, the dose was increased for the next patient, and if cardiovascular response to laryngeal mask airway placement did not occur, the dose was decreased, and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response to laryngeal mask airway placement was defined as increase in maximum mean arterial pressure or maximum heart rate by≥20% of baseline values within 2 min after laryngeal mask airway placement.The median effective dose (ED 50), 95% effective dose (ED 95) and 95% confidence interval (95% CI) of alfentanil inhibiting cardiovascular responses to laryngeal mask airway placement in elderly patients were calculated by the Probit method. Results:When combined with midazolam and etomidate, the ED 50 (95% CI) of alfentanil inhibiting the cardiovascular responses to laryngeal mask airway placement in elderly patients were 5.605 (5.036-6.082) μg/kg, and the ED 95 (95% CI) were 6.625 (6.125-9.763) μg/kg. Conclusions:When combined with midazolam and etomidate, the ED 50 and ED 95 of alfentanil inhibiting the cardiovascular responses to laryngeal mask airway placement are 5.605 and 6.625 μg/kg, respectively, in elderly patients.

Dose-effect relationship of alfentanil inhibiting cardiovascular responses to endotracheal intubation when combined with midazolam and etomidate / 中华麻醉学杂志

Objective:To investigate the dose-effect relationship of alfentanil inhibiting cardiovascular responses to tracheal intubation when combined with midazolam and etomidate.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index<32 kg/m 2, undergoing elective operation under general anesthesia with endotracheal intubation, were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation, and 5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at an interval of 3 min, and the mean value was calculated and served as the baseline value.Etomidate 0.3 mg/kg was intravenously injected, and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value < 60, and then 1.4 min later tracheal intubation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 20 μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular responses to tracheal intubation, and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response was defined as as positive when the maximum value of mean arterial pressure or heart rate increased by ≥20% of the baseline value within 2 min after endotracheal intubation.Probit method was used to determine the ED 50, ED 95 and 95% confidence interval of alfentanil inhibiting cardiovascular responses to tracheal intubation. Results:When combined with midazolam and etomidate, the ED 50 (95% confidence interval) of alfentanil inhibiting cardiovascular responses to tracheal intubation was 21.343 (19.105-24.516) μg/kg, and the ED 95 (95% confidence interval) was 25.043 (22.983-48.983) μg/kg. Conclusions:When combined with midazolam and etomidate, the ED 50 and ED 95 of alfentanil inhibiting cardiovascular responses to tracheal intubation are 21.343 and 25.043 μg/kg, respectively.